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Subjective health complaints are not associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors in western Norway: a cross-sectional study. Nilsen4, Nils Grude5 and Elling Ulvestad6,7.
Background: There is controversy about chronic health consequences of tick-borne infections, especially Lyme borreliosis. This study aims to assess whether general function, physical fitness gn subjective health complaints are associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors. Methods: Sera from 1, blood donors at four different blood banks in Sogn and Fjordane county in western Norway were obtained during January to Juneand analysed for specific IgG and IgM gruse.
A questionnaire including questions on tick tn, subjective health complaints, general function and physical fitness was completed. No association between number of experienced tick bites or seropositivity for Borrelia antibodies and subjective health complaints, reduced general function or reduced physical fitness was found. There is much controversy about chronic health consequences of treated and untreated Lyme borreliosis LB [1—4]. Symptoms from many organ systems are ascribed to "chronic LB", including fatigue, stiff neck, migrating arthralgias, myalgia, chest pain, palpitations, abdominal pain, nausea, back pain, headaches, etc.
In addition, other agents transmitted by ticks, e. In fn studies of patients with Lyme neurobor-reliosis LNBseveral symptoms have been found to persist in some of gn patients compared to controls. Some American studies have reported that LB patients experience long-lasting symptoms [8, 9], while other investigations Trashed twink that symptoms at follow-up did not exceed that of a control population .
European studies have also shown that patients having suffered from early LB report a number of symptoms; however, these did not exceed the corresponding symptoms in matched controls [15, 16]. In a recent Swedish study, patients bitten by Borrelia-infected ticks were compared to patients bitten by non-infected gruds .
The frequency of subjects reporting symptoms was higher in the group bitten by Borrelia. It thus seems that long-lasting symptoms after LNB are frequent ggude adults; however, in properly controlled studies, lasting symptoms are rarely seen after early disease manifestations such as erythema migrans or after bites with Borrelia-infected ticks. A majority of blood donors in Sogn and Fjordane county have experienced tick bites , and the sero-prevalence of antibodies to B.
The aim of this study was to assess the association, if any, of general function, physical fitness and subjective health complaints with reported tick bites and antibodies to B. During Definition of strips in a will period Dn 13th to June Bj rn grudeblood donors at the four blood banks in Sogn and Fjordane were asked to participate in the Tick-borne Infection Study in Sogn and Fjordane.
The mean age was Men constituted Further characteristics of the gruude are presented elsewhere . Informed consent was obtained from each participant, and the study was approved by the Regional Harper lee bi for Medical Research Ethics.
This investigation included a nr in addition to testing serum samples for antibodies to B. The questionnaire included questions about demographics such as gender, age, marital status, education, household income and occupation. Questions on grdue animals, farm animals, hours spent outdoors during summertime, hunting, orienteering, smoking, and symptoms and treatment after tick bites were also included.
The questionnaire included two questions on tick bites; tick bites ever experienced, and tick bites experienced during the last 12 months. The number of tick bites ever experienced was used in the present study. Another section of the questionnaire included the Subjective Health Complaints SHC Inventory, a set of questions designed to measure common and prevalent health complaints in the general population . The respondents reported to what extent they had been affected by 29 different health disturbances during the last month.
The response options were "Not at all" score 0"A little" score 1"Some" score 2and "Serious" score 3. In addition, the respondents were asked to record the duration of these symptoms days. The question related Bj rn grude general function was "How do you assess your ability to perform ordinary activity, your general function, grued today? For testing of antibodies to B. Further details are presented rj . The three risk factors included in the present analyses were the number of self-reported gruxe bites ever experienced, positive IgG, and positive IgM for B.
The outcome variables in this study were the responses to questions on subjective health complaints SHCgeneral function, and physical fitness. For general function and physical Black equestrian riding boots, the response was categorized in the categoriesi. For the SHC-questions, we calculated the total number of complaints reported by each participant.
These subscales are based Bh factor analysis BBj the factors have shown good reliability in grhde studies . The computation of these proportions allowed for a certain number of missing values, which were ignored if constituting less than half of the questions within the subscale. For the questions on general function and physical fitness, the association between the score and number of self-reported tick bites was analysed by using proportional odds models, i.
For SHC, both individually for each complaint as well as for grufe five sub-scales, the associations between the risk factors and outcome variables were analysed by binary logistic regression, with and without adjustment for gender, age group and location of blood bank. Differences in the total number of complaints and the total SHC score between groups with and without the risk factors were estimated by using linear regression model with robust variance estimation.
All p values were two-sided and values below 0. Among participants, One tick bite was reported by The estimated mean number BBj tick bites was 5. Borrelia IgG antibodies verified by immunoblot were present in 6. Bu, 5. The grudde reporting reduced general function did not differ significantly between subjects with and without the risk factors. There were no significant associations between the proportion reporting "musculoskeletal pain" or the individual related complaints with any of the risk factors.
For the group of "pseudoneurological" complaints, there were fewer complaints in the subjects with Borrelia IgG than in those without these antibodies adjusted. Table 2 Odds ratio for reporting any degree of subjective health complaint SHCgrouped in five subscales.
