山东省沂蒙山区莱姆病自然疫源地调查

目的 :调查山东省沂蒙山区莱姆病自然疫源地。方法 :1992～ 1999年设点 ,用间接免疫荧光抗体试验进行人群莱姆病感染调查 ;用直接免疫荧光抗体法进行蜱中肠带螺旋体率调查 ;取鼠的肾脏、膀胱分离病原。结果 :沂蒙山区人群莱姆病平均感染率为 7.50 % ,林区人群感染率明显高于非林区人群 ;该地区蜱类以长角血蜱为优势种 ,该蜱中肠携带莱姆病螺旋体率为 12 .0 % ,从86组长角血蜱培养物中获得 2株莱姆病螺旋体。结论 :从病原学上证实沂蒙山区为莱姆病自然疫源地     

湘南莽山林区莱姆病疫源地的调查

「目的」证实湘南莽山林区莱姆闰疫源地的存在。「方法」选择莽山林区为调查点,用间接免疫荧光抗体试验（ＩＦＡ）进行人群的血清学检测;用直接免疫荧光抗体试验（ＤＦＡ）和暗视野显微镜观察进行媒介蜱的病原学鉴定。「结果」检测３９５份自然人群的血清,莱姆病感染率为６．３３％,不同职业人群感染率差异无显著性（χ＾２＝２．５２８,Ｐ〉０．０５）;检查蜱２１２只,微小牛蜱为优势种,其中肠带莱姆病螺旋体率为１５％（３／２０）。「结论」可以确定湘南莽山林区存在莱姆病的自然疫源地。     

Not All Erythema Migrans Lesions Are Lyme Disease

Background

Lyme disease is the number one arthropod-transmitted disease in the US, and one of the diagnostic criteria for the illness is development of an erythematous bull's-eye rash around a tick bite that may expand over time, hence the term erythema migrans. However, there are other erythema migrans-like rashes, such as those from a condition known as southern tick-associated rash illness. This article describes a patient with an erythema migrans-like lesion similar to that associated with Lyme disease, resulting from a bite by a nymphal-stage lone star tick, Amblyomma americanum.

海南省关节炎和神经系统疾病患者莱姆病调查

目的 了解我国海南省关节炎或神经性疾病患者的莱姆病感染状况,并确认海南省是否存在莱姆病人。方法 海南省三亚市人民医院提供血清542份,均为关节炎或神经性疾病患者。采用间接免疫荧光法(Indirect Fluorescent-Antibody Test, IFA)和免疫印迹法(Western Blot,WB)对血清标本进行莱姆病抗体检测;并采用巢式PCR法对WB抗体阳性的血清标本进行病原学检测。结果 IFA方法检测血清样本542份,54份阳性,阳性率为9.96%。应用WB法对上述54份IFA阳性血清样本进行检测,12份阳性。采用巢式PCR方法检测12份WB阳性样本,2份阳性,测序结果表明两份均为B.garinii基因型。结论 本研究证实了海南省人群中存在莱姆病。建议当地医生在诊治关节炎和神经性疾病患者时,可以考虑其是否罹患莱姆病。     

IFA、ELISA和WB用于莱姆病血清学诊断的比较研究

目的比较研究间接免疫荧光试验（IFA）、酶联免疫吸附试验（ELISA）和蛋白免疫印迹试验（WB）3种检测方法对莱姆病血清学的诊断效果。方法收集临床疑似莱姆病患者血清标本及其流行病学和临床资料,分别采用IFA、ELISA和WB进行血清抗伯氏疏螺旋体抗体（IgM和IgG）检测,结合流行病学和临床资料进行综合分析。结果实验共检测莱姆病疑似患者血清398份,ELISA阳性86例,阳性率21.61%,其中IgM阳性27例,IgG阳性59例;IFA阳性82例,阳性率20.60%,其中IgM阳性26例,IgG阳性56例;WB阳性83例,阳性率20.85%,其中IgM阳性31例,IgG阳性52例;并且实验表明,在对于游走性红斑病例的诊断上,WB法阳性率明显高于ELISA和IFA（χ2=6.34,P〈0.05）。结论在莱姆病的实验室诊断中,IFA、ELISA和WB3种方法结合运用,可提高诊断的灵敏性和特异性;WB在排除ELISA和IFA的假阳性结果中有着重要作用。     

