Lyme-Borreliose: Kutane und neurologische Manifestationen, Falldefinitionen und Therapie

2020 ◽  
Vol 145 (01) ◽  
pp. 19-28
Author(s):  
Cora Scheerer ◽  
Rick Dersch ◽  
Hans-Iko Huppertz ◽  
Heidelore Hofmann
Keyword(s):  
Antibiotic Treatment ◽  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Similar Efficacy ◽  
Lyme Neuroborreliosis ◽  
Beta Lactam ◽  
Case Definitions ◽  
Acrodermatitis Chronica Atrophicans ◽  
Neurologische Manifestationen ◽  
Csf Analysis

AbstractLyme borreliosis is the most common zoonosis in Germany with an incidence of up to 138/100 000. More than 90 % of all cases show dermatological manifestations. Early manifestations are erythema migrans, multiple erythemata migrantia, and (less frequently) borrelial lymphocytoma. A typical late manifestation is acrodermatitis chronica atrophicans. Lyme neuroborreliosis is much less common with an incidence of about 0.8/100 000 inhabitants in Germany. Bannwarth’s syndrome (painful radiculoneuritis) is the most common manifestation of Lyme neuroborreliosis in adults followed by meningitis. International case definitions exist regarding the likelihood of Lyme neuroborreliosis on the basis of diagnostic test results. A CSF analysis should be performed in patients with suspected Lyme neuroborreliosis. The first line treatment for dermatological manifestations of Lyme borreliosis is doxycycline, in children and pregnant women amoxicillin. Doxycycline and beta-lactam antibiotics show similar efficacy regarding neurological symptoms and adverse effects for treatment of neurological manifestations. Treatment duration for early manifestations is 10 to 14 days, in Lyme neuroborreliosis it should not exceed 21 days. All manifestations, also Lyme neuroborreliosis, usually show a favourable prognosis after antibiotic treatment. Antibiotic treatment does not show any efficacy in patients with unspecific symptoms and concurrent positive anti-borrelial serology.

Lyme borreliosis

2013 ◽  
pp. 772-777
Author(s):  
Andreas Krause ◽  
Volker Fingerle
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Lyme Arthritis ◽  
Symptomatic Therapy ◽  
Positive Serology ◽  
Antibiotic Resistant ◽  
Acrodermatitis Chronica Atrophicans ◽  
Rapid Healing ◽  
The Central Nervous System

Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in late manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years or induce a persisting immunopathological response that may cause acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or antibiotic resistant Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.

Lyme borreliosis

2013 ◽  
Author(s):  
Andreas Krause ◽  
Volker Fingerle
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Lyme Arthritis ◽  
Symptomatic Therapy ◽  
Positive Serology ◽  
Antibiotic Resistant ◽  
Acrodermatitis Chronica Atrophicans ◽  
Rapid Healing ◽  
The Central Nervous System

Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in late manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years or induce a persisting immunopathological response that may cause acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or antibiotic resistant Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.

scholarly journals Disseminated and chronic Lyme borreliosis in Norway, 1995 – 2004

2005 ◽  
Vol 10 (10) ◽  
pp. 1-2 ◽  
Author(s):  
K Nygård ◽  
A B Brantsaeter ◽  
R Mehl
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Laboratory Diagnosis ◽  
Incidence Rates ◽  
Tick Bites ◽  
Serological Tests ◽  
Clear Trend ◽  
Acrodermatitis Chronica Atrophicans ◽  
Insect Repellents

Lyme borreliosis is the most common tickborne infection in Norway. All clinical manifestations of Lyme borreliosis other than erythema migrans are notifiable to Folkehelseinstituttet, the Norwegian Institute of Public Health. During the period 1995-2004 a total of 1506 cases of disseminated and chronic Lyme borreliosis were reported. Serological tests were the basis for laboratory diagnosis in almost all cases. The annual numbers of cases showed no clear trend over the period, but varied each year between 120 and 253 cases, with the highest number of cases reported in 2004. Seventy five per cent of cases with information on time of onset were in patients who fell ill during the months of June to October. There was marked geographical variation in reported incidence rates, with the highest rates reported from coastal counties in southern and central Norway. Fifty six per cent of the cases were in males and 44% in females. The highest incidence rate was found in children aged between 5 and 9 years. Neuroborreliosis was the most common clinical manifestation (71%), followed by arthritis/arthralgia (22%) and acrodermatitis chronica atrophicans (5%). Forty six per cent of patients were admitted to hospital. Prevention of borreliosis in Norway relies on measures to prevent tick bites, such as use of protective clothing and insect repellents, and early detection and removal of ticks. Antibiotics are generally not recommended for prophylaxis after tick bites in Norway.

