scholarly journals Lyme Disease among Patients at an Ambulatory Unit in a Highly Endemic Country: Lithuania

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 184
Author(s):  
Agnė Petrulionienė ◽  
Daiva Radzišauskienė ◽  
Algimantas Paulauskas ◽  
Algirdas Venalis
Keyword(s):  
Lyme Disease ◽  
Clinical Symptoms ◽  
Erythema Migrans ◽  
Sensu Stricto ◽  
Lyme Arthritis ◽  
Middle Aged ◽  
Female Ratio ◽  
Lyme Carditis ◽  
Nervus Facialis ◽  
Vilnius University

Background and objectives: Lyme disease is the most common tick-borne infectious disease in Europe, caused by the spirocheta bacteria of Borrelia burgdorferi. Several genospecies of B. burgdorferi are pathogenic to humans. B. burgdorferi sensu stricto, which is prevalent in North America, causes reactive arthritis, whereas B. garinii and B. afzelii, common in Europe, can affect the skin, heart, or nervous system; it has been shown that the clinical symptoms of the disease may be very different. The objective of this study was to identify the baseline characteristics of Lyme disease and to elucidate the frequency of different Lyme disease syndromes in Lithuania. Materials and Methods: Patients who were diagnosed with Lyme disease during an ambulatory visit to the Center of Infectious Diseases, Vilnius University Santaros clinics, from 2014 to 2016, were enrolled in this study. A retrospective material analysis was conducted. Results: In total, 1005 patients were enrolled with the following prevalence of clinical syndromes: erythema migrans (EM), 945 (94.02%); Lyme arthritis, 32 (3.18%); neuroborreliosis, 23 (2.28%); Lyme carditis, 4 (0.39%); and acrodermatitis, 1 (0.09%). Erythema migrans was dominant among middle-aged women, with a rash appearing mainly on the lower extremities. Lyme arthritis mainly manifested among middle-aged women as an oligoarthritis, mostly affecting the knee joint. Neuroborreliosis was seen more often in middle-aged women than men and the main symptom was nervus facialis neuropathy. Lyme carditis, manifested as an atrioventricular block, with a male/female ratio of 3:1, and the median age was 51. Acrodermatitis was diagnosed in a 61-year-old woman, as a painful, red rash on the hand. Conclusions: According to the prevalence of B. garinii and B. afzelii in Europe, previously it was thought that Lyme disease presented as erythema migrans, and less frequently as neuroborreliosis; however, this study revealed that other syndromes may also be seen. In addition, we revealed that the longer it takes for erythema migrans to appear, the greater the likelihood of Lyme arthritis developing.

scholarly journals 17 Lyme Disease in Eastern Ontario - A Paediatric Centre’s Experience from 2009-2018

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e6-e7
Author(s):  
Stephanie Zahradnik ◽  
Nick Barrowman ◽  
Anne Tsampalieros ◽  
Mary-Ann Harrison ◽  
Jennifer Bowes ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Laboratory Data ◽  
Geographic Location ◽  
Retrospective Chart Review ◽  
Lyme Arthritis ◽  
Annual Number ◽  
Eastern Region ◽  
Local Public Health ◽  
Inpatient Ward ◽  
Lyme Carditis

