[Interferon inductors in treatment of associative forms of tick-borne infection in children].

Thirty three children with associative forms of thick-borne infection (thick-borne encephalitis with ixodic borreliosis) were clinically observed. The disease was characterized by subfebrile temperature, moderate intoxication, rare erythema (39.5%) and frequent cardiovascular disorders with development of Lyme carditis (32.6 +/- 7.2%) and further rise of hepatomegalia in the diseases dynamics and development of meningeal symptoms. There were observed changes in the cytokine spectrum, characterized by INF-gamma high levels, and hypersecretion of the whole spectrum cytokines in the dynamics, that provided the Th2 type immune response. High clinicoimmunological efficacy of the complex therapy with cycloferon as an immunomodulator providing more balanced production of pro- and anti-inflammatory cytokines (IL-1alpha, INF-gamma and IL-10) was shown.

Prospects for suppressing transmission of Lyme disease.

A variety of methods have been developed to prevent human infection by the Lyme disease spirochete in the northeastern United States, mainly based on the observations that nymphal Ixodes dammini serve as vector, that deer serve as hosts for the reproductive stage of this tick, that white-footed mice serve as the reservoir of infection, and that nymphs are most abundant in early summer and must attach for 2 days before infection is transmitted. Methods for personal protection included seasonal avoidance of infested sites, the use of repellants, and prompt removal of attached ticks. Destruction of mouse habitat, but not of mice, was locally effective. Nondestructive acaricidal treatment of deer proved ineffective, but the elimination of these hosts resulted in reduced transmission after several years. Treatment of mice by means of acaricide-impregnated bedding material effectively reduced transmission.

Neuroborreliosis.

Neuroborreliosis, a manifestation of infection with the spirochete Borellia burgdorferi, has become the most frequently recognised arthropod-borne infection of the nervous system in Europe and the USA. The best criterion of an early infection with B. burgdorferi is erythema migrans (EM), but this is present in only about 40-60% of patients with validated borreliosis. Therefore use of the duration of the disease as a classification criterion for neuroborreliosis is increasing, the chronic form being distinguished from the acute when symptoms persist for more than 6 months. The diverse manifestations of neuroborreliosis require that it be included in the differential diagnosis of many neurological disorders. In Europe, meningopolyradiculoneuritis (Bannwarth's syndrome) represents the most common manifestation of acute neuroborreliosis, with the facial nerve being affected much more frequently than the other cranial nerves. Clinical symptoms affecting the central nervous system are rarely observed and then mostly in chronic courses. By far the most common manifestation of chronic neuroborreliosis is encephalomyelitis with spastic-ataxic disturbances and a disturbance of micturition. The current diagnosis of neuroborreliosis is a clinical one, which has to be confirmed by laboratory testing. In most patients, examination of the cerebrospinal fluid (CSF) reveals lymphocytic pleocytosis, damage to the blood-CSF-barrier and an intrathecal synthesis immunoglobulin (Ig) M, IgG, and sometimes IgA. Confirmation of a borrelial infection of the nervous system requires demonstration of an intrathecal synthesis of borrelial-specific antibodies in the CSF or detection of borrelial DNA in the CSF by polymerase chain reaction (PCR). There is no generally accepted therapeutic regime for the treatment of neuroborreliosis, but recent studies have shown ceftriaxone 2 g/day and cefotaxime 6 g/day to be effective in acute and chronic courses. Penicillin G 20 mega units/day and doxycycline 200 mg/day may be suitable for uncomplicated meningopolyneuritis, without involvement of the central nervous system. The durationof treatment--at least 2 weeks in the acute forms and 3 weeks in the chronic forms of neuroborreliosis--is very important for successful treatment. Corticosteroids are recommended only for patients with severe pain that does not respond to antibiotics an analgesics.

[Borrelia burgdorferi encephalomyelitis]. / Formes encéphalomyélitiques de l'infection a Borrelia burgdorferi.

We report two patients with chronic encephalomyelitis due to Borrelia burgdorferi in whom the definite diagnosis was delayed because of atypical clinical features. The first patient presented with chronic spastic paraparesis, slight ataxia and nystagmus of several years' duration. A tentative diagnosis of multiple sclerosis was made in spite of important abnormalities of the CSF biological characteristics. The second patient presented with an acute aphasia and a bilateral Babinski's sign. He was thought to suffer from benign herpetic meningoencephalitis. Several months later, as the patient experienced relapses with cerebellar and spinal cord involvement, falsely positive tests for syphilis were found and an antibiotic treatment was given. High protein content, low glucose levels, pleocytosis and oligoclonal bands were observed in all CSF samples, but the definite diagnosis was based on the detection of serum and CSF antibodies against B. burgdorferi.

[The role of ticks and small mammals in propagation of Borrelia burgdorferi and Babesia microti]. / Rola kleszczy i drobnych ssaków w szerzeniu sie zakazen Borrelia burgdorferi i Babesia microti.

In the present article, the role of ticks and small mammals in the epidemiology of Borrelia burgdorferi and Babesia microti is reviewed. Contrary to other European countries, the zoonotic reservoir of both potogens in Poland is unknown. In particular a preliminary analysis of B. burgdorferi and B. microti infections of rodents in District of Mazury Lake is presented.

