Nancy Walsh

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 (71%) children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both IgM and IgG antibodies, according to Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present even though no clinical symptoms remained. Serology can therefore be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick.

In 42.5% of the infected children, symptoms were nonspecific, whereas, in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

All children received oral amoxicillin or tetracycline, and those with neuroborreliosis were given ceftriaxone intravenously for 3–4 weeks. Complete recovery was seen in 72 (83%) of the children following the first course of therapy.

Improvement was first observed in children with erythema migrans, 5–7 days after treatment began. At 7–10 days those with facial palsy began to respond, as did those with meningitis after 10–14 days.

Recovery following a second course of treatment with amoxicillin or ceftriaxone was seen in four children with fever, in three with headache, in two with nerve palsy, in two with gonitis, and in one with mental disturbances and acrodermatitis chronica atrophicans.

One patient with radiculitis improved after a second course, but muscular atrophy persisted. One child with palsy of cranial nerve VIII experienced irreversible unilateral deafness despite three courses of treatment.

Early diagnosis and directed treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 (71%) children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both IgM and IgG antibodies, according to Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present even though no clinical symptoms remained. Serology can therefore be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick.

In 42.5% of the infected children, symptoms were nonspecific, whereas, in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

All children received oral amoxicillin or tetracycline, and those with neuroborreliosis were given ceftriaxone intravenously for 3–4 weeks. Complete recovery was seen in 72 (83%) of the children following the first course of therapy.

Improvement was first observed in children with erythema migrans, 5–7 days after treatment began. At 7–10 days those with facial palsy began to respond, as did those with meningitis after 10–14 days.

Recovery following a second course of treatment with amoxicillin or ceftriaxone was seen in four children with fever, in three with headache, in two with nerve palsy, in two with gonitis, and in one with mental disturbances and acrodermatitis chronica atrophicans.

One patient with radiculitis improved after a second course, but muscular atrophy persisted. One child with palsy of cranial nerve VIII experienced irreversible unilateral deafness despite three courses of treatment.

Early diagnosis and directed treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 (71%) children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both IgM and IgG antibodies, according to Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present even though no clinical symptoms remained. Serology can therefore be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick.

In 42.5% of the infected children, symptoms were nonspecific, whereas, in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

All children received oral amoxicillin or tetracycline, and those with neuroborreliosis were given ceftriaxone intravenously for 3–4 weeks. Complete recovery was seen in 72 (83%) of the children following the first course of therapy.

Improvement was first observed in children with erythema migrans, 5–7 days after treatment began. At 7–10 days those with facial palsy began to respond, as did those with meningitis after 10–14 days.

Recovery following a second course of treatment with amoxicillin or ceftriaxone was seen in four children with fever, in three with headache, in two with nerve palsy, in two with gonitis, and in one with mental disturbances and acrodermatitis chronica atrophicans.

One patient with radiculitis improved after a second course, but muscular atrophy persisted. One child with palsy of cranial nerve VIII experienced irreversible unilateral deafness despite three courses of treatment.

Early diagnosis and directed treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — A single intramuscular injection of 0.6 mg/kg dexamethasone decreased the duration of symptoms and hospital stay among young children with bronchiolitis in a randomized, placebo controlled trial, according to Jamaree Teeratakulpisarn, M.D.

The optimal treatment of acute bronchiolitis remains controversial, Dr. Teeratakulpisarn said.

Some reports in the literature suggest that corticosteroids may be helpful, and a single dose of dexamethasone has been shown to be beneficial in the treatment of croup.

“We therefore conducted a randomized, double-blind, placebo controlled trial in 174 children younger than 2 years hospitalized with acute bronchiolitis,” Dr. Teeratakulpisarn wrote in a poster session at an international congress of the World Society for Pediatric Infectious Diseases.

The primary outcome was time to symptom resolution, which was defined as a respiratory rate score of 0 or 1, wheezing score of 0 or 1, retraction muscle score of 0 or 1, and oxygen saturation of 95% or greater without oxygenation, the physician said.

Analysis showed that dexamethasone treatment was associated with a significant increase in favorable outcome—shorter duration of symptoms—with a hazard ratio of 1.56, compared with placebo, he said.

The treatment significantly decreased the mean duration of symptoms by 11.8 hours, duration of oxygen therapy by 16.6 hours, and length of hospital stay by 13.4 hours, reported Dr. Teeratakulpisarn of the department of pediatrics, Khon Kaen (Thailand) University.

There were very few minor side effects with the medication, and there were no significant differences between the active treatment group and the placebo group in additional drugs used, adverse effects, and complications, Dr. Teeratakulpisarn said.

This treatment should be recommended for acute bronchiolitis, Dr. Teeratakulpisarn concluded.

WARSAW — A single intramuscular injection of 0.6 mg/kg dexamethasone decreased the duration of symptoms and hospital stay among young children with bronchiolitis in a randomized, placebo controlled trial, according to Jamaree Teeratakulpisarn, M.D.

The optimal treatment of acute bronchiolitis remains controversial, Dr. Teeratakulpisarn said.

Some reports in the literature suggest that corticosteroids may be helpful, and a single dose of dexamethasone has been shown to be beneficial in the treatment of croup.

“We therefore conducted a randomized, double-blind, placebo controlled trial in 174 children younger than 2 years hospitalized with acute bronchiolitis,” Dr. Teeratakulpisarn wrote in a poster session at an international congress of the World Society for Pediatric Infectious Diseases.

The primary outcome was time to symptom resolution, which was defined as a respiratory rate score of 0 or 1, wheezing score of 0 or 1, retraction muscle score of 0 or 1, and oxygen saturation of 95% or greater without oxygenation, the physician said.

Analysis showed that dexamethasone treatment was associated with a significant increase in favorable outcome—shorter duration of symptoms—with a hazard ratio of 1.56, compared with placebo, he said.

The treatment significantly decreased the mean duration of symptoms by 11.8 hours, duration of oxygen therapy by 16.6 hours, and length of hospital stay by 13.4 hours, reported Dr. Teeratakulpisarn of the department of pediatrics, Khon Kaen (Thailand) University.

There were very few minor side effects with the medication, and there were no significant differences between the active treatment group and the placebo group in additional drugs used, adverse effects, and complications, Dr. Teeratakulpisarn said.

This treatment should be recommended for acute bronchiolitis, Dr. Teeratakulpisarn concluded.

WARSAW — A single intramuscular injection of 0.6 mg/kg dexamethasone decreased the duration of symptoms and hospital stay among young children with bronchiolitis in a randomized, placebo controlled trial, according to Jamaree Teeratakulpisarn, M.D.

The optimal treatment of acute bronchiolitis remains controversial, Dr. Teeratakulpisarn said.

Some reports in the literature suggest that corticosteroids may be helpful, and a single dose of dexamethasone has been shown to be beneficial in the treatment of croup.

“We therefore conducted a randomized, double-blind, placebo controlled trial in 174 children younger than 2 years hospitalized with acute bronchiolitis,” Dr. Teeratakulpisarn wrote in a poster session at an international congress of the World Society for Pediatric Infectious Diseases.

The primary outcome was time to symptom resolution, which was defined as a respiratory rate score of 0 or 1, wheezing score of 0 or 1, retraction muscle score of 0 or 1, and oxygen saturation of 95% or greater without oxygenation, the physician said.

Analysis showed that dexamethasone treatment was associated with a significant increase in favorable outcome—shorter duration of symptoms—with a hazard ratio of 1.56, compared with placebo, he said.

The treatment significantly decreased the mean duration of symptoms by 11.8 hours, duration of oxygen therapy by 16.6 hours, and length of hospital stay by 13.4 hours, reported Dr. Teeratakulpisarn of the department of pediatrics, Khon Kaen (Thailand) University.

