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Krcatovich EH, Workman J, Stasiak K, Goldstein RE. Comparative evaluation of Borrelia burgdorferi antibody detection between the VetScan Flex4 and SNAP 4Dx Plus. Top Companion Anim Med 2024; 59:100862. [PMID: 38508488 DOI: 10.1016/j.tcam.2024.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 02/11/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Two studies were developed to compare Borrelia burgdorferi antibody detection between the VetScan Flex4 and SNAP 4Dx Plus tests. The objective of the first study was to evaluate the diagnostic sensitivity (Se) and specificity (Sp) of VetScan Flex4 and SNAP 4Dx Plus B. burgdorferi results using field sourced samples compared to a Western Blot reference method. The sensitivity and specificity of VetScan Flex4 were 81.9 % (95 % CI: 71.9 %-89.5 %) and 89.3 % (95 % CI: 85.2 %-92.9 %) respectively, and SNAP 4Dx Plus's sensitivity and specificity were 80.7 % (95 % CI: 70.6 %-88.6 %) and 92.8 % (95 % CI: 89.1 %-95.5 %) respectively. When comparing VetScan Flex4 and Snap 4Dx Plus, the Simple Kappa Coefficient estimate was 0.76 (95 % CI: 0.69-0.84) indicating substantial agreement between the two methods. McNemar's Test revealed concordance between the two methods was not statistically significant (P = 0.05). The objective of the second study was to evaluate whether VetScan Flex4 differentiates between B. burgdorferi antibodies derived from infection versus vaccination with commonly used canine Lyme vaccines. The sensitivity and specificity of the VetScan Flex4 in differentiating canine Lyme vaccination from infection with Borrelia burgdorferi were 100 % (Se 95 % CI: 78.2 %-100 %; Sp 95 % CI: 91.2 %-100 %). In conclusion, the VetScan Flex4 is a reliably sensitive and specific point-of-care test that is similar to Snap 4Dx Plus, can differentiate between infection and Lyme vaccination, and can be utilized by veterinarians for Lyme disease diagnosis and surveillance of B. burgdorferi exposure.
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Affiliation(s)
- Elise H Krcatovich
- Zoetis Global Diagnostics Medical Affairs (Krcatovich, Stasiak, Goldstein), Zoetis Global Diagnostics Veterinary Medical Research and Development (Workman), MI, USA
| | - Jason Workman
- Zoetis Global Diagnostics Medical Affairs (Krcatovich, Stasiak, Goldstein), Zoetis Global Diagnostics Veterinary Medical Research and Development (Workman), MI, USA
| | - Karen Stasiak
- Zoetis Global Diagnostics Medical Affairs (Krcatovich, Stasiak, Goldstein), Zoetis Global Diagnostics Veterinary Medical Research and Development (Workman), MI, USA.
| | - Richard E Goldstein
- Zoetis Global Diagnostics Medical Affairs (Krcatovich, Stasiak, Goldstein), Zoetis Global Diagnostics Veterinary Medical Research and Development (Workman), MI, USA
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Samaddar S, O’Neal AJ, Marnin L, Rolandelli A, Singh N, Wang X, Butler LR, Rangghran P, Laukaitis HJ, Cabrera Paz FE, Fiskum GM, Polster BM, Pedra JHF. Metabolic disruption impacts tick fitness and microbial relationships. bioRxiv 2023:2023.05.26.542501. [PMID: 37292783 PMCID: PMC10245996 DOI: 10.1101/2023.05.26.542501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Arthropod-borne microbes rely on the metabolic state of a host to cycle between evolutionarily distant species. For instance, arthropod tolerance to infection may be due to redistribution of metabolic resources, often leading to microbial transmission to mammals. Conversely, metabolic alterations aids in pathogen elimination in humans, who do not ordinarily harbor arthropod-borne microbes. To ascertain the effect of metabolism on interspecies relationships, we engineered a system to evaluate glycolysis and oxidative phosphorylation in the tick Ixodes scapularis. Using a metabolic flux assay, we determined that the rickettsial bacterium Anaplasma phagocytophilum and the Lyme disease spirochete Borrelia burgdorferi, which are transstadially transmitted in nature, induced glycolysis in ticks. On the other hand, the endosymbiont Rickettsia buchneri, which is transovarially maintained, had a minimal effect on I. scapularis bioenergetics. Importantly, the metabolite β-aminoisobutyric acid (BAIBA) was elevated during A. phagocytophilum infection of tick cells following an unbiased metabolomics approach. Thus, we manipulated the expression of genes associated with the catabolism and anabolism of BAIBA in I. scapularis and detected impaired feeding on mammals, reduced bacterial acquisition, and decreased tick survival. Collectively, we reveal the importance of metabolism for tick-microbe relationships and unveil a valuable metabolite for I. scapularis fitness.
