scholarly journals Tick-transmitted co-infections among erythema migrans patients in a general practice setting in Norway: a clinical and laboratory follow-up study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Knut Eirik Eliassen ◽  
Lukas Frans Ocias ◽  
Karen A. Krogfelt ◽  
Peter Wilhelmsson ◽  
Susanne Gjeruldsen Dudman ◽  
...  
Keyword(s):  
General Practice ◽  
Disease Duration ◽  
Spotted Fever ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Babesia Microti ◽  
Spotted Fever Group ◽  
Skin Biopsies ◽  
The Impact

Abstract Background Erythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than Borrelia, and the impact of co-infection on the clinical manifestations and disease duration. Methods Skin biopsies from 139/188 EM patients were analyzed using PCR for Neoehrlichia mikurensis, Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Follow-up sera from 135/188 patients were analyzed for spotted fever group (SFG) Rickettsia, A. phagocytophilum and Babesia microti antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8/188) or EM duration of ≥ 21 days (69/188) were analyzed, using PCR, for A. phagocytophilum, Rickettsia spp., Babesia spp. and N. mikurensis. Day 14 sera were tested for TBEV IgG. Results We detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG Rickettsia and A. phagocytophilum were detected in 11/135 and 8/135, respectively. Three patients exhibited both SFG Rickettsia and A. phagocytophilum antibodies, albeit negative PCR. No antibodies were detected against B. microti. 2/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection. Conclusions Co-infection with N. mikurensis, A. phagocytophilum, SFG Rickettsia, Babesia spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG Rickettsia and A. phagocytophilum in some patients, no clinical implications could be demonstrated.

scholarly journals Surveillance of Ticks and Tick-Borne Pathogens in Suburban Natural Habitats of Central Maryland

2021 ◽  
Author(s):  
Matthew T Milholland ◽  
Lars Eisen ◽  
Robyn M Nadolny ◽  
Andrias Hojgaard ◽  
Erika T Machtinger ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Spotted Fever ◽  
Babesia Microti ◽  
Borrelia Burgdorferi Sensu Lato ◽  
Spotted Fever Group ◽  
Borrelia Miyamotoi ◽  
Natural Habitats ◽  
Questing Ticks ◽  
Tick Vectors

Abstract Lyme and other tick-borne diseases are increasing in the eastern United States and there is a lack of research on integrated strategies to control tick vectors. Here we present results of a study on tick-borne pathogens detected from tick vectors and rodent reservoirs from an ongoing 5-yr tick suppression study in the Lyme disease-endemic state of Maryland, where human-biting tick species, including Ixodes scapularis Say (Acari: Ixodidae) (the primary vector of Lyme disease spirochetes), are abundant. During the 2017 tick season, we collected 207 questing ticks and 602 ticks recovered from 327 mice (Peromyscus spp. (Rodentia: Cricetidae)), together with blood and ear tissue from the mice, at seven suburban parks in Howard County. Ticks were selectively tested for the presence of the causative agents of Lyme disease (Borrelia burgdorferi sensu lato [s.l.]), anaplasmosis (Anaplasma phagocytophilum), babesiosis (Babesia microti), ehrlichiosis (Ehrlichia ewingii, Ehrlichia chaffeensis, and ‘Panola Mountain’ Ehrlichia) and spotted fever group rickettsiosis (Rickettsia spp.). Peromyscus ear tissue and blood samples were tested for Bo. burgdorferi sensu stricto (s.s), A. phagocytophilum, Ba. microti, and Borrelia miyamotoi. We found 13.6% (15/110) of questing I. scapularis nymphs to be Bo. burgdorferi s.l. positive and 1.8% (2/110) were A. phagocytophilum positive among all sites. Borrelia burgdorferi s.s. was found in 71.1% (54/76) of I. scapularis nymphs removed from mice and 58.8% (194/330) of captured mice. Results from study on tick abundance and pathogen infection status in questing ticks, rodent reservoirs, and ticks feeding on Peromyscus spp. will aid efficacy evaluation of the integrated tick management measures being implemented.