There were very few minor side effects with the medication, and there were no significant differences between the active treatment group and the placebo group in additional drugs used, adverse effects, and complications, Dr. Teeratakulpisarn said.

This treatment should be recommended for acute bronchiolitis, Dr. Teeratakulpisarn concluded.

NEW YORK — Racial disparities in access to health care will disappear only when adequate and representative samples of minorities participate in clinical trials, Winston Price, M.D., said at the annual meeting of the National Medical Association.

That disparities in delivery of health care exist is not in question. The Institute of Medicine report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare" revealed the extent of the problem, showing that disparities remain even after adjustment for factors such as insurance coverage and socioeconomic status.

But a widespread mistrust of the U.S. health care system among minorities—not least because of past abuses such as the Tuskegee Syphilis Study, in which blacks went untreated for many years despite the availability of effective therapy—has led to an unwillingness among African Americans to participate in the clinical trials that might directly benefit their own health.

An increasing understanding of genetic differences and racial differences in response to medications now makes it imperative that minorities be included and their needs addressed in the drug development process, said Dr. Price of the State University of New York Health Science Center, Brooklyn.

The experience with BiDil, a fixed-dose combination of isosorbide dinitrate and hydralazine approved specifically for the treatment of heart failure in black patients, shows it can be done (July 2005, page 1).

"You had 1,050 African Americans who enrolled in the study, and the attrition rate was zero," Dr. Price, who is also president of the NMA, said in a press briefing. "Every single one stayed with that study until completion. The drug was approved by the Food and Drug Administration on June 23, not because it was the right thing to do but because it was pure science and evidence based. All we're asking for is parity."

Other model programs also are demonstrating that blacks can be recruited successfully, Christopher L. Edwards, Ph.D., said at the briefing.

Programs that are successful tend to be well entrenched in the community; they have significant outreach and education and strong, ongoing relationships with local organizations such as churches and fraternities, Dr. Edwards said.

They do not pressure potential study participants, but rather provide information and allow patients to process the information at home and respond to the investigators when they are ready, he said.

Successful investigators are available to the community not only when recruiting; they are able to articulate the tangible benefits of participation, not only for patients themselves but also for future generations. Dr. Edwards' program in the department of psychiatry at Duke University Medical Center, Durham, N.C., is an example.

"We make ourselves available for interviews on television, religious radio, and pop radio. In one creative marketing plan, we placed advertisements for one of our genetic studies on the side of 20 city buses, and have seen a significant number of patients responding," he said.

The overall strategy of information dissemination is to go where the patients are, and not to rely on them to come to us, he said. "With the bus advertisements, the demographic we were recruiting was reliant on public transportation," he added. And the advertisements provided phone numbers, not e-mail addresses or Web sites because these would not be particularly helpful for a population that doesn't own computers.

In the Duke program, the relevant stakeholders are at the table when recruiting programs are being designed. "If we are recruiting college students, we had students who sat on review panels and advisory boards to give us guidance as to what they would respond to, how, and in what setting," Dr. Edwards said.

Another panel member, Rahn K. Bailey, M.D., said that throughout his career he has been interested in issues such as differences in drug metabolism between African Americans and other patients. For example, about 40% of black patients are slow or intermediate metabolizers of many psychiatric medications, said Dr. Bailey of the department of psychiatry and human behavior, University of Texas, Houston, and chair of the NMA psychiatry and behavioral sciences section.

NEW YORK — Racial disparities in access to health care will disappear only when adequate and representative samples of minorities participate in clinical trials, Winston Price, M.D., said at the annual meeting of the National Medical Association.

That disparities in delivery of health care exist is not in question. The Institute of Medicine report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare" revealed the extent of the problem, showing that disparities remain even after adjustment for factors such as insurance coverage and socioeconomic status.

But a widespread mistrust of the U.S. health care system among minorities—not least because of past abuses such as the Tuskegee Syphilis Study, in which blacks went untreated for many years despite the availability of effective therapy—has led to an unwillingness among African Americans to participate in the clinical trials that might directly benefit their own health.

An increasing understanding of genetic differences and racial differences in response to medications now makes it imperative that minorities be included and their needs addressed in the drug development process, said Dr. Price of the State University of New York Health Science Center, Brooklyn.

The experience with BiDil, a fixed-dose combination of isosorbide dinitrate and hydralazine approved specifically for the treatment of heart failure in black patients, shows it can be done (July 2005, page 1).

"You had 1,050 African Americans who enrolled in the study, and the attrition rate was zero," Dr. Price, who is also president of the NMA, said in a press briefing. "Every single one stayed with that study until completion. The drug was approved by the Food and Drug Administration on June 23, not because it was the right thing to do but because it was pure science and evidence based. All we're asking for is parity."

Other model programs also are demonstrating that blacks can be recruited successfully, Christopher L. Edwards, Ph.D., said at the briefing.

Programs that are successful tend to be well entrenched in the community; they have significant outreach and education and strong, ongoing relationships with local organizations such as churches and fraternities, Dr. Edwards said.

They do not pressure potential study participants, but rather provide information and allow patients to process the information at home and respond to the investigators when they are ready, he said.

Successful investigators are available to the community not only when recruiting; they are able to articulate the tangible benefits of participation, not only for patients themselves but also for future generations. Dr. Edwards' program in the department of psychiatry at Duke University Medical Center, Durham, N.C., is an example.

"We make ourselves available for interviews on television, religious radio, and pop radio. In one creative marketing plan, we placed advertisements for one of our genetic studies on the side of 20 city buses, and have seen a significant number of patients responding," he said.

The overall strategy of information dissemination is to go where the patients are, and not to rely on them to come to us, he said. "With the bus advertisements, the demographic we were recruiting was reliant on public transportation," he added. And the advertisements provided phone numbers, not e-mail addresses or Web sites because these would not be particularly helpful for a population that doesn't own computers.

In the Duke program, the relevant stakeholders are at the table when recruiting programs are being designed. "If we are recruiting college students, we had students who sat on review panels and advisory boards to give us guidance as to what they would respond to, how, and in what setting," Dr. Edwards said.

Another panel member, Rahn K. Bailey, M.D., said that throughout his career he has been interested in issues such as differences in drug metabolism between African Americans and other patients. For example, about 40% of black patients are slow or intermediate metabolizers of many psychiatric medications, said Dr. Bailey of the department of psychiatry and human behavior, University of Texas, Houston, and chair of the NMA psychiatry and behavioral sciences section.

NEW YORK — Racial disparities in access to health care will disappear only when adequate and representative samples of minorities participate in clinical trials, Winston Price, M.D., said at the annual meeting of the National Medical Association.

That disparities in delivery of health care exist is not in question. The Institute of Medicine report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare" revealed the extent of the problem, showing that disparities remain even after adjustment for factors such as insurance coverage and socioeconomic status.

But a widespread mistrust of the U.S. health care system among minorities—not least because of past abuses such as the Tuskegee Syphilis Study, in which blacks went untreated for many years despite the availability of effective therapy—has led to an unwillingness among African Americans to participate in the clinical trials that might directly benefit their own health.

An increasing understanding of genetic differences and racial differences in response to medications now makes it imperative that minorities be included and their needs addressed in the drug development process, said Dr. Price of the State University of New York Health Science Center, Brooklyn.

The experience with BiDil, a fixed-dose combination of isosorbide dinitrate and hydralazine approved specifically for the treatment of heart failure in black patients, shows it can be done (July 2005, page 1).

