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Diagnosis and treatment of Lyme arthritis.

Lyme arthritis typically causes intermittent attacks of oligoarticular arthritis in a few large joints, especially the knee. A small percentage of patients may develop chronic arthritis, again affecting primarily the knee. The diagnosis is usually based on the presence of this characteristic clinical picture, exposure in an endemic area, and a positive IgG antibody response to B. burgdorferi determined by ELISA and Western blotting. In addition, spirochetal DNA can often be detected in joint fluid by PCR. Joint involvement in this infection can usually be treated successfully with a 1- or 2-month course of oral doxycycline or amoxicillin, but patients with certain genetic and immune markers may have persistent arthritis despite treatment with oral or intravenous antibiotics. If patients have persistent arthritis despite a second course of antibiotics and if the results of PCR testing are negative, the author treats such patients with anti-inflammatory agents or arthroscopic synovectomy.

Amoxicillin↗

Some relationships between spirochaete infections and digital dermatitis in four UK dairy herds.

Digital dermatitis, presenting as a focal necrotic dermatitis on the skin of cows' feet adjacent to the interdigital space, has been associated with dermal infection by spirochaetes. Lesions cause severe, transient lameness. An enzyme-linked immunoassay (ELISA) was used to measure IgG(2) antibody titres against three different spirochaetes: USA bovine Treponema isolates 1-9185MED and 2-1498, and a UK strain of Borrelia burgdorferi B31. Logistic models were used to describe lesion prevalence in terms of the antibody titres, herd and milking status, year, lactation number, and yield. The antibody titres and milking status (P<0.001) dominated the logistic fits, with the other variables adding little. Generalised linear models were used to describe the antibody titres in terms of the presence or absence of lesions, herd, year, lactation number, and yield. The presence or absence of lesions had the most significant effect for all three antibodies (P<0.001). Neither the herd effects nor the effects due to lactation number or yield showed consistent patterns.

Animal Husbandry↗

Is multiple sclerosis caused by an oral spirochaete?

Evidence of a direct link between chronic sinusitis and multiple sclerosis (MS) prompted examination of the old "spirochaetal hypothesis". This hypothesis has not been shown to be erroneous and a spirochaetal infection of the central nervous system could explain the specific pathological, immunological, and epidemiological features of MS.

Acute Disease↗