Publications

dna characterization of the spirochete that causes lyme disease.	lyme disease, a tick-borne disease long recognized in europe but only recently recognized in the united states, was shown in 1982-1983 to be caused by a spirochete, the lyme disease spirochete. whether one or more species of the spirochete exists is unknown, as is its taxonomic status. to answer these questions, we determined (i) the dna base (guanidine-plus-cytosine) content for five strains; (ii) the dna relatedness of 10 strains from europe or the united states (isolated from ticks, humans, a ...	1984	6490812
arthritis caused by borrelia burgdorferi in dogs.	from october 1982 to may 1984, we studied 34 dogs from the lyme, conn area that had a history of tick exposure and lameness associated with pain, warmth, and/or swelling in one or more joints. large numbers of polymorphonuclear leukocytes were seen in giemsa-stained smears of synovial fluid from 9 dogs, and spirochetes (borrelia burgdorferi) were found in 1 sample by darkfield microscopy and immunoperoxidase techniques. the geometric mean antibody titer to b burgdorferi in the 34 dogs was 1:2,70 ...	1985	3997648
chemical and biologic characterization of a lipopolysaccharide extracted from the lyme disease spirochete (borrelia burgdorferi).	a lipopolysaccharide (lps) was isolated from the lyme disease spirochete by a modification of the hot phenol-water method. the material was composed of 45% carbohydrate, 8% protein, 44% lipid a, and 1% 3-deoxy-d-mannooctulosonic acid and accounted for approximately 1.5% of the cellular dry weight. the isolated lps possessed several biologic activities characteristic of endotoxins. the lps was pyrogenic for rabbits, mitogenic for human mononuclear cells and murine splenocytes, capable of clotting ...	1985	4008983
fatal pancarditis in a patient with coexistent lyme disease and babesiosis. demonstration of spirochetes in the myocardium.	a 66-year-old man developed fever, chills, myalgias, three erythematous skin lesions, and transient left eyelid lag. because of persistent fever, he was hospitalized 4 weeks after the onset of disease; a peripheral blood smear showed babesia microti in 3% of his erythrocytes. eighteen hours later, he died unexpectedly. autopsy showed pancarditis with a diffuse lymphoplasmacytic infiltrate, and spirochetes were found in the myocardium. antibody titers to both the lyme disease spirochete borrelia ...	1985	4040723
electron microscopy studies of human intestinal spirochetes.	the ultrastructure of twenty human intestinal spirochetes was analyzed using the electron microscope. negatively stained cells were generally found to be loosely and irregularly waved. the isolates had cell dimensions ranging from 0.18-0.35 micron in width and from 3.9-14.2 micron in length. twin bundles of flagella were present in the space between the cytoplasmic membrane and the outer membrane. the majority of isolates had five flagella inserted sub-terminally at each cell end. human intestin ...	1987	3609249
[epidemiology of ixodes-borreliosis in southern germany].	intimate adaptation occurs between european strains of borrelia burgdorferi and the local hard tick ixodes ricinus. i. dammini, the important vector in usa, could not be infected experimentally with a strain of the lyme spirochete from southern germany. other species of blood suckers are sometimes able to maintain uptaken spirochetes for a few days, but never to compensate the tick vector. man seems to be a good host for b. burgdorferi but without epidemiological significance due to his poor vec ...	1987	3623604
role of immunoglobulin g in killing of borrelia burgdorferi by the classical complement pathway.	the antibody and complement requirements for killing of borrelia burgdorferi 297 by normal human serum (nhs) and nhs plus immunoglobulin g (igg) were examined. b. burgdorferi activated both the alternative and classical complement pathways in nhs. in nhs chelated with 10 mm ethylene glycol-bis(beta-aminoethyl ether)-n,n,n',n'-tetraacetic acid plus 4 mm mgcl2 (mg-egta) to block classical pathway activation, consumption (activation) of total hemolytic complement, complement component 3 (c3), and c ...	1988	3276623
[immunochemical analysis of the immune response in late manifestations of lyme borreliosis].	compared to american strains, european borrelia burgdorferi strains revealed considerable heterogeneity of major proteins. four strains isolated from ticks, human skin and human csf were selected from our 23 borrelia burgdorferi isolates. these strains and the american type strain b31 were characterized by sds-page (coomassie blue staining) and western blots (using rabbit immune sera against two of the strains and two monoclonal antibodies (h5323 and h3ts) against a major outer surface protein ( ...	1988	3381603
host responses to borrelia burgdorferi in dogs and horses.	by using paired sera the igm and igg host responses were analyzed in dogs with elisa and western blot techniques. antibodies in clinical seropositive dogs bound to 4-25 igm and up to 40 or more igg antigenic determinants. early igm response to the 41-kda flagellin persisted for at least 9 months and involved as many as seven other peptides. igg response expanded later in the disease and involved more immunogens than are currently recognized in late human disease. a percentage of asymptomatic dog ...	1988	3190094
lyme disease.	lyme disease is of interest to the neurologist and neuroscientist for a variety of reasons. as more arthropod hosts throughout the world are infected with the causative organism, borrelia burgdorferi, the illness in humans is becoming more prevalent; in addition, recognition of the disease in humans and susceptible animals is increasing. the neurological manifestations include acute and chronic forms, and it has become clear that b. burgdorferi has joined treponema pallidum, herpes simplex virus ...	1989	2472690
restriction endonuclease analysis of four borrelia burgdorferi strains.	a restriction endonuclease analysis was performed on four strains of borrelia burgdorferi: one isolated from man (sf), one from ixodes dammini (b31) and two from i. ricinus (bits in italy and b45 in germany). digestion by taq i and hae iii gave the best resolution of the dna fragments. three different restriction patterns were obtained: bits and b45 showed only one band difference. these results correlate with the reactivity of the four strains with monoclonal antibodies.	1989	2560664
antibodies to borrelia sp. in wild foxes and coyotes from wisconsin and minnesota.	serum samples from 93 red foxes (vulpes vulpes) and nine gray foxes (urocyon cinereoargenteus) trapped in wisconsin and 23 coyotes (canis latrans) trapped in wisconsin and minnesota were tested for antibodies to borrelia sp. with an indirect fluorescent antibody test which used borrelia burgdorferi as the whole-cell antigen. seven red foxes (8%) and two coyotes (9%) had antibody titers greater than or equal to 1:64. all the positive samples were from areas known to be endemic for human lyme dise ...	1989	2644451
