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The cause of Lyme disease, Borrelia burgdorferi, was discovered in 1983. A 2-tiered testing protocol was established for serodiagnosis in 1994, involving an enzyme immunoassay (EIA) or indirect fluorescence antibody, followed (if reactive) by immunoglobulin M and immunoglobulin G Western immunoblots. These assays were prepared from whole-cell cultured B. burgdorferi, lacking key in vivo expressed antigens and expressing antigens that can bind non-Borrelia antibodies. Additional drawbacks, particular to the Western immunoblot component, include low sensitivity in early infection, technical complexity, and subjective interpretation when scored by visual examination. Nevertheless, 2-tiered testing with immunoblotting remains the benchmark for evaluation of new methods or approaches. Next-generation serologic assays, prepared with recombinant proteins or synthetic peptides, and alternative testing protocols, can now overcome or circumvent many of these past drawbacks. This article describes next-generation serodiagnostic testing for Lyme disease, focusing on methods that are currently available or near-at-hand.

Infections with West Nile virus (WNV) are typically asymptomatic, but some patients experience severe neurological disease and even death. Over 1500 fatalities have resulted from the more than 37,000 WNV cases in the USA between 1999 and 2012. While it is clear that age is a significant risk factor, markers of immune status associated with susceptibility to severe infections are incompletely defined. We have taken advantage of stable characteristics of individual status to profile immune markers from a stratified cohort of healthy subjects with a history of asymptomatic or severe infection with WNV. We characterized individual variations in antibody and serum cytokine levels and genome-wide transcriptional profiles of peripheral blood cells (PBMCs). While antibody levels were not significantly different between cohorts, we found that subjects with a history of severe infection had significantly lower levels of serum IL-4, and that these changes in IL-4 levels were associated with altered gene expression patterns in PBMCs. In addition, we identified a signature of 105 genes that displayed altered expression levels when comparing subjects with a history of asymptomatic or severe infection. These results suggest that systems-level analysis of immune system status can be used to identify factors relevant for susceptibility to severe infections, and specifically point to an important contribution for IL-4 in resistance to WNV infection.

Background: Detailed information about how patients with head and neck carcinoma (HNC) are treated across practice settings does not exist. The authors conducted a prospective, observational study to examine the patterns of care for a series of patients with newly diagnosed HNC in the United States and to test 2 hypotheses: 1) There is no difference in the pattern of care between community and academic settings; and 2) the results of major randomized clinical trials will change the pattern of care in both practice settings within 1 year of publication in peer-reviewed journals., Methods: Patients aged ≥ 18 years were enrolled in the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN) after providing written informed consent if they had a confirmed diagnosis of new HNC and were scheduled to receive treatment other than surgery alone., Results: Between 2005 and 2010, 100 centers enrolled 4243 patients, including 2612 patients (62%) from academic investigators and 1631 patients (38%) from community centers. Initial treatments were radiation with concurrent chemotherapy (30%) or cetuximab (9%), adjuvant radiotherapy (21%), induction chemotherapy (16%), and other (24%). Intensity modulated radiation therapy was the dominant radiation technique (84%). Single-agent cisplatin was prescribed in nearly half of patients and more often in academic centers (53% vs 43% of patients; P < .0001). Single-agent cetuximab was the next most common drug used (19%) and was prescribed more frequently in community settings (24% vs 17%; P = .0001). The data rejected the 2 prospective hypotheses., Conclusions: LORHAN documented differences in patient characteristics and treatments between community and academic settings for a large series of patients in the United States., (Copyright © 2012 American Cancer Society.)

Babesiosis is usually acquired from a tick bite or through a blood transfusion. We report a case of babesiosis in an infant for whom vertical transmission was suggested by evidence of Babesia spp. antibodies in the heel-stick blood sample and confirmed by detection of Babesia spp. DNA in placenta tissue.

Background: A study was undertaken to examine the patterns of systemic therapy use in conjunction with radiation therapy for patients with locally advanced head and neck squamous cell cancer., Methods: Between December 1, 2005 and May 11, 2009, 2874 patients with newly diagnosed head and neck squamous cell cancer who were scheduled to receive radiotherapy and/or drug therapy were registered in a prospective national database. The database was specifically analyzed to examine patients who received chemotherapy in conjunction with definitive radiotherapy., Results: A total of 1144 patients received systemic therapy in conjunction with radiotherapy; 645 (56%) patients received agents concurrent with radiation therapy, 49 (4%) patients received chemotherapy before radiotherapy (induction), 224 (20%) patients received chemotherapy before and during radiotherapy (sequential), and 226 (20%) patients received chemoradiation after surgery. Single-agent cisplatin, single-agent cetuximab, and carboplatin plus paclitaxel were, in order, the 3 most commonly prescribed concurrent regimens. Concurrent cisplatin was more frequently used in the academic setting compared with the community setting (P = .0015). Postoperative chemoradiation, rather than radiation alone, was more commonly used in academic centers compared with community practice centers (P = <.0001)., Conclusions: The LORHAN (Longitudinal Oncology Registry of Head and Neck Carcinoma) database is a useful barometer of current US practice patterns and can be applied to analyze future trends in the combined modality management of head and neck cancer. Sequential chemotherapy is used frequently, but cisplatin-based concurrent chemoradiation remains the most commonly used regimen for locally advanced head and neck cancer., (Copyright © 2010 American Cancer Society.)

West Nile virus (WNV; Flavivirus, Flaviviridae) is a spherical enveloped virion containing single-stranded, positive-sense RNA, approximately 11 kb in length. The virus is the most widely distributed flavivirus in the world. Genetic analysis reveals two major lineages of virus, I and II, and several possible newly recognized lineages. Lineage I strains are most commonly associated with outbreaks of neurologic disease, although lineage II virus has led to large epidemics of fever, as in South Africa in 1974. Infection with WNV leads to a wide range of diseases from mildly febrile to severely neurologic, but asymptomatic -infections occur most frequently. Approximately one in 140 infected individuals develop neurologic -disease. The virus is maintained in an enzootic cycle, where it is transmitted between ornithophilic mosquitoes of the Culex genus and predominantly passeriform birds. Equines and humans are considered incidental hosts since they do not mount high enough viremia for mosquitoes to become infected -following feeding. Laboratory diagnosis of WNV infection is predominantly serological, although -caution is advised because of the high degree of cross-reactivity among flaviviruses. Field specimens, especially mosquitoes and dead birds, collected as part of surveillance programs, are tested for the presence of viral nucleic acid, viral antigen, or infectious virus. Rapid test protocols have been developed in response to the expansion of WNV in the United States. Since WNV is classified as a Biosafety Level-3 (BSL-3) agent by CDC, it is recommended that once this virus is identified in a diagnostic specimen, all infectious virus should be handled in a BSL-3 laboratory in Class II biosafety cabinets by laboratory staff who are trained to work at this level of containment. Assay protocols are described and the necessary equipment and supplies listed.