Enfermedad de Lyme: a propósito de un caso clínico importado / Lyme disease: about an imported case report

Resumen Presentamos el caso clínico de una mujer norteamericana que consultó en nuestro país por un eritema migrans múltiple, diagnosticándose una enfermedad de Lyme. Este cuadro infeccioso es causado por espiroquetas del complejo Borrelia burgdorferi sensu lato (Bbsl) y es transmitido por la mordedura de garrapatas. Tradicionalmente Bbsl había sido detectada en garrapatas sólo en el hemisferio norte. Sin embargo, desde el 2013 ha habido reportes en Sudamérica. En Chile, recientemente se describió Borrelia chilensis, la cual no tiene una enfermedad asociada en humanos. Se discuten aspectos del agente infeccioso, su epidemiología, sus vectores y nuevos hallazgos en Sudamérica. Además, se plantean los criterios diagnósticos clínicos, de laboratorio y tratamiento, de acuerdo a la etapa en su historia natural.

This is a case report of an american woman who consulted in our country for multiple erythema migrans, from which a Lyme disease was diagnosed. This infectious disease is caused by spirochetes from the Borrelia burgdorferi sensu lato complex (Bbsl) and is transmitted by the bite of ticks. Traditionally Bbsl had been detected in ticks only in the Northern Hemisphere. However, since 2013 there have been reports in South America. In Chile, Borrelia chilensis was recently described, which does not have an associated disease in humans. Aspects of the infectious agent, its epidemiology, its vectors and new findings in South America are discussed. Likewise, the clinical diagnostic criteria, laboratory and appropriate treatment are proposed, according to the stage in their natural history.

Chronic unremitting headache associated with Lyme disease-like illness / Dor de cabeca incessante cronica associada com a doenca de Lyme simile

The Brazilian Lyme-disease-like illness (BLDLI) or Baggio-Yoshinari syndrome is a unique zoonosis found in Brazil. It reproduces all the clinical symptoms of Lyme disease except for the high frequencies of relapse and the presence of autoimmune manifestations. Two cases of borreliosis manifesting with unremitting headache, which is a symptom associated with late-stage BLDLI, were presented. Clinical, therapeutic, and prognostic aspects of the BLDLI and its associated headaches were showed and discussed in this article. BLDLI diagnosis requires additional attention by physicians, since the disease has a tendency to progress to the late, recurrent stage or the chronic form, and the associated headache can be confused with chronic primary headache or with analgesic-overuse one. Special attention should be paid to patients with headaches who have traveled to endemic areas.

A doença de Lyme símile brasileira (BLDLI) ou síndrome de Baggio-Yoshinari é uma zoonose diferenciada encontrada no Brasil. Ela reproduz todos os sintomas clínicos da doença de Lyme, exceto as altas frequências de recidivas e a presença de manifestações autoimunes. Dois casos de borreliose, manifestando-se com cefaleia incessante, que é um sintoma associado à fase tardia da BLDLI, foram apresentados. Os aspectos clínicos, terapêuticos e prognósticos da BLDLI, bem como as cefaleias associadas com a doença de Lyme, foram mostrados e discutidos. O diagnóstico da BLDLI requer maior atenção dos médicos, já que a doença tende a progredir em seu estágio tardio, na forma recorrente ou crônica, e a cefaleia pode ser confundida com cronificação primária ou por abuso excessivo de analgésicos. Atenção especial deve ser dada aos pacientes que viajaram para áreas endêmicas.

Enfermedad de Lyme: historia, microbiología, epizootiología y epidemiología / Lyme disease: history, microbiology, epizootiology and epidemiology

Objetivo: teniendo en cuenta el riesgo potencial que para Cuba constituye la presencia del agente trasmisor, los autores consideran importante la revisión del tema con vistas a una actualización de los especialistas y demás entidades del sistema de salud que puedan intervenir en la vigilancia y control epidemiológico de esta enfermedad. Desarrollo: se comenta la historia de la enfermedad, la microbiología, la epizootiología y la epidemiología, así como las manifestaciones clínicas en los principales animales domésticos. Conclusiones: la borreliosis de Lyme es una nueva enfermedad infecciosa; comparte como otras borrelias y espiroquetas su afinidad por el sistema nervioso central y el sistema nervioso periférico, y se convierte en un diagnóstico de exclusión optimista en Neurología. Conocer sus vectores, su distribución geográfica y algunas de las características biológicas específicas de esta nueva especie de borrelia es de suma importancia para el médico práctico de este nuevo siglo, donde la inmunología y la biología molecular iluminan el oscuro camino de viejas y nuevas interrogantes

