Lyme-Borreliose

Lyme borreliosis is a multisystem infectious disease affecting mainly the skin, nervous system, joints and heart. It is caused by spirochetes of the Borrelia burgdorferi sensu lato complex which are transmitted by ticks. The diagnosis of Lyme borreliosis is based primarily on typical clinical symptoms and signs with serological confirmation. Antibiotic therapy is beneficial for all manifestations and treatment refractory cases are rare. The diagnosis “chronic Lyme borreliosis” is increasingly being misused for all conceivable medically unexplained symptoms.     

Lyme disease: An update

Lyme disease is a multisystem illness caused by the spirochete Borrelia burgdorferi, and it is the most common vector-borne illness in the United States. Lyme disease is also endemic in Europe and Asia. There have been major advances in the field since the disease was first described, including the sequencing of the B. burgdorferi genome; an increase in understanding of the interactions among the spirochete, the tick, and the mammalian host; new and improved laboratory tests; and a vaccine for prevention of the disease. Still, the diagnosis of Lyme disease remains based on history and clinical findings, supplemented by careful use of laboratory tests, and requires that the physician be familiar with the disease’s clinical manifestations and the shortcomings of the available diagnostic tests.     

Hepatic disorders related to Lyme disease. Study of two cases and a review of the literature

We report two cases of Lyme disease, revealed by hepatic damage in a 71- and a 59-year old man. In the first case, the disease was revealed by febrile jaundice whereas, in the second case, results of liver tests showed cytolytic and cholestatic abnormalities with fever. Lyme disease is a zoonosis due to infection by Borrelia burdorferi transmitted by ticks. The multiple phases of the disease explain the polymorphism of the clinical manifestations. Usually, extrahepatic symptoms are first observed, including neurological tropisms of Borrelia burdorferi. On the contrary, hepatic impairment due to Lyme disease is rare, often asymptomatic and with biological manifestations only.     

Lyme Disease: A Review

Lyme disease is the most common vector-borne illness in the United States and is also endemic in Europe and Asia. It is caused by the spirochete Borrelia burgdorferi and transmitted by the bite of the Ixodes (deer) tick. It occurs most frequently during spring and summer and may involve the skin, nervous system, heart, and joints. This article reviews the pathogenesis, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of Lyme disease.     

Infection with Borrelia burgdorferi Increases the Replication and Dissemination of Coinfecting Powassan Virus in Ixodes scapularis Ticks

Powassan virus (POWV) is a tick-borne neuroinvasive flavivirus endemic to North America. It is generally transmitted by the tick, Ixodes scapularis. This species also transmits Borrelia burgdorferi, the causative agent of Lyme disease. Infection with B. burgdorferi can result in arthritis, carditis, and neuroborreliosis. These pathogens experience sylvatic overlap. To determine the risk of human exposure to coinfected ticks, the interactions between POWV and B. burgdorferi are assessed in laboratory-infected I. scapularis. Adult male and female I. scapularis ticks are orally inoculated with either both pathogens, POWV only, B. burgdorferi only, or uninfected media. After twenty-one days, the ticks are dissected, and RNA is extracted from their midguts and salivary glands. In infected midguts, the quantity of POWV in coinfected ticks was elevated compared to those with only POWV. In addition, the salivary glands of ticks with infected midguts had increased POWV dissemination to those with only POWV. RNA sequencing is performed to identify the potential mechanism for this pattern, which varies between the organs. Ixodes scapularis ticks are found to be capable of harboring both POWV and B. burgdorferi with a benefit to POWV replication and dissemination.     

