Lyme Disease Hall of Shame
Eugene D. Shapiro, MD
Lyme disease is a serious bacterial infection caused by a tick bite and
affects humans and animals.
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This page contains citations and abstracts for medical and scientific articles from the National Institutes of Health (NIH), National Library of Medicine (NLM) MEDLINE database about Lyme disease by Eugene D. Shapiro, MD.
Table of Contents
General information about Eugene D. Shapiro, MD
MEDLINE search link for Lyme disease citations and abstracts with Shapiro as author
Summaries of all MEDLINE citations on Lyme disease for Eugene D. Shapiro, MD
Complete text of all MEDLINE citations on Lyme disease for Eugene D. Shapiro, MD
Back to the Lyme Disease Hall of Shame home page
For more information on Lyme disease
General information about Eugene D. Shapiro, MD
Eugene D. Shapiro, MD
------------------------------------
mailto:eugene.shapiro@yale.edu
office_phone: (203)688-4518
Yale University School of Medicine
Department of Pediatrics
Yale University School of Medicine
333 Cedar St, New Haven, CT 06520-8064
The following link was used to find all MEDLINE citations and abstracts pertaining
to Lyme disease with Shapiro as one of the authors:
MEDLINE - Shapiro AND Lyme disease - 18 citations found on 2 Feb 00
Summaries of all MEDLINE citations on Lyme disease for Eugene D. Shapiro, MD
[Note: Items 1, 14, and 18 were by a different Shapiro, but item 5 by
Shapiro EE was assumed to be a typo]
2 - "...the prognosis for children with Lyme arthritis who are treated
with appropriate antimicrobial therapy is excellent." COMMENT: See no.
7 where Shapiro used the term "standard antimicrobial regimens" in the
same context.
3 - Title: Lyme disease. [No abstract available.]
4 - Title: Tick-borne diseases. [No abstract available.]
5 - Title: Guillain-Barre syndrome in a child with serologic evidence of
Borrelia burgdorferi infection. [No abstract available.] [Note: Shapiro
EE assumed to be a typo.]
6 - Title: Lyme disease and facial nerve palsy [editorial] [No abstract
available.]
7 - "...prognosis is excellent for children with Lyme disease who have
been treated with standard antimicrobial regimens".
8 - "About 90 percent of children with Lyme disease present with
erythema migrans, which is an early stage of the disease. The prognosis
is excellent for those with early Lyme disease who are treated promptly
with conventional courses of antimicrobial agents."
9 - Title: Misdiagnosis of Lyme disease: when not to order serologic
tests. [no abstract available.]
10 - "Careful prospective studies have found that nearly 90% of children
with Lyme disease have erythema migrans. Although there has been great
concern about congenital Lyme disease, no data suggest that it is a
significant problem, nor has transmission of Lyme disease through breast
milk been documented. Virtually all children will respond well to
treatment for any stage of Lyme disease. Misdiagnosis is the most common
reason for treatment failure. Long-term follow-up studies indicate that
the prognosis for children with Lyme disease is excellent."
11 - "The IgM rOspC ELISA is a convenient, readily automated, easily
standardized serologic test that is significantly more sensitive for the
diagnosis of early Lyme disease than either WC ELISA or immunoblot
assay."
12 - "The risk of acquiring either Lyme disease or babesiosis from a
blood transfusion in Connecticut is very low."
13 - Title: Lyme disease. [No abstract available.]
15 - "The existence of a form of early Lyme disease characterized by a
flu-like illness without erythema migrans is controversial. ...The
existence of a flu-like illness without erythema migrans of early
Lyme disease has been clearly established." COMMENT: The existence of
persisting or relapsing Lyme disease seems to be controversial for some
researchers. ........
16 - "Even in an area in which Lyme disease is endemic, the risk of
infection with B. burgdorferi after a recognized deer-tick bite is so
low that prophylactic antimicrobial treatment is not routinely
indicated." COMMENT: Lots of controversey on this paper evidenced by
the number of comments to it. See all comments at:
Antimicrobial Prophylaxis after Tick Bites, NEJM 1993; 328: 1418-1420
For more on prophylactic antibiotic treatment of tick bites, see:
Antibiotic Prophylaxis After Tick Bite For Prevention Of Lyme Disease -
An Annotated Bibliography
17 - Title: Diagnosis of Lyme disease in children. [No abstract
available.]
