Long-Term or Repeated Antibiotic Treatment or Therapy
for
Lyme Disease
A Bibliography with Highlighted Full Abstracts
Lyme disease is a serious bacterial infection caused by a tick bite and
affects humans and animals.
This page contains citations and complete abstracts for medical and scientific articles from the National Institutes of Health (NIH), National Library of Medicine (NLM) MEDLINE database about long-term or repeated antibiotic therapy for Lyme disease. Citations are sorted by date within categories with particularly significant portions highlighted in bold red lettering.
Note: Most of the citations or abstracts in this section were gleaned from abstracts found by the following MEDLINE "search" link:
MEDLINE - long-term therapy AND Lyme disease - 180 citations found on 13 Jun 01
Highlighted Abstracts
TITLE:
[Lyme disease and facial paralysis in children].
[Article in French]
AUTHORS:
Tuerlinckx D, Bodart E.
AUTHOR
AFFILIATION:
Service de Pediatrie, Universite Catholique de Louvain, Mont-Godinne.
SOURCE:
Rev Med Liege 2001 Feb;56(2):93-6
ABSTRACT:
Lyme disease is one of the most common cause of acute peripheral facial palsy in
children. Overall nervous system involvement is also the predominant
manifestation of Lyme disease in children, chiefly as facial palsy and/or
aseptic meningitis. The medical records of ten patients with discharge diagnosis
of facial palsy associated to borreliosis were retrospectively reviewed. The
diagnostic criteria for borreliosis included acute peripheral facial palsy
associated with erythema migrans (1/10) and/or positive Lyme serology in serum
(10/10) or CSF (6/10). Facial palsy was associated with a high rate (9/10) of
occult meningitis. Cerebrospinal fluid findings showed lymphocytic pleocytosis
associated to moderate increased protein level. PCR assays displayed a very low
sensitivity. All patients with meningitis were treated with intravenous
ceftriaxone for 3 weeks and received their treatment as outpatients with an
heparinised venous catheter. Our study confirm that borreliosis should be
considered in every case of peripheral facial palsy and based on the high rate
of occult meningitis, we also advocate to perform a lumbar puncture.
Although
long term prognosis of facial palsy associated with Lyme disease in children
appears excellent, current treatment recommendations advocate prolonged
antibiotic therapy.
PMID: 11294055
TITLE:
Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin
lesion in a seronegative patient with generalized ulcerating bullous lichen
sclerosus et atrophicus.
AUTHORS:
Breier F, Khanakah G, Stanek G, Kunz G, Aberer E, Schmidt B, Tappeiner G.
AUTHOR
AFFILIATION:
Department of Dermatology, Lainz Municipal Hospital, Wolkersbergenstrasse 1,
A-1130 Vienna, Austria. brf@der.khl.magwien.gv.at
SOURCE:
Br J Dermatol 2001 Feb;144(2):387-92
ABSTRACT:
A 64-year-old woman presented with bullous and ulcerating lichen sclerosus et
atrophicus (LSA) on the neck, trunk, genital and perigenital area and the
extremities. Histology of lesional skin showed the typical manifestations of
LSA; in one of the biopsies spirochaetes were detected by silver staining.
Despite treatment with four courses of ceftriaxone with or without
methylprednisone for up to 20 days, progression of LSA was only stopped for a
maximum of 1 year.
Spirochaetes were isolated from skin cultures obtained from
enlarging LSA lesions. These spirochaetes were identified as Borrelia afzelii by
sodium dodecyl sulphate--polyacrylamide gel electrophoresis and polymerase chain
reaction (PCR) analyses. However, serology for B. burgdorferi sensu lato was
repeatedly negative.
After one further 28-day course of ceftriaxone the lesions
stopped expanding and sclerosis of the skin was diminished. At this time
cultures for spirochaetes and PCR of lesional skin for B. afzelii DNA remained
negative.
These findings suggest a pathogenetic role for B. afzelii in the
development of LSA and a beneficial effect of appropriate antibiotic treatment.
PMID: 11251580
TITLE:
Lyme arthritis in children and adolescents: outcome 12 months after initiation
of antibiotic therapy.
AUTHORS:
Bentas W, Karch H, Huppertz HI.
AUTHOR
AFFILIATION:
Children's Hospital and Institute of Hygiene and Microbiology, University of
Wurzburg, Germany.
SOURCE:
J Rheumatol 2000 Aug;27(8):2025-30
Comment in:
J Rheumatol. 2000 Aug;27(8):1836-8
ABSTRACT:
OBJECTIVE: Lyme arthritis in children and adolescents due to infection with
Borrelia burgdorferi responds well to intravenous and oral antibiotics, but
nonresponders have been described with all antibiotic regimens tested and a
standard therapy has not yet been established. We examined causes of the failure
of antibiotic treatment in the presence of persistent organisms and autoimmune
mechanisms. METHODS: A prospective multicenter study was carried out in 55
children and adolescents with Lyme arthritis. RESULTS: There were significant
differences between younger and older patients with pediatric Lyme arthritis.
