1/42. Lyme arthritis in a 12-year-old patient after a latency period of 5 years.Lyme arthritis (LA) may be confused with other rheumatic diseases, particularly in the absence of a history of erythema migrans (EM). We report the case of a 12-year-old patient who developed a large effusion of the right knee joint. The titer for antinuclear antibodies was 1:80 and the test for rheumatoid factor was negative. Investigations for antibody response to borrelia burgdorferi demonstrated remarkable elevation of IgG antibody and no specific IgM response.These results were confirmed by immunoblotting reactivity with the bands p83/100, p58, p43, p41, p39, OspA, p30, OspC, p21, and p17. We subsequently learned that the child had suffered a tick bite followed by an EM 5 years earlier and had been treated with trimethoprim/sulfamethoxazole at that time. The patient now was given intravenous ceftriaxone, 2 g daily for 14 days. In the absence of clinical improvement 3 weeks later a knee joint aspiration was performed which resulted in a positive polymerase chain reaction (PCR) test for B. burgdorferi dna (OspA) in the synovial fluid.The patient fully recovered 2 months later without further treatment. The case indicates that the latency period between EM and onset of LA may last up to 5 years. In addition to serologic test methods, analysis of synovial fluid using PCR may be decisive for making the final diagnosis of LA.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
2/42. lyme disease: a clinical update.With adequate attention to specifics and details, the diagnosis and management of lyme disease are usually relatively straight-forward. Still, there can be subtleties--for instance, in determining precisely what pathogen a tick bite transmitted, whether a patient's arthralgia is truly Lyme arthritis, or whether "positive" serologies represent refractory lyme disease.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
3/42. Posterior scleritis associated with borrelia burgdorferi (lyme disease) infection.OBJECTIVE: To report on the clinical findings in a patient with posterior scleritis associated with infection with borrelia burgdorferi. DESIGN: Interventional case report. PARTICIPANT: A 39-year-old male ranger who experienced posterior scleritis after several tick bites with erythema migrans. TESTING: Extensive ophthalmic and systemic workup, including serologic testing and imaging techniques. RESULTS: Sonography and contrast-enhanced computed tomography showed a large scleral mass (16 x 12 x 13 mm) in a patient with painful proptosis in the left eye with episcleral vascular dilation, reduction in bulbar motility, and chorioretinal folds in the upper temporal quadrant. Treatment with high-dose corticosteroids resulted in rapid regression of clinical symptoms and of the scleral mass. Intensive workup revealed immunoglobulin m antibodies (enzyme-linked immunoassay, Western immunoblot) and a positive lymphocyte transformation assay against B. burgdorferi. No other cause for posterior scleritis could be identified. CONCLUSIONS: Posterior scleritis should be added to the list of ocular manifestations associated with lyme disease. Because corticosteroids alone resulted in rapid improvement of clinical symptoms, the scleritis might be mediated by autoimmunologic mechanisms.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
4/42. lyme disease masquerading as brown recluse spider bite.We report a case of lyme disease with clinical features resembling those described from brown recluse spider bites. The most striking manifestation was a necrotic skin wound. brown recluse spider bites may be overdiagnosed in some geographic regions. Tick bite and infection with borrelia burgdorferi should be considered in the differential diagnosis of necrotic arachnidism in regions endemic for lyme disease.- - - - - - - - - - ranking = 7keywords = bite (Clic here for more details about this article) |
5/42. Nodular fasciitis, erythema migrans, and oligoarthritis: manifestations of Lyme borreliosis caused by Borrelia afzelii.We describe a 35-year old patient with nodular fasciitis, erythema migrans, and gonarthritis four months after a bite of a Borrelia afzelii infected tick. The Borrelia afzelii infection was identified by a polymerase chain reaction and direct sequencing of the amplification product. Borrelia-specific dna was also detectable in nodular fasciitis tissue. We therefore conclude that Borrelia afzelii can be a causative agent of nodular fasciitis and Lyme arthritis in a highly endemic region of Northern germany.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
6/42. Dual infection: tularemia and Lyme borreliosis acquired by single tick bite in northwest croatia.A case of dual infection, tularemia and Lyme borreliosis acquired by a single tick bite in northwest croatia is presented. The patient came from a highly endemic region for Lyme borreliosis, where 45% of the ticks are infected with borrelia burgdorferi. Clinically, tularemia manifested as the ulceroglandular form, and Lyme borreliosis manifested with arthritis (knee). Both diseases responded well to combined antibiotic therapy.- - - - - - - - - - ranking = 5keywords = bite (Clic here for more details about this article) |