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Affiliation(s)
- Sourabh Samaddar
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Anya J. O’Neal
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Liron Marnin
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Agustin Rolandelli
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Nisha Singh
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Xiaowei Wang
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - L. Rainer Butler
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Parisa Rangghran
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Hanna J. Laukaitis
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Francy E. Cabrera Paz
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
| | - Gary M. Fiskum
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Brian M. Polster
- Department of Anesthesiology and Center for Shock, Trauma and Anesthesiology Research, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Joao H. F. Pedra
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, Maryland 21201, USA
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Raffetin A, Hansmann Y, Sauvat L, Schramm F, Tattevin P, Baux É, Patrat-Delon S. [Lyme borreliosis]. Rev Prat 2023; 73:187-196. [PMID: 36916263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
LYME BORRELIOSIS. Lyme borreliosis (LB) is the most common vector-borne disease in the Northern Hemisphere, caused by the bacterium Borrelia burgdorferi sensu lato, transmitted to humans by a bite of ticks Ixodes. Prevention is based on simple measures to evict ticks, and on their rapid extractionin the event of a bite. The diagnosis of LB is based on 3 arguments: an exposure to tick bites; clinically compatible symptoms (cutaneous, neurological or rheumatological manifestations, +/- functional symptoms such as fatigue or polyarthromyalgia), evolving in 3 stages (early localized or erythema migrans, early or late disseminated LB); a positive two-tier serological test (ELISA +/- Western-Blot). Serology can be negative for the first 6 weeks, without excluding the diagnosis. Since serology can remain positive for life, evolution is only evaluated clinically. LB treatment is mainly based on doxycycline for 14 to 28 days, depending on the clinical stage and manifestations, without demonstrated interest in prolonging it, even if symptoms persist. Nonetheless their management is crucial as often responsible for medical wandering. Attentive listening to the patient is essential. The prognosis of LB in the medium-term is favorable, especially if they beneficiate of an early management.
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Affiliation(s)
- Alice Raffetin
- Centre de référence des maladies vectorielles à tiques, Paris et région Nord, CH Villeneuve-Saint- Georges, France
| | - Yves Hansmann
- Centre de référence des maladies vectorielles à tiques, région Grand-Est, CHRU Strasbourg, France
| | - Léo Sauvat
- Centre de référence des maladies vectorielles à tiques, Région Centre, CHU Clermont-Ferrand, France
| | | | - Pierre Tattevin
- Centre de référence des maladies vectorielles à tiques, Région Grand-Ouest, CHU Rennes Pontchaillou, France
| | - Élisabeth Baux
- Centre de référence des maladies vectorielles à tiques, Région Grand Est, CHRU Nancy, Vandoeuvre les Nancy, France
| | - Solène Patrat-Delon
- Centre de référence des maladies vectorielles à tiques, Région Grand-Ouest, CHU Rennes Pontchaillou, France
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Antoine C, Amouyel M. [A rare cause of ischemic stroke: Lyme disease]. Rev Prat 2022; 72:67. [PMID: 35258258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Abstract
OBJECTIVE Lyme borreliosis is a tick-borne infectious disease that may confer an increased risk of mental disorders, but previous studies have been hampered by methodological limitations, including small sample sizes. The authors used a nationwide retrospective cohort study design to examine rates of mental disorders following Lyme borreliosis. METHODS Using Denmark's National Patient Register and the Psychiatric Central Research Register, and including all persons living in Denmark from 1994 through 2016 (N=6,945,837), the authors assessed the risk of mental disorders and suicidal behaviors among all individuals diagnosed with Lyme borreliosis in inpatient and outpatient hospital contacts (N=12,156). Incidence rate ratios (IRRs) were calculated by Poisson regression analyses. RESULTS Individuals with Lyme borreliosis had higher rates of any mental disorder (IRR=1.28, 95% CI=1.20, 1.37), of affective disorders (IRR=1.42, 95% CI=1.27, 1.59), of suicide attempts (IRR=2.01, 95% CI=1.58, 2.55), and of death by suicide (IRR=1.75, 95% CI=1.18, 2.58) compared with those without Lyme borreliosis. The 6-month interval after diagnosis was associated with the highest rate of any mental disorder (IRR=1.96, 95% CI=1.53, 2.52), and the first 3 years after diagnosis was associated with the highest rate of suicide (IRR=2.41, 95% CI=1.25, 4.62). Having more than one episode of Lyme borreliosis was associated with increased incidence rate ratios for mental disorders, affective disorders, and suicide attempts, but not for death by suicide. CONCLUSIONS Individuals diagnosed with Lyme borreliosis in the hospital setting had an increased risk of mental disorders, affective disorders, suicide attempts, and suicide. Although the absolute population risk is low, clinicians should be aware of potential psychiatric sequelae of this global disease.
