Document Detail


Decreased Th1-type inflammatory cytokine expression in the skin is associated with persisting symptoms after treatment of erythema migrans.
MedLine Citation:
PMID:  21483819     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite the good prognosis of erythema migrans (EM), some patients have persisting symptoms of various character and duration post-treatment. Several factors may affect the clinical outcome of EM, e.g. the early interaction between Borrelia (B.) burgdorferi and the host immune response, the B. burgdorferi genotype, antibiotic treatment as well as other clinical circumstances. Our study was designed to determine whether early cytokine expression in the skin and in peripheral blood in patients with EM is associated with the clinical outcome.
METHODS: A prospective follow-up study of 109 patients with EM was conducted at the Åland Islands, Finland. Symptoms were evaluated at 3, 6, 12 and 24 months post-treatment. Skin biopsies from the EM and healthy skin were immunohistochemically analysed for expression of interleukin (IL)-4, IL-10, IL-12p70 and interferon (IFN)-γ, as well as for B. burgdorferi DNA. Blood samples were analysed for B. burgdorferi antibodies, allergic predisposition and levels of systemic cytokines.
FINDINGS: None of the patients developed late manifestations of Lyme borreliosis. However, at the 6-month follow-up, 7 of 88 patients reported persisting symptoms of diverse character. Compared to asymptomatic patients, these 7 patients showed decreased expression of the Th1-associated cytokine IFN-γ in the EM biopsies (p=0.003). B. afzelii DNA was found in 48%, B. garinii in 15% and B. burgdorferi sensu stricto in 1% of the EM biopsies, and species distribution was the same in patients with and without post-treatment symptoms. The two groups did not differ regarding baseline patient characteristics, B. burgdorferi antibodies, allergic predisposition or systemic cytokine levels.
CONCLUSION: Patients with persisting symptoms following an EM show a decreased Th1-type inflammatory response in infected skin early during the infection, which might reflect a dysregulation of the early immune response. This finding supports the importance of an early, local Th1-type response for optimal resolution of LB.
Authors:
Johanna Sjöwall; Linda Fryland; Marika Nordberg; Florence Sjögren; Ulf Garpmo; Christian Jansson; Sten-Anders Carlsson; Sven Bergström; Jan Ernerudh; Dag Nyman; Pia Forsberg; Christina Ekerfelt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-03-31
Journal Detail:
Title:  PloS one     Volume:  6     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2011  
Date Detail:
Created Date:  2011-04-12     Completed Date:  2011-08-25     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e18220     Citation Subset:  IM    
Affiliation:
Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Borrelia burgdorferi / immunology*
Cytokines / blood,  metabolism*
Erythema Chronicum Migrans / blood*,  immunology*
Female
Humans
Immunohistochemistry
Interferon-gamma / blood
Interleukin-10 / blood
Interleukin-12 / blood
Interleukin-4 / blood
Male
Middle Aged
Prospective Studies
Skin / immunology*,  metabolism*,  microbiology
Young Adult
Chemical
Reg. No./Substance:
0/Cytokines; 130068-27-8/Interleukin-10; 187348-17-0/Interleukin-12; 207137-56-2/Interleukin-4; 82115-62-6/Interferon-gamma
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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