human necrotizing splenitis caused by borrelia burgdorferi.	a 25-year-old hispanic male presented to the emergency room with complaints of severe left upper quadrant pain. physicians determined that the patient had an acute inflammatory process with a possible diagnosis of splenic abscess. a splenectomy was performed. histologic examination of the tissue sections revealed extensive necrosis and inflammation, but no etiologic agent was discernible. microbiologic cultures of the tissue had negative results. a dieterle silver stain revealed an overwhelming ...	1989	2648803
temporary pacing in complete heart block due to lyme disease: a case report.	the authors present the case of a 44-year-old man who was admitted with complete heart block and signs of severe bradycardia. after steroid administration and temporary pacemaker treatment the complete heart block resolved. during this therapy transient st segment and t wave abnormalities occurred. the positive borrelia burgdorferi antibody titer arrived only after therapy had been completed. this is regarded as the first case of lyme carditis with complete heart block diagnosed in eastern europ ...	1989	2476769
comparison of immunofluorescence and enzyme linked immunosorbent assays for diagnosing lyme disease.	a new enzyme linked immunosorbent assay (elisa) method was assessed in parallel with an indirect immunofluorescence assay (ifa) for the serological testing of specimens submitted for detection of lyme disease. wells of an elisa microtitre plate were coated with sonicated whole cells of borrelia burgdorferi in carbonate buffer. after overnight incubation at 4 degrees c the plates were washed three times, then incubated at 37 degrees c for an hour sequentially with a blocking solution, diluted tes ...	1989	2671054
identification and characterization of an endoflagellar antigen of borrelia burgdorferi.	the 41-kd antigen of borrelia burgdorferi is an immunodominant protein that is recognized early by antibodies in sera from lyme disease patients and known to be associated with the endoflagella. we identified the 41-kd endoflagellar antigen to be a single polypeptide with an apparent isoelectric point (pi) of 6.5 by two-dimensional (2-d) electrophoresis. this polypeptide, which we designated p41f alpha, was heavily labeled by 125i in 2-d autoradiographs of b. burgdorferi whole-cell lysates and w ...	1989	2738156
borrelia burgdorferi and babesia microti: efficiency of transmission from reservoirs to vector ticks (ixodes dammini).	in endemic regions, peromyscus leucopus, the mouse reservoir of the lyme disease spirochete (borrelia burgdorferi) and the piroplasm causing human babesiosis (babesia microti), is nearly universally infected with both agents. paradoxically, spirochetal infection is nearly twice as prevalent as is babesial infection in populations of field-collected nymphal ixodes dammini, the tick vector. in the laboratory, a similarly disproportionate rate of infection was observed among nymphal ticks, feeding ...	1990	2295326
interaction between borrelia burgdorferi and endothelium in vitro.	during the pathogenesis of lyme disease, borrelia burgdorferi spreads hematogenously from the site of a tick bite to several tissues throughout the body. the specific mechanism of spirochete emigration is presently unknown. using cultured human umbilical vein endothelial cells, we found that borrelia burgdorferi bound to the endothelial cells and to the subendothelial matrix. low passage isolates adhered 22-30-fold greater than a strain maintained in culture continuously. spirochete binding to s ...	1990	2332509
persistence of antibodies to borrelia burgdorferi in dogs of new york and connecticut.	multiple blood samples were obtained from privately owned dogs living in tick-infested areas of new york (westchester county) and connecticut, where lyme disease in human beings has been reported. of the 175 dogs examined, 127 (72.6%) had limb/joint disorder, whereas the remaining 48 dogs were considered healthy. results of analysis of 419 serum samples revealed igm antibody to borrelia burgdorferi in healthy and lame dogs during all seasons. prevalence of seropositivity was significantly (p les ...	1990	2329074
[a case of "neuralgic amyotrophy" with elevated serum antibody titer against borrelia burgdorferi].	a 39-year-old man experienced an abrupt onset of right back pain. the pain improved spontaneously, but weakness of the right upper extremity developed. the weakness deteriorated during the next month, and he was admitted to our hospital. neurological examination disclosed impairment of superficial sensation in his right upper extremity. blood examination showed no abnormal data. the cerebrospinal fluid was normal. neuroradiological findings were also negative. electrophysiological examinations w ...	1990	2331826
characterization of borrelia burgdorferi proteins reactive with antibodies in synovial fluid of a patient with lyme arthritis.	four borrelia burgdorferi proteins reactive with antibodies in the synovial fluid of a patient with lyme arthritis were characterized. homology between amino acid sequences of immunoreactive spirochetal proteins and human proteins, including members of the escherichia coli groel protein family, suggests that antigenic mimicry may play a role in the pathogenesis of lyme arthritis.	1990	2365463
[the first results and objectives of the study of lyme disease in the ussr].	results of research on the prevalence, etiology, laboratory diagnosis, epidemiology, epizootology, and other aspects of lyme's disease, which was initiated in this country in 1984, are summed up. this borrelia-caused condition is now suggested to be a lead in morbidity rate among human diseases of natural nidus. the most topical, priority directions of further research are discussed.	1990	2220040
[dilated myocardial disease as sequela of chronic lyme carditis].	a report is given on a 39-year-old man, who developed, after a tick bite, erythema, progressing symptoms and, after 3 years, showed the typical clinical and echocardiographic signs of a dilative cardiomyopathy. a serological test for lyme borreliosis was positive. most of the symptoms disappeared after high-dose penicillin therapy.	1990	2220017
incidence of tick-bite in man in aland islands: reference to the spread of lyme borreliosis.	the common tick ixodes ricinus is a vector both for the virus of tick-borne viral encephalitis (kumlinge disease, kd) and of borrelia burgdorferi (lyme borreliosis, lb). bites of the tick are believed to be common in aland, an island province of finland in the baltic sea. kd has been seen there for many years, and cases of lb have been diagnosed lately. the purpose of this study was to find the incidence of tick-bite among the population with possible implications for the spread of lb. a questio ...	1990	2320965
short-tailed shrews as reservoirs of the agents of lyme disease and human babesiosis.	to determine whether short-tailed shrews (blarina brevicauda) serve as reservoir hosts for the lyme disease spirochete (borrelia burgdorferi) and the agent of human babesiosis (babesia microti), we examined nymphal ticks that had fed as larvae on shrews collected from 3 enzootic sites in coastal massachusetts for evidence of infection by either or both of these agents. xenodiagnosis indicated that 11 of 14 shrews were infected by b. burgdorferi. one of 3 piroplasm-infected shrews also infected t ...	1990	2213411
