Clinical features of double infection with tick-borne encephalitis and Lyme borreliosis transmitted by tick bite.

BACKGROUND: In Latvia and other endemic regions, a single tick bite has the potential to transmit both tick-borne encephalitis (TBE) and Lyme borreliosis. OBJECTIVE: To analyse both the clinical features and differential diagnosis of combined tick-borne infection with TBE and Lyme borreliosis, in 51 patients with serological evidence, of whom 69% had tick bites. RESULTS: Biphasic fever suggestive of TBE occurred in 55% of the patients. Meningitis occurred in 92%, with painful radicular symptoms in 39%. Muscle weakness occurred in 41%; in 29% the flaccid paralysis was compatible with TBE. Only two patients presented with the bulbar palsy typical of TBE. Typical Lyme borreliosis facial palsy occurred in three patients. Typical TBE oculomotor disturbances occurred in two. Other features typical of Lyme borreliosis detected in our patients were distal peripheral neuropathy (n = 4), arthralgia (n = 9), local erythema 1-12 days after tick bite (n = 7) and erythema chronicum migrans (n = 1). Echocardiogram abnormalities occurred in 15. CONCLUSIONS: Patients with double infection with TBE and Lyme borreliosis fell into three main clinical groups: febrile illness, 3 (6%); meningitis, 15 (30%); central or peripheral neurological deficit (meningoencephalitis, meningomyelitis, meningoradiculitis and polyradiculoneuritis), 33 (65%). Systemic features pointing to Lyme borreliosis were found in 25 patients (49%); immunoglobulin (Ig)M antibodies to borreliosis were present in 18 of them. The clinical occurrence of both Lyme borreliosis and TBE vary after exposure to tick bite, and the neurological manifestations of each disorder vary widely, with considerable overlap. This observational study provides no evidence that co-infection produces unusual manifestations due to unpredicted interaction between the two diseases. Patients with tick exposure presenting with acute neurological symptoms in areas endemic for both Lyme borreliosis and TBE should be investigated for both conditions. The threshold for simultaneous treatment of both conditions should be low, given the possibility of co-occurrence and the difficulty in ascribing individual neurological manifestations to one condition or the other.

Activation of human herpesviruses 6 and 7 in patients with chronic fatigue syndrome.

BACKGROUND: Human herpesvirus 6 (HHV-6) and 7 (HHV-7) have been suggested as possible triggering agents for chronic fatigue syndrome (CFS). OBJECTIVES: To determine the possible association of HHV-6 and HHV-7 infections with CFS. STUDY DESIGN: The prevalence of latent/persistent and active viral infections by nPCR, characteristic of HHV-6 variants using restriction endonuclease analysis and changes of lymphocyte subsets in peripheral blood by laser flow-cytometry in 17 CFS patients was examined. In addition, 12 patients with unexplained chronic fatigue and 20 blood donors (BD) were studied. RESULTS: No difference in prevalence of latent/persistent single viral infections between the patients and BD was found but dual infection rate was significantly higher in CFS patients. Active HHV-6 and dual (HHV-6 + HHV-7) infections were detected in CFS patients only and frequency of HHV-7 reactivation was also significantly higher in these patients. HHV-6 variant B was predominant in CFS patients (12/13). The changes of immunological parameters in CFS patients with active dual infection were characterized by significant decrease of CD3+ and CD4+ T cells, significant increase of CD95+ cells and decrease of CD4+/CD8+ ratio. CONCLUSIONS: HHV-6 and HHV-7 may be involved in the pathogenesis of CFS and reactivation of both viruses may provoke changes in the phenotype of circulating lymphocytes.

Diphtheria with polyneuropathy in a closed community despite receiving recent booster vaccination.

INTRODUCTION AND METHODS: We report 20 patients aged 18-24 years from Latvia with diphtheritic polyneuropathy. All lived in a closed community and 80% were known to have been fully vaccinated against diphtheria until at least 14 years old. Diphtheria antitoxin had been administered within 3 days of the onset of upper respiratory tract infection in 16 patients and 15 received antibiotics. RESULTS: Neurological symptoms developed after a median of 43 days (range 35-58) compared to only 10 days in previous studies of unvaccinated patients. All showed evidence of mild limb polyneuropathy with electrophysiological evidence of polyneuropathy. Only 30% showed early bulbar abnormalities compared to the usual rate of over 95% in diphtheritic polyneuropathy. However, 45% had later bulbar deterioration coinciding with the limb polyneuropathy. CONCLUSIONS: These patients show that an attenuated form of polyneuropathy of later onset, with less prominent early bulbar features, can occur in patients vaccinated against diphtheria according to schedule but living in a closed community in a country where diphtheria remains endemic.

Reasons for stopping antiretrovirals used in an initial highly active antiretroviral regimen: increased incidence of stopping due to toxicity or patient/physician choice in patients with hepatitis C coinfection.