Younger patients were more likely to have fever at the onset of arthritis and to
have acute or episodic arthritis. Older patients were more likely to have
chronic arthritis, higher levels of IgG antibodies to B. burgdorferi (by ELISA
and immunoblot), and a longer interval between antibiotic treatment and the
disappearance of arthritis. Of 51 patients followed for at least 12 months after
initiation of antibiotic treatment, 24% retained manifestations of the disease
including arthritis (8 patients) and arthralgias (4 patients). These patients
were predominantly female (9/12) and were significantly older than patients
without residual symptoms.
Patients who had received intraarticular steroids
prior to antibiotic treatment required significantly more courses of antibiotic
treatment
and the time required for disappearance of the arthritis was longer.
CONCLUSION: Pediatric Lyme arthritis is more benign in younger children. Lyme
arthritis should be excluded as a possible cause of arthritis prior to the
administration of intraarticular steroids.
PMID: 10955347
TITLE:
[Clinical characteristics and risk factors of hepatic damage in lyme
borrheliosis].
[Article in Russian]
AUTHORS:
Bessonova EN, Lesniak OM, Podymova SD, Bazarnyi VV.
SOURCE:
Klin Med (Mosk) 2000;78(4):36-40
ABSTRACT:
The study is based on the study of data on 33 patients with Lyme Borrelia
infection in the presence of typical erythema migrans in whom elevated levels of
serum bilirubin or transaminases were detected simultaneously with erythema or
just shortly. The obligatory criterion was no history evidence of hepatitis and
abnormal hepatic functional tests. Higher levels of serum aminotransferases were
a major manifestation of Lyme hepatitis in the Sverdlovsk region. In 32
patients, ALT was increased, on the average, up to 176 U/l, and AST activity was
up to 113 U/l within the first 2 weeks of the disease in the absence of clinical
manifestations of hepatic and biliary diseases. There were changes in the levels
of serum transaminases and bilirubin following 3- and
8-month antibiotic
therapy.
The presence of viruses A and C in moderate chronic hepatitis induced
long-term increases in the activity of transaminases in 3 cases, as evidenced by
histological studies of hepatic biopsy specimens.
PMID: 10833889
TITLE:
Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis.
AUTHORS:
Oksi J; Nikoskelainen J; Viljanen MK
AUTHOR
AFFILIATION:
Department of Medicine, Turku University Central Hospital, Finland.
SOURCE:
Eur J Clin Microbiol Infect Dis 1998 Oct;17(10):715-9
ABSTRACT:
Two treatment regimens for disseminated Lyme borreliosis (mainly
neurologic and musculoskeletal manifestations) were compared in a
randomized trial. A group of 30 patients received oral cefixime 200
mg combined with probenecid 500 mg three times daily for 100 days.
Another group of 30 patients received intravenous ceftriaxone 2 g
daily for 14 days followed by oral amoxicillin 500 mg combined with
probenecid 500 mg three times daily for 100 days. There was no
statistically significant difference in the outcome of infection
between the two groups. However, the total number of patients with
relapses or no response at all and the number of positive polymerase
chain reaction findings after therapy were greater in the cefixime
group.
The general outcomes of infection in patients with
disseminated Lyme borreliosis after 3-4 months of therapy indicate
that prolonged courses of antibiotics may be beneficial in this
setting, since 90% of the patients showed excellent or good treatment
responses.
TITLE:
Lyme borreliosis--a review of the late stages and treatment of four cases.
AUTHORS:
Petrovic M; Vogelaers D; Van Renterghem L; Carton D; De Reuck J; Afschrift M
AUTHOR
AFFILIATION:
Department of Internal Medicine, University Hospital Ghent, Belgium.
SOURCE:
Acta Clin Belg 1998 Jun;53(3):178-83
ABSTRACT:
Difficulties in diagnosis of late stages of Lyme disease include low
sensitivity of serological testing and late inclusion of Lyme disease
in the differential diagnosis.
Longer treatment modalities may have
to be considered in order to improve clinical outcome of late disease
stages.
These difficulties clinical cases of Lyme borreliosis.[sic]
The
different clinical cases illustrate several aspects of late
borreliosis: false negative serology due to narrow antigen
composition of the used ELISA format, the need for prolonged
antibiotic treatment in chronic or recurrent forms and typical
presentations of late Lyme disease, such as lymphocytic
meningo-encephalitis and polyradiculoneuritis.
TITLE:
Culture-positive Lyme borreliosis.
AUTHORS:
Hudson BJ, Stewart M, Lennox VA, Fukunaga M, Yabuki M, Macorison H,
Kitchener-Smith J.