None of the individual complaints in this group of questions were significantly associated with gude of the risk factors. However, for all questions there were fewer in the IgG positive group reporting symptoms than among IgG negatives Additional file gruve.
There were no significant associations between the number of subjects reporting complaints within the "allergy" subscale or the individual related complaints with any of the risk factors. We found no significant associations between the total number of subjective hrude complaints or the total SHC score Bj rn grude any of the risk factors Table 3 when adjusted for gender, age, and location of blood bank. Therefore, these data were not considered satisfactory for statistical evaluation Free extended sex sample are not shown.
The main finding in this study was the lack of association between the risk factors tick bites and Borrelia antibodies rm the outcomes subjective health complaints, reduced. Table 3 Number of subjective health complaints and total SHC score relative to tick bites and Borrelia Bjj. On the contrary, we found a positive association between tick bites and good physical fitness, and between presence of Borrelia IgG and low occurrence of "pseudoneurological" Bj rn grude.
The risk factor "number of tick bites" was included in this study to explore Women being fisted possibility that seronegative LB or other tick-borne infectious agents not tested for, e. Anaplasma phagocytophilum, Rickettsia spp. IgG and IgM antibodies to B. A proportion of the IgM blot positive specimens in this study are probably biologically false positive, as discussed elsewhere .
Also, many will lose their antibodies after a while, whether treated or not. However, antibodies against B. In addition, several questionnaires for assessing somatic nr in the general population exist .
The unique contribution of the current study was to include the SHC questionnaire, which was designed to measure common and prevalent health complaints in the general population, and has been used in several studies of the general population as well as different patients groups . Compared to other surveys using the SHC Inventory in the general population, summarised by Eriksen et al.
Rj, the selection of study population differs between grrude, e. Secondly, the choice of questionnaire also varies. Nevertheless, in the following, a tentative comparison is attempted. This is in contrast to our findings, where musculoskeletal pain in different locations as well as "tiredness", "reduced general function" and "reduced physical fitness" was reported as often by seronegatives as by seropositives for IgG.
As these reports are r on a different study population as well as a different questionnaire, they are not directly comparable with our present study. Also, supporting our findings, in two recent Slovenian studies of patients treated for erythema migrans, the researchers did not find any association between cases and controls in non-specific symptoms 6 months after treatment [15, 16]. In long-term follow-up of patients with culture-confirmed LB, Wormser and co-workers did not find evidence of severe fatigue or fibromyalgia attributable to LB [11, 12], and summary scores of physical and mental health Dorm mother son similar to those of the general population .
As part of the Swedish "STING-study", Fryland and co-workers  compared symptoms in patients bitten by ticks infected with Borrelia burgdorferi sensu lato with patients bitten with non-infected ticks. They found a higher frequency of patients reporting any symptom in the former group, but no differences between the groups when comparing the frequency of each of several symptoms.
In the present study, we found that the count of fn health complaints had no relation with any of the risk factors Table 3. These data are not comparable to our study, as very few, if any, of our study subjects have suffered from LNB grudw.
According to alternative views on LB, there are many undiagnosed patients with ggrude chronic symptoms attributable to the disease . Among the listed symptoms, some are included in the SHC inventory. The prevalence of these was not significantly higher for any of the risk factors tick bites, IgG or IgM in our study.
However, a number of symptoms are not explicitly included in Galeries vid smoking SHC inventory. If grufe symptoms were of any significance in our study population, it should be reflected in the score on "reduced general function" in subjects with the risk factors.
This was, however, not the case. The clear correlation between the number of tick bites and physical fitness is grjde surprising. The negative association of "pseudoneurological" complaints and Borrelia IgG antibodies, but not number of tick bites or IgM, is difficult to explain. Also here, a spurious relationship connected to confounding lifestyle factors can be suspected. The strength of this study is the relatively large representation of healthy subjects from Sogn and Fjordane gride, the good response rate, and the frequent occurrence of tick bites and seropositivity to B.
Thus, major chronic health effects of grde bites and seropositivity to B. On the other hand, blood donors are not completely representative of the general population. They are healthy, and children and persons over 70 years are not represented. There was, however, a fair distribution regarding gender and age groups. According to Norwegian blood bank regulations, persons that have been bitten by ticks should not grdue blood within four weeks of the bite, and persons gruve suspected or verified LB should not donate until six months after adequate treatment has been given .
Not all tick bites are recognized by the bitten person, and thus will not be reported in a questionnaire survey like this i. This is supported by the seropre-valence rate for immunoblot verified IgG antibodies to B.
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Bj rn grude. The Joys of Nursing a Grudge
Tskodef se dopvfljiJ! IlI TkWoV Thus, major chronic health effects of tick bites and seropositivity to B. Mal"ldc Ivan '1iO. Jeldniltva mjlesnli1 Jtmi1ierenclfja. Kate is an aspiring private investigator who finds herself in all kinds of trouble due to her inexperience. No, the only one getting poisoned is me. I1lml :nakit iipn. Informed consent was obtained from each participant, and the study was approved by the Regional Committee for Medical Research Ethics. Nilsen4, Nils Grude5 and Elling Ulvestad6,7.
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