"You had 1,050 African Americans who enrolled in the study, and the attrition rate was zero," Dr. Price, who is also president of the NMA, said in a press briefing. "Every single one stayed with that study until completion. The drug was approved by the Food and Drug Administration on June 23, not because it was the right thing to do but because it was pure science and evidence based. All we're asking for is parity."

Other model programs also are demonstrating that blacks can be recruited successfully, Christopher L. Edwards, Ph.D., said at the briefing.

Programs that are successful tend to be well entrenched in the community; they have significant outreach and education and strong, ongoing relationships with local organizations such as churches and fraternities, Dr. Edwards said.

They do not pressure potential study participants, but rather provide information and allow patients to process the information at home and respond to the investigators when they are ready, he said.

Successful investigators are available to the community not only when recruiting; they are able to articulate the tangible benefits of participation, not only for patients themselves but also for future generations. Dr. Edwards' program in the department of psychiatry at Duke University Medical Center, Durham, N.C., is an example.

"We make ourselves available for interviews on television, religious radio, and pop radio. In one creative marketing plan, we placed advertisements for one of our genetic studies on the side of 20 city buses, and have seen a significant number of patients responding," he said.

The overall strategy of information dissemination is to go where the patients are, and not to rely on them to come to us, he said. "With the bus advertisements, the demographic we were recruiting was reliant on public transportation," he added. And the advertisements provided phone numbers, not e-mail addresses or Web sites because these would not be particularly helpful for a population that doesn't own computers.

In the Duke program, the relevant stakeholders are at the table when recruiting programs are being designed. "If we are recruiting college students, we had students who sat on review panels and advisory boards to give us guidance as to what they would respond to, how, and in what setting," Dr. Edwards said.

Another panel member, Rahn K. Bailey, M.D., said that throughout his career he has been interested in issues such as differences in drug metabolism between African Americans and other patients. For example, about 40% of black patients are slow or intermediate metabolizers of many psychiatric medications, said Dr. Bailey of the department of psychiatry and human behavior, University of Texas, Houston, and chair of the NMA psychiatry and behavioral sciences section.

GLASGOW, SCOTLAND — Hypnotherapy led to marked and persistent improvements in symptoms and quality of life in a pilot study of patients with moderate to severe atopic dermatitis, Susannah E. Baron, M.B., reported at the annual meeting of the British Association of Dermatologists.

The study included seven adults, five of whom were women whose mean age was 49 years, and two children, a 12-year-old girl and a 5-year-old boy. Baseline assessments included the severity scoring of atopic dermatitis (SCORAD) index and a patient-completed visual analog scale (VAS). Adults also completed the dermatology life quality index (DLQI) and the hospital anxiety and depression scale (HADS). Children completed the child dermatology life quality index (CDLQI), and their parents completed a family impact questionnaire (FIQ).

Throughout the 12-month study, patients used topical emollients and corticosteroids.

All participants underwent three or four sessions of hypnotherapy and were taught self-hypnosis techniques, which they were encouraged to continue.

Symptoms rated on the SCORAD index improved in all adults and one child during the course of hypnotherapy, and improved in all when rated according to VAS.

Mean SCORAD index reduction was from 43.5 at baseline to 32.8, representing a 25% improvement. Mean VAS reduction was from 5.9 to 3.5, which was an improvement of 41%, Dr. Baron explained in a poster session.

Improvements continued through the yearlong follow-up, with mean SCORAD index ratings of 29.9, 20.8, and 21.1 at 3, 6, and 12 months, respectively.

Mean DLQI improved from 15.4 to 7.3 (53%), while the mean CDLQI improved from 17 to 8.5 (50%) over the course of treatment. Mean FIQ was reduced from 18 to 6.5 (64%).

At 12 months there was a further reduction in mean CDLQI to 5 and in mean FIQ to 2.5.

Mean anxiety scores decreased from 9.1 to 5.2, and mean depression scores decreased from 5.6 to 2.4 during the course of treatment. HADS and DLQI improvements were maintained throughout follow-up.

“Hypnotherapy may be beneficial in the management of atopic dermatitis by reducing symptoms, breaking the itch-scratch habit cycle, and reducing the anxiety associated with flare,” wrote Dr. Baron of the dermatology department of the General Infirmary at Leeds (England).

In addition, patients enjoyed the hypnotherapy sessions and reported that they found self-hypnosis to be a useful skill for the long-term management of their disease, she noted.

GLASGOW, SCOTLAND — Hypnotherapy led to marked and persistent improvements in symptoms and quality of life in a pilot study of patients with moderate to severe atopic dermatitis, Susannah E. Baron, M.B., reported at the annual meeting of the British Association of Dermatologists.

The study included seven adults, five of whom were women whose mean age was 49 years, and two children, a 12-year-old girl and a 5-year-old boy. Baseline assessments included the severity scoring of atopic dermatitis (SCORAD) index and a patient-completed visual analog scale (VAS). Adults also completed the dermatology life quality index (DLQI) and the hospital anxiety and depression scale (HADS). Children completed the child dermatology life quality index (CDLQI), and their parents completed a family impact questionnaire (FIQ).

Throughout the 12-month study, patients used topical emollients and corticosteroids.

All participants underwent three or four sessions of hypnotherapy and were taught self-hypnosis techniques, which they were encouraged to continue.

Symptoms rated on the SCORAD index improved in all adults and one child during the course of hypnotherapy, and improved in all when rated according to VAS.

Mean SCORAD index reduction was from 43.5 at baseline to 32.8, representing a 25% improvement. Mean VAS reduction was from 5.9 to 3.5, which was an improvement of 41%, Dr. Baron explained in a poster session.

Improvements continued through the yearlong follow-up, with mean SCORAD index ratings of 29.9, 20.8, and 21.1 at 3, 6, and 12 months, respectively.

Mean DLQI improved from 15.4 to 7.3 (53%), while the mean CDLQI improved from 17 to 8.5 (50%) over the course of treatment. Mean FIQ was reduced from 18 to 6.5 (64%).

At 12 months there was a further reduction in mean CDLQI to 5 and in mean FIQ to 2.5.

Mean anxiety scores decreased from 9.1 to 5.2, and mean depression scores decreased from 5.6 to 2.4 during the course of treatment. HADS and DLQI improvements were maintained throughout follow-up.

“Hypnotherapy may be beneficial in the management of atopic dermatitis by reducing symptoms, breaking the itch-scratch habit cycle, and reducing the anxiety associated with flare,” wrote Dr. Baron of the dermatology department of the General Infirmary at Leeds (England).

In addition, patients enjoyed the hypnotherapy sessions and reported that they found self-hypnosis to be a useful skill for the long-term management of their disease, she noted.

GLASGOW, SCOTLAND — Hypnotherapy led to marked and persistent improvements in symptoms and quality of life in a pilot study of patients with moderate to severe atopic dermatitis, Susannah E. Baron, M.B., reported at the annual meeting of the British Association of Dermatologists.

The study included seven adults, five of whom were women whose mean age was 49 years, and two children, a 12-year-old girl and a 5-year-old boy. Baseline assessments included the severity scoring of atopic dermatitis (SCORAD) index and a patient-completed visual analog scale (VAS). Adults also completed the dermatology life quality index (DLQI) and the hospital anxiety and depression scale (HADS). Children completed the child dermatology life quality index (CDLQI), and their parents completed a family impact questionnaire (FIQ).

Throughout the 12-month study, patients used topical emollients and corticosteroids.

All participants underwent three or four sessions of hypnotherapy and were taught self-hypnosis techniques, which they were encouraged to continue.

Symptoms rated on the SCORAD index improved in all adults and one child during the course of hypnotherapy, and improved in all when rated according to VAS.