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Affiliation(s)
- Brian A Fallon
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fallon); Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Madsen, Erlangsen, Benros); Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Capital Region of Denmark (Erlangsen); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Center of Mental Health Research, Australian National University, Canberra, Australia (Erlangsen); Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (Benros)
| | - Trine Madsen
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fallon); Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Madsen, Erlangsen, Benros); Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Capital Region of Denmark (Erlangsen); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Center of Mental Health Research, Australian National University, Canberra, Australia (Erlangsen); Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (Benros)
| | - Annette Erlangsen
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fallon); Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Madsen, Erlangsen, Benros); Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Capital Region of Denmark (Erlangsen); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Center of Mental Health Research, Australian National University, Canberra, Australia (Erlangsen); Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (Benros)
| | - Michael E Benros
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fallon); Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Madsen, Erlangsen, Benros); Danish Research Institute of Suicide Prevention, Mental Health Center Copenhagen, Capital Region of Denmark (Erlangsen); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Erlangsen); Center of Mental Health Research, Australian National University, Canberra, Australia (Erlangsen); Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (Benros)
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Shea J. Physical Therapist Recognition and Referral of Individuals With Suspected Lyme Disease. Phys Ther 2021; 101:6277050. [PMID: 34003263 PMCID: PMC8389172 DOI: 10.1093/ptj/pzab128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/14/2021] [Accepted: 04/18/2021] [Indexed: 11/12/2022]
Abstract
The most commonly reported vector-borne and tick-borne disease in the United States is Lyme disease. Individuals with Lyme disease may present with a wide array of symptoms with resultant musculoskeletal, neurological, and cardiac manifestations that may cause them to seek physical therapist services. The symptoms may develop insidiously and with a variable presentation among individuals. Many persons with Lyme disease do not recall a tick bite or present with an erythema migrans rash, which is considered pathognomonic for the disease. Even if they do, they may fail to associate either with their symptoms, making the diagnosis elusive. It is important to diagnose individuals early in the disease process when antibiotic treatment is most likely to be successful. Physical therapists are in a unique position to recognize the possibility that individuals may have Lyme disease and refer them to another practitioner when appropriate. The purpose of this article is to (1) present an overview of the etiology, incidence, and clinical manifestations of Lyme disease, (2) review evaluation findings that should raise the index of suspicion for Lyme disease, (3) discuss the use of an empirically validated tool for differentiating those with Lyme disease from healthy individuals, (4) discuss the current state of diagnostic testing, and (5) review options for diagnosis and treatment available to individuals for whom referral is recommended.
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Affiliation(s)
- Jennifer Shea
- Retired Adjunct Faculty, Physical Therapy Department, Springfield College, 263 Alden Street, Springfield, MA 01109 USA,Address all correspondence to Ms Shea at:
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Cheung B, Lutwick L, Cheung M. Possible Lyme Carditis with Sick Sinus Syndrome. IDCases 2020; 20:e00761. [PMID: 32368492 DOI: 10.1016/j.idcr.2020.e00761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 12/25/2022] Open
Abstract
Borrelia burgdorferi (B. burgdorferi) is a spirochete bacterium that is transmitted via the Ixodes tick. Infection results in Lyme disease with possible cardiac manifestations, which is also known as Lyme carditis. Patients can present with bradycardia due to rapidly fluctuating atrioventricular block (AVB), which is the hallmark of Lyme carditis. However, we present a rare case of sick sinus syndrome (SSS) without AVB in a 47-year-old man with Lyme disease. He initially presented with a headache and subsequently developed new onset bradycardia and a right cranial nerve (CN) VI palsy with diplopia. B. burgdorferi enzyme-linked immunosorbent assay (ELISA) screen and IgM western blot were positive. He was admitted to the intensive care unit. Electrocardiography (EKG) indicated a heart rate in the high 30 s beats per minute (BPM) with several pauses, but no AVB was present. The patient responded well to therapy, and was discharged with an outpatient regimen of doxycycline. Lyme carditis should be considered in patients who develop new onset bradycardia and live in endemic areas.