Complete text of all MEDLINE citations on Lyme disease for Eugene D. Shapiro, MD
2
TITLE:
Lyme arthritis in children: clinical epidemiology and long-term
outcomes.
AUTHORS: Gerber MA; Zemel LS; Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
NLM PUBMED CIT. ID: 9755263 NLM CIT. ID: 98429612
SOURCE: Pediatrics 1998 Oct;102(4 Pt 1):905-8
ABSTRACT:
OBJECTIVE: Although Lyme disease has become a relatively common cause
of arthritis among children in areas of the country in which the
disease is endemic, little information is available about the
clinical epidemiology and long-term outcomes of children with Lyme
arthritis. We conducted a long-term follow-up study to determine the
clinical epidemiology of Lyme arthritis in children as well as their
long-term outcomes. PATIENTS AND METHODS: All children seen between
1982 and 1991 at the Pediatric Rheumatology Clinic at Newington
Children's Hospital (Newington, CT) with an initial diagnosis of Lyme
disease were identified. Medical records were reviewed and structured
telephone interviews were conducted to obtain demographic, clinical,
and follow- up data. RESULTS: A total of 90 children (63% boys) with
a mean age of 8.3 years (range, 1.8-16 years) at the time of
diagnosis of Lyme arthritis were evaluated. Lyme arthritis was
preceded by early Lyme disease in 23 (26%) of the children; however,
only 8 (35%) of these children had been treated with appropriate
antimicrobial therapy at that early stage. Ninety percent of the
children had arthritis of at least one knee, while small joints were
rarely involved. For the 31 children who underwent arthrocentesis,
the mean white blood cell count in the synovial fluid was 38 000
cells/mm3 (range, 7000-99 000 cells/mm3) with predominantly
neutrophils. For the 79 children for whom an erythrocyte
sedimentation rate was determined, the highest level for 61 (77%) was
>20 mm/h and for 36 (46%) was >50 mm/h. Antimicrobial therapy was
initiated 2 days to 5.5 years (median, 2 months) after the onset of
symptoms. However, 5 of the children were never treated with
antimicrobials. Fifty-one percent of the patients had a single
episode of arthritis, while 49% reported recurrent episodes of
arthritis over a period of 1 week to 8 years (median, 6 months). Two
children (2%) developed chronic arthritis and underwent arthroscopic
synovectomy. At the time of the telephone follow-up evaluation,
performed 2 to 12 years (median, 7 years) after the onset of the Lyme
arthritis, 4 children had ongoing musculoskeletal complaints that
resulted in mild to moderate impairment of school or sports
activities, but none of the children had evidence of active
arthritis. CONCLUSION: The results of this investigation suggest that
the prognosis for children with Lyme arthritis who are treated with
appropriate antimicrobial therapy is excellent.
3
TITLE:
Lyme disease.
AUTHORS: Shapiro ED
AUTHOR AFFILIATION:
Yale University School of Medicine, New Haven, CT, USA.
NLM PUBMED CIT. ID: 9584524 NLM CIT. ID: 98245503
SOURCE: Pediatr Rev 1998 May;19(5):147-54
[No abstract available.]
4
TITLE:
Tick-borne diseases.
AUTHORS: Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New
Haven, Connecticut, USA.
NLM PUBMED CIT. ID: 9544313 NLM CIT. ID: 98205957
SOURCE: Adv Pediatr Infect Dis 1997;13:187-218
[No abstract available.]
5
TITLE:
Guillain-Barre syndrome in a child with serologic evidence of
Borrelia burgdorferi infection [published erratum appears in Pediatr
Infect Dis J 1998 Jun;17(6):481]
AUTHORS: Shapiro EE
AUTHOR AFFILIATION:
Yale University School of Medicine, New Haven, CT, USA.
NLM PUBMED CIT. ID: 9535265 NLM CIT. ID: 98194913
SOURCE: Pediatr Infect Dis J 1998 Mar;17(3):264-5
[No abstract available.]
6
TITLE:
Lyme disease and facial nerve palsy [editorial]
AUTHORS: Shapiro ED; Gerber MA
NLM PUBMED CIT. ID: 9412591 NLM CIT. ID: 98074067
SOURCE: Arch Pediatr Adolesc Med 1997 Dec;151(12):1183-4
[No abstract available.]
7
TITLE:
Lyme disease in children.
