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Background:
Lyme Borreliosis is a multisystemic infection caused by spirochetes of Borrelia burgdorferi sensu lato complex. 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 B...
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Lyme borreliosis is caused by Borrelia burgdorferi sensu lato infection, which responds well to antibiotic therapy in the overwhelming majority of cases. However, despite adequate antibiotic treatment some patients report persisting symptoms which are commonly summarised as post-treatment Lyme disease syndrome (PTLDS). In 2005, the Swiss Society of...
Lyme disease is a highly prevalent tick-borne infection caused by Borrelia burgdorferi spirochetes in North America and Eurasia. Diagnosis of the early disease remains difficult with the currently approved serological tests in the absence of noticeable tick bite or erythema migrans due to presentation of non-specific symptoms and the absence of ant...
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...
Introduction
Lyme borreliosis (LB) is the most common vector disease in temperate countries of the northern hemisphere. It is caused by Borrelia burgdorferi sensu lato complex.
Methods
To study the case presentation of LB in France, we contacted about 700 physicians every year between 2003 and 2011. An anonymous questionnaire was established allow...
In Lyme borreliosis, the skin is the key site for bacterial inoculation by the infected tick and for cutaneous manifestations. We previously showed that different strains of Borrelia burgdorferi sensu stricto isolated from tick and from different clinical stages of the Lyme borreliosis (erythema migrans, and acrodermatitis chronica atrophicans) eli...
Citations
... Ранняя локализованная стадия может сопровождаться развитием следующих дерматологических феноменов: 1) мигрирующей эритемы Афцелиуса -Липшютца (МЭ), выявляемой у 50-85% пациентов [5][6][7]; 2) доброкачественного лимфаденоза кожи (ДЛК) (лимфоцитомы), в дебюте возникает в 1-2% случаев [8][9][10]; 3) еще более редким первичным проявлением ИКБ является ДЛК в сочетании с МЭ, последняя развивается вокруг ДЛК (в среднем через 14-56 дней после присасывания клеща) [11]. Как видно из приведенной статистики, при ранней локализованной стадии ИКБ наиболее частым дерматологическим феноменом является МЭ. ...
В статье представлены данные литературных источников, которые посвящены этиологии, эпидемиологии, дерматологическим феноменам, лечению и профилактике иксодового клещевого боррелиоза (ИКБ). Актуальность данной инфекции обусловлена рядом факторов: повсеместностью распространения ИКБ, ежегодным ростом инфицированности клещей боррелиями, изменением продолжительности периода активности клещей и, наконец, наличием диагностических ошибок при ранних и более поздних стадиях заболевания, допускаемых дерматологами на поликлиническом приеме.
The literature review describes etiology, epidemiology, dermatological phenomena, treatment and prevention of ixodic tick-borne borreliosis (ITBB). The significance of ITBB is determined by its ubiquity, by the annual increase of infected ticks with Borrelia, by changes in the duration of the period of activity of ticks and,finally, by the presence of diagnostic errors in the early and later stages of the disease, made by dermatologists at outpatient visits.
... It has been hypothesized that symptoms may vary geographically, and also according to the specific Borrelia genospecies causing the infection, although EM is recognized as the predominant manifestation of LB in childhood [30][31][32][33][34]. Indeed, most LB cases in our study were associated with EM, which is consistent with data from the Italian endemic region of Friuli Venezia Giulia [35]. Based on history and clinical examination, we confirmed a diagnosis of early LB in 57% of the presumptive EM cases. ...