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St Pierre SE, Gould ON, Lloyd V. Knowledge and Knowledge Needs about Lyme Disease among Occupational and Recreational Users of the Outdoors. Int J Environ Res Public Health 2020; 17:E355. [PMID: 31948017 DOI: 10.3390/ijerph17010355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/01/2022]
Abstract
As the prevalence of Lyme disease increases across Canada, it is imperative that the educational needs of at-risk groups be identified. The current study compared the level of knowledge and the knowledge needs about Lyme disease among individuals that spend time outdoors for work and for recreational purposes. Between December 2018 and February 2019, a survey was distributed to outdoor organizations across New Brunswick, Canada. Within the current sample of 137 individuals, 36% spent time outdoors for their occupation and 64% for recreational activities. Results showed no significant difference between these groups with regard to their level of knowledge, perceived efficacy and performance of various methods of prevention, and educational needs. Overall, the entire sample reported a low level of knowledge about Lyme disease. Participants perceived each prevention behavior to be at least somewhat effective, and behaviors perceived to be more effective were more likely to be carried out, but the performance of the behaviors varied. The most frequently performed behaviors included wearing long pants and protective footwear. Participants identified several aspects of Lyme disease about which they would like to have more information. The findings call attention to the specific needs of at-risk groups that must be considered when developing educational interventions.
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Lucente LN, Abu-Dayya A, Hennon T, Islam S, Wrotniak BH, Abdul Aziz R. Lyme Arthritis in Children on the Uptick in Western New York Area. Clin Med Insights Arthritis Musculoskelet Disord 2019; 12:1179544119890851. [PMID: 31819695 PMCID: PMC6882034 DOI: 10.1177/1179544119890851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
Objective: This study explores a suspected increasing incidence of Lyme arthritis in the Western New York pediatric population. In addition, we aim to describe a clinical picture of Lyme arthritis and the clinical features that distinguish it from other forms of arthritis. Methods: Patients diagnosed with Lyme arthritis between January 2014 and September 2018 were identified using International Classification of Diseases—10th Revision (ICD 10) codes for Lyme disease and Lyme arthritis. Patients were included in the study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, and (3) exhibited a positive Western blot. Results: A total of 22 patients were included in the study. There was a general trend toward an increasing number of cases of Lyme arthritis over the 45-month observation period. We identified 1 case in each 2014 and 2015, 4 cases in 2016, 7 in 2017, and 9 in the first 9 months of 2018. In total, 17 patients had arthritis as their only symptom at the time of diagnosis and 10 patients had a rash or a history that prompted suspicion of Lyme disease. The knee was the most frequent joint (86.4% of patients), and patients typically had 2 or fewer joints affected (86.4% of patients). Conclusions: A significant increase (P = .02) in Lyme arthritis cases was observed at Oishei Children’s Hospital of Buffalo. Lyme arthritis may clinically present similarly to other forms of arthritis, such as oligoarticular juvenile idiopathic arthritis, so health care providers should be aware of distinguishing clinical features, which include rapid onset of swelling and patient age. Because the geographic area of endemic Lyme disease is expanding, all health care providers need to be aware of Lyme arthritis as a possible diagnosis.
