Limits...
Seroreactivity for spotted fever rickettsiae and co-infections with other tick-borne agents among habitants in central and southern Sweden.

Lindblom A, Wallménius K, Nordberg M, Forsberg P, Eliasson I, Påhlson C, Nilsson K - Eur. J. Clin. Microbiol. Infect. Dis. (2012)

Bottom Line: Symptoms of arthritis, fever, cough and rash were predominant.In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection.The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.

View Article: PubMed Central - PubMed

Affiliation: Unit of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

ABSTRACT
Patients seeking medical care with erythema migrans or flu-like symptoms after suspected or observed tick bite in the southeast of Sweden and previously investigated for Borrelia spp. and/or Anaplasma sp. were retrospectively examined for serological evidence of rickettsial infection (Study 1). Twenty of 206 patients had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64. Seven of these 20 patients showed seroconversion indicative of recent or current infection and 13 patients had titres compatible with past infection, of which five patients were judged as probable infection. Of 19 patients with medical records, 11 were positive for Borrelia spp. as well, and for Anaplasma sp., one was judged as positive. Five of the 19 patients had antibodies against all three pathogens. Erythema migrans or rash was observed at all combinations of seroreactivity, with symptoms including fever, muscle pain, headache and respiratory problems. The results were compared by screening an additional 159 patients (Study 2) primarily sampled for the analysis of Borrelia spp. or Mycoplasma pneumoniae. Sixteen of these patients were seroreactive for Rickettsia spp., of which five were judged as recent or current infection. Symptoms of arthritis, fever, cough and rash were predominant. In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection. The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.

Show MeSH

Related in: MedlinePlus

Western blot (WB) analysis of IgG antibodies against an antigenic peptide (ompB) of Rickettsia helvetica. Lanes A, B and C demonstrate the specific reactions for each serum sample (S2) for patient nos. 6, 14 and 15 in Study 1 against the protein in the 60-kDa region. Lane D shows the specific reaction between the antigenic peptide and polyclonal rabbit anti-serum
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3569577&req=5

Fig1: Western blot (WB) analysis of IgG antibodies against an antigenic peptide (ompB) of Rickettsia helvetica. Lanes A, B and C demonstrate the specific reactions for each serum sample (S2) for patient nos. 6, 14 and 15 in Study 1 against the protein in the 60-kDa region. Lane D shows the specific reaction between the antigenic peptide and polyclonal rabbit anti-serum

Mentions: The serological results and details from the medical records on each patient are summarised in Tables 1 and 2. Of all patients analysed, 20/206 (9.7 %) had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64 (Table 1). All negative controls were negative. All but one patient had available medical records from the time of disease, and their data are summarised in Table 2. Seven of the patients were males and 13 were females. The median age was 54 years, range 20–74 years. Seven of the seroreactive patients (nos. 1, 6, 7, 9, 14, 15 and 19) showed seroconversion or significant rise of titre, indicating recent infection or current infection, and 13 patients had titres compatible with past infection, of which five patients (nos. 5, 8, 13, 17 and 18) were judged as probable infection. Eleven of the 19 Rickettsia spp. seroreactive patients were positive also for Borrelia spp. Six of the 19 were seroreactive for Anaplasma sp., of which five were serologically judged as having a probable infection and one was judged as positive. Five patients were seroreactive for all three agents (Table 2). None of the patients that were seroreactive for Rickettsia spp. were co-infected with TBE. Seven of the 19 patients had detectable antibodies only for Rickettsia spp., two of which had titres indicating recent infection, three compatible with past infection and two a probable infection. EM and/or rash for a period of 0–7 days were observed at all combinations of seroreactivity (Table 2). A total of 15 patients presented EM (between 5 and 15 cm in diameter). Nine of these 15 were co-infected with Borrelia spp. and/or Anaplasma sp., and six patients presenting EM had antibodies only against Rickettsia spp. The corresponding figures for the rash were nine Rickettsia spp.-reactive, of which six were co-infected (Table 2). Seventeen of the 19 Rickettsia spp.-reactive patients were tick-bitten 1–4 weeks earlier, two had suspected bites, five reported fever (>37.5 and <39 °C) lasting less than 1 week and 4 of 5 also experienced chills for a period of 0–3 days. Eight experienced headache lasting between 0 and 7 days. Five of 19 patients had muscle pain. Seven of 19 had respiratory symptoms, usually cough. All patients showed normal values for haemoglobin, white blood cell count, platelet cell count, alanine and aspartate aminotransferase, and lactate dehydrogenase in both serum S1 and S2. Three of the 19 patients were treated with doxycycline 100 mg once a day, the others with phenoximethyl penicillin. All patients except one (no. 7) were cured at follow-up after 2 months. Patient no. 7 showed persistent skin problems. WB for patient nos. 6, 14 and 15 showed a specific response to the mass-specific protein antigen in the 60-kDa region for IgG (Fig. 1).Table 1


Seroreactivity for spotted fever rickettsiae and co-infections with other tick-borne agents among habitants in central and southern Sweden.

