Chronic neurologic manifestations of Lyme disease

Article Abstract:

Lyme disease results from infection with the bacteria Borrelia burgdorferi, a spirochete that is carried by ticks. Neurologic complications are common in Lyme borreliosis; many patients have headaches and mild meningism, and about 15 percent develop neurologic abnormalities, such as facial palsy or lymphocytic meningitis. Most of these neurologic complications resolve within a few months, even without antibiotic treatment. Unfortunately, a few patients develop chronic neurologic manifestations; to gain further knowledge of this problem, 27 patients with chronic neurologic complications of Lyme disease were evaluated. The emerging picture bears some resemblance to neurosyphilis, which results from another, and perhaps more widely known, spirochete (Treponema pallidum). The most common form of central nervous system involvement, seen in 24 of the 27 patients, was subacute encephalopathy, which results in mood changes, sleep disturbances, and memory problems. As in neurosyphilis, this encephalopathy can occur after a long latent period; in one patient the original symptoms of Lyme disease preceded the encephalopathy by 14 years. The precise pathological basis for these symptoms is not yet known, but spirochetes were tentatively identified in brain biopsies of two patients. Polyneuropathy, which affected 19 patients, is another chronic neurologic complication of Lyme borreliosis. It involves abnormalities of peripheral nerves and symptoms may include tingling, burning, spasms, or shooting pains. In seven patients, polyneuropathy was limited to a ''pins and needles'' sort of tingling sensation. Other less specific symptoms observed among these patients included headaches and marked fatigue. Also comparable to neurosyphilis is the disease's poor susceptibility to antibiotics, which was far less than had been hoped. All patients were treated with intravenous ceftriaxone for two weeks. Recovery was rarely complete, and only 17 patients (63 percent) showed improvement when evaluated six months after treatment. Four patients had not improved while six had improved and then relapsed at the end of the six-month follow-up period. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Central nervous system, Borrelia

---

Association of chronic lyme arthritis with HLA-DR4 and HLA-DR2 alleles

Article Abstract:

Lyme disease is caused by Borrelia burgdorferi, a spirochete which is carried by ticks. About 80 percent of the patients with Lyme disease experience some joint paint, which may include arthritis. For a small percentage of patients, this Lyme arthritis does not respond to antibiotics and remains chronic. To determine why some patients recover and others develop chronic Lyme arthritis, the antigens of the major histocompatibility complex were examined in 80 Lyme disease patients with arthritis. Certain histocompatibility antigens are found to be preferentially associated with particular diseases, most often when the disease has an immune component, as in the sequelae to some infections. This turns out to be the case in chronic Lyme arthritis, as well. Of the 28 patients with chronic arthritis, 16, or 57 percent, had the HLA-DR4 specificity, a Class II antigen. The same HLA-DR4 specificity was found in 23 percent of the patients with Lyme arthritis of moderate duration and 9 percent of the patients with mild arthritis (short duration). HLA-DR4 is found in about 31 percent of normal individuals where the study took place. A second association was found between HLA-DR2 and Lyme arthritis, although it was not as strong as for HLA-DR4. About 43 percent of chronic arthritis patients and 40 percent of patients with moderate arthritis had the HLA-DR2 haplotype, compared with only 18 percent of the patients with mild arthritis. The results of this study confirm the results of several European studies, which found an association between Lyme disease arthritis and HLA-DR4 and HLA-DR2. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Causes of, Physiological aspects, Genetic aspects, HLA histocompatibility antigens, HLA antigens, Arthritis, Major histocompatibility complex

---

Cost effectiveness of oral as compared with intravenous antibiotic therapy for patients with early Lyme disease or Lyme arthritis

Article Abstract:

Oral doxycycline is more cost-effective for treating most patients with Lyme disease than intravenous ceftriaxone. Researchers created a model to decide which therapy was more cost-effective using several studies that evaluated both. In almost all cases, patients with early Lyme disease or Lyme arthritis would benefit most from oral doxycycline, which is substantially cheaper than intravenous ceftriaxone. The only possible exception would be patients in which the infection had spread to the nervous system. Physicians should try to identify such patients quickly so that intravenous ceftriaxone can be started.

Health aspects, Models, Cost benefit analysis, Doxycycline, Ceftriaxone

Similar abstracts:

• Abstracts: Prognostic indicators of the resolution of nonimmune hydrops fetalis and survival of the fetus. Quantifiable polyhydramnios: diagnosis and management
• Abstracts: Prenatal diagnosis of congenital toxoplasmosis. Detection of congenital toxoplasmosis by chorionic villus sampling and early amniocentesis
• Abstracts: The role of ultrasound in evaluation of patients with elevated maternal serum alpha-fetoprotein: a review. Monozygotic twins discordant for partial trisomy 1
• Abstracts: Severe hypertension after liver transplantation in alpha-1 antitrypsin deficiency. Viral and Toxoplasma gondii infections in children after liver transplantation

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.