Wiener klinische Wochenschrift
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Serum and cerebrospinal fluid (CSF) procalcitonin levels were assessed and compared for different groups of patients with Lyme borreliosis. ⋯ In the large majority of patients with Lyme borreliosis procalcitonin values are within normal range. Serum and CSF procalcitonin levels are of no value for differentiation between early localised, early disseminated and chronic Lyme borreliosis.
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Wien. Klin. Wochenschr. · Jul 2002
Isolation of Borrelia burgdorferi sensu lato from a fibrous nodule in a patient with acrodermatitis chronica atrophicans.
A 66-year-old woman presented with a 2-year history of acrodermatitis chonica atrophicans of her left hand and associated fibrous nodules. In addition to skin changes she experienced profound fatigue, and pains and swelling of the left elbow and dorsum of the left hand. On clinical examination, typical livid-red discoloration of the skin distally from the left elbow was evident with atrophy on the dorsum of the hand. ⋯ The patient received a 3-week course of ceftriaxone (2 g daily, i.v.). Her condition progressively improved: pains and swelling vanished by the end of treatment, fibrous nodules diminished and skin lesions gradually began to fade. According to a MEDLINE literature search this is the first report of the isolation of B. burgdorferi sensu lato from a fibrous nodule in a patient with acrodermatitis chronica atrophicans.
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Wien. Klin. Wochenschr. · Jul 2002
Development of erythema migrans in spite of treatment with antibiotics after a tick bite.
The recent information on the appearance of erythema migrans despite prophylaxis with 200 mg of doxycycline was the stimulus for a search among our patients for those who developed the skin lesion regardless of receiving antibiotics after a tick bite. ⋯ Our study did not enable us to assess the frequency of antimicrobial prophylaxis failure or the efficacy of individual antibiotics for the prevention of Lyme borreliosis. However, the seven patients presented demonstrate that antibiotic prophylaxis for Lyme borreliosis after a tick bite, at least in Europe, is not entirely effective.
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During the period from 1986 to 2000, 85 adult patients with solitary borrelial lymphocytoma were diagnosed at the Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia. There were 36 (42.4%) females and 49 (57.6%) males with a median age of 49 (15-74) years. Borrelial lymphocytoma was located on the breast (nipple--areola mammae region) in 68 (80%) patients, on the ear lobe in eight (9.4%), and in other locations in nine (10.6%). ⋯ Median time to complete disappearance of lymphocytoma was 28 days (range 7-270 days) after the institution of antibiotic treatment; disappearance took longer in patients with prolonged duration of the skin lesion prior to treatment. Treatment failure was registered in 11 (12.9%) patients who were later re-treated. The outcome of borrelial infection assessed at the end of a follow-up period of one year was favourable.
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Wien. Klin. Wochenschr. · Jul 2002
Cerebrospinal fluid findings in adult patients with multiple erythema migrans.
This prospective study was performed at the Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia, in the period from 1991 to 2000. We included all adult patients with multiple erythema migrans who gave consent to lumbar puncture, had routine blood and CSF tests performed, and borrelial antibody titres in CSF and blood determined. In the majority of these patients skin, blood, and CSF specimens were cultured in MKP medium for the presence of Borrelia. ⋯ Intrathecal borrelial antibody production was demonstrated in eight (4%) patients (only three of them had elevated CSF cell counts) and B. burgdorferi sensu lato was isolated from skin lesions, blood, and CSF in 77/191 (40.3%), 3/154' (1.95%), and 2/200 (1%) patients, respectively. B. afzelii predominated among the isolates. In patients with multiple erythema migrans abnormal CSF findings are not rare and may be present without any clinical sign of central nervous system involvement.