Epidemiology of Lyme Disease in a Highly Endemic European Zone

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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Disseminated and chronic Lyme borreliosis in Norway, 1995 – 2004

Eurosurveillance ◽

10.2807/esm.10.10.00568-en ◽

2005 ◽

Vol 10 (10) ◽

pp. 1-2 ◽

Cited By ~ 19

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.

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Scientific rationale for medical and preventive measures improvement in lyme disease endemic areas (based on the data of Udmurt Republic)

Kazan medical journal ◽

10.17816/kmj1961 ◽

2013 ◽

Vol 94 (4) ◽

pp. 517-522

Author(s):

N G Guznischeva ◽

A A Gilmanov ◽

I G Zakirov

Keyword(s):

Lyme Disease ◽

Lyme Borreliosis ◽

Preventive Measures ◽

Erythema Migrans ◽

Tick Bite ◽

Tick Bites ◽

Medical Aid ◽

Udmurt Republic ◽

Endemic Areas ◽

Scientific Rationale

Aim. To provide the scientific rationale for medical and preventive measures improvement in Lyme disease endemic areas. Methods. Epidemiologic and biostatistical analysis of preventive measures holding in Lyme disease endemic areas was performed. Results. A decrease in mean longstanding prevalence of Lyme borreliosis by 31.5% was observed in the Udmurt Republic since 1999 to 2010. The tick-invaded area has increased by 25%, there was an increase in a borrelia-harboring ticks rate by 34.6%. The number of patients seeking medical aid because of the tick bites has increased by 25.4%, which can be attributed to increased social awareness. 62.5% of patients diagnosed with Lyme borreliosis were over 41 years old, the rate of unemployed patients was 61.1%. High prevalence of Lyme borreliosis in peasants living in highly endemic areas (southern part of the Udmurt Republic) related to low medical aid appealability due to tick bites and therefore untimely medical preventive measures, was registered. The prevalence of erythema migrans-free disease has increased 4.3 times. Among the Lyme borreliosis forms associated with erythema migrans, the 1.6 times increase in multiple erythema prevalence was observed, with increase by 24 times in the areas of high disease prevalence. The most severe disease course was observed in patients over 61 years old with erythema migrans-free disease. A single oral dose of doxycycline should be used for disease prevention in all patients seeking medical aid because of the tick bite. Conclusion. The offered preventive algorithm for Lyme disease allowed to prevent the disease development in 99.7% of all cases, the economical efficacy of doxycycline prophylaxis counted on 1 borrelia-harboring tick bite was estimated as 20 400 rubles.

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Clinical and epidemiological features of lyme borreliosis

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2021;9(1):80-86 ◽

2021 ◽

Vol 9 (1) ◽

pp. 80-86

Author(s):

I.V. Lutai ◽

A.S. Ivanova ◽

T.A. Husieva

Keyword(s):

Lyme Disease ◽

Lyme Borreliosis ◽

Clinical Signs ◽

Clinical Manifestations ◽

Multiple Choice Questions ◽

Tick Bites ◽

Working Population ◽

Anonymous Questionnaire ◽

Epidemiological Features ◽

Number Of Patients

Lyme borreliosis (LB) is the most common transmissible disease of tick-borne origin. This disease is a significant medical challenge due to the damage to many organs and systems and the tendency to chronicity and long-term disability in the future. Currently, there is an upward trend in the incidence of Lyme disease in Sumy Oblast. Thus, in Ukraine in 2015 the incidence was 7.96 per 100,000 population, and in 2019 it increased to 10.62. The average level of indicators was exceeded in Kyiv Oblast (29.0), Cherkasy Oblast (25.4), Vinnytsia Oblast (23.09), Sumy (25.89) Oblast, and Kyiv (2.54). The peak of tick activity in Ukraine is registered in May and has increased by 4.23 times. The maximum number of patients falls within the working population and causes significant state financial damage. The increase in the number of cases indicates a spread of Lyme disease in Sumy Oblast. In order to prevent the spread, it is necessary to study all possible causes of this disease and find ways to eliminate them. This was the ground for the creation of a unified anonymous questionnaire, which covers the main issues regarding this disease from the standpoint of different population groups. A unified anonymous "Questionnaire for Lyme disease patients" contains 16 multiple choice questions and an option for comments. The first group of questions concerned gender, age, and social data of respondents (the largest part of patients fell within the working population – 42.86%). The next group of questions clarified the epidemiological features of this pathology (circumstances, date, time, location, body part bitten). Most often tick bites occurred during walks in the urban forests (42.86% of cases). Most respondents reported that tick bites had happened in June and July (39.29%). Other questions were designed to determine patients' awareness about Lyme borreliosis prevention. The next group of questions was aimed at clarifying the clinical features of the disease (lower extremities were the most frequent site of a tick bite) (46.43%), with erythema dominating among the clinical manifestations of Lyme borreliosis (91.07%). According to the anonymous questionnaire, we analyzed and evaluated awareness of diagnosis, clinical signs, and measures of Lyme disease prevention in the patients who were receiving treatment at Municipal Non-Commercial Enterprise of Sumy Regional Council "Medical Clinical Center of Infectious Diseases and Dermatology Named After Z. Krasovytskyi" and SSU University Clinic.

