Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.621
Filtrar
1.
BMJ ; 369: m1041, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32457042

RESUMO

Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.


Assuntos
Antibacterianos/uso terapêutico , Doença de Lyme/tratamento farmacológico , Doença de Lyme/patologia , Acrodermatite/etiologia , Acrodermatite/patologia , Antibacterianos/administração & dosagem , Artrite/diagnóstico , Artrite/etiologia , Artrite/microbiologia , Grupo Borrelia Burgdorferi/genética , Eritema Migrans Crônico/etiologia , Eritema Migrans Crônico/microbiologia , Eritema Migrans Crônico/patologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Doença de Lyme/sangue , Doença de Lyme/epidemiologia , Masculino , América do Norte/epidemiologia , Síndrome Pós-Lyme/epidemiologia , Prevalência
2.
Dtsch Med Wochenschr ; 145(1): 19-28, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31914465

RESUMO

Lyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. A typical late manifestation is acrodermatitis chronica atrophicans. Lyme neuroborreliosis is much less common with an incidence of about 0.8/100 000 inhabitants in Germany. Bannwarth's syndrome (painful radiculoneuritis) is the most common manifestation of Lyme neuroborreliosis in adults followed by meningitis. International case definitions exist regarding the likelihood of Lyme neuroborreliosis on the basis of diagnostic test results. A CSF analysis should be performed in patients with suspected Lyme neuroborreliosis. The first line treatment for dermatological manifestations of Lyme borreliosis is doxycycline, in children and pregnant women amoxicillin. Doxycycline and beta-lactam antibiotics show similar efficacy regarding neurological symptoms and adverse effects for treatment of neurological manifestations. Treatment duration for early manifestations is 10 to 14 days, in Lyme neuroborreliosis it should not exceed 21 days. All manifestations, also Lyme neuroborreliosis, usually show a favourable prognosis after antibiotic treatment. Antibiotic treatment does not show any efficacy in patients with unspecific symptoms and concurrent positive anti-borrelial serology.


Assuntos
Doença de Lyme , Antibacterianos/uso terapêutico , Criança , Doxiciclina/uso terapêutico , Eritema Migrans Crônico , Feminino , Dedos/patologia , Alemanha/epidemiologia , Humanos , Incidência , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Doença de Lyme/fisiopatologia , Masculino , Gravidez , Pele/patologia
3.
Medicine (Baltimore) ; 98(46): e17977, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725662

RESUMO

RATIONALE: Both Borrelia burgdorferi sensu lato and spotted fever group Rickettsiae (SFGR) are pathogens carried by ticks. There is a possibility of co-infection with these tick-borne diseases. PATIENT CONCERNS: Male patient, 63 years-of-age, admitted to hospital with skin rash presenting for 1 week and fever with cough and expectoration for 3 days before admission. DIAGNOSES: We diagnosed that the patient was co-infected by B burgdorferi sl and SFGR using laboratory test results and the patient's clinical manifestations. INTERVENTIONS: The patient started therapy with oral minocycline, then levofloxacin by intravenous injection for SFGR. Meanwhile, he was treated with penicillin G sodium, cefoperazone sulbactam sodium and ceftriaxone by intravenous injection for B burgdorferi sl. OUTCOMES: After the patient was in stable condition, he was discharged from hospital. LESSONS: This case report highlights the possibility of co-infection by 2 tick-borne diseases in Urumqi, Xinjiang Uygur Autonomous Region, China. The antibiotic therapy should be based on the detection of pathogenic bacteria, and the different susceptibilities of co-infecting bacteria should be considered.


Assuntos
Doença de Lyme/complicações , Rickettsiose do Grupo da Febre Maculosa/complicações , Doenças Transmitidas por Carrapatos/complicações , Antibacterianos/uso terapêutico , Borrelia burgdorferi , China , Humanos , Doença de Lyme/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Rickettsiose do Grupo da Febre Maculosa/tratamento farmacológico , Doenças Transmitidas por Carrapatos/tratamento farmacológico
4.
BMC Infect Dis ; 19(1): 732, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429716

