Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study.

Despite rather strict recommendations for antibiotic treatment of disseminated Lyme borreliosis (LB), evidence-based studies on the duration of antibiotic treatment are scarce. The aim of this multicenter study was to determine whether initial treatment with intravenous ceftriaxone (CRO) for 3 weeks should be extended with a period of adjunct oral antibiotic therapy. A total of 152 consecutive patients with LB were randomized in a double-blind fashion to receive either amoxicillin (AMOX) 1 g or placebo (PBO) twice daily for 100 days. Both groups received an initial treatment of intravenous CRO 2 g daily for 3 weeks, followed by the randomized drug or PBO. The outcome was evaluated using the visual analogue scale at the follow-up visits. The final analysis included 145 patients, of whom 73 received AMOX and 72 PBO. Diagnoses of LB were categorized as either definite or possible, on the basis of symptoms, signs, and laboratory results. The diagnosis was definite in 52 of the 73 (71.2%) AMOX-treated patients and in 54 of the 72 (75%) PBO patients. Of the patients with definite diagnoses, 62 had neuroborreliosis, 45 arthritis or other musculoskeletal manifestations, and 4 other manifestations of LB. As judged by the visual analogue scale and patient records, the outcome after a 1-year follow-up period was excellent or good in 114 (78.6%) patients, controversial in 14 (9.7%) patients, and poor in 17 (11.7%) patients. In patients with definite LB, the outcome was excellent or good in 49 (92.5%) AMOX-treated patients and 47 (87.0%) PBO patients and poor in 3 (5.7%) AMOX-treated patients and 6 (11.1%) PBO patients (difference nonsignificant, p = 0.49). Twelve months after the end of intravenous antibiotic therapy, the levels of antibodies against Borrelia burgdorferi were markedly decreased in 50% of the patients with definite LB in both groups. The results indicate that oral adjunct antibiotics are not justified in the treatment of patients with disseminated LB who initially receive intravenous CRO for 3 weeks. The clinical outcome cannot be evaluated at the completion of intravenous antibiotic treatment but rather 6-12 months afterwards. In patients with chronic post-treatment symptoms, persistent positive levels of antibodies do not seem to provide any useful information for further care of the patient.

Analysis of Borrelia burgdorferi IgG antibodies with a combination of IgG ELISA and VlsE C6 peptide ELISA.

Enzyme-linked immunosorbent assays (ELISAs) were used to detect antibodies to the C6 peptide of the Borrelia burgdorferi VlsE protein and a selection of B. burgdorferi IgG antigens, separately and as a combination, in 355 serum specimens from blood donors and patients. Western immunoblotting was used as the reference method. The sensitivity of the combined analysis of IgG antigen and C6 peptide analysis was markedly superior to those of the separate analyses. When the C6 peptide and IgG results were concordant, the customary confirmatory Western immunoblotting assay could be omitted, thus reducing the time and cost of analysis.

IgG seroprevalence of Lyme borreliosis in the population of the Aland Islands in Finland.

This is a study of people living in Aland, a group of islands in the Baltic Sea between Finland and Sweden. 500 blood donors and 3,248 health service clients who did not have Lyme borreliosis were examined for Borrelia burgdorferi IgG antibodies. The method used was an ELISA containing a selection of diagnostic antigens to a Borrelia burgdorferi PKo strain. It was found that the distribution according to sex, age and titre values was identical in the 2 groups, which were therefore treated as one. 19.7% of all the sera was positive. The prevalence in men was 23.6%, and in women 16.7%. The prevalence rises with age, the highest prevalence being seen in men (44.7%) and women (37.0%) over 70 y of age. The data show that the Aland islands are strongly endemic for Lyme borreliosis compared with international levels of infection.

Megacystis-microcolon-intestinal hypoperistalsis syndrome. Antenatal appearance in two cases.

Two cases with severe congenital megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) are presented. This is a rarely encountered syndrome in neonates and 45 cases have earlier been reported. The disease is usually lethal and it now seems clear that MMIHS is an autosomal recessive disorder. The enlarged bladder, typical of this syndrome, is however easy to define by ultrasound, sometimes even in early pregnancy. The concomitant finding of a dilatation of the urinary tract and the absence of oligohydramnios may lead the physician to suspect the diagnosis. Because of the information available from sonography, appropriate investigations can be undertaken immediately after delivery. Prenatal ultrasound examination in subsequent pregnancies is recommended.

Evaluation of regret after tubal sterilization.

Many different criteria and profiles have been suggested for the possible cause of regret and requests for reversal after tubal sterilization. Evaluation of data obtained from 2253 women who had undergone tubal sterilization showed a strong correlation between regrets and youthful age and to changes in marital situation. Previously demonstrated risk factors, such as sterilization in connection with abortion or labor were not related to regret in this study material.

25 year follow-up of the Aland thyroid study of 1956. Thyroid status and incidence of rheumatoid arthritis.

In 1956, a study of the iodine metabolism in endemic goitre was made on a group of inhabitants of the Aland Islands, an autonomous province of Finland. The number of Alanders studied was 130. In a follow-up study 25 years later, 101 still living subjects from the original study could be traced. 17 of them had become hyperthyroid, 7 had been operated on for non-toxic goitre, and 4 had become hypothyroid. There was no correlation between thyroid hormone excretion values in 1956 and subsequent hyperthyroidism. Rheumatoid arthritis was overrepresented in the goitre group compared with the group without goitres, as well as compared with statistical figures on the frequency of rheumatic disease among the population in general of Aland and of Finland as a whole.

Cyclical thrombocytopenia with remission during lynestrenol treatment in a woman.

A woman of 40 had cyclical thrombocytopenia occurring midway between menstruations, with bruising and platelet counts down to 2000/mm3. The thrombocytopenic episodes disappeared after treatment with lynestrenol was started. The patient's platelets had a functional defect of the "aspirin-like" type. The availability of platelet factor 3 increased when oestrogen was added to platelet-rich plasma from the patient.

Detection of human and chick nuclear antigens in nuclei of chick erythrocytes during reactivation in heterokaryons with HeLa cells.

Inactive nuclei of chick erythrocyte resume RNA synthesis and increase in volume and dry mass in heterokaryons made by virus-induced fusion of human tumor cells (HeLa) with chick erythrocytes. Nuclear growth is due primarily to migration of human macromolecules into the chick nucleus. Human nucleoplasmic antigens were detected in the nucleoplasm and human nucleolar antigens were detected in the nucleoli of reactivated chick erythrocyte nuclei. After some time, chick-specific nucleolar antigens appear in the nucleoli of both the reactivated chick nuclei and the HeLa cellnuclei. The results suggest that human nuclear proteins play an important part in the reactivation of the chick genome.