THE VALUE OF SEROLOGICAL TESTING FOR LYME DISEASE IN THE UK

Although the prevalence of Lyme disease (LD) in the UK is low,patients with clinical presentations compatible with the conditionare common. Arthritis often complicates LD in North America,however it is a very rare complication of the condition in theUK. Many patients seen at St George's Hospital, London havevisited endemic areas for LD within the UK, Europe and NorthAmerica. To determine the value of serological testing for LDin the UK, we prospectively studied 120 patients seen at thishospital with clinical manifestations suggestive of LD (12 ofwhom were recruited to the LD clinic from outside the hospitalcatchment area), regardless of whether an alternative diagnosisseemed likely. A history of tick bite was obtained and serumantibodies to Borrelia burgdorferi detected initially by enzyme-linkedimmunosorbent assay (ELISA) and reactive samples immunoblottedto further assess antibody specificity. Tick bites were reportedby 22 patients, 16 of whom were bitten in endemic areas forLD. A further 11 patients had exposure to tick habitats in endemicareas, but were unaware of a tick bite. Raised antibody levelswere detected by ELISA in 14 individuals (seven of whom hada history of tick bite or tick exposure in an endemic area);however, only four of these had specific antibodies to B. burgdorfericonfirmed on immunoblot. All of these four had a history oftick bite in an endemic area, all had arthritis and in threeof the four, this was the only manifestation of the condition.These data indicate that (1) serological testing for LD is onlyof value in patients with a history of exposure to tick habitatsin an endemic area, (2) ELISA is a useful screening test, althoughit lacks specificity and reactive specimens should always befurther examined by immunoblot and (3) in some patients in theUK, arthritis may be the sole manifestation of Lyme diseaseand a high degree of diagnostic awareness is therefore requiredto recognize these cases. KEY WORDS: Lyme disease, Borrelia burgdorferi, Antibodies, Arthritis     

An enzootic transmission cycle of Lyme borreliosis spirochetes in the southeastern United States

Lyme borreliosis, or Lyme disease (LD), is a tick-borne zoonotic infection of biomedical significance, caused by Borrelia burgdorferi sensu lato (s.l.) spirochetes and transmitted by Ixodes species ticks. It usually circulates among wildlife vertebrate reservoirs and vector ticks but may infect humans, causing multisystem problems. In far western and northern North America, the host reservoirs, tick vectors, and genospecies of Borrelia are well known but not so in the southern U.S., where there is controversy as to the presence of "true" LD. Here we report the presence of the LD spirochete B. burgdorferi sensu stricto (s.s.) and Borrelia bissettii, three main reservoir hosts, and two enzootic tick vectors in the southeastern U.S. The two enzootic tick vectors, Ixodes affinis and Ixodes minor, rarely bite humans but are more important than the human biting "bridge" vector, Ixodes scapularis, in maintaining the enzootic spirochete cycle in nature. We also report extraordinary longevities and infections in the reservoir rodents Peromyscus gossypinus, Sigmodon hispidus, and Neotoma floridana.     

莱姆病治疗进展

莱姆病是一种由伯氏疏螺旋体所引起的,以硬蜱为主要传播媒介的自然疫源性疾病。对莱姆病的治疗主要是早期使用抗生素。莱姆病是一种全身性慢性传染病,临床表现复杂多样,侵犯多系统多器官引起损伤,根据其病程发展可分为早中晚三期,而针对不同分期、不同表现及不同发病人群的莱姆病其治疗方法又各不相同,本文将对此进行详细综述。     

Laboratory Biosafety: Sentinel surveillance of Lyme disease risk in Canada, 2019: Results from the first year of the Canadian Lyme Sentinel Network (CaLSeN)

