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Biomedical subjects

G Stanek

Publications and source records attributed to G Stanek.

At least 37 records · Page 2Linked to original sources
PubMed1998

Detection of Borrelia burgdorferi sensu lato in ticks: immunofluorescence assay versus polymerase chain reaction.

Immunofluorescence (IFA) and polymerase chain reaction (PCR) were examined as methods for detecting Borrelia burgdorferi sensu lato spirochaetes in unfed Ixodes ricinus nymphs. Although similar results were produced in some cases, a great deal of variation occurred. Furthermore, in both the highly controlled initial laboratory study, involving 252 shared samples, and the study on field-collected ticks (n = 460), the IFA tended to detect more infected ticks than the PCR. The basis for these findings are as yet undetermined. The development of a quality assurance scheme is recommended so that laboratories can validate their methods and a preliminary feasibility study suggested that such a scheme is practical.

Animals↗
PubMed1998

Epidemiology of European Lyme borreliosis.

Lyme borreliosis occurs throughout Europe and is particularly prevalent in the east. In a small proportion of untreated cases serious sequelae may occur, but Lyme borreliosis alone does not cause death. Clinical and serological diagnosis can still be problematic and the various genomospecies may cause different disease manifestations as well as differing immunological responses. However, considerable progress has been made in standardising case definitions and serological testing and interpretation. Few countries have official reporting systems for Lyme borreliosis and most figures on incidence are extrapolated from serodiagnosis data and seroprevalence studies. Geographical variations in incidence seem to correlate with the prevalence of infected ticks, which are mainly associated with varied deciduous forest. The complex ecology of Lyme borreliosis makes it difficult to implement preventive measures, so improving public knowledge of risk factors and methods for personal protection remain the best option at present.

Animals↗
PubMed1998

European interlaboratory comparison of Lyme borreliosis serology.

Serological testing for Lyme borreliosis was compared in 5 European reference laboratories with a total of 79 sera in order to determine variations in laboratory performance. A considerable range of methods were used and several laboratories employed 2 or 3 genomospecies of Borrelia burgdorferi sensu lato. No laboratory relied routinely on a single test and each weighted the significance of the findings of the various tests differently. A difference in strategy between laboratories in high and low prevalence areas was apparent in that laboratories in low prevalence areas emphasised specificity more than sensitivity and therefore produced fewer false positives, but also missed some cases. Overall agreement between the laboratories was poor and it was concluded that there is a need for a quality assurance scheme within Europe.

Antibodies, Bacterial↗
PubMed1998

European Lyme borreliosis clinical spectrum.

At a series of meetings, involving 27 clinicians from 11 countries, case definitions for the diagnosis of Lyme borreliosis in Europe were agreed and are presented here, with appropriate serological criteria, as a diagnostic guide. In a separate study questionnaires directed to clinicians were used to collect information on clinical aspects and risk factors of Lyme borreliosis. Data on the number of Lyme borreliosis patients seen by physicians indicated a low prevalence of the disease in western Europe and a relatively high prevalence in eastern Europe. The most commonly encountered symptom was erythema migrans, followed by neurological manifestations. Cardiac problems were rare. Tick bite was strongly associated with Lyme borreliosis, but the only other significantly associated risk factor was the pastime of gardening.

Diagnostic Errors↗
PubMed1998

The European Union Concerted Action World Wide Web site for Lyme borreliosis.

This web site (URL http://www.dis.strath.ac.uk/vie/LymeEU/) provides information on Lyme borreliosis for physicians, scientists, health care workers, veterinarians and students. It consists of a review of the spirochaetes, vectors, reservoir hosts, diagnosis, treatment, epidemiology and prevention of the disease, as well as an account of the activities of EUCALB.

Computer Communication Networks↗
PubMed1997

Preliminary survey of Leptospirosis and Lyme disease amongst febrile patients attending community hospital ambulatory care in Maputo, Mozambique.