Abstract Background Lyme disease (LD) is caused by the tick-borne bacterium Borrelia burgdorferi. Over the past ten years, robust local public health data indicates that the incidence of LD has increased significantly in the eastern region of Ontario due to the spread of its vector, the blacklegged tick. As a result, we have seen an increase in the number of cases of LD in children at our tertiary paediatric centre, at all stages of infection. Familiarity with Lyme disease is important as incidence increases. We sought to characterize the cases at our centre. Objectives To describe the epidemiology of LD in children at our centre from 2009-2018, as well as the variety of clinical presentations of paediatric LD. Design/Methods We completed a retrospective chart review from 2009-2018 of all cases admitted or seen in the Infectious Disease (ID) clinic or the Emergency Department (ED) with a diagnosis of LD. Demographic, clinical and laboratory data were collected, including geographic location where infection occurred and resource utilization. We used descriptive statistics to describe cases and comparative statistics to determine changes in number of cases over time. Results There were 171 LD cases managed at our centre during this period. Mean age was 7.4 (SD 4.5) years, 89 (52.0%) were male. The annual number of cases from 2009 - 2018 increased from 1 to 44 and peaked in 2017 (47 cases). The highest number of cases occurred among children <6, the lowest in children ≥11. Most cases occurred in summer (60%), with the fewest in winter months (4%). Stage of LD was not documented in 1 case. Of the remainder, 98 (57.6%) cases were early localized, 41 (25.7%) early disseminated and 31 (19.7%) late disseminated LD. Early and late disseminated cases occurred more commonly in the summer and accounted for the majority of admissions. These included neurologic Lyme (lymphocytic meningitis [2, 1.2%], polyneuropathy [1, 0.6%], cranial nerve palsy [13, 7.6%]), Lyme carditis (5, 2.9%), and Lyme arthritis (29, 17.0%). There were 133 (77.8%) patients managed in ED, 66 (38.6%) in the ID clinic and 17 (9.9%) in the inpatient ward; median length of stay was 6 (IQR 5, 9) days, with a range of 1 to 30 days. The most common geographic locations of infection acquisition were Ottawa (120 cases, 71.0%) and Kingston (26, 15.4%). Conclusion Cases of LD managed at our paediatric centre have increased in keeping with population trends, with all LD stages experienced. Severe cases of meningitis, carditis, and arthritis resulted in hospitalization, with increasing numbers over the study period.

scholarly journals Seasonality of Acute Lyme Disease in Children

2021 ◽  
Vol 6 (4) ◽  
pp. 196
Author(s):  
Kathryn M. Sundheim ◽  
Michael N. Levas ◽  
Fran Balamuth ◽  
Amy D. Thompson ◽  
Desiree N. Neville ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Regression Models ◽  
Disease Incidence ◽  
Erythema Migrans ◽  
The United States ◽  
Lyme Arthritis ◽  
Cranial Neuropathy ◽  
Acute Arthritis ◽  
Presenting Symptoms ◽  
Fourier Regression

Due to the life cycle of its vector, Lyme disease has known seasonal variation. However, investigations focused on children have been limited. Our objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States. We enrolled children presenting to one of eight Pedi Lyme Net participating emergency departments. Cases were classified based on presenting symptoms: early (single erythema migrans (EM) lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis). We defined a case of Lyme disease by the presence of an EM lesion or a positive two-tier Lyme disease serology. To measure seasonal variability, we estimated Fourier regression models to capture cyclical patterns in Lyme disease incidence. While most children with early or early-disseminated Lyme disease presented during the summer months, children with Lyme arthritis presented throughout the year. Clinicians should consider Lyme disease when evaluating children with acute arthritis throughout the year.

scholarly journals Lyme disease: New knowledge regarding its physiopathology, diagnosis, therapy and prevention

2002 ◽  
Vol 55 (5-6) ◽  
pp. 207-212
Author(s):  
Jovan Vukadinov ◽  
Sinisa Sevic ◽  
Grozdana Canak ◽  
Nadezda Madle-Samardzija ◽  
Vesna Turkulov ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Antigenic Variation ◽  
Clinical Symptoms ◽  
Epidemiological Studies ◽  
Lyme Arthritis ◽  
Major Protein ◽  
Selective Treatment ◽  
Multisystem Disease ◽  
New Guidelines

Introduction Lyme disease is a tick-borne disease caused by a spirochete Borrelia burgdorferi, which manifests as a multisystem disease of the skin nervous system, heart and joints. Recently it is the most common vector-borne disease in Yugoslavia. New epidemiological studies New epidemiological studies revealed that ticks can occasionally be infected not only by Borrelia burgdorferi, but also by some other microbes that can cause diseases in humans. Recently discovered the variable major protein-like sequence, antigenic variation of B. burgdorferi B 31 partly explains the ability of this organism to evade an active immune response. A key role in development of clinical symptoms associated with lyme disease belongs to the connection with ability of B. burgdorferi to induce and activate metallopeptidases and fibrinolytic enzymes, leading to extracellular matrix destruction. Diagnosis and treatment Diagnosis of Lyme borreliosis is made on the basis of clinical picture, exposure to ticks in endemic areas and serologic confirmation. It seems that polymerase chain reaction has little role in detection of B. burgdorferi in urine, blood, and spinal fluid samples, but it is most useful in evaluating the effectiveness of antibiotic therapy of Lyme arthritis. Infectious Diseases Society of America had prepared new guidelines for selective treatment of Lyme disease. Vaccination is still the best way of prevention for people living in high-risk areas.