lyme carditis in immunodeficient mice during experimental infection of borrelia burgdorferi.	recently, we described the severe combined immunodeficiency (scid) mouse as a laboratory model for b. burgdorferi infection. scid mice inoculated with the virulent low-passage tick isolate borrelia burgdorferi zs7 developed a severe pancarditis involving endocardium, myocardium and epicardium in the absence of functional b- or t-cells. soon after inoculation perivascular infiltration was observed, later diffuse infiltration of the interstitium of the subendocardial and subepicardial areas was se ...	1990	2114691
neutrophil chemotactic factors in synovial fluids of patients with lyme disease.	we examined synovial fluid samples from 14 patients with lyme arthritis for the presence of neutrophil chemotactic factors. thirteen of the synovial fluids stimulated chemotaxis of normal human neutrophils. the chemotactic activity was heat-sensitive and was not inhibited by antibody to c5a or antibody to interleukin-8, or by a competitive inhibitor of the chemotactic peptide f-met-leu-phe. a culture supernatant of borrelia burgdorferi also contained neutrophil chemoattractants. chromatography d ...	1991	2053924
dogs as sentinels for lyme disease in massachusetts.	an investigation of the relationship between incident human cases of lyme disease and seroprevalence of antibodies to b. burgdorferi in dogs was undertaken in order to determine whether dogs might serve as sentinels for lyme disease.	1991	1951802
antibiotic treatment in lyme borreliosis.	before the etiology of lyme borreliosis became known, its human manifestations were most often treated with penicillin. treatment was mostly successful, in spite of the fact that lower doses were generally used, but the doses were given with shorter intervals. lately, other antibiotics have been tried, more or less successfully, but there is still no consensus as to which--if any--antibiotic is superior to others, or if one manifestation of the infection is better treated than another with a par ...	1991	1947804
susceptibility of iron-loaded borrelia burgdorferi to killing by hydrogen peroxide and human polymorphonuclear leucocytes.	borrelia burgdorferi grew more slowly in iron-depleted than in iron-sufficient media. the addition of increasing concentrations of iron stimulated borrelial growth and resulted in the intracellular accumulation of this element. compared with iron-starved borrelia, iron-enriched organisms showed enhanced sensitivity to hydrogen peroxide. intracellular iron-content did not, however, influence susceptibility to killing by human polymorphonuclear leucocytes [corrected].	1991	1874405
ixodes scapularis (acari: ixodidae) in kansas: a new distribution record.	the blacklegged tick, ixodes scapularis say, previously known to occur only in the extreme southeastern corner of kansas, has been collected in douglas and jefferson counties in the northeast. the new collections extend the northern range of this species in kansas by approximately 240 km. the role of i. scapularis as a vector of the lyme borreliosis spirochete, borrelia burgdorferi, makes this a noteworthy extension of its known range. the proximity of these new collection sites to large centers ...	1991	1770524
babesia microti, human babesiosis, and borrelia burgdorferi in connecticut.	babesia microti was isolated from a white-footed mouse (peromyscus leucopus) that was captured in southeastern connecticut in 1988, when the first human case of babesiosis acquired in connecticut was recognized. to date, 13 cases of babesiosis have been reported in connecticut, the largest number of human cases reported on the mainland united states. two of nine patients quiried remembered a prior tick bite. since babesia parasites are known to be vectored only by ticks, we surmise that 12 of th ...	1991	1757548
immunological characterization of a low molecular mass polypeptidic antigen of borrelia burgdorferi.	the presence of a low molecular mass polypeptidic antigen in borrelia burgdorferi was described. the protein was exposed at the bacterial surface since it was clearly identified by mab 3h4 using the immunofluorescence test performed with living bacteria. this antigen was cleaved by proteinase k treatment, whereas it was resistant to the action of chymotrypsin, trypsin and thermolysin. western blotting analysis of the immunological reactivity of this antigenic structure performed using monoclonal ...	1991	1725956
t cell and antibody reactivity with the borrelia burgdorferi 60-kda heat shock protein in lyme arthritis.	the reactivity of cloned t cells and serum antibodies, obtained from patients with chronic lyme arthritis, with expressed recombinant b. burgdorferi 60-kda heat shock protein homologue (hsp60) was analyzed. the expressed recombinant borrelia burgdorferi hsp60 was bound by antibodies in the sera of patients with lyme arthritis, but not by control sera. a t cell clone (cr253), isolated from one of four patients examined, exhibited an hla-dr2 restricted proliferative response to the expressed recom ...	1991	1709664
the epidemiology of lyme borreliosis.	the tick-transmitted bacterial infection known as lyme disease, or lyme borreliosis, has recently emerged as the leading arthropod-borne disease in europe and north america. several thousand new cases of human lyme disease are reported each year from europe and the usa. the causative agent, borrelia burgdorferi, has been isolated from several species of mammals, birds, ticks and insects and, in this article, thomas jaenson discusses the geographical differences in the epidemiology of the infecti ...	1991	15463419
antibodies to borrelia burgdorferi in rodents in the eastern and southern united states.	serologic studies were conducted to determine whether white-footed mice (peromyscus leucopus) and cotton mice (peromyscus gossypinus) contained serum antibodies to borrelia burgdorferi, the causative agent of lyme borreliosis. enzyme-linked immunosorbent assays detected antibodies to this spirochete in 35.7 and 27.3% of 56 p. leucopus and 535 p. gossypinus serum samples, respectively, collected in connecticut, north carolina, south carolina, georgia, florida, alabama, and mississippi. antibody t ...	1992	1624561
population genetic analysis of borrelia burgdorferi isolates by multilocus enzyme electrophoresis.	fifty borellia burgdorferi strains isolated from humans and ticks in europe and the united states were analyzed by multilocus enzyme electrophoresis. eleven genetic loci were characterized on the basis of the electrophoretic mobilities of their products. ten loci were polymorphic. the average number of alleles per locus was 5.9, with a mean genetic diversity of 0.673 among electrophoretic types (ets). the strains were grouped into 35 ets constituting three main divisions (i, ii, and iii) separat ...	1992	1548090