OBJECTIVES: To evaluate the importance of the spirochetes Leptospira interrogans s.l. and Borrelia burgdorferi s.l., as causes of human diseases (leptospirosis and Lyme borreliosis), in order to guide the development of laboratory services and patient management and to identify the appropriateness of future epidemiological studies. DESIGN: Cross sectional serological survey. SETTING: Maputo, the capital city of Mozambique. SUBJECTS: 160 adult patients (18 to 50 years of age) presenting, sequentially and for the first time, with a febrile illness at the outpatient's department of a community hospital. METHODS: All sera were examined for L. interrogans s.l. antibodies by the standard microtiter technique (MAT), using as live culture antigens a battery of serovars representing 20 pathogenic serogroups. The IgM and IgG antibody response to B. burgdorferi s.l. was determined in all sera with an indirect IgG ELISA. In order to study potential serological cross-reactivity in malaria positive sera, all samples were further examined for antibodies against Plasmodium falciparum by indirect immunofluorescence. This was complemented with a standardised clinical history and physical examination. MAIN OUTCOME MEASURES: Presence of antibodies to Leptospira interrogans s.l. and to Borrelia burgdorferi s.l.. RESULTS AND CONCLUSIONS: Although not conclusive, because of the inability to attempt rising serology and positive cultures, the results suggest that 10% of non-specific febrile illnesses could be attributed to leptospirosis. This study may thus form the background for a definitive Leptospira research in the same location. We confirm reports from other African countries that Lyme disease is an unlikely occurrence. We further suggest that some of the seropositivity observed for Lyme disease in Maputo could be attributed to serological cross reactivity with antibodies to P. falciparum malaria, leptospirosis or syphilis.

Adolescent↗
PubMed1996

European Union Concerted Action on Risk Assessment in Lyme Borreliosis: clinical case definitions for Lyme borreliosis.

The EU Concerted Action on Risk Assessment in Lyme Borreliosis (EUCALB) has consulted other clinicians and scientists in Europe to produce case definitions of the principal manifestations of European Lyme borreliosis. These case definitions will not only be helpful in supporting its own research interests, but are also intended to assist other clinicians in appropriate management and to support further studies aimed at determining the full clinical spectrum of the disease. The case definitions were achieved after a series of meetings organised by EUCALB with other expert clinicians and scientists from twelve European countries. The definitions and the diagnostic criteria presented thus represent the consensus reached at these meetings. The proposed case definitions consider skin, nervous system, cardiac and musculoskeletal presentations and the role of laboratory investigation in supporting diagnosis.

Acrodermatitis↗
PubMed1996

Characterization of peripheral-compartment kinetics of antibiotics by in vivo microdialysis in humans.

The calculation of pharmacokinetic/pharmacodynamic surrogates from concentrations in serum has been shown to yield important information for the evaluation of antibiotic regimens. Calculations based on concentrations in serum, however, may not necessarily be appropriate for peripheral-compartment infections. The aim of the present study was to apply the microdialysis technique for the study of the peripheral-compartment pharmacokinetics of select antibiotics in humans. Microdialysis probes were inserted into the skeletal muscle and adipose tissue of healthy volunteers and into inflamed and noninflamed dermis of patients with cellulitis. Thereafter, volunteers received either cefodizime (2,000 mg as an intravenous bolus; n = 6), cefpirome (2,000 mg as an intravenous bolus; n = 6), fleroxacin (400 mg orally n = 6), or dirithromycin (250 mg orally; n = 4); the patients received phenoxymethylpenicillin (4.5 x 10(6) U orally; n = 3). Complete concentration-versus-time profiles for serum and tissues could be obtained for all compounds. Major pharmacokinetic parameters (elimination half-life, peak concentration in serum, time to peak concentration, area under the concentration-time curve [AUC], and AUC/MIC ratio) were calculated for tissues. For cefodizime and cefpirome, the AUCtissue/AUCserum ratios were 0.12 to 0.35 and 1.20 to 1.79, respectively. The AUCtissue/AUCserum ratios were 0.34 to 0.38 for fleroxacin and 0.42 to 0.49 for dirithromycin. There was no visible difference in the time course of phenoxymethylpenicillin in inflamed and noninflamed dermis. We demonstrated, by means of microdialysis, that the concept of pharmacokinetic/pharmacodynamic surrogate markers for evaluation of antibiotic regimens originally developed for serum pharmacokinetics can be extended to peripheral-tissue pharmacokinetics. This novel information may be useful for the rational development of dosage schedules and may improve predictions regarding therapeutic outcome.