Lindblom A, Wallménius K, Nordberg M, Forsberg P, Eliasson I, Påhlson C, Nilsson K - Eur. J. Clin. Microbiol. Infect. Dis. (2012)

Western blot (WB) analysis of IgG antibodies against an antigenic peptide (ompB) of Rickettsia helvetica. Lanes A, B and C demonstrate the specific reactions for each serum sample (S2) for patient nos. 6, 14 and 15 in Study 1 against the protein in the 60-kDa region. Lane D shows the specific reaction between the antigenic peptide and polyclonal rabbit anti-serum
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569577&req=5

Fig1: Western blot (WB) analysis of IgG antibodies against an antigenic peptide (ompB) of Rickettsia helvetica. Lanes A, B and C demonstrate the specific reactions for each serum sample (S2) for patient nos. 6, 14 and 15 in Study 1 against the protein in the 60-kDa region. Lane D shows the specific reaction between the antigenic peptide and polyclonal rabbit anti-serum
Mentions: The serological results and details from the medical records on each patient are summarised in Tables 1 and 2. Of all patients analysed, 20/206 (9.7 %) had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64 (Table 1). All negative controls were negative. All but one patient had available medical records from the time of disease, and their data are summarised in Table 2. Seven of the patients were males and 13 were females. The median age was 54 years, range 20–74 years. Seven of the seroreactive patients (nos. 1, 6, 7, 9, 14, 15 and 19) showed seroconversion or significant rise of titre, indicating recent infection or current infection, and 13 patients had titres compatible with past infection, of which five patients (nos. 5, 8, 13, 17 and 18) were judged as probable infection. Eleven of the 19 Rickettsia spp. seroreactive patients were positive also for Borrelia spp. Six of the 19 were seroreactive for Anaplasma sp., of which five were serologically judged as having a probable infection and one was judged as positive. Five patients were seroreactive for all three agents (Table 2). None of the patients that were seroreactive for Rickettsia spp. were co-infected with TBE. Seven of the 19 patients had detectable antibodies only for Rickettsia spp., two of which had titres indicating recent infection, three compatible with past infection and two a probable infection. EM and/or rash for a period of 0–7 days were observed at all combinations of seroreactivity (Table 2). A total of 15 patients presented EM (between 5 and 15 cm in diameter). Nine of these 15 were co-infected with Borrelia spp. and/or Anaplasma sp., and six patients presenting EM had antibodies only against Rickettsia spp. The corresponding figures for the rash were nine Rickettsia spp.-reactive, of which six were co-infected (Table 2). Seventeen of the 19 Rickettsia spp.-reactive patients were tick-bitten 1–4 weeks earlier, two had suspected bites, five reported fever (>37.5 and <39 °C) lasting less than 1 week and 4 of 5 also experienced chills for a period of 0–3 days. Eight experienced headache lasting between 0 and 7 days. Five of 19 patients had muscle pain. Seven of 19 had respiratory symptoms, usually cough. All patients showed normal values for haemoglobin, white blood cell count, platelet cell count, alanine and aspartate aminotransferase, and lactate dehydrogenase in both serum S1 and S2. Three of the 19 patients were treated with doxycycline 100 mg once a day, the others with phenoximethyl penicillin. All patients except one (no. 7) were cured at follow-up after 2 months. Patient no. 7 showed persistent skin problems. WB for patient nos. 6, 14 and 15 showed a specific response to the mass-specific protein antigen in the 60-kDa region for IgG (Fig. 1).Table 1

Bottom Line: Symptoms of arthritis, fever, cough and rash were predominant.In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection.The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.

View Article: PubMed Central - PubMed

Affiliation: Unit of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

ABSTRACT
Patients seeking medical care with erythema migrans or flu-like symptoms after suspected or observed tick bite in the southeast of Sweden and previously investigated for Borrelia spp. and/or Anaplasma sp. were retrospectively examined for serological evidence of rickettsial infection (Study 1). Twenty of 206 patients had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64. Seven of these 20 patients showed seroconversion indicative of recent or current infection and 13 patients had titres compatible with past infection, of which five patients were judged as probable infection. Of 19 patients with medical records, 11 were positive for Borrelia spp. as well, and for Anaplasma sp., one was judged as positive. Five of the 19 patients had antibodies against all three pathogens. Erythema migrans or rash was observed at all combinations of seroreactivity, with symptoms including fever, muscle pain, headache and respiratory problems. The results were compared by screening an additional 159 patients (Study 2) primarily sampled for the analysis of Borrelia spp. or Mycoplasma pneumoniae. Sixteen of these patients were seroreactive for Rickettsia spp., of which five were judged as recent or current infection. Symptoms of arthritis, fever, cough and rash were predominant. In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection. The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.

Show MeSH
Related in: MedlinePlus