Biomedical subjects
Publications and source records attributed to G Stanek.
CSF investigation in a 61-year old female patient with clinical picture of motoneuron disease gave evidence for chronic infection with Borrelia burgdorferi. Improvement of clinical and CSF findings could be observed after antibiotic therapy. The diagnosis of amyotrophic lateral sclerosis which was initially suspected had to be revised and the disorder was interpreted as chronic neuroborreliosis.
A 35-year old man was presented with organic psychosyndrome. Anamnestic reports informed about changes in his behaviour like loss of interest, reduced concentration and short-term-memory loss within the last 2 years. The practicing psychiatrist diagnosed a depressive syndrome in conjunction with a borderline syndrome and administered antidepressive and neuroleptic therapy. Specific serologic tests were not done. Neurologically, there was a picture of influent and slurred speech, and ataxic gait. Muscle tonus was normal, muscle reflexes were of the same diminished intensity on both sides. The psychic status revealed a person mostly oriented in time, location and situation but with severe disorders of recognition, concentration, and memory. Laboratory diagnosis proved the suspected diagnosis of neurosyphilis. Additionally, there were antibodies to Borrelia burgdorferi (Bb) in serum and CSF and a positive CSF/serum index of 9.0 (threshold: 1.9). The neuroradiologic examination (CCT, NMR, SPECT) showed an intense, diffuse, frontotemporal atrophy of the cortex. By NMR, massive gliosis was found in both hippocampi. Angiographically, an aneurysma (1 cm in diameter) of the medial cerebral artery was demonstrated. Specific treatment was performed with Na penicillin (5 Mio. i.v./4 h over 21 days). No remission could be achieved.
A 23-year old patient suffered from transient oligoarthritis and second degree AV block. The diagnosis of stage II systemic Lyme borreliosis was supported by a history of tick bites and the detection of both IgG and IgM borrelia antibodies in the patient's serum. The ECG-findings (bradyarrhythmia and AV block II) were detected several weeks after the onset of arthritis, whilst the patient reported no cardiac symptoms. Treatment was started with ceftriaxone and then continued with doxycycline because of an allergic reaction to the first antibiotic.
According to current opinion there is acute, self-limiting Lyme carditis, and chronic Lyme carditis. Acute Lyme carditis manifests mostly as transient conduction disorders of the heart (e.g. AV-blocking I to III), and as supraventricular and ventricular rhythm disturbances, pericarditis, myocarditis, and pancarditis in single cases. Chronic Lyme carditis is defined as a case of chronic heart failure confirmed by positive serology and endomyocardial biopsy. Anamnestic aid is rare. Neither tick-bites nor preceding or accompanying erythema chronicum migrans are constantly reported. Seropositivity and control of its specificity by western blot are indicative but no etiological proof. Even histological detection of spirochetes in endomyocardial tissue or cultivation of borrelia from endomyocardial biopsy are no final etiological proof of the respective cardial disorder. Those findings, however, are an indication for antibiotic treatment. According to the severity of the disorder, antibiotics are administered orally (penicillin or derivatives) or parenterally with penicillin or cephalosporins of the 3rd generation over 4 and 2 weeks, respectively.
Lyme disease is a multisystem disease, which can involve the heart causing myopericarditis. We describe 1 patient with serological and histological evidence of Lyme borreliosis and demonstration of pathologic myocardial signal enhancement in magnetic resonance imaging.
BACKGROUND: Lyme borreliosis is a tick-borne multisystem disorder that may present as self-limiting early or persistent chronic diseases of the skin, nervous system, joints, heart, and other organs. Cardiac involvement has mainly been reported as acute atrioventricular conduction disturbances or transient ventricular dysfunction. METHODS AND RESULTS: We treated a patient with clinical signs of acute myopericarditis and serologic evidence of Lyme borreliosis confirmed by silver staining of endomyocardial biopsy specimens and indium 111-monoclonal antimyosin antibody scan, which we believe has not been reported previously. Additionally, magnetic resonance imaging revealed epicardial and myocardial areas of increased intensity. CONCLUSION: Indium 111-monoclonal antimyosin antibody scanning and magnetic resonance imaging might play an additional important role in assessing and confirming the diagnosis of Lyme carditis in the presence of clinical symptoms and positive serologic findings.
