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PubMed1990

[Lyme disease].

Lyme disease is a multisystem disorder caused by a tick-transmitted spirochete, Borrelia burgdorferi. Clinical manifestations typically begin with characteristic skin lesions, erythema (chronicum) migrans. Weeks to months later, some patients develop the second stage of the illness characterized by neurologic abnormalities, migratory joint pain, cardiac involvement. Months to years later, in many patients the disease progresses to the third stage of manifestation such as chronic arthritis, chronic encephalomyelitis, acrodermatitis chronica atrophicans and keratitis. Zoonotic infection with B. burgdorferi is also widespread within endemic regions among domestic as well as wild animals. The diagnosis is based on clinical and epidemiological findings in most patients, particularly those with erythema migrans or tick bites. Detection of specific antibodies to B. burgdorferi is a useful confirmatory test in many patients. In atypical cases, a positive test result can be valuable for determining the diagnosis. However, serologic testing in Lyme disease is not yet standardized and the results obtained from different assay systems or commercial kits may vary. Moreover, because of poor agreement in sensitivity and/or specificity, data obtained from different laboratories are not comparable. We emphasize that serologic findings must be interpreted with caution; the physician must beware of its strengths and limitations.

Animals↗
PubMed1990

Lyme borreliosis: aspects of tick-borne Borrelia burgdorferi infection from a dermatologic viewpoint.

During this decade, Lyme borreliosis has emerged as an important health problem, especially in Europe and in the United States, and there has been an explosive growth of knowledge about this condition. The true incidence of lxodes-borne borrelial infection is probably increasing, at least in parts of the world, but the reported increase is also partly attributable to a greater recognition and awareness of this infection. This paper reviews the basic knowledge about Borrelia burgdorferi, its vectors, and its reservoirs. The tendency for Lyme borreliosis to mimic other diseases and the similarities to syphilis are described. The nomenclature of the dermatologic manifestations and the staging of the disease as a localized, disseminated, and chronic infection are summarized. The clinical manifestations, from the dermatologist's point of view, and the sometimes difficult task of diagnosis both at the clinical and laboratory level are reviewed. The dermatologic manifestations erythema migrans, secondary, multiple erythema migranslike skin lesions, borrelial lymphocytoma, and acrodermatitis chronica atrophicans may serve as helpful landmarks in the identification of Lyme borreliosis.

Animals↗
PubMed1990

[Determination of antibodies against Borrelia burgdorferi in patients with morphea, lichen sclerosus et atrophicus and erythema chronicum migrans].

Several cutaneous entities described in Europe as Chronic Migrans Erythema (CME), Mild Cutis Lymphadenosis (MCL) and Chronic Atrophyc Acrodermatitis (CAA) constitute clinical manifestations of a Borrellia Burgdorferi. The presence of clinical and hystologic lesions similar to those of liquen esclerosus and atrophyc (LEA) and localized esclerodermia (morphea) in patients with CAA has driven to several authors to demonstrate the aethiologic participation of B. Burgdorferi in patients carrying those cutaneous lesions with contradictory results. A serologic study with indirect immunofluorescence (IIF) and FIAX test was performed in 16 patients (9 with morphea, 6 with LEA and 1 with CME) in order to evaluate the role of this microorganism in our environment. Five reactive sera were obtained of which only one presented IgG antibodies titrated at 1/256. The IgM antibodies by IIF and IgG by FIAX test turned out to be negative. A specific relationship between B. Burgdorferi and the studied entities could not be established.

Adolescent↗
PubMed1990

[Zinc deficiency in a premature infant].

A premature infant with a birth-weight of 1,218 g developed severe zinc depletion about two months after birth. He had received his mother's breast-milk which was found to have a low zinc content of about 5 mumol/l. The clinical symptoms of zinc deficiency included stunted growth, catarrhal symptoms and a characteristic eczematous eruption on the face and diaper region known as acrodermatitis. Serum zinc was lowered (6.8 mumol/l) and so was serum alkaline phosphatase activity. Oral zinc sulphate supplementation, initially 22.5 mg daily and subsequently 11 mg zinc daily, had a prompt effect on the patient's well-being and the skin was restored to normal after about a week.

Humans↗
PubMed1990

[Antibiotic therapy of Lyme borreliosis].