scholarly journals POS0941 IN SPONDYLOARTHRITIS PATIENTS THE PRESENCE OF COMORBIDITIES IS AN INDEPENDENT PREDICTOR OF INSUFFICIENT RESPONSE TO THERAPY WITH BIOLOGIC AGENTS AND TREATMENT DISCONTINUATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 733.2-734
Author(s):  
I. Flouri ◽  
N. Kougkas ◽  
N. Avgustidis ◽  
A. Repa ◽  
A. Eskitzis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Disease Duration ◽  
Cox Regression ◽  
Independent Predictor ◽  
Response To Therapy ◽  
Treatment Discontinuation ◽  
Randomized Controlled Studies ◽  
Insufficient Response ◽  
The Impact

Background:Long-term observational studies of patients under biologic disease-modifying anti-rheumatic drug (bDMARD) therapies in routine clinical practice can provide us with important data regarding patients with comorbidities, who are usually excluded from randomized controlled studies.Objectives:To study the impact of comorbidities in the outcome (response and persistence to therapy) of patients with spondyloarthritis (SpA) receiving bDMARDs in real-world clinical practice.Methods:Prospective study of all patients who start a bDMARD in a tertiary centre University Hospital after their consent. All patient comorbidities [among a list of approximately 100 pre-specified major comorbidities] are registered by treating physicians at baseline and during follow-up.Comorbidities were studied as total Comorbidities Count (CC) and rheumatic disease comorbidity index (RDCI). Statistical analyses were performed using logistic and Cox regression models, adjusting for the potential confounding of age, sex, disease duration, diagnosis (axial vs. peripheral SpA), number of previous conventional synthetic and biologic DMARDs, year of therapy start, and co-administered methotrexate and corticosteroids (yes/no). Analyses of response to therapy also included baseline BASDAI or ASDAS indices as confounding variables.Results:A total of 603 biologic treatments (1st: 298, 2nd: 157, ≥3rd: 148) were analyzed. Half (51%) of the patients were female, 413 patients had axial SpA (AxSpA) and 190 peripheral SpA (perSpA). At baseline, median (IQR) age: 48 (38-57) years, disease duration: 11 (4-19) years, CC: 2 (1-4) and RDCI: 1 (0-2). Both comorbidity indices were significantly higher in perSpA compared to AxSpA (p<0.001).At 6 months of therapy, 31% of patients with AxSpA achieved BASDAI50 and 39% had ASDAS-ESR < 2.1. Higher CC was an independent predictor of insufficient response according to BASDAI50 [OR (95%) = 0.70 (0.52-0.94), p=0.019] and higher RDCI was predicting failure to achieve ASDAS-ESR < 2.1 [OR (95%) = 0.59 (0.37-0.94), p=0.027]. Other independent predictors of non-response were age, longer disease duration and (for ASDAS-ESR<2.1) higher baseline disease activity.During 1405 patient-years of follow-up, 349 (58%) treatments were discontinued. The adjusted hazard ratio for bDMARD discontinuation within the first 2 years of treatment due to insufficient response was doubled in patients with CC ≥2 versus those with CC ≤1 [HR = 2.27 (1.14-4.53), p=0.020] or with RDCI ≥1 (vs. RDCI = 0) [HR = 2.23 (1.22-4.07), p=0.009]. Comorbidities’ indices were not significant predictors of treatment discontinuations due to adverse events.Conclusion:The presence of comorbidities in patients with SpA is an independent predictor for insufficient 6-month response to bDMARDs and resultant treatment discontinuation due to failure.Acknowledgements:This research is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Reinforcement of Postdoctoral Researchers - 2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (ΙΚΥ).Disclosure of Interests:None declared

scholarly journals Spotted fever rickettsiosis in Coronel Fabriciano, Minas Gerais State

2003 ◽  
Vol 36 (4) ◽  
pp. 479-481 ◽  
Author(s):  
Márcio Antônio Moreira Galvão ◽  
Simone Berger Calic ◽  
Chequer Buffe Chamone ◽  
Cláudio Lísias Mafra S. ◽  
Gracco Cesarino Filho ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Spotted Fever ◽  
Clinical Manifestations ◽  
Minas Gerais ◽  
Spotted Fever Group ◽  
Minas Gerais State ◽  
Brazilian Spotted Fever ◽  
Spotted Fever Group Rickettsia ◽  
Rickettsial Diseases

We report cases of spotted fever rickettsiosis in Coronel Fabriciano Municipality of Minas Gerais State, Brazil. The cases occurred in May and June of 2000. During this period there were two deaths among children from an area named Pedreira in a periurban area of this municipality. In a boy who died with clinical manifestations of Brazilian spotted fever, a necropsy revealed the presence of a spotted fever group Rickettsia. The serological results confirm the difficulty in the differential diagnosis of patients with symptoms of rickettsial diseases.

