Diagnosis of Lyme Disease

While there have been very few documented cases of Lyme disease in Oklahoma, diagnostic testing is often considered. This is a concise summary of the evidence regarding diagnostic tests for Lyme disease and how and when to use or not use them. James W. Mold, MD, MPH

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Lyme disease is the most common tick-borne illness in the US, occurring predominantly in the Northeast, the upper Midwest, and Northern California, with increasing incidence and geographic range.1 Lyme disease can cause a skin lesion at the site of the initial tick bite as well as disseminated disease, including neuropathy, meningitis, acute myocarditis/pericarditis (often with associated conduction abnormalities), and arthritis. Accurate diagnosis is the first step in the optimal management of Lyme disease.

Author/s:

Pitrak, D, Nguyen, C. T., Cifu, A. S.

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

Saige Blanchard — Thu, 07 Oct 2021 23:14:35 +0000

Date Added:

October 7, 2021

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Pages:

1-10

URL:

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2109730

Keywords

PMID (1):

34614328

MeSH

Coronavirus

retrospective studies

During active surveillance in Israel, the incidences of symptomatic myocarditis following the Pfizer COVID vaccine were on the order of 1 (after first dose) to 4 (after the second dose) per 100,000 for males and .1/ 100,000 and 0.5 per 100,000 for females. However, the rates were 1.5/100,00 (after first dose) and 13/100,000 (after second dose) in males 16 – 24 years of age. James W. Mold, MD, MPH

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Background: Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance.

Methods: We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons.

Results: Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637.

Conclusions: The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.

Author/s:

Mevorach, D., Anis, E., Cedar, N., Bromberg, M., Haas, E. J., Nadir, E., Olsha-Castell, S., Arad, D., Hasin, T., Levi, N., Asleh, R., Amir, O., Meir, K., Cohen, D., Dichtiar, R., Novick, D., Hershkovitz, Y., Dagan, R., Leitersdorf, I., Ben-Ami, R., Miskin, I., Saliba, W., Muhsen, K., Levi, Y., Green, M. S., Beinan-Boker, L., Alroy-Preis, S.