in vitro and in vivo induction of tumor necrosis factor alpha by borrelia burgdorferi.	tumor necrosis factor alpha (tnf-alpha) is an immunoregulatory cytokine with many biological activities including the mediation of inflammation. we examined sera and synovial fluids from patients seropositive for infection with borrelia burgdorferi using a radioimmunoassay specific for tnf-alpha. significant elevation of tnf-alpha was found in the sera and synovial fluids of patients examined, while controls showed no elevation. sera of mice infected with b. burgdorferi contained elevated levels ...	1992	1541526
serodiagnosis of lyme borreliosis by western immunoblot: reactivity of various significant antibodies against borrelia burgdorferi.	the significance of various antibodies against borrelia burgdorferi was studied by western blot (immunoblot) by using 578 human serum samples. the proteins regularly detected by using samples from patients with lyme borreliosis were those with bands with molecular masses of 94, 83, 75, 66, 60, 55, 46, 41, 39, 34, 31, 29, 22, and 17 kda. the detectable frequencies of most of these proteins appeared to be significantly different between the sera from patients with lyme borreliosis and those from n ...	1992	1537905
borrelia burgdorferi stimulates release of interleukin-1 activity from bovine peripheral blood monocytes.	infection with borrelia burgdorferi is suspected to be a cause of lameness and arthritis in cattle. interleukin-1 (il-1) activity has been detected in joint fluids from human patients affected by various arthritides, including lyme arthritis. in addition, human monocytes and murine macrophages have been reported to release il-1 activity when incubated with b. burgdorferi in vitro. to address a possible mechanism by which b. burgdorferi might cause a bovine arthritic syndrome, we determined wheth ...	1992	1500171
the 93-kilodalton protein of borrelia burgdorferi: an immunodominant protoplasmic cylinder antigen.	using immunoblots, we identified proteins of borrelia burgdorferi recognized by sera from 62 patients with either acute or chronic lyme disease. in all groups studied, the 41-kda flagellar protein and a relatively minor 93-kda protein (p93) were the most commonly recognized antigens in patients with acute and chronic disease due to b. burgdorferi. a murine monoclonal antibody (mab 181.1) was developed against p93, and the antigen was detected by immunoblot analysis in four european and american ...	1992	1398941
molecular detection of persistent borrelia burgdorferi in a man with dermatomyositis.	a 40-year-old white man with a several year history of various immunologic disorders, including anti-jo-1 autoantibody positive dermatomyositis, developed clinical lyme disease after being biten by a tick. the patient was treated with oral tetracycline and his initial symptoms resolved; however, he suffered an exacerbation of his muscle disease which was difficult to control despite cytotoxic therapy. antibiotic therapy was reinstituted after borrelia burgdorferi was detected in the patient's pe ...	1992	1395222
lyme disease.	lyme disease is a multisystem disorder caused by the spirochete borrelia burgdorferi. it is transmitted to human and animal hosts primarily by ticks of the ixodes ricinis complex. recognition of its characteristic skin and eye manifestations facilitates diagnosis and treatment.	1992	1395157
sequence homology between spirochaete flagellin and human myelin basic protein.		1992	1382434
borrelia burgdorferi hsp70 homolog: characterization of an immunoreactive stress protein.	the gene encoding an immunoreactive borrelia burgdorferi hsp70 homolog was isolated and characterized. the predicted amino acid sequence of this spirochetal protein confirms that this gene encodes a member of the hsp70 family of proteins. although there appears to be a single copy of this gene on the spirochetal chromosome, two distinct transcripts hybridizing to the hsp70 probe are detected in rna isolated from b. burgdorferi. the amount of spirochetal hsp70 rna transcripts is shown to be therm ...	1992	1379988
epitopes on the outer surface protein a of borrelia burgdorferi recognized by antibodies and t cells of patients with lyme disease.	we have characterized immunogenic epitopes of the 31-kda outer surface protein a (ospa) protein of borrelia burgdorferi, which is a major surface ag of the spirochete causing lyme disease. full length and truncated forms of rospa proteins were expressed in escherichia coli, and their reactivities with antibodies and human t cell clones isolated from patients with lyme disease were determined. the epitopes recognized by three of four ospa-reactive t cell clones are contained within the 60 cooh-te ...	1992	1370170
[transient complete av block as a sequela of borrelia myocarditis].	a 49-year-old man suddenly developed dyspnoea, sweating, fever (up to 38.5 degrees c), vertigo and angina. after emergency admittance to hospital the ecg showed 3 degrees a-v block, requiring temporary pacemaker insertion. the patient reported that a month before he had been bitten, probably by a tick. serological tests demonstrated a recent borrelia infection (rise of igg antibody titre to 1:2048, igm antibody titre to 1:128). coronary angiography excluded any haemodynamically significant coron ...	1992	1735375
cluster of tick-borne infections at fort chaffee, arkansas: rickettsiae and borrelia burgdorferi in ixodid ticks.	human intrusion into pristine habitats increases the likelihood of acquiring infectious agents from potentially infective ticks. as part of a larger human serological investigation into tick-borne illnesses, 3,000 ixodid ticks were collected during may, august, and november 1990 at fort chaffee, arkansas. ticks were examined to determine whether they harbor rickettsiae, ehrlichiae, and borrelia burgdorferi, and to assess relationship to human exposure to tick-borne infections at fort chaffee, ar ...	1992	1495077
distribution, density, and lyme disease spirochete infection in ixodes dammini (acari: ixodidae) on white-tailed deer in maryland.	a statewide survey of ticks parasitizing white-tailed deer was carried out in maryland during november 1989 to assess the status of the deer tick, ixodes dammini spielman, clifford, piesman & corwin, the major vector of lyme disease in the northeastern united states. ticks were collected from deer carcasses brought in by hunters at 23 check stations (one per county). a total of 3,437 i. dammini were collected from 538 of 1,281 deer (42%), together with 2,013 dermacentor albipictus (packard) and ...	1992	1552529
comparison of whole-cell antibodies and an antigenic flagellar epitope of borrelia burgdorferi in serologic tests for diagnosis of lyme borreliosis.	a recombinant protein (p41-g) of an antigenic region of flagellin was used in a standard and amplified enzyme-linked immunosorbent assay (elisa) to detect antibodies to borrelia burgdorferi, the causative agent of lyme borreliosis. comparable sensitivities (88 to 94%) were noted when sera from 17 persons who had erythema migrans and antibodies to whole-cell b. burgdorferi were tested against the p41-g antigen. in tests of a second study group of 36 persons who had erythema migrans but no detecta ...	1992	1280650
