In 1987, follow-up studies were conducted on 72 patients who had had meningoradiculitis and encephalomyelitis (8 patients) due to Borrelia burgdorferi 5-27 years previously. These patients had not been treated with antibiotics, either during the acute disease or during the interval prior to follow-up studies. The patients had exhibited the typical symptoms of Bannwarth's syndrome during the acute phase. At the follow-up studies, 33 patients showed no, and 23 only mild, clinical residual symptoms including normal CSF findings and low-positive serum IgG borrelia antibody titres (IFT; ELISA). Three patients without sequelae exhibited persistent intrathecal secretion of oligoclonal B. burgdorferi-specific CSF IgG antibodies (Immunoblot; positive borrelia CSF IgG antibody titres). Thirteen patients exhibited mild-to-medium sequelae with persistent intrathecal formation of oligoclonal B. burgdorferi-specific CSF IgG antibodies, up to 21 years after the acute illness. This persistence can be interpreted as an "immunological scar syndrome". Our follow-up studies appear to indicate that neurological manifestations of B. burgdorferi infections are generally (with few exceptions) of a benign nature. Most patients can be classified as having been cured without antibiotic therapy. No late manifestations of chronic progressive CNS borreliosis comparable to that of neurosyphilis have been seen following acute untreated neuroborreliosis.
The structural relation of YOP-1 of "european" and "american" Yersinia enterocolitica serotypes O:3, O:9, O:5,27, and O:8 and O:20, respectively, and Y. pseudotuberculosis serotypes I, II, and III was compared by sodium dodecyl sulfate polyacrylamide gel electrophoresis and peptide mapping using Staphylococcus aureus protease V8. Apparent molecular weights of YOP-1 ranged from 206,000 (O:3) to approx. 180,000 (O:8). According to their respective peptide maps YOP-1 of the "european" and "american" Y. enterocolitica serotypes and Y. pseudotuberculosis serotypes could be assigned to three different groups. Evaluation of several isolates of Y. enterocolitica serotypes O:3, O:9, and O:8 by peptide mapping indicated that YOP-1 is conserved within a serotype. However, one serotype O:8 isolate differed from the consensus peptide pattern of the other serotype O:8 and O:20 isolates. The similarity of the peptide patterns of Yersinia serotypes which predominate in certain geographical locations, i.e., "european" and "american" Y. enterocolitica serotypes, suggest common evolution of YOP-1 of these serotypes independent of the evolution of the other serotypes.
Follow-up studies on 56 patients who suffered from antibiotically untreated, acute, monophasic neuroborreliosis five to 23 years ago revealed significant positive levels of IgG antibodies to Borrelia burgdorferi (Bb) in the serum and cerebrospinal fluid (CSF) of 20 patients (IFT, ELISA, Bb-specific IgG Western blot, Bb-specific IEF-IgG immunoblot). Nine of 10 tested patients had a definitely positive T-cell proliferative response to whole B. burgdorferi, with a mean (+/- -SEM) stimulation index of 7.2 +/- 1.8. Because the patients studied exhibited no, or only mild to medium sequelae without any evidence of a chronic-progressive disease, we interpret the long-term persistence of specific T- and B-lymphocyte responses to B. burgdorferi as an "immunological scar syndrome". Finally, diagnostic criteria of active neuroborreliosis are proposed.
Ten years after treatment of secondary syphilis a 44-year-old otherwise asymptomatic HIV-infected patient developed acute meningovascular syphilis with multifocal manifestations and neurological deficit. Whether it was a reactivation or new infection could not be established. High-dosage intravenous penicillin treatment failed to eliminate completely the CNS disease process. Inflammatory CSF findings with pleocytosis and demonstration of intrathecally formed specific antibodies, still present a year later, made it likely that the syphilitic infection was persisting. The concurrent HIV infection probably aggravated the course of the neurosyphilis. Serological tests for syphilis should be done in every HIV-infected patient, followed by CSF examination if the results are suspicious. Analogous to the known opportunistic CNS infections, a more extensive period of treatment should also be considered in the case of neurosyphilis in HIV-infected patients.
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