莱姆病研究进展

莱姆病(Lyme Disease)是以动物为维持宿主, 由硬蜱为媒介的传播包柔螺旋体疾病(Borreliosis)[1,2].

宫本疏螺旋体,一种新发现的复发热螺旋体

复发热是由复发热螺旋体经虫媒传播引起的急性传染病,复发热螺旋体属于疏螺旋体属,又名包柔螺旋体属,按其传播媒介分虱传与蜱传两类,蜱的分布有严格的地区性,故其所致的复发热亦有严格的地区性。1995年,Fukunaga等发现了一种新型的复发热螺旋体,由硬蜱属全沟硬蜱传播,将其命名为宫本疏螺旋体。这一发现扩大了人类对地理范围内复发热螺旋体感染人类的认知。本文就宫本疏螺旋体的基本情况做一简要概述。

Production of reactive oxygen species and expression of inducible nitric oxide synthase in rat isolated Kupffer cells stimulated by Leptospira interrogans and Borrelia burgdorfen

AIM： To evaluate the production of reactive oxygen species （ROS） and the expression of inducible nitric oxide synthase （iNOS） in rat isolated Kupffer cells （KCs） stimulated by Leptospira interrogans and Borrelia burgdorferi. METHODS： Rat Kupffer cells were separated by perfusion of the liver with 0.05% collagenase, and purified by Percoll gradients. Pudfied Kupffer cells were tested in vitro with alive L.interogans and B. burgdorferi preparations. The production of ROS was determined by chemiluminescence, whereas iNOS protein expression was evaluated by Western blot assay using anti-iNOS antibodies. RESULTS： B. burgdorferi and to a less extent L. interrogans induced ROS production with a peak 35 min after infection. The chemiluminescence signal progressively diminished and was undetectable by 180 min of incubation. Leptospirae and borreliae induced an increased iNOS expression in Kupffer cells that peaked at 6 hours and was still evident 22 h after infection. CONCLUSION： Both genera of spirochetes induced ROS and iNOS production in rat Kupffer cells. Since the cause of liver damage both in leptospiral as well as in borrelial infections are still unknown, we suggest that leptospira and borrelia damage of the liver can be initially mediated by oxygen radicals, and is then maintained at least in part by nitric oxide.

BORRELIA BURGDORFERI DNA IN BIOLOGICAL SAMPLES FROM PATIENTS WITH SARCOIDOSIS USING THE POLYMERASE CHAIN REACTION TECHNIQUE

Polymerase chain reaction (PCR) was used to detect the presence of Barrelia burgdoferi DNA in biological samples from patients with sarcoidosis. The target DNA sequence was of chromosomal origin. The amplified DNA sequence was analyzed by agarose gel electrophoresis, PAGE with silver staining, and the identity of amplified DNA was confirmed by restriction enzyme cleavage and DNA-DNA hybridization with a 32P-labelled probe. The assay was sensitive to fewer than two copies of B. burgdorferi genome, even in the presence of a 104-fold excess of human eukaryotic DNA , and was also specific to different B. burgdorferi strains tested. Sera serologically positive to B. burgdcrferi (n=26), bronchoalveolar lavage fluid and supernatant of BALF (n=26) and peripheral blood (n=9) from sarcoidosis patients were tested. The positive rate was low (4/26, 2/26. and 0/9, respectively). It was considered that DNA from B. burgdor ferimay be identified in a minority of patients with sarcoidosis, and it may play a pathogenetic role in such cases. More studies need to be done before advancing the hypothesis of an etiologic role of B. burgdorferi in sarcoidosis.

DETECTION OF BORRELIA BURGDOFERI DNA IN GRANULOMATOUS TISSUES FROM PATIENTS WITH SARCOIDOSIS USING POLYMERASE CHAIN REACTION IN SITU TECHNIQUE

To investigate the correlation between sarcoidosis and Borrelia burgdorferi (Bb ) infection , flagella DNA of Bb were detected in 23 granulomatous tissue specimens from patients with confirmed sarcoidosis using polymerase chain reaction in siju technique (in situ PCR) and the antibodies to Bb were examined in 55 serum samples obtained from the patients by indirect immunoflurescence assays. Our data presented that:(1) None of granulomatous tissues was found to have Bb DNA in 23 tissue samples. (2) Thirty of 55 (54. 6% ) patients with sarcoidosis were found antibodies to Bb positive ,in contrast ,six of 60 (10%) normal subjects had antibodies against Bb ,the positive rate was remarkably higher in patient group than that in healthy group (P<0. 005) . The results suggest that Bb might not be the causative agent of sarcoidosis.the elevated titres of serum antibodies against Bb in patients with sarcoidosis is a nonspecific response.

莱姆病的眼底表现及其治疗

莱姆病系由硬蜱传播包柔螺旋体所引起的一种全身性疾病,可累及眼部多个部位而致视力丧失。1989年以来收治了51例,88只眼,其眼底表现以视网膜血管炎合并增殖性改变为主。依据病史、检查和血清莱姆病抗体(≥1∶128)作出诊断。3例玻璃体发现螺旋体。采用玻璃体切除术(11只眼)、氩离子激光(27只眼)和先锋霉素V等药物综合治疗,莱姆病抗体阴转率约80％,致盲率45.1％。

莱姆病的神经系统表现

莱姆病是由蜱叮咬传播的一种包柔螺旋体感染性全身疾病。约15％～20％患者可出现末梢神经炎、颅神经炎、脑膜炎、脑炎及血管闭塞等多种神经系统表现。大剂量青霉素、菌必治治疗有效。皮质类固酵对并发脑脊髓炎、根性疼痛等神经症状,效果较显著。本文尚对本病的流行病学、疾病分期、诊断与鉴别诊断,作了简要的阐述。

Lyme病眼部表现30例分析

报告３０例Ｌｙｍｅ病，它是由蜱传播的一种传染性流行病，侵犯人体多数系统，累及皮肤神经，心血管，关节和眼等。早期眼部表现有结膜炎，后期主要为色素膜炎。诊断主要依据病史，临床表现和实验室检查。本病应与梅毒的眼部病变鉴别。早期口服抗生素可治愈，晚期需大剂量抗生素静脉滴注治疗。有１６％的复发病。长期全身使用激素会预先造成病人对抗生素失效。使用适量激素可促进眼部炎症消退和防止并发症。

湖北省东北部地区发现莱姆病

应用免疫荧光方法（ＩＦＡ）对湖北省东北部地区的英山县进行了莱姆病的流行病学调查。结果，人群总感染率为８．８％（２４／２７２），其中林区居民及非林区居民感染率分别为１２．８％（２２／１７２）及２．０％（２／１００），两者差异有高度显著性（Ｐ＝０．００５）；共采集蜱４８４只，其中微小牛蜱３０８只，豪猪血蜱１３６只，二棘血蜱４０只。经检测，不同蜱种带菌率为０～１５％。本调查证实湖北省东北部地区存在莱姆病，人群感染菜姆病与环境性蜱暴露有密切关系。