scholarly journals Peptide-Based OspC Enzyme-Linked Immunosorbent Assay for Serodiagnosis of Lyme Borreliosis

1998 ◽  
Vol 36 (12) ◽  
pp. 3474-3479 ◽  
Author(s):  
Marianne J. Mathiesen ◽  
Michael Christiansen ◽  
Klaus Hansen ◽  
Arne Holm ◽  
Eva Åsbrink ◽  
...  
Keyword(s):  
Lyme Borreliosis ◽  
Immunosorbent Assay ◽  
Erythema Migrans ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Amino Acid Residues ◽  
Serum Samples ◽  
Igg Antibody ◽  
Acrodermatitis Chronica Atrophicans ◽  
Increased Sensitivity

Sera from 210 patients with Lyme borreliosis (LB) were studied by an enzyme-linked immunosorbent assay (ELISA) based on a synthetic peptide (pepC10) comprising the C-terminal 10-amino-acid residues of OspC of Borrelia burgdorferi. We found that 36.3 and 45.0% of the serum samples from patients with erythema migrans (EM) and neuroborreliosis (NB), respectively, displayed immunoglobulin M (IgM) anti-pepC10 reactivities, while these samples rarely (≤8%) displayed IgG antibody reactivities. Sera from patients with acrodermatitis chronica atrophicans did not contain anti-pepC10 antibodies. The diagnostic performance of this newly developed peptide ELISA was compared with those of an ELISA based on the full-length recombinant OspC protein (rOspC) and a commercially available ELISA based on theB. burgdorferi flagellum (Fla). The sensitivity of the IgM pepC10 ELISA was slightly lower (P < 0.04) than that of the rOspC ELISA for EM patients (36.3 versus 43.8%), while there was no difference for NB patients (45.0 versus 48.0%). However, the optical density values obtained by the pepC10 ELISA were generally higher than those obtained by the rOspC ELISA, leading to a significantly better quantitative discrimination between seropositive patients with NB and controls (P < 0.008). The specificity of the pepC10 ELISA was similar to those of the rOspC ELISA and the Fla ELISA for relevant controls including patients with syphilis and mononucleosis. Although the overall diagnostic sensitivity of the Fla ELISA was superior, 8.8 and 12.0% of the EM and NB patients, respectively, were antibody positive only by the pepC10 ELISA. Thus, use of a diagnostic test for LB based on the detection of IgM antibodies to pepC10 and Fla has increased sensitivity for the diagnosis of early LB.

scholarly journals Chemokine Signatures in the Skin Disorders of Lyme Borreliosis in Europe: Predominance of CXCL9 and CXCL10 in Erythema Migrans and Acrodermatitis and CXCL13 in Lymphocytoma

2007 ◽  
Vol 75 (9) ◽  
pp. 4621-4628 ◽  
Author(s):  
Robert R. Müllegger ◽  
Terry K. Means ◽  
Junghee J. Shin ◽  
Marshall Lee ◽  
Kathryn L. Jones ◽  
...  
Keyword(s):  
T Cell ◽  
B Cell ◽  
Mrna Expression ◽  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Mrna Levels ◽  
Skin Disorders ◽  
Lesional Skin ◽  
Acrodermatitis Chronica Atrophicans ◽  
Reverse Transcription Pcr

