Lyme disease: why the controversy?

Some Australians have become convinced of the existence of locally acquired Lyme disease (LD). The history of LD, since its recognition in the early 1970s, is reviewed as a model for investigative approaches to unknown syndromes. Australian Management Guidelines for LD include the requirement for diagnostic testing by National Association of Testing Authorities‐accredited laboratories using Therapeutic Goods Administration‐licensed tests, which result in the efficient diagnosis of LD in overseas travellers. Despite this, patients who have not left Australia pay many thousands of dollars for non‐specialist consultations and testing at overseas laboratories. Unproven long‐term therapy with multiple antibiotics has resulted in serious complications, including allergies, line sepsis, pancreatitis and pseudomembranous colitis. Studies have shown that LD vectors are not found in Australia, and Lyme Borrelia has not been found in Australian vectors, animals or patients with autochthonous illnesses. I propose that (i) A non‐controversial name for the chronic syndrome should be adopted, ‘Australian Multisystem Disorder’. (ii) Research funding should enable the development of a consensus case definition and studies of the epidemiology of this syndrome with laboratory investigations to identify an aetiology and surrogate markers of disease. Prospective, randomised treatment studies could then be undertaken using ethical protocols.     

Diagnosis not to be missed: Lyme carditis,rare but reversible cause of complete atrioventricular block

Lyme carditis is a known cause of atrioventricular block and in most cases, atrioventricular block is reversible with appropriate antibiotic treatment. The diagnosis can be challenging if the disease is either not suspected, or if the initial cutaneous manifestation of erythema migrans is missed. It is important to diagnose Lyme carditis as the cause of complete heart block if unnecessary pacemaker implantation is to be avoided. We present a 43-year-old male who presented with complete heart block and also illsustained ventricular tachycardia due to Lyme carditis that reversed completely with antibiotic therapy.     

Seroprevalencia de enfermedad de Lyme en el suroccidente de Asturias

IntroductionTo correctly interpret the serological markers of Lyme disease, it is very important to determine the region's infection rate. The aim of this study was to ascertain the prevalence of specific antibodies against Borrelia burgdorferi in a rural district in northern Spain.MethodsThe presence of IgG antibodies against B. burgdorferi was determined by qualitative enzyme immunoassay in the serum of 1,432 people divided into 3 groups: 316 blood donors, 432 individuals who attended the hospital without infection and 684 for whom Lyme serology testing was specifically requested as part of a differential diagnosis. In the latter group, the presence or absence of an occupational risk factor was recorded.ResultsAntibodies against B. burgdorferi were detected in 189 individuals (13.2%): 16 (5.1%) in the blood donors group, 62 (14.4%) in subjects who attended hospital without infection and 111 (16.2%) in subjects in whom a differential diagnosis of Lyme disease was requested (p < 0.0001). In subjects with an occupational risk factor, the prevalence was 23.5%, peaking at 45.8% in men over 65 years.ConclusionOur study showed a high prevalence of antibodies against B. burgdorferi and higher than that seen in other areas with similar characteristics in Spain. However, our results are similar to those published from other European regions. The prevalence in the blood donors group was lower than that observed in the other groups. Older age, the male gender and occupational risks were associated with a higher prevalence of Lyme disease.     

以急性脑膜炎为首发症状的莱姆病：附一例报告

为加强对莱姆病的认识，报道１例以急性脑膜炎为首发症状、经血清学检测（ＥＬＩＳＡ及Ｗｅｓｔｅｒｎｂｌｏｔｉｎｇ两种方法）证实为神经莱姆病的诊治经过。表明北京地区有莱姆病存在。如发现淋巴细胞增多性脑膜炎而原因不明时，神经莱姆病应作为鉴别诊断之一，及时送检血清及脑脊液莱姆病的抗体检测将有助于诊断。     

Enfermedad de Lyme

Lyme disease (LD) is a worldwide-distributed multisystemic process caused by Borrelia burgdorferi sensu lato (s.l.) and transmitted by hard ticks. In fact, it is the most common tick-borne infectious disease in the northern hemisphere. In Spain it is transmitted by Ixodes ricinus ticks and Borrelia garinii is the genoespecies of B. burgdorferi s.l. mostly involved in our area. LD is known as “the last great imitator” due to the broad clinical spectrum that may cause. Except in the case of erythema migrans (pathognomonic feature of the disease), the remaining clinical manifestations should be confirmed using microbiological tests.This review is intended to provide readers a current vision of the etiology, epidemiology, clinical manifestations, laboratory diagnosis and treatment of Lyme disease in our environment. Controversial aspects arising from the use of non-validated microbiological tests that are being used without scientific rigor are highlighted.     