AUTHORS: Shapiro ED; Seltzer EG
AUTHOR AFFILIATION:
Department of Pediatrics, Children's Clinical Research Center, Yale
University School of Medicine, New Haven, Connecticut 06520-8064,
USA.
NLM PUBMED CIT. ID: 9166958 NLM CIT. ID: 97309543
SOURCE: Semin Neurol 1997 Mar;17(1):39-44
ABSTRACT:
Neurologic manifestations of Lyme disease are common in children,
among whom the incidence of Lyme disease is higher than among adults.
Cranioneuropathies, in particular palsy of the facial nerve, occur in
approximately 3-5% of children with Lyme disease, followed in
frequency by meningitis (1% of symptomatic children). Children with
only non- specific symptoms such as headache, arthralgia or fatigue
commonly are misdiagnosed as having Lyme disease. Although such
non-specific symptoms often accompany more specific signs and
symptoms (e.g., erythema migrans, arthritis) in children with Lyme
disease, very rarely are non-specific symptoms the sole manifestation
of Lyme disease. A number of carefully conducted follow-up studies
have indicated that the prognosis is excellent for children with Lyme
disease who have been treated with standard antimicrobial regimens.
8
TITLE:
Lyme disease in children in southeastern Connecticut. Pediatric
Lyme Disease Study Group [see comments]
See complete text at:
Original Articles -- NEJM 1996; 335: 1270-1274
AUTHORS: Gerber MA; Shapiro ED; Burke GS; Parcells VJ; Bell GL
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut School of Medicine,
Connecticut Children's Medical Center, Hartford, CT 06106, USA.
COMMENTS:
Comment in: N Engl J Med 1997 Apr 10;336(15):1107; discusssion 1107-8
Correspondence -- NEJM 1997; 336: 1107-1108
NLM PUBMED CIT. ID: 8857006 NLM CIT. ID: 96427293
SOURCE: N Engl J Med 1996 Oct 24;335(17):1270-4
ABSTRACT:
BACKGROUND: Although the incidence of Lyme disease is highest in
children, there are few prospective data on the clinical
manifestations and outcomes in children. METHODS: We conducted a
prospective, longitudinal, community-based cohort study of children
with newly diagnosed Lyme disease in an area of Connecticut in which
the disease is highly endemic. We obtained clinical and demographic
information and performed serial antibody tests and follow-up
evaluations. RESULTS: Over a period of 20 months, 201 consecutive
patients were enrolled; their median age was 7 years (range, 1 to
21). The initial clinical manifestations of Lyme disease were a
single erythema migrans lesion in 66 percent, multiple erythema
migrans lesions in 23 percent, arthritis in 6 percent, facial-nerve
palsy in 3 percent, aseptic meningitis in 2 percent, and carditis in
0.5 percent. At presentation, 37 percent of the patients with a
single erythema migrans lesion and 89 percent of those with multiple
erythema migrans lesions had antibodies against Borrelia burgdorferi.
All but 3 of the 201 patients were treated for two to four weeks with
conventional antimicrobial therapy, which was administered orally in
96 percent. All had prompt clinical responses. After four weeks, 94
percent were completely asymptomatic (including the two patients
whose parents had refused to allow antimicrobial treatment). At
follow-up a mean of 25.4 months later, none of the patients had
evidence of either chronic or recurrent Lyme disease. Six patients
subsequently had a new episode of erythema migrans. CONCLUSIONS:
About 90 percent of children with Lyme disease present with erythema
migrans, which is an early stage of the disease. The prognosis is
excellent for those with early Lyme disease who are treated promptly
with conventional courses of antimicrobial agents.
9
TITLE:
Misdiagnosis of Lyme disease: when not to order serologic tests.
AUTHORS: Seltzer EG; Shapiro ED
AUTHOR AFFILIATION:
Department of Medicine, Yale University School of Medicine, New Haven,
CT 06520-8064, USA.
NLM PUBMED CIT. ID: 8878216 NLM CIT. ID: 97032320
SOURCE: Pediatr Infect Dis J 1996 Sep;15(9):762-3
[No abstract available.]
10
TITLE:
Lyme disease in children.
AUTHORS: Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New
Haven, Connecticut 06520-8064, USA.