Mean SCORAD index reduction was from 43.5 at baseline to 32.8, representing a 25% improvement. Mean VAS reduction was from 5.9 to 3.5, which was an improvement of 41%, Dr. Baron explained in a poster session.

Improvements continued through the yearlong follow-up, with mean SCORAD index ratings of 29.9, 20.8, and 21.1 at 3, 6, and 12 months, respectively.

Mean DLQI improved from 15.4 to 7.3 (53%), while the mean CDLQI improved from 17 to 8.5 (50%) over the course of treatment. Mean FIQ was reduced from 18 to 6.5 (64%).

At 12 months there was a further reduction in mean CDLQI to 5 and in mean FIQ to 2.5.

Mean anxiety scores decreased from 9.1 to 5.2, and mean depression scores decreased from 5.6 to 2.4 during the course of treatment. HADS and DLQI improvements were maintained throughout follow-up.

“Hypnotherapy may be beneficial in the management of atopic dermatitis by reducing symptoms, breaking the itch-scratch habit cycle, and reducing the anxiety associated with flare,” wrote Dr. Baron of the dermatology department of the General Infirmary at Leeds (England).

In addition, patients enjoyed the hypnotherapy sessions and reported that they found self-hypnosis to be a useful skill for the long-term management of their disease, she noted.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both antibodies, noted Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present, but no clinical symptoms remained.

Serology can be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick.

In 42.5% of the infected children, symptoms were nonspecific, whereas in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

Early diagnosis and treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both antibodies, noted Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present, but no clinical symptoms remained.

Serology can be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick.

In 42.5% of the infected children, symptoms were nonspecific, whereas in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

Early diagnosis and treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both antibodies, noted Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present, but no clinical symptoms remained.

Serology can be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick.

In 42.5% of the infected children, symptoms were nonspecific, whereas in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

Early diagnosis and treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — Efforts to develop combination vaccines that would streamline immunization schedules have hit some surprising snags, including unpredictable immunogenicity, Jim P. Buttery, M.B., said at an international congress of the World Society for Pediatric Infectious Diseases.

Protein-polysaccharide glycoconjugate vaccines comprise an integral component of immunization efforts against encapsulated bacteria. “Since the staggering success of Haemophilus influenzae type b vaccines in reducing invasive Hib disease in many developed countries, different multivalent vaccines have been licensed against up to four meningococcal serogroups and seven pneumococcal serotypes,” Dr. Buttery said.

A combination meningococcal/pneumococcal vaccine could eliminate up to four extra injections for U.S. infants by age 18 months, he said at the conference.

But during development of these vaccines, some important and unexpected interactions have been revealed, including interactions of H. influenzae type b (Hib) vaccine when admixed or combined with acellular pertussis-containing vaccines.

Other effects have included possible carrier-induced epitope suppression and unexplained effects upon the immunogenicity of other combination vaccine antigens and even separately coadministered vaccines, said Dr. Buttery of the Murdoch Children's Research Institute, University of Melbourne, and the department of pediatrics, Royal Children's Hospital, Melbourne.

A recent phase II randomized trial evaluating the immunogenicity and safety of a combination pneumococcal and meningococcal vaccine illustrated these observations.

In the study, 240 infants received immunizations of diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine admixed with Hib conjugate, in the right anterolateral thigh at 2, 3, and 4 months. They also received oral polio vaccine and were randomized to receive in the left anterolateral thigh either a combination 9-valent pneumococcal/group C meningococcal polysaccharide protein conjugate (Pnc9-MenC) vaccine or a monovalent serogroup C meningococcal glycoconjugate vaccine (MenC).

The study found that the combination pneumococcal and meningococcal vaccine was less immunogenic than the monovalent meningococcal vaccine. A smaller proportion of infants receiving the Pcn9-MenC vaccine exceeded the protective titer threshold of 1:8, as well as the putative long-term protective threshold titer of 1:128 (JAMA 2005; 293:1751–8).

Antidiphtheria antibody levels and Hib antibody concentrations also were lower in the combination group.

One hypothesis that has been proposed for inadequate immunogenicity in conjugate vaccines is carrier-induced epitope suppression, where the immune response is directed against the carrier protein and the response to the polysaccharide is suppressed. “Not only are these expensive and technically complex vaccines, but they also require increasing amounts of carrier protein,” he said.

“The increased amount of carrier protein in each Pnc9-MenC dose (38 mcg vs. 10 mcg in MenC) offers some support to this theory,” said Dr. Buttery, who was the lead investigator for the trial.

The diminution of antibody response to H. influenzae type b also was unexpected. Because the injection site was different from the meningococcal vaccine, physical or chemical interference cannot be blamed. Carrier-induced epitope suppression also is unlikely to be the cause, as there were no shared carrier proteins between the study vaccine and the Hib vaccine, he said.

From this study, which highlighted the fact that immune responses can be unpredictable in combination vaccines, one lesson learned is that there appears to be a quantitative limit to carrier proteins and “to how much we can stack into a vaccine,” Dr. Buttery said.

WARSAW — Efforts to develop combination vaccines that would streamline immunization schedules have hit some surprising snags, including unpredictable immunogenicity, Jim P. Buttery, M.B., said at an international congress of the World Society for Pediatric Infectious Diseases.

Protein-polysaccharide glycoconjugate vaccines comprise an integral component of immunization efforts against encapsulated bacteria. “Since the staggering success of Haemophilus influenzae type b vaccines in reducing invasive Hib disease in many developed countries, different multivalent vaccines have been licensed against up to four meningococcal serogroups and seven pneumococcal serotypes,” Dr. Buttery said.

A combination meningococcal/pneumococcal vaccine could eliminate up to four extra injections for U.S. infants by age 18 months, he said at the conference.

But during development of these vaccines, some important and unexpected interactions have been revealed, including interactions of H. influenzae type b (Hib) vaccine when admixed or combined with acellular pertussis-containing vaccines.

Other effects have included possible carrier-induced epitope suppression and unexplained effects upon the immunogenicity of other combination vaccine antigens and even separately coadministered vaccines, said Dr. Buttery of the Murdoch Children's Research Institute, University of Melbourne, and the department of pediatrics, Royal Children's Hospital, Melbourne.

A recent phase II randomized trial evaluating the immunogenicity and safety of a combination pneumococcal and meningococcal vaccine illustrated these observations.

In the study, 240 infants received immunizations of diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine admixed with Hib conjugate, in the right anterolateral thigh at 2, 3, and 4 months. They also received oral polio vaccine and were randomized to receive in the left anterolateral thigh either a combination 9-valent pneumococcal/group C meningococcal polysaccharide protein conjugate (Pnc9-MenC) vaccine or a monovalent serogroup C meningococcal glycoconjugate vaccine (MenC).

The study found that the combination pneumococcal and meningococcal vaccine was less immunogenic than the monovalent meningococcal vaccine. A smaller proportion of infants receiving the Pcn9-MenC vaccine exceeded the protective titer threshold of 1:8, as well as the putative long-term protective threshold titer of 1:128 (JAMA 2005; 293:1751–8).

Antidiphtheria antibody levels and Hib antibody concentrations also were lower in the combination group.

One hypothesis that has been proposed for inadequate immunogenicity in conjugate vaccines is carrier-induced epitope suppression, where the immune response is directed against the carrier protein and the response to the polysaccharide is suppressed. “Not only are these expensive and technically complex vaccines, but they also require increasing amounts of carrier protein,” he said.

“The increased amount of carrier protein in each Pnc9-MenC dose (38 mcg vs. 10 mcg in MenC) offers some support to this theory,” said Dr. Buttery, who was the lead investigator for the trial.

