BACKGROUND:Geographic differences of particular species of ticks and variant strains of Borrelias impede the comparison of local and foreign experience. The authors tried to support some literary observations with their own results and designed a study aimed at determination of anti-Borrelia antibodies (AB) in the selected population samples. The goal of the study was to find and statistically evaluate: a) difference in distribution of values of AB in the sample of probands from the risk and non-risk environment (foresters in Sumava and Prague blood donors, respectively) by means of ELISA method, b) tick bite frequency in the risk and non-risk groups, c) to determine and statistically evaluate the prevalence of probands with increased levels of antiborrelial antibodies in the local study population by ELISA method and the prevalence of probands with non-normal values found by Western blot (WB) method.METHODS AND RESULTS:In the group of Prague blood donors (control group), in total 200 probands were examined; in the risk group, 71 probands from Sumava forest were examined. Blood specimens were examined in the National Reference Laboratory for Lyme Borreliosis in Prague. In all specimens, ELISA NRLB KC90 was used. Western blot assay was used for confirmation.CONCLUSIONS:On the basis of literature review from Europe and USA, it is possible to generalize the following, despite some equivocations: 1. regional differences are not significant, with the exception of high-risk territories or "occupational exposure"; 2. there is no significant difference between males and females; 3. considerable caution is necessary in comparing the control and risk groups; prerequisite for such comparison is defining the characteristics of both groups.

A heart involvement known as Lyme carditis (LC), a consequence of Lyme borreliosis (LB), is relatively rare in contrast to the involvement of skin, joints and nervous system; it accounts for < 4% of all these patients in European countries. However, the diagnosis of the disease belongs to the most difficult challenges. While various forms of AV blocks dominate in the USA as confirmed by the literature, there is a clear predominance of arrhythmias of various incidence in the Czech Republic. The authors of this article focused on the form belonging to the rarest manifestations of LC, namely dilated cardiomyopathy (DCMP). The goal was to elucidate the etiological participation of Borrelia infection in the development of DCMP, which has attracted controversial opinions so far. In total, 33 patients with DCMP were enrolled in the study, 23 males and 10 females, with mean age 57.7 years (range 24-76 years). ELISA NRLB KC 90 method was used in all blood samples for detection of Borrelia infection (BI), Western blot method was used for confirmation, followed by identification of DNA of pathogenic Borreliae using PCR method. Bioptic material was examined by electronmicroscopy with an attempt to detect Spirochaetae in myocardium. 16 patients were excluded from the study owing to the absence of signs of LB. The study group included 17 patients (3 females, 13 males) with mean age 58 years (range 43-76 years), in whom the presence of Bb was proved by identification of DNA of pathogenic Borreliae or by electronmicroscopic detection of Spirochetae in myocardial bioptic sample. The findings obtained during the study confirmed that BI very probably participated in the development of dilated cardiomyopathy. It may be concluded that most of cases were either unapparent forms of LB or insufficiently treated cutaneous forms of this disease.

The relatively low percent of patients affected with the cardiac form of Lyme borreliosis is difficult to diagnose, especially if the disease manifests itself in ways other than atrio-ventricular blockade. The advanced stage of Lyme carditis manifesting as dilated cardiomyopathy is a special case of this affliction. The authors of this report present clinical experience with an attempt to support the working hypothesis about involvement of Lyme borreliosis infection in the development of dilated cardiomyopathy. The patients were clinically examined thoroughly with special attention to the cardiovascular system. In addition to the basic clinical methods, the following procedures have been employed: dynamic Holter's electrocardiography, exercise ECG test, coronarography, and myocardial biopsy. From laboratory methods pertaining to the detection of Borrelia, ELISA method, Western blot, PCR, electron microscopy and histopathological analysis were used. In all three cases, clinical and laboratory findings provided the evidence of the borreliosis infection involvement in the development of dilated cardiomyopathy.

A significant part of patients with carotid artery stenosis is operated on without preoperative angiography, to reduce the risks and cost of such examination. Duplex ultrasound often cannot reliable visualise the proximal parts of the aortic arch vessels. We evaluated the ability of duplex ultrasound to identify those types of lesions and ascertain their prevalence. We analysed retrospectively carotid duplex scans and carotid angiography in 448 carotid arteries. 17 significant proximal lesions (3.89%) were identified on the duplex scan and confirmed by angiography. Lesions of the proximal parts of the aortic arch vessels are rare and may be reliably detected by duplex ultrasound.

A long-term prospective study of patients with confirmed non-cardiac form of Lyme disease (n=221) over a mean follow-up period of 40.6 months is reported. The study revealed no case of Borrelia-related cardiac involvement developed after several years in patients who had received antibiotic therapy in the early period. Therefore, these patients do not need follow-up by a cardiologist.

