Meningoencephalomyeloradiculoneuritis in one case of Borrelia burgdorferi infection (Lyme disease)

We describe a patient having serologically confirmed Borrelia burgdorferi infection manifesting meningoencephalomyeloradiculoneuritis. The clinical and MRI features suggested a multifocal vascular nervous system involvement. EMG-ENG showed abnormalities consistent with axonal degeneration initially involving the more proximal segments of the lower limb nerves.

---

Sommario Viene descritto un paziente con meningoencefalomieloradicoloneurite da Borrelia burgdorferi. Le caratteristiche cliniche e neuroradiologiche sono indicative di una vasculopatia multifocale del sistema Nervoso. I reperti elettromiografici-elettroneurografici mostrano una degenerazione assonale con iniziale interessamento delle porzioni più prossimali dei tronchi nervosi periferici degli arti inferiori.

     

Active and Passive Surveillance and Phylogenetic Analysis of Borrelia burgdorferi Elucidate the Process of Lyme Disease Risk Emergence in Canada

Background

Northward expansion of the tick Ixodes scapularis is driving Lyme disease (LD) emergence in Canada. Information on mechanisms involved is needed to enhance surveillance and identify where LD risk is emerging.

Objectives

We used passive and active surveillance and phylogeographic analysis of Borrelia burgdorferi to investigate LD risk emergence in Quebec.

Methods

In active surveillance, we collected ticks from the environment and from captured rodents. B. burgdorferi transmission was detected by serological analysis of rodents and by polymerase chain reaction assays of ticks. Spatiotemporal trends in passive surveillance data assisted interpretation of active surveillance. Multilocus sequence typing (MLST) of B. burgdorferi in ticks identified likely source locations of B. burgdorferi.

Results

In active surveillance, we found I. scapularis at 55% of sites, and we were more likely to find them at sites with a warmer climate. B. burgdorferi was identified at 13 I. scapularis–positive sites, but infection prevalence in ticks and animal hosts was low. Low infection prevalence in ticks submitted in passive surveillance after 2004—from the tick-positive regions identified in active surveillance—coincided with an exponential increase in tick submissions during this time. MLST analysis suggested recent introduction of B. burgdorferi from the northeastern United States.

Conclusions

These data are consistent with I. scapularis ticks dispersed from the United States by migratory birds, founding populations where the climate is warmest, and then establishment of B. burgdorferi from the United States several years after I. scapularis have established. These observations provide vital information for public health to minimize the impact of LD in Canada.     

吉林省珲春地区蜱中伯氏疏螺旋体与斑点热群立克次体复合感染研究

目的了解吉林省珲春地区伯氏疏螺旋体与斑点热群立克次体的复合感染情况.方法运用PCR方法对吉林省珲春地区采集的蜱标本,进行伯氏疏螺旋体5S～23S rRNA间隔区基因与斑点热群立克次体外膜蛋白A（ompA）基因的检测.测序并用PHYLIP软件进行序列分析.结果全沟硬蜱中伯氏疏螺旋体感染率为36.0%,在全沟硬蜱中检测到了斑点热群立克次体的感染,其感染率为2 0%.二者的复合感染率为2.0%;森林革蜱中伯氏疏螺旋体感染率30.9%,斑点热群立克次体感染率29.1%,二者的复合感染率16.8%.伯氏疏螺旋体的序列分析显示吉林地区的伯氏疏螺旋体都属于B.garinii基因型,同源性较高.对斑点热阳性片段序列分析表明新测序列与斯洛伐克新发现的IRS3株和IRS4株核苷酸序列同源性为97%.结论吉林省珲春地区全沟硬蜱及森林革蜱中检测到伯氏疏螺旋体与斑点热群立克次体的感染,并检测到2种病原体的复合感染情况.     

Chronic symptoms are common in patients with neuroborreliosis -- a questionnaire follow-up study

OBJECTIVES: The existence of chronic neuroborreliosis is controversial. The aim of our study was to investigate the existence and kind of persistent symptoms in patients previously treated because of neurological symptoms as a result of neuroborreliosis. MATERIALS AND METHODS: A total of 106 patients with neuroborreliosis, according to established criteria, and a control group of 123 patients with Borrelia induced erythema migrans diagnosed in a general practitioner office were studied. A questionnaire was sent to patients and controls concerning their health situation. Time from onset of neurological symptoms to the questionnaire send out was 32 months (mean) for the patients with neuroborreliosis and 33 months (mean) for the controls. RESULTS: Fifty per cent of the individuals in the patient group compared with 16% of the individuals in the control group showed persistent complaints after their Borrelia infection (P < 0.0001). The most significant differences between the groups were the presence of neuropsychiatric symptoms such as headache, attention problems, memory difficulties and depression. Paresthesia, pain and persistent facial palsy was also significantly more common in patients treated because of neuroborreliosis. CONCLUSION: Our study shows that persisting neurological symptoms are common after a neuroborreliosis infection. The pathological mechanisms that lay behind the development of chronic symptoms, however, are still uncertain.     