Objective: bearing in mind the risk posed by the presence of the vector of Lyme disease in Cuba, the authors have considered it necessary to carry out a review of the disease with the purpose of contributing updated information to specialists and health institutions involved in its surveillance and epidemiological control. Content: a discussion is presented of the history, microbiology, epizootiology and epidemiology of Lyme disease, as well as its clinical manifestations in the main domestic animal hosts. Conclusions: Lyme borreliosis is a new infectious disease. Like other borrelias and spirochetes, it has an affinity for the central nervous system and the peripheral nervous system, thus becoming a diagnosis of optimistic exclusion in neurology. Knowledge about the vectors, geographic distribution and some specific biological characteristics of this new borrelia species is crucial for practitioners of the 21st century, a time when immunology and molecular biology shed new light on old and new questions alike

Borreliose de Lyme / Lyme borreliosis

As borrelioses constituem um grupo de doenças infecciosas causadas por espiroquetas do gênero Borrelia. A borreliose de Lyme, também denominada doença de Lyme, é uma doença infecciosa, não contagiosa, causada por espiroquetas pertencentes ao complexo Borrelia burgdorferi Sensu Lato e transmitida, mais frequentemente, por picada de carrapatos do gênero Ixodes. A doença apresenta quadro clínico variado, podendo desencadear manifestações cutâneas, articulares, neurológicas e cardíacas.

Borreliosis is an infectious disease caused by spirochetes of the genus Borrelia. Lyme borreliosis, also known as Lyme disease, is a non-contagious infectious disease caused by spirochetes belonging to the complex Borrelia burgdorferi sensu lato and more often transmitted by the bite of infected ticks of the genus Ixodes.The disease is characterized by a varied clinical profile, which can trigger cutaneous, articular, neurological and cardiac manifestations.

Enfermedad de Lyme. Experiencia en niños mexicanos / Lyme disease. Experience in Mexican children

La Enfermedad de Lyme o borreliosis de Lyme es una enfermedad infecciosa emergente causada por la bacteria Borrelia burgdorferi sensu lato, la cual es transmitida por la mordedura de garrapatas del género Ixodes. En esta revisión se presentan los aspectos generales de la enfermedad como los agentes etiológicos, las formas clínicas de manifestarse, los métodos de diagnóstico que se recomiendan para establecer con mayor certeza la etiología y se resume la experiencia acumulada durante 10 años en cuanto a las características clínico-epidemiológicas, serológicas y de identificación etiológica de niños atendidos en dos centros pediátricos del Distrito Federal.

Lyme disease or Lyme borreliosis is an emerging infectious disease produced by Borrelia burgdorferi sensu lato, which is a bacteria transmitted to the host organism by the bite of Ixodes ticks. In this report we present the general knowledge about the etiological agent, clinical manifestations of the disease and diagnostic laboratory tests. We offer cumulative information about Lyme disease in Mexican children treated at two children's hospitals in Mexico City during the last 10 years.

Borreliose de Lyme Símile - relato de caso / Lyme disease - first case report in Pará

Objetivo: relatar o primeiro caso de borreliose de Lyme símile documentado no Estado do Pará. Relato do caso: paciente apresentou, inicialmente, lesão eritematodescamativa, ovalar, de aspecto arciforme, com clareamento central, crescimento centrífugo e lento, acompanhado de cefaléia e cansaço. Posteriormente novas lesões surgiram em joelho, panturrilha e dorso do pé esquerdo. Ao exame histopatológico, observou-se leve infiltrado linfocitário perivascular, edema e congestão, bem como nervos dérmicos e músculos piloeretores livres de infiltrado inflamatório. A coloração por impregnação pela prata resultou negativa para espirilo. A sorologia para doença de Lyme foi positiva. Realizado tratamento com tetraciclina e posteriormente com oxacilina, sem resultados satisfatórios, pois o paciente evoluiu com novas lesões, prolongando seu tratamento com a oxacilina. Considerações finais: relatado o primeiro caso de borreliose de Lyme símile no estado do Pará. São discutidas dificuldades terapêuticas, com prognóstico reservado em relação à cura definitiva.

Objective: report the first case of a patient with Lyme disease in Pará (Braszil). Case Report: a 23-year-old, male pacient presented to the demzatology service with Headache, muscle pain and a history of a progressive skin eruption, with annular shape and growing centrifugally, with central clearly, characteriing the erythema migrans. Latelly, new eruptions appeared on the knees, legs and left foot. The pacient also showed sorological exams positive to Lyme disease and the histopatological study showed . lt was started a treatment with, but new lesion appeared, so the drgs were changed. The eruptions did not stop to appear. So the authors concluded it was reported the firste case of Lyme disease in Pará.