AUTHOR
AFFILIATION:
Microbiology Department, Royal North Shore Hospital, Sydney, NSW.
bhudson@med.usyd.edu.au
SOURCE:
Med J Aust 1998 May 18;168(10):500-2
Comment in:
Med J Aust. 1998 May 18;168(10):479-80
ABSTRACT:
We report a case of Lyme borreliosis. Culture of skin biopsy was positive for
Borrelia garinii, despite repeated prior treatment with antibiotics.
The patient
had travelled in Europe 17 months before the onset of symptoms, but the clinical
details indicate that the organism could have been acquired in Australia. The
results of conventional serological and histopathological tests were negative,
despite an illness duration of at least two years.
PMID: 9631675
TITLE:
Tetracycline therapy for chronic Lyme disease.
AUTHORS:
Donta ST
AUTHOR
AFFILIATION:
Boston University Medical Center and Boston Veterans Affairs Medical Center, Massachusetts 02118, USA.
SOURCE:
Clin Infect Dis 1997 Jul;25 Suppl 1:S52-6
ABSTRACT:
Two hundred seventy-seven patients with chronic Lyme disease were
treated with tetracycline for 1 to 11 months (mean, 4 months); the
outcomes for these patients were generally good.
Overall, 20% of the
patients were cured; 70% of the patients' conditions improved, and
treatment failed for 10% of the patients. Improvement frequently did
not take place for several weeks; after 2 months of treatment, 33% of
the patients' conditions were significantly improved (degree of
improvement, 75%-100%), and after 3 months of treatment, 61% of the
patients' conditions were significantly improved. Treatment outcomes
for seronegative patients (20% of all patients) were similar to those
for seropositive patients. Western immunoblotting showed reactions to
one or more Borrelia burgdorferi-specific proteins for 65% of the
patients for whom enzyme-linked immunosorbent assays were negative.
Whereas age, sex, and prior erythema migrans were not correlated with
better or worse treatment outcomes, a history of longer duration of
symptoms or antibiotic treatment was associated with longer treatment
times to achieve improvement and cure.
These results support the use
of longer courses of treatment in the management of patients with
chronic Lyme disease.
Controlled trials need to be conducted to
validate these observations.
TITLE:
Inflammatory brain changes in Lyme borreliosis. A report on three patients and
review of literature.
AUTHORS:
Oksi J, Kalimo H, Marttila RJ, Marjamaki M, Sonninen P, Nikoskelainen J,
Viljanen MK.
AUTHOR
AFFILIATION:
Department of Internal Medicine, Turku University Central Hospital, Finland.
SOURCE:
Brain 1996 Dec;119 ( Pt 6):2143-54
ABSTRACT:
Despite a rapid increase in the number of patients with Lyme neuroborreliosis
(LNB), its neuropathological aspects are poorly understood. The objective of
this study was evaluation of neuropathological, microbiological, and magnetic
resonance imaging (MRI) findings in three patients with the Borrelia burgdorferi
infection and neurological disease from whom brain tissue specimens were
available. Perivascular or vasculitic lymphocytic inflammation was detected in
all specimens. Large areas of demyelination in periventricular white matter were
detected histologically and by MRI in one patient. The disease had a fatal
outcome in this patient. Brain MRI suggested malignancies in two patients before
histopathological studies were carried out. One of these two patients was a
child with sudden hemiparesis.
Another was a 40-year-old man presenting with
epileptic seizures and MRI-detected multifocal lesions, which disappeared after
repeated courses of antibiotics.
We conclude that cerebral lymphocytic
vasculitis and multifocal encephalitis may be associated with B. burgdorferi
infection. The presence of B. burgdorferi DNA in tissue samples from areas with
inflammatory changes indicates that direct invasion of B. burgdorferi may be the
pathogenetic mechanism for focal encephalitis in LNB.
PMID: 9010017
TITLE:
Formation and cultivation of Borrelia burgdorferi spheroplast-L-form variants [published erratum appears in Infection 1996 Jul-Aug;24(4):335]
AUTHORS:
Mursic VP; Wanner G; Reinhardt S; Wilske B; Busch U; Marget W
AUTHOR
AFFILIATION:
Max von Pettenkofer-Institut, Ludwig-Maximilians-Universitat Munchen, Germany.
SOURCE:
Infection 1996 May-Jun;24(3):218-26
ABSTRACT:
As clinical persistence of Borrelia burgdorferi in patients with
active Lyme borreliosis occurs despite obviously adequate antibiotic
therapy, in vitro investigations of morphological variants and
atypical forms of B. burgdorferi were undertaken.
In an attempt to
learn more about the variation of B. burgdorferi and the role of
atypical forms in Lyme borreliosis, borreliae isolated from
antibiotically treated and untreated patients with the clinical
diagnosis of definite and probable Lyme borreliosis and from patient
specimens contaminated with bacteria were investigated. Furthermore,
the degeneration of the isolates during exposure to penicillin G in
vitro was analysed. Morphological analysis by darkfield microscopy
and scanning electron microscopy revealed diverse alterations.
Persisters isolated from a great number of patients (60-80%) after
treatment with antibiotics had an atypical form. The morphological
alterations in culture with penicillin G developed gradually and
increased with duration of incubation.