There are still no definite patterns for antibiotic therapy of Lyme borreliosis. Recent studies have shown that ceftriaxone or tetracyclines are superior to the conventional penicillin. Against erythema chronica migrans (stage I) oral therapy, preferably with tetracycline, is sufficient. In cases with stage II symptoms, such as arthritis or neurological affections, high dose parenteral treatment, preferably with ceftriaxone, is recommended, although its effect on the neurologic symptoms is not yet proven. Carditis also calls for high dose parenteral administration of antibiotics, even though there are no published studies on this treatment as yet. Opinion is divided on the cutaneous symptoms such as acrodermatitis chronica atrophicans, morphea, lichen sclerosus et atrophicus (acute inflammatory stage) and lymphadenitis cutis benigna. Even if oral penicillin or tetracycline can cure existing symptoms, in the absence of longterm observations, it remains an open question whether oral treatment can prevent further complications or evolution to chronicity (stage III). For these clinical pictures there is also a tendency to give high dose parenteral antibiotics, and ceftriaxone is likely to win favour. In stage II Lyme borreliosis, autoimmune processes occur which scarcely respond to antibiotics any longer. Nevertheless, parenteral administration of high dose antibiotics remains sensible as a means of eradicating pathogens from the tissues, CSF or synovial fluids, and to avoid further complications. Evaluation of the therapeutic effects of corticosteroids or other immunosuppressive agents would require prospective studies.

Anti-Bacterial Agents↗
PubMed1987

Evidence for spirochetal origin of circumscribed scleroderma (morphea).

Acrodermatitis chronica atrophicans (ACA) and morphea are clinically distinct skin diseases with some common features and possible coexistence. We found antibodies to Borrelia burgdorferi in eight of fifteen patients with morphea. Six of them had IgG antibodies and two both IgG and IgM antibodies. Four of the eight seropositive and five of the seven seronegative patients had been treated with high dose penicillin previously. Spirochetal organisms could be cultured in Barbour-Stoenner-Kelly's medium from a skin biopsy of one seropositive untreated patient. Spirochetes were recovered from histological sections in three of eight, two seropositive and one seronegative morphea and in one of three erythema chronicum migrans patients by an avidin-biotin immunoperoxidase method. The similar clinical picture of ACA and morphea, the response to penicillin therapy in both entities, the presence of antispirochetal antibodies, the isolation of spirochetes in culture and the detection of spirochetal organisms on histological sections suggest a close relationship among these diseases. We conclude that morphea may represent a Borrelia infection. The correlation to ACA is discussed.

Adolescent↗
PubMed1989

Antibodies to the Borrelia burgdorferi flagellum in patients with scleroderma, granuloma annulare and porphyria cutanea tarda.

It is generally accepted that cutaneous Lyme borreliosis comprises erythema chronicum migrans, lymphadenosis benigna cutis, and acrodermatitis chronica atrophicans. In recent years the tick-borne spirochete Borrelia burgdorferi has been associated with a number of other cutaneous disorders. We therefore investigated sera from 175 patients with localized scleroderma (morphea) (n = 64), systemic sclerosis (n = 74), granuloma annulare (n = 16) and porphyria cutanea tarda (n = 21) with the new, highly sensitive and specific Borrelia burgdorferi flagellum ELISA assay. As controls (n = 297) served normal healthy volunteers and patients with other skin diseases. It was found that the distribution of individual antibody values and the median antibody levels were identical in controls and in patients with scleroderma, granuloma annulare and porphyria cutanea tarda. These data do not support the hypothesis of an etiological association between Borrelia burgdorferi infection and scleroderma, granuloma annulare or porphyria cutanea tarda.

Adolescent↗
PubMed1989

[Investigation of Lyme disease in northeast of China].

In 1987-1988, we conducted investigation of Lyme disease in Northeast of China. The disease was widespread in the forest areas of Heilonjiang and Jilin provinces where Ixodes persulcatus population thrives. The disease occurred at Daqing tree farm where 628 people were inquired and examined among them, 37 cases including 23 cases of ECM, 6 cases of neurological abnormalities, 7 cases of arthritis and 1 case of acrodermatitis chronica atrophicans were confirmed being Lyme disease. The sera of patients suspected with the disease and that of the residents at Xiaobai tree farm were tested for antibodies against Borrelia burgdorferi (B31) by ELISA. Seventeen out of 22 patients were positive and 54 out of 240 residents had significant IgG titers. Samples of tick midgut were inoculated into BSK medium and cultivated. Three isolates of spirochetes were cultivated from Ixodes persulcatus. One of them (M7) was confirmed being Borrelia burgdorferi. Recently another isolate was cultivated from a patient with ECM.

Animals↗
PubMed1989

[Borrelia burgdorferi, clinical aspects, cultivation and identification of the pathogen in erythema migrans in Berlin].