scholarly journals Geographical and genospecies distribution of Borrelia burgdorferi sensu lato DNA detected in humans in the USA

2014 ◽  
Vol 63 (5) ◽  
pp. 674-684 ◽  
Author(s):  
Kerry L. Clark ◽  
Brian F. Leydet ◽  
Clifford Threlkeld
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Skin Biopsy ◽  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Skin Lesions ◽  
Sensu Stricto ◽  
Borrelia Burgdorferi Sensu Lato ◽  
Southern States ◽  
The Usa

The present study investigated the cause of illness in human patients primarily in the southern USA with suspected Lyme disease based on erythema migrans-like skin lesions and/or symptoms consistent with early localized or late disseminated Lyme borreliosis. The study also included some patients from other states throughout the USA. Several PCR assays specific for either members of the genus Borrelia or only for Lyme group Borrelia spp. (Borrelia burgdorferi sensu lato), and DNA sequence analysis, were used to identify Borrelia spp. DNA in blood and skin biopsy samples from human patients. B. burgdorferi sensu lato DNA was found in both blood and skin biopsy samples from patients residing in the southern states and elsewhere in the USA, but no evidence of DNA from other Borrelia spp. was detected. Based on phylogenetic analysis of partial flagellin (flaB) gene sequences, strains that clustered separately with B. burgdorferi sensu stricto, Borrelia americana or Borrelia andersonii were associated with Lyme disease-like signs and symptoms in patients from the southern states, as well as from some other areas of the country. Strains most similar to B. burgdorferi sensu stricto and B. americana were found most commonly and appeared to be widely distributed among patients residing throughout the USA. The study findings suggest that human cases of Lyme disease in the southern USA may be more common than previously recognized and may also be caused by more than one species of B. burgdorferi sensu lato. This study provides further evidence that B. burgdorferi sensu stricto is not the only species associated with signs and/or symptoms consistent with Lyme borreliosis in the USA.

scholarly journals Lyme Carditis in Hospitalized Children and Adults, a Case Series

2021 ◽  
Author(s):  
Richard V Shen ◽  
Carol A McCarthy ◽  
Robert P Smith
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Early Recognition ◽  
Erythema Migrans ◽  
Case Series ◽  
Outpatient Setting ◽  
Temporary Pacing ◽  
Lyme Carditis ◽  
Viral Illness ◽  
History Presentation

Abstract Background Lyme carditis is an uncommon manifestation of Lyme disease. This report compares Lyme carditis presentation, management, and outcomes in pediatric and adult populations. Methods Charts of pediatric and adult patients with heart block (PR >300ms) and positive Lyme serologies hospitalized in Portland, Maine between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described. Results Ten children and 20 adults were admitted for Lyme carditis between June and October. Ninety percent were male, and 87% had no prior cardiac history. Seventeen had outpatient evaluation prior to admission. Of these, a minority (41%) had Lyme disease suspected in the outpatient setting, and fewer (12%) were initiated on Lyme disease treatment. The most common alternate diagnoses were viral illness and erythema multiforme. More children than adults had disseminated erythema migrans and fever. First-degree heart block was more prevalent in children, and Mobitz type 2 heart block was more prevalent in adults. Ten patients presented with syncope. Proportionately more adults needed temporary pacing. Children had shorter antibiotic durations compared to adults. Of the 30 cases, twenty-seven had improved heart block, while 3 adults required a pacemaker at discharge. Nine children and 14 adults were discharged with a PR 200-300ms. There was a single death in this series. Conclusion Cases tended to be younger males. Most patients had some heart block on discharge. Of patients evaluated as outpatients, Lyme disease was suspected in 41%. Improved early recognition and treatment of Lyme disease may decrease Lyme carditis.

scholarly journals Enzyme-Linked Immunosorbent Assay Using Recombinant OspC and the Internal 14-kDa Flagellin Fragment for Serodiagnosis of Early Lyme Disease

1998 ◽  
Vol 36 (4) ◽  
pp. 857-861 ◽  
Author(s):  
Sebastian Rauer ◽  
Nicole Spohn ◽  
Christiane Rasiah ◽  
Uwe Neubert ◽  
Arnold Vogt
Keyword(s):  
Lyme Disease ◽  
Immunosorbent Assay ◽  
Erythema Migrans ◽  
Cell Extract ◽  
Sensu Stricto ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Epstein Barr Virus Infection ◽  
Serum Samples ◽  
Antigen Elisa

