***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Tests to determine serum antibody levels-the 2-tier sonicate immunoglobulin M ( IgM ) and immunoglobulin G ( IgG ) enzyme-linked immunosorbent assay ( ELISA ) and Western blot method or the IgG of the variable major protein-like sequence-expressed ( VlsE ) sixth invariant region ( C6 ) peptide ELISA method -are the major tests available for support of the diagnosis of Lyme disease . However , these tests have not been assessed prospect ively . METHODS We used these tests prospect ively to determine serologic responses in 134 patients with various manifestations of Lyme disease , 89 patients with other illnesses ( with or without a history of Lyme disease ) , and 136 healthy subjects from areas of endemicity and areas in which the infection was not endemic . RESULTS With 2-tier tests and the C6 peptide ELISA , only approximately one-third of 76 patients with erythema migrans had results that were positive for IgM or IgG seroreactivity with Borrelia burgdorferi in acute-phase sample s. During convalescence , 3 - 4 weeks later , almost two-thirds of patients had seroreactivity with the spirochete B. burgdorferi . The frequencies of seroreactivity were significantly greater among patients with spirochetal dissemination than they were among those who lacked evidence of disseminated disease . Of the 44 patients with Lyme disease who had neurologic , heart , or joint involvement , all had positive  C6 peptide ELISA results , 42 had IgG responses with 2-tier tests , and 2 patients with facial palsy had only IgM responses . However , among the control groups , the IgG Western blot was slightly more specific than the C6 peptide ELISA . The differences between the 2 test systems ( 2-tier testing and C6 peptide ELISA ) with respect to sensitivity and specificity were not statistically significant . CONCLUSIONS Except in patients with erythema migrans , both test systems were sensitive for support of the diagnosis of Lyme disease . However , with current methods , 2-tier testing was associated with slightly better specificity BACKGROUND Traditional and largely qualitative review s of evidence are now giving way to much more structured systematic overviews that use a quantitative method to calculate the overall effect of treatment . The latter approach is dependent on the quality of primary studies , which may introduce bias if they are of poor method ologic quality . OBJECTIVE To test the hypothesis that the inclusion of poor- quality trials in meta-analyses would bias the conclusions and produce incorrect estimates of treatment effect . METHODS An overview of r and omized trials of antiestrogen therapy in subfertile men with oligospermia was performed to test the hypothesis . Data sources included online search ing of MEDLINE and Science Citation Index data bases between 1966 and 1994 , scanning the bibliography of known primary studies and review articles , and contacting experts in the field . After independent , blind assessment , nine of 149 originally identified studies met the inclusion criteria and were selected . We assessed study quality independently . Outcome data from each study were pooled and statistically summarized . RESULTS There was a marginal improvement in pregnancy rate with antiestrogen treatment ( odds ratio , 1.6 ; 95 % confidence interval , 0.9 to 2.6 ) . Sensitivity analyses on the basis of method ologic quality demonstrated that poor- quality studies produced a positive effect with treatment , whereas no benefit was observed with high- quality studies . CONCLUSION The results of a meta- analysis are influenced by the quality of the primary studies included . Method ologically , poor studies tend to exaggerate the overall estimate of treatment effect and may lead to incorrect inferences OBJECTIVE To determine if the early antibiotic treatment of deer tick bites prevented Lyme disease . DESIGN Prospect i ve , double-blind , placebo-controlled , antibiotic treatment . SETTING Private practice in an area endemic for Lyme disease . STUDY PARTICIPANTS Patients between 3 and 19 years of age who received antibiotic treatment within 3 days following a deer tick bite . INTERVENTIONS Patients