ABSTRACT The three skin disorders of Lyme borreliosis in Europe include erythema migrans, an acute, self-limited lesion; borrelial lymphocytoma, a subacute lesion; and acrodermatitis chronica atrophicans, a chronic lesion. Using quantitative reverse transcription-PCR, we determined mRNA expression of selected chemokines, cytokines, and leukocyte markers in skin samples from 100 patients with erythema migrans, borrelial lymphocytoma, or acrodermatitis chronica atrophicans and from 25 control subjects. Chemokine patterns in lesional skin in each of the three skin disorders included low but significant mRNA levels of the neutrophil chemoattractant CXCL1 and the dendritic cell chemoattractant CCL20 and intermediate levels of the macrophage chemoattractant CCL2. Erythema migrans and particularly acrodermatitis lesions had high mRNA expression of the T-cell-active chemokines CXCL9 and CXCL10 and low levels of the B-cell-active chemokine CXCL13, whereas lymphocytoma lesions had high levels of CXCL13 and lower levels of CXCL9 and CXCL10. This pattern of chemokine expression was consistent with leukocyte marker mRNA in lesional skin. Moreover, using immunohistologic methods, CD3+ T cells and CXCL9 were visualized in erythema migrans and acrodermatitis lesions, and CD20+ B cells and CXCL13 were seen in lymphocytoma lesions. Thus, erythema migrans and acrodermatitis chronica atrophicans have high levels of the T-cell-active chemokines CXCL9 and CXCL10, whereas borrelial lymphocytoma has high levels of the B-cell-active chemokine CXCL13.

Lyme-Borreliose: Serologische und mikrobiologische Diagnostik und Differenzialdiagnostik

2020 ◽  
Vol 145 (01) ◽  
pp. 29-34
Author(s):  
Volker Fingerle ◽  
Andreas Sing
Keyword(s):  
Lyme Borreliosis ◽  
Clinical Symptoms ◽  
Wide Spectrum ◽  
Erythema Migrans ◽  
Dark Field ◽  
Antibody Detection ◽  
Band Spectrum ◽  
Case Definitions ◽  
Detection Rates ◽  
Microbiological Diagnostics

AbstractLyme borreliosis caused by at least six Borrelia burgdorferi species, is the most important tick-borne disease in the northern hemisphere. With a wide spectrum of possible symptoms, the microbiological diagnosis of this disease is associated with a wide variety of ideas, divergent approaches and much uncertainty. The aim of the article is to introduce the treating physicians to a meaningful microbiological diagnostic procedure. Most important messages include that (I) the suspected diagnosis of Lyme borreliosis is first based on anamnestic data and clinical symptoms (compare “case definitions”) which is substantiated by microbiological examinations; (II) microbiological diagnostics – primarily antibody detection, downstream PCR and culture – are only indicated if there are indicative symptoms, with typical erythema migrans not requiring microbiological diagnostics; (III) keep in mind: The more unspecific the symptoms are the lower the positive and the higher the negative predictive value of microbiological testing; (IV) serological diagnosis should follow a two-step procedure: a sensitive ELISA as first step, if reactive followed by immunoblot (IgM and IgG). Detection rates are ca. 50 % in localized, 70– > 90 % in disseminated early and nearly 100 % (only IgG relevant) in late disease; (V) in the immunoblot early forms of disease show a narrow band spectrum, late forms show a broad spectrum; (VI) methods that are not recommended for diagnostic purposes include lymphocyte activation or transformation tests (LTT, MELISA, ELISPOT), PCR or antigen detection from urine or blood, lymphocyte subpopulations, or direct detection of borreliae from patient material using dark field- or focus floating microscopy.

Lyme borreliosis: diagnosis and management

BMJ ◽  
2020 ◽  
pp. m1041 ◽  
Author(s):  
Bart Jan Kullberg ◽  
Hedwig D Vrijmoeth ◽  
Freek van de Schoor ◽  
Joppe W Hovius
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Antimicrobial Treatment ◽  
Post Exposure Prophylaxis ◽  
Acrodermatitis Chronica Atrophicans ◽  
Persistent Symptoms ◽  
Clinical Signs And Symptoms ◽  
Exposure Prophylaxis