The outer surface protein C (OspC) and the internal 14-kDa flagellin fragment of strain GeHo of Borrelia burgdorferisensu stricto were expressed as recombinant proteins inEscherichia coli and were purified for use in an immunoglobulin M (IgM) enzyme-linked immunosorbent assay (OspC–14-kDa antigen ELISA). No hint at disturbing protein-protein interferences, which might influence the availability of immunoreactive epitopes, was found when the recombinant antigens were combined in the ELISA. The recombinant OspC–14-kDa antigen ELISA was compared to a commercial IgM ELISA that used a detergent cell extract from Borrelia afzelii PKo as the antigen. According to the manufacturer’s information, the cell extract contains, in addition to other antigens, the following diagnostically relevant antigens: the 100-kDa (synonyms, 93- and 83-kDa antigens), 41-kDa, OspA, OspC, and 17-kDa antigens. The specificity was adjusted to 95% on the basis of data for 154 healthy controls. On testing of 104 serum samples from patients with erythema migrans (EM), the sensitivity of the recombinant ELISA (46%) for IgM antibodies was similar to that of the commercial ELISA (45%). However, when 42 serum samples from patients with polyclonal B-cell stimulation due to an Epstein-Barr virus infection were tested, false-positive reactions were significantly less frequent in the recombinant ELISA (10%) than in the whole-cell-extract ELISA (23%). OspC displays sequence heterogeneity of up to 40% according to the genomospecies. However, when the reactions of serum specimens from controls and EM patients with OspC from representative strains of B. burgdorferi sensu stricto (strain GeHo) and B. afzelii (strain PKo) were compared in an ELISA, almost no differences in specificity and sensitivity were seen. This demonstrates that the sera predominantly recognize the common epitopes of OspC tested in this study. In conclusion, we suggest that the OspC–14-kDa antigens ELISA is a suitable test for the detection of an IgM response in early Lyme disease.

scholarly journals 134. A Comparison of Lyme Carditis in Children and Adults, a Case Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S95-S95
Author(s):  
Richard V Shen ◽  
Carol A McCarthy ◽  
Robert P Smith
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Erythema Migrans ◽  
Case Series ◽  
Adult Patients ◽  
Male Predominance ◽  
Temporary Pacing ◽  
Lyme Carditis ◽  
Viral Illness ◽  
History Presentation

Abstract Background Lyme disease is a common entity in Maine, and Lyme carditis is an uncommon manifestation of this disease. This case series describes and compares the presentation, management, and outcomes of Lyme carditis in pediatric and adult populations. Methods Charts of pediatric and adult patients with heart block and positive Lyme serologies hospitalized in Portland, Maine between January 2010 and December 2018 were analyzed. Data on medical history, presentation, treatment, and outcomes are described. Results Ten children (range 7–17, mean 12.4 years) and 20 adults (range 22–81, mean 41.4 years) were admitted for Lyme carditis in the examined period. All cases presented between June and October. Twenty-seven (90%) were male, and 26 (87%) had no prior cardiac history. Of the adults, 1 (5%) reported using cocaine, 4 (20%) opioids, and 6 (30%) marijuana. Seventeen (57%) had outpatient evaluation prior to admission. Ten patients (59%) were not recognized as having Lyme disease. One case suspected to have Lyme was not initially treated with doxycycline. The most common alternative diagnoses were a viral illness and erythema multiforme. No coinfections were noted. Proportionately more children than adults had disseminated erythema migrans (40% vs. 20%) and fever (60% vs. 35%). First degree heart block was more prevalent in children (40%), and Mobitz type 2 heart block was more prevalent in adults (55%). Ten patients (30%) presented with syncope. More adults than children needed temporary pacing, 9 (45%) vs. 2 (20%). Children had shorter antibiotic durations compared with adults (mean 19.8 days vs. 23.6 days) Twenty-seven (90%) had improved heart block. Three adult patients (10%) required a pacemaker following hospitalization. Nine (90%) children and 14 (70%) adults were discharged with a PR 200-300ms. There was a single death in this series, which occurred after discharge to another state. Conclusion Cases tended to be in younger patients with male predominance. Most patients still had some degree of heart block on discharge. The majority of patients were evaluated prior to hospitalization but Lyme disease was suspected in only 41%. Improved recognition of early Lyme disease and more prompt treatment may lead to decreased complications of Lyme carditis. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of Selected Borrelia burgdorferi lp54 Plasmid-Encoded Gene Products Expressed during Mammalian Infection as Antigens To Improve Serodiagnostic Testing for Early Lyme Disease