the biological and social phenomenon of lyme disease.	lyme disease, unknown in the united states two decades ago, is now the most common arthropod-borne disease in the country and has caused considerable morbidity in several suburban and rural areas. the emergence of this disease is in part the consequence of the reforestation of the northeastern united states and the rise in deer populations. unfortunately, an accurate estimation of its importance to human and animal health has not been made because of difficulties in diagnosis and inadequate surv ...	1993	8503006
an unexpected result from burning vegetation to reduce lyme disease transmission risks.	the risk for human infection with lyme disease appears linked to the abundance of infected vector ticks, principally ixodes dammini spielman, clifford, piesman & corwin, in the eastern united states. habitat destruction by burning, although not well studied, has long been considered as an effective alternative to synthetic insecticides as a means of reducing tick populations. we evaluated the effect of a single spring burning of the woodland understory on the transmission risk of lyme disease sp ...	1993	8510127
early and early disseminated phases of lyme disease in the rhesus monkey: a model for infection in humans.	we demonstrate that borrelia burgdorferi infection in the rhesus monkey mimics the early and early disseminated phases of human lyme disease. clinical, bacteriological, immunological, and pathological signs of infection were investigated during 13 weeks after inoculation of the spirochete. three animals were given b. burgdorferi (strain jd1) by needle inoculations, six animals were exposed to the bite of b. burgdorferi-infected ixodes dammini ticks, and three animals were uninfected controls. b. ...	1993	8514412
molecular mimicry in lyme disease: monoclonal antibody h9724 to b. burgdorferi flagellin specifically detects chaperonin-hsp60.	a monoclonal antibody (h9724), specific for the 41-kda flagellar protein of the lyme disease pathogen borrelia burgdorferi, cross-reacts with human axons and detects one major protein in human neuroblastoma cell extracts. the homologous cross-reacting protein has now been isolated from calf adrenal and identified as chaperonin-hsp60 by n-terminal sequencing.	1993	8096152
molecular and immunological characterization of a novel polymorphic lipoprotein of borrelia burgdorferi.	we describe the cloning, expression, and molecular characterization of a novel polymorphic borrelia burgdorferi lipoprotein recognized by monoclonal antibody la7. sequence analysis revealed an open reading frame encoding a 21,866-da polypeptide (ipla7). comparison with other known proteins indicated sequence similarity between ipla7 signal peptides and those of other prokaryotic lipoproteins, including the immunodominant b. burgdorferi outer surface proteins ospa, ospb, pc, and ospd. both natura ...	1993	8104894
the polymerase chain reaction for the detection of borrelia burgdorferi in human body fluids.	to analyze clinical fluids for the presence of borrelia burgdorferi dna using the polymerase chain reaction (pcr).	1993	8489545
acute lyme neuropathy presenting with polyradicular pain, abdominal protrusion, and cranial neuropathy.	a 53-year-old man developed multifocal radicular pain. the diagnosis of lyme neuroborreliosis was delayed until bifacial paresis and right lower abdominal wall weakness developed, prompting further evaluation. cerebrospinal fluid (csf) examination showed aseptic meningitis. antibodies directed against borrelia burgdorferi were present in the serum; higher titers were present in the csf, indicating local antibody production. electrophysiologic studies showed both an axonal polyradiculopathy as we ...	1993	8413380
adherence of borrelia burgdorferi and borrelia hermsii to mammalian cells in vitro.	this study investigated the ability of borrelia burgdorferi and borrelia hermsii to attach the surface of several types of in vitro-cultured mammalian cells. borreliae showed different adhesion efficiencies depending on cell type and temperature. temperatures both lower and higher than 33 degrees and 37 degrees c respectively, decreased the adhesion of borreliae which preferentially adhere to human fibroblast-like cells. the adhesion process, mediated by structures exposed onto the surface of th ...	1993	8469170
invasion of human skin fibroblasts by the lyme disease spirochete, borrelia burgdorferi.	the ability of borrelia burgdorferi to attach to and invade human fibroblasts was investigated by scanning electron and confocal microscopy. by scanning electron microscopy, b. burgdorferi were tightly adherent to fibroblast monolayers after 24-48 h but were eliminated from the cell surface by treatment with ceftriaxone (1 microgram/ml) for 5 days. despite the absence of visible spirochetes on the cell surface after antibiotic treatment, viable b. burgdorferi were isolated from lysates of the fi ...	1993	8486939
protective immunity elicited by recombinant bacille calmette-guerin (bcg) expressing outer surface protein a (ospa) lipoprotein: a candidate lyme disease vaccine.	the current vaccine against tuberculosis, mycobacterium bovis strain bacille calmette-guerin (bcg), offers potential advantages as a live, innately immunogenic vaccine vehicle for the expression and delivery of protective recombinant antigens (stover, c.k., v.f. de la cruz, t.r. fuerst, j.e. burlein, l.a. benson, l.t. bennett, g.p. bansal, j.f. young, m.h. lee, g.f. hatfull et al. 1991. nature [lond]. 351:456; jacobs, w.r., jr., s.b. snapper, l. lugosi and b.r. bloom. 1990. curr. top. microbiol. ...	1993	8315378
efficacy of clarithromycin for treatment of experimental lyme disease in vivo.	clarithromycin provided effective therapy against arthritis induced by borrelia burgdorferi infection in the hamster. in vitro, clarithromycin was at least 1 log more potent than tetracycline against two isolates of b. burgdorferi from human sources, as measured by mics and 50% inhibitory concentrations. clarithromycin was effective in preventing the onset of b. burgdorferi-induced arthritis, as determined by several parameters of paw swelling. when administered after the onset of arthritis, cla ...	1993	8328782
[infection by borrelia burgdorferi in patients with the human immunodeficiency virus. a diagnostic problem].	given that lyme's disease and hiv infection may present with similar clinical symptoms and that the serologic tests for the determination of antibodies against borrelia burgdorferi present frequent false positives, the presence of antibodies against b. burgdorferi in patients with hiv in different evolutive stages was studied.	1993	8332020
integrin alpha iib beta 3 mediates binding of the lyme disease agent borrelia burgdorferi to human platelets.	lyme disease is a chronic, multisystemic infection caused by the tick-borne spirochete borrelia burgdorferi. attachment of the spirochete to host cells via specific receptors is likely to be important in the establishment of infection. b. burgdorferi have previously been shown to bind to a variety of mammalian cells in vitro. here we demonstrate that binding of b. burgdorferi to human platelets is mediated by the integrin alpha iib beta 3 (glycoprotein iib-iiia), a critical receptor in thrombosi ...	1993	8394007