RESUMO

BACKGROUND: Lyme borreliosis (LB) is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato species. Due to a variety of clinical manifestations, diagnosing LB can be challenging, and laboratory work-up is usually required in case of disseminated LB. However, the current standard of diagnostics is serology, which comes with several shortcomings. Antibody formation may be absent in the early phase of the disease, and once IgG-seroconversion has occurred, it can be difficult to distinguish between a past (cured or self-cleared) LB and an active infection. It has been postulated that novel cellular tests for LB may have both higher sensitivity earlier in the course of the disease, and may be able to discriminate between a past and active infection. METHODS: VICTORY is a prospective two-gate case-control study. We strive to include 150 patients who meet the European case definitions for either localized or disseminated LB. In addition, we aim to include 225 healthy controls without current LB and 60 controls with potentially cross-reactive conditions. We will perform four different cellular tests in all of these participants, which will allow us to determine sensitivity and specificity. In LB patients, we will repeat cellular tests at 6 weeks and 12 weeks after start of antibiotic treatment to assess the usefulness as 'test-of-cure'. Furthermore, we will investigate the performance of the different cellular tests in a cohort of patients with persistent symptoms attributed to LB. DISCUSSION: This article describes the background and design of the VICTORY study protocol. The findings of our study will help to better appreciate the utility of cellular tests in the diagnosis of Lyme borreliosis. TRIAL REGISTRATION: NL7732 (Netherlands Trial Register, trialregister.nl).


Assuntos
Doença de Lyme/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Borrelia burgdorferi/imunologia , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Doença de Lyme/tratamento farmacológico , Estudos Multicêntricos como Assunto , Países Baixos , Estudos Prospectivos
5.
Dermatol Clin ; 37(4): 443-454, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466585

RESUMO

Primary cutaneous B-cell lymphomas are a group of diseases with indolent and aggressive behavior. The goal of the initial workup is to evaluate for systemic involvement, provide adequate staging, and guide therapy. Histopathological studies are a critical part of the workup for classification of these lymphomas because they are similar to their nodal counterparts. There are limited data for treatment guidelines, and thus, therapy differs among institutions. Overall, localized therapies are preferred for indolent types and chemotherapy or immunotherapy for the aggressive forms.


Assuntos
Antineoplásicos/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos , Linfoma de Células B/terapia , Neoplasias Cutâneas/terapia , Administração Cutânea , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bexaroteno/uso terapêutico , Borrelia burgdorferi , Ciclofosfamida/uso terapêutico , Procedimentos Cirúrgicos de Citorredução , Gerenciamento Clínico , Doxorrubicina/análogos & derivados , Doxorrubicina/uso terapêutico , Humanos , Injeções Intralesionais , Doença de Lyme/tratamento farmacológico , Linfoma de Células B/diagnóstico , Linfoma de Células B/patologia , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/microbiologia , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma de Zona Marginal Tipo Células B/terapia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Mecloretamina/uso terapêutico , Polietilenoglicóis/uso terapêutico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Vincristina/uso terapêutico
6.
Infect Immun ; 87(10)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31308087

RESUMO

A basic feature of infection caused by Borrelia burgdorferi, the etiological agent of Lyme borreliosis, is that persistent infection is the rule in its many hosts. The ability to persist and evade host immune clearance poses a challenge to effective antimicrobial treatment. A link between therapy failure and the presence of persister cells has started to emerge. There is growing experimental evidence that viable but noncultivable spirochetes persist following treatment with several different antimicrobial agents. The current study utilized the mouse model to evaluate if persistence occurs following antimicrobial treatment in disease-susceptible (C3H/HeJ [C3H]) and disease-resistant (C57BL/6 [B6]) mouse strains infected with B. burgdorferi strains N40 and B31 and to confirm the generality of this phenomenon, as well as to assess the persisters' clinical relevance. The status of infection was evaluated at 12 and 18 months after treatment. The results demonstrated that persistent spirochetes remain viable for up to 18 months following treatment, as well as being noncultivable. The phenomenon of persistence in disease-susceptible C3H mice is equally evident in disease-resistant B6 mice and not unique to any particular B. burgdorferi strain. The results also demonstrate that, following antimicrobial treatment, both strains of B. burgdorferi, N40 and B31, lose one or more plasmids. The study demonstrated that noncultivable spirochetes can persist in a host following antimicrobial treatment for a long time but did not demonstrate their clinical relevance in a mouse model of chronic infection. The clinical relevance of persistent spirochetes beyond 18 months following antimicrobial treatment requires further studies in other animal models.