A subset of patients (50%) with neuroborreliosis (Lyme disease) showed IgG reactivity to cardiolipin in solid phase ELISA. In addition, a subset of patients with neuroborreliosis (29%) and syphilis (59%) had IgM reactivity to gangliosides with a Gal(beta 1-3) GalNac terminal sequence (GM1, GD1b, and asialo GM1). Anti-ganglioside IgM antibodies were significantly more frequent in these two groups of patients compared to patients with cutaneous and articular Lyme disease, primary antiphospholipid syndrome, systemic lupus erythematosus and normal controls. Correlative evidence and adsorption experiments indicated that antibodies to cardiolipin had separate specificities from those directed against the gangliosides. IgM antibodies to Gal(beta 1-3) GalNac gangliosides appeared to have similar specificities since these were positively correlated and inhibitable by cross adsorption assays. Given the clinical associations of patients with neuroborreliosis and syphilis with IgM reactivity to gangliosides sharing the Gal(beta 1-3) GalNac terminus, we suggest that these antibodies could represent a response to injury in neurological disease or a cross reactive event caused by spirochetes.
We investigated 103 consecutive patients primarily admitted to our Department of Neurosurgery (36 women, age: median 44, range 21-79; 67 men, age: 47, range 19-77) suffering from low back pain radiating into one or both legs. Neurological examination combined with computer tomography and lumbar myelography revealed lumbar-disc herniation in 74, vertebrostenosis in 10 and relapsed disc herniation in 9 patients. In 9 patients the diagnosis of pseudoradicular syndrome was established without definite neuroradiological morphological evidence. Two patients were diagnosed as having polyneuropathy, and 1 patient suffered from a nervus ischiadicus lesion due to a gluteal abscess. CSF of all patients was examined according to a fixed routine schedule (cells, protein, sugar, immunoglobulins, IgG index). Antibodies to Borrelia burgdorferi were found in the serum and CSF of 5.8%, and in the serum alone of 2% of patients. Intrathecally produced specific antibodies were detected in 3 patients (2.9%) with neuroradiological evidence of disc or spinal-canal disease, indicating the coexistence of previous CNS infection by B. burgdorferi with lumbar-disc herniation. None of the patients showed CSF pleocytosis; thus, in no case was acute radiculitis due to B. burgdorferi infection diagnosed.
An analysis was undertaken to the records of 651 patients (median age 51 years, range 1-91; 334 male and 317 female patients), who were admitted for various reasons to the department of neurology and psychosomatics of the county hospital in Villach (Kärnten, Austria), over the period of one year. The clinical diagnoses were mostly neurological and psychiatric (n = 599), involving 25 different conditions. Other diagnoses (n = 52) comprised a group of 13 various conditions. Sera of all these patients were tested for antibodies to Borrelia burgdorferi. Overall seropositivity was 37.8%. Seropositivity increased significantly with age (p < 0.01). Seroprevalence exceeded 40% in patients with meningitis, paresis of the cranial nerves, cervical syndrome, pareses and sponylitis. The erythrocyte sedimentation rate (ESR) was raised in 37.9% of cases which was not related to seropositivity. ESR was significantly increased in patients with lumbago (p < 0.01) and with arthritis (p < 0.05). Antibiotics and dosages used were recorded in 164 cases. All these cases improved after therapy. Of 81 patients with a history of tick bite, 43 (53%) were seropositive. This is a significantly higher incidence than that of patients without tick bites (p < 0.01). The retrospective evaluation of patients' records showed that anamnestic and clinical findings alone do not suffice to establish the specific diagnosis of Lyme borreliosis and, hence, do not provide the indication of appropriate therapy. Furthermore, the mere demonstration of serum antibodies to Borrelia burgdorferi does not give information on the current state of infection. In case of a suspected Borrelia burgdorferi infection confirmatory tests are needed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Studies of the microflora of the external auditory canal should help to clarify the frequent acute diffuse external otitis which may occur in recreational scuba-divers and swimmers during a stay in the tropics. We found that colonisation with facultatively pathogenic microorganisms increased after exposure. Apart from this contamination, indirect factors such as the tropical climate and intensive exposure to water may play an important role in the aetiology of the external otitis. For individual preventive measures, topical application of paraffin-oil before, and an aqueous solution of alcohol and acetic acid after exposure are recommended.