persistence of borrelia burgdorferi in ligamentous tissue from a patient with chronic lyme borreliosis.	to document the persistence of borrelia burgdorferi in ligamentous tissue samples obtained from a woman with chronic lyme borreliosis.	1993	8240439
heritable susceptibility to severe borrelia burgdorferi-induced arthritis is dominant and is associated with persistence of large numbers of spirochetes in tissues.	in human lyme disease, symptoms with widely varying levels of severity have been observed. a mouse model of lyme disease has been developed which allows analysis of mice with mild, moderate, and severe pathologies after inoculation with the spirochete borrelia burgdorferi. to determine whether the differences in symptoms reflect differences in the number of spirochetes persisting in affected tissues, a sensitive pcr technique was developed to detect b. burgdorferi dna in virtually any tissue of ...	1994	8300208
lyme disease: a search for a causative agent in ticks in south-eastern australia.	attempts were made to identify the causative organism of lyme disease in australia from possible tick vectors. ticks were collected in coastal areas of new south wales, australia, from localities associated with putative human infections. the ticks were dissected; a portion of the gut contents was examined for spirochaetes by microscopy, the remaining portion inoculated into culture media. the detection of spirochaetes in culture was performed using microscopy, and immunochemical and molecular ( ...	1994	8150011
detection of borrelia burgdorferi sensu lato in lesional skin of patients with erythema migrans and acrodermatitis chronica atrophicans by ospa-specific pcr.	the aim of this study was to develop a sensitive and specific pcr for the detection of borrelia burgdorferi dna. the plasmid-located gene coding for the outer surface protein a (ospa [31-kda protein]) was used as a target. nucleotide sequence information from different b. burgdorferi ospa genotypes was used to design primers homologous to different genotypes. the sensitivity of the nested pcr differed from 1 fg to 1 pg of borrelial dna, depending on the strain analyzed. no cross-reactions with d ...	1994	7883886
[detection of anti-bb antibodies in human sera by vidas system].	lyme disease is an infectious disease just known in the latest decade. the sera of people from various origins were detected for anti-bb antibodies (igm+igg) by vidas system. the results are as follows: of 83 sera from the health-cared people, 8 were positive (9.6%); of 20 sera from the patients clinical diagnosed as tuberculosis, none was positive; of 46 sera from the patients clinical diagnosed or suspected as node diseases, 4 were positive (8.7%); of 57 sera from the patients with various oph ...	1994	7874709
[lyme disease in the province of soria: clinico-epidemiologic study].	to determine the prevalence of the borrelia burgdorferi infection in the soria province, and the detection of the human disease cases.	1994	8011711
comparison of different strains of borrelia burgdorferi sensu lato used as antigens in enzyme-linked immunosorbent assays.	eight strains of borrelia burgdorferi sensu lato were tested with serum samples from persons who had lyme borreliosis or syphilis in class-specific enzyme-linked immunosorbent assays (elisas). antigens of b. burgdorferi sensu stricto, of borrelia garinii, and of borrelia spirochetes in group vs461 were prepared from cultured bacteria isolated from ticks, a white-footed mouse (peromyscus leucopus), or human tissues in north america, the former soviet union, and japan. nearly all of the serum spec ...	1994	8051239
primary cutaneous immunocytoma. a b-cell lymphoma that can easily be mistaken for cutaneous lymphoid hyperplasia.	it has been estimated that immunocytomas comprise roughly 2% of all cutaneous lymphomas. we studied five patients with primary cutaneous immunocytomas who presented with cutaneous nodules or plaques. many of the infiltrates were "top-heavy" and polymorphous with admixed eosinophils, macrophages, lymphoid follicles, and non-neoplastic lymphocytes. other potentially confusing findings were one case each of spongiotic dermatitis and leukocytoclastic vasculitis. the neoplastic cells were often situa ...	1994	8092399
t cell subset-dependent modulation of immunity to borrelia burgdorferi in mice.	the possible involvement of specific t cells in resolution of infections with borrelia burgdorferi (bb), the causative agent of human lyme disease, has not been adequately studied. to investigate the potential role of t cell subsets in resistance, we have depleted mice of cd4+ and cd8+ t cell subsets in vivo by the administration of specific mabs and have examined outcomes after infection with bb. our results indicate that cd4+ t cells are required for immunologic control of spirochete levels, b ...	1995	7836761
treponema pallidum and borrelia burgdorferi lipoproteins and synthetic lipopeptides activate monocytes/macrophages.	the observation that the major membrane immunogens of the spirochetal pathogens. treponema pallidum and borrelia burgdorferi are lipoproteins prompted studies to investigate macrophage activation by the 47-kda lipoprotein of t. pallidum and the acylated outer surface protein a (ospa) of b. burgdorferi. both lipoproteins induced the synthesis of biologically active tnf-alpha and chloramphenicol acetyltransferase in a murine macrophage cell line transfected with a chloramphenicol acetyltransferase ...	1995	7876555
borrelia burgdorferi mutant lacking osp: biological and immunological characterization.	all borrelia burgdorferi sensu lato isolates characterized to date have one or a combination of several major outer surface proteins (osps). mutants of b. burgdorferi lacking osps were selected with polyclonal or monoclonal antibodies at a frequency of 10(-6) to 10(-5). one mutant that lacked ospa, -b, -c, and -d was further characterized. it was distinguished from the ospa+b+ cells by its (i) autoaggregation and slower growth rate, (ii) decreased plating efficiency on solid medium, (iii) serum ...	1995	7890424
cultivation of borrelia burgdorferi from human tick bite sites: a guide to the risk of infection.	the risk of acquiring lyme disease has been evaluated by xenodiagnostic procedures with laboratory strains of borrelia burgdorferi and laboratory-reared ixodes ticks, or by clinical trials in which diagnosis was based on clinical findings, culture, or serologic tests.	1995	7829700
ixodes dammini as a potential vector of human granulocytic ehrlichiosis.	little is known about the epidemiology and mode of transmission of the agent of human granulocytic ehrlichiosis (hge). analyses of an engorged female ixodes dammini tick removed from an hge patient and 101 field-collected i. dammini and dermacentor variabilis from three wisconsin counties for borrelia burgdorferi and ehrlichia phagocytophila/ehrlichia equi dna revealed that the patient tick and 7 of 68 i. dammini ticks from washburn county collected in 1982 and 1991 were positive for ehrlichial ...	1995	7561173