Assuntos
Antibacterianos/farmacologia , Borrelia burgdorferi/efeitos dos fármacos , Ceftriaxona/farmacologia , Resistência à Doença/genética , Farmacorresistência Bacteriana/genética , Doença de Lyme/microbiologia , Animais , Borrelia burgdorferi/genética , Borrelia burgdorferi/metabolismo , Borrelia burgdorferi/patogenicidade , Modelos Animais de Doenças , Feminino , Predisposição Genética para Doença , Doença de Lyme/tratamento farmacológico , Doença de Lyme/patologia , Camundongos , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Músculo Esquelético/microbiologia , Músculo Esquelético/patologia , Miocárdio/patologia , Plasmídeos/química , Plasmídeos/metabolismo
7.
BMJ Case Rep ; 12(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167768

RESUMO

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy-reverted to normal sinus rhythm and discharged home. He returned a few days later-this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.


Assuntos
Fibrilação Atrial/diagnóstico , Bloqueio Atrioventricular/diagnóstico , Doença de Lyme/diagnóstico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/tratamento farmacológico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Doença de Lyme/tratamento farmacológico , Doença de Lyme/imunologia , Masculino , Resultado do Tratamento , Adulto Jovem
8.
Folia Med Cracov ; 59(1): 5-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180072

RESUMO

Lyme disease is an emerging problem in Poland. Analysis has been undertaken of the medical documentation of 86 patients hospitalized in the Infectious Diseases Department, University Hospital in Cracow in 2013-2016, suspected of Lyme arthritis. It has especially considered medical history including potential exposure to the infection, detailed characteristics of the symptoms, diagnostic challenges and results of the treatment. Only some patients had a history of erythema migrans and not all of them recalled tick-bite. The majority of the patients had affected large joints, especially knee joints, and polyarthritis was rarely observed. Symptoms were resolved completely or partially after antibiotic treatment in most patients. The diagnosis of Lyme arthritis in areas endemic for Lyme disease is still a diagnostic challenge in patients with other rheumatic diseases, including osteoarthritis.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Eritema Migrans Crônico/tratamento farmacológico , Doença de Lyme/tratamento farmacológico , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/fisiopatologia , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Eritema Migrans Crônico/diagnóstico , Eritema Migrans Crônico/etiologia , Feminino , Articulações do Pé , Articulação da Mão , Articulação do Quadril , Hospitalização , Hospitais Universitários , Humanos , Articulação do Joelho , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Doença de Lyme/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Polônia , Articulação do Ombro , Picadas de Carrapatos , Resultado do Tratamento
9.
Pharmazie ; 74(6): 345-349, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31138371

RESUMO

Azithromycin was loaded onto the µm-sized mesoporous silica Davisil® SP53D-11920 using the wetness impregnation method with fractional steps (WIFS) and further incorporated into a 5 % hydroxypropyl cellulose gel to prevent Lyme disease. Maximum loadings (32.0 % w/w and 33.2 % w/w) were produced by different concentrated loading solutions and determined by X-ray diffraction (XRD). A total of 24 months stability of the amorphous azithromycin state in the silica (33.2 % loading) and 18 months stability in the gel (33.2 % loading) at 4 °C were also confirmed by XRD. The higher kinetic solubility at 40 min (1,300 µg/mL versus 93 µg/mL) and higher porcine ear skin penetration compared to the raw drug powder indicated higher dermal bioavailability of the azithromycin-loaded silica (32.0 % loading), even when compared to the "gold standard" nanocrystals and another clinical effective azithromycin formulation with ethanol. In summary, maximum loaded silicas with azithromycin by WIFS is a promising dermal formulation for prophylaxis against Lyme disease.


Assuntos
Azitromicina/administração & dosagem , Azitromicina/química , Disponibilidade Biológica , Química Farmacêutica/métodos , Dióxido de Silício/administração & dosagem , Administração Cutânea , Animais , Doença de Lyme/tratamento farmacológico , Nanopartículas/administração & dosagem , Pele/efeitos dos fármacos , Solubilidade , Suínos , Difração de Raios X
10.
Sports Health ; 11(4): 350-354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136727

RESUMO

CONTEXT: Lyme disease is the most common tick-borne illness in North America and Europe, and Lyme arthritis is a frequent late-stage manifestation in the United States. However, Lyme arthritis has rarely been reported as a postoperative complication. EVIDENCE ACQUISITION: The PubMed database was queried through June 2018, and restricted to the English language, in search of relevant articles. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: A total of 5 cases of Lyme arthritis as a postoperative complication have been reported in the literature. CONCLUSION: These cases highlight the importance for providers practicing in Lyme-endemic regions to keep such an infection in mind when evaluating postoperative joint pain and swelling. We propose herein an algorithm for the workup of potential postoperative Lyme arthritis. STRENGTH OF RECOMMENDATION TAXONOMY (SORT): C.