Adipose Tissue↗
PubMed1996

Lymphoproliferative responses to Borrelia burgdorferi in circumscribed scleroderma.

Humoral immune responses to Borrelia burgdorferi (Bb) have been reported to occur in certain patients with circumscribed scleroderma (CS) (morphoea). Together with the isolation of spirochaetes from CS skin biopsies, this finding was taken to suggest Bb as the aetiological agent of CS. Since there is cellular immunoreactivity to Bb in patients with chronic Lyme borreliosis (LB), Bb-specific lymphocytic responses were tested in patients with CS. For this purpose, peripheral blood mononuclear cells from CS patients and, as controls, from patients with various manifestations of LB, and from healthy volunteers without any evidence of Bb infection, were exposed to Bb organisms for 5 days and then assayed for DNA synthesis. Stimulation indices (SI) > 10 were scored positive. By performing lymphocyte proliferation tests we found: (i) that not only patients with various manifestations of LB but also a considerable percentage of seropositive (five of 13 = 38%) and seronegative (six of 26 = 23%) CS patients exhibit an elevated Bb-induced lymphocyte proliferation; (ii) that the magnitude of the cellular response seen in CS patients is comparable to that encountered in patients with established Bb manifestations; and (iii) that, within a given patient, antibiotic therapy can result in a significant reduction of this response. These results support a causative role of Bb in at least some CS patients. Bb-induced lymphocyte responses were also seen in both seropositive and seronegative erythema chronicum migrans patients. These findings show that the pattern of Bb-specific immune responses is more complex than previously thought, and underscore the importance of lymphocyte function assays in evaluating the diagnosis of potential Bb infection in seronegative patients.

Adolescent↗
PubMed1995

Borreliosis and Travel Medicine.

For several decades, borreliosis was synonymous with relapsing fever. Since the discovery of the agent of Lyme disease at the beginning of the 1980s, the term borreliosis now covers both relapsing fever and Lyme borreliosis. The relapsing fevers form a group of similar diseases that differ from each other, principally, in the different arthropod hosts used by the spirochete as a reservoir and vector. Relapsing fever may be transmitted either by lice (louse-borne relapsing fever) or by soft ticks of the genus Ornithodoros (tick-borne relapsing fever). For several years, reports on relapsing fever have been rare or nonexistent; however, louse-borne and tick-borne relapsing fever still occur. The disease is most probably confined to parts of Africa, Asia, and the Americas. For a deeper understanding of relapsing fever, recommended is a reading of the excellent monograph Borrelia by Oscar Felsenfeld.1 Lyme borreliosis is reported from those areas of the world where hard ticks of the genus Ixodes, which are the principal vectors of Lyme borreliosis in the Northern Hemisphere, occur. There is also speculation about the presence of Lyme borreliosis in the tropics.

Journal Article↗
PubMed1995

Lyme disease in a 74-year-old forest owner with symptoms of dermatomyositis.

We describe a 73-year-old forest owner with widespread erythema, myalgia, and proximal muscle weakness. The clinical signs and the results of electromyography, magnetic resonance imaging, and a muscle biopsy were consistent with dermatomyositis. However, serology was positive for Borrelia burgdorferi. More importantly, B burgdorferi DNA was detected in skin by polymerase chain reaction techniques, and spirochete-like organisms were detected in the muscle by silver staining. Lyme disease with muscle involvement can mimic or trigger dermatomyositis and should be considered in the differential diagnosis of dermatomyositis.

Aged↗
PubMed1995

Reactive arthritis: urogenital swab culture is the only useful diagnostic method for the detection of the arthritogenic infection in extra-articularly asymptomatic patients with undifferentiated oligoarthritis.

