A Clinical Diagnostic System for Late-Stage Neuropsychiatric Lyme Borreliosis Based upon an Analysis of 100 Patients

Many late-stage chronic Lyme disease clinical findings are neuropsychiatric. A total clinical assessment is critical in diagnosis, especially since controversy surrounds the reliability of laboratory testing. The clinical findings of one hundred Lyme disease patients with chronic neuropsychiatric symptoms were entered into a database. The prevalence of each clinical finding pre-infection and post-infection was compared and calculated within the 95% confidence interval. Patients had minimal symptoms pre-infection, but a high post-infection prevalence of a broad spectrum of acquired multisystem symptoms. These findings included impairments of attention span, memory, processing, executive functioning, emotional functioning, behavior, psychiatric syndromes, vegetative functioning, neurological, musculoskeletal, cardiovascular, upper respiratory, dental, pulmonary, gastrointestinal, genitourinary, and other symptoms. The most prevalent symptoms included sustained attention impairments, brain fog, unfocused concentration, joint symptoms, distraction by frustration, depression, working memory impairments, decreased school/job performance, recent memory impairments, difficulty prioritizing multiple tasks, fatigue, non-restorative sleep, multitasking difficulties, sudden mood swings, hypersomnia, mental apathy, decreased social functioning, insomnia, tingling, word finding difficulties, name retrieval, headaches, sound hypersensitivity, paresis, anhedonia, depersonalization, cold intolerance, body temperature fluctuations, light sensitivity and dysfluent speech. The average patient had five symptoms pre-infection and 82 post-infection. Pattern recognition is critical in making a diagnosis. This study was used to develop three clinical assessment forms.

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Impact of the experimental removal of lizards on Lyme disease risk

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2010.2402 ◽

2011 ◽

Vol 278 (1720) ◽

pp. 2970-2978 ◽

Cited By ~ 60

Author(s):

Andrea Swei ◽

Richard S. Ostfeld ◽

Robert S. Lane ◽

Cheryl J. Briggs

Keyword(s):

Lyme Disease ◽

Disease Ecology ◽

Disease Risk ◽

Large Fraction ◽

Host Community ◽

Deer Mice ◽

Infection Prevalence ◽

Alternate Host ◽

Experimental Removal ◽

Tick Infection

The distribution of vector meals in the host community is an important element of understanding and predicting vector-borne disease risk. Lizards (such as the western fence lizard; Sceloporus occidentalis ) play a unique role in Lyme disease ecology in the far-western United States. Lizards rather than mammals serve as the blood meal hosts for a large fraction of larval and nymphal western black-legged ticks ( Ixodes pacificus —the vector for Lyme disease in that region) but are not competent reservoirs for the pathogen, Borrelia burgdorferi . Prior studies have suggested that the net effect of lizards is to reduce risk of human exposure to Lyme disease, a hypothesis that we tested experimentally. Following experimental removal of lizards, we documented incomplete host switching by larval ticks (5.19%) from lizards to other hosts. Larval tick burdens increased on woodrats, a competent reservoir, but not on deer mice, a less competent pathogen reservoir. However, most larvae failed to find an alternate host. This resulted in significantly lower densities of nymphal ticks the following year. Unexpectedly, the removal of reservoir-incompetent lizards did not cause an increase in nymphal tick infection prevalence. The net result of lizard removal was a decrease in the density of infected nymphal ticks, and therefore a decreased risk to humans of Lyme disease. Our results indicate that an incompetent reservoir for a pathogen may, in fact, increase disease risk through the maintenance of higher vector density and therefore, higher density of infected vectors.

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Diversifying forest communities may change Lyme disease risk: extra dimension to the dilution effect in Europe

Parasitology ◽

10.1017/s0031182016000688 ◽

2016 ◽

Vol 143 (10) ◽

pp. 1310-1319 ◽

Cited By ~ 15

Author(s):

SANNE C. RUYTS ◽

EVY AMPOORTER ◽

ELENA C. COIPAN ◽

LANDER BAETEN ◽

DIETER HEYLEN ◽

...