received an antibiotic or placebo and were followed up for stage I and II disease . All patients had blood drawn at the time of presentation and 6 weeks later for immunofluorescent antibodies ( IFA ) . MEASUREMENTS /MAIN RESULTS One patient in the placebo group developed clinical Lyme disease associated with an IFA titer of 1:32 , considered weakly positive . Three other patients in the placebo group developed an IFA titer of 1:32 ; one had an influenzalike illness and two had no symptoms . None of the study patients developed any neurologic , cardiac , or arthritic symptoms in the 1- to 3-year follow-up . CONCLUSION Based on the low frequency of illness , the absence of stage II disease , and the inability to establish the efficacy of early antibiotic treatment , we suggest that physicians not routinely use prophylactic antibiotics for deer tick bites Animal studies have shown an exponential increase in the risk of Borrelia burgdorferi infection after 48 - 72 h of deer tick attachment . Persons with tick bites were prospect ively studied to determine if those with prolonged tick attachment constitute a high-risk group for infection . Ticks were identified , measured for engorgement , and assayed by polymerase chain reaction ( PCR ) for B. burgdorferi DNA .  Duration of attachment was determined from the scutal index of engorgement . Of 316 su bmi ssions , 229 were deer ticks ; 14 % were positive by PCR .  Paired sera and an intact tick for determination of duration of attachment were available for 105 subjects ( 109 bites ) . There were 4 human cases ( 3.7 % of bites ) of B. burgdorferi infection . The incidence was significantly higher for duration of attachment > or = 72 h than for < 72 h : 3 ( 20 % ) of 15 vs. 1 ( 1.1 % ) of 94 ( P = .008 ; odds ratio , 23.3 ; 95 % confidence interval , 2.2 - 242 ) . PCR was an unreliable predictor of infection . Tick identification and measurement of engorgement can be used to identify a small , high-risk subset of persons who may benefit from antibiotic prophylaxis BACKGROUND Tick-borne relapsing fever ( TBRF ) is an acute febrile illness . In Israel , TBRF is caused by Borrelia persica and is transmitted by Ornithodoros tholozani ticks . We examined the safety and efficacy of postexposure treatment to prevent TBRF . METHODS In a double-blind , placebo-controlled trial , 93 healthy subjects with suspected tick exposure ( 52 with signs of tick bites and 41 close contacts -- those without signs but with a similar risk of contact with ticks ) were r and omly assigned to receive either doxycycline ( Dexxon , in a dose of 200 mg the first day and then 100 mg per day for four days ) or placebo after presumed exposure to TBRF . Cases of TBRF were defined by fever and a positive blood smear . Serologic analysis for cross-reactivity to Borrelia burgdorferi and polymerase chain reaction ( PCR ) for the borrelia glpQ gene were also performed . RESULTS After r and omization , 47 subjects ( 26 with signs of tick bites and 21 close contacts ) received doxycycline . Forty-six other subjects ( 26 with signs of tick bites and 20 close contacts ) received placebo . All 10 cases of TBRF identified by a positive blood smear were in the placebo group of subjects with signs of a tick bite ( P<0.001 ) . These findings suggested a 100 percent efficacy of preemptive treatment ( 95 percent confidence interval , 46 to 100 percent ) . PCR for the borrelia glpQ gene was negative at baseline for all subjects and subsequently positive in all subjects with fever and a positive blood smear . Seroconversion was detected in eight of nine cases of TBRF . PCR and serum sample s were negative for all of the other subjects tested . No major treatment-associated adverse effects were identified . CONCLUSIONS Treatment with doxycycline is safe and efficacious in preventing TBRF after suspected exposure to ticks in a high-risk environment . ( Clinical Trials.gov number , NCT00237016 [ Clinical Trials.gov ] . ) We compared the efficacy of three antibiotics ( ceftriaxone , erythromycin and clarithromycin ) against Borrelia garinii infection in mice . The nymphal ticks of Ixodes persulcatus infected with the strain JEM6 of Japanese B. garinii were allowed