Metabolic differentiation of early Lyme disease from southern tick–associated rash illness (STARI)
Claudia R. MolinsLaura V. AshtonGary P. WormserBarbara AndréAnn M. HessMark J. DeloreyMark A. PilgardBarbara J. B. JohnsonKristofor J. WebbM. Nurul IslamAdoracion Pegalajar‐JuradoIrida MollaMollie W. JewettJohn T. Belisle
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Abstract:
Metabolic profiling provides a biochemical signature to objectively differentiate two illnesses with nearly identical clinical presentations, early Lyme disease and STARI.Essential informationErythema migrans is a skin rash associated specifically with Lyme disease and is present in approximately two thirds of all cases. Often described as looking like a ‘bullseye’, it is a spreading red rash that usually appears one to four weeks following a bite by an infected tick.
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Erythema migrans
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Objective To investigate the immunization status in children with measles rash. Methods Flow cytometry and ELISA was employed to investigate the changes of CD4+T,CD8+T,TL-2,TL-4,TL-6,TL-10 in early rash and after rash,and then compared with those in healthy children. Results CD4+T decreased,while CD8+T increased in early rash,and returned to normal after rash. TL-2 increased significantly in early rash(P0.01) ,and decreased after the rash,but still maintained high level(P0.05) . TL-4,TL-6 was low and increased immediately after the rash(P0.05) ,and TL-10 always maintained a high level in early rash and after rash(P0.05) . All the changes had no relation with gender and age,but in younger patients,the younger the patients,the greater CD4+T declined may be in the early rash. Conclusion There is the brief reversible immunosuppression in children with measles,TH1 dominates the early while TH2 plays an important role after rash. TL-10 plays an important regulatory role in children with measles immunization. Immune disorders may be more serious in younger patients
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Objective:To evaluate the relationship between erlotinib-induced skin rash and clinical outcome and explore the effective way to prevent skin rash.Methods:The data from 76 non-small cell lung cancer(NSCLC) patients who experienced erlotinib-induced skin rash from Dec 2005 to Sep 2008 were collected.All the patients were confirmed with NSCLC by pathological and cytological examination and received erlotinib 150 mg/d till they had progressive disease or intolerable adverse reaction.The severity of skin rash was recorded and graded according to National Cancer Institute-Common Toxicity Criteria(NCI-CTC).The therapeutic outcome of skin rash was observed.Results:The skin rash develops as early as 3 days after commencement of erlotinib therapy,with median onset at 8 days.Twenty-seven(35.5%) patients experienced grade 1 skin rash,44 patients(57.9%) had grade 2 and 5 cases(6.6%) had grade 3 skin rash.A statistically significant correlation was observed between skin rash and erlotinib therapy.The disease-controlling rate was 63.0% for grade 1 skin rash patients including 5 cases with partial remission and 12 cases with stable disease and 91.8% for grade 2/3 skin rash patients including 32 cases with partial remission and 13 cases with stable disease(P0.05).The median time to progression(TTP) and median overall survival(OS) were prolonged in patients experienced grade 2/3 skin rash compared with those in patients with grade 1 skin rash(TTP:5.1 months vs 9.7 months,P0.01;OS:10.0 months vs 14.6 months,P0.01).The skin rash was alleviated in 60 out of 76 patients(78.9%).Conclusion:Skin rash is a potent surrogate marker of favorable outcome in patients who received erlotinib treatment.It was tolerable to most patients.Appropriate therapy may be useful in decreasing the severity of skin rash.
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Objective To summarize the experience of identifying rash of the pediatric patients and improve the recognition rate of rash.Methods A total of 419 pediatric outpatients with rash were recruited.The characteristics of rash,accompanying symptoms,doctors diagnose and the status of identify triage wereanalyzed.Results The average accuracy of triage of rash Was 76.13%.11le accuracy of triage of rash in allersic skin diseases was 82.4% and in viral or bacterial infectious disases was 66.3%.The top five triage diseases were eczenma,acute urticaria,drug rash,chicken pox,hand,foot and mouth disease.Conclusions Since the pediatric patients'rash con be found in a vailety of diseases,triage nurses should carefully observe the performance and characteristics of the rash in order to prevent errors triage.
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Children; Rash; Triage
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Lyme disease is often identified by the hallmark erythema migrans rash, but not all early cases present with a rash. In other cases the rash may be unseen or unrecognized by a physician. In these situations, Lyme disease is difficult to diagnose because it masquerades as a non-specific viral-like illness. The seasonal peak of Lyme disease ranging from May through September overlaps with that of viral illnesses such as enteroviral infections, West Nile virus, and in rare years such as 2009, early influenza season. We present a case of a patient with Lyme disease who was initially misdiagnosed with influenza A during the summer of 2009. Because of the diagnostic importance of recognizing the erythema migrans rash, physicians in endemic regions should always ask about new rashes or skin lesions and perform a thorough physical examination when patients present over the summer with viral-like symptoms. Even when no rash is evident, Lyme disease should be considered if these symptoms persist or worsen without a specific diagnosis.
Erythema migrans
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Abstract Ticks are blood-sucking arthropod ectoparasites of vertebrates, which are vectors of many diseases. They cause varied skin manifestations, which occur either due to the attachment of the tick to the host or due to the infections it spreads. Dermoscopy serves as a precise diagnostic tool for tick bites and also helps in ensuring complete removal of the tick. Prompt removal and identification of the tick, along with appropriate antibiotic therapy, are important aspects of the management of this condition. Herein, we present a case series of nine patients with tick bites, by ticks of similar morphology but at different body sites and with varied predisposing factors.
Tick-borne disease
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Humans reliably produce high concentrations of borreliacidal OspC antibodies specific for the seven C-terminal amino acids shortly after infection with Borrelia burgdorferi. We show that dogs also produce OspC borreliacidal antibodies but that their frequencies, intensities, and antigenicities differ significantly. The findings therefore confirm a major difference between the borreliacidal antibody responses of humans and canines with Lyme disease.
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Regression equations, based on scutal index (body length/scutal width), were developed to determine the duration of attachment for nymphal and adult female Ixodes scapularis ticks. Feeding times were calculated for 444 nymphal and 300 female ticks submitted by bite victims between 1985 and 1989 in Westchester County, New York, an area where Lyme disease is highly endemic. Nymphs were attached for a mean of 34.7 hours, with 26.8%removed after 48 hours, the critical time for transmission of Borrelia burgdorferi. Attachment times increased with victim age class (Kruskal-Wallis test, р<0.05). Mean duration of attachment for female ticks (28.7 hours) was significantly less (Kruskal-Wallis test, p<0.05) than that for nymphs, with 23.3% attached for more than 48 hours. The 0- to 9-year age class had the highest proportion (37.1%)of females attached for more than 48 hours. Nymphs remain attached to adult tick-bite victims longer than they remain attached to children. However, children have a high risk of acquiring Lyme disease because they receive more nymphal bites and also because they are less likely to have female ticks removed in time to prevent transmission. Am J Epidemiol 1996;143:187–92
Ixodes scapularis
Tick-borne disease
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