The diminution of antibody response to H. influenzae type b also was unexpected. Because the injection site was different from the meningococcal vaccine, physical or chemical interference cannot be blamed. Carrier-induced epitope suppression also is unlikely to be the cause, as there were no shared carrier proteins between the study vaccine and the Hib vaccine, he said.

From this study, which highlighted the fact that immune responses can be unpredictable in combination vaccines, one lesson learned is that there appears to be a quantitative limit to carrier proteins and “to how much we can stack into a vaccine,” Dr. Buttery said.

WARSAW — Efforts to develop combination vaccines that would streamline immunization schedules have hit some surprising snags, including unpredictable immunogenicity, Jim P. Buttery, M.B., said at an international congress of the World Society for Pediatric Infectious Diseases.

Protein-polysaccharide glycoconjugate vaccines comprise an integral component of immunization efforts against encapsulated bacteria. “Since the staggering success of Haemophilus influenzae type b vaccines in reducing invasive Hib disease in many developed countries, different multivalent vaccines have been licensed against up to four meningococcal serogroups and seven pneumococcal serotypes,” Dr. Buttery said.

A combination meningococcal/pneumococcal vaccine could eliminate up to four extra injections for U.S. infants by age 18 months, he said at the conference.

But during development of these vaccines, some important and unexpected interactions have been revealed, including interactions of H. influenzae type b (Hib) vaccine when admixed or combined with acellular pertussis-containing vaccines.

Other effects have included possible carrier-induced epitope suppression and unexplained effects upon the immunogenicity of other combination vaccine antigens and even separately coadministered vaccines, said Dr. Buttery of the Murdoch Children's Research Institute, University of Melbourne, and the department of pediatrics, Royal Children's Hospital, Melbourne.

A recent phase II randomized trial evaluating the immunogenicity and safety of a combination pneumococcal and meningococcal vaccine illustrated these observations.

In the study, 240 infants received immunizations of diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine admixed with Hib conjugate, in the right anterolateral thigh at 2, 3, and 4 months. They also received oral polio vaccine and were randomized to receive in the left anterolateral thigh either a combination 9-valent pneumococcal/group C meningococcal polysaccharide protein conjugate (Pnc9-MenC) vaccine or a monovalent serogroup C meningococcal glycoconjugate vaccine (MenC).

The study found that the combination pneumococcal and meningococcal vaccine was less immunogenic than the monovalent meningococcal vaccine. A smaller proportion of infants receiving the Pcn9-MenC vaccine exceeded the protective titer threshold of 1:8, as well as the putative long-term protective threshold titer of 1:128 (JAMA 2005; 293:1751–8).

Antidiphtheria antibody levels and Hib antibody concentrations also were lower in the combination group.

One hypothesis that has been proposed for inadequate immunogenicity in conjugate vaccines is carrier-induced epitope suppression, where the immune response is directed against the carrier protein and the response to the polysaccharide is suppressed. “Not only are these expensive and technically complex vaccines, but they also require increasing amounts of carrier protein,” he said.

“The increased amount of carrier protein in each Pnc9-MenC dose (38 mcg vs. 10 mcg in MenC) offers some support to this theory,” said Dr. Buttery, who was the lead investigator for the trial.

The diminution of antibody response to H. influenzae type b also was unexpected. Because the injection site was different from the meningococcal vaccine, physical or chemical interference cannot be blamed. Carrier-induced epitope suppression also is unlikely to be the cause, as there were no shared carrier proteins between the study vaccine and the Hib vaccine, he said.

From this study, which highlighted the fact that immune responses can be unpredictable in combination vaccines, one lesson learned is that there appears to be a quantitative limit to carrier proteins and “to how much we can stack into a vaccine,” Dr. Buttery said.

The clinical effects that many alternative practitioners and patients report for homeopathy are placebo and context effects, and further attempts to scientifically justify the 200-year-old system should now be abandoned, according to the authors of a new analysis.

A group of European investigators led by Aijing Shang, Ph.D., of the University of Berne (Switzerland), identified 110 placebo-controlled trials of homeopathy and matched the trials with 110 conventional medicine trials that studied similar disorders and used similar outcome measures. The average sample size was about 65 participants for both the homeopathy studies and the conventional trials.

The studies were parallel group in design and were placebo controlled, with random or quasi-random assignment of subjects.

The authors postulated that the effects of homeopathy could be explained by methodologic deficits and reporting bias, and that the effects of conventional medicine treatments could not be explained by these factors.

Initial analyses suggested that both homeopathy and allopathy showed beneficial effects, but a meta-regression of those trials considered to be of higher methodologic quality suggested that bias played a larger part in the homeopathy trials. The authors wrote, “When analyses were restricted to large trials of higher quality, there was no convincing evidence that homeopathy was superior to placebo, whereas for conventional medicine an important effect remained” (Lancet 2005;366:726–32).

But the authors went on to say that the clinical effects of homeopathy extend beyond the specific effects that the studies were designed to detect. “Context effects,” they noted, can be a significant aspect of therapeutic interventions, with the relationship between the patient and homeopath being a particularly important component. “Practitioners of homeopathy can form powerful alliances with their patients, because patients and caregivers commonly share strong beliefs about the treatment's effects, and other cultural beliefs, which might be both empowering and restorative.”

They recommended that further research focus on these context effects and the potential place of homeopathy in the overall health care system, rather than on additional placebo-controlled trials and metaanalyses.

An unsigned editorial that accompanied the report echoed that sentiment. The Lancet editors wrote, “Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalized care.”

The clinical effects that many alternative practitioners and patients report for homeopathy are placebo and context effects, and further attempts to scientifically justify the 200-year-old system should now be abandoned, according to the authors of a new analysis.

A group of European investigators led by Aijing Shang, Ph.D., of the University of Berne (Switzerland), identified 110 placebo-controlled trials of homeopathy and matched the trials with 110 conventional medicine trials that studied similar disorders and used similar outcome measures. The average sample size was about 65 participants for both the homeopathy studies and the conventional trials.

The studies were parallel group in design and were placebo controlled, with random or quasi-random assignment of subjects.

The authors postulated that the effects of homeopathy could be explained by methodologic deficits and reporting bias, and that the effects of conventional medicine treatments could not be explained by these factors.

Initial analyses suggested that both homeopathy and allopathy showed beneficial effects, but a meta-regression of those trials considered to be of higher methodologic quality suggested that bias played a larger part in the homeopathy trials. The authors wrote, “When analyses were restricted to large trials of higher quality, there was no convincing evidence that homeopathy was superior to placebo, whereas for conventional medicine an important effect remained” (Lancet 2005;366:726–32).

But the authors went on to say that the clinical effects of homeopathy extend beyond the specific effects that the studies were designed to detect. “Context effects,” they noted, can be a significant aspect of therapeutic interventions, with the relationship between the patient and homeopath being a particularly important component. “Practitioners of homeopathy can form powerful alliances with their patients, because patients and caregivers commonly share strong beliefs about the treatment's effects, and other cultural beliefs, which might be both empowering and restorative.”

They recommended that further research focus on these context effects and the potential place of homeopathy in the overall health care system, rather than on additional placebo-controlled trials and metaanalyses.

An unsigned editorial that accompanied the report echoed that sentiment. The Lancet editors wrote, “Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalized care.”

The clinical effects that many alternative practitioners and patients report for homeopathy are placebo and context effects, and further attempts to scientifically justify the 200-year-old system should now be abandoned, according to the authors of a new analysis.

A group of European investigators led by Aijing Shang, Ph.D., of the University of Berne (Switzerland), identified 110 placebo-controlled trials of homeopathy and matched the trials with 110 conventional medicine trials that studied similar disorders and used similar outcome measures. The average sample size was about 65 participants for both the homeopathy studies and the conventional trials.