Low adherence and toxicities among HIV-positive patients starting highly active antiretroviral therapy (HAART) can lead to discontinuation of therapy and treatment failure. Little is known about hepatitis C (HCV) status and discontinuation of HAART. Poisson regression was used to determine factors related to discontinuation of any part of an initial HAART regimen due to treatment failure (TF) or toxicities and patient/physician choice (TOX), and to investigate the relationship between HCV and discontinuation of a HAART regimen in 1198 patients staring HAART after 1999 from the EuroSIDA study. At 1 year after starting HAART, 70% of patients remained on their original regimen, 24% had changed, and 6% were off all treatment. The most frequent reason for discontinuation was toxicities (30.4%). There was no change over time in the proportion of patients discontinuing after stratification by reason for discontinuation (p = 0.18). Of patients 190 stopped at least one antiretroviral drug used in their initial HAART regimen due to toxicities; the toxicity reported did not vary according to HCV status (p = 0.90). Anti-HCV seropositive patients had a higher incidence of discontinuation due to TOX (IRR 1.46, 95% CI 1.13-1.88, p = 0.0042) compared to patients without HCV. Patients with HCV were more likely to discontinue all or part of their HAART regimens due to toxicity or patient/physician choice. Managing adverse events must remain a key intervention in maintaining HAART. There is a need for further studies to describe the relationship between HCV, specific antiretrovirals, and different treatment strategies.

Reasons for stopping antiretrovirals used in an initial highly active antiretroviral regimen: increased incidence of stopping due to toxicity or patient/physician choice in patients with hepatitis C coinfection.

Low adherence and toxicities among HIV-positive patients starting highly active antiretroviral therapy (HAART) can lead to discontinuation of therapy and treatment failure. Little is known about hepatitis C (HCV) status and discontinuation of HAART. Poisson regression was used to determine factors related to discontinuation of any part of an initial HAART regimen due to treatment failure (TF) or toxicities and patient/ physician choice (TOX), and to investigate the relationship between HCV and discontinuation of a HAART regimen in 1198 patients staring HAART after 1999 from the EuroSIDA study. At 1 year after starting HAART, 70% of patients remained on their original regimen, 24% had changed, and 6% were off all treatment. The most frequent reason for discontinuation was toxicities (30.4%). The incidence of any discontinuation was significantly lower after 1999 compared to before [incidence rate ratio (IRR) 0.43; 95% CI 0.35-0.53, p < 0.0001], this pattern was most marked for toxicities (IRR 0.28; 95% CI 0.20-0.39, p < 0.0001) and patient/physician choice (IRR 0.49; 95% CI 0.33-0.73, p < 0.0001). Patients with HCV had a higher incidence of discontinuation due to TOX (IRR 1.46, 95% CI 1.13-1.88, p = 0.0042) compared to patients without HCV. Patients with HCV were more likely to discontinue all or part of their HAART regimens due to toxicity or patient/physician choice. Managing adverse events must remain a key intervention in maintaining HAART. There is a need for further studies to describe the relationship between HCV, specific antiretrovirals, and different treatment strategies.

[Lipid peroxidation and its connection with the change in composition and antioxidant properties of lipids in comatogenic forms of acute viral hepatitis B]. / Peroksidnoe okislenie lipidov i ego sviaz' s izmeneniem sostava i antiokslitel'nykh svoistv lipidov pri komatogennykh formakh ostrogo virusnogo gepatita B.

81 patients of acute viral hepatitis B (AVHB) without symptoms of acute hepatic encephalopathy, 39 AVHB patients with such symptoms and 115 age and sex match healthy controls were biochemically and clinically investigated. Besides usual biochemical analyses, some special parameters such as interrelationship between the patterns of lipid peroxidation (LPO) (conjugated dienes and ketodienes and the lipid antioxidant activity) and alterations in lipid composition (content of total lipids, phospholipids and cholesterol) were studied in blood serum. Concentration of LPO products in patients with mild, moderate and severe AVHB without symptoms of encephalopathy was found to be significantly lower than in controls. Relative content of phospholipids in the total lipid fraction as well as antioxidant activity of lipids were elevated, while relative content of cholesterol and level of lipid oxidation were lowered. Increasing of antioxidant activity and decreasing of LPO products coincides with the severity of disease. Intensification of LPO occurs only in patients with symptoms of acute hepatic encephalopathy (in coma and precoma). High levels of LPO products and low levels of total phospholipids in blood serum were found in these patients. The persistence of a high level of peroxides in AVHB suggests the existence of severe, irreversible lesions. Among the patients a risk for the development of severe outcome was found. We suppose that the parameters of oxidative stress may be useful as early prognostic factor and that antioxidants may be a useful for the optimal therapy of comatogenous state of AVHB.

[The use of hemoperfusion through a suspension of cryopreserved hepatocytes in acute liver failure]. / Primenenie gemoperfuzii cherez vzves' kriokonservirovannykh gepatotsitov pri ostroi pechenochnoi nedostatochnosti.

The present work deals with results of intensive therapy and temporary organ substitution by using hemoperfusion through a suspension of living donor hepatocytes in 71 patients with acute hepatic insufficiency. Hemoperfusion was performed through a suspension of fresh living hepatocytes or through a suspension of cryo-conserved (during 60 days) living hepatocytes. Lethality was 37-42%.

Temporary organ substitution by hemoperfusion through suspension of active donor hepatocytes in a total complex of intensive therapy in patients with acute hepatic insufficiency.

The results of intensive therapy and temporary organ substitution by hemoperfusion through a suspension of active hepatocytes in 126 patients suffering from acute hepatic insufficiency (AHI) induced by virus B hepatitis, virus non-A, non-B hepatitis, acute toxic hepatitis, active liver cirrhosis, sepsis leptospirosis long-term subhepatic jaundice are presented in this paper. Hepatic encephalopathia confirmed both clinically and electroencephalographically was registered in all the patients. The patients were subdivided into two groups: a complex of commonly used curative measures according to the intensive therapy for AHI was applied in Group A (67 patients); in Group B (59 patients), alongside with the above measures, temporary organ substitution by hemoperfusion through a suspension of active porky hepatocytes was also performed. The lethality in Group A made up 59% and that in Group B was 37%.