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Borrelial lymphocytoma (BL) is a rare cutaneous manifestation of Lyme borreliosis. Epidemiological data show that BL is more common in children than in adults. It presents as a single bluish-red swelling located on the earlobe in children, near the nipple in adults. In our paper, we present a case of a pregnant woman with BL, which appeared after tick bite and disappeared completely after antibiotic therapy. The aim of the paper was to emphasize that in tick-borne disease endemic areas BL should be taken into consideration in cases of skin lesions., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Tularemia is a rare zoonosis. The most common way is ingestion of contaminated meat or water, but the infection may also be acquired by insect bite. The clinical picture of the disease may be nonspecific. Due to polymorphisms of clinical picture, specific treatment is often delayed. In the last 50 years, in Poland, the most infections were acquired by handling hares. In our article, we present the case of a patient who was infected with Francisella tularensis due to arthropod bite. In the presented case, the diagnosis was difficult, because of the nonspecific clinical picture. Information of the epidemiology and the clinical picture changes of tularemia may have great clinical significance. Tularemia requires the special attention of physicians. All patients with lymphadenopathy and arthropod bite history should be screened for tularemia in the outpatient department and, if necessary, treated in hospital.

Articular involvement following Borrelia burgdorferi invasion into synovial tissue, is one of the typical clinical forms of Lyme borreliosis. It may manifest itself at any stage of the disease and has a wide clinical spectrum, from transient musculoskeletal symptoms to chronic, persistent inflammation of the large joints. Typically, however, the natural course of the disease is favorable, leading to elimination of the spirochete and regression of symptoms even if untreated. Antibiotic therapy is highly effective in eliminating Borrelia burgdorferi at any stage of the disease, but in minority of antibiotically treated patients autoimmunological phenomena may account for prolonged inflammation. Diagnosis is based on detection of specific antiborrelial antibodies in patients with history and symptoms consistent with Lyme arthritis. Results of the serologic examinations must be interpreted with caution, as their specificity in recognizing active infection is limited.

Antibiotic treatment has been proven to be effective in about 90% of patients with Lyme arthritis in controlled studies. Overt arthritis persisting in spite of antibiotic therapy is rare and most likely has an autoimmune background. More frequently, patients with history of Lyme borreliosis present with non-specific articular and musculosceletal symptoms, which seem to be permanent sequelae of arthritis or constitute part of so called post-Lyme disease syndrome, of unclear pathogenesis. As persistence of active infection after proper antibiotic therapy is unlikely, repeated treatment seems of no benefit in most of the patients. No more than 2-3 attempts of antibiotic therapy should be undertaken; if symptoms persist, symptomatic and anti-inflammatory treatment should be introduced. Lack of response to antibiotics should also point to co-existing musculoskeletal morbidity or to improper diagnosis of Lyme borreliosis, which is frequent due to common occurrence of false-positive serologic tests results.

Primary cause of Lyme arthritis (LA) is an invasion and survival of Borrelia burgdorferi s.l. spirochetes within joint tissues. Elimination of the pathogen is an effective treatment method in a great majority of patients and can be achieved by a number of antibiotic regimens of confirmed efficacy. Antibiotic therapy lasting for 2 to 4 weeks enables eradication of the infection, followed by resolution of arthritis within weeks to months. If insufficient, the course of therapy may be repeated up to 3 times in a few months' intervals, although effectiveness of repeated treatment is not so well confirmed and probably small. Further symptoms, persisting in spite of proper antibiotherapy, typically are not caused by ongoing infection, but rather by autoimmune phenomena or persistent damage to the joint, so further administration of antibiotics in such patients seems of no benefit.

The aim of the study was to assess the frequency of Borrelia burgdorferi DNA detection in the blood and urine of patients diagnosed with erythema migrans, and compare the results of PCR-based methods with ELISA methodology. The latter was used to detect serum antibodies against Borrelia burgdorferi of the IgM and IgG classes, before and after antibiotic therapy. The study included 86 patients hospitalized in the Department of Infectious Diseases and Neuroinfections in the Medical Academy in Białystok, diagnosed with the erythema migrans phase of Lyme borreliosis. Examinations were carried out twice: the first at the moment of diagnosis (Trial 1), the second after 4 weeks of antibiotic therapy. The study showed that antibiotic therapy in the early phase of borreliosis does not decrease the sensitivity of PCR and that after 4 weeks of therapy (Trial 2), spirochete DNA is still detectable in most patients (45/86). There was no correlation between detectability of spirochete DNA and the presence of antibodies against B. burgdorferi s.l. (assessed by ELISA) during the course of erythema migrans. The largest percentage of positive results in the detection of B. burgdorferi s.l. DNA was observed in patients who simultaneously possessed IgM and IgG antibodies against B. burgdorferi, while the lowest percentage of PCR positive results was among patients with only IgM antibodies.

The purpose of this work was to evaluate phagocytosis and oxidative burst changes in neutrophils of patients with Lyme arthritis before and after antibiotic treatment. The examined patients were divided into three groups: group 1-18 patients with diagnosed Lyme arthritis, group 2-12 patients with Lyme arthritis after 14-day treatment with cefuroxime and control group--25 healthy individuals. The phagocytic activity of peripheral blood neutrophils (percentage of phagocytic cells and fluorescence) was measured using standard cytometric flow assay (Phagotest-kit, Orpegen Pharma). The oxidative metabolism (percentage of bursting cells and fluorescence stimulated by Escherichia coli and PMA) was measured using cytometric flow assay (Burst-test, Orpegen Pharma). The results were statistically analysed using Mann-Whitney test. Evaluation of phagocytosis demonstrated no changes in the percentage of phagocytic cells. But fluorescence increased significantly after treatment. The comparison of oxidative metabolism activity showed no changes despite E. coli and PMA stimulation. Parameters of phagocytosis and oxidative metabolism did not correlate with neutrophil count in analysed groups of patients.

We estimated serum concentrations of cytokines: IL-1, IL-6, TNF-alpha in patients with diagnosed Lyme disease treated for 14 days with antibiotics. The detection of proinflammatory cytokines was performed by ELISA tests. The examination was carried out before and after the treatment. The comparison with control group stated statistically significant higher concentration of IL-1, IL-6 and TNF-alpha before and after the treatment. Comparing the concentrations of cytokines after treatment with control group showed normalization only in a few cases. In the majority of cases serum cytokines concentrations remained significantly higher. That is why we conclude that 14-day-therapy with antibiotic in patients with Lyme disease may not be sufficient.