Assuntos
Doença de Lyme/diagnóstico , Procedimentos Ortopédicos/efeitos adversos , Algoritmos , Antibacterianos/uso terapêutico , Artralgia/microbiologia , Ceftriaxona/uso terapêutico , Desbridamento , Doxiciclina/uso terapêutico , Humanos , Doença de Lyme/tratamento farmacológico , Doença de Lyme/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/cirurgia , Irrigação Terapêutica
11.
Artigo em Inglês | MEDLINE | ID: mdl-31052190

RESUMO

This study examines potential challenges facing Lyme disease patients in Canada's Maritime provinces-New Brunswick, Nova Scotia, Prince Edward Island-and considers how issues could be addressed. Reviews of both the academic and grey literature are complemented by surveys targeting both medical professionals and decision makers in government. Combined, the literature reviews and surveys demonstrate that there is considerable debate surrounding the effectiveness of testing, treatment options, and the existence of chronic Lyme disease. As the focus on the Maritimes demonstrates, these debates often pit the medical community against patients and patient advocates and, thus far, governments have been unable to produce policy that entirely pleases either side. Moving forward, this study recommends the creation of a discussion forum via a federal Commission of inquiry to review best practise guidelines for Lyme disease. The key is to foster an unbiased probe of central issues surrounding treatment and diagnosis without alienating stakeholders. This course of action will not necessarily solve the issue of Lyme disease, but would foster a greater understanding through dialogue that includes and validates the experiences of stakeholders, which is something that is currently missing.


Assuntos
Doença de Lyme/prevenção & controle , Médicos/estatística & dados numéricos , Doença Crônica/tratamento farmacológico , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Novo Brunswick/epidemiologia , Nova Escócia/epidemiologia , Ilha do Príncipe Eduardo/epidemiologia
12.
BMC Infect Dis ; 19(1): 428, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096922

RESUMO

BACKGROUND: Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. CASE PRESENTATION: A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120-200 ms). Physical exam was unremarkable. The cardiologist's initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. CONCLUSIONS: Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.


Assuntos
Teste de Esforço/efeitos adversos , Bloqueio Cardíaco/etiologia , Doença de Lyme/complicações , Miocardite/etiologia , Adulto , Antibacterianos/uso terapêutico , Bradicardia/etiologia , Ceftriaxona/uso terapêutico , Morte Súbita , Doxiciclina/uso terapêutico , Exercício Físico/fisiologia , Frequência Cardíaca , Humanos , Doença de Lyme/tratamento farmacológico , Masculino
13.
Artigo em Inglês | MEDLINE | ID: mdl-31036693

RESUMO

Borrelia burgdorferi is the etiological agent of Lyme disease. In the current study, we used direct-detection PCR and electrospray ionization mass spectrometry to monitor and genotype B. burgdorferi isolates from serially collected whole-blood specimens from patients clinically diagnosed with early Lyme disease before and during 21 days of antibiotic therapy. B. burgdorferi isolates were detected up to 3 weeks after the initiation of antibiotic treatment, with ratios of coinfecting B. burgdorferi genotypes changing over time.


Assuntos
Antibacterianos/uso terapêutico , Borrelia burgdorferi/efeitos dos fármacos , Borrelia burgdorferi/patogenicidade , Doença de Lyme/tratamento farmacológico , Doença de Lyme/microbiologia , Borrelia burgdorferi/genética , Genótipo , Humanos , Reação em Cadeia da Polimerase , Espectrometria de Massas por Ionização por Electrospray
14.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036741

RESUMO

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.


Assuntos
Fibrilação Atrial/etiologia , Bloqueio Atrioventricular/etiologia , Doença de Lyme/diagnóstico , Miocardite/diagnóstico , Administração Intravenosa , Antibacterianos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Western Blotting/métodos , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Eletrocardiografia , Humanos , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças Raras , Síncope/etiologia , Resultado do Tratamento
17.
Discov Med ; 27(148): 125-138, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30946803