Pleomorphism, the presence of
elongated forms and spherical structures, the inability of cells to
replicate, the long period of adaptation to growth in MKP-medium and
the mycoplasma-like colonies after growth in solid medium (PMR agar)
suggest that B. burgdorferi produce spheroplast-L-form variants. With
regard to the polyphasic course of Lyme borreliosis, these forms
without cell walls can be a possible reason why Borrelia survive in
the organism for a long time (probably with all beta-lactam
antibiotics) [corrected] and the cell-wall-dependent antibody titers
disappear and emerge after reversion.
TITLE:
Treatment of Lyme arthritis.
AUTHORS:
Cimmino MA; Moggiana GL; Parisi M; Accardo S
AUTHOR
AFFILIATION:
Dipartimento di Medicina Interna, Universita di Genova, Italy.
SOURCE:
Infection 1996 Jan-Feb;24(1):91-3
ABSTRACT:
The efficacy of different therapeutic regimens for Lyme arthritis is
reviewed. The first treatment for Lyme arthritis, intramuscular
benzathine penicillin 2.4 million units weekly for 3 weeks, had a
success rate of 35%. Another study employed intravenous penicillin G
at a dosage of 20 million units daily for 10 days, which cured 55% of
patients. Intravenous ceftriaxone has been shown to be superior to
penicillin with a response rate of 94%. However, these results have
been challenged in recent reports. Oral doxycycline or amoxicillin in
association with probenecid seems to work equally well although
neuroborreliosis was more frequent following treatment with
amoxicillin. An anecdotal report indicates the usefullness of
long-term benzathine penicillin for chronic Lyme arthritis.
Long-term
antibiotic therapy, which is recommended also for Reiter's syndrome,
may be useful for eradicating the sanctuaries of Borrelia
burgdorferi.
Disease-modifying drugs such as hydroxychloroquine or
sulphasalazine, a drug which is commonly used in reactive arthritis
following enteric infections, may be of value in Lyme arthritis
resistant to antibiotics but have not been tested to date. The role
of intraarticular injections of steroids or synovectomy is still
controversial. Antibiotic treatment is the cornerstone of Lyme
arthritis treatment. Additional interventions should be studied for
patients with Lyme arthritis resistant to antibiotics.
TITLE:
Rapidly progressive frontal-type dementia associated with Lyme disease.
AUTHORS:
Waniek C; Prohovnik I; Kaufman MA; Dwork AJ
AUTHOR
AFFILIATION:
New York State Psychiatric Institute, NY 10032, USA.
SOURCE:
J Neuropsychiatry Clin Neurosci 1995 Summer;7(3):345-7
ABSTRACT:
The authors report a case of fatal neuropsychiatric Lyme disease (LD)
that was expressed clinically by progressive frontal lobe dementia
and pathologically by severe subcortical degeneration. Antibiotic
treatment resulted in transient improvement, but the patient relapsed
after the antibiotics were discontinued. LD must be considered even
in cases with purely psychiatric presentation, and prolonged
antibiotic therapy may be necessary.
TITLE:
[Lyme arthritis: the joint lesions in Lyme borreliosis in the USA]
AUTHORS:
Steere AC
SOURCE:
Ter Arkh 1995;67(11):43-5
ABSTRACT:
Of 55 untreated patients with erythema migrans only 20% were free of
follow-up manifestations of Lyme's disease. The rest exhibited
episodes of articular, periarticular or musculoskeletal pains (18%),
one or more episodes of arthritis (51%) or chronic arthritis (11%).
Lyme's arthritis arises due to invasion of Borrelia burgdorferi into
articular tissues. This became evident after detection of borrelian
DNA in the synovia. The study of different cytokine concentrations in
the synovial fluid in 83 patients with Lyme's arthritis showed that
chronicity of arthritis depends on IL-1b and IL-1ra balance. As
indicated by examination of 80 patients with Lyme's arthritis chronic
persistence of articular syndrome in 57% was associated with HLA-DR4,
in 43% with HLA-DR2.
Lyme's arthritis requires long-term treatment.
In its failure arthroscopic synovectomy is indicated.
TITLE:
Seronegative chronic relapsing neuroborreliosis.
AUTHORS:
Lawrence C, Lipton RB, Lowy FD, Coyle PK.
AUTHOR
AFFILIATION:
Department of Medicine, Albert Einstein College of Medicine, New York, N.Y.,
USA.
SOURCE:
Eur Neurol 1995;35(2):113-7
Comment in:
Eur Neurol. 1996;36(6):394-5
ABSTRACT:
We report an unusual patient with evidence of Borrelia burgdorferi infection who
experienced repeated neurologic relapses despite aggressive antibiotic therapy.
Each course of therapy was associated with a Jarisch-Herxheimer-like reaction.
Although the patient never had detectable free antibodies to B. burgdorferi in
serum or spinal fluid, the CSF was positive on multiple occasions for complexed
anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.
PMID: 7796837
TITLE:
The epidemiology of Lyme disease in Delaware 1989-1992.
AUTHORS:
Wolfe D; Fries C; Reynolds K; Hathcock L
AUTHOR
AFFILIATION:
Delaware Division of Public Health, Dover.
SOURCE:
Del Med J 1994 Nov;66(11):603-6, 609-13
ABSTRACT:
OBJECTIVES: The study was conducted to describe the temporal,
geographic, demographic and treatment characteristics of Lyme disease
in Delaware and to assist health planners in developing and
implementing control strategies.
METHODS: All physician-submitted
Centers for Disease Control and Prevention (CDC) follow-up Lyme
disease report forms from 1989 through 1992 were reviewed for
completeness. Data were gathered from completed forms only. All cases
were classified according to the 1990 CDC surveillance case
definition. Cases were further subdivided into two groups. Antibiotic
usage patterns were then identified for each group. Data on the
percentage of infected ticks by county were obtained from a 1988
study conducted by the University of Delaware; Delaware Health and
Social Services, Division of Public Health; and the Department of
Natural Resources and Environmental Control. RESULTS: Reported cases
of Lyme disease increased 246 percent between 1989 and 1992. The 1992
statewide incidence rate was 12.6 cases per 100,000 population.
Whites were four times more likely to contract Lyme disease than were
blacks. The majority of cases were reported between June and October.
The number of patients being treated with oral antibiotics for
localized disease for three weeks or longer increased from 52 percent
in 1991 to 94 percent in 1992. Ixodid ticks infected with Borrelia
burgdorferi were found in all three counties. CONCLUSION: The
Delaware State Board of Health made Lyme disease reportable in
September 1989. This requirement increased the quality of Lyme
disease surveillance; however, the disease is probably under-reported
since Delaware does not actively solicit Lyme disease reports.
Delaware's case data reflect national data which indicate an increase
in reported cases. A trend toward longer duration of treatment for
localized Lyme disease is evident.
TITLE:
Lyme disease: a neuropsychiatric illness.
AUTHORS:
Fallon BA; Nields JA
AUTHOR
AFFILIATION:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
SOURCE:
Am J Psychiatry 1994 Nov;151(11):1571-83
ABSTRACT:
OBJECTIVE: Lyme disease is a multisystemic illness that can affect the
central nervous system (CNS), causing neurologic and psychiatric
symptoms. The goal of this article is to familiarize psychiatrists
with this spirochetal illness. METHOD: Relevant books, articles, and
abstracts from academic conferences were perused, and additional
articles were located through computerized searches and reference
sections from published articles. RESULTS: Up to 40% of patients with
Lyme disease develop neurologic involvement of either the peripheral
or central nervous system. Dissemination to the CNS can occur within
the first few weeks after skin infection. Like syphilis, Lyme disease
may have a latency period of months to years before symptoms of late
infection emerge. Early signs include meningitis, encephalitis,
cranial neuritis, and radiculoneuropathies. Later, encephalomyelitis
and encephalopathy may occur. A broad range of psychiatric reactions
have been associated with Lyme disease including paranoia, dementia,
schizophrenia, bipolar disorder, panic attacks, major depression,
anorexia nervosa, and obsessive-compulsive disorder. Depressive
states among patients with late Lyme disease are fairly common,
ranging across studies from 26% to 66%.
The microbiology of Borrelia
burgdorferi sheds light on why Lyme disease can be relapsing and
remitting and why it can be refractory to normal immune surveillance
and standard antibiotic regimens. CONCLUSIONS: Psychiatrists who work
in endemic areas need to include Lyme disease in the differential
diagnosis of any atypical psychiatric disorder. Further research is
needed to identify better laboratory tests and to determine the
appropriate manner (intravenous or oral) and length (weeks or months)
of treatment among patients with neuropsychiatric involvement.
TITLE:
Treatment of late Lyme borreliosis.
AUTHORS:
Wahlberg P; Granlund H; Nyman D; Panelius J; Seppala I
AUTHOR AFFILIATION:
Department of Medicine, Aland Central Hospital,
Mariehamn, Finland.
SOURCE:
J Infect 1994 Nov;29(3):255-61
ABSTRACT:
The aim of this study was to develop a treatment for late
Lyme borreliosis and to compare the clinical results with
serological findings before and after treatment.
It was done
in the Aland Islands (population 25,000), a region endemic
for Lyme borreliosis. The patients were the first
consecutive 100 patients from the Aland Islands with late
Lyme borreliosis. They were followed for at least 1 year
after treatment. The clinical results of treatment were
compared with results of analyses of flagellar IgG
antibodies to Borrelia burgdorferi done at the time of
diagnosis before treatment and up to 12 months afterwards.
