Infectiologic differential diagnosis of chronic Lyme disease and so ...

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the depiction of chronic yersiniosis: chronic persistent arthralgias, ankylosing spondylitis, rheumatoid arthritis, iridocyclitis, chronic abdominal pains, chronic diarrhea, ulcerative colitis, nervous disorders, nephritis, thyroid disorders, insulin- dependent Diabetes mellitus, chronic hepatitis, (multisystem diseases) and a substantial reduction of the overall life expectancy. Many of the different relationships were depicted in further publications by these authors [252 - 256, 257]. Studies which immediately suggest a possible relationship between Yersinia and inflammatory intestinal disorders [257] close the pathophysiological circle between Yersinia, inflammatory intestinal disorders and enteropathic arthritides. Despite this, it should be noted that the relationship between Yersinia infection and the above-mentioned numerous disease manifestations (except for arthritis) have been inadequately analyzed. This may be due to the fact that yersiniosis’ significance as a disease has only been recently recognized. The so-called reactive arthritis primarily affects the hip, knee and upper ankle joints as well as the sacroiliac joints; occasionally there are additionally chronic pains in the lumbosacral region [165]. This arthritis can last for months, and exhibit recurrent and symptom-free intervals in the disease course. — The so-called reactive arthritis in yersiniosis can occur alone, but occasionally also in connection with conjunctivitis and urethritis (previously termed Reiter's syndrome [162]). In the differential diagnosis of Lyme disease, it is of particular interest that the pathogen (Y. enterocolitica) could be detected in articular effusions in studies of the so-called reactive arthritis [163, 164]. Sometimes these arthritides last for many years. In addition, there is a relationship between yersiniosis and thyroiditis. All these facts (chronic arthritides, multisystem disorders, disease course lasting for years, correlation with regard to thyroiditis) can be observed in the same manner in Lyme disease. Thus, the differential diagnosis is sometimes extremely difficult. 30
The laboratory diagnostics of Yersinia enterocolitica infection is presented in Table 17. Table 17 Laboratory diagnostics of Yersinia enterocolitica infection Serology LTT* Pathogen detection � PCR � Culture As is the case in Lyme disease, there is often seropositivity in non-diseased people Information on a possible seronegativity in chronic yersiniosis is not available. In the disease course the serological findings can correlate with the disease expression [165]. It is not at all seldom that a highly significant pathological Yersinia LTT is found in patients whose complaint symptomatology is primarily consistent with chronic Lyme disease. In correspondence to chronic Lyme disease, the positive yersinia LTT could be an indication of a chronic persistent infection especially in cases involving reproducibility. The focuses which are to be considered in the differential diagnosis of chronic Lyme disease or chronic yersiniosis, respectively, are depicted in Table 16. Pathogen detection is particularly possible in articular effusion as well as in the lymphatic tissue of the intestine as well as in early stages also by means of a throat swab. Data on the sensitivity of pathogen detection using PCR or culture methods does not exist in the relevant literature. 31
Page 1 and 2: Infectiologic differential diagnosi
Page 3 and 4: 3 Anamnistically, one has to consid
Page 5 and 6: Table 2 LD coinfections (not tick-b
Page 7 and 8: Table 5 Bartonellosis’ infection
Page 9 and 10: Table 6 Main disease manifestations
Page 11 and 12: 11 Fig. 1. Erythrocytes infected wi
Page 13 and 14: 13 Bartonellae are localized in ery
Page 15 and 16: ESR und CRP elevated Hypercalcemia
Page 18 and 19: Table 9 Antibiotic treatment of bar
Page 20 and 21: antibiosis is that the antibiotic i
Page 22 and 23: The laboratory diagnostics for Chla
Page 24 and 25: The arthritis occurs in 1% of the u
Page 26 and 27: In the differential diagnosis of Ly
Page 28 and 29: Late phase: - Reactive arthritis -
Page 32 and 33: In Yersinia-PCR-positive patients,
Page 34 and 35: - Incubation period 3 weeks - Atypi
Page 36 and 37: system, of the skin and other organ
Page 38 and 39: - Ehrlichia chaffeensis [1] - Anapl
Page 40 and 41: Since seroprevalence merely express
Page 42 and 43: B. microti is the predominant patho
Page 44 and 45: epresent a major health hazard and
Page 46 and 47: The decisive diagnostic information
Page 48 and 49: Probable: IFA IgG 1:1024 and one of
Page 50 and 51: The main manifestation of the Campy
Page 52 and 53: The term “reactive arthritis” i
Page 54 and 55: In the diagnosis of a “reactive a
Page 56 and 57: Table 27 Disease manifestations of
Page 58 and 59: addition, other pathogens discussed
Page 60 and 61: [8] Schouls LM, Van De Pol I, Rijpk
Page 62 and 63: [25] Hermanowska-Szpakowicz T, Skot
Page 64 and 65: [43] Bakken JS, Krueth JK, Lund T,
Page 66 and 67: [60] Fox LM, Wingerter S, Ahmed A e
Page 68 and 69: [80] Marra CM. Neurologic complicat
Page 70 and 71: [100] Pulliainen AT, Dehio C. Barto
Page 72 and 73: [118] Bass JW, Freitas BC, Freitas
Page 74 and 75: [137] Gaydos CA, Roblin PM, Hammers
Page 76 and 77: [155] Cover TL, Aber RC. Yersinia e
Page 78 and 79: multi-organ donors for the presence
Page 80 and 81:
[190] Straubinger RK, Straubinger A
Page 82 and 83:
[208] Bitnun A, Ford-Jones E, Blase
Page 84 and 85:
patients with reactive and undiffer
Page 86 and 87:
[242] Appelbaum PC, Gillespie SH, B
Page 88 and 89:
pneumoniae infection associated wit
Page 90 and 91:
[276] Thomas NH, Collins JE, Robb S
Page 92 and 93:
[294] File TM Jr, Segreti J, Dunbar
Page 94 and 95:
[310] Sorvillo FJ, Lieb LE, Waterma
Page 96 and 97:
henselae Isolates Collected from Ca
Page 98 and 99:
[345] Raoult D, Levy PY, Harlé JR,
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