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Affiliation(s)
- Lauren N Lucente
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Aseel Abu-Dayya
- Department of Pediatrics, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA
| | - Teresa Hennon
- Department of Pediatric Rheumatology, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA
| | - Shamim Islam
- Department of Pediatric Infectious Disease, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA
| | - Brian H Wrotniak
- Department of Pediatrics, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA
| | - Rabheh Abdul Aziz
- Department of Pediatric Rheumatology, University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA.,Division of Allergy/Immunology and Rheumatology, UBMD Pediatrics, University at Buffalo, Buffalo, NY, USA
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Cheema J, Huynh AC, Prat SS. Multiple Sclerosis and psychosis: A case report. Mult Scler Relat Disord 2019; 34:158-161. [PMID: 31302591 DOI: 10.1016/j.msard.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 11/25/2022]
Abstract
Psychiatric symptoms resulting from Multiple Sclerosis (MS) itself or its treatment are well known. However, the relationship between psychotic episodes and Multiple Sclerosis remains debated. In this paper, we present the case of a woman who developed a chronic psychotic disorder a few months after the onset of MS. We describe the process which led us to make the diagnosis of Psychotic Disorder due to Medical Condition (Multiple Sclerosis). Because her criminal charges brought significant attention to her case, we also address the difficulty in treating a neurological condition with psychiatric features within the forensic context. Moreover, one of the main concerns of the patient was that Lyme Disease was the correct diagnosis as opposed to MS. We also report the difficulty of treating and initiating successful follow-up for a patient whose paranoia is enabled by the opinions of certain health advocacy groups.
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Affiliation(s)
- Jasreen Cheema
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | | | - Sébastien S Prat
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada; Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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Weiss T, Zhu P, White H, Posner M, Wickiser JK, Washington MA, Barnhill J. Latent Lyme Disease Resulting in Chronic Arthritis and Early Career Termination in a United States Army Officer. Mil Med 2019; 184:e368-e370. [PMID: 30839071 DOI: 10.1093/milmed/usz026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/07/2019] [Accepted: 02/05/2019] [Indexed: 11/12/2022] Open
Abstract
Lyme disease is a continuing threat to military personnel operating in arboriferous and mountainous environments. Here we present the case of a 24-year-old Second Lieutenant, a recent graduate from the United States Military Academy, with a history of Lyme disease who developed recurrent knee effusions following surgery to correct a hip impingement. Although gonococcal arthritis was initially suspected from preliminary laboratory results, a comprehensive evaluation contradicted this diagnosis. Despite antibiotic therapy, aspiration of the effusions, and steroid treatment to control inflammation, the condition of the patient deteriorated to the point where he was found to be unfit for duty and subsequently discharged from active military service. This case illustrates the profound effect that latent Lyme disease can have on the quality of life and the career of an active duty military member. It highlights the need for increased surveillance for Borrelia burgdorferi (B. burgdorferi) in military training areas and for the early and aggressive diagnosis and treatment of military personnel who present with the symptoms of acute Lyme disease.
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Affiliation(s)
- Thomas Weiss
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
| | - Peter Zhu
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
| | - Hannah White
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
| | - Matthew Posner
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
| | - J Kenneth Wickiser
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
| | - Michael A Washington
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
| | - Jason Barnhill
- Department of Chemistry and Life Science, Bartlett Hall, 753 Cullum Road, West Point, NY
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White J, Noonan-Toly C, Lukacik G, Thomas N, Hinckley A, Hook S, Backenson PB. Lyme Disease Surveillance in New York State: an Assessment of Case Underreporting. Zoonoses Public Health 2018; 65:238-246. [PMID: 27612955 PMCID: PMC10880064 DOI: 10.1111/zph.12307] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 11/29/2022]
Abstract
Despite the mandatory nature of Lyme disease (LD) reporting in New York State (NYS), it is believed that only a fraction of the LD cases diagnosed annually are reported to public health authorities. Lack of complete LD case reporting generally stems from (i) lack of report of provider-diagnosed cases where supportive laboratory testing is not ordered or results are negative (i.e. provider underreporting) and (ii) incomplete case information (clinical laboratory reporting only with no accompanying clinical information) such that cases are considered 'suspect' and not included in national and statewide case counts (i.e. case misclassification). In an attempt to better understand LD underreporting in NYS, a two-part study was conducted in 2011 using surveillance data from three counties. Case misclassification was assessed by obtaining medical records on suspect cases and reclassifying according to the surveillance case definition. To assess provider underreporting, lists of patients for whom ICD-9-CM code 088.81 (LD) had been used were reported to NYS Department of Health (NYSDOH). These lists were matched to the NYSDOH case reporting system, and medical records were requested on patients not previously reported; cases were then classified according to the case definition. When including both provider underreporting and case misclassification, approximately 20% (range 18.4-24.6%) more LD cases were identified in the three-county study area than were originally reported through standard surveillance. The additional cases represent a minimum percentage of unreported cases; the true percentage of unreported cases is likely higher. Unreported cases were more likely to have a history of erythema migrans (EM) rash and were more likely to be young paediatric cases. Results of the study support the assertion that LD cases are underreported in NYS. Initiatives to increase reporting should highlight the importance of reporting clinically diagnosed EM and be targeted to those providers most likely to diagnose LD, specifically providers treating paediatric patients.
