Serum samples from hunters (n ؍ 440), their hunting dogs (n ؍ 448), and hunters without dog ownership (n ؍ 53) were collected in The Netherlands at hunting dog trials and were tested for antibodies against Borrelia burgdorferi by a whole-cell enzyme-linked immunosorbent assay. Additionally, 75 healthy pet dogs were tested. The results of this study indicate that the seroprevalence among hunting dogs (18%) was of the same order as the seroprevalence among pet dogs (17%) and hunters (15%). The seropositivity of a hunting dog was not a significant indicator of increased risk of Lyme borreliosis for its owner. No significant rise in seroprevalence was found in dogs older than 24 months. This indicated that seropositivity after an infection with B. burgdorferi in dogs is rather short, approximately 1 year. In humans this is considerably longer but is also not lifelong. Therefore, the incidence of B. burgdorferi infections among dogs was greater than that among hunters, despite a similar prevalence of seropositivity among hunters and their hunting dogs. Because no positive correlation was observed between the seropositivity of a hunter and the seropositivity of the hunter's dog, direct transfer of ticks between dog and hunter does not seem important and owning a dog should not be considered a risk factor for Lyme borreliosis.Lyme borreliosis (LB) is a zoonotic disease caused by the spirochete Borrelia burgdorferi (5, 41). An animal reservoir of approximately 40 mammals and birds has been established (15) in Europe. The disease is transmitted primarily by ticks feeding on mammals and birds, with the most common vector in Europe being the tick Ixodes ricinus (1). In humans, LB in its early stages is characterized by influenza-like symptoms, followed in 60 to 80% of the cases by erythema migrans (40), a skin lesion that spreads outward from around the site of a tick bite. If untreated, the disease may proceed to a second or a third stage in which neurological disorders and arthritis are common symptoms (42). Much less is known about LB in animals than is known about the disease in humans. The most common symptom of LB in dogs is migratory arthritis (30) without divergent radiographic findings. Other but less common symptoms reported in dogs are carditis (25), glomerulonephritis (17), and neuritis (2; B. M. Feder, R. J. Joseph, S. D. Moroff, et al., Abstr. Proc. 9th ACVIM, p. 892, 1991). B. burgdorferi infections or serologic evidence of B. burgdorferi infections have been reported in dogs in the United States (3,7,26,29,30). In Europe, relatively few reports exist on LB in animals. In Sweden (13), Denmark (18), Germany (20,21,35,45,47), The Netherlands (19), the United Kingdom (32), Belgium (33), France (9,11,12,14), Switzerland (37), Slovakia (43), Slovenia (34), and Spain (10), antibodies to B. burgdorferi and/or clinical symptoms of LB have been found in dogs. However, in Europe, the use of dogs as sentinel animals for the estimation of the risk of Lyme borreliosis for humans in that region has not been examine...
The performance of 11 commercially available enzyme immunoassays (EIA) and four Western blot (WB) tests for the detection of IgM and IgG antibodies against Borrelia burgdorferi were compared. A total of 229 serum specimens were used: 26 from patients with early Lyme borreliosis, 13 from patients with late Lyme borreliosis, 62 from healthy controls and 128 from patients with disorders clinically mimicking Lyme borreliosis and/or known to cause cross-reactivity in Lyme borreliosis serological tests (patient control group). In specimens from patients with early Lyme borreliosis, the sensitivity of the individual tests ranged from 35 to 81% for detection of IgM. In late Lyme borreliosis, sensitivity of the tests ranged from 46 to 92%. In healthy controls the specificity of the tests ranged from 89 to 100% and from 82 to 97% for IgM and IgG tests, respectively. In the patient control group, specificity of the tests ranged from 75 to 90% for IgM and from 84 to 100% for IgG tests. The Behring (Germany) and Genzyme Virotech (Germany) IgM EIA tests showed the best performance in detecting early Lyme borreliosis. For the detection of late Lyme borreliosis, the Dako (Denmark) IgG test was the best despite its low sensitivity. The maximum sensitivity of Western blotting for detecting IgM in patients with early Lyme borreliosis and IgG in patients with late Lyme borreliosis was 50 and 46%, respectively. The use of an EIA-WB two-test protocol improved the specificity and positive predictive values of the EIA results but caused a significant loss in sensitivity. Patients with Epstein-Barr virus or cytomegalovirus infection who had a positive reaction in the IgM EIA could not be discriminated from patients with early Lyme borreliosis with the help of Western blotting. Hence, positive and negative predictive values in combination with sensitivity and specificity values indicated that the exclusion of these infections was more relevant than the confirmation of a positive IgM EIA with Western blot.
Objectives: To determine the effect of amoxicillin treatment on resistance selection in patients with communityacquired lower respiratory tract infections in a randomized, placebo-controlled trial.Methods: Patients were prescribed amoxicillin 1 g, three times daily (n ¼ 52) or placebo (n ¼ 50) for 7 days. Oropharyngeal swabs obtained before, within 48 h post-treatment and at 28 -35 days were assessed for proportions of amoxicillin-resistant (ARS; amoxicillin MIC ≥2 mg/L) and -non-susceptible (ANS; MIC ≥0.5 mg/L) streptococci. Alterations in amoxicillin MICs and in penicillin-binding-proteins were also investigated. ITT and PP analyses were conducted.Results: ARS and ANS proportions increased 11-and 2.5-fold, respectively, within 48 h post-amoxicillin treatment compared with placebo [ARS mean increase (MI) 9.46, 95% CI 5.57-13.35; ANS MI 39.87, 95% CI 30.96-48.78; P,0.0001 for both]. However, these differences were no longer significant at days 28-35 (ARS MI 23.06, 95% CI 27.34 to 1.21; ANS MI 4.91, 95% CI 24.79 to 14.62; P.0.1588). ARS/ANS were grouped by pbp mutations. Group 1 strains exhibited significantly lower amoxicillin resistance (mean MIC 2.8 mg/L, 95% CI 2.6-3.1) than group 2 (mean MIC 9.3 mg/L, 95% CI 8.1-10.5; P,0.0001). Group 2 strains predominated immediately post-treatment (61.07%) and although decreased by days 28-35 (30.71%), proportions remained higher than baseline (18.70%; P¼0.0004).Conclusions: By utilizing oropharyngeal streptococci as model organisms this study provides the first prospective, experimental evidence that resistance selection in patients receiving amoxicillin is modest and short-lived, probably due to 'fitness costs' engendered by high-level resistance-conferring mutations. This evidence further supports European guidelines that recommend amoxicillin when an antibiotic is indicated for community-acquired lower respiratory tract infections.
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