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Neuroborreliosis-an epidemiological, clinical and healthcare cost study from an endemic area in the south-east of Sweden
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
Klinisk mikrobiologi, Länssjuhuset Ryhov, Jönköping.
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2010 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 16, no 8, 1245-1251 p.Article in journal (Refereed) Published
Abstract [en]

We studied retrospectively the medical records of all patients (n = 150) diagnosed, by cerebrospinal fluid (CSF) analysis, with neuroborreliosis (NB) in Jonkoping County, Sweden during 2000-2005. The number of NB cases increased from 5/100 000 to 10/100 000 inhabitants/year. In 17% of the patients, anti-Borrelia antibodies were found in CSF but not in serum at the time of diagnosis. Facial palsy, headache and fever were frequent manifestations in children, whereas unspecific muscle and joint pain were the most commonly reported symptoms in older patients. Post-treatment symptoms persisting for more than 6 months occurred in 13%, and the patients concerned were significantly older, had longer-lasting symptoms prior to treatment, had higher levels of Borrelia-specific IgG in CSF, and more often had radiculitis. The total cost of NB-related healthcare was estimated to be euro500 000 for the entire study group (euro3300 per patient), and the cost of social benefits was estimated to be euro134 000 (euro2000 per patient). CSF analysis is necessary for the diagnosis of NB, because some patients develop antibodies in serum later than in CSF. Early diagnosis of borreliosis would result in reduced human suffering and in economic gain.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd , 2010. Vol. 16, no 8, 1245-1251 p.
Keyword [en]
Clinical, epidemiology, healthcare economy, Lyme disease, neuroborreliosis
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:liu:diva-58536DOI: 10.1111/j.1469-0691.2009.03059.xISI: 000280359900034OAI: oai:DiVA.org:liu-58536DiVA: diva2:343393
Note
This is the pre-reviewed version of the following article: A J Henningsson, Bo-Eric Malmvall, Jan Ernerudh, A Matussek and Pia Forsberg, Neuroborreliosis-an epidemiological, clinical and healthcare cost study from an endemic area in the south-east of Sweden, 2010, CLINICAL MICROBIOLOGY AND INFECTION, (16), 8, 1245-1251. which has been published in final form at: http://dx.doi.org/10.1111/j.1469-0691.2009.03059.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html Available from: 2010-08-13 Created: 2010-08-13 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Clinical, epidemiological and immunological aspects of Lyme borreliosis with special focus on the role of the complement system
Open this publication in new window or tab >>Clinical, epidemiological and immunological aspects of Lyme borreliosis with special focus on the role of the complement system
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lyme borreliosis (LB) is the most common vector-borne disease in the Northern Hemisphere. The infection is caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, and it is transmitted to humans by ticks. LB is associated with several clinical manifestations, of which erythema migrans (EM) and neuroborreliosis (NB) are the most common inEurope. The course of the disease is usually benign, but can vary between individuals. The underlying pathogenic mechanisms are not fully understood, but the prognosis is probably determined by a complex interplay between the bacteria and the host’s immune response. Previous studies have indicated that a strong initial T helper (Th) 1-response followed by a Th2 response is beneficial for the clinical outcome in LB.

The aims of this thesis were to follow the incidence of NB inJönköping County,Sweden, over time, to search for clinical and laboratory markers associated with the risk of developing long-lasting post-treatment symptoms, and to explore the role of the complement system as well as the relative balance between Th-associated cytokine/chemokine responses in LB.

The number of NB cases, diagnosed by cerebrospinal fluid (CSF) analysis, increased from 5 to 10/100,000 inhabitants/year in Jönköping County during 2000-2005. Post-treatment symptoms persisting more than 6 months occurred in 13 %, and were associated with higher age, longer-lasting symptoms prior to treatment, higher levels of Borrelia-specific IgG in CSF, and reported symptoms of radiculitis. Facial palsy, headache and fever were frequent manifestations in children, whereas unspecific muscle and joint pain were the most commonly reported symptoms in older patients.

Complement activation occurred both locally in the skin in EM and in CSF of NB patients. However, no activation could be detected in blood in NB patients. Elevated levels of C1q, C4 and C3a in CSF, along with correlation between C1q and C3a levels, suggest complement activation via the classical pathway locally in the central nervous system in NB. In vitro experiments with two clinical Borrelia isolates revealed that B. garinii LU59 induced higher complement activation in human plasma compared to B. afzelii K78 that recruited more of complement regulator factor H. To elucidate the role of complement in the phagocytosis process, experiments were performed using whole blood from healthy donors incubated with fluorescence-labelled spirochetes and different complement inhibitors. The results illustrated a central role of complement for phagocytosis of Borrelia spirochetes.

We also studied the relative contribution of different Th-associated cytokines/chemokine responses in NB. The results support the notion that early NB is dominated by a Th1 response, eventually accompanied by a Th2 response. IL-17A was increased in CSF in half of the patients with confirmed NB, suggesting a hitherto unknown role of Th17 in NB.

In conclusion, the risk of developing long-lasting post-treatment symptoms tend to increase mainly with age and duration of symptoms prior to treatment in NB. The complement system seems to play an important role in host defence to recognize and kill Borrelia spirochetes. However, complement activation in inappropriate sites or to an excessive degree may cause tissue damage, and therefore, the role of complement in relation to disease course needs to be studied further. Likewise, the role of Th17 in LB pathogenesis and host defence should be further evaluated in prospective studies.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 116 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1255
Keyword
Lyme borreliosis, neuroborreliosis, clinical, epidemiology, inflammation, complement, cytokine, chemokine
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-71117 (URN)978-91-7393-097-0 (ISBN)
Public defence
2011-11-25, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-03 Created: 2011-09-30 Last updated: 2012-03-23Bibliographically approved

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