Tracing the profile of pediatric Lyme borreliosis (LB) in Europe is difficult due to the interregional variation in its incidence and lack in notifications. Moreover, the identification of LB can be challenging. This study is an 18-year case series of 130 children and adolescents aged under 18 years referred to the Pediatric Infectious Diseases Unit at L. Sacco Hospital, Milan, with suspicion of LB, between January 2005 and July 2023. The routine serological workup consisted of a two-step process: an initial screening test followed by Western blot (WB). Forty-four (34%) patients were diagnosed with LB. The median age was six years, and 45% were females. Of the children with erythema migrans (EM), 33 (57%) were confirmed as having true EM, and, of these, 4 (12%) were atypical. Ten (23%) patients had early disseminated/late diseases, including facial nerve palsy (n = 3), early neuroborreliosis (n = 1), arthritis (n = 3), relapsing fever (n = 2), and borrelial lymphocytoma (n = 1). No asymptomatic infections were documented. Over seventy percent of confirmed LB cases (n = 31/44) recalled a history of tick bites; in this latter group, 19 (61%) were from the area of the Po River valley in Lombardy. Almost half of the children evaluated for LB complained of non-specific symptoms (fatigue, musculoskeletal pain, skin lesions/rash, and persistent headache), but these symptoms were observed in only two patients with confirmed LB. Most LB cases in our study were associated with EM; two-tier testing specificity was high, but we found frequent non-adherence to international recommendations with regard to the timing of serology, application of the two-step algorithm, and antibiotic over-prescription. Most children were initially assessed for a tick bite or a skin lesion suggestive of EM by a family pediatrician, highlighting the importance of improving awareness and knowledge around LB management at the primary healthcare level. Finally, the strengthening of LB surveillance at the national and European levels is necessary.
... Borrelia DNA positivity was significantly associated with PCL among different entities: marginal zone 7.3%, follicular 8.1%, diffuse large B-cell 7.5%, mycosis fungoides 8%. The presence of Borrelia in PCL had been previously detected in studies from endemic areas, such as Austria, Scotland and north-eastern Italy [75][76][77]. In the literature, 6 out of 11 cases of PCL treated with antibiotics responded, while five did not. ...
... The incidence of LB has increased in recent decades in several western European countries, together with evidence of a geographical expansion of the disease into previously non-endemic areas (Wilking et al., 2014;Vandenesch et al., 2014;Hofhuis et al., 2015;Cairns et al., 2019;Vandekerckhove et al., 2019). In Italy, after the first case described by Crovato et al. (1985), numerous LB cases have been reported exclusively in northern and central regions where the I. ricinus vector is present (Bianchi et al., 1990;Cimmino et al., 1992;Frediani et al., 1993;Gaddoni et al., 1998;Ciceroni et al., 1998;Santino et al., 2000;Pavan, 2009;Nazzi et al., 2010;Pistone et al., 2010;Esposito et al., 2013;Stinco et al., 2014;Rimoldi et al., 2020). Several entomologic studies show that the ticks of these mountain and dune areas are infected by B. afzelii, B. garinii, B. burgdorferi sensu stricto, B. valaisiana and B. lusitaniae (Mantelli et al., 2006;Nazzi et al., 2010;Capelli et al., 2012;Beltrame et al., 2018;Martello et al., 2019;Garcia-Vozmediano et al., 2020). ...
We investigated the epidemiology, clinical manifestations, laboratory data and antibiotic treatment of Lyme borreliosis in the province of Verona, Northern Italy, during the period 2015 - 2019. One hundred and 29 cases of Lyme borreliosis were diagnosed in a single hospital representing 27% of all cases reported in the Veneto region in the same period. The mean annual incidence of Lyme borreliosis was 0.992/100,000 inhabitants. A peak incidence of 2/100,000 inhabitants was observed in 2018. Early localized Lyme borreliosis was the most common presentation (74%), followed by early disseminated Lyme borreliosis (21%). One possible early Lyme neuroborreliosis and two cranial neuropathies were diagnosed. IgM and/or IgG borrelia antibodies were positive in 90% of the cases. This significant increase of Lyme borreliosis incidence in the province of Verona highlights the need to increase knowledge on its epidemiology and clinical manifestation among both the general population and clinicians to allow early diagnosis and treatment.