Rickettsial Infections around the World, Part 1: Pathophysiology and the Spotted Fever Group

2005 ◽  
Vol 9 (2) ◽  
pp. 54-62
Author(s):  
Jashin J. Wu ◽  
David B. Huang ◽  
Katie R. Pang ◽  
Stephen K. Tyring
Keyword(s):  
Spotted Fever ◽  
Clinical Manifestations ◽  
Review Article ◽  
Learning Activity ◽  
Clinical Aspects ◽  
Spotted Fever Group ◽  
Infectious Agents ◽  
Important Group ◽  
Rickettsial Infections ◽  
Rickettsial Diseases

Background: The rickettsial diseases are an important group of infectious agents that have dermatological manifestations. These diseases are important to consider in endemic areas, but in certain suspicious cases, possible acts of bioterrorism should warrant prompt notification of the appropriate authorities. Objective: In this two part review article, we review these diverse diseases by examining established and up-to-date information about the pathophysiology, epidemiology, clinical manifestations, and treatment of the ricksettsiae. Methods: Using PubMed to search for relevant articles, we browsed over 500 articles to compose a clinically based review article. Results: Part one focuses on pathophysiology of the rickettsial diseases and the clinical aspects of the spotted fever group. Conclusions: At the completion of part one of this learning activity, participants should be able to discuss all of the clinical manifestations and treatments of the sported fever group. Participants should also be familiar with the pathophysiology of the rickettsial diseases.

scholarly journals Venous and Lung Thromboembolism in the Context of Lung Cancer: Clinical Manifestations, Risk Factors and Prognosis

2019 ◽  
Vol 32 (10) ◽  
pp. 647 ◽  
Author(s):  
Rosana Maia ◽  
Inês Neves ◽  
António Morais ◽  
Henrique Queiroga
Keyword(s):  
Lung Cancer ◽  
Venous Thromboembolism ◽  
Cancer Diagnosis ◽  
Negative Impact ◽  
Clinical Manifestations ◽  
Research Subjects ◽  
Lung Cancer Diagnosis ◽  
The Impact ◽  
The Relationship

Introduction: The relationship between cancer and thromboembolic events has been known for a long time. Lung and venous thromboembolism are frequent complications of lung cancer and its treatment, being a great cause of morbidity and mortality. We pretend to establish the relationship between lung and venous thromboembolism and lung cancer, describe patient characteristics and analyze the impact in the survival and prognosis.Material and Methods: It was a retrospective study. All research subjects were selected from lung cancer patients with a newly diagnosed lung and venous thromboembolism event admitted to Hospital S. João, between January 2008 and December 2013 and were followed until December 2014. Statistical analysis was performed with SPSS.Results: From the search, we obtained 113 patients. The majority was male, smokers or ex-smokers, and adenocarcinoma was the most frequent histologic type, being diagnosed mostly in advanced stages. We noticed that the median time between lung cancer diagnosis and lung venous thromboembolism was 2.9 months. In 24 patients (21.4%), the lung cancer diagnosis occurred after the lung and venous thromboembolism event and in 86 patients (76.8%), it occurred before the event. After a median follow up of 1.4 months, 107 (94.7%) patients died, 1 (0.9%) was lost to follow-up and 5 (4.4%) were still alive. The median survival rate was 1.5 months.Discussion: The diagnosis of lung and venous thromboembolism in patients with lung cancer is associated with bad prognosis. It occurs most frequently in patients with advanced disease, in the first months after lung cancer diagnosis and after beginning chemotherapy.Conclusion: Disease progression is an independent predictor with negative impact in overall survival.

