| BACKGROUND: We report on a 42-year-old female patient who presented with a schizophreniform disorder and complete relief of symptoms after specific therapy. methods: cerebrospinal fluid and magnetic resonance imaging findings led to the diagnosis of lyme disease. RESULTS: To our knowledge this is the first reported case with an exclusive psychiatric manifestation of lyme disease. CONCLUSIONS: In case of first manifestation of psychotic disorder, although neurological symptoms are lacking, lyme disease should be considered and be excluded by cerebrospinal fluid analysis. ( info) |
2/43. Isolation of Borrelia afzelii from circumscribed scleroderma. A 45-year-old man presented with circumscribed scleroderma (CS) on the extremities. histology of lesional skin showed the typical manifestations of scleroderma including a perivascular and interstitial infiltrate of lymphocytes and plasma cells; in one of the biopsies spirochaetes could be detected. Despite treatment with penicillin, progression of CS was observed and spirochaetes were isolated from skin cultures obtained from active scleroderma lesions. These spirochaetes were identified as Borrelia afzelii by sodium dodecyl sulphate-polyacrylamide gel electrophoresis of outer surface proteins and polymerase chain reaction (PCR) analysis of their chromosome. After two courses with ceftriaxone the lesions stopped expanding and sclerosis of the skin was diminished. At this time cultures for spirochaetes and PCR of lesional skin for Borrelia afzelii dna remained negative. The pathogenetic role of Borrelia afzelii in the development of CS is discussed. ( info) |
| Severe anemia requiring blood transfusion may complicate falciparum malaria, but is rare in nonfalciparum malaria. We present a case of a young man with high fever, severe hemolytic anemia, and a blood film containing massive co-infection with plasmodium vivax and with Borrelia. The possible importance of the co-infection on the magnitude of hemolysis will be discussed. ( info) |
4/43. Contrast enhancement of the cerebrospinal fluid on MRI in two cases of spirochaetal meningitis. We report two patients with meningitis due to spirochaetal infection, both of whom showed diffusely enhancing meninges around the brain and spinal cord. In addition, there was enhancement of the cerebrospinal fluid after intravenous administration of Gd-DTPA. ( info) |
5/43. Borrelia lonestari infection after a bite by an Amblyomma americanum tick. Erythematous rashes that are suggestive of early lyme disease have been associated with the bite of Amblyomma americanum ticks, particularly in the southern united states. However, borrelia burgdorferi, the causative agent of lyme disease, has not been cultured from skin biopsy specimens from these patients, and diagnostic serum antibodies usually have not been found. Borrelia lonestari sp nov, an uncultured spirochete, has been detected in A. americanum ticks by dna amplification techniques, but its role in human illness is unknown. We observed erythema migrans in a patient with an attached A. americanum tick. dna amplification of the flagellin gene flaB produced B. lonestari sequences from the skin of the patient that were identical to those found in the attached tick. B. lonestari is a probable cause of erythema migrans in humans. ( info) |
6/43. borrelia burgdorferi-associated lymphocytoma cutis simulating a primary cutaneous large B-cell lymphoma. The distinction between primary cutaneous B-cell lymphoma and B-cell pseudolymphoma on a histologic basis may be difficult, particularly in some cases of borrelia burgdorferi-associated lymphoid proliferations. We report two cases of B. burgdorferi-associated pseudolymphoma that showed a dense infiltrate with a predominance of large atypical B cells. Because of this misleading histologic feature, a diagnosis of primary cutaneous large B-cell lymphoma was first suspected in both cases. In one case, successive recurrences led to aggressive therapies before the B. burgdorferi infection was recognized. However, a detailed review of histologic and immunohistochemical features was finally suggestive of a B. burgdorferi-associated pseudolymphoma in both cases. The etiologic role of B. burgdorferi was confirmed by serology, polymerase chain reaction analysis of B. burgdorferi dna within the lesional skin, and response to antibiotic therapy. Because the distinction between B. burgdorferi-associated pseudolymphoma and primary cutaneous B-cell lymphomas may be difficult and true B. burgdorferi-associated B-cell lymphomas have been described, we suggest that antibiotic therapy should be considered as a first-line treatment in suspected or confirmed cases of primary cutaneous B-cell lymphoma in regions with endemic B. burgdorferi infection. ( info) |
7/43. Dropped head syndrome in mitochondriopathy. In a 63-year-old, 165-cm-tall woman with a history of repeated tick bites, dilative cardiomyopathy, osteoporosis, progressive head ptosis with neck stiffness and cervical pain developed. The family history was positive for thyroid dysfunction and neuromuscular disorders. Neurological examination revealed prominent forward head drop, weak anteflexion and retroflexion, nuchal rigidity, weakness of the shoulder girdle, cogwheel rigidity, and tetraspasticity. The lactate stress test was abnormal. Electromyograms of various muscles were myogenic. Muscle biopsy showed non-specific myogenic abnormalities and generally weak staining for cytochrome oxydase. Mitochondriopathy with multi-organ involvement was suspected. The response to anti-Parkinson medication was poor. In conclusion, dropped head syndrome (DHS) may be due to multi-organ mitochondriopathy, manifesting as Parkinsonism, tetraspasticity, dilative cardiomyopathy, osteoporosis, short stature, and myopathy. Anti-Parkinson medication is of limited effect. ( info) |
8/43. First isolation of Borrelia lusitaniae from a human patient. The first human isolate of Borrelia lusitaniae recovered from a Portuguese patient with suspected Lyme borreliosis is described. This isolate, from a chronic skin lesion, is also the first human isolate of Borrelia in portugal. Different phenotypic and molecular methods are used to characterize it. ( info) |
| In spite of significant advances in immunologically based testing, accurate diagnosis of Lyme borreliosis remains problematic. To address this issue, a dna amplification-based diagnostic test was developed utilizing the polymerase chain reaction (PCR) and oligonucleotide primers specific for the OspA and OspB genes of borrelia burgdorferi. In this approach, a relatively large dna fragment is amplified with an outer set of primers, and a "nested" internal sequence of the PCR product subsequently reamplified with an inner set of primers. This nested approach coupled with simple differential centrifugation allowed specific detection of as few as four B. burgdorferi organisms mixed in 2 ml of blood. This methodology was utilized on patients' samples, and it allowed detection of B. burgdorferi in the peripheral blood and urine of several individuals with clinical evidence of Lyme borreliosis. PCR became negative and symptoms improved following antibiotic therapy of treated individuals. These studies suggest that direct detection of Borrelia in infected individuals can aid in diagnosis and evaluation of therapy for Lyme borreliosis. ( info) |
10/43. Painful hallucinations and somatic delusions in a patient with the possible diagnosis of neuroborreliosis. Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in europe and the united states. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. She was diagnosed with neuroborreliosis; she received various courses of antibiotics over several years, but without any clinical improvement in her condition. Her eventual admission to a psychiatric ward due to mental symptoms and neuroleptic treatment led to a dramatic improvement of her pain symptoms. However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis. ( info) |