BackgroundLyme disease is an emerging vector-borne zoonotic disease of increasing public health importance in Canada. As part of its mandate, the Canadian Lyme Disease Research Network (CLyDRN) launched a pan-Canadian sentinel surveillance initiative, the Canadian Lyme Sentinel Network (CaLSeN), in 2019.ObjectivesTo create a standardized, national sentinel surveillance network providing a real-time portrait of the evolving environmental risk of Lyme disease in each province.MethodsA multicriteria decision analysis (MCDA) approach was used in the selection of sentinel regions. Within each sentinel region, a systematic drag sampling protocol was performed in selected sampling sites. Ticks collected during these active surveillance visits were identified to species, and Ixodes spp. ticks were tested for infection with Borrelia burgdorferi, Borrelia miyamotoi, Anaplasma phagocytophilum, Babesia microti and Powassan virus.ResultsIn 2019, a total of 567 Ixodes spp. ticks (I. scapularis [n=550]; I. pacificus [n=10]; and I. angustus [n=7]) were collected in seven provinces: British Columbia, Manitoba, Ontario, Québec, New Brunswick, Nova Scotia and Prince Edward Island. The highest mean tick densities (nymphs/100 m²) were found in sentinel regions of Lunenburg (0.45), Montréal (0.43) and Granby (0.38). Overall, the Borrelia burgdorferi prevalence in ticks was 25.2% (0%–45.0%). One I. angustus nymph from British Columbia was positive for Babesia microti, a first for the province. The deer tick lineage of Powassan virus was detected in one adult I. scapularis in Nova Scotia.ConclusionCaLSeN provides the first coordinated national active surveillance initiative for tick-borne disease in Canada. Through multidisciplinary collaborations between experts in each province, the pilot year was successful in establishing a baseline for Lyme disease risk across the country, allowing future trends to be detected and studied.     

Lyme-Borreliose

Lyme borreliosis is a multi-system infectious disease that primarily affects the skin, nervous system, heart, and joints. It is caused by the tick-borne spirochete Borrelia burgdorferi sensu lato. Diagnosis is made on the basis of clinical symptoms and supported by a positive serology. Antibiotic therapy should be started immediately after the diagnosis has been established and is administered according to stage and symptoms of the disease. Doxycycline, amoxicillin, and ceftriaxone are the antibiotics of choice. Early Lyme disease is almost always cured by one antibiotic course that also prevents subsequent disease manifestations. After antibiotic therapy of late disease manifestations, symptoms resolve only slowly and remission is usually achieved after weeks or even months. Chronic or therapy-resistant disease courses and residual symptoms after therapy are rare.     

Borrelia infection in Ixodes pararicinus ticks (Acari: Ixodidae) from northwestern Argentina

The aim of this work was to describe for the first time the presence of Borrelia burgdorferi sensu lato infecting ticks in Argentina. Unfed specimens of Ixodes pararicinus collected from vegetation in Jujuy Province were tested for Borrelia infection by PCR targeting the gene flagellin (fla), the rrfA-rrlB intergenic spacer region (IGS) and the 16S rDNA (rrs) gene. One male and one female of I. pararicinus collected in Jujuy were found to be positive to Borrelia infection with the three molecular markers tested. Phylogenetically, the Borrelia found in I. pararicinus from Jujuy belongs to the B. burgdorferi s.l complex, and it was similar to one of the genospecies detected in I. aragaoi from Uruguay. Also, this genospecies is closely related to two genospecies known from USA, Borrelia americana and the Borrelia sp. genospecies 1. The epidemiological risk that implies the infection with Borrelia in I. paracinus ticks from Argentina appears to be low because the genospecies detected is not suspected of having clinical relevance and there are no records of Ixodes ticks biting humans in the southern cone of South America. Further studies are needed to assess accurately if there is risk of borreliosis transmitted by ticks in South America.     

Survival of Borrelia burgdorferi in antibiotically treated patients with lyme borreliosis

Summary The persistence ofBorrelia burgdorferi in patients treated with antibiotics is described. The diagnosis of Lyme disease is based on clinical symptoms, epidemiology and specific IgG and IgM antibody titers toB. burgdorferi in serum. Antibiotic therapy may abrogate the antibody response to the infection as shown in our patients.B. burgdorferi may persist as shown by positive culture in MKP-medium; patients may have subclinical or clinical disease without diagnostic antibody titers toB. burgdorferi. We conclude that early stage of the disease as well as chronic Lyme disease with persistence ofB. burgdorferi after antibiotic therapy cannot be excluded when the serum is negative for antibodies againstB. burgdorferi.