Keyword(s):

North America ◽

Lyme Disease ◽

Borrelia Burgdorferi ◽

Disease Risk ◽

Severe Disease ◽

Dilution Effect ◽

Ixodid Ticks ◽

Infection Prevalence ◽

Host Diversity ◽

Pine Stands

SUMMARYLyme disease is caused by bacteria of theBorrelia burgdorferigenospecies complex and transmitted by Ixodid ticks. In North America only one pathogenic genospecies occurs, in Europe there are several. According to the dilution effect hypothesis (DEH), formulated in North America, nymphal infection prevalence (NIP) decreases with increasing host diversity since host species differ in transmission potential. We analysedBorreliainfection in nymphs from 94 forest stands in Belgium, which are part of a diversification gradient with a supposedly related increasing host diversity: from pine stands without to oak stands with a shrub layer. We expected changing tree species and forest structure to increase host diversity and decrease NIP. In contrast with the DEH, NIP did not differ between different forest types. Genospecies diversity however, and presumably also host diversity, was higher in oak than in pine stands. Infected nymphs tended to harbourBorrelia afzeliiinfection more often in pine stands whileBorrelia gariniiandBorrelia burgdorferiss. infection appeared to be more prevalent in oak stands. This has important health consequences, since the latter two cause more severe disease manifestations. We show that the DEH must be nuanced for Europe and should consider the response of multiple pathogenic genospecies.

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Transient light sensitivity after femtosecond laser flap creation: Clinical findings and management

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2005.11.015 ◽

2006 ◽

Vol 32 (1) ◽

pp. 91-94 ◽

Cited By ~ 76

Author(s):

Karl G. Stonecipher ◽

Jon G. Dishler ◽

Teresa S. Ignacio ◽

Perry S. Binder

Keyword(s):

Femtosecond Laser ◽

Light Sensitivity ◽

Clinical Findings ◽

Flap Creation

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Principles of clinical examination in children

10.1093/med/9780199642489.003.0005_update_002 ◽

2016 ◽

Author(s):

Sharmila Jandial ◽

Helen Foster

Keyword(s):

Young People ◽

Clinical Examination ◽

Clinical Assessment ◽

Clinical Skills ◽

Detailed Examination ◽

Evidence Base ◽

Clinical Findings ◽

Whole Child ◽

Children And Young People ◽

Musculoskeletal Development

The clinical examination of children and adolescents is an essential component of assessment, facilitates appropriate interpretation of investigations and is integral to the process of making a diagnosis. The clinical assessment of children and young people differs from that of adults, requiring greater reliance on physical examination as the history may be vague and illocalized and requires knowledge of normal musculoskeletal development, normal motor milestones and different patterns of clinical presentations across the ages. The interpretation of clinical findings needs to be in the context of the whole child and the clinical presentation. The degree of expertise required in clinical skills varies with the clinical practice of the examiner and ranges from the basic screening assessment to a more detailed examination of joints, muscles and anatomical regions. The evidence base for clinical assessment in children and young people is accruing and undoubtedly, competent clinical skills requires learning to be embedded in core child health teaching and assessment starting at medical school and reinforced in postgraduate training.

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Characteristics of Nontuberculous Mycobacterial Infections at a Midwestern Tertiary Hospital: A Retrospective Study of 365 Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa173 ◽

2020 ◽

Vol 7 (6) ◽

Cited By ~ 1

Author(s):

Claire E Hannah ◽

Bradley A Ford ◽

Jina Chung ◽

Dilek Ince ◽

Karolyn A Wanat

Keyword(s):

