Description of Lyme disease-like syndrome in Brazil: is it a new tick borne disease or Lyme disease variation?

An emerging clinical entity that reproduces clinical manifestations similar to those observed in Lyme disease (LD) has been recently under discussion in Brazil. Due to etiological and laboratory particularities it is named LD-like syndrome or LD imitator syndrome. The condition is considered to be a zoonosis transmitted by ticks of the genus Amblyomma, possibly caused by interaction of multiple fastidious microorganisms originating a protean clinical picture, including neurological, osteoarticular and erythema migrans-like lesions. When peripheral blood of patients with LD-like syndrome is viewed under a dark-field microscope, mobile uncultivable spirochete-like bacteria are observed. PCR carried out with specific or conservative primers to recognize Borrelia burgdorferi sensu stricto or the genus Borrelia has been negative in ticks and in biological samples. Two different procedures, respectively involving hematoxylin and eosin staining of cerebrospinal fluid and electron microscopy analysis of blood, have revealed spirochetes not belonging to the genera Borrelia, Leptospira or Treponema. Surprisingly, co-infection with microorganisms resembling Mycoplasma and Chlamydia was observed on one occasion by electron microscopy analysis. We discuss here the possible existence of a new tick-borne disease in Brazil imitating LD, except for a higher frequency of recurrence episodes observed along prolonged clinical follow-up.

Search for Borrelia sp. in ticks collected from potential reservoirs in an urban forest reserve in the State of Mato Grosso do Sul, Brazil: a short report

A total of 128 ticks of the genus Amblyomma were recovered from 5 marsupials (Didelphis albiventris) - with 4 recaptures - and 17 rodents (16 Bolomys lasiurus and 1 Rattus norvegicus) captured in an urban forest reserve in Campo Grande, State of Mato Grosso do Sul, Brazil. Of the ticks collected, 95 (78.9 percent) were in larval form and 22 (21.1 percent) were nymphs; the only adult (0.8 percent) was identified as A. cajennense. Viewed under dark-field microscopy in the fourth month after seeding, 9 cultures prepared from spleens and livers of the rodents, blood of the marsupials, and macerates of Amblyomma sp. nymphs revealed spiral-shaped, spirochete-like structures resembling those of Borrelia sp. Some of them showed little motility, while others were non-motile. No such structures could be found either in positive Giemsa-stained culture smears or under electron microscopy. No PCR amplification of DNA from those cultures could be obtained by employing Leptospira sp., B. burgdorferi, and Borrelia sp. primers. These aspects suggest that the spirochete-like structures found in this study do not fit into the genera Borrelia or Leptospira, requiring instead to be isolated for proper identification

Borrelia-like spirochetes recovered from ticks and small mammals collected in the Atlantic Forest Reserve, Cotia county, State of Sao Paulo, Brazil

Forty-four marsupials, 77 rodents and 161 ticks were captured in an Atlantic Forest Reserve in Cotia county, State of Sao Paulo, where human cases of Lyme disease (LD) simile were reported. Twenty-one borrelia-like spirochete isolates were recovered from the mammals' blood and rodent livers or spleens, and triturated ticks inoculated into BSK II medium. Our results suggest that the reservoirs and ticks collected may harbor borrelia-like spirochetes, some of which have an antigenic similarity with the unknown causative agent of LD simile in Brazil, and/or with North American Borrelia burgdorferi s.s.

Doença de Lyme: acometimento cutâneo e tratamento das fases iniciais / Lyme diseases: cutaneous involvement and initial phases treatment

A doença de Lyme é uma moléstia infecto-contagiosa transmitida por carrapatos contaminados pela Borrelia burgodorferi. Caracteriza-se por acometer a pele, coraçäo, articulaçöes e sistema nervos central e periférico. No Brasil ainda näo se descreveu um caso com devida confirmaçäo laboratorial. Os autores apresentam um caso com diagnóstico clínico e sorológico em que o principal acometimento foi o cutâneo. Com este achado, discutem as formas de acometimento cutâneo da doença, bem como o tratamento das formas iniciais

Eritromelalgia primária / Primary erythromelalgia

Eritromelalgia é uma afecçäo rara que se caracteriza por intenso rubor, dor em queimaçäo e aumento da temperatura das extremidades. Formas primárias e secundárias têm sido descritas, em particular com trombocitemia essencial e policitemia vera. Os autores fazem o relato de um paciente de 15 anos, portador de eritromelalgia primária, e discutem os aspectos patogênicos, clínicso e tarapêuticso dessa entidade

Vasculite urticariforme.Relato de caso e revisao de literatura. / Urticarial vasculitis. A case report and review of the literature

Relatamos o caso do paciente do sexo masculino, de 27 anos, com urticaria cronica como manifestacao de vasculite necrosante cutanea, associada a artrite, febre, emagrecimento e hipocomplementemia. A sindrome caracterizada neste paciente e semelhante aos casos previamente relatados como "vasculite hipocomplementemica", "vasculite necrosante associada a urticaria cronica" e "vasculite urticariforme". Apresentamos revisao de literatura e discussao do diagnostico diferencial e tratamento. Acreditamos que essa nova sindrome constitui uma subpopulacao distinta de patologia colageno-vascular