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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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Neurologic Manifestations in Children With Lyme Disease

PEDIATRICS ◽

10.1542/peds.96.6.1053 ◽

1995 ◽

Vol 96 (6) ◽

pp. 1053-1056

Author(s):

Peter M. Bingham ◽

Steven L. Galetta ◽

Balu Athreya ◽

John Sladky

Keyword(s):

Lyme Disease ◽

Erythema Migrans ◽

Clinical Manifestations ◽

Definitive Diagnosis ◽

Neurologic Manifestations ◽

Neurologic Involvement ◽

Wide Range ◽

History Of ◽

Primary Basis ◽

Made In

Objective. Lyme disease (LD) is a tickborne spirochetal infection with a wide range of neurologic and non-neurologic manifestations. The clinical diversity of LD and limitations in serologic diagnosis often make it difficult to document the diagnosis of neurobor-reliosis with certainty. Methods. We reviewed clinical manifestations in 97 seropositive children with particular attention to neurologic manifestafions. Diagnostic criteria used in other case surveys were applied to determine how often a definitive diagnosis of neuroborreliosis could be made in children. Results. Of 69 children who met criteria for LD, 32% (22) had new neurologic signs, 73% (16) of which were accounted for by facial palsy and aseptic meningitis. Five of those with neurologic findings also had erythema migrans (EM), and one had both EM and arthritis. Among those with neurologic involvement, boys outnumbered girls two to one. Neurologic abnormalities resolved spontaneously in five children before their serologic results were known. Conclusion. In our series, only 27% of children with neurologic abnormalities due to LD had a history of EM or arthritis. Seropositivity commonly constituted the primary basis for diagnosis of LD. Despite its nonspecificity, seropositivity for LD in children with neurologic symptoms usually signifies active neuroborreliosis.

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Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19

Russian Clinical Laboratory Diagnostics ◽

10.51620/0869-2084-2021-66-11-689-694 ◽

2021 ◽

Vol 66 (11) ◽

pp. 689-694

Author(s):

A. L. Shutikova ◽

G. N. Leonova ◽

A. F. Popov ◽

M. Yu. Shchelkanov

Keyword(s):

Lyme Disease ◽

Erythema Migrans ◽

Clinical Manifestations ◽

Underlying Disease ◽

Laboratory Diagnostics ◽

Igg Antibodies ◽

Serum Samples ◽

Igm Antibodies ◽

Chronic Encephalitis ◽

Tbev Strain

The coexistence of various pathogens inside the patient’s body is one of the poorly studied and current issues. The aim of the study is to identify the relationship between the indicators of complex laboratory diagnostics and the clinical manifestations of a mixed disease during subsequent infection with the SARS-CoV-2 virus using the example of a case of chronic encephalitis-borreliosis infection. Seven blood serum samples were collected from the patient over the course of a year. For the etiological verification of the causative agents of TBE, Lyme disease and COVID-19, the methods of ELISA and PCR diagnostics were used. The patient was diagnosed with Lyme disease on the basis of the detection of IgG antibodies to Borrelia 5 months after the onset of the disease, since she denied the tick bite. In the clinical picture, there was an articular syndrome and erythema migrans. Later, IgG antibodies to the TBEV were found in the blood. Throughout the study, IgM antibodies to Borrelia were not detected. The exacerbation of Lyme disease could be judged by the clinical manifestations of this disease and by the growth of specific IgG antibodies. A feature of this case was that during an exacerbation of the Lyme disease, an infection with the SARS-CoV-2 virus occurred. Treatment (umifenovir, hydroxychloroquine, azithromycin, ceftriaxone) was prescribed, which improved the condition of the underlying disease, decreased joint pain, decreased IgG levels to borrelia. However, during this period, serological markers of TBEV appear: antigen, IgM antibodies, and the titer of IgG antibodies increases. Most likely, this was facilitated by the switching of the immune system to the SARS-CoV-2 virus, with the simultaneous suppression of borrelia with antibiotics and the appointment of hydroxychloroquine, which has an immunosuppressive effect. Despite the activation of the virus, clinical manifestations of TBE were not observed in the patient, which is most likely associated with infection with a weakly virulent TBEV strain. The further course of tick-borne infections revealed the dominant influence of B. burgdorferi in relation to TBEV. Laboratory studies have shown that suppression of the activity of the borreliosis process by etiotropic treatment subsequently led to the activation of the persistent TBEV.