Risk Factors ◽

Mycobacterium Avium ◽

Disease Surveillance ◽

Mycobacterium Avium Complex ◽

Retrospective Chart Review ◽

Common Species ◽

Tertiary Hospital ◽

Population Based ◽

Clinical Findings ◽

Infection Prevalence

Abstract Background The prevalence of infections due to nontuberculous mycobacteria (NTM) is increasing worldwide, yet little is known about the epidemiology and pathophysiology of these ubiquitous environmental organisms. Pulmonary disease due to Mycobacterium avium complex is most prevalent, but many other NTM species can cause disease in virtually any organ system. As NTM becomes an increasingly common cause of morbidity and mortality, more information is needed about the epidemiology of NTM disease. Methods We conducted a retrospective chart review of all patients with cultures that grew NTM at a Midwestern tertiary hospital from 1996 to 2017. Information on demographics, medical history, clinical findings, treatment, and outcome was obtained from medical records of all NTM isolates. American Thoracic Society/Infectious Diseases Society of America criteria were used to define pulmonary NTM infections. Results We identified 1064 NTM isolates, 365 of which met criteria for NTM infection. Pulmonary cases predominated (185 of 365; 50.7%), followed by skin/soft tissue (56 of 365; 15.3%), disseminated (40 of 365; 11%), and lymphatic (28 of 365; 7.7%) disease. Mycobacterium avium complex was the most common species (184 of 365; 50.4%). Individuals aged >50 years were most affected (207 of 365; 56.7%). Common comorbidities included structural lung disease (116 of 365; 31.8%), use of immunosuppressive medications (78 of 365; 21.4%), malignancy (59 of 365; 16.2%), and human immunodeficiency virus (42 of 365; 11.5%). Conclusions This large cohort provides information on the demographics, risk factors, and disease course of patients with pulmonary and extrapulmonary NTM infections. Most patients had medical comorbidities that resulted in anatomic, genetic, or immunologic risk factors for NTM infection. Further population-based studies and increased disease surveillance are warranted to further characterize NTM infection prevalence and trends.

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Natural Lyme disease cycles maintained via sheep by co-feeding ticks

Parasitology ◽

10.1017/s0031182097001868 ◽

1997 ◽

Vol 115 (6) ◽

pp. 591-599 ◽

Cited By ~ 104

Author(s):

N. H. OGDEN ◽

P. A. NUTTALL ◽

S. E. RANDOLPH

Keyword(s):

Lyme Disease ◽

Experimental Evidence ◽

Infection Prevalence ◽

Female Tick ◽

Experimental Transmission ◽

Tick Abundance ◽

Virtual Absence ◽

Questing Ticks ◽

Transmission Studies ◽

Systemic Infections

We present observational and experimental evidence that cycles of the Lyme disease spirochaete, Borrelia burgdorferi s.l., can be maintained by sheep in the virtual absence of alternative hosts. A 2-year field study in upland moorland habitats of northwest UK established that sheep feed up to 80% of larval, >99% of nymphal and all of the adult female tick (Ixodes ricinus) population. Infection prevalence of B. burgdorferi in questing ticks reaches over 20%, but amplification of infection occurs principally as nymphs (20- to 30-fold), rather than larvae (4- to 7-fold), feed on sheep, and transmission from sheep to ticks occurred only during peak tick abundance in May and September. Experimental transmission studies confirmed that sheep, previously exposed to infected ticks on the moorland site, do not support systemic infections of B. burgdorferi, but they can transmit localized infections from infected to uninfected ticks co-feeding at the same site on the sheep's body.

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Two Cases of Orbital Myositis as a Rare Feature of Lyme Borreliosis

Case Reports in Infectious Diseases ◽

10.1155/2011/372470 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

Arnaud Sauer ◽

Claude Speeg-Schatz ◽

Yves Hansmann

Keyword(s):

Lyme Disease ◽

Erythema Migrans ◽

Clinical Findings ◽

Resonance Imaging ◽

Imaging Diagnosis ◽

Chain Reaction ◽

Orbital Myositis ◽

Rare Manifestation ◽

Polymerase Chain ◽

Diagnosis Criteria

Myositis has been reported as a rare manifestation of Lyme disease, and the Lyme disease spirochetes can be an important consideration in the differential diagnosis of unusual cases of myositis, especially in patients who live in or travel to endemic areas. We report the case of two patients who presented with focal orbital myositis which are rare localization for Lyme disease. Myositis were confirmed by magnetic resonance imaging. Diagnosis criteria forBorrelia burgdorferi (B. burgdorferi)infection was supported by (i) medical history (tick bite in an endemic area), (ii) systemic clinical findings (Erythema migrans, neurological manifestation or arthritis), (iii) positive Lyme serology and/or the detection ofB. burgdorferiDNA by polymerase chain reaction, as well as (iv) exclusion of other infectious and inflammatory causes. The current cases are reviewed in the context of findings from previous myositis descriptions.