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Affiliation(s)
- J. White
- New York State Department of Health, Albany, NY, USA
| | | | - G. Lukacik
- New York State Department of Health, Albany, NY, USA
| | - N. Thomas
- New York State Department of Health, Albany, NY, USA
| | - A. Hinckley
- Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - S. Hook
- Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Abstract
INTRODUCTION Urine is a highly desirable biospecimen for biomarker analysis because it can be collected recurrently by non-invasive techniques, in relatively large volumes. Urine contains cellular elements, biochemicals, and proteins derived from glomerular filtration of plasma, renal tubule excretion, and urogenital tract secretions that reflect, at a given time point, an individual's metabolic and pathophysiologic state. AREAS COVERED High-resolution mass spectrometry, coupled with state of the art fractionation systems are revealing the plethora of diagnostic/prognostic proteomic information existing within urinary exosomes, glycoproteins, and proteins. Affinity capture pre-processing techniques such as combinatorial peptide ligand libraries and biomarker harvesting hydrogel nanoparticles are enabling measurement/identification of previously undetectable urinary proteins. Expert commentary: Future challenges in the urinary proteomics field include a) defining either single or multiple, universally applicable data normalization methods for comparing results within and between individual patients/data sets, and b) defining expected urinary protein levels in healthy individuals.
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Affiliation(s)
- Michael Harpole
- a Center for Applied Proteomics and Molecular Medicine , George Mason University , Manassas , VA , USA
| | - Justin Davis
- b Department of Chemistry/Biochemistry , George Mason University , Manassas , VA , USA
| | - Virginia Espina
- a Center for Applied Proteomics and Molecular Medicine , George Mason University , Manassas , VA , USA
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Malhotra K, Ramanathan RS, Scott TF. Transient IgG deficiency with lesions in brain and spinal cord: a mimicker of common variable immunodeficiency syndrome. Acta Neurol Belg 2017; 117:761-763. [PMID: 27848135 DOI: 10.1007/s13760-016-0722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Konark Malhotra
- Department of Neurology, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA.
| | | | - Thomas F Scott
- Department of Neurology, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
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Abstract
Experimental Lyme arthritis provides a mouse model for exploring the development of pathology following infection of C3H mice with Borrelia burgdorferi. Infected mice develop a reliable inflammatory arthritis of the ankle joint with severity that typically peaks around two to three weeks post-infection and then undergoes spontaneous resolution. This makes experimental Lyme arthritis an excellent model for investigating the mechanisms that drive both the development and resolution phases of inflammatory disease. Eicosanoids are powerful lipid mediators of inflammation and are known to regulate multiple aspects of inflammatory processes. While much is known about the role of eicosanoids in regulating immune responses during autoimmune disease and cancer, relatively little is known about their role during bacterial infection. In this review, we discuss the role of eicosanoid biosynthetic pathways in mediating inflammatory responses during bacterial infection using experimental Lyme arthritis as a model system. We point out the critical role eicosanoids play in disease development and highlight surprising differences between sterile autoimmune responses and those occurring in response to bacterial infection. These differences should be kept in mind when designing therapies and treatments for inflammatory diseases.
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Affiliation(s)
- Charles R Brown
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO 65211, USA.
| | - Edward A Dennis
- Departments of Chemistry/Biochemistry and Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA.
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Miraglia CM. A Review of the Centers for Disease Control and Prevention's Guidelines for the Clinical Laboratory Diagnosis of Lyme Disease. J Chiropr Med 2016; 15:272-280. [PMID: 27857635 DOI: 10.1016/j.jcm.2016.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to review information regarding the current guidelines for the clinical laboratory diagnosis of Lyme disease as set forth by the Centers for Disease Control and Prevention (CDC) to chiropractic physicians and to discuss the clinical utility of this testing. METHODS The CDC's website was reviewed to determine what their current recommendations are for the clinical laboratory testing of Lyme disease. RESULTS The CDC's established guidelines recommend the use of a 2-tiered serologic testing algorithm for the evaluation of patients with suspected Lyme disease. CONCLUSION This review provides doctors of chiropractic with information to remain current with the CDC's recommended guidelines for Lyme disease testing because patients may present to their office with the associated signs and symptoms of Lyme disease.