Anti-interleukin-15 prevents arthritis in Borrelia-vaccinated and -infected mice.

We showed previously that interleukin-17 (IL-17) plays a significant role in the induction of arthritis associated with Borrelia vaccination and challenge. Little information, however, is available about the chain of immunologic events that leads to the release of IL-17. The production of IL-17 has been linked to stimulation of memory cells by IL-15. Therefore, we hypothesized that IL-15 is involved in the induction of arthritis associated with Borrelia vaccination and infection of mice. Here we present evidence that treatment of Borrelia-vaccinated and -infected mice with anti-IL-15 antibody prevents swelling of the hind paws. More importantly, both anti-IL-15 antibody- and recombinant IL-15 receptor alpha-treated Borrelia-vaccinated and -infected mice were free of major histopathologic indications of arthritis, including hyperplasia, hypertrophy, and vilus formation of the synovium. Similarly, the synovial space and perisynovium were free of inflammatory cells. By contrast, the synovium of nontreated Borrelia-vaccinated and -infected mice had overt hyperplasia, hypertrophy, and vilus formation. Moreover, the synovial space and perisynovium were infiltrated with neutrophils, macrophages, and lymphocytes. Finally, we show that recombinant IL-15 stimulates the release of IL-17 from lymph node cells obtained near the arthritic site. These results suggest that IL-15 plays a major role in orchestrating IL-17 induction of arthritis associated with Borrelia-vaccinated and -infected mice.

Some transfusion-induced parasitic infections in Zambia.

The risk of acquiring a transfusion-induced infection in Zambia was studied for the first time. Blood slide examination of donors, despite the insensitivity of the method, established malaria as the most serious hazard. The species involved was Plasmodium falciparum, the cause of cerebral malaria, and which could be rapidly fatal in a non-immune host visiting an endemic area. Microfilariae of Dipetalonema perstans and Wuchereria bancrofti were also found in donor populations. While no disease may be induced, allergic reactions due to the breakdown products of dead microfilariae may manifest themselves. Several cases of transfusion-induced malaria, a case of relapsing fever and a case of rhodesian trypanosomiasis are reported. Toxoplasmosis and kalatazar, which may also be transfusion-induced, are both known to occur in the country but no cases were observed. It is emphasized that prophylactic measures should be mandatory in areas where no regular, screened, donor panel is available. The awareness and ackowledgement of the risk of transfusion-induced infections may be the best safeguard against the serious consequences in developing countries.

Neurologic complications of erythema-migrans-disease in childhood--clinical aspects.

Erythema-migrans-disease represents a tick-borne borreliosis with a high and widespread incidence according to first epidemiological surveys. The early symptom is a distinctive erythema migrans eventually followed by arthritis and cardiac involvement as well as neurologic complications in the form of lymphocytic meningoradiculitis Garin-Bujadoux-Bannwarth. In a one-year-period we observed 9 children who developed neurologic complications as the predominant feature of erythema-migrans-disease. Eight children suffered from a lymphocytic meningitis and/or a peripheral facial palsy and one child presented with a severe polyradiculoneuritis with complete transverse myelitis. In contrast to adults the clinical course of neurologic manifestations in children seems to be milder and shorter and not associated with the typical painful radiculitis. Acute Bell's palsy seems to be a rather common symptom, whereas other peripheral pareses of the mononeuritis multiplex type were not observed. With respect to the assumed frequency and because of the possibility of antibiotic therapy, erythema-migrans-disease should be ruled out in any case of so-called idiopathic facial palsy or aseptic meningitis, which are frequently encountered in children.

Acute and chronic illness after tick-bite Borrelia burgdorferi-infections: results of treatment.

We report on clinical and laboratory findings of 28 patients with tick-bite Borrelia burgdorferi-infection. In 5 cases chronic tertiary metaluetic manifestations were recognized. All were treated either with high-dose penicillin intravenously or tetracycline. Results of treatment and recommendations are given.

Tick-borne Borrelia-meningitis in children. An outbreak in the Kalmar area during the summer of 1984.

Nine children, aged 5 to 11 years, with subacute or chronic meningitis were studied. Symptoms started during the summer season in all patients and in eight of the patients the disease began with a localized erythematous lesion (ECM), mostly in the face. In one patient only there was a history of an insect bite at the site of the erythema. The neurological abnormalities included aseptic meningitis, peripheral facial nerve palsy (5/9) and oculomotor nerve palsy (1/9). Most children complained of headache, fatigue, loss of appetite and had a low grade fever. High antibody titers to Borrelia spirochetes in serum and/or cerebrospinal fluid (CSF) were demonstrated by ELISA in eight of the nine patients and by indirect immunofluorescence assay (IFA) in three patients. All patients had a dramatic improvement in their general condition and became afebrile within three days of institution of i.v. penicillin G treatment (i.v. cefuroxime in one patient).

[Ocular findings in tick borreliosis]. / Augenbefunde bei Zecken-Borreliose.

Tick-transmitted borreliosis is by no means a rare infectious disease. It is found especially in southern parts of Germany. Eyes are seldom affected. The disease can lead to nerve palsy of the eye muscles. One case of panophthalmitis and one of optic disk edema have been described. The authors found a bilateral palsy of the abducens nerve in one patient with tick-transmitted borreliosis. Motility normalized under therapy with highly-dosed penicillin.