to feed on female C3H mice . The mice were treated with each of the antibiotics for 5 consecutive days 1 , 3 , or 7 weeks after tick detachment . The doses of antibiotics per day were as follows : 5 mg intraperitoneal injection of ceftriaxone , 2 mg intraperitoneal injection of erythromycin and 1 mg peroral administration of clarithromycin . The infection status in treated mice was monitored by culturing their earlobes , hearts and urinary bladders in BSK II medium . Ceftriaxone  eliminated borreliae completely ; however , a recurrence of infection was observed in mice treated with erythromycin and clarithromycin During 1980 and 1981 , we compared antibiotic regimens in 108 adult patients with early Lyme disease . Erythema chronicum migrans and its associated symptoms resolved faster in penicillin- or tetracycline-treated patients than in those given erythromycin ( mean duration , 5.4 and 5.7 versus 9.2 days , F = 3.38 , p less than 0.05 ) . None of 39 patients given tetracycline developed major late complications ( meningoencephalitis , myocarditis , or recurrent attacks of arthritis ) compared with 3 of 40 penicillin-treated patients and 4 of 29 given erythromycin ( chi square with 2 degrees of freedom = 5.33 , p = 0.07 ) . In 1982 , all 49 adult patients were given tetracycline ; again , none of them developed major complications . However , with all three antibiotic agents nearly half of the patients had minor late symptoms such as headache , musculoskeletal pain , and lethargy . These complications correlated significantly with the initial severity of illness . For patients with early Lyme disease , tetracycline appears to be the most effective drug , then penicillin , and finally erythromycin Summary A study on prevention of borreliosis in humans bitten by infected ticks was performed in 1992–1994 in the Perm ' region of Russia . AdultIxodes persulcatus ticks were removed from the study subjects , and live preparations made from the material obtained from the gut of each tick were microscopically analyzed ( up to 250 microscopic fields per preparation ) . Persons were divided into experimental and control groups ( 261 and 97 persons , respectively ) . The experimental group received doxycycline ( 100 mg twice daily ) for 3–5 days after the tick bite . In the control ( untreated ) group , 12 persons contracted borreliosis . In the experimental group , the disease was diagnosed in three subjects . Morbidity per 100 patients  in the experimental group was 1.1 , i.e. 11 times lower than that in the control group . Identification ofBorrelia in ticks by microscopic analysis , followed by a short-term treatment with antibiotics according to microbiological indications , is an efficient method for preventing persons from contracting borreliosis . ZusammenfassungIn der Perm-Region , Rußl and , wurde von 1992–1994 eine Studie bei Personen , die von borrelieninfizierten Zecken gestochen worden waren , durchgeführt . Erwachsene Zecken der SpeziesIxodes persulcatus wurden abgenommen und nach Sektion auf Anwesenheit von Borrelien i m Darm mikroskopisch untersucht ( bis zu 250 Gesichtsfelder pro Präparat wurden untersucht ) . In der experimentellen Gruppe waren 261 und in der Kontrollgruppe 97 Personen eingeschlossen . Die experimentelle Gruppe erhielt eine Therapie mit 100 mg Doxycyclin zweimal täglich für 3–5 Tage nach dem Zeckenstich . In der unbeh and elten Kontrollgruppe zogen sich 12 Personen eine Borrelieninfektion zu . In der experimentellen Gruppe wurde bei drei Personen eine Borreliose diagnostiziert . Die Morbidität war in der beh and elten Gruppe mit 1,1/100 11 mal geringer als in der Kontrollgruppe . Identifizierung von Borrelien in den Zecken unter dem Mikroskop und kurzzeitige Antibiotikabeh and lung entsprechend dem mikroskopischen Befund erwies sich als effiziente Method e , um nach Zeckenstick eine Borrelia-Infektion zu verhüten Etude des mesures de prevention et du traitement au cours d'une etude faite dans le 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- 
    Output:
    
The available evidence to date supports the use of antibiotic prophylaxis for the prevention of Lyme disease in endemic areas following an Ixodes tick bite .