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Objectives: Clinical guidelines disagree on the diagnostic usefulness of Borrelia burgdorferi (Bb) serum antibodies (serum-Bb) in investigation of Lyme neuroborreliosis (LNB). We investigated the association between serum-Bb and Bb intrathecal antibody index (Bb-AI) and rates of seroconversion and seroreversion after LNB. Methods: Danish residents who had a Bb-AI and corresponding serum-Bb measured between 1994 and 2020 were identified at all Danish departments of clinical microbiology. We used descriptive statistics to examine the proportions of positive Bb-AI combined with positive or negative serum-Bb antibody tests. Next, the rate of seroconversion and seroreversion among those with positive Bb-AI and either an initial negative or positive serum-Bb was estimated. Results: We included 34 609 individuals with a Bb-AI and corresponding serum-Bb. The proportion of individuals with positive Bb-AI who had negative serum-Bb was 16.8% (95% CI, 15.1–18.6). The proportion of individuals with positive serum-Bb IgM, serum-Bb IgG, or serum-Bb IgM and IgG antibodies who had positive Bb-AI was 10.6% (95% CI, 9.5–11.8), 24.7% (95% CI, 23.0–26.4), and 45.0% (95% CI, 42.4–48.0), respectively. The proportion of children (

We describe a case of fatal pneumonia in a previously healthy 14-year-old boy. The patient was severely affected at the time of admission with high fever, tachypnea, tachycardia and peripheral cyanosis. The condition worsened despite treatment with antibiotics as well as respiratory and pressure support. Acidosis and critical leucopenia supervened and the patient died just short of 24 hours after admission. Subsequent bacterial cultivation showed Panton-Valentine Leucocidin-producing Staphylococcus aureus.

This paper describes the development of a Bayesian model for diagnosis of patients suspected of Lyme disease, and the integration of such a model into a medical information system. A Bayesian network incorporating the clinical history and laboratory results has been constructed. Because many of the symptoms are not exclusive to Lyme disease and they develop over time, the clinical history is important for making the correct diagnosis. The model is based on time slices, where each time slice contains the observed pathological picture from one consultation with for example, the general practitioner. Since the time intervals between consultations typically are not equivalent, we have developed a novel method that can handle non-equivalent time intervals between the time slices in the network. The method is based on a description of the general development pattern of Lyme disease, which is implemented in a model that states the conditional probabilities of experiencing a certain pathological picture given time since infection. The model has been integrated into a web-based medical information system, called Borrelia Systems, which has enabled us to evaluate the model during a progressive diagnostic process. The integration has been accomplished through the development of a Bayesian Application Framework. This framework specifies a communication data structure in XML providing a graphical user interface and database components, which can be used when developing systems that are based on Bayesian networks. The framework generalizes the integration of Bayesian networks so that it is possible to switch network without manually having to update or change the system.

The laboratory diagnosis of Lyme disease in Denmark is reviewed with recommendations for serological testing. In Denmark the laboratory testing is performed with an ELISA technique. Most laboratories use an assay based on purified flagella antigen. The two-tier approach with Western Blot as confirmatory testing is not recommended since the contribution to the diagnostic specificity is only marginal. Predictive values of Lyme serology are presented, based on the estimated prevalence of the different stages of Lyme disease in Denmark.

Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total knee joint replacement. A retrospective study was conducted among 702 consecutive primary knee joint replacements performed between January 2009 and December 2012 in our department. Increased postoperative serum creatinine was considered indicative of postoperative renal injury according to RIFLE criteria. Sixty three patients (9.7%) had significant moderate or severe postoperative renal dysfunction in which 8 patients (1.2%) ended with severe and permanent renal impairment. Advanced age, low intraoperative blood pressure, hypertension, general anaesthesia, and prophylactic dicloxacillin were identified as significant risk factors. Male gender and BMI were independent risk factors for postoperative increase in serum creatinine. Smoking, female gender, diabetes mellitus and duration of surgery were not identified as significant risk factors.