The article summarizes basic characteristics of Lyme borreliosis, its incidence, epidemiology, pathogenesis and clinical image. Particular attention is given to the review of papers aimed at the cardiac abnormalities--the Lyme carditis. Though they are not very frequent, due to the variability of their clinical course and due to various forms, which are difficult to diagnose, they can represent a specific problem. Major part of the article is given to the authors' own experience with the dilated cardiomyopathy of the Borrelia origin and namely to the perspective study of the patients after the skin form of the disease erythema migrans, who were treated "lege artis" in the early phase of the disease with antibiotics. Authors were interested how many of those patients would develop later the cardiac abnormalities.

OBJECTIVEThe objective of the work was to test whether differently formulated hypotheses, when using correct statistical methods, and the same data lead to the same results. The work pertains to the interpretation of the prevalence of antiborrelia antibody levels in more or less high risk populations.GROUPA group of 200 blood donors from Prague (100 men, mean age 33.5 years and 100 women mean age 24.4 years) and 71 subjects with a higher risk of contact with ticks infected with Borrelia burgdorferi--forestry workers from the Sumava mountains (39 men, mean age 40.6 years and 32 women, mean age 44.5 years).METHODIn all participants antiborrelia antibodies class IgM and IgG were assessed and using the Western blot method the presence of specific antigens was examined. The blood samples of all probands were analyzed in the national reference laboratory for Lyme borreliosis CEM in the National Institute of Public Health in Prague. To test the hypothesis on the difference of groups as regards the frequency of positive antibody levels the chi square test was used. For testing the hypothesis on the difference of the groups as regards antibodies irrespective of normal laboratory values the non-parametric method--the Mann-Whitney test was used.RESULTSThe group of Prague blood donors and forestry workers from the Sumava mountains do not differ as to the individual frequency of positive antibody values assessed by the ELISA method in class IgM and IgG but they differ in class IgM assessed by the Western blot method. Both groups differ moreover markedly in the general distribution of antibodies unrelated to normal laboratory values assessed by the ELISA method in class IgM, in class IgG the distribution does not differ.CONCLUSIONWe provided evidence that when using a different formulation of the hypothesis while using correct statistical methods identical data can be differently interpreted. Thus in the interpretation of the prevalence of antiborrelia antibody levels in healthy populations with a different risk--even if the two groups do not differs as to the frequency of positive findings, there is a significant statistical difference in their distribution.

Health problems related to the use of cellular telephones become a "hot" journalistic topic. Incompetent and uninformed authors of newspaper articles inform, deform and sometimes even frighten their users with malignant effects of electromagnetic radiation starting with impairment of psychic concentration, sleep disorders till development brain tumors. Such (and so far not proved apprehensions) have to be confound with scientific arguments. One of the first studies aimed at possibility of brain tumor formation brought about negative answer. The lack of empirical evidences of the mobile phone electromagnetic radiation cancerogenity suggests that cellular phones do not represent a serious risk of cancer.

Biological weapons were conceived for years by the world community only as a potential evil. A fundamental change of opinions regarding their real menace occurred only after the premeditated criminal attack on the USA on September 11, 2001. It was logical that publicists for mall types of media demanded from representatives of the state administration of the Czech Republic information how out country is prepared for this type of danger. Their reactions were hesitant and in a way reflect a certain chaos associated with the reorganization of the army and at the same time unpreparedness of civil defence. To a certain extent all this can be conceived as the consequence of the fundamental transformation of our society and thus it may be excused to a certain extent. Nevertheless it is obvious that not even the most advanced countries are quite clear as regards defence against the horror of biological weapons. Evidence to this effect is the following document, devoted to the problem in the USA, major parts of which we reproduce from the prestigious periodical The England Journal of Medicine.

BACKGROUND Although the frequency of Lyme carditis is not high, it is one of the most challenging conditions in terms of diagnosis. No long-term studies that would help expand our body of knowledge concerning the circumstances of its development and the natural course of this form of Lyme borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have been reported to date. AIM The authors sought to describe and assess the consequences of a less common form of Lyme carditis (LC). An assessment of the following aspects was made: a) the forms, natural history and sequelae of the less common clinical appearances of LC, b) the role of antibiotic therapy with reference to the late manifestations of LB. METHODS Three patients were selected from a group of 60 consecutive patients with demonstrated LC during a follow-up period from 1987 to 2000. Patient no. 1 was being followed for myocarditis with frequent ventricular extrasystoles, patient no. 2 for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late manifestation of LB. In addition to routine examination at entry, the patients were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG monitoring, exercise testing (bicycle ergometry), investigations of antibodies using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests) and mineral levels. RESULTS The study showed no significant correlation between the clinical course and levels of specific antibodies. It confirmed the concept that inadequate or no therapy with antibiotics in the initial stage of the disease has a significant effect on the development of late sequelae. CONCLUSION Based on the long-term treatment of three patients with less common, yet clinically urgent findings, the authors conclude that even a relatively serious clinical course is associated with no major limitations for affected individuals after an interval of several years.