Abstract Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

scholarly journals Clinical Features of 705Borrelia burgdorferiSeropositive Patients in an Endemic Area of Northern Italy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Giuseppe Stinco ◽  
Maurizio Ruscio ◽  
Serena Bergamo ◽  
Davide Trotter ◽  
Pasquale Patrone
Keyword(s):  
Borrelia Burgdorferi ◽  
Clinical Features ◽  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Geographic Area ◽  
Borrelia Burgdorferi Sensu Lato ◽  
Neurological Involvement ◽  
Clinical Feature ◽  
Cutaneous Manifestations ◽  
Acrodermatitis Chronica Atrophicans

Background. Lyme Borreliosis is a multisystemic infection caused by spirochetes ofBorrelia burgdorferi sensu latocomplex. The features of Lyme Borreliosis may differ in the various geographical areas, primarily between the manifestations found in America and those found in Europe and Asia.Objective. to describe the clinical features of Lyme Borreliosis in an endemic geographic area such as Friuli-Venezia Giulia in the Northeastern part of Italy.Methods. The medical records of patients resulted seropositive forBorrelia burgdorferihave been retrospectively recorded and analyzed.Results. Seven hundred and five patients met the inclusion criteria, 363 males and 342 females. Erythema migrans was the most common manifestation, detected in 437 patients. Other classical cutaneous manifestations included 58 cases of multiple erythema migrans, 7 lymphadenosis benigna cutis, and 18 acrodermatitis chronica atrophicans. The musculoskeletal system was involved in 511 patients. Four hundred and sixty patients presented a neurological involvement. Flu-like symptoms preceded or accompanied or were the only clinical feature in 119 patients.Comments. The manifestations of Lyme borreliosis recorded in this study are similar to the ones of other endemic areas in Europe, even if there are some peculiar features which are different from those reported in Northern Europe and in the USA.

Lyme borreliosis

2013 ◽  
pp. 772-777
Author(s):  
Andreas Krause ◽  
Volker Fingerle
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Lyme Arthritis ◽  
Symptomatic Therapy ◽  
Positive Serology ◽  
Antibiotic Resistant ◽  
Acrodermatitis Chronica Atrophicans ◽  
Rapid Healing ◽  
The Central Nervous System

Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in disseminated manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years, causing acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or Lyme arthritis. Moreover, the infection may induce a persisting immunopathological response, resulting in ‘antibiotic-resistant’ Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.

scholarly journals Atrophosclerodermic Manifestations of Lyme Borreliosis

2016 ◽  
Vol 10 (1) ◽  
pp. 27-43 ◽  
Author(s):  
Elisabeth Aberer ◽  
Nora Wutte
Keyword(s):  
Antibiotic Treatment ◽  
Lyme Borreliosis ◽  
Polyclonal Antibodies ◽  
Single Case ◽  
Case Reports ◽  
Lichen Sclerosus ◽  
Skin Lesions ◽  
Lichen Sclerosus Et Atrophicus ◽  
Acrodermatitis Chronica Atrophicans ◽  
Chronic Skin

This review summarizes the literature on scleratrophic skin lesions as a manifestation of aBorreliainfection. An association of morphea with Lyme borreliosis was mainly reported from Middle-European Countries, Japan and South America.B. afzeliihas been identified predominantly from the chronic skin lesions of acrodermatitis chronica atrophicans (ACA) and has been cultivated from morphea lesions in isolated cases. Scleratrophic skin lesions like morphea, lichen sclerosus et atrophicus (LSA) and anetoderma have been observed in coexistence with ACA. Since all these diseases show clinical and histological similarities, they might have a common origin. The laboratory results that point to a borrelial origin of these diseases, however, are contradictory. Antibodies againstB. burgdorferiwere detected in up to 50% of patients.BorreliaDNA was shown in up to 33% of morphea and 50% of LSA patients.Borreliawere visualized on histological slides by polyclonal antibodies in up to 69% of morphea and 63% of LSA patients. In other reports no evidence ofBorrelia– associated morphea or LSA has been reported. For anetoderma, single case reports showed positiveBorreliaserology and/or PCR and a response to antibiotic treatment. The response of scleratrophic skin lesions to antibiotic treatment varies and can be seen in patients with or without a proven association to aBorreliainfection. This suggests that scleratrophic diseases might be of heterogeneous origin, but aBorreliainfection could be one cause of these dermatoses.

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