7/42. Transverse myelitis secondary to coexistent lyme disease and babesiosis.OBJECTIVE: To describe transverse myelitis secondary to coexistent lyme disease and babesiosis. METHOD: Case report. BACKGROUND: A 74-year-old man presented with rapid onset of weakness, numbness, and tingling in his legs, with symptoms ascending to his hands and forearms within days. He recalled an insect bite to his scapular area 2 weeks earlier. FINDINGS: T2-weighted magnetic resonance imaging demonstrated diffuse hyperintensity from T1 through T12. Western blot and enzyme-linked immunosorbent assay identified infection with borrelia burgdorferi, the spirochete responsible for lyme disease. Giemsa-stained blood smears identified ring forms later recognized by polymerase chain reaction as babesia microti, the piroplasm responsible for babesiosis. Initial examination revealed C7 motor and T3 sensory complete tetraplegia, with recovery to T4 paraplegia by 2 months. CONCLUSION: The history, physical examination, imaging, and serologic studies were consistent with transverse myelitis related to lyme disease and babesiosis. The severity and permanence of this patient's deficits were greater than those reported in the majority of previous cases of transverse myelitis due to lyme disease alone, suggesting a possible role for coinfection with babesiosis.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
8/42. Coexistence of antibodies to tick-borne agents of babesiosis and Lyme borreliosis in patients from Cotia county, State of Sao Paulo, brazil.This paper reports a case of coinfection caused by pathogens of lyme disease and babesiosis in brothers. This was the first case of borreliosis in brazil, acquired in Cotia County, State of S o Paulo, brazil. Both children had tick bite history, presented erythema migrans, fever, arthralgia, mialgia, and developed positive serology (ELISA and Western-blotting) directed to borrelia burgdorferi G 39/40 and babesia bovis antigens, mainly of IgM class antibodies, suggestive of acute disease. Also, high frequencies of antibodies to B. bovis was observed in a group of 59 Brazilian patients with Lyme borreliosis (25.4%), when compared with that obtained in a normal control group (10.2%) (chi-square = 5.6; p < 0.05). Interestingly, both children presented the highest titers for IgM antibodies directed to both infective diseases, among all patients with Lyme borreliosis.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
9/42. Molecular detection of persistent borrelia burgdorferi in a man with dermatomyositis.A 40-year-old white man with a several year history of various immunologic disorders, including anti-Jo-1 autoantibody positive dermatomyositis, developed clinical lyme disease after being biten by a tick. The patient was treated with oral tetracycline and his initial symptoms resolved; however, he suffered an exacerbation of his muscle disease which was difficult to control despite cytotoxic therapy. Antibiotic therapy was reinstituted after borrelia burgdorferi was detected in the patient's peripheral blood leukocytes by the polymerase chain reaction (PCR). All serologic, T-cell stimulation, and western blot analyses, however, were negative. The patient's disease responded to oral ampicillin, probenecid therapy and concurrent cytotoxic therapy. Subsequent leukocyte PCR testing has been negative for the causative agent of lyme disease. This case may provide an example of the in vivo immuno-modulatory effects of spirochetes in human autoimmune disease. In addition, this case emphasizes the potential clinical utility of PCR technology in evaluating the persistent sero-negative lyme disease which may occur in immunocompromised individuals.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
10/42. Emergence of lyme arthritis after autologous chondrocyte transplantation.We report herein the first known incidence of the emergence of borrelial arthritis following autologous chondrocyte transplantation for repair of a cartilage defect. The patient had no recent manifestation of Lyme borreliosis, but 15 years earlier had had an expanding erythematous lesion after a tick bite. The current infection resulted in massive joint swelling, elevated body temperature, dissemination of the graft, and transplant failure. Results of routine bacteriologic studies were negative. A diagnosis of Lyme arthritis was first considered following the detection of Borrelia-specific serum antibodies. Additional evidence was provided when borrelial dna sequences were detected in the synovial fluid through polymerase chain reaction. The diagnosis was confirmed by culture of borrelia burgdorferi from the synovial fluid. The possibility of a dormant borrelial infection should be considered in patients who undergo repair of cartilage defects with autologous chondrocyte transplantation. We recommend that synovial fluid and joint tissue be screened for the presence of viable Borrelia before transplantation of an autologous graft.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
| | Next -> |