The studies were parallel group in design and were placebo controlled, with random or quasi-random assignment of subjects.

The authors postulated that the effects of homeopathy could be explained by methodologic deficits and reporting bias, and that the effects of conventional medicine treatments could not be explained by these factors.

Initial analyses suggested that both homeopathy and allopathy showed beneficial effects, but a meta-regression of those trials considered to be of higher methodologic quality suggested that bias played a larger part in the homeopathy trials. The authors wrote, “When analyses were restricted to large trials of higher quality, there was no convincing evidence that homeopathy was superior to placebo, whereas for conventional medicine an important effect remained” (Lancet 2005;366:726–32).

But the authors went on to say that the clinical effects of homeopathy extend beyond the specific effects that the studies were designed to detect. “Context effects,” they noted, can be a significant aspect of therapeutic interventions, with the relationship between the patient and homeopath being a particularly important component. “Practitioners of homeopathy can form powerful alliances with their patients, because patients and caregivers commonly share strong beliefs about the treatment's effects, and other cultural beliefs, which might be both empowering and restorative.”

They recommended that further research focus on these context effects and the potential place of homeopathy in the overall health care system, rather than on additional placebo-controlled trials and metaanalyses.

An unsigned editorial that accompanied the report echoed that sentiment. The Lancet editors wrote, “Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalized care.”

VIENNA — The expanding universe of targeted cytokine therapy for autoimmune disease now includes anti-interferon-γ with results of a small, double-blind study suggesting equal efficacy compared with anti-tumor-necrosis factor-α treatment in refractory rheumatoid arthritis (RA).

The trial included 55 patients who had failed previous treatment with at least one disease-modifying antirheumatic drug. The patients were randomly assigned to receive five intramuscular injections of anti-interferon-γ (20 patients), anti-tumor necrosis factor-α (20 patients), or placebo (15 patients), Galina V. Lukina, M.D., said at the annual European congress of rheumatology.

A total of 16 patients stopped treatment because of lack of efficacy, 2 of them were in the anti-IFN-γ group, 3 in the anti-TNF-α group, and 11 in the placebo group.

By day 28, the total number of ACR responders was 14 in the anti-IFN-γ group, 11 in the anti-TNF-α group, and zero in the placebo group, said Dr. Lukina of the laboratory of clinical pharmacology at the Institute of Rheumatology, Moscow.

At day 7, three patients in each active treatment group had achieved an American College of Rheumatology (ACR) 70 response.

This number doubled by day 28 in the anti-IFN-γ group, but fell to zero in the anti-TNF-α group. (See chart.)

Also at day 7, significant decreases in serum rheumatoid factor were observed in the anti-IFN-γ group but not in the other two groups, she said at the meeting, which was sponsored by the European League Against Rheumatism.

Synovial ultrasound was performed before and after treatment. Only in the anti-IFN-γ-treated patients was there significant reduction in inflammation of the synovial membrane, she said.

Clinical remission persisted up to 36 months in five patients in each anticytokine group.

“The degree of improvement in patients treated with anti-IFN-γ was comparable with that in patients having received anti-TNF-α and in some aspects was superior to it,” Dr. Lukina said.

These results suggest that IFN-γ plays an important role in the pathogenesis of RA, and inhibition of this cytokine is “a promising approach to the therapy of RA, especially in its refractory forms,” she said.

An ultrasound of the synovial membrane is shown before treatment.

After anti-interferon therapy, synovial inflammation is significantly reduced. Photos courtesy Dr. Galina V. Lukina

VIENNA — The expanding universe of targeted cytokine therapy for autoimmune disease now includes anti-interferon-γ with results of a small, double-blind study suggesting equal efficacy compared with anti-tumor-necrosis factor-α treatment in refractory rheumatoid arthritis (RA).

The trial included 55 patients who had failed previous treatment with at least one disease-modifying antirheumatic drug. The patients were randomly assigned to receive five intramuscular injections of anti-interferon-γ (20 patients), anti-tumor necrosis factor-α (20 patients), or placebo (15 patients), Galina V. Lukina, M.D., said at the annual European congress of rheumatology.

A total of 16 patients stopped treatment because of lack of efficacy, 2 of them were in the anti-IFN-γ group, 3 in the anti-TNF-α group, and 11 in the placebo group.

By day 28, the total number of ACR responders was 14 in the anti-IFN-γ group, 11 in the anti-TNF-α group, and zero in the placebo group, said Dr. Lukina of the laboratory of clinical pharmacology at the Institute of Rheumatology, Moscow.

At day 7, three patients in each active treatment group had achieved an American College of Rheumatology (ACR) 70 response.

This number doubled by day 28 in the anti-IFN-γ group, but fell to zero in the anti-TNF-α group. (See chart.)

Also at day 7, significant decreases in serum rheumatoid factor were observed in the anti-IFN-γ group but not in the other two groups, she said at the meeting, which was sponsored by the European League Against Rheumatism.

Synovial ultrasound was performed before and after treatment. Only in the anti-IFN-γ-treated patients was there significant reduction in inflammation of the synovial membrane, she said.

Clinical remission persisted up to 36 months in five patients in each anticytokine group.

“The degree of improvement in patients treated with anti-IFN-γ was comparable with that in patients having received anti-TNF-α and in some aspects was superior to it,” Dr. Lukina said.

These results suggest that IFN-γ plays an important role in the pathogenesis of RA, and inhibition of this cytokine is “a promising approach to the therapy of RA, especially in its refractory forms,” she said.

An ultrasound of the synovial membrane is shown before treatment.

After anti-interferon therapy, synovial inflammation is significantly reduced. Photos courtesy Dr. Galina V. Lukina

VIENNA — The expanding universe of targeted cytokine therapy for autoimmune disease now includes anti-interferon-γ with results of a small, double-blind study suggesting equal efficacy compared with anti-tumor-necrosis factor-α treatment in refractory rheumatoid arthritis (RA).

The trial included 55 patients who had failed previous treatment with at least one disease-modifying antirheumatic drug. The patients were randomly assigned to receive five intramuscular injections of anti-interferon-γ (20 patients), anti-tumor necrosis factor-α (20 patients), or placebo (15 patients), Galina V. Lukina, M.D., said at the annual European congress of rheumatology.

A total of 16 patients stopped treatment because of lack of efficacy, 2 of them were in the anti-IFN-γ group, 3 in the anti-TNF-α group, and 11 in the placebo group.

By day 28, the total number of ACR responders was 14 in the anti-IFN-γ group, 11 in the anti-TNF-α group, and zero in the placebo group, said Dr. Lukina of the laboratory of clinical pharmacology at the Institute of Rheumatology, Moscow.

At day 7, three patients in each active treatment group had achieved an American College of Rheumatology (ACR) 70 response.

This number doubled by day 28 in the anti-IFN-γ group, but fell to zero in the anti-TNF-α group. (See chart.)

Also at day 7, significant decreases in serum rheumatoid factor were observed in the anti-IFN-γ group but not in the other two groups, she said at the meeting, which was sponsored by the European League Against Rheumatism.

Synovial ultrasound was performed before and after treatment. Only in the anti-IFN-γ-treated patients was there significant reduction in inflammation of the synovial membrane, she said.

Clinical remission persisted up to 36 months in five patients in each anticytokine group.

“The degree of improvement in patients treated with anti-IFN-γ was comparable with that in patients having received anti-TNF-α and in some aspects was superior to it,” Dr. Lukina said.