Short periods of treatment were not generally effective. The
outcome was successful in four of 13 treatments with 14
days of intravenous ceftriaxone alone, in 50 of 56
assessable treatments with ceftriaxone followed by 100
days of amoxycillin plus probenecid, and in 19 of 23
completed treatments with ceftriaxone followed by 100 days
of cephadroxil.
Titres of IgG antibodies to B. burgdorferi
flagella declined significantly after 6 and 12 months in the
patients who had successful treatments. All patients whose
final titres were less than 30% of the initial titre were in the
successful group. Their titres usually remained above the
upper limit of normal for a long time but a decline to a value
of less than 30% of that before treatment was always a sign
of cure.
TITLE:
Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection.
AUTHORS:
Liegner KB; Shapiro JR; Ramsay D; Halperin AJ; Hogrefe W; Kong L
AUTHOR
AFFILIATION:
Department of Medicine, Northern Westchester Hospital Center,
Mount Kisco, NY.
SOURCE:
J Am Acad Dermatol 1993 Feb;28(2 Pt 2):312-4
ABSTRACT:
Erythema migrans recurred in a patient 6 months after a course of
treatment with minocycline for Lyme disease.
Polymerase chain
reaction on heparinized peripheral blood at that time demonstrated
the presence of Borrelia burgdorferi-specific DNA. The patient was
seronegative by Lyme enzyme-linked immunosorbent assay but showed
suspicious bands on Western blot. Findings of a Warthin-Starry stain
of a skin biopsy specimen of the eruption revealed a
Borrelia-compatible structure. Reinfection was not believed to have
occurred.
Further treatment with minocycline led to resolution of the
erythema migrans.
TITLE:
Ceftriaxone-associated biliary complications of treatment of suspected disseminated Lyme disease--New Jersey, 1990-1992.
SOURCE:
MMWR Morb Mortal Wkly Rep 1993 Jan 22;42(2):39-42
ABSTRACT:
Lyme disease (LD) is endemic in Monmouth and Ocean counties, New
Jersey (1). In June 1992, CDC and the New Jersey Department of Health
(NJDOH) conducted a telephone survey in both counties of 65
schoolchildren who required home instruction because of suspected LD
to determine the public health impact of the disease. Most children
had received prolonged and repeated courses of oral antimicrobials
and/or home intravenous infusion of antimicrobials;
79% had been
hospitalized for treatment of suspected LD or management of treatment
complications, most notably drug-induced symptoms of gallbladder
disease occurring in patients receiving ceftriaxone (Rocephin), and
bloodstream infections associated with intravenous catheters. To
determine the characteristics of and treatment complications for
patients hospitalized for treatment of LD, a computerized search of
hospital discharge data in New Jersey was performed; nearly 30% of
all hospitalizations for LD during 1990-1991 were at a regional
hospital serving Monmouth and Ocean counties. This report presents
findings of an analysis of patients admitted to that hospital for
treatment of LD.
TITLE:
Long term treatment of chronic Lyme arthritis with benzathine penicillin.
AUTHORS:
Cimmino MA; Accardo S
AUTHOR
AFFILIATION:
Dipartimento di Medicina Interna, Universita di Genova, Genoa, Italy.
SOURCE:
Ann Rheum Dis 1992 Aug;51(8):1007-8
ABSTRACT:
The cases are reported of two patients with chronic Lyme arthritis
resistant to the recommended antibiotic regimens who were cured by
long term treatment with benzathine penicillin. It is suggested that
the sustained therapeutic levels of penicillin were effective either
by the inhibition of germ replication or by lysis of the spirochaetes
when they were leaving their sanctuaries.
TITLE:
[Nodular panniculitis: a manifestation of Lyme borreliosis]?
[Article in German]
AUTHORS:
Hassler D, Zorn J, Zoller L, Neuss M, Weyand C, Goronzy J, Born IA, Preac-Mursic
V.
AUTHOR
AFFILIATION:
Allgemeinmedizinische Praxis, Kraichtal.
SOURCE:
Hautarzt 1992 Mar;43(3):134-8
ABSTRACT:
Infection with Borrelia burgdorferi can induce various skin manifestations. The
type of skin manifestation and the histopathological picture depend on the stage
of infection and vary from local inflammatory infiltrates to chronic atrophic
skin disease. Involvement of subcutaneous tissue has been observed only very
rarely. We report on two patients suffering from nodular panniculitis
(Pfeifer-Weber-Christian) and present evidence that the disease was caused by
Borrelia burgdorferi.
In one of the cases Borrelia burgdorferi was repeatedly
isolated from skin and subcutaneous tissue biopsies in spite of repeated
high-dose therapy with ceftriaxone, Doxycycline and cefotaxime.
PMID: 1577601
TITLE:
Lyme borreliosis in Texas.
AUTHORS:
Goldings AS; Taylor JP; Rawlings J
AUTHOR
AFFILIATION:
Department of Health, Austin, TX 78756.