Is It Possible to Make a Correct Diagnosis of Lyme Disease on Symptoms Alone? Review of Key Issues and Public Health Implications

There is much confusion and misinformation about the diagnosis of Lyme disease, as well as its treatment. This review explains why one cannot make a correct diagnosis of Lyme disease based on symptoms alone. It also provides evidence to support the validity of two-tier testing for the laboratory diagnosis of Lyme disease. The public health consequences of failing to consider these issues are discussed.     

Diagnosis and Treatment of Lyme Carditis: JACC Review Topic of the Week

The incidence of Lyme disease, a tick-borne bacterial infection, is dramatically increasing in North America. The diagnosis of Lyme carditis (LC), an early disseminated manifestation of Lyme disease, has important implications for patient management and preventing further extracutaneous complications. High-degree atrioventricular block is the most common presentation of LC, and usually resolves with antibiotic therapy. A systematic approach to the diagnosis of LC in patients with high-degree atrioventricular block will facilitate the identification of this usually transient condition, thus preventing unnecessary implantation of permanent pacemakers in otherwise healthy young individuals.     

中国6省莱姆病螺旋体主要宿主动物鼠的初步调查

目的了解中国吉林、山西、甘肃、青海、贵州、湖南6省林区莱姆病螺旋体宿主动物鼠的感染情况。方法在每个省各选取两个采样点进行捕鼠,采用病原分离培养和巢式PCR方法对野鼠的脾脏、肾脏和膀胱进行了病原学检测。并通过基因测序方法确定基因型。结果从贵州黑线姬鼠中分离到了2株莱姆病螺旋体;从5省(贵州未检测到)野鼠的脾脏和/或肾脏中检查到了莱姆病螺旋体的特异片段,其中青海黄南(28.85%)和湖南石门(19.6%)两地标本的PCR阳性率较高,各地区阳性率的差异有统计学意义。通过序列同源性分析确定吉林、青海、甘肃和山西的基因型均为Borrelia garinii。湖南的基因型为Borreliavalaisiana。结论本次调查表明各地宿主动物鼠的感染状况不同,各地应根据具体情况进一步扩大调查以明确当地的主要宿主动物种类及携带病原体情况。     

晋城市山林地区莱姆病感染状况调查

目的 了解晋城市林区莱姆病的感染、流行及发病情况.方法 在晋城市所辖5县(市)山林地区进行调查,对有蜱叮咬史或局部皮肤损害等症状的人群采集血液标本,用间接免疫荧光抗体试验进行人群莱姆病血清抗体特异性检测,结合流行病学和临床表现了解莱姆病感染情况.结果 共调查608人,对有蜱叮咬史或局部皮肤损害等症状的113人进行流行病...     

结节病病人血清抗布氏疏螺旋体抗体测定及其意义

用酶联免疫检测法（ＥＬＩＳＡ）测定４０例患者血清抗布氏疏螺旋体（ＢｏｒｒｅｌｉａＢｕｒｇｄｏｒｆｅｒｉ，简称ＢＢ）抗体水平，其中结节病２３例，非结节病１７例。结节病病人血清抗ＢＢ抗体阳性１８例，占７８．３％，非结节病病人阳性１３例，占７６．５％。初步认为结节病可能是一种自身免疫异常疾病，血清抗ＢＢ抗体可能是机体对某种不明抗原刺激所产生的一种自体抗体，与风湿病、结核病、肿瘤和莱姆病可能存在着交叉反应；但是否有另外一种可能：即ＢＢ抗原本身是一种混合物，不同疾病中的不同抗体与ＢＢ抗原中的不同组分起反应？因此，ＢＢ抗体不能作为诊断结节病的特异性指标。     

Respiratory modulation of cardiac vagal tone in Lyme disease

AIM: To conduct the first systematic test of the hypothesis that modulation of cardiac vagal tone is impaired in Lyme disease.METHODS: The response of cardiac vagal tone to respiratory modulation was measured in 18 serologically positive Lyme disease patients and in 18 controls.RESULTS: The two groups were matched in respect of age,sex,body mass,mean arterial blood pressure,mean resting heart rate and mean resting cardiac vagal tone. The mean maximum cardiac vagal tone during deep breathing in the Lyme disease patients [11.2(standard error 1.3)] was lower than in the matched controls [16.5(standard error 1.7); P = 0.02].CONCLUSION: Respiratory modulation of cardiac vagal tone is impaired in Lyme disease,which suggests that Lyme disease may directly affect the vagus nerve or the brainstem.