These results suggest that IFN-γ plays an important role in the pathogenesis of RA, and inhibition of this cytokine is “a promising approach to the therapy of RA, especially in its refractory forms,” she said.

An ultrasound of the synovial membrane is shown before treatment.

After anti-interferon therapy, synovial inflammation is significantly reduced. Photos courtesy Dr. Galina V. Lukina

WARSAW — Efforts to develop combination vaccines that would streamline immunization schedules have hit some surprising snags, including unpredictable immunogenicity, Jim P. Buttery, M.B., said at an international congress of the World Society for Pediatric Infectious Diseases.

Protein-polysaccharide glycoconjugate vaccines comprise an integral component of immunization efforts against encapsulated bacteria. “Since the staggering success of Haemophilus influenzae type b vaccines in reducing invasive Hib disease in many developed countries, different multivalent vaccines have been licensed against up to four meningococcal serogroups and seven pneumococcal serotypes,” Dr. Buttery said.

A combination meningococcal/pneumococcal vaccine could eliminate up to four extra injections for U.S. infants by age 18 months, he said. But during development of these vaccines, some important and unexpected interactions have been revealed, including interactions of H. influenzae type b (Hib) vaccine when admixed or combined with acellular pertussis-containing vaccines.

Other effects have included possible carrier-induced epitope suppression and unexplained effects upon the immunogenicity of other combination vaccine antigens and even separately coadministered vaccines, said Dr. Buttery of the Murdoch Children's Research Institute, University of Melbourne, and the department of pediatrics, Royal Children's Hospital, Melbourne.

A recent phase II trial evaluating the immunogenicity and safety of a combination vaccine illustrated these observations. In the study, 240 infants received immunizations of diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine admixed with Hib conjugate, in the right anterolateral thigh at 2, 3, and 4 months. They also received oral polio vaccine and were randomized to receive in the left anterolateral thigh either a combination 9-valent pneumococcal/group C meningococcal polysaccharide protein conjugate (Pnc9-MenC) vaccine or a monovalent serogroup C meningococcal glycoconjugate vaccine (MenC).

The results showed the pneumococcal/meningococcal vaccine was less immunogenic than the monovalent meningococcal vaccine. A smaller proportion of infants who received the Pcn9-MenC vaccine exceeded the protective titer threshold of 1:8, as well as the putative long-term protective threshold titer of 1:128 (JAMA 2005;293:1751–8). Levels of antidiphtheria antibody, as well as Hib antibody concentrations, also were lower in the combination group.

One hypothesis that has been proposed for inadequate immunogenicity in conjugate vaccines is carrier-induced epitope suppression, where the immune response is directed against the carrier protein and the response to the polysaccharide is suppressed. “Not only are these expensive and technically complex vaccines, but they also require increasing amounts of carrier protein,” he said. “The increased amount of carrier protein in each Pnc9-MenC dose (38 mcg vs. 10 mcg in MenC) offers some support to this theory,” said Dr. Buttery, who was the lead investigator for the trial.

The diminution of antibody response to H. influenzae type b also was unexpected. Because the injection site was different from the meningococcal vaccine, physical or chemical interference cannot be blamed. Carrier-induced epitope suppression also is unlikely to be the cause, as there were no shared carrier proteins between the study vaccine and the Hib vaccine, he said.

From this study, one lesson learned is that there appears to be a quantitative limit to carrier proteins and “to how much we can stack into a vaccine,” Dr. Buttery said.

These experiences also have underlined the importance of measuring the immunogenicity of all vaccines administered within a vaccine study, including routine, already-licensed, and coadministered vaccines, he said.

WARSAW — Efforts to develop combination vaccines that would streamline immunization schedules have hit some surprising snags, including unpredictable immunogenicity, Jim P. Buttery, M.B., said at an international congress of the World Society for Pediatric Infectious Diseases.

Protein-polysaccharide glycoconjugate vaccines comprise an integral component of immunization efforts against encapsulated bacteria. “Since the staggering success of Haemophilus influenzae type b vaccines in reducing invasive Hib disease in many developed countries, different multivalent vaccines have been licensed against up to four meningococcal serogroups and seven pneumococcal serotypes,” Dr. Buttery said.

A combination meningococcal/pneumococcal vaccine could eliminate up to four extra injections for U.S. infants by age 18 months, he said. But during development of these vaccines, some important and unexpected interactions have been revealed, including interactions of H. influenzae type b (Hib) vaccine when admixed or combined with acellular pertussis-containing vaccines.

Other effects have included possible carrier-induced epitope suppression and unexplained effects upon the immunogenicity of other combination vaccine antigens and even separately coadministered vaccines, said Dr. Buttery of the Murdoch Children's Research Institute, University of Melbourne, and the department of pediatrics, Royal Children's Hospital, Melbourne.

A recent phase II trial evaluating the immunogenicity and safety of a combination vaccine illustrated these observations. In the study, 240 infants received immunizations of diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine admixed with Hib conjugate, in the right anterolateral thigh at 2, 3, and 4 months. They also received oral polio vaccine and were randomized to receive in the left anterolateral thigh either a combination 9-valent pneumococcal/group C meningococcal polysaccharide protein conjugate (Pnc9-MenC) vaccine or a monovalent serogroup C meningococcal glycoconjugate vaccine (MenC).

The results showed the pneumococcal/meningococcal vaccine was less immunogenic than the monovalent meningococcal vaccine. A smaller proportion of infants who received the Pcn9-MenC vaccine exceeded the protective titer threshold of 1:8, as well as the putative long-term protective threshold titer of 1:128 (JAMA 2005;293:1751–8). Levels of antidiphtheria antibody, as well as Hib antibody concentrations, also were lower in the combination group.

One hypothesis that has been proposed for inadequate immunogenicity in conjugate vaccines is carrier-induced epitope suppression, where the immune response is directed against the carrier protein and the response to the polysaccharide is suppressed. “Not only are these expensive and technically complex vaccines, but they also require increasing amounts of carrier protein,” he said. “The increased amount of carrier protein in each Pnc9-MenC dose (38 mcg vs. 10 mcg in MenC) offers some support to this theory,” said Dr. Buttery, who was the lead investigator for the trial.

The diminution of antibody response to H. influenzae type b also was unexpected. Because the injection site was different from the meningococcal vaccine, physical or chemical interference cannot be blamed. Carrier-induced epitope suppression also is unlikely to be the cause, as there were no shared carrier proteins between the study vaccine and the Hib vaccine, he said.

From this study, one lesson learned is that there appears to be a quantitative limit to carrier proteins and “to how much we can stack into a vaccine,” Dr. Buttery said.

These experiences also have underlined the importance of measuring the immunogenicity of all vaccines administered within a vaccine study, including routine, already-licensed, and coadministered vaccines, he said.

WARSAW — Efforts to develop combination vaccines that would streamline immunization schedules have hit some surprising snags, including unpredictable immunogenicity, Jim P. Buttery, M.B., said at an international congress of the World Society for Pediatric Infectious Diseases.

Protein-polysaccharide glycoconjugate vaccines comprise an integral component of immunization efforts against encapsulated bacteria. “Since the staggering success of Haemophilus influenzae type b vaccines in reducing invasive Hib disease in many developed countries, different multivalent vaccines have been licensed against up to four meningococcal serogroups and seven pneumococcal serotypes,” Dr. Buttery said.

A combination meningococcal/pneumococcal vaccine could eliminate up to four extra injections for U.S. infants by age 18 months, he said. But during development of these vaccines, some important and unexpected interactions have been revealed, including interactions of H. influenzae type b (Hib) vaccine when admixed or combined with acellular pertussis-containing vaccines.