... Lyme hastalığında en yaygın izlenen semptom EM'dir [20] . İtalya'da yapılan 705 hastayı kapsayan bir çalışmada, %65.2 oranında çeşitli nörolojik semptomlar, %61.9 oranında EM, %16.9 oranında grip benzeri semptomlar, %10.1 oranında göz bulguları izlenmiştir [20] . ...
... Lyme hastalığında en yaygın izlenen semptom EM'dir [20] . İtalya'da yapılan 705 hastayı kapsayan bir çalışmada, %65.2 oranında çeşitli nörolojik semptomlar, %61.9 oranında EM, %16.9 oranında grip benzeri semptomlar, %10.1 oranında göz bulguları izlenmiştir [20] . Çalışmaya aldığımız olgularda da benzer şekilde EM en sık görülen lezyon iken, nörolojik bulgular daha az oranda, göz bulguları benzer oranda idi. ...
... For example, in Bulgaria, both BL and ACA account for 0.3% of LB cases [5]. In Norway, ACA accounts for 5% of all clinical cases of LB [6], and in northern Italy -2.5% [7]. ...
... According to the literature, women are more predisposed to ACA (women are more than two thirds of patients) [7,10]. This tendency was also observed in our study. ...
Introduction:
Acrodermatitis chronica atrophicans (ACA) is probably the most common late and chronic manifestation of the Lyme borreliosis seen in European patients.
Aim:
To analyze epidemiological data, and to investigate the effects of treatment of patients with ACA.
Material and methods:
Nine patients were included in the study. All patients had serological examinations (ELISA and Western blot) and histopathological examination of the skin lesions performed. Eight patients had PCR in the skin biopsy performed.
Results:
The duration of symptoms ranged from 2 months to 2 years. In 7 patients, skin lesions were located on lower limbs, in 2 patients - in a non-typical body area - abdomen. In 1 patient, scleroderma and in 3 patients, diabetes mellitus was diagnosed. Borrelia burgdorferi DNA was detected in 25% of the skin biopsy specimens. IgG anti-B. burgdorferi specific antibodies were present in serum of all patients (confirmed by Western blot). In all cases, the diagnosis was confirmed by histopathological examination. The response to ceftriaxone therapy varied. In 5 cases, the lesions resolved completely, in others they faded.
Conclusions:
Despite raising awareness of Lyme borreliosis, late forms of the disease such as ACA are still observed. Acrodermatitis chronica atrophicans skin lesions may be located in non-characteristic areas, e.g. abdominal skin. Symptoms are not irritating or painful, therefore patients do not seek medical help. The effect of antibiotic treatment varies.
... A large clinical study of disease characterization indicated that this occurs in 70-80% of cases [8]. However, variations in rash appearance [9], region [9,10], and possibly even gender [11] may influence the accurate reporting of EM incidence. Following hematogenous dissemination of the spirochete, the heart, joints and nervous system may become colonized, leading to inflammation and signs/symptoms associated with this systemic infection. ...
The efficacy and accepted regimen of antibiotic treatment for Lyme disease has been a point of significant contention among physicians and patients. While experimental studies in animals have offered evidence of post-treatment persistence of Borrelia burgdorferi, variations in methodology, detection methods and limitations of the models have led to some uncertainty with respect to translation of these results to human infection. With all stages of clinical Lyme disease having previously been described in nonhuman primates, this animal model was selected in order to most closely mimic human infection and response to treatment. Rhesus macaques were inoculated with B. burgdorferi by tick bite and a portion were treated with recommended doses of doxycycline for 28 days at four months post-inoculation. Signs of infection, clinical pathology, and antibody responses to a set of five antigens were monitored throughout the ~1.2 year study. Persistence of B. burgdorferi was evaluated using xenodiagnosis, bioassays in mice, multiple methods of molecular detection, immunostaining with polyclonal and monoclonal antibodies and an in vivo culture system. Our results demonstrate host-dependent signs of infection and variation in antibody responses. In addition, we observed evidence of persistent, intact, metabolically-active B. burgdorferi after antibiotic treatment of disseminated infection and showed that persistence may not be reflected by maintenance of specific antibody production by the host.
... Bekanntermaßen wird der klinische Verlauf einer Borreliose in 3 Stadien eingeteilt, wobei jedes Stadium seine spezifischen kutanen Symptome hat, die sich nicht notgedrungen manifestieren müssen, da Stadien übersprungen werden können. Das Leitsymptom des Stadium I, der lokalisierten Frühinfektion, ist mit 70 -90 % das Erythema (chronicum) migrans (EM, Wanderröte)[3]. Es entwickelt sich als kleine erythematöse Makula oder Papel nach etwa 1 bis 2 Wochen (3 bis 32 Tagen) meist an der Stichstelle. Das rundlich-ovale, scharf begrenzte, zentral abblassende, blasse bis livide Erythem dehnt sich langsam zentrifugal aus. ...
Bekanntermaßen wird der klinische Verlauf einer Borreliose in 3 Stadien eingeteilt. Serologische Untersuchungen sind in der Frühphase oft nicht zielführend, denn die Immunantwort tritt spät auf und im Rahmen einer früheren Infektion gebildete Antikörper verschwinden nur langsam. In der Frühphase wird die Diagnose klinisch gestellt, allerdings können Stadien übersprungen werden und die Bandbreite der kutanen Manifestationen ist groß. Hier möchten wir eine seltenere Erstmanifestation einer Borreliose präsentieren.
... Other rare cutaneous manifestations include morphea, lichen sclerosus, cutaneous B-cell lymphoma, granuloma annulare, interstitial granulomatous dermatitis, cutaneous sarcoid-like reaction, necrobiosis lipoidica, and necrobiotic xanthogranuloma [8]. Multiple erythema migrans or erythema multiforme-like lesions have been occasionally observed and interpreted as a sign of hematological spread of spirochetes [9,10]. We suggest the same in our patient. ...
Cutaneous manifestations of Borrelia infection are common with
erythema migrans seen most frequently. However, there are rather
unusual cutaneous signs associated with borreliosis. We report about
a 70-year-old male patient suffering from colitis ulcerosa among
other internal diseases who developed an early disseminated disease
after tick bite. We observed an asymptomatic reticulated truncal
erythema characterized by dermal angiectasias and lymphocytic
infiltrate.
... However, LD itself in small percentage (about 10%) can present with fever, chills and headache. Such an epidemiologic report is confirmed also in Europe: in an Italian study conducted on more than 700 people living in an endemic area for LD, flu-like symptoms as fever, myalgia and headache preceded, accompanied or were the only clinical sign of LD in 16.88% of patients [35]. ...
Lyme disease is one of the most frequent tick-borne diseases worldwide, it can be multi-systemic and insidious, in particular when it shows a chronic course.
In recent years co-infections represent an emerging issue in Lyme disease spectrum because in addition to Borrelia burgdorferi sl many other potential pathogens may be transmitted by hard ticks Ixodes species. The main co-infections found in Lyme disease described in this review are represented by Anaplasma phagocytophilum, Babesia species, Bartonella species, Rickettsiae species and tick-borne encephalitis virus . For each single co-infecting micro-organism, clinical features, diagnostic issues and therapeutical approaches are discussed.
Co-infections represent an emerging problem because they might exacerbate Lyme disease clinical features, they can also mimic Lyme borreliosis sharing common manifestations, and eventually they can change the course of the disease itself.
The presence of one or more co-infecting agent during the course of Lyme disease may represent an issue especially in endemic areas for tick-borne diseases and in people occupationally exposed.
The aim of this review is to summarize the more important co-infections in patients with Lyme disease and to discuss their importance in the disease process.