Among other manifestations, the following diseases caused by Borrelia burgdorferi in Europe are transmitted by ticks of the species ixodes ricinus: erythema migrans (EM), lymphadenosis benigna cutis (LBC), lymphocytic meningo-radiculitis (Bannwarth's syndrome), and acrodermatitis chronica atrophicans (ACA). We report on a female patient, who developed EM 10 days after a-tick bite in Berlin. Borrelia burgdorferi could be cultivated from a skin biopsy specimen taken from the periphery of the EM. The isolates were identified as Borrelia burgdorferi by indirect immunofluorescence using the monoclonal antibodies H 9724 and H 5332.

Animals↗
PubMed1989

[Articular involvement in Swiss patients with a Borrelia burgdorferi infection--report of 8 cases].

Eight cases of Lyme's arthritis are reported. In four of them, they are related to an erythema chronicum migrans, in two to an acrodermatitis atrophicans. In two cases, there was no cutaneous manifestation, but the serology was strongly positive for Borrelia burgdorferi, and there was rapid relief of the pain with antibiotic therapy. It is suggested that Lyme's arthritis is not rare in Switzerland and that it must be searched for in every case of arthritis of unknown etiology, especially when there is a history of cutaneous involvement. The arthritis is cured by antibiotics.

Adolescent↗
PubMed1989

[Unusual manifestations of Lyme borreliosis. A contribution to the clinical spectrum of this disease group].

Since the discovery that EM (erythema migrans), ACA (acrodermatitis chronica atrophicans) and BL (borrelial lymphocytoma) have an infectious etiology, these syndromes have been receiving particular attention. This report describes four patients whose dermatological symptoms did not at first indicate borreliosis. In all four cases serological antibody tests proved that they were caused by Borrelia burgdorferi. In two of these cases these findings were confirmed by bacterial cultures. The unusual skin symptoms, i.e. multiple disseminated erythema, erysipelas-like manifestations, swelling and discoloration of the eyelids and lichenoid papules, extend the known clinical spectrum of cutaneous borreliosis in Europe.

Adult↗
PubMedDate not supplied

[A new and original therapy for seborrheic dermatitis].

The AA describe the results of an original therapy for seborrhoic dermatitis in both localized and spread forms (Leiner's Disease). Due to similarity of seborrhoic dermatitis in the two forms with acrodermatitis enterophatica and considering that this last disease reacts positively after Zinc administration, the AA stated the validity of such therapy also for seborrhoic dermatitis and discuss its possible mechanism of action.

Administration, Oral↗
PubMed1988

[Serodiagnosis of Lyme borreliosis].

There are various serodiagnostic tests available for the detection of antibodies against Borrelia burgdorferi. An indirect hemagglutination assay, which can detect both IgM and IgG antibodies, was developed for antibody screening. Regarding the confirmation and differentiation of IgM and IgG, we use the indirect immunofluorescence assay (most specific when performed with sera previously absorbed with Treponema phagedenis) as well as the ELISA test. The detection of significantly elevated antibody titers depends on the stage of the disease. In erythema migrans, only 20-50% of the patients are seropositive (with a prevalence of IgM); in neuroborreliosis, the figures amount to 70-90% of the patients (prevalence of IgM in early stages and IgG in advanced stages); and 90-100% of the cases with acrodermatitis and arthritis show elevated titers of IgG (IgM antibodies usually are not detectable in late manifestations). The clinical manifestations of the disease is serologically marked by IgM antibodies or--in neuroborreliosis--by intrathecal production or antibodies which can be detected on account of an increased CSF/serum index.

Antibodies, Bacterial↗
PubMed1988

[Acute and chronic borreliosis transmitted by ticks in Europe].

Ticks are direct pathogenic agents, and also transmit some infectious diseases such as borreliosis. Clinical manifestations of borreliosis are multiple. They most often affect the skin, nervous system, joints and heart. Cutaneous pseudolymphomas, erythema chronicum migrans of Afzelius, acrodermatitis chronica atrophicans of Pick-Herxheimer, meningo-radiculitis and various arthropathies are the most commonly encountered diseases.

Acute Disease↗
PubMed1988

[Multiple neurologic manifestations of Borrelia burgdorferi infection].