European neuroborreliosis: quality of life 30 months after treatment

Eikeland R, Mygland Å, Herlofson K, Ljøstad U. European neuroborreliosis: quality of life 30 months after treatment.
Acta Neurol Scand: 2011: 124: 349–354.
© 2011 John Wiley & Sons A/S. Objectives – The prognosis after Lyme neuroborreliosis (LNB) is debated. The aim of this study was to assess health‐related Quality of Life (QoL) and neurological symptoms 30 months after treatment in European patients with LNB. Materials and methods – In a prospective case–control designed study, we investigated 50 well‐characterized patients with LNB who had participated in a treatment trial for LNB 30 months earlier and 50 matched control persons with the health QoL questionnaire Short‐Form 36 (SF‐36), the Fatigue Severity Scale (FSS), the Montgomery and Åsberg Depression Rating Scale (MADRS), the Starkstein Apathy Scale (SAS), and the Mini Mental State (MMS). Clinical and demographic data were collected by semi‐structured interviews and clinical neurological examination. Results – Lyme neuroborreliosis‐treated patients scored lower than control persons in the SF‐36 domains physical component summary (PCS) (44 vs 51 P < 0.001) and mental component summary (MCS) (49 vs 54 P = 0.010). They also scored lower than control persons in all the SF‐36 subscales, except for bodily pain, and on FSS (3.5 vs 2.1 P < 0.001), but not on MMS (28 vs 29 P = 0.106). There was a difference in MADRS (3.1 vs 0. 8 P = 0.003) and SAS (13 vs 11 P = 0.016), but the scores were low in both groups. Fatigue was the most frequently reported symptom among LNB‐treated patients (50%). Patients who reported complete recovery (56%) after LNB had similar QoL scores as the controls. Conclusion – European persons treated for LNB have poorer health‐related QoL and have more fatigue than persons without LNB.     

Neuroborreliosis—an epidemiological,clinical and healthcare cost study from an endemic area in the south-east of Sweden

We studied retrospectively the medical records of all patients (n = 150) diagnosed, by cerebrospinal fluid (CSF) analysis, with neuroborreliosis (NB) in Jönköping County, Sweden during 2000–2005. The number of NB cases increased from 5/100 000 to 10/100 000 inhabitants/year. In 17% of the patients, anti-Borrelia antibodies were found in CSF but not in serum at the time of diagnosis. Facial palsy, headache and fever were frequent manifestations in children, whereas unspecific muscle and joint pain were the most commonly reported symptoms in older patients. Post-treatment symptoms persisting for more than 6 months occurred in 13%, and the patients concerned were significantly older, had longer-lasting symptoms prior to treatment, had higher levels of Borrelia-specific IgG in CSF, and more often had radiculitis. The total cost of NB-related healthcare was estimated to be €500 000 for the entire study group (€3300 per patient), and the cost of social benefits was estimated to be €134 000 (€2000 per patient). CSF analysis is necessary for the diagnosis of NB, because some patients develop antibodies in serum later than in CSF. Early diagnosis of borreliosis would result in reduced human suffering and in economic gain.     

The benefit of the reverse transfer function in the fitting process of the Vibrant Soundbridge middle ear implant

From an otological standpoint, Lyme disease can manifest itself as Ménière's disease both clinically and electrophysiologically. The aim of this study was to describe the findings of routine clinical, auditory and vestibular tests in patients with Ménière's and Lyme disease and to use electrocochleography (ECoG) to assess the presence of endolymphatic hydrops (EH) in both diseases. Transtympanic ECoG was performed in 91 patients with Ménière's disease and in 11 patients with confirmed Lyme disease. In both diseases the majority of patients had more than one complaint. There was one case with isolated hearing loss in the Lyme disease group. Typical clinical manifestations of Ménière's disease (vertigo, sensorineural hearing loss and tinnitus) were found in 6 11 patients (54.5%) in the Lyme disease group. The ECoG results indicated that there were 65 91 patients (71.4%) with Ménière's disease and 5 patients (45.5%) with Lyme disease who presented with EH. No statistically significant difference was found between the incidence of different symptoms of Ménière's and Lyme disease. On the basis of these results, patients with Lyme disease should undergo careful examination and investigation, especially in endemic regions. The presence of EH does not exclude the presence of infection with borreliosis as a cause of Ménière's disease-like symptoms.