SOURCE:
Tex Med 1991 Sep;87(9):62-6
ABSTRACT:
Lyme borreliosis is a protean infection caused by B burgdorferi, a
recently recognized arthropod-borne spirochete. The disease is
generally acquired during warm weather, and its onset is
characterized by a skin lesion, EM, and flulike symptoms. Neurologic,
cardiac, and/or rheumatologic abnormalities may emerge weeks, months,
or years later. In the absence of the pathognomonic skin lesion,
determination of antibody response is currently the most practical
laboratory aid in diagnosis. However, clinical judgement is necessary
for the correct interpretation of laboratory results because
false-positive and false-negative results are common.
Antibiotics
remain the mainstay of therapy. Longer courses of antibiotic therapy
than those previously recommended may be needed to obtain a cure,
particularly in later stages of the illness.
TITLE:
Lyme disease: clinical features, classification, and epidemiology in
the upper midwest.
AUTHORS:
Agger W; Case KL; Bryant GL; Callister SM
AUTHOR
AFFILIATION:
Section of Infectious Disease, La Crosse Lutheran Hospital, Wisconsin.
SOURCE:
Medicine (Baltimore) 1991 Mar;70(2):83-90
ABSTRACT:
Lyme disease can be classified using the terminology of syphilis. In
this series of 95 cases from the upper midwest, early cases, defined
as an illness of less than 2 months, were more likely to have lived
in or recently visited a highly endemic area. Unlike late cases,
early cases presented entirely in the nonwinter months (p less than
.001). Early disease was further subdivided into primary and
secondary disease. Ninety percent of primary and 43% of secondary
cases had erythema migrans, while no late cases had active erythema
migrans (p less than .001). Clinical manifestations of nonspecific
inflammation, except for arthralgia, were more common in early than
late disease (p less than .01). In secondary cases, monoarticular
arthritis was slightly more common than polyarticular arthritis, with
the reverse occurring in late disease (p less than .05). Indirect
fluorescent antibody testing revealed a ratio of IgM to IgG
antibodies to be helpful in distinguishing early from late disease.
Antibacterial therapy in early, primary cases caused
Jarisch-Herxheimer reaction 7% of the time.
Despite longer and more
frequent parenteral therapy, late Lyme disease frequently required
retreatment, owing to poor clinical response (p less than .05).
TITLE:
Clinical implications of delayed growth of the Lyme borreliosis
spirochete, Borrelia burgdorferi.
AUTHORS:
MacDonald AB; Berger BW; Schwan TG
AUTHOR
AFFILIATION:
Department of Pathology, Southampton Hospital, New York 11968.
SOURCE:
Acta Trop 1990 Dec;48(2):89-94
ABSTRACT:
Lyme borreliosis, a spirochetal infection caused by Borrelia
burgdorferi, may become clinically active after a period of latency
in the host. Active cases of Lyme disease may show clinical relapse
following antibiotic therapy. The latency and relapse phenomena
suggest that the Lyme disease spirochete is capable of survival in
the host for prolonged periods of time.
We studied 63 patients with
erythema migrans, the pathognomonic cutaneous lesion of Lyme
borreliosis, and examined in vitro cultures of biopsies from the
active edge of the erythematous patch. Sixteen biopsies yielded
spirochetes after prolonged incubations of up to 10.5 months,
suggesting that Borrelia burgdorferi may be very slow to divide in
certain situations.
Some patients with Lyme borreliosis may require
more than the currently recommended two to three week course of
antibiotic therapy to eradicate strains of the spirochete which grow
slowly.
TITLE:
Borrelia burgdorferi infection of the brain: characterization of the
organism and response to antibiotics and immune sera in the mouse model [see comments]
AUTHORS:
Pachner AR; Itano A
AUTHOR
AFFILIATION:
Department of Neurology, Georgetown University Hospital, Washington, DC 20007.
SOURCE:
Neurology 1990 Oct;40(10):1535-40
COMMENT:
Comment in: Neurology 1991 Mar;41(3):463
ABSTRACT:
To learn more about the neurologic involvement in Lyme disease, we
inoculated inbred mice with the causative agent of Lyme disease,
Borrelia burgdorferi. We cultured brains and other organs, and
measured anti-B burgdorferi antibody titers. We further studied a
brain isolate for its plasmid DNA content and its response in vitro
to immune sera and antibiotics. One strain of B burgdorferi, N40, was
consistently infective for mice, and resulted in chronic infection of
the bladder and spleen. SJL mice developed fewer culture-positive
organs and had lower antibody titers than Balb/c and C57Bl/6 mice.
Organism was cultured from the brain early in the course of
infection, and this isolate, named N40Br, was further studied in
vitro. The plasmid content of N40Br was different from that of the
infecting strain, implying either a highly selective process during
infection or DNA rearrangement in the organism in vivo. N40Br was
very sensitive to antibiotics, but only after prolonged incubation.
Immune sera from both mice and humans infected with B burgdorferi
were unable to completely kill the organism by complement-mediated
cytotoxicity. These data demonstrate that B burgdorferi infects the
brain of experimental animals, and is resistant to immune sera in
vitro but sensitive to prolonged treatment with antibiotics.