characterization of outer membranes isolated from treponema pallidum, the syphilis spirochete.	previous freeze-fracture electron microscopy (em) studies have shown that the outer membrane (om) of treponema pallidum contains sparse transmembrane proteins. one strategy for molecular characterization of these rare om proteins involves isolation of t. pallidum oms. here we describe a simple and extremely gentle method for om isolation based upon isopycnic sucrose density gradient ultracentrifugation of treponemes following plasmolysis in 20% sucrose. evidence that t. pallidum oms were isolate ...	1995	7591054
binding of human plasminogen to borrelia burgdorferi.	we studied the binding of plasminogen to borrelia burgdorferi, a spirochete which causes lyme disease and produces no endogenous proteases which digest extracellular matrix proteins. using 125i-labeled plasminogen, we demonstrated that b. burgdorferi bound human plasminogen and that this binding was inhibitable with unlabeled plasminogen. 125i-labeled plasminogen binding by b. burgdorferi was also inhibited by the lysine analog epsilon-aminocaproic acid. there was no significant difference in th ...	1995	7642282
fetal outcome in murine lyme disease.	lyme disease is an inflammatory syndrome caused by infection with borrelia burgdorferi. although this syndrome has important implications for human pregnancy, little is known about gestational infection with b. burgdorferi. fetal death occurred in 33 of 280 gestational sacs (12%) in 39 c3h/hen female mice infected by intradermal injection of b. burgdorferi 4 days after mating (acute infection), compared with 0 of 191 sacs in 25 control mice (p = 0.0001). forty-six percent of acutely infected mic ...	1995	7806385
inoculation of nonhuman primates with the n40 strain of borrelia burgdorferi leads to a model of lyme neuroborreliosis faithful to the human disease.	we injected rhesus macaques with a highly infective strain of borrelia burgdorferi to assess whether experimentally inoculated nonhuman primates (nhps) could serve as models of human lyme neuroborreliosis (lnb). the animals developed biopsy-confirmed erythema migrans in the area of the inoculations. elisa testing of sera revealed strong antibody reactivity to b burgdorferi antigens, and western blotting showed that 16-, 22-, 31-, 34-, and 41-kd proteins of the spirochete were major antigens reco ...	1995	7824109
environmental risk and prevention of lyme disease.	an understanding of the environmental determinants of lyme disease risk is essential to evaluate human disease potential and to recommend strategies for disease prevention. tick vectors of lyme disease require a vertebrate blood meal during each of three motile developmental stages (larva, nymph, and adult). although the immature stages (larvae and nymphs) exhibit broad and overlapping host ranges, adult ticks are primarily dependent on deer for feeding and reproduction. consequently, the distri ...	1995	7726188
borrelia burgdorferi upregulates expression of adhesion molecules on endothelial cells and promotes transendothelial migration of neutrophils in vitro.	the accumulation of leukocytic infiltrates in perivascular tissues is a key step in the pathogenesis of lyme disease, a chronic inflammatory disorder caused by borrelia burgdorferi. during an inflammatory response, endothelial cell adhesion molecules mediate the attachment of circulating leukocytes to the blood vessel wall and their subsequent extravasation into perivascular tissues. using cultured human umbilical vein endothelial cells (huvec) in a whole-cell enzyme-linked immunosorbent assay, ...	1995	7591083
detection of borrelia burgdorferi dna in human skin biopsies and dog synovial fluid by the polymerase chain reaction.	the polymerase chain reaction was used to amplify dna sequences of the etiologic agent of lyme disease, borrelia burgdorferi, and was applied to the detection of the spirochete in humans and dogs. oligonucleotide primers used in the reaction flank a 244-base-pair representing part of the variable region v4 of the b. burgdorferi 16s rrna from biopsies of patients with acrodermatitis, and in synovial fluid from a dog with arthritis. these data suggest the presence of the disease in our state.	1995	7784735
binding of human plasminogen and urokinase-type plasminogen activator to the lyme disease spirochete, borrelia burgdorferi.	many bacteria that spread in the skin produce enzymes that digest extracellular matrix components. borrelia burgdorferi spreads from a skin inoculation site to form the characteristic erythema migrans skin lesion. it was determined that b. burgdorferi does not produce collagenase, elastase, hyaluronidase, or other enzymes that digest extracellular matrix components. however, b. burgdorferi bound human plasmin, plasminogen (pgn), and urokinase-type plasminogen activator (upa). when spirochetes we ...	1995	7751701
seasonal variation in the role of grey squirrels as hosts of ixodes ricinus, the tick vector of the lyme disease spirochaete, in a british woodland.	data are presented on the variable patterns of the seasonal dynamics of ixodes ricinus l. ticks seen questing on the vegetation and feeding on small rodents (mice and voles) and squirrels within a british woodland focus of lyme borreliosis. information on tick infestation levels on pheasants is also presented. the results show a prolonged, unimodal pattern of tick activity, with ticks feeding throughout the year in this sheltered habitat. if host density is taken into account, squirrels are quan ...	1995	9599431
analysis of the human antibody response to outer surface protein c (ospc) of borrelia burgdorferi sensu stricto, b. garinii, and b. afzelii.	the aim of this study was to determine by western blotting (wb) the prevalence of anti-outer surface protein c (ospc) igm and igg antibodies in patients with lyme borreliosis according to each of the three genospecies of borrelia burgdorferi sensu lato. strains of b. burgdorferi sensu stricto (mul), b. garinii (dk 6), and b. afzelii (dk 26) served as antigen, all of which expressed abundant ospc. we examined sera from 117 patients with untreated early and late lyme borreliosis, as well as from 1 ...	1996	9007816
[antibody titers against borrelia in horses in serum and in eyes and occurrence of equine recurrent uveitis].	in germany very little is known about antibody titers against borrelia burgdorferi in the horse. in the usa there exist some studies on the titer levels and symptoms due to borrelia infections. beside lameness, fever, polyarthritis, pneumonia and dullness there is a study showing a connection between panuveitis and borrelia infection in the horse. in human medicine the infection with borrelia burgdorferi becomes more and more important. uveitis and other eye diseases due to borrelia burgdorferi ...	1996	9005836