Other effects have included possible carrier-induced epitope suppression and unexplained effects upon the immunogenicity of other combination vaccine antigens and even separately coadministered vaccines, said Dr. Buttery of the Murdoch Children's Research Institute, University of Melbourne, and the department of pediatrics, Royal Children's Hospital, Melbourne.

A recent phase II trial evaluating the immunogenicity and safety of a combination vaccine illustrated these observations. In the study, 240 infants received immunizations of diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine admixed with Hib conjugate, in the right anterolateral thigh at 2, 3, and 4 months. They also received oral polio vaccine and were randomized to receive in the left anterolateral thigh either a combination 9-valent pneumococcal/group C meningococcal polysaccharide protein conjugate (Pnc9-MenC) vaccine or a monovalent serogroup C meningococcal glycoconjugate vaccine (MenC).

The results showed the pneumococcal/meningococcal vaccine was less immunogenic than the monovalent meningococcal vaccine. A smaller proportion of infants who received the Pcn9-MenC vaccine exceeded the protective titer threshold of 1:8, as well as the putative long-term protective threshold titer of 1:128 (JAMA 2005;293:1751–8). Levels of antidiphtheria antibody, as well as Hib antibody concentrations, also were lower in the combination group.

One hypothesis that has been proposed for inadequate immunogenicity in conjugate vaccines is carrier-induced epitope suppression, where the immune response is directed against the carrier protein and the response to the polysaccharide is suppressed. “Not only are these expensive and technically complex vaccines, but they also require increasing amounts of carrier protein,” he said. “The increased amount of carrier protein in each Pnc9-MenC dose (38 mcg vs. 10 mcg in MenC) offers some support to this theory,” said Dr. Buttery, who was the lead investigator for the trial.

The diminution of antibody response to H. influenzae type b also was unexpected. Because the injection site was different from the meningococcal vaccine, physical or chemical interference cannot be blamed. Carrier-induced epitope suppression also is unlikely to be the cause, as there were no shared carrier proteins between the study vaccine and the Hib vaccine, he said.

From this study, one lesson learned is that there appears to be a quantitative limit to carrier proteins and “to how much we can stack into a vaccine,” Dr. Buttery said.

These experiences also have underlined the importance of measuring the immunogenicity of all vaccines administered within a vaccine study, including routine, already-licensed, and coadministered vaccines, he said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis and who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 (71%) children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both IgM and IgG antibodies, according to Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present even though no clinical symptoms remained.

Serology can therefore be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick. In 42.5% of the infected children, symptoms were nonspecific, whereas, in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

All children received oral amoxicillin or tetracycline, and those with neuroborreliosis were given ceftriaxone intravenously for 3–4 weeks. Complete recovery was seen in 72 (83%) of the children following the first course of therapy.

Improvement was first observed in children with erythema migrans, 5–7 days after treatment began. At 7–10 days those with facial palsy began to respond, as did those with meningitis after 10–14 days.

Recovery following a second course of treatment with amoxicillin or ceftriaxone was seen in four children with fever, in three with headache, in two with nerve palsy, in two with gonitis, and in one with mental disturbances and acrodermatitis chronica atrophicans.

One patient with radiculitis improved after a second course, but muscular atrophy persisted. One child with palsy of cranial nerve VIII experienced irreversible unilateral deafness despite three courses of treatment.

Early diagnosis and directed treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis and who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 (71%) children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both IgM and IgG antibodies, according to Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present even though no clinical symptoms remained.

Serology can therefore be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick. In 42.5% of the infected children, symptoms were nonspecific, whereas, in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

All children received oral amoxicillin or tetracycline, and those with neuroborreliosis were given ceftriaxone intravenously for 3–4 weeks. Complete recovery was seen in 72 (83%) of the children following the first course of therapy.

Improvement was first observed in children with erythema migrans, 5–7 days after treatment began. At 7–10 days those with facial palsy began to respond, as did those with meningitis after 10–14 days.

Recovery following a second course of treatment with amoxicillin or ceftriaxone was seen in four children with fever, in three with headache, in two with nerve palsy, in two with gonitis, and in one with mental disturbances and acrodermatitis chronica atrophicans.

One patient with radiculitis improved after a second course, but muscular atrophy persisted. One child with palsy of cranial nerve VIII experienced irreversible unilateral deafness despite three courses of treatment.

Early diagnosis and directed treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.

WARSAW — While erythema migrans is the presenting manifestation of Lyme borreliosis in the majority of cases, nonspecific symptoms predominate in many infected children.

Thus, serologic testing should be considered for these children who have a history of tick bite or who have visited a wooded area, Dr. n. med. Ewa Duszczyk said in a poster at an international congress of the World Society for Pediatric Infectious Diseases.

A group of 171 children with suspected Lyme borreliosis and who ranged in age from 6 months to 17.5 years underwent serologic testing with an enzyme-linked immunosorbent assay (ELISA). A total of 111 (65%) had a history of tick bite, and 60 (35%) had visited a wooded location.

They were divided into two groups: those with erythema migrans (104 children) and those with nonspecific symptoms such as other skin lesions, lymphadenopathy, fever, and pain and/or edema of joints (67 children).

In the group with erythema migrans, 74 (71%) children were seropositive, 72 with IgM antibodies to Borrelia burgdorferi, 17 with IgG antibodies, and 13 with both IgM and IgG antibodies, according to Dr. Duszczyk and her colleagues in the department of children's infectious diseases, Medical University of Warsaw.

In the group with nonspecific symptoms, antibodies were detected in 16 (24%) children. Of these, IgM antibodies were detected in 13 children, IgG in 5, and both IgM and IgG in 2.

All children were treated to symptom resolution. In 35 seropositive children, serologic testing was repeated after 2–20 months; all showed a decline in IgM levels. In three cases followed for 13, 16, and 20 months, respectively, IgM antibodies were still present even though no clinical symptoms remained.

Serology can therefore be used to monitor treatment to some extent, but the persistent presence of antibodies does not necessarily indicate treatment failure, she cautioned.

In another poster session, Prof. dr. hab. Teresa Wozniakowska-Gesicka noted that in a series of 87 children with confirmed Lyme borreliosis, only 57.4% had a history of contact with a tick. In 42.5% of the infected children, symptoms were nonspecific, whereas, in 28.7%, neuroborreliosis was diagnosed with symptoms that included facial palsy, meningitis, cranial nerve palsy, paresthesias, radiculoneuritis, and mental disturbances. Erythema migrans and acrodermatitis chronica atrophicans were observed in 19.5%, and arthritis in 9.3%, reported Dr. Wozniakowska-Gesicka of the department of pediatrics, Polish Mother's Hospital, Lodz, Poland.

Acrodermatitis chronica atrophicans is seen primarily in European borreliosis, and is usually associated with infection with B. afzelii.

All children received oral amoxicillin or tetracycline, and those with neuroborreliosis were given ceftriaxone intravenously for 3–4 weeks. Complete recovery was seen in 72 (83%) of the children following the first course of therapy.

Improvement was first observed in children with erythema migrans, 5–7 days after treatment began. At 7–10 days those with facial palsy began to respond, as did those with meningitis after 10–14 days.

Recovery following a second course of treatment with amoxicillin or ceftriaxone was seen in four children with fever, in three with headache, in two with nerve palsy, in two with gonitis, and in one with mental disturbances and acrodermatitis chronica atrophicans.

One patient with radiculitis improved after a second course, but muscular atrophy persisted. One child with palsy of cranial nerve VIII experienced irreversible unilateral deafness despite three courses of treatment.

Early diagnosis and directed treatment are needed in this serious diagnostic and therapeutic problem, Dr. Wozniakowska-Gesicka said.