天津市蓟县地区莱姆病螺旋体主要生物媒介的调查研究

目的了解当地莱姆病的主要生物媒介一蜱的种类、带菌状况以及在传播莱姆病中的作用。方法采用布旗法及动物诱捕法在山林地区采集蜱。对蜱种进行鉴定。并进行病原分离培养和PCR检测。结果共收集到1226只蜱，经鉴定属于硬蜱科中2属2种：硬蜱届的全沟硬蜱和血蜱属的长角血蜱。其中以长角血蜱为优势种，构成比占92．58％（1135／1226）；随机对300只长角血蜱进行针对莱姆病螺旋体的PCR．检测，有14只阳性，阳性率为4．67％。并对其余926只蜱进行病原分离培养，未得到莱姆病螺旋体。结论血蜱可能是天津蓟县地区莱姆病传播的主要生物媒介。     

Distribution and prevalence of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks of canton Ticino (Switzerland)

Free-living Ixodes ricinus ticks were collected from 12 different sites of canton Ticino, south of the Alps (Switzerland). Each tick was examined for the presence of Borrelia burgdorferi sensu lato (sl), the etiologic agent of Lyme borreliosis using direct fluorescent antibody assay, and isolation of the bacteria. Borreliae were characterized by PCR followed by RFLP. The abundance and infection rates of I. ricinus ticks varied greatly between the areas. Two localities were found free of Borrelia. The prevalence of infected ticks ranged from 5 to 19%. Most ticks (96%) were found infected by <50 spirochetes. Three B. burgdorferi sl species were successfully isolated: B. garinii dominated, followed by B. lusitaniae and B. valaisiana. Additionally, a mixed infection with B. garinii and B. valaisiana was observed. The distribution of the various Borrelia species in the different areas was heterogeneous. This is the first report of the presence of B. lusitaniae in I. ricinus in Switzerland.     

广西首次分离到莱姆病螺旋体

目的 从广西鼠类的膀胱中分离莱姆病螺旋体。方法 膀胱组织标本接种BSK－Ⅱ培养基进行莱姆病病原分离培养。结果 从广西雅长林场捕获的23只野鼠（8只鼠标本培养污染）中共分离出6株莱姆病螺旋体,分别命名为GXLD－4,8,9,16,18,20,分离阳性率为40％（6／15）。结论 首次从广西莱姆病宿主动物中分离出伯氏螺旋体,证实广西存在莱姆病的流行。     

湘南莽山林区莱姆病疫源地的调查

「目的」证实湘南莽山林区莱姆闰疫源地的存在。「方法」选择莽山林区为调查点,用间接免疫荧光抗体试验（ＩＦＡ）进行人群的血清学检测;用直接免疫荧光抗体试验（ＤＦＡ）和暗视野显微镜观察进行媒介蜱的病原学鉴定。「结果」检测３９５份自然人群的血清,莱姆病感染率为６．３３％,不同职业人群感染率差异无显著性（χ＾２＝２．５２８,Ｐ〉０．０５）;检查蜱２１２只,微小牛蜱为优势种,其中肠带莱姆病螺旋体率为１５％（３／２０）。「结论」可以确定湘南莽山林区存在莱姆病的自然疫源地。     

Tick bite and Lyme borreliosis risk at a recreational site in England

The risk of tick bite and Lyme borreliosis in a forested area in England with public access was studied over a two-year period. Tick infestation levels were high with more than 1000 members of the public reporting for tick removal at a local clinic. Most of the attached ticks were nymphs (82%) and distinct differences in anatomical sites of attachment were observed in children and adults. Children sustained nymphal bites to the head, neck and axilla region much more frequently than adults (48 vs. 10%), whereas adults were bitten on the lower legs more frequently than children (46 vs. 9%). The vegetation was heavily infested with ticks and high numbers were particularly associated with areas used by deer. The average density of nymphs collected from the vegetation was 14.1 per 10 m²(range 5.1–43.6). Infection rates of these nymphs determined by PCR and indirect IFA ranged from 5.2–17.0%, and the genospeciesBorrelia valaisianaand B. gariniiwere detected, suggesting that birds may be important reservoir hosts in this area. It is estimated that, at the level of tick challenge observed here, at least 50 persons per year may be bitten by infected ticks at this site. However, no cases of Lyme borreliosis have been reported through the clinic follow-up procedure, and sera from 19 forest workers were negative for antibody to B. burgdorferisensu lato. Despite the high challenge from tick bites, this particular recreational forest site poses a low risk of infection to the general public, and prophylactic antibiotic treatment or serological testing following a bite is not justified.     

Epidemiological characteristics of dogs with Lyme borreliosis in the province of Soria (Spain)

From the point of view of the human disease, dogs are the most important animal reservoir of Lyme borreliosis; therefore, they are used as sentinel animals. In order to know the epidemiological characteristics of dogs with antibodies against Borrelia burgdorferi, 146 canine sera samples collected during 1993–94 have been studied. The antibody detection was made by an indirect immunofluorescence method and confirmed by a haemagglutination test. Seventeen dogs (11.6%) were seropositive, of which seven were hunting dogs, three were shepherd dogs, five were domestic pets, one was a watchdog and one was a stray dog. Seven dogs had longhair phenotype, 2 medium length type, 4 hard-hair and the other 4 were short-haired. Twelve seropositive dogs were males and five were females. All seropositive dogs were more than 1 year old. The dogs with greater seroprevalence were those that harboured ticks more often than the rest. Spring and summer were the seasons when more ticks were observed. The seroprevalence found in dogs was similar to that previously obtained in humans in this area. This finding gave evidence to an intimate association between human and canine seroprevalence.