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Lyme borreliosis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0101_update_002 ◽

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.

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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

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Diagnostic parameters of modified two-tier testing in European patients with early Lyme disease

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-020-03946-0 ◽

2020 ◽

Vol 39 (11) ◽

pp. 2143-2152

Author(s):

ME Baarsma ◽

JFP Schellekens ◽

BC Meijer ◽

AH Brandenburg ◽

T. Souilljee ◽

...

Keyword(s):

General Practice ◽

Lyme Disease ◽

General Population ◽

Lyme Borreliosis ◽

Erythema Migrans ◽

Diagnostic Parameters ◽

Second Tier ◽

Population Controls ◽

Higher Sensitivity ◽

Better Than

Abstract Modified two-tier testing (MTTT) for Lyme borreliosis (i.e. confirmation with an EIA instead of an immunoblot) has been shown to have improved sensitivity compared with standard two-tier testing (STTT) in samples from American patients, without losing specificity. The current study assesses the sensitivity and specificity of various algorithms of MTTT in European patients with erythema migrans (EM) as a model disease for early Lyme borreliosis, and in appropriate controls. Four different immunoassays were used in the first tier, followed by either an immunoblot or the C6-EIA, or were used as standalone single-tier test. These tests were performed on consecutively collected sera of 228 Dutch patients with physician-diagnosed EM in the setting of general practice, 231 controls from the general population, and 50 controls with potentially cross-reactive antibodies. All the variants of MTTT that were studied had significantly higher sensitivity compared with their equivalent STTT, while retaining comparable specificity. Within the MTTT algorithms, classifying equivocal results as positive yielded better diagnostic parameters than classifying equivocal results as negative. The best diagnostic parameters were found using the Enzygnost-2 assay in the first tier, followed by a C6-ELISA in the second tier (sensitivity 77.6%, 95% CI 71.7–82.9; specificity 96.1%, 95% CI 92.7–98.2). This algorithm performed significantly better than the equivalent STTT algorithm in terms of sensitivity (p < 0.001), while maintaining comparable specificity (population controls p = 0.617). Our results show that MTTT can be a useful tool for the serodiagnosis of European patients with early Lyme borreliosis.

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Diagnostic Tools for Borrelia Assessment in Humans

The Open Dermatology Journal ◽

10.2174/1874372201610010062 ◽

2016 ◽

Vol 10 (1) ◽

pp. 62-69 ◽

Cited By ~ 1

Author(s):

Serena Bonin

Keyword(s):

Polymerase Chain Reaction ◽

Lyme Disease ◽

Web Sites ◽

Clinical Manifestations ◽

Review Article ◽

Diagnostic Tools ◽

Chain Reaction ◽

Wide Range ◽

Controversial Topic ◽

Polymerase Chain

Although the etiological agent of Lyme disease has been known since 1980s, diagnosis of Lyme disease is still a controversial topic because of the wide range of clinical manifestations and the limited diagnostic tools available to assessBorreliain humans.The most used diagnostic tool for Lyme disease is currently serology, but also Polymerase chain reaction (PCR) and other methods are often used to proveBorreliainfection in different patients’ specimens. The present article deals with most of the diagnostic tools used in clinical practice for Lyme disease detection in human samples. Direct and indirect specific methods forBorreliainfection detection will be discussed.The most recent peer reviewed publications as well as original results from our study and information provided by companies’ web sites have been analyzed to compile this review article.

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