Child Health General Practice Hubs: a service evaluation

2015 ◽  
Vol 101 (4) ◽  
pp. 333-337 ◽  
Author(s):  
Sarah Montgomery-Taylor ◽  
Mando Watson ◽  
Robert Klaber
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Child Health ◽  
Service Evaluation ◽  
High Patient Satisfaction ◽  
Patient Reported ◽  
The Impact ◽  
Lower Capacity ◽  
Inside Out

ObjectiveTo evaluate the impact of an integrated child health system.DesignMixed methods service evaluation.Setting and patientsChildren, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form ‘hubs’.InterventionsHospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an ‘Inside-Out’ change known as ‘Connecting Care For Children (CC4C)’.Main outcome measuresCases seen in clinic or discussed at MDT meetings and their follow-up needs. Hospital Episode data: outpatient and inpatient activity and A&E attendance. Patient-reported experience measures and professionals’ feedback.ResultsIn one hub, 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice. In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions and a 22% decrease in A&E attenders. Smaller hubs running at lower capacity in early stages of implementation had less impact on hospital activity. Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP and all respondents said they would recommend the service to family and friends. Professionals valued the improvement in knowledge and learning and, most significantly, the development of trust and collaboration.ConclusionsChild Health GP Hubs increase the connections between secondary and primary care, reduce secondary care usage and receive high patient satisfaction ratings while providing learning for professionals.

LABORATORY CONFIRMATION OF THE SPOTTED FEVER GROUP RICKETTSIOSES AMONG PATIENTS WITH TYPICAL AND ATYPICAL CLINICAL MANIFESTATIONS

2020 ◽  
Author(s):  
T.A. Chekanova ◽  
Keyword(s):  
New Species ◽  
Primary Infection ◽  
Spotted Fever ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Spotted Fever Group ◽  
Single Group ◽  
Laboratory Confirmation ◽  
Atypical Manifestations

In the group of patients with typical clinical signs of acute tick-borne rickettsioses, specific IgM and/or IgG with/without IgA were found in 75.6% cases. IgG were low avidity in most cases, which indicated the recent primary infection. More than 20% of sera have single group specific IgA. In patients with atypical manifestations highly avidity IgG were predominant, that along with the presence of IgM and/or IgA may indicate re-infection or infection by new species, which is different from previous pathogen of the tick-borne spotted group rickettsioses.

scholarly journals Clinical and epidemiologic characteristics of lyme borreliosis and tick-borne encephalitis mixed infections in Krasnoyarsk kray

2013 ◽  
Vol 94 (2) ◽  
pp. 211-215
Author(s):  
N S Minoranskaya ◽  
E I Minoranskaya
Keyword(s):  
Clinical Features ◽  
Lyme Borreliosis ◽  
Mixed Infection ◽  
Large Population ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Control Group ◽  
Mixed Infections ◽  
Tick Borne Encephalitis

Aim. To reveal clinical features of Lyme borreliosis and tick-borne encephalitis mixed infections in Krasnoyarsk Kray. Methods. The main group consisted of 226 patients with mixed infection of Lyme borreliosis and tick-borne encephalitis (males - 57.1%, females- 42.9%, mean age 43.7±1.0 years), who were examined and compared to the control group of 88 patients with tick-borne encephalitis alone (males - 56.8%, females - 43.2%, mean age 43.9±1.8 years). Results. About 40% of acute Lyme borreliosis cases in Krasnoyarsk Kray are a mixed infection of Lyme borreliosis and tick-borne encephalitis, that is closely related to a large population of Ixodidae infected by both agents. There is no characteristic epidemiologic background in more than a half of all cases. Typical clinical features for mixed infection of Lyme borreliosis and tick-borne encephalitis are severe onset with toxic constant hyperthermia or hyperpyrexia, and joint pain (18.6% of cases). Erythema migrans was present in 22.6% of cases, involvement of central nervous system (35.4%) was mostly often associated with meningitis and meningoencephalitis (29.2%). Bannwarth syndrome (3.1%) is a clinical type of Lyme borreliosis not associated with erythema in mixed infection. Cardiovascular system damage is transient and associated with intoxication. In 57.1% of cases the diagnosis of mixed infection was confirmed at dispensary follow-up 1.5, 3, 6 months after the clinical manifestations of the disease. Conclusion. The most common clinical form of mixed infection is the non-erithemic form of Lyme borreliosis and febrile form of tick-borne encephalitis, late Lyme borreliosis after the suffered mixed infection was registered in 30.1% of cases.