NLM PUBMED CIT. ID: 7726195 NLM CIT. ID: 95243257
SOURCE: Am J Med 1995 Apr 24;98(4A):69S-73S
ABSTRACT:
Lyme disease is the most common vector-borne disease among children in
the United States; the incidence of Lyme disease is higher among
children than among adults. Extensive publicity in the lay press
about the effects of Lyme disease has led to widespread anxiety about
this illness that is out of proportion to the actual frequency of
severe consequences, especially among children. The problem is
exacerbated by the difficulty of documenting the diagnosis (or more
often of ruling out the diagnosis in children with vague symptoms),
especially when the diagnosis depends on serologic tests that are
often inaccurate. This caveat applies particularly to commercial
laboratories using prepackaged kits, which often give inaccurate
results that should not be relied on by themselves to make a
diagnosis. Careful prospective studies have found that nearly 90% of
children with Lyme disease have erythema migrans. Although there has
been great concern about congenital Lyme disease, no data suggest
that it is a significant problem, nor has transmission of Lyme
disease through breast milk been documented. Virtually all children
will respond well to treatment for any stage of Lyme disease.
Misdiagnosis is the most common reason for treatment failure.
Long-term follow-up studies indicate that the prognosis for children
with Lyme disease is excellent.
11
TITLE:
Recombinant outer surface protein C ELISA for the diagnosis of early Lyme disease.
AUTHORS: Gerber MA; Shapiro ED; Bell GL; Sampieri A; Padula SJ
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut Health Center,
Farmington.
NLM PUBMED CIT. ID: 7876628 NLM CIT. ID: 95181889
SOURCE: J Infect Dis 1995 Mar;171(3):724-7
ABSTRACT:
To compare the sensitivity of a new ELISA for IgM antibodies to
Borrelia burgdorferi that uses a recombinant outer surface protein C
(rOspC) with those of a whole cell (WC) ELISA and an immunoblot assay
for the diagnosis of early Lyme disease, serum specimens from 82
consecutive patients with physician-documented erythema migrans were
analyzed. To compare the specificities of the three assays, serum
specimens from 50 patients without a history of Lyme disease and from
an area in which B. burgdorferi is not endemic were analyzed. The
sensitivities of the WC ELISA, immunoblot assay, and IgM rOspC ELISA
were 28%, 29%, and 46%, respectively, while the specificities were
100%, 100%, and 98%, respectively. The IgM rOspC ELISA is a
convenient, readily automated, easily standardized serologic test
that is significantly more sensitive for the diagnosis of early Lyme
disease than either WC ELISA or immunoblot assay.
12
TITLE:
The risk of acquiring Lyme disease or babesiosis from a blood
transfusion.
AUTHORS: Gerber MA; Shapiro ED; Krause PJ; Cable RG; Badon SJ; Ryan RW
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut School of
Medicine, Farmington.
NLM PUBMED CIT. ID: 8014507 NLM CIT. ID: 94284646
SOURCE: J Infect Dis 1994 Jul;170(1):231-4
ABSTRACT:
To determine the risk of acquiring Lyme disease or babesiosis from
blood transfusion, serum was collected before and 6 weeks after
patients received multiple transfusions during cardiothoracic surgery
and antibodies to Borrelia burgdorferi and Babesia microti were
measured. Of 155 subjects, 149 received 601 total units of packed red
blood cells (PRBC) and 48 received 371 total units of platelets. No
patient developed clinical or serologic evidence of Lyme disease; 1
(who received 5 units of PRBC) developed clinical and serologic
evidence of babesiosis. The risk of acquiring Lyme disease from a
transfused unit of PRBC was 0 (95% confidence interval [CI], 0-0.5%)
and from a transfused unit of platelets was 0 (95% CI, 0-0.8%); the
same risks for babesiosis were 0.17% (95% CI, 0.004%-0.9%) and 0 (95%
CI, 0-0.8%), respectively. The risk of acquiring either Lyme disease
or babesiosis from a blood transfusion in Connecticut is very low.
13
TITLE:
Lyme disease.
AUTHORS: Baltimore RS; Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New
Haven, CT.
NLM PUBMED CIT. ID: 8036192 NLM CIT. ID: 94310110
SOURCE: Pediatr Rev 1994 May;15(5):167-73; quiz 174
[No abstract available.]
15
TITLE:
Early Lyme disease: a flu-like illness without erythema migrans.
AUTHORS: Feder HM Jr; Gerber MA; Krause PJ; Ryan R; Shapiro ED
AUTHOR AFFILIATION:
Department of Family Medicine, University of Connecticut Health
Center, Farmington 06030.