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Affiliation(s)
- Caterina M Miraglia
- University of Massachusetts Dartmouth Department of Medical Laboratory Science, North Dartmouth, MA
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Affiliation(s)
- Tanja Petnicki-Ocwieja
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center Boston, MA, USA
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Welsh EJ, Cohn KA, Nigrovic LE, Thompson AD, Hines EM, Lyons TW, Glatz AC, Shah SS. Electrocardiograph Abnormalities in Children With Lyme Meningitis. J Pediatric Infect Dis Soc 2012; 1:293-8. [PMID: 26619422 DOI: 10.1093/jpids/pis078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/03/2012] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the prevalence of and identify risk factors for electrocardiographic (ECG) changes in children presenting with Lyme meningitis. DESIGN This was a cross-sectional study. SETTING The study was set in three large urban pediatric tertiary care centers. PARTICIPANTS Children who were diagnosed with Lyme meningitis and underwent ECG testing were included. OUTCOME MEASURE The presence of an ECG abnormality associated with early-disseminated Lyme infection was the outcome measure. RESULTS Multivariable logistic regression was used to identify factors independently associated with ECG abnormalities. ECG testing was performed in 103 (66%) of 157 children with Lyme meningitis. The median age of these children was 10.8 years; 68% were male. ECG abnormalities, identified in 34 (33%) subjects, included one or more of the following: atrioventricular block (n = 16; 16%), ST-T wave changes (n = 14; 14%), and prolongation of the corrected QT interval (n = 11; 11%). In multivariate analysis, age ≥13 years and fever for ≥5 days were independently associated with ECG abnormalities. The probability of ECG abnormalities was greater than 50% in those with fever for ≥5 days or age ≥13 years, and if a subject fulfilled both criteria, the probability of ECG abnormalities was 83% (95% confidence interval: 50%-96%). CONCLUSIONS Electrocardiographic abnormalities occur commonly in children with Lyme meningitis. While older children with prolonged fever were most likely to have such abnormalities, the clinical consequences of asymptomatic ECG abnormalities in children with Lyme meningitis are not known.
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Affiliation(s)
| | - Keri A Cohn
- Emergency Medicine, and Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | - Amy D Thompson
- Division of Emergency Medicine, Alfred I. duPont Hospital for Children, Wilmington, Delaware; Divisions of
| | | | - Todd W Lyons
- Emergency Medicine, and Harvard Medical School, Boston, Massachusetts
| | - Andrew C Glatz
- Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Samir S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, and Divisions of Infectious Diseases Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio
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Praharaj AK, Jetley S, Kalghatgi AT. Seroprevalence of Borrelia burgdorferi in North Eastern India. Med J Armed Forces India 2011; 64:26-8. [PMID: 27408074 DOI: 10.1016/s0377-1237(08)80140-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 07/13/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is paucity of data on Lyme disease in India. A seroprevalence study of B burgdorferi infection was carried out in North-Eastern states of India to assess the same. METHODS Sera from 500 individuals of North-Eastern states of India were tested for IgG antibody by enzyme linked immunosorbent assay using commercial kits containing recombinant antigen. RESULT Out of 500 persons, 65 (13%) were positive for B burgdorferi specific lgG Females showed higher positivity rate as compared to males (15.86% vs 10.95%). Higher prevalence rate was observed in the age group of 15-30 years in both sexes (11.48% in male and 18.69% in female). Arunachal Pradesh showed higher seroprevalence rate (17.8%) as compared to other North-Eastern states (8.46-9.6%). CONCLUSION Seropositivity to B burgdorferi suggests infection by the organism and presence of Lyme disease in these areas. Further population and vector biology studies are required to find out the exact species involved in transmission of the organism.
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Affiliation(s)
| | - S Jetley
- Ex-Classified Specialist (Pathology), AFTC, Delhi Cantt
| | - A T Kalghatgi
- Director (Pension), Office of DGAFMS, Ministry of Defence, M Block New Delhi
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