The neurological spectrum of Borrelia burgdorferi infections is still enlarging. We review epidemiological, pathological and serological data of Lyme disease. The course of the disease is divided in three stages: stage 1 during the first month is characterised by erythema chronicum migrans and associated manifestations; stage 2 includes not only the classical European meningoradiculitis but also less specific neurological symptoms: isolated lymphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, peripheral nerve involvement, acute transverse myelitis, severe encephalitis, myositis. During stage 3, three to five months or longer after the onset of the disease, chronic arthritis, acrodermatitis chronica atrophicans and various neurological symptoms can be observed: chronic neuropathy with mainly sensory or motor signs, recurrent strokes due to cerebral angiopathy and progressive encephalomyelitis; this third stage the central nervous system involvement is characterised by slowly progressive or fluctuating course during months or years, ataxic or spastic gait disorder, bladder disturbances, cranial nerve dysfunction including optic atrophy and hypoacusia, dysarthria, focal and diffuse encephalopathy. This chronic central nervous system disease can mimic multiple sclerosis, anorexia nervosa, psychic disorders or subacute presenile dementia. It is often associated with pleiocytosis, abnormal EEG and evoked potentials, sometimes multifocal and mainly periventricular white matter lesions visualised by CT or MRI, and as a rule high antibody titers against Borrelia burgdorferi. High doses of penicillin can halt the disease, sometimes induce spectacular regression of symptoms or sometimes be inefficient; ceftriaxone could be a more powerful therapy. Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parenchymatous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator.

Animals↗
PubMed1988

[Cutaneous B cell lymphoma in chronic Borrelia burgdorferi infection. Report of 2 cases and a review of the literature].

Low-grade malignant B-cell lymphomas of the skin can be distinguished from lymphadenosis benigna cutis (Bäfverstedt) by immunohistological methods developed in the last few years. Its coexistence with Borrelia burgdorferi infection can be shown by clinical and serological findings. In the chronic stage of this infection, lymphocytic cell infiltrations consistent with histological and immunohistological findings of malignant B-cell lymphoma can be found. Predominantly at the extremities, multiple plaque-shaped or nodular lesions are seen, showing a follicular pattern in their periphery. The tumors do not respond to antibiotic therapy. They regress totally after X-ray treatment, but local recurrences are rather common. They show a long persistent course with only slow progression and seem to be of low-grade malignancy independent from the cytological findings. In most cases the tumors remain limited to the skin and to one anatomical site; nevertheless, the development of systemic involvement has been reported. We present two cases of malignant B-cell lymphoma of the skin in patients with chronic B. burgdorferi infection. Both cases showed the typical clinical and histological features of this entity. Similar reports from the literature indicate close relationships with the chronic stage of Borrelia infection, with the simultaneous presence of acrodermatitis chronica atrophicans as an indicator. We conclude that an elevated titer indicating Borrelia infection is an important finding for the diagnosis and prognosis of this particular type of cutaneous B-cell lymphoma.

Aged↗
PubMed1986

Chelating drugs and zinc.

Essential trace metals participate in a wide range of biochemical processes. Administration of drugs containing nucleophilic atoms, primarily N-, O- and S-ligands, may result in formation of organometallic non-ionic complexes or chelates. The stability of the complex depends on the position of the metal in the first transition series, except for Cu2+, which forms stronger bindings than Zn2+ does. In nature, a wide range of chelates occur, e.g. as vitamin-metal complexes (Zn-thiamine, Zn-pyridoxamine and Zn-biotin). Phytate in unleavened grains forms unsoluble Zn-complexes. In the body, complex-formation is essential for the transport of Zn with circulating plasma albumin. Some examples of chelating drugs are given. Zn-pyrithione is used for local treatment of dandruff and pityrosporum folliculitis. Ethambutol is a strong metal-binding drug used for tuberculosis therapy. The mechanism of action is possibly related to inactivation of Zn and Cu in the pathogenic organisms. 8-hydroxyquinolines enhance Zn absorption, which is the reason for the successful treatment of acrodermatitis enteropathica. Effects of D-penicillamine, phenytoin, tetracycline and disulfiram on Zn metabolism are discussed.

Animals↗
PubMed1987

Zinc deficiency and immune function.

Deficiency in zinc, an essential trace element, is a frequent human dietary problem in the United States and is also associated with such disease states as alcoholism, renal disease, burns, gastrointestinal tract disorders, and acrodermatitis enteropathica. Skin lesions and poor wound healing are observed in severe forms of the deficiency. However, modest deficits in zinc cause lymphopenia and reduced immune capacity among affected humans. With the mouse used as a model because it has an immune system analogues to that of humans, the effects of zinc deficiency on immune function have been well characterized. A suboptimal intake of zinc causes marked atrophy of the thymus, a 50% reduction in leukocytes, a rise in corticosterone levels, and a 40% to 70% reduction in antibody-mediated, cell-mediated, and delayed-type hypersensitivity responses.

Animals↗