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Nationwide questionnaire data of 229 Williams-Beuren syndrome patients using WhatsApp tool

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0450 ◽

2021 ◽

Vol 79 (11) ◽

pp. 950-956

Author(s):

Lucas Vieira Lacerda Pires ◽

Rogério Lemos Ribeiro ◽

Adriana Modesto de Sousa ◽

Bianca Domit Werner Linnenkamp ◽

Sue Ellen Pontes ◽

...

Keyword(s):

Neuropsychiatric Symptoms ◽

Learning Difficulties ◽

Failure To Thrive ◽

Clinical Findings ◽

First Year ◽

Medical Specialties ◽

Abdominal Colic ◽

Age Of Diagnosis ◽

Tract Infections ◽

Emotional Dependence

ABSTRACT Background: Williams-Beuren syndrome is a multisystemic disorder caused by a microdeletion of the 7q11.23 region. Although familial cases with autosomal dominant inheritance have been reported, the vast majority are sporadic. Objective: To investigate the main complaints and clinical findings of patients with Williams-Beuren syndrome. Methods: A total of 757 parents of patients registered in the Brazilian Association of Williams-Beuren Syndrome (ABSW) received a questionnaire via WhatsApp from March to July 2017. Results: In total, 229 parents answered the survey. Age of diagnosis ranged from 2 days to 34 years (median: 3 years). The main clinical findings reported by the parents were abdominal colic (83.3%), failure to thrive (71.5%), feeding difficulty in the first year (68.9%), otitis (56.6%), urinary tract infections (31.9%), precocious puberty (27.1%) and scoliosis (15.9%). Cardiac defects were present in 66% of patients, and the most frequent defect was supravalvular aortic stenosis (36%). Arterial hypertension was reported in 23%. Hypercalcemia was reported in 10.5% of patients, mainly during the first year of life. Hyperacusis and hypersociability were common complaints (both present in 89%). Other behavioral and neuropsychiatric symptoms reported by the parents included attention deficit (89%), anger crises (83%), excessive fear (66%), depression (64%), anxiety (67%) and hypersexuality (33%). The most common complaints were hypersensitivity to sounds, talkative personality, emotional dependence and learning difficulties. In 98.3%, the parents denied family history. Conclusions: Williams-Beuren syndrome requires close follow-up with different medical specialties due to their variable clinical comorbidities, including language and school learning difficulties, behavioral and psychiatric problems.

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A Case Report of two siblings with Alstrom syndrome without hearing loss associated with two new ALMS1 variants

10.21203/rs.2.9239/v2 ◽

2019 ◽

Author(s):

Maria Fedorovna Shurygina ◽

Maria A. Parker ◽

Catie Schlechter ◽

Rui Chen ◽

Yumei Li ◽

...

Keyword(s):

Hearing Loss ◽

Late Onset ◽

Light Sensitivity ◽

Clinical Findings ◽

Alström Syndrome ◽

Mild Developmental Delay ◽

Novel Variants ◽

Normal Stature ◽

Alstrom Syndrome

Abstract Background Alström syndrome (AS) is a rare monogenic disorder characterized by progressive multi-organ pathology including retinal degeneration, hearing impairment and type 2 diabetes. Here we present clinical features in two siblings diagnosed with Alström syndrome associated with novel biallelic changes in ALMS1. Case presentation Two siblings originally diagnosed as having achromatopsia presented with mild light sensitivity, nonspecific otitis media, and mild developmental delay during the first decade of life with a relatively stable ocular appearance during second decade, late onset of nystagmus and dyschromatopsia (after 20 years) and preserved vision during the third decade of life. One sibling had late onset hearing loss and both siblings had symmetric high myopia, normal stature, and ptosis. Clinical findings revealed structural and functional tests consistent with a cone-rod dystrophy. Novel variants c.9894dupC (p.S3298fs) and c.10769delC (p.T3590fs) in ALMS1 gene were found. Conclusions Two North American siblings who presented with a mild clinical phenotype of Alström syndrome were found to have novel mutations in ALMS1. These two frame-shift mutations segregated with the disease phenotype lending evidence to their pathogenicity.

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