The prevalence and clinical characteristics of tick-borne diseases at One Sentinel Hospital in Northeastern China

Parasitology ◽  
2018 ◽  
Vol 146 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Hong-Bo Liu ◽  
Ran Wei ◽  
Xue-Bing Ni ◽  
Yuan-Chun Zheng ◽  
Qiu-Bo Huo ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Spotted Fever ◽  
Erythema Migrans ◽  
Northeastern China ◽  
Spotted Fever Group ◽  
Tick Abundance ◽  
Granulocytic Anaplasmosis ◽  
Indirect Immunofluorescent Assay ◽  
Tick Borne Disease ◽  
Human Infections

AbstractNortheastern China is a region of high tick abundance, multiple tick-borne pathogens and likely human infections. The spectrum of diseases caused by tick-borne pathogens has not been objectively evaluated in this region for clinical management and for comparison with other regions globally where tick-transmitted diseases are common. Based on clinical symptoms, PCR, indirect immunofluorescent assay and (or) blood smear, we identified and described tick-borne diseases from patients with recent tick bite seen at Mudanjiang Forestry Central Hospital. From May 2010 to September 2011, 42% (75/180) of patients were diagnosed with a specific tick-borne disease, including Lyme borreliosis, tick-borne encephalitis, human granulocytic anaplasmosis, human babesiosis and spotted fever group rickettsiosis. When we compared clinical and laboratory features to identify factors that might discriminate tick-transmitted infections from those lacking that evidence, we revealed that erythema migrans and neurological manifestations were statistically significantly differently presented between those with and without documented aetiologies (P< 0.001,P= 0.003). Twelve patients (6.7%, 12/180) were co-infected with two tick-borne pathogens. We demonstrated the poor ability of clinicians to identify the specific tick-borne disease. In addition, it is necessary to develop specific laboratory assays for optimal diagnosis of tick-borne diseases.

scholarly journals Ankylosing spondylitis and non-radiographic axial spondyloarthritis: Two stages of disease?

2017 ◽  
Vol 89 (5) ◽  
pp. 33-37 ◽  
Author(s):  
D G Rumyantseva ◽  
T V Dubinina ◽  
A B Demina ◽  
O A Rumyantseva ◽  
E M Agafonova ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Duration ◽  
Axial Spondyloarthritis ◽  
Early Stage ◽  
Clinical Manifestations ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Two Stages

Aim. To compare the clinical manifestations of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA). Subjects and methods. A Moscow early spondyloarthritis cohort has now included 132 patients with axial spondyloarthritis, of whom 69 patients who have been followed up at least 12 months are to be involved in a preliminary analysis. The mean age at the time of inclusion in the study was 28.1±5.5 years; the mean disease duration was 24.7±15.8 months; 63 (91.3%) patients were HLA-B27 positive; 41 and 28 included patients were diagnosed with AS and nrAxSpA, respectively. Results. Men were significantly more in the AS group than in the nrAxSpA group (58.5 and 32.1%, respectively; p=0.05). The patients of the two groups did not differ in main clinical parameters (the presence of arthritis and enthesitis), disease activity (BASDAI, ASDAS-CRP) and functional status (BASFI). All indicators of inflammatory activity decreased nearly 2-fold in both groups after 12 months of follow up. In 7 (25%) patients with nrAxSpA, radiologically detectable sacroiliitis (SI) developed over 12 months and the diagnosis of AS was verified. Among them, 2 (28.5%) patients had initially active SI detected by magnetic resonance imaging (MRI); 4 (57.1%) had chronic SI, and 1 (14.4%) had no pathological MRI changes. Conclusion. Due to the fact that the clinical manifestations of AS and nrAxSpA are comparable, it can be assumed that the latter is an early stage of AS.

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