human dendritic cells phagocytose and process borrelia burgdorferi.	there is strong evidence that the immune response to borrelia burgdorferi (bb) contributes to the pathogenesis of lyme disease. bb are transmitted by ticks to the skin, which is particularly rich in dendritic cells (dc). the initial reaction of these apcs may already set the course to immune pathogenesis. to study the role of dc, biopsies from human skin were incubated with bb and investigated in toto with electron microscopy. in addition, dc freshly isolated from dermis (ddc) and epidermis (lan ...	1996	8816408
borrelia burgdorferi possesses a collagenolytic activity.	lyme disease is a multisystemic disorder caused by borrelia burgdorferi, an invasive spirochete. b. burgdorferi has a predilection for collagenous tissue and one major clinical manifestation of the disease is arthritis. we have identified a collagenolytic activity in b. burgdorferi detergent lysates using iodinated gelatin as well as iodinated pepsinized human collagen types ii and iv as protein substrates. in addition, we describe several proteolytic activities in b. burgdorferi with molecular ...	1996	8870250
a simple method of transmission risk assessment in enzootic foci of lyme borreliosis.	the proposed method consists in examining individual host-seeking vector ticks of the ixodes ricinus complex by microscopy for borreliae and evaluating the proportion of ticks with more than 100 borreliae. the investigations were carried out in a deciduous oak forest habitat in south moravia, czech republic, over four years (1991-1994). in may (i.e., at the peak of seasonal activity of i. ricinus), about 150 nymphal and 200 adult ticks were examined each year. it was found that annual incidence ...	1996	8891535
membrane protein variations associated with in vitro passage of borrelia burgdorferi.	borrelia burgdorferi, the causative agent of lyme disease, undergoes a loss in virulence with repeated passage in vitro. defining the changes which occur after conversion to avirulence may assist in identifying virulence factors and mechanisms of pathogenesis. we have used a cross-adsorption technique and two-dimensional nonequilibrium ph gradient electrophoresis to compare virulent (low-passage) and avirulent (high-passage) variants of b. burgdorferi b31. using cross-adsorbed rabbit sera to pro ...	1996	8550182
borrelia burgdorferi induces secretion of pro-urokinase-type plasminogen activator by human monocytes.	borrelia burgdorferi is transmitted by infected ticks and causes lyme disease. to infect distant organ sites, b. burgdorferi spirochetes must disseminate from the site of the tick bite. during dissemination from the dermal tissue, they breach tissue barriers, probably by proteolysis. the previous findings that spirochetes bind serum-derived plasminogen and that plasmin favors spirochetal invasiveness and infectivity suggested a role for plasmin in the pathogenicity of b. burgdorferi. binding of ...	1996	8926103
molecular characterization of borrelia burgdorferi sensu lato from slovenia revealing significant differences between tick and human isolates.	one hundred twenty-nine slovenian isolates of borrelia burgdorferi sensu lato derived from patients (69 strains) or ixodes ricinus ticks (60 strains) were characterized. all of the strains were first- or second-passage isolates obtained in 1992 and 1993 from the same endemic region. the techniques used for the molecular analysis of strains included species-specific polymerase chain reaction (pcr) typing, and pulsed-field gel electrophoretic separation of undigested and mlui-digested genomic dna. ...	1996	8781883
[lyme disease in chile. prevalence study in selected groups].	the prevalence of lyme disease in chile is unknown.	1996	9035504
identification and mapping of a chromosomal gene cluster of borrelia burgdorferi containing genes expressed in vivo.	a clone containing a 6.4 kb borrelia burgdorferi chromosomal dna insert reacted only with sera from patients with lyme disease and not with any normal human or rabbit sera. restriction enzyme analysis indicated that this dna fragment was located on the b. burgdorferi chromosomal map between rpob and p22a; its direction of transcription was towards p22a. sequence analysis suggests that la006 encodes six proteins: three previously described immunodominant lipoproteins of the 39 kda bmp protein fam ...	1996	8978084
binding of human urokinase type plasminogen activator and plasminogen to borrelia species.	borrelia burgdorferi binds human urokinase plasminogen activator (upa), which cleaves plasminogen (pgn) to plasmin. the ability of other borrelia species to bind upa, pgn, or both was investigated. borrelia coriacae, borrelia garinii, borrelia parkeri, borrelia anserina, and borrelia turicatae were compared with infectious and noninfectious b. burgdorferi isolates. all borrelia species lacked endogenous proteases capable of digesting casein, but all species bound human upa and pgn, generating pg ...	1996	8656020
outer surface lipoproteins of borrelia burgdorferi activate vascular endothelium in vitro.	previously, we reported that activation of vascular endothelium by the lyme disease pathogen borrelia burgdorferi results in enhanced expression of endothelial cell adhesion molecules and promotion of the transendothelial migration of neutrophils in vitro. to investigate the role of spirochetal lipoproteins in this process, we assessed the ability of a synthetic lipohexapeptide corresponding to the n terminus of b. burgdorferi outer surface protein a (ospa) to activate human umbilical vein endot ...	1996	8757851
risk of human exposure to vector ticks (acari: ixodidae) in a heavily used recreational area in northern california.	the risk of humans encountering vector ticks along hiking trails or in picnic grounds in a lyme disease-endemic area was evaluated in a multipurpose recreational area (tilden regional park) in the populous san francisco bay region of california. four hillside hiking trails (two high-use, two low-use) were sampled by dragging and walking through low vegetation biweekly for one year; four heavily used picnic areas were sampled concurrently by dragging. adults of three human-biting ticks were enume ...	1996	8780455
characteristics of lyme disease spirochetes in archived european ticks.	to determine whether the characteristics of the lyme disease spirochete (borrelia burgdorferi) in europe may have changed during the past century, dna was amplified from archived ixodes ricinus ticks. tick dna could be amplified, even when ticks had been stored under museum conditions for nearly a century. spirochetal dna was detected by polymerase chain reaction in 6 ticks preserved for as long as a century; the oldest was collected in 1884. borrelia garinii, which predominates in modern ticks ...	1996	8699081
acute urticaria caused by pigeon ticks (argas reflexus).	a 28-year-old man was admitted to our institute because of acute urticaria appearing a few hours earlier. the patient stated that during sleep he had been bitten by a large number of "insects," which had dropped from wooden ceiling beams under the roof of his room. the patient was living in the center of milan in a very old house, where numerous pigeons had built their nests under the rooftop. the patient brought along with him some examples of these "insects," which were later classified as pig ...	1996	8838926