NLM PUBMED CIT. ID: 8424027 NLM CIT. ID: 93141312
SOURCE: Pediatrics 1993 Feb;91(2):456-9
ABSTRACT:
The existence of a form of early Lyme disease characterized by a flu-
like illness without erythema migrans is controversial. To confirm
the existence and define the clinical characteristics of the flu-like
illness without erythema migrans of localized Lyme disease, the
authors studied patients from a Lyme disease endemic area of
Connecticut who visited their primary care physicians with an
undefined flu-like illness. Patients kept a diary of their symptoms.
Acute and convalescent sera were obtained. The diagnosis of Lyme
disease was based on the appearance of IgM or IgG antibodies to
Borrelia burgdorferi as demonstrated by both enzyme-linked
immunosorbent assay and immunoblot assay. Twenty-four untreated
patients were studied. In five patients acute serologic evidence of
Lyme disease developed. The flu-like illness in these five patients
was characterized by fever and fatigue and resolved spontaneously in
5 to 21 days. Symptoms recurred in three of these five patients. The
existence of a flu-like illness without erythema migrans of early
Lyme disease has been clearly established. Prospective, controlled
studies are needed to better define its incidence, characteristics,
and prognosis so that appropriate diagnostic and therapeutic
strategies can be developed.
16
TITLE:
A controlled trial of antimicrobial prophylaxis for Lyme disease
after deer-tick bites [see comments]
AUTHORS: Shapiro ED; Gerber MA; Holabird NB; Berg AT;
Feder HM Jr; Bell GL; Rys PN; Persing DH
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New
Haven, Conn. 06510-8064.
COMMENTS:
Comment in: N Engl J Med 1993 May 13;328(19):1418; discussion 1420
Comment in: N Engl J Med 1993 May 13;328(19):1418-9; discussion 1420
Comment in: N Engl J Med 1993 May 13;328(19):1419; discussion 1420
Comment in: N Engl J Med 1993 May 13;328(19):1419-20
[Note: For all comments above, see:
Correspondence -- Antimicrobial Prophylaxis after Tick Bites, NEJM 1993; 328: 1418-1420
]
NLM PUBMED CIT. ID: 1435930 NLM CIT. ID: 93063129
SOURCE: N Engl J Med 1992 Dec 17;327(25):1769-73
ABSTRACT:
BACKGROUND. Borrelia burgdorferi, which causes Lyme disease, is
transmitted by deer ticks (lxodes dammini) in the northeastern and
midwestern United States. Although deer-tick bites are common in
areas in which the disease is endemic, there is uncertainty about how
to manage the care of persons who are bitten. METHODS. To assess the
risk of infection with B. burgdorferi and the efficacy of
prophylactic antimicrobial treatment after a deer-tick bite, we
conducted a double- blind, placebo-controlled trial in an area of
southeastern Connecticut in which Lyme disease is endemic. Children
and adults who had been bitten by deer ticks were randomly assigned
to receive either amoxicillin or placebo for 10 days. Subjects were
followed for one year for clinical manifestations of Lyme disease.
Serum samples obtained at enrollment and six weeks and three months
later were tested for antibodies against B. burgdorferi. RESULTS. Of
the 387 subjects, 205 (53 percent) were assigned to receive
amoxicillin and 182 (47 percent) to receive placebo. Of 344 deer
ticks submitted and analyzed by the polymerase chain reaction, 15
percent were infected with B. burgdorferi. Erythema migrans developed
in two subjects, both of whom had received placebo. There were no
asymptomatic seroconversions and no late manifestations of Lyme
disease. The risk of infection with B. burgdorferi in the
placebo-treated subjects was 1.2 percent (95 percent confidence
interval, 0.1 to 4.1 percent), which was not significantly different
(P = 0.22) from the risk in the amoxicillin-treated subjects (0
percent; 95 percent confidence interval, 0 to 1.5 percent).
CONCLUSIONS. Even in an area in which Lyme disease is endemic, the
risk of infection with B. burgdorferi after a recognized deer-tick
bite is so low that prophylactic antimicrobial treatment is not
routinely indicated.
17
TITLE:
Diagnosis of Lyme disease in children.
AUTHORS: Gerber MA; Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut School of
Medicine, Farmington 06030.
NLM PUBMED CIT. ID: 1625075 NLM CIT. ID: 92325856
SOURCE: J Pediatr 1992 Jul;121(1):157-62
[No abstract available.]
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