Disseminated and chronic Lyme borreliosis in Norway, 1995 – 2004

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.

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Lyme borreliosis

10.1093/med/9780199642489.003.0101 ◽

2013 ◽

Cited By ~ 1

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.

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Epidemiology of Lyme Disease in a Highly Endemic European Zone

Medicina ◽

10.3390/medicina56030115 ◽

2020 ◽

Vol 56 (3) ◽

pp. 115 ◽

Cited By ~ 3

Author(s):

Agnė Petrulionienė ◽

Daiva Radzišauskienė ◽

Arvydas Ambrozaitis ◽

Saulius Čaplinskas ◽

Algimantas Paulauskas ◽

...

Keyword(s):

Lyme Disease ◽

Lyme Borreliosis ◽

Erythema Migrans ◽

Geographical Area ◽

Clinical Manifestations ◽

Communicable Diseases ◽

Urban Residents ◽

Tick Bites ◽

Wide Range ◽

Baseline Characteristics

Background and objective: Lyme disease, also known as Lyme borreliosis (LB), is a tick-borne infectious disease caused by the spirochete bacteria Borrelia. The risk of infection depends on the geographical area, ecological factors, and human behavior. Clinical manifestations of Lyme borreliosis have a wide range, but the most frequent clinical symptom, which is also a diagnostic symptom, is a skin rash called erythema migrans (EM). The disease is very common worldwide. In Lithuania, the disease frequency is 99.9 cases per 100,000 population (Centre for Communicable Diseases and AIDS, Lithuania, 2017). The main aim of this study was to obtain the baseline characteristics of the disease regarding the infected Lithuanian population. Materials and Methods: We analyzed data from the Centre for Communicable Diseases and AIDS about all Lyme disease (A69.2) diagnosed patients over a three-year period (from 2014 to 2016) in Lithuania. Results: In 2014–2016, 7424 (crude incidence rate 85.4) cases with LB were diagnosed in Lithuania. Most of them (4633 (62.4%)) were identified in women. Older people were more likely to suffer from LB. Urban residents were 2.6 times more often affected that those living in villages. Tick bites were primarily observed in high season months, from May to September (90%), with the highest peak in July. There was a higher number of observed tick bites (p = 0.003) in the urban residents. Erythema migrans occurred in 75.6% LB cases, while other symptoms did not exceed a quarter of all LB cases. There were 7353 (99.6%) cases where LB was confirmed via clinical symptoms and/or laboratory tests. Also, 1720 (23.2%) patients were tested for LB immunoglobulins. Conclusions: This study found a high incidence of Lyme disease in Lithuania. We elucidated the baseline characteristics regarding the infected Lithuanian population which may ease medical clinicians’ work on new Lyme diagnoses.

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Lyme borreliosis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0101_update_003 ◽

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.

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Lyme borreliosis (Lyme disease): molecular and cellular pathobiology and prospects for prevention, diagnosis and treatment

Expert Reviews in Molecular Medicine ◽

10.1017/s1462399404007276 ◽

2004 ◽

Vol 6 (2) ◽

pp. 1-22 ◽

Cited By ~ 8

Author(s):

Paul G. Auwaerter ◽

John Aucott ◽

J. Stephen Dumler

Keyword(s):

Lyme Borreliosis ◽

Clinical Presentation ◽

Tissue Injury ◽

Erythema Migrans ◽

Clinical Manifestations ◽

Systemic Infection ◽

Ecological Risks ◽

Tick Bites ◽

Active Infection ◽

Immunological Reactions

Lyme borreliosis is a systemic infection caused by the spirochaete Borrelia burgdorferi, which is transmitted by tick bites and maintained in a delicately balanced ecological cycle. Recent increases in the population densities of tick hosts, the abundance of ticks and the proximity of man to natural tick habitats have led to an escalating worldwide incidence of Lyme borreliosis, and nonspecific clinical manifestations have yielded significant misunderstanding of the disease. After entry, B. burgdorferi activates local inflammation, yet evades host defences and facilitates dissemination by potentially masquerading with host components such as plasmin and complement. The extent of tissue injury is determined by the aggressiveness of host inflammation and immunological reactions, as well as by genetic attributes of the spirochaete. The clinical presentation can be highly varied, including early manifestations that are limited to erythema migrans and ranging to disseminated infection with arthritis, carditis, cranial nerve palsy, peripheral neuropathy, meningitis, or other manifestations. Diagnostic tests have improved, but are unhelpful during certain stages of infection. Therapy varies depending on the degree of involvement, and recovery is usually rapid and complete. Post-treatment clinical manifestations in the absence of evidence for active infection are still poorly understood. The understanding of how B. burgdorferi survives in the environment and interacts with human and mammalian hosts has improved. However, further advances in prevention and therapy depend on continued investigation of the ecological risks and improved understanding of the pathobiology of this obligate bacterial parasite.

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Lyme borreliosis

10.1093/med/9780199642489.003.0101_update_001 ◽

2016 ◽

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.