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Persistenz der Borrelia burgdorferi bei negativer Serologie und Behandlung mit Antibiotika

Zusammenfassung Es wird über die Persistenz vonBorrelia burgdorferi bei sechs Patienten berichtet. Nach dem Zecken- bzw. Insektenstich und Erythema migrans konnteB. burgdorferi noch Wochen nach der Antibiotikatherapie nachgewiesen werden. Serologische Befunde waren außer bei einem Patienten negativ. Diese Ergebnisse bestätigen unsere früheren Beobachtungen und sprechen dafür, dß die Antibiotikabehandlung die Antikörperbildung gegenB. burgdorferi beeinflussen kann. Ferner zeigen diese Ergebnisse und Beobachtungen, daß nicht nur im Frühstadium der Lyme Borreliose, sondern auch in chronischen Stadien bzw. bei Persistenz des Erregers der Nachweis von Antikörpern negativ bleiben kann.

     

Lyme borreliosis: A neglected zoonosis in Egypt

Borrelia burgdorferi, the causal organism of Lyme borreliosis. In Egypt, available data about the occurrence of Lyme disease are scarce and no structured studies documented the presence of Lyme borreliosis in Egyptian animals and tick reservoirs verifying its zoonotic evidence. Besides, no successful trials to isolate B. burgdorferi from clinical samples have occurred. This study was conducted to investigate B. burgdorferi infection as an emerging zoonosis neglected in Egypt. A total number of 92 animals, tick and human companion specimens were collected and subjected for culture, PCR and/or serodetection. B. burgdorferi has been detected and isolated from Egyptian animal breeds. We also detected the presence of outer surface protein A gene of B. burgdorferi by PCR as well as anti-B. burgdorferi IgM by ELISA in human contacts who were suffering from fever of unknown origin. This report represents the first systematic study on animals associated with patients suffering from febrile illness to confirm the emerging of such neglected zoonosis in Egypt.     

Meteorological Influences on the Seasonality of Lyme Disease in the United States

Lyme disease (Borrelia burgdorferi infection) is the most common vector-transmitted disease in the United States. The majority of human Lyme disease (LD) cases occur in the summer months, but the timing of the peak occurrence varies geographically and from year to year. We calculated the beginning, peak, end, and duration of the main LD season in 12 highly endemic states from 1992 to 2007 and then examined the association between the timing of these seasonal variables and several meteorological variables. An earlier beginning to the LD season was positively associated with higher cumulative growing degree days through Week 20, lower cumulative precipitation, a lower saturation deficit, and proximity to the Atlantic coast. The timing of the peak and duration of the LD season were also associated with cumulative growing degree days, saturation deficit, and cumulative precipitation, but no meteorological predictors adequately explained the timing of the end of the LD season.     

Lyme disease in children

Lyme borreliosis is a multisystem disorder caused by Borrelia burgdorferi and transmitted by ticks in the northern hemisphere. The disease is common in children. In addition to frequently recognized manifestations such as erythema migrans, neuroborreliosis, and Lyme arthritis, rarer manifestations, including eye and ear disease, are increasingly understood. Clinical diagnosis is supported by serologic confirmation. Improvement of laboratory methodology, especially polymerase chain reaction-based tests, is continuing. Actual treatment recommendations based on controlled studies reflect expanding scientific knowledge. In the United States, license of a vaccine to prevent infection in children is awaited. Lyme borreliosis is an intriguing human example of bacterial persistence in the presence of the host immune system. Chronic Lyme arthritis is a model of chronic arthritis resembling forms of arthritis of unknown cause, such as rheumatoid arthritis and juvenile idiopathic arthritis.     