Reactive arthritis (ReA) is a seronegative oligoarthritis triggered by a preceding extra-articular infection. While evidence of a microbial infection is mandatory for establishing the diagnosis of ReA, the sensitivity of bacteriological and serological tests has not been determined in patients without symptoms of infection. In a retrospective study, we evaluated the usefulness of urogenital swab cultures, serology and stool culture to identify infections in 234 patients with undifferentiated oligoarthritis. One hundred and forty-four patients complaining about joint pain who had no sign or history of inflammatory arthritis served as controls. Urogenital swab cultures showed a microbial infection in 44% of the patients with oligoarthritis (15% Chlamydia, 14% Mycoplasma, 28% Ureaplasma), whereas in the control group only 26% had a positive result (4% Chlamydia, 7% Mycoplasma, 21% Ureaplasma) (P < 0.001). A Chlamydia IgG-antibody titre > or = 1:256 was found in 22% of the patients in the oligoarthritis group and in 9% of the controls (P < 0.01). However, for only half of Chlamydia IgG-positive patients could a Chlamydia infection be confirmed by urogenital swab culture. Twenty-one per cent of patients with oligoarthritis vs 23% of the controls had positive antibody titres for Salmonella (not significant), 15% vs 5% for Yersinia (P < 0.05) and 17% vs 3% for Borrelia IgG (P < 0.01). In two patients, stool cultures were positive for Campylobacter. Urogenital swab culture is a sensitive diagnostic method to identify the triggering infection in ReA. A single determination of antibodies against Chlamydia trachomatis is of limited value because of the high prevalence of positive results in the control group.

Adult↗
PubMed1995

[Lyme borreliosis].

In Europe and in other parts of the world, Lyme borreliosis is recognized increasingly by physicians and serodiagnostic laboratories. However, it is currently difficult to present conclusive epidemiologic data. There are no widely accepted case definitions for the numerous clinical features due to or supposed to be linked to infection with Borrelia burgdorferi. Clinical diagnosis of suspected cases of Lyme borreliosis requires confirmation by the demonstration of the aetiologic agent and the recognition of its causative role in the respective disorder. The specificity of serological tests for Lyme borreliosis is impaired by several phenomena including cross-reacting antibodies. Interpretation of serological test results may lead to the clinical diagnosis of Lyme borreliosis and in consequence to antibiotic treatment. Complications in order to treat suspected disseminated Lyme disease may be severe, as recently reported (45). No reliable data of Lyme borreliosis prevalence can be offered so far. This is partly due to incomplete reporting of Lyme borreliosis cases to specialized institutions, and partly due to the insufficiency of the diagnostic process. The true incidence and prevalence of this disease cannot be determined and one must wait for the results of the development of specific and dependable methods to identify actual infection.

Adult↗
PubMed1995

[Lymphocyte proliferation test in cutaneous manifestations of Lyme borreliosis].

The humoral immunoreactivity in Lyme borreliosis is a well characterized parameter for establishing the diagnosis of a Borrelia burgdorferi (Bb) infection. Since patients with seronegative Lyme borreliosis have been described, lymphocyte proliferation tests may be used for detecting patients who only develop a cellular immunoreactivity against Bb organisms. We performed a the lymphocyte proliferation assays in order to determine the cellular immunoreactivity to these spirochetes in given patients with histologically confirmed diagnosis of erythema migrans (EM), acrodermatitis chronica atrophicans (ACA), and for control purposes patients with Lyme disease non associated dermatoses (NLDH) and healthy volunteers (G). Stimulation index was defined as 3H thymidine-uptake in peripheral mononuclear cells, calculated as quotient dpm (stimulated cells)/dpm (unstimulated cells) (dpm = disintegrations per minute). Stimulation indices > 10 were considered positive. We detected elevated cellular immunoreactivity of peripheral mononuclear cells in 33% EM-patients (3/9) and in 23% (3/13) ACA patients tested. Patients tested before and after antibiotic therapy showed a significant decrease of stimulation index after antimicrobial treatment (p < 0.05). Patients the EM, who are mostly seronegative at the onset of cutaneous eruption exhibit in a third of patients an elevated cellular immune response to Bb. Therefore lymphocyte proliferation assays can be recommended as an additional test system in case of lack of serological response. The significant decrease of stimulation index after antimicrobial therapy indicates for downregulation of the cellular immune response to these spirochetes investigated, and counts for the specificity of this test system.

Acrodermatitis↗