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Surveillance of Lyme borreliosis in Germany, 2002 and 2003

Eurosurveillance ◽

10.2807/esm.10.04.00531-en ◽

2005 ◽

Vol 10 (4) ◽

pp. 5-6 ◽

Cited By ~ 22

Author(s):

W H Mehnert ◽

G Krause

Keyword(s):

Lyme Borreliosis ◽

Erythema Migrans ◽

Clinical Manifestations ◽

Risk Of Infection ◽

Notifiable Disease ◽

German States ◽

Serious Infection ◽

East German ◽

Vector Borne ◽

Made In

Lyme borreliosis is a potentially serious infection common in Germany, but little data about its incidence, distribution, and clinical manifestations are available. Lyme borreliosis is not a notifiable disease in Germany, but six of Germany’s 16 states – Berlin, Brandenburg, Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt and Thüringen, have enhanced notification systems, which do include Lyme borreliosis. The efforts made in these states to monitor confirmed cases through notification are therefore an important contribution to understanding the epidemiology of Lyme borreliosis in Germany. This report summarises the analysis of Lyme borreliosis cases submitted to the Robert Koch-Institut during 2002-2003. The average incidence of Lyme borreliosis of the six East German states was 17.8 cases per 100 000 population in 2002 and increased by 31% to 23.3 cases in 2003, respectively. Patient ages were bimodally distributed, with incidence peaks among children aged 5- 9 and elderly patients, aged 60- 64 in 2002, and 65- 69 in 2003. For both years, 55% of patients were female. Around 86% of notified cases occurred from May to October. Erythema migrans affected 2697 patients (89.3%) in 2002 and 3442 (86.7%) in 2003. For a vector-borne disease, like Lyme borreliosis, the risk of infection depends on the degree and duration of contact between humans and ticks harbouring Borrelia burgdorferi. As infectious ticks probably occur throughout Germany, it is likely that the situation in the remaining 10 German states is similar to that of the states in this study.

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

Journal of Clinical Microbiology ◽

10.1128/jcm.36.12.3474-3479.1998 ◽

1998 ◽

Vol 36 (12) ◽

pp. 3474-3479 ◽

Cited By ~ 43

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.

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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

Infection and Immunity ◽

10.1128/iai.00263-07 ◽

2007 ◽

Vol 75 (9) ◽

pp. 4621-4628 ◽

Cited By ~ 43

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.

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FRI0442 APPROPRIATE USE OF SEROLOGY TESTS FOR THE DIAGNOSIS OF LYME DISEASE. EXPERIENCE IN AN URBAN AREA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6586 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 819.2-819

Author(s):

D. Lobo Prat ◽

L. Sainz Comas ◽

V. Pomar ◽

A. M. Millán Arciniegas ◽

H. Park ◽

...

Keyword(s):

Lyme Disease ◽

Urban Area ◽

Rural Areas ◽

Erythema Migrans ◽

Clinical Manifestations ◽

Serological Tests ◽

Potential Exposure ◽

North East ◽

History Of ◽

Serology Test

Background:Lyme disease (LD) is a multisystemic animal-borne disease caused by spirochetes of theBorrelia burgdorferi s.lcomplex and transmitted by ticks of the speciesIxodes ricinus. In Spain, most cases occur in rural areas of the north-east region with a peak of maximum incidence between spring and early autumn. The diagnosis is based on a history of potential exposure to ticks, the recognition of characteristic clinical manifestations and serological testing.Objectives:To assess the suitability of serological study for the diagnosis of LD in an urban area.Methods:Retrospective observational study that included all LD serology tests made between April 2017 and September 2019 at a tertiary hospital in Barcelona covering a population of 450,000 people. Demographic data and the medical department that requested the serology test were collected along with serology test results. The medical records of patients with positive serology were consulted to identify which patients were finally diagnosed with LD along with their clinical manifestations, treatment and outcome.Results:A total of 574 serological tests were included and 78 (13.59%) of them were positive. Only 1.04% (6) of all serological tests belonged to patients finally diagnosed with LD. The department that made most requests was Neurology (37.3%) followed by Infectious Diseases (21%), Internal Medicine (14.5%), Emergency Medicine (4.7%), Dermatology (4.5%), Critical Care Medicine (2.3%) and Rheumatology (2.1%). 50% of the diagnosed patients were women with a mean age of 57.7±7.7DE years. In 50% of diagnosed cases, patients remembered a tick bite during activities in the mountain or rural areas. The most common clinical manifestations were erythema migrans (67%), non-inflammatory arthralgias (50%), fatigue and malaise (67%), together with one case of meningoencephalitis and one of knee monoarthritis. All diagnosed patients received antibiotic treatment with ceftriaxone (33%) or doxycycline (66%). Only one patient presented post-Lyme syndrome.The serological test for LD in our center had a total individual cost of 15.75 eur, so the cost of the 574 requests was 9,040.5 eur. 7,812 eur corresponded to negative results and 1,134 eur to false positive results.Conclusion:Our study indicates the overuse of diagnostic testing for LD with implications for patient care and cost-effective health management. In the absence of a history of potential exposure to infected vector ticks or characteristic clinical manifestations, unnecessary microbiological tests should not be performed.Disclosure of Interests:David Lobo Prat: None declared, Luís Sainz Comas: None declared, Virginia Pomar: None declared, Ana Milena Millán Arciniegas: None declared, HyeSang Park: None declared, Andrea García-Guillén: None declared, Sicylle Jeria: None declared, Ana Laiz: None declared, Berta Magallares: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Patricia Moya: None declared, Cesar Díaz-Torné: None declared, Susana P. Fernandez-Sanchez: None declared, Hector Corominas: None declared

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