Dr. Murai Éva szerk.: Parasitologia Hungarica 24. (Budapest, 1991)

Lyme borreliosis in Hungary 25 Table 9 Borrelia isolation from ticks by different techniques methods dark- direct indirect field IF IF cultivation Tick-isolates MK5 N + MK6 N + GyK3 + N + GyK4 + N + + GyK6 - N + * N=not done All the other symptoms may have an obscure onset or finish. A significantly faster improvement was seen in the penicillin- than in the doxycycline-treated group (Fig. 27). In Figure 28, the data of patients followed up for a long term can be seen. The seronegative ECM cases only exceptionally became seropositive after treatment. Antibody titer decreased significantly in most of the antibiotic treated patients, but only 25% of them became seronegative. Not just the antibiotic itself, but the dosage also had a strong influence on the rapidity of improvement. Only a slight difference was found between the low-dose treated and the untreated groups (Fig. 29). On the contrary, high-dose treatment resulted in a rapid disappearance of ECM. Treatment failure Twelve (5.1%) of the 234 ECM patients followed up for a long-term developed new symptoms of Lb despite having been treated with adequate antibiotics. In five of them, the second symptom of Lb appeared during the treatment, so they may not be considered as treatment failures. Major symptoms developed in four of the remaining seven cases: meningitis, facial palsy and recurrence of ECM were observed, each after the low-dose oral penicillin treatment. The fourth patient was treated with 250 mg tetracycline q.i.d.; ECM disappeared on the 14th day. A year later, arthritis of the knee and the elbow developed, then improved spontaneously. A fluctuating, second degree atrioventricular block developed 18 months after the onset of ECM, and it was cured after ceftriaxone treatment. Slight, spontaneously improving symptoms such as headache and arthralgia developed in the further three cases. In cases without ECM, a second illness was registered in five more cases.