2015 ◽  
Vol 22 (11) ◽  
pp. 1176-1186 ◽  
Author(s):  
Zachary P. Weiner ◽  
Rebecca M. Crew ◽  
Kevin S. Brandt ◽  
Amy J. Ullmann ◽  
Martin E. Schriefer ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Recombinant Proteins ◽  
Erythema Migrans ◽  
Disease Patient ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
Early Stages ◽  
Lyme Carditis ◽  
Mammalian Infection

ABSTRACTLaboratory testing for the diagnosis of Lyme disease is performed primarily by serologic assays and is accurate for detection beyond the acute stage of the infection. Serodiagnostic assays to detect the early stages of infection, however, are limited in their sensitivity, and improvement is warranted. We analyzed a series ofBorrelia burgdorferiproteins known to be induced within feeding ticks and/or during mammalian infection for their utility as serodiagnostic markers against a comprehensive panel of Lyme disease patient serum samples. The antigens were assayed for IgM and IgG reactivity in line immunoblots and separately by enzyme-linked immunosorbent assay (ELISA), with a focus on reactivity against early Lyme disease with erythema migrans (EM), early disseminated Lyme neuroborreliosis, and early Lyme carditis patient serum samples. By IgM immunoblotting, we found that recombinant proteins BBA65, BBA70, and BBA73 reacted with early Lyme EM samples at levels comparable to those of the OspC antigen used in the current IgM blotting criteria. Additionally, these proteins reacted with serum samples from patients with early neuroborreliosis and early carditis, suggesting value in detecting early stages of this disease progression. We also found serological reactivity against recombinant proteins BBA69 and BBA73 with early-Lyme-disease samples using IgG immunoblotting and ELISA. Significantly, some samples that had been scored negative by the Centers for Disease Control and Prevention-recommended 2-tiered testing algorithm demonstrated positive reactivity to one or more of the antigens by IgM/IgG immunoblot and ELISA. These results suggest that incorporating additionalin vivo-expressed antigens into the current IgM/IgG immunoblotting tier in a recombinant protein platform assay may improve the performance of early-Lyme-disease serologic testing.

scholarly journals Four Clones of Borrelia burgdorferiSensu Stricto Cause Invasive Infection in Humans

1999 ◽  
Vol 67 (7) ◽  
pp. 3518-3524 ◽  
Author(s):  
Gerald Seinost ◽  
Daniel E. Dykhuizen ◽  
Raymond J. Dattwyler ◽  
William T. Golde ◽  
John J. Dunn ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Outer Surface ◽  
Systemic Disease ◽  
Erythema Migrans ◽  
Surface Protein ◽  
Sensu Stricto ◽  
Tick Bite ◽  
Invasive Infection ◽  
Frequency Distributions ◽  
Outer Surface Protein

ABSTRACT Lyme disease begins at the site of a tick bite, producing a primary infection with spread of the organism to secondary sites occurring early in the course of infection. A major outer surface protein expressed by the spirochete early in infection is outer surface protein C (OspC). In Borrelia burgdorferi sensu stricto, OspC is highly variable. Based on sequence divergence, alleles ofospC can be divided into 21 major groups. To assess whether strain differences defined by ospC group are linked to invasiveness and pathogenicity, we compared the frequency distributions of major ospC groups from ticks, from the primary erythema migrans skin lesion, and from secondary sites, principally from blood and spinal fluid. The frequency distribution of ospC groups from ticks is significantly different from that from primary sites, which in turn is significantly different from that from secondary sites. The major groups A, B, I, and K had higher frequencies in the primary sites than in ticks and were the only groups found in secondary sites. We define three categories of major ospC groups: one that is common in ticks but very rarely if ever causes human disease, a second that causes only local infection at the tick bite site, and a third that causes systemic disease. The finding that all systemicB. burgdorferi sensu stricto infections are associated with four ospC groups has importance in the diagnosis, treatment, and prevention of Lyme disease.

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