TITLE:
Lyme disease [see comments]
AUTHORS:
Steere AC
AUTHOR
AFFILIATION:
Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111.
SOURCE:
N Engl J Med 1989 Aug 31;321(9):586-96
COMMENT:
Comment in: N Engl J Med 1990 Feb 15;322(7):474-5
ABSTRACT:
Within the last decade, Lyme borreliosis has emerged as a complex new
infection whose distribution is worldwide. The disorder is caused by
a recently recognized spirochete, B. burgdorferi, transmitted by
ticks of the I. ricinus complex. Certain species of mice are critical
in the life cycle of the spirochete, and deer appear to be crucial to
the tick. Although the disorder's basic outlines are similar
everywhere, there are regional variations in the causative
spirochete, animal hosts, and clinical manifestations of the illness.
In the United States, Lyme disease commonly begins in summer with a
characteristic skin lesion, erythema migrans, accompanied by flu-like
or meningitis-like symptoms. Weeks or months later, the patients may
have neurologic or cardiac abnormalities, migratory musculoskeletal
pain, or arthritis, and more than a year after onset, some patients
have chronic joint, skin, or neurologic abnormalities. After the
first several weeks of infection, almost all patients have a positive
antibody response to the spirochete, and serologic determinations are
currently the most practical laboratory aid in diagnosis.
Treatment
with appropriate antibiotics is usually curative, but longer courses
of therapy are often needed later in the illness, and some patients
may not respond.
TITLE:
Treatment of Lyme disease.
AUTHORS:
Schoen RT
SOURCE:
Conn Med 1989 Jun;53(6):335-7
ABSTRACT:
Lyme disease, a tick-transmitted spirochetal infection, can be divided
into three stages that can overlap or occur alone. The goals of
antibiotic therapy in stage one are to shorten the duration of early
disease and to prevent the development of later stages of the
illness. This can usually be accomplished with oral antibiotic
therapy.
Later stages of the illness are frequently more difficult to
treat, requiring prolonged oral or intravenous antibiotic therapy.
TITLE:
New chemotherapeutic approaches in the treatment of Lyme borreliosis.
AUTHORS:
Luft BJ; Volkman DJ; Halperin JJ; Dattwyler RJ
AUTHOR
AFFILIATION:
Department of Medicine, Health Science Center, SUNY, Stony Brook 11794.
SOURCE:
Ann N Y Acad Sci 1988;539:352-61
ABSTRACT:
1. It was demonstrated that while B. burgdorferi may be sensitive to
relatively small concentrations of penicillin and ceftriaxone, the
organism is killed slowly. This implies that, as in syphilis,
prolonged blood levels of these drugs may be necessary in order to
ensure cure.
In contrast, the activity of tetracycline is more rapid
in its action but is more dependent on drug concentration achieved.
Unfortunately, the MIC and MBC for some strains are at or above the
peak level achieved under optimal conditions. 2. Increasing the
concentrations of penicillin or ceftriaxone above the MIC for the
organism has little effect on the rate of killing. In contrast, the
killing by tetracycline can be augmented by increasing concentrations
of the drug. 3. Ceftriaxone is more active than penicillin, as
measured by MIC, against the five strains of B. burgdorferi tested.
4. Ceftriaxone was efficacious in the treatment of Lyme borreliosis,
which was recalcitrant to penicillin therapy. In a randomized trial
comparing ceftriaxone to high-dose penicillin therapy, ceftriaxone
was significantly more efficacious than penicillin in the treatment
of the late complications of Lyme borreliosis.
See related annotated bibliographies at:
Persistence or Relapse of Lyme Disease - A Bibliography with Highlighted Full Abstracts
http://www.geocities.com/HotSprings/Oasis/6455/persistence-special-abstracts.html
Seronegative or False Negative Lyme disease - An Annotated Bibliography
http://www.geocities.com/HotSprings/Oasis/6455/seronegative-special.html
Latent, dormant, subclinical, or asymptomatic Lyme Disease - An Annotated Bibliography
http://www.geocities.com/HotSprings/Oasis/6455/latent-biblio.html
For more information about antibiotics and Lyme disease, see:
Antibiotics and Lyme Disease
http://www.geocities.com/HotSprings/Oasis/6455/antibiotics-links.html
This document can be found at:
Long-Term or Repeated Antibiotic Treatment or Therapy for Lyme Disease -
A Bibliography with Highlighted Full Abstracts
http://www.geocities.com/HotSprings/Oasis/6455/therapy-special-abstracts.html
For more information about Lyme disease, see:
Lots Of Links On Lyme Disease
http://www.geocities.com/HotSprings/Oasis/6455/lyme-links.html
Comments or questions concerning this page should be directed to
Art Doherty.
Last updated on 13 June 2001 by
Art Doherty
Lompoc, California
doherty@utech.net
|
