Lyme disease: Insight from social sciences

This article is a selective literature review of social science works published on Lyme disease that draws on other articles published on similar health hazards. These works present Lyme borreliosis as an “archetypal” example of modern infectious risks. It is an “invisible” risk resulting from interactions between human activities, ecosystems, and pathogens. To tackle this risk, health authorities promote individual-based prevention measures. Perceptions of the general population should thus be better understood: different from the perceptions of experts, the general population's perceptions are socially differentiated, inclined to an “optimism bias”, and influenced by personal stories. One should also not forget the dilemmas faced by the general population when contemplating preventive behavior. The “chronic Lyme disease” controversy illustrates the modern disappointment in science, the leveling of the general population's and experts’ relative opinions, and the progressive interference of the former with expert matters.     

The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort

The 1996 Five-Factor Score (FFS) for systemic necrotizing vasculitides (polyarteritis nodosa [PAN], microscopic polyangiitis [MPA], and Churg-Strauss syndrome [CSS]) is used to evaluate prognosis at diagnosis. In the current study we revisited the FFS, this time including Wegener granulomatosis (WG).We analyzed clinical, laboratory, and immunologic manifestations present at diagnosis of systemic necrotizing vasculitides for 1108 consecutive patients registered in the French Vasculitis Study Group database. All patients met the American College of Rheumatology and Chapel Hill nomenclature criteria. Univariable and multivariable analyses yielded the 2009 FFS for the 4 systemic necrotizing vasculitides.Overall mortality was 19.8% (219/1108); mortality for each of the SNV is listed in descending order: MPA (60/218, 27.5%), PAN (86/349, 24.6%), CSS (32/230, 13.9%), and WG (41/311, 13.2%) (p < 0.001). The following factors were significantly associated with higher 5-year mortality: age >65 years, cardiac symptoms, gastrointestinal involvement, and renal insufficiency (stabilized peak creatinine ≥150 μmol/L). All were disease-specific (p < 0.001); the presence of each was accorded +1 point. Ear, nose, and throat (ENT) symptoms, affecting patients with WG and CSS, were associated with a lower relative risk of death, and their absence was scored +1 point (p < 0.001). Only renal insufficiency was retained (not proteinuria or microscopic hematuria) as impinging on outcome. According to the 2009 FFS, 5-year mortality rates for scores of 0, 1, and ≥2 were 9%, 21% (p < 0.005), and 40% (p < 0.0001), respectively.The revised FFS for the 4 systemic necrotizing vasculitides now comprises 4 factors associated with poorer prognosis and 1 with better outcome. The retained items demonstrate that visceral involvement weighs heavily on outcome. The better WG prognosis for patients with ENT manifestations, even for patients with other visceral involvement, compared with the prognosis for those without ENT manifestations, probably reflects WG phenotype heterogeneity.     

A prospective follow-up of Epstein-Barr virus LMP1 genotypes in saliva and blood during infectious mononucleosis

To monitor multiple Epstein-Barr virus (EBV) infections during the early and convalescent stages of infectious mononucleosis (IM), a cloning and sequencing study of the LMP1 gene was conducted in saliva and peripheral blood mononuclear cells (PBMCs) from 23 patients with IM at day 0 (D0) and day 180 (D180) after the onset of the disease. Multiple EBV strains were detected in 9 (39%) of the patients during follow-up, with 7 of 9 cases detected as early as D0. Six of the nine patients harbored the same dominant strain in saliva and PBMCs during follow-up, with a trend toward a restriction of the number of EBV strains in saliva but not in PBMCs at D180. Furthermore, transmission of a minor strain was observed between partners in a heterosexual couple. There was no correlation between multiple infections and EBV DNA load in either compartment.     

Platelet alloimmunization after multiple transfusions: a prospective study of 50 patients

Fifty polytransfused patients were prospectively studied to determine the frequency of post-transfusion alloimmunization and its influence on the response to platelet transfusion. Platelet- and HLA-specific antibodies were detected by means of the standard and antiglobulin-augmented lymphocytotoxicity techniques (LCT), the platelet suspension indirect immunofluorescence test (PSIIFT), and monoclonal antibody immobilization of platelet antigens (MAIPA). HLA antibodies were detected in 13 patients (26%) (IgM = 6; IgG = 6; IgM + IgG = 1). The standard LCT was positive in 12 of these 13 patients. Complement-independent HLA antibodies, only detectable in the PSIIFT and the antiglobulin-augmented LCT, were documented in two patients and were associated with poor post-transfusion platelet recovery in the patient who could be evaluated. All the HLA antibodies were detected in the PSIIFT, while only four were detected in the MAIPA. Platelet-specific alloantibodies were found in two patients by means of PSIIFT or MAIPA and may have led to poor post-transfusion platelet recovery in one patient. Platelet autoantibodies were detected in two patients but were not associated with platelet refractoriness. Paraformaldehyde-dependent platelet antibodies were detected in 11 patients but were not associated with platelet refractoriness.     

Social acceptability of HIV screening among pregnant women

The paper presents the results of a survey about risk perception, knowledge, and attitudes towards HIV infection among 397 pregnant women in France. The survey was carried out between December 1987 and March 1988 in two Paris-region maternity hospitals where HIV testing is routinely proposed during the first prenatal visit. Uptake of HIV prenatal testing has been rapid in France: before coming to the maternity hospitals, 26.5% of women had already been tested. Social acceptability of testing is high, 68.8% of the sample even supporting mandatory prenatal HIV screening. Such acceptability appears to be based less on an in-depth knowledge about the risks of transmission from mother-to-fetus than on the general French context of free-of-charge mandatory prenatal care and on the potentially reassuring effect of a true negative test. Consensus about abortion for HIV-infected pregnant women is strong (80.1%) and is not influenced by religious beliefs, in contrast to attitudes toward abortion in the case of fetal handicaps. This social environment creates special difficulties for the management of the complex dilemmas regarding pregnancy and childbearing for HIV-infected women.