RESUMO

Although most patients with Lyme disease can be cured with a 2-4 week antibiotic therapy, about 10-20% of patients continue to suffer prolonged persistent symptoms, a condition called post-treatment Lyme disease syndrome (PTLDS). The cause for PTLDS is unclear and hotly debated. Borrelia burgdorferi develops morphological variants under stress conditions but their significance is not clear. Here we isolated the biofilm-like microcolony (MC) and planktonic (spirochetal form and round body) (SP) variant forms from the stationary phase culture of B. burgdorferi and showed that the MC and SP variant forms were not only more tolerant to the current Lyme antibiotics but also caused more severe arthritis in mice than the log phase spirochete form (LOG). We propose to divide the persistent Lyme disease into two categories: (1) early development of persistent disease from inoculation with persister/biofilm at the beginning of infection introduced by tick bites, or Type I persistent disease (i.e., PTLDS); and (2) late development of persistent disease due to initial infection not being diagnosed or treated in time such that the infection develops into late persistent disease, or Type II persistent disease. Importantly, we show that the murine infection caused by LOG could be eradicated by ceftriaxone whereas the persistent infection established with MC could not be eradicated by doxycycline (Doxy), ceftriaxone (CefT), or vancomycin (Van), or Doxy+CefT or Van+CefT, but could only be eradicated by the persister drug combination daptomycin+doxycycline+ceftriaxone. We conclude that varying levels of persistence and pathologies of Borrelia infection and the corresponding different treatment responses are mostly dictated by the heterogeneous B. burgdorferi variant forms inoculated at the time of tick bites. These findings may have broad implications for understanding pathogenesis and treatment of not only persistent Lyme disease but also other persistent infections in general and call for studies to evaluate if treatment of persistent infections with persister drug combination regimens is more effective than the current mostly single-antibiotic monotherapy.


Assuntos
Biofilmes/efeitos dos fármacos , Borrelia burgdorferi/fisiologia , Ceftriaxona/farmacocinética , Doença de Lyme , Síndrome Pós-Lyme , Animais , Biofilmes/crescimento & desenvolvimento , Modelos Animais de Doenças , Feminino , Doença de Lyme/tratamento farmacológico , Doença de Lyme/microbiologia , Doença de Lyme/patologia , Camundongos , Síndrome Pós-Lyme/tratamento farmacológico , Síndrome Pós-Lyme/microbiologia , Síndrome Pós-Lyme/patologia , Falha de Tratamento
18.
BMC Infect Dis ; 19(1): 324, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987580

RESUMO

BACKGROUND: After antibiotic treatment of Lyme borreliosis, a subset of patients report persistent symptoms, also referred to as post-treatment Lyme disease syndrome. The reported prevalence of persistent symptoms varies considerably, and its pathophysiology is under debate. The LymeProspect study has been designed to investigate the prevalence, severity, and a wide range of hypotheses on the etiology of persistent symptoms among patients treated for Lyme borreliosis in the Netherlands. METHODS: LymeProspect is a prospective, observational cohort study among adults with proven or probable Lyme borreliosis, either erythema migrans or disseminated manifestations, included at the start of antibiotic treatment. During one year of follow-up, participants are subjected to questionnaires every three months and blood is collected repeatedly during the first three months. The primary outcome is the prevalence of persistent symptoms after treatment, assessed by questionnaires online focusing on fatigue (CIS, subscale fatigue severity), pain (SF-36, subscale pain) and neurocognitive dysfunction (CFQ). Potential microbiological, immunological, genetic, epidemiological and cognitive-behavioral determinants for persistent symptoms are secondary outcome measures. Control cohorts include patients with long-lasting symptoms and unconfirmed Lyme disease, population controls, and subjects having reported a tick bite not followed by Lyme borreliosis. DISCUSSION: This article describes the background and design of the LymeProspect study protocol. This study is characterized by a prospective, explorative and multifaceted design. The results of this study will provide insights into the prevalence and determinants of persistent symptoms after treatment for Lyme borreliosis, and may provide a rationale for preventive and treatment recommendations. TRIAL REGISTRATION: NTR4998 (Netherlands Trial Register). Date of registration: 13 February 2015.


Assuntos
Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Adulto , Idoso , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/complicações , Protocolos Clínicos , Estudos de Coortes , Eritema Migrans Crônico/tratamento farmacológico , Eritema Migrans Crônico/epidemiologia , Eritema Migrans Crônico/etiologia , Fadiga/etiologia , Humanos , Doença de Lyme/etiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Carrapatos
20.
Nurs Clin North Am ; 54(2): 261-275, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027665

RESUMO

Lyme disease is caused by the spirochete Borrelia burgdorferi and is increasing in incidence in the United States. Patient education and early recognition and treatment of the disease are critical to reduce the impact of chronic long-term infection.


Assuntos
Antibacterianos/uso terapêutico , Borrelia burgdorferi , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Guias de Prática Clínica como Assunto , Carrapatos , Animais , Vetores Aracnídeos , Humanos , Incidência , Doença de Lyme/epidemiologia , Doença de Lyme/fisiopatologia , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA