posted 01 December 2004 01:12            

I have also included some newer abstracts about syphlis... because it is also a spirochetal disease... and there is more information on it than just Lyme and co-infections.

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Microbes Infect. 2000 Oct;2(12):1431-4.

Detection of serum antibodies to Bartonella henselae and Coxiella
burnetii from Japanese children and pregnant women.

Numazaki K, Ueno H, Yokoo K, Muramatsu Y, Chiba S, Morita C.

Department of Pediatrics, Sapporo Medical University School of Medicine, S.1 W.16
Chuo-ku, Hokkaido, 060-8543, Sapporo, Japan. numazaki@sapmed.ac.jp

The participation of Bartonella henselae and Coxiella burnetii in the pathogenesis of
fever of unknown origin (FUO) and lymphadenopathy has not been completely
clarified. Prevalence of these two agents in Japanese children is also unknown. Serum
IgG and IgM antibodies to B. henselae and to C. burnetii were examined by the
indirect fluorescence antibody assay. Enzyme immunoassay kits were used to detect
serum IgG and IgA antibodies against Chlamydia trachomatis. Out of 200 healthy
normal pregnant women, two (1.0%) had serum IgG antibodies to B. henselae, four
(2.0%) to C. burnetii and 49 (24.5%) to C. trachomatis. Out of 29 patients with FUO,
one (3.4%) had serum IgG antibodies to B. henselae, four (13.8%) to C. burnetii and
none to C. trachomatis. Out of 31 patients with cervical lymphadenopathy, three
(9.6%) had serum IgG antibodies to B. henselae, two (6.5%) to C. burnetii and none
to C. trachomatis. Out of 22 patients with generalized lymphadenopathy, one (4.5%)
had serum IgG antibodies to B. henselae, three (13.6%) to C. burnetii and none to C.
trachomatis. Prevalences of serum antibodies to C. burnetii in the patients with FUO
and generalized lymphadenopathy and to B. henselae in the patients with cervical
lymphadenopathy were significantly higher than those of normal pregnant women
(Welch's t-test; P<0.01). These two agents may have some roles in the pathogenesis
of FUO and lymphadenopathy in Japanese children.

PMID: 11099929 [PubMed - indexed for MEDLINE]

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Scand J Infect Dis. 2002;34(11):853-5.

Treatment of human granulocytic ehrlichiosis during pregnancy and
risk of perinatal transmission.

Casau NC, Hewins ME, Zaleznik DF.

Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Harvard
Medical School, Boston, MA, USA. nathalie.casau@nbhn.net

A pregnant woman from Nantucket Island, MA was diagnosed with human
granulocytic ehrlichiosis at 34 weeks gestation. We describe the diagnostic and
therapeutic dilemmas involved and discuss the risks of perinatal transmission.

Publication Types:
Case Reports

PMID: 12578161 [PubMed - indexed for MEDLINE]

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1: Przegl Epidemiol. 2004;58(2):289-94.

[Human granulocytic ehrlichiosis conincident with Lyme borreliosis
in pregnant woman--a case study]

[Article in Polish]

Brzostek T.

Oddzial Obserwacyjno-Zakazny Zespolu Opieki Zdrowotnej w Debicy.

A case of 25 years old woman, living in an endemic area for Lyme borreliosis was
examined. In 29 th week of pregnancy trombocytophenia, fever and fatique were
observed, in the last 7 weeks erythema migrans was present. The woman was not
treated by that time. The infant presented trombocytophenia in the first few weeks of
life. 3 months after delivery erythema migrans disseminata was observed, by that
time Lyme borreliosis and HGE were serologically confirmed. It was not confirmed
that the infection was transferred to the infant, but it is possible that
trombocytophenia was caused by the infection with A. phagocytophila.

PMID: 15517809 [PubMed - in process]

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Bull World Health Organ. 2004 Jun;82(6):433-8.

Maternal syphilis: pathophysiology and treatment.

Berman SM.

Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta,
GA, USA 30306, USA. sberman@cdc.gov

Despite the long history of medical interest in syphilis and its effects on pregnancy
outcome, many fundamental questions about the pathophysiology and treatment of
syphilis during pregnancy remain unanswered. However, understanding has been
advanced by recent scientific reports such as those which delineate the complete
sequence of the genome of the syphilis spirochaete, provide a more precise
description of fetal and neonate infection by use of rabbit infectivity tests and
describe the gestational age distribution of fetal death secondary to syphilis. It
appears that fetal syphilitic involvement progresses in a rather predictable fashion,
and although there is disagreement about the optimal prenatal treatment regimen,
programmatic efforts to prevent fetal death must provide seropositive pregnant
women with a recommended treatment early in pregnancy, and certainly before the
third trimester.

Publication Types:
Review
Review, Tutorial

PMID: 15356936 [PubMed - indexed for MEDLINE]

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Gynecol Obstet Invest. 2001;52(2):114-8.

Clinical and epidemiological features of syphilis in pregnant women:
the course and outcome of pregnancy.

Mavrov GI, Goubenko TV.

Institute of Dermatology and Venereology, Academy of Medical Sciences of Ukraine,
Kharkiv, Ukraine. uniidiv@vlink.kharkov.ua

Clinical and epidemiological features of syphilis and the course and outcome of
pregnancy were studied in 155 pregnant women infected with syphilis; 95 (61%)
women were unemployed, 47% were unmarried. Syphilis proceeded without clinical
manifestations in 121 cases (78%). Discordant results of complement fixation
(Wassermann) test, precipitation test, Treponema pallidum immobilization test, and
fluorescent antibody test were observed in 22 (14%) of the women. Pregnancy
pathology was observed in 75 cases (48.8%) and more often appeared as anemia in
49 (31.5%), stillborn in 46 (29.8%) and toxicosis in 44 (28.4%). Fetal ultrasonic
stigmas of infection were evident in 23 cases (49%). There was distension of the
brain ventricle system and hepatomegaly each in 1 case (2%), transvascular
infiltration of liver in 2 cases (4%), dilation of intestinal loops, gastromegaly,
ventriculomegaly and petrifaction in lungs each in 1 case; ultrasonic changes in
vessels of organs: of the liver in 4 cases (8%), intestines and stomach in 16 cases
(32%), lungs in 4 cases (8%), kidneys in 10 cases (21%) and of the ventricular system
in 9 cases (19%). Fetus development retardation was revealed in 3 cases (6%), fetal
hypoxia in 1 (2%), hypohydrosis in 2 (4%) and hydropsy in 1 case (2%). The
pregnancy pathology in women with syphilis was considered not pathognomonic.
Copyright 2001 S. Karger AG, Basel

PMID: 11586039 [PubMed - indexed for MEDLINE]

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Ceska Slov Farm. 2004 Jul;53(4):159-64.

[Pharmacological aspects of Lyme borreliosis]

[Article in Czech]

Dvorakova J, Celer V.

Ustav humanni farmakologie a toxikologie VFU a FF, Brno.

Clinical signs of Lyme boreliosis in humans are versatile and in their whole scope
they finally affect the nervous system, heart, and joints. The therapeutic effect of
antibiotics is maximal in the first acute stage of the disease when doxycycline and
amoxiciline are administered. These antibiotics possess a comparable in vitro effect,
tissue penetration, pharmacokinetics, and therapeutic effect. The treatment of
disseminated infections in the second stage, such as neuroborreliosis, carditis, and
iritis, is difficult and with relative success they are treated with large doses of
penicillin G, or cefriaxon, and doxycycline. The treatment of the third stage of
borreliosis aims at chronic inflammatory changes in the affected organs. Antibiotics,
however, are successfully effective only in 50% of cases. Administration of
antibiotics, such as tetracycline, cefuroxim, doxycycline, or large doses of penicillin
is a long-term one, coming up to four weeks. A special therapeutic regimen is used in
pregnant women and children.

PMID: 15369225 [PubMed - in process]

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MMWR Morb Mortal Wkly Rep. 2004 Aug 13;53(31):716-9.

Congenital syphilis--United States, 2002.

Centers for Disease Control and Prevention (CDC).

Congenital syphilis (CS) occurs when the spirochete Treponema pallidum is
transmitted from a pregnant woman with syphilis to her fetus. Untreated syphilis
during pregnancy can lead to stillbirth, neonatal death, or infant disorders such as
deafness, neurologic impairment, and bone deformities. This report summarizes 2002
CS surveillance data, which indicated that CS rates have decreased among all
racial/ethnic minority populations and in all regions of the United States except the
Northeast. To further decrease CS, collaborative efforts among health-care providers,
health insurers, policymakers, and the public are needed to increase prenatal care and
syphilis screening during pregnancy for women at risk for delivering infants with CS.

PMID: 15306757 [PubMed - indexed for MEDLINE]

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Am Fam Physician. 2004 Apr 15;69(8):1935-7.

Identifying the vector of Lyme disease.

Lo Re V 3rd, Occi JL, MacGregor RR.

Division of Infectious Diseases, University of Pennsylvania School of Medicine,
Philadelphia 19104, USA. vincent.lore@uphs.upenn.edu

Lyme disease is the most common vector-borne illness in the United States. It is
caused by the spirochete Borrelia burgdorferi, which is transmitted by the deer tick.
Deer ticks have a four-stage life cycle (egg, larva, nymph, and adult), and nymphal
ticks transmit B. burgdorferi to humans more frequently than adult ticks.
Transmission of this spirochete typically requires a minimum of 24 to 48 hours of
tick attachment. Early stages of Lyme disease are characterized by a hallmark rash,
erythema migrans. The overall risk of acquiring Lyme disease is low in a person who
has a deer tick bite. If erythema migrans develops at the site of the bite, treatment
may include doxycycline in persons who are at least eight years of age.
Administration of amoxicillin is appropriate for pregnant women or children younger
than eight years. For those who are allergic to these medications, cefuroxime axetil
may be used.

PMID: 15117014 [PubMed - indexed for MEDLINE]

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Arch Pathol Lab Med. 2002 Oct;126(10):1237-8.

Passively acquired treponemal antibody from intravenous
immunoglobulin therapy in a pregnant patient.

Rossi KQ, Nickel JR, Wissel ME, O'Shaughnessy RW.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, the
Ohio State University College of Medicine and Public Health, Columbus, USA.

Intravenous immunoglobulin is purified, concentrated immunoglobulin G antibodies
pooled from human blood donors. The passive transmission of various antibodies
from intravenous immunoglobulin has been reported. However, to the best of our
knowledge, there are no reports of acquisition of treponemal antibody from
immunoglobulin therapy. A woman with a pregnancy complicated by neonatal
alloimmune thrombocytopenia was treated with intravenous immunoglobulin to
manage her fetal thrombocytopenia. The patient had no history of a syphilis infection.
The patient's blood was screened for syphilis antibodies regularly and routinely
because she donated platelets for transfusion to her fetus. During her intravenous
immunoglobulin treatments, a positive result on a fluorescence antibody absorption
test was confirmed, but the result on a rapid plasma reagin test was negative. Eleven
weeks after her final dose, results of the fluorescence antibody absorption test were
negative, with a negative rapid plasma reagin test result, suggesting passive
acquisition of the treponemal antibody. Clinicians and pathologists must be aware of
the possible acquisition of this antibody during the treatment and counseling of
patients receiving intravenous immunoglobulin.

PMID: 12296768 [PubMed - indexed for MEDLINE]

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J Immunol. 2001 Jun 15;166(12):7404-9.

Gestational attenuation of Lyme arthritis is mediated by
progesterone and IL-4.

Moro MH, Bjornsson J, Marietta EV, Hofmeister EK, Germer JJ, Bruinsma E,
David CS, Persing DH.

Department of Immunology, Mayo Foundation, Rochester, MN 55905, USA.

Infection of different strains of laboratory mice with the agent of Lyme disease,
Borrelia burgdorferi, results in arthritis, the severity of which has been correlated
with the dominance of Th1 cytokines. In this study, we demonstrate that changes in
B. burgdorferi-specific immunologic responses associated with pregnancy can alter
the outcome of Lyme arthritis in mice. Whereas nonpregnant female C3H mice
consistently developed severe Lyme arthritis, pregnant mice had a marked reduction
in arthritis severity that was associated with a slight reduction in IFN-gamma and
markedly increased levels of IL-4 production by B. burgdorferi-specific T cells.
Similar reductions in arthritis severity and patterns of cytokine production were
observed in nonpregnant, progesterone-implanted mice. Ab neutralization of IL-4 in
progesterone-implanted mice resulted in severe arthritis. Our results are consistent
with the known shift toward Th2 cytokine expression at the maternal-fetal interface,
and are the first to show a pregnancy-related therapeutic effect in an infectious
model.

PMID: 11390492 [PubMed - indexed for MEDLINE]

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Eur J Obstet Gynecol Reprod Biol. 2000 Jul;91(1):99-101.

Lyme borreliosis as a cause of facial palsy during pregnancy.

Grandsaerd MJ, Meulenbroeks AA.

Department of Otorhinolaryngology, Rijnstate hospital Wagnerlaan 55 6815 AD,
Arnhem, The Netherlands.

The medical history of a pregnant woman in whom the initial pattern of complaints
suggested hyperemesis gravidarum is described. After about 18 days the patient
developed left facial palsy. Repeated tests eventually confirmed the diagnosis of
neuroborreliosis. The problems concerning diagnostics, therapy and the possible
complications of Lyme borreliosis during gestation are described.

Publication Types:
Case Reports

PMID: 10817889 [PubMed - indexed for MEDLINE]

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Wien Klin Wochenschr. 1999 Dec 10;111(22-23):933-40.

Erythema migrans in pregnancy.

Maraspin V, Cimperman J, Lotric-Furlan S, Pleterski-Rigler D, Strle F.

Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia.

From 1990 through to 1997, 105 pregnant women with typical EM were investigated
at the Lyme Borreliosis Outpatients' Clinic of the Department of Infectious Diseases
at the University Medical Centre in Ljubljana, Slovenia. Twenty-five (23.8%)
patients acquired borrelial infection during the first trimester of pregnancy; eight
(7.6%) of them had noticed the skin lesion before they became pregnant. In 43
(40.6%) patients the EM appeared in the second trimester, and in 37 (35%) patients
in the third trimester of pregnancy. Two (1.9%) patients received phenoxymethyl
penicillin (1 million IU t.i.d.), three (2.9%) benzyl penicillin (10 million IU b.i.d.),
and 100 (95.2%) ceftriaxone (2 g daily). All patients were treated for 14 days except
three (2.9%) in whom the treatment with ceftriaxone was discontinued because of
mild side effects. The outcome of disease was good in all 105 patients. Ninety-three
(88.6%) out of 105 patients had normal pregnancies; the infants were delivered at
term, were clinically healthy, and subsequently had a normal psychomotor
development. In the remaining 12 (11.4%) patients an adverse outcome was
observed. Two (1.9%) pregnancies ended with an abortion (one missed abortion at 9
weeks, one spontaneous abortion at 10 weeks), and six (5.7%) with preterm birth.
One of the preterm babies had cardiac abnormalities and two died shortly after birth.
Four (3.8%) babies born at term were found to have congenital anomalies; one had
syndactyly at birth and three had urologic abnormalities which were registered at the
age of 5, 7, and 10 months, respectively. A causal association with borrelial infection
was not proven in any infant. For at least some unfavourable outcomes a plausible
explanation not associated with Lyme borreliosis was found.

Publication Types:
Case Reports

PMID: 10666804 [PubMed - indexed for MEDLINE]

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South Med J. 1982 Sep;75(9):1063-6.

Rocky Mountain spotted fever in pregnancy: differential diagnosis
and treatment.

Herbert WN, Seeds JW, Koontz WL, Cefalo RC.

Rocky Mountain spotted fever (RMSF) presents both diagnostic and therapeutic
difficulties in the pregnant patient. Early clinical manifestations may be mistaken for
normal pregnancy changes. Accurate diagnosis is essential, since several of the
disorders in the differential diagnosis may have important obstetric implications.
Antibiotics generally used to treat serious infections during pregnancy are ineffective
in treating RMSF. Chloramphenicol is the antibiotic of choice. Specific
recommendations for evaluating pregnant patients with suspected RMSF are given.

PMID: 7123324 [PubMed - indexed for MEDLINE]

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J Parasitol. 1999 Jun;85(3):426-30.

Investigation of venereal, transplacental, and contact transmission of
the Lyme disease spirochete, Borrelia burgdorferi, in Syrian
hamsters.

Woodrum JE, Oliver JH Jr.

Institute of Arthropodology and Parasitology, Department of Biology, Georgia
Southern University, Statesboro 30460, USA.

A hamster was inoculated with the SI-1 strain of Borrelia burgdorferi and
subsequently served as a host to larval Ixodes scapularis Say. Approximately 68% of
the nymphs resulting from the fed larvae were infected. Nymphs from this group were
fed on uninfected hamsters, and 3 of 4 males and 6 of 6 females became infected.
The infected hamsters were allowed to mate with uninfected partners to test for
venereal transmission. Six infected females were mated with 6 uninfected males,
whereas 3 infected males were mated with 6 uninfected females. None of the
uninfected hamsters became infected after mating. Two protocols were used to
determine if transplacental transmission of B. burgdorferi occurred. One group
included 6 nonpregnant infected females that were subsequently mated and became
pregnant. Three of the females were allowed to carry to full term, whereas the other 3
were killed prior to parturition. All fetuses and offspring were negative for B.
burgdorferi based on cultures and monoclonal antibody assays. Another group of 6
females was infected via tick bite after becoming pregnant; those females were
allowed to carry fetuses to birth and all were negative. Attempts at contact
transmission of B. burgdorferi from 2 infected females to 2 uninfected male and 2
uninfected female hamsters and from 2 infected males to 2 uninfected male and
uninfected female hamsters via urine or feces failed.

PMID: 10386432 [PubMed - indexed for MEDLINE]

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J Infect Dis. 2002 Oct 1;186(7):948-57. Epub 2002 Sep 03.

Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal
syphilis screening and single-dose benzathine penicillin treatment for
the prevention of adverse pregnancy outcomes.

Watson-Jones D, Gumodoka B, Weiss H, Changalucha J, Todd J, Mugeye K,
Buve A, Kanga Z, Ndeki L, Rusizoka M, Ross D, Marealle J, Balira R, Mabey D,
Hayes R.

Department of Infectious and Tropical Diseases, London School of Hygiene and
Tropical Medicine, London, United Kingdom. deborah.watson-jones@lshtm.ac.uk

Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million
units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To
examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant
women was recruited in Tanzania. Birth outcomes were compared among women
treated for high-titer (n=133; rapid plasma reagin [RPR] titer > or = 1:8 and
Treponema pallidum hemagglutination assay [TPHA]/fluorescent treponemal
antibody [FTA] positive) and low-titer (n=249; RPR titer <1:8 and TPHA/FTA
positive) active syphilis and 950 uninfected women. Stillbirth or low-birth-weight
live births were observed in 2.3% and 6.3%, respectively, of women treated for
high-titer active syphilis and in 2.5% and 9.2%, respectively, of seronegative women.
There was no increased risk for adverse pregnancy outcome for women treated for
high-titer active syphilis (odds ratio [OR], 0.76; 95% confidence interval [CI],
0.4-1.4) or low-titer active syphilis (OR, 0.95; 95% CI, 0.6-1.5), compared with
seronegative women. Single-dose treatment is effective in preventing adverse
pregnancy outcomes attributable to maternal syphilis.

Publication Types:
Clinical Trial

PMID: 12232835 [PubMed - indexed for MEDLINE]

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