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:
Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia.
AUTHORS:
Sigal LH; Patella SJ
AUTHOR AFFILIATION:
Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick.
SOURCE:
Pediatrics 1992 Oct;90(4):523-8
ABSTRACT:
In areas endemic for Lyme disease there is increasing concern and anxiety about possible chronic and untreatable manifestations of the disease. The authors have diagnosed fibromyalgia in many patients with chronic musculoskeletal complaints in whom chronic Lyme arthritis had previously been diagnosed as the cause of their joint pains. Fibromyalgia is a common disorder, causing arthralgia (not true arthritis), fatigue, and debility. The repeated and/or long-term antibiotic therapy prescribed for "chronic Lyme disease" is not successful in curing the symptoms of fibromyalgia. Especially in areas where anxiety about Lyme disease is great, it is important to be careful in diagnosing chronic Lyme disease. Fibromyalgia is a potentially treatable and curable cause of chronic complaints and should be considered in the differential diagnosis of "refractory Lyme arthritis."

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 borreliosis.
AUTHORS:
Holt DA; Pattani NJ; Sinnott JT 4th; Bradley E
AUTHOR AFFILIATION:
Department of Internal Medicine, University of South Florida College of Medicine, Tampa.
SOURCE:
Infect Control Hosp Epidemiol 1991 Aug;12(8):493-6
ABSTRACT:
Lyme borreliosis is a complex infectious process that primarily involves the skin, heart, joints, and nervous systems. The infectious agent is the spirochete B burgdorferi, which is transmitted by the Ixodes genus of ticks. The clinical presentations of Lyme disease are protean because of the overlap of stages and varied organ system involvement. Furthermore, as previously mentioned, approximately one-third of Lyme patients are unable to recall a tick bite. Lyme borreliosis should be suspected in anyone with a tick bite. The findings of an EM lesion and flu-like symptoms strongly favor the diagnosis of stage 1 disease. Stage 2 evolves weeks to months after a tick bite, with cardiac and neurological findings as well as musculoskeletal pain. Stage 3 primarily manifests itself as arthritis associated with continuing or additional neurologic complications. Serologic studies are currently the most practical laboratory aid in diagnosis, because almost all infected individuals have a positive antibody response to the spirochete. Treatment with antibiotics usually proves successful, although longer courses of therapy may be needed in later stages of the disease, and some patients may not respond.

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.reocities.com/HotSprings/Oasis/6455/persistence-special-abstracts.html

Seronegative or False Negative Lyme disease - An Annotated Bibliography
http://www.reocities.com/HotSprings/Oasis/6455/seronegative-special.html

Latent, dormant, subclinical, or asymptomatic Lyme Disease - An Annotated Bibliography http://www.reocities.com/HotSprings/Oasis/6455/latent-biblio.html

For more information about antibiotics and Lyme disease, see:

Antibiotics and Lyme Disease http://www.reocities.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.reocities.com/HotSprings/Oasis/6455/therapy-special-abstracts.html



For more information about Lyme disease, see:

Lots Of Links On Lyme Disease
http://www.reocities.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


This page hosted by Get your own Free Home Page