Genospecies diversity of Lyme disease spirochetes in rodent reservoirs.

To determine whether particular Borrelia burgdorferi s.l. genospecies associate solely with rodent reservoir hosts, we compared the genospecies prevalence in questing nymphal Ixodes ticks with that in xenodiagnostic ticks that had fed as larvae on rodents captured in the same site. No genospecies was more prevalent in rodent-fed ticks than in questing ticks. The three main spirochete genospecies, therefore, share common rodent hosts

Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis

Presence of BB-specific antibodies in the cerebrospinal fluid (CSF) with evidence of their intrathecal production in conjunction with the white cell count in the CSF and typical clinical symptoms is the traditional diagnostic gold standard of Lyme neuroborreliosis (LNB). Few data are available on the CSF lactate concentration in European adults with the diagnosis of acute LNB. The objective of the study was to investigate the CSF changes during acute LNB. Routine CSF parameters [leukocyte count, protein, lactate and albumin concentrations, CSF/serum quotients of albumin (QAlb), IgG, IgA and IgM, and oligoclonal IgG bands] and the Borrelia burgdorferi (BB)-specific antibody index were retrospectively studied in relation to the clinical presentation in patients diagnosed with acute LNB. A total of 118 patients with LNB were categorized into the following groups according to their symptoms at presentation; group 1: polyradiculoneuritis (Bannwarth’s syndrome), group 2: isolated facial palsy and group 3: predominantly meningitic course of the disease. In addition to the CSF of patients with acute LNB, CSF of 19 patients with viral meningitis (VM) and 3 with neurolues (NL) were analyzed. There were 97 patients classified with definite LNB, and 21 as probable LNB. Neck stiffness and fever were reported by 15.3% of patients. Most of these patients were younger than 50 years. Polyradiculoneuritis was frequently found in patients older than 50 years. Lymphopleocytosis was found in all patients. Only 5 patients had a CSF lactate ≥3.5 mmol/l, and the mean CSF lactate level was not elevated (2.1 ± 0.6 mmol/l). The patients with definite LNB had significantly higher lactate levels than patients with probable LNB. Elevated lactate levels were accompanied by fever and headache. In the Reiber nomograms, intrathecal immunoglobulin synthesis was found for IgM in 70.2% followed by IgG in 19.5%. Isoelectric focussing detected an intrathecal IgG synthesis in 83 patients (70.3%). Elevated BB AIs in the CSF were found in 97 patients (82.2%). Patients with VM showed lower CSF protein concentration and CSF/serum quotients of albumin than LNB patients. In acute LNB, all patients had elevated cerebrospinal fluid (CSF) leukocyte counts. In contrast to infections by other bacteria, CSF lactate was lower than 3.5 mmol/l in all but 5 patients. The CSF findings did not differ between polyradiculoneuritis, facial palsy, and meningitis. The CSF in LNB patients strongly differed from CSF in VM patients with respect to protein concentration and the CSF/serum albumin quotient

Komplikationen und Verläufe bei tiefen Halsinfektionen: Eine retrospektive Analyse

Einleitung: Abszedierende Prozesse der tiefen Halsweichteile haben nicht selten weitere Komplikationen zur Folge, und die von ihnen ausgehenden Verwicklungen nehmen häufig einen lebensbedrohlichen Charakter an. Diese Analyse gibt einen Überblick über die Komplikationen und Verläufe tiefer Halsinfektionen und Einflussfaktoren, die zu lebensbedrohlichen Komplikation führen können. Methoden: Von Jan. 2002 bis Dez. 2012 wurden 63 Patienten mit tiefen Halsinfektionen behandelt und retrospektiv ausgewertet. Die Inzidenz der häufigsten Komplikationen wurde analysiert und mit bestimmten Komorbiditäten verglichen. Ergebnisse: Mit 31,7% (20 Pat.) häufigste lebensbedrohliche Komplikation war eine Obstruktion der oberen Atemwege. Zweithäufigste Komplikation - mit 17,5% (11 Pat.) - war eine Mediastinitis, gefolgt von der nekrotisierenden Fasziitis, die bei 12,5% (8 Pat.) auftrat, gefolgt von MRSA-Besiedelungen (6,3%), PEG-Sonden-Anlage (3,2%) und je zu 1% einer Sepsis, Lungenembolie, Pneumonie und N. hypoglossus Parese. Im Verlauf sind 2 (3%) der 63 Patienten verstorben. Patienten mit einem Diabetes mellitus entwickelten in 66,6% (8 von 12 Pat.) der Fälle eine Komplikation, hingegen traten diese nur in 21 von 51 Fällen (41,1%) bei Nicht-Diabetikern auf. Schlussfolgerungen: Aufgrund der engen topographischen Nähe zu wichtigen Strukturen können tiefe Halsinfektionen lebensbedrohliche Komplikationen verursachen, wie z. B. Atemwegsobstruktionen durch Ödeme, bevorzugt im parapharyngealen Raum. Wesentliche RF für das Auftreten von Komplikationen stellen ein DM, kardiovaskuläre und pulmonale Erkrankungen sowie ein Nikotinabusus dar. Daher ist die Kenntnis um die Komplikationen tiefer Halsinfektionen für jeden HNO-Arzt unverzichtbar und für den weiteren Verlauf des Patienten entscheidend.Der Erstautor gibt keinen Interessenkonflikt an

Primarily chronic and cerebrovascular course of Lyme neuroborreliosis: case reports and literature review

As part of an ongoing study aiming to define the clinical spectrum of neuroborreliosis in childhood, we have identified four patients with unusual clinical manifestations. Two patients suffered from a primarily chronic form of neuroborreliosis and displayed only non-specific symptoms. An 11 year old boy presented with long standing symptoms of severe weight loss and chronic headache, while the other patient had pre-existing mental and motor retardation and developed seizures and failure to thrive. Two further children who presented with acute hemiparesis as a result of cerebral ischaemic infarction had a cerebrovascular course of neuroborreliosis. One was a 15 year old girl; the other, a 5 year old boy, is to our knowledge the youngest patient described with this course of illness. Following adequate antibiotic treatment, all patients showed substantial improvement of their respective symptoms. Laboratory and magnetic resonance imaging findings as well as clinical course are discussed and the relevant literature is reviewed.