Lyme borreliosis is an infectious disease caused by the spirochete Borrelia burgdorferi. Neurological complications are frequently reported but the pathogenesis remains largely unknown. We report on a patient with positive borrelia antibodies at ELISA and immunoblotting and with histological and immunofluorescence study of peripheral nerve biopsy consistent with vasculitic neuropathy.
Lyme borreliosis (LB) is a multisystem disorder that may cause self-limiting or chronic diseases of the skin, the nervous system, the joints, heart and other organs. The aetiological agent is the recently discovered Borrelia burgdorferi. In 1980, cardiac manifestations of LB were first described, including acute conduction disorders, atrioventricular block, transient left ventricular dysfunction and even cardiomegaly. Pathohistological examination showed spirochaetes in cases of acute perimyocarditis. Recently, we were able to cultivate Borrelia burgdorferi from the myocardium of a patient with long-standing dilated cardiomyopathy. In this study, we have examined 54 consecutive patients suffering from chronic heart failure for antibodies to Borrelia burgdorferi. On ELISA, 32.7% were clearly seropositive. The endomyocardial biopsy of another patient also revealed spirochaetes in the myocardium by a modified Steiner's silver stain technique. These findings give further evidence that LB is associated with chronic heart muscle disease.
Borrelia burgdorferi, the causative agent of Lyme disease, was detected in patients' serum by DNA amplification using the polymerase chain reaction (PCR). B burgdorferi was pelleted from serum samples by centrifugation (10,000 x g for 10 minutes) and lysed by treatment with ammonium hydroxide (100 degrees C for 15 minutes). Two pairs of "nested" PCR primers complementary to the gene encoding a major outer surface protein (OSP A) of B burgdorferi were used in DNA amplification under standard PCR conditions (Perkin-Elmer Cetus). Two out of five patients with erythema migrans, the characteristic primary skin lesion associated with early Lyme disease, were positive by the PCR. This method could form the basis of a useful routine laboratory test in those cases of early Lyme disease where conventional serological testing commonly yields equivocal or false negative results.
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Thirty patients with different clinical manifestations of morphea (circumscribed scleroderma) were investigated for serum antibodies against Borrelia burgdorferi determined by ELISA and Western blot analysis. Forty-six percent of the patients were seropositive. Western blots confirmed the ELISA results in 10 of 25 patients (40%), showing a reactivity pattern which can be seen in the course of Lyme borreliosis. In some cases the outcome after antibiotic treatment suggests a direct correlation between the further development of skin lesions and Borrelia infection. Because of these findings we suggest some morphea types to be possibly due to a B. burgdorferi infection.
Since 1980 cardiac manifestations of Lyme borreliosis have been described as selflimited conduction and transient left ventricular disorders or even cardiomegaly. An etiologic role of Borrelia burgdorferi in long-standing chronic heart disturbances is suggested by the cultivation of a strain of Borrelia burgdorferi which we were able to isolate from an endomyocardial biopsy of a patient with long-standing dilated cardiomyopathy. The aim of this study was to acquire information about the prevalence of serum antibodies to Borrelia burgdorferi in patients with dilated cardiomyopathy. By ELISA, we studied the sera of 72 consecutive patients with chronic heart failure due to dilated cardiomyopathy, of 55 patients with coronary heart disease, and of 61 healthy blood donors; positive ELISA values were determined in 26.4%, 12.7%, and 8.2% of serum samples, respectively. These findings further suggest an association or even an etiologic role for Borrelia burgdorferi in dilated cardiomyopathy.
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