The authors tried to confirm data on the prevalence of antiborrelia antibodies class IgM and IgG in the local healthy population (200 blood donors) and in subjects with an increased risk of infection (forestry labourers, forestry workers and huntsmen). All blood samples were analyzed in the National Reference Laboratory for Lyme borreliosis CEM (LB) in the National Institute of Public Health in Prague by the ELISA NRLB KC 90 method and in case of a positive result they were confirmed by the Western blot Lyme method. All patients completed a special questionnaire used as a standard procedure in the consultation centre for LB. In the group of blood donors 100 men were examined, mean age 33.5 years and 100 women, mean age 24.4 years. In 26 positive antibodies against Borrelia burgdorferi (Bb) were confirmed, but on invitation to medical examination only 22 attended, 11 men and 11 women (10.1%). Examination of antiborrelia antibodies by the ELISA method proved positivity of class IgM 7 times and of class IgG 9 times. By the Western blot method (WB) class IgG was confirmed three times. In the risk group 39 men were examined, mean age 40.6 years and 32 women. In 12 of them (17.9%) positivity of antiborrelia antibodies against Borrelia burgdorferi (Bb) was proved by the ELISA method as well as the WB method. If the percentage confidence interval of the control group is taken as a basis for comparison, then the value of the risk group is within this interval at a significance value of alpha = 0.01. In the conclusion the authors discuss the problem of interpretation of positive serological results and the pitfalls of their evaluation not only from the aspect of validity of laboratory findings, due to the absence of standardization of methods, but also with regards to obscure aspects of the persistence of IgM antibodies after years of lege artis antibiotic treatment.

The authors present a review of contemporary views on the most frequent anthropozoonosis--Lyme borreliosis. They mention its history, microbiology of the causal agent Borrelia burgdorferi, epidemiology, pathogenesis, laboratory and clinical diagnosis. The authors describe also briefly the clinical stages, forms and possible treatment.

A significant part of patients with carotid artery stenosis is operated on without preoperative angiography, to reduce the risks and cost of this examination. Duplex ultrasound often cannot reliable visualise the proximal parts of the aortic arch vessels. To establish the the ability of duplex ultrasound to identify these types of lesions, duplex scans and arteriograms of 224 consecutive patients had been reviewed. 16 proximal lesions were identified on the duplex scan and confirmed by angiography. Two stenoses < 35% were not identified by duplex ultrasound. The overall sensitivity (for occlusions and stenoses 35-99%) was 89 (100)%, specificity 100 (100)%, positive predictive value 100 (100)%, negative predictive value 99,5 (100)%, accuracy 99,6 (100)%. Prevalence of proximal lesions was 4,01%. We conclude, that lesions of the proximal parts of the aortic arch vessels are rare and may be reliable detected by duplex ultrasound.

According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVE include fatigue, lethargy and syncope- Margagni-Adams-Stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovasvcular system. They correlated the clinical stale with ECG findings, as well as with the levels of the Borrelia burgdorferi antibodies. The following results were obtained : 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.

According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-Adams-Stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the Borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.

The ever increasing rate of new cases of Lyme disease, the tendency for chronicity in certain forms of the disease and especially the disputable effect of causal therapy resulted in strenuous efforts to develop an effective vaccine. The authors sum up recent experience with vaccination in the U.S.A. and Europe. Two studies in the U.S. during the years 1994 through 1997 included more than 20,000 probands. In one of the studies, coordinated by Steer (10,936 probands), during the first year twenty-two people of the vaccinated group contracted the disease compared to forty-three people of the non-vaccinated, i.e. placebo group. The vaccine efficacy was 49 percent. During the second year of the study, after the third dose of the vaccine, sixteen vaccinated people contracted the disease vs. sixty-six placebo probands. Vaccine efficacy was 76 percent. Its administration was accompanied by mild to moderate local or systemic reaction lasting up to three days. In the next study, coordinated by Sigal (10,305 probands) the vaccine efficacy was sixty-eight percent in the first year and ninety-two percent in the second, respectively. Both studies proved the vaccine to be safe and efficient in Lyme disease prevention. In comparison with these large long-term double-blind, placebo-controlled studies European research results presented to the medical community for the first time in 1998 in Vienna appear to be of lesser value. Recombinant polyvalent vaccine based on OspC lipoprotein isolated from Borrelia burgdorferi sensu lato was used but only eighty volunteers from Aland Islands participated in the study.

A maximum of 10% of the patients suffering from Lyme borreliosis suffer from cardiac damage. This affection is usually the source of diagnostic doubts, mainly because of the significant variability of clinical manifestations, the objectivization of which is difficult. Great variability is pathognomic also for electrocardiograms. For a three-month period 7 patients aged 43 years (29-53) were followed up under conditions of ambulatory ECG monitoring, i.e. using Holter s dynamic electrocardiography (HM) and ECG transmission by telephone (TTM). The focus of interest and objective of this pilot study was evaluation of the structure and dynamics of ECG changes, in particular from the aspect of types and frequencies of ectopic activity of the atria and ventricles and the ECG correlate of symptomatic events. Findings pertaining to the incidence of symptomatic (total 67) as well as asymptomatic events (total 25) are valuable. Systematic ECG checks of patients with Lyme carditis revealed a relatively large number of cases of impaired rhythm with a completely asymptomatic course.