Seronegative Lyme arthritis caused by Borrelia garinii

A case of a female patient suffering from Lyme arthritis (LA) without elevated antibody levels to Borrelia burgdorferi sensu lato is reported. Seronegative Lyme arthritis was diagnosed based on the classic clinical manifestations and DNA-detected Borrelia garinii in blood and synovial fluid of the patient, after all other possible causes of the disease had been ruled out. The disease was resistant to the first treatment with antibacterial agents. Six months after the therapy, arthritis still persisted and DNA of Borrelia garinii was repeatedly detected in the synovial fluid and the tissue of the patient. At the same time, antigens or parts of spirochaetes were detected by electron microscopy in the synovial fluid, the tissue and the blood of the patient. The patient was then repeatedly treated by antibiotics and synovectomy has been performed. Received: 28 August 2001 / Accepted: 1 January 2002     

Genetic diversity of Borrelia burgdorferi sensu lato in Ixodes ricinus ticks collected in north-west Poland

Borrelia burgdorferi sensu lato (s. l.), the etiological agent of Lyme diesease, is transmitted by the bite of Ixodes ricinus. During May and September 1999, field surveys on Lyme disease spirochetes were conducted in three locations of a region of north-west Poland, known as recreational districts visited by many people. The ticks Ixodes ricinus were collected in natural habitats by dragging a flanel cloth over the vegetation. Sex and developmental stage of each tick were determined. Based on a polymerase chain reaction test with primers that recognize a chromosomal gene of all strains, out of the total 1414 specimens collected, 126 (8.9%) were found to be infected. The species B. burgdorferi s. l. comprises at least three pathogenic genomospecies, B. burgdorferi sensu stricto (s. s.), Borrelia garinii, and Borerelia afzelii, witch could be distinguished in nested-PCR tests with species-specific primers. B. burgdorferi s. s. was most prevalent (96% of infected ticks), followed by B. garinii (1.3%), and B. afzelii. was not found. Of the infected ticks, over the 99% were infected with a single species, one specimens was infected with two species. For 4 ticks, the infecting species could not be identied. The difference in rates of prevalence was observed among the tree locations (17%--5.3%--3.2%).     

Lyme disease.

Lyme disease (LD) is the most common tick-borne disease in the United States. The overall trend has been an average annual increase in reported cases since surveillance was initiated by the Centers for Disease Control and Prevention in 1982. Ixodes ticks often carry more than one potential pathogen, and co-infection with Borrelia burgdorferi and other organisms has been reported. The impact of dual infection upon the clinical course of LD is not known. Further studies of erythema migrans-like rashes in the Southern United States have indicated that it is likely caused by a related spirochetal organism. Case reports of unusual presentations have broadened our understanding of the clinical spectrum of LD. Studies in patients with chronic Lyme arthritis have indicated that an autoimmune process may be responsible for such cases. Results of two large, placebo-controlled trials of a recombinant Lyme vaccine have been reported and results indicate that the vaccine is safe and effective in preventing LD in adults.     

Sinus Pause in Association with Lyme Carditis

Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement of the atrioventricular node. On rare occasions, Lyme carditis patients present with other conduction system disorders such as bundle branch block, intraventricular conduction delay, and supraventricular or ventricular tachycardia. We report the unusual case of a 59-year-old man who presented with new-onset symptomatic sinus pauses one month after hiking in upstate New York. To our knowledge, this is the first case report from North America that describes the relationship between symptomatic sinus pause and Lyme carditis.     

Lyme disease

Lyme disease (LD) is the most common tick-borne disease in the US. The overall trend has been an average annual increase in cases since surveillance was initiated by the Centers for Disease Control and Prevention in 1982. To date, 10 different Borrelia species have been described within the Borrelia burgdorferi sensu lato complex, although only Borrelia burgdorferi sensu strico, Borrelia garinii, and Borrelia afzelii have been associated with human disease. Ixodes ticks often carry more than one potential pathogen, and co-infection with B. burgdorferi and other organisms have been reported. Recent findings suggested that maintenance cycles of other tick-borne pathogens may be different than those for B. burgdorferi. A better understanding of the pathogenesis of Lyme arthritis has provided clues about the mechanisms responsible for variation in clinical expression of the disease. Results of therapeutic trials in Lyme neuroborreliosis are likely to have an impact upon treatment recommendations. A long term follow-up study of children treated for LD indicated that the prognosis is excellent in most cases. A safe vaccine for the prevention of LD has been approved in adults. Preliminary data suggested that the vaccine is safe and immunogenic in children.