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.

Enfermedad de Lyme en pediatría: distintas caras, una misma enfermedad. Serie de casos / Lyme disease in Pediatrics: different faces, the same disease. Cases series

La enfermedad de Lyme es producida por la espiroqueta Borrelia burgdorferi, que se transmite mediante la picadura de las garrapatas del género Ixodes ricinus. Se caracteriza por la aparición de un eritema migratorio en la zona de la picadura en las fases iniciales. Su diagnóstico se retrasa en gran parte de los casos y se presenta con formas diseminadas o tardías. El diagnóstico es fundamentalmente clínico; la serología suele ser negativa en las fases precoces, pero sirve de apoyo en el caso de las formas más avanzadas. El tratamiento se realiza con antibiótico oral durante 14-28 días, salvo en formas recurrentes o con afectación del sistema nervioso central. Presentamos cuatro casos de borreliosis de Lyme en niños con el fin de dar a conocer distintas formas de presentación de esta entidad y su manejo en la población pediátrica.

Lyme disease is caused by Borrelia burgdorferi infection which is transmittedby Ixodes ricinus. Erythema migrans, a rash spreading from the site of a tick bite, is the earliest and most common manifestation of the disease. If untreated, late manifestations of disseminated disease, mainly neurological and musculoskeletal, may occur. Serologic studies are usually negative in early stages and are not necessary to confirm the diagnosis in cases of erythema migrans. Laboratory confirmation is needed for disseminated disease. Most presentations, including facial nerve palsy, can be treated with oral antibiotics. Ceftriaxone is recommended in other cases of neuroborreliosis. Four cases of Lyme disease in children are reported to illustrate the different presentations of this disease and its management in children.

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.

Clinical Study of Erythema Migrans / 대한피부과학회지

BACKGROUND: Lyme disease, an infection caused by Borrelia(B.) burgdorferi, has been reported in many countries. But in Korea, only 5 cases of serologically diagnosed lyme disease have been reported. Because several strains of B. burgdorferi were isolated from Ixodes ticks which were captured in Kangwon and Chungbuk province, there might be more cases of serologically undiagnosed lyme diseases presenting with erythema migrans. OBJECTIVE: To understand the clinical patterns and laboratory findings of erythema migrans in Korea. METHODS: A clinical survey was retrospectively performed on 9 patients with erythema migrans which occurred after tick bites. RESULTS: Among 9 patients with erythema migrans, 3 patients were male and 6 patients were female. The onset age of erythema migrans ranged from 26 to 71 years old (mean, 51.3 years old). The mean duration of erythema migrans after tick bite was 26.4 days and the diameter of the lesion ranged from 6 to 34 cm (mean, 18.3 cm). All cases developed from May to September and systemic symptoms such as fatigue, fever and/or chills, myalgia, palpitation, headache, arthralgia and dyspnea were present at the time of hospital visits of 3 patients. Clinically, 3 patterns of erythema migrans were seen; typical target pattern, homogenous and erythematous plaque pattern, and linear solitary plaque pattern with central postinflammatory pigmentation. Only 2 of the 7 patients (28.6%) were seropositive for IgM and IgG antibody titers by enzyme-linked immunosorbent assay in consecutive serologic tests. PCR for Borrelia DNA in paraffin-embedded tissue showed full negativity in 6 patients with erythema migrans. CONCLUSION: Although lyme disease is not endemic in Korea, some patients with erythema migrans might be undiagnosed as lyme disease serologically with erythema migrans. To take into consideration false negative serelogic results in early erythema migrans, early oral tetracycline therapy should be included through clinical and historical diagnosis.

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.

A Case of Lyme Disease with Unusual Cutaneous Manifestations / 대한피부과학회지

Lyme disease (borreliosis) is a multi-systemic spirochetal infection, primarily caused by Borrelia burgdorferi, which is transmitted by Ixodes (Ixodid) species of ticks. Although it is the most common arthropod-borne disease in the U.S. and Europe, there have been relatively fewer reports of clinical cases in Korea. During the early disseminated stage, secondary erythema migrans may occur at sites distant from the site of tick attachment, signaling hematogenous dissemination of B. burgdorferi. We report a case of a 22-year-old woman who presented with unusual primary erythema migrans and multiple secondary erythema migrans. Despite lack of typicality of the clinical features, serologic investigations including immunofluorescent assay and Western immunoblot against specific antigens revealed Lyme disease.

Lyme Disease

Lyme disease is a vector-borne infection primarily transmitted by Ixodes ticks and is caused by at least three different but closely related species of borrelia. Although it is the most common arthropod-borne disease in the U.S. and Europe, reports of the clinical cases have been relatively rare in Korea. The disease may affect different organs, such as nervous system, joints, heart or eyes, and the clinical pictures include meningitis, cranial neuritis, arthritis, temporary atrioventricular block, and conjunctivitis. The cutaneous manifestations are erythema(chronicum) migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. Early localized infection occurs a few weeks after a tick bite, and erythema migrans is a classic cutaneous manifestation at this stage of infection. Several weeks later, early disseminated infection occurs with bacterial dissemination. Multiple erythema migrans-like skin lesions, neuroborreliosis, arthritis, and carditis can develop. Without treatment, the disease can progress to late or chronic infection, and then acrodermatitis chronica atrophicans may develop in addition to the systemic manifestations. The disease can be diagnosed with serologic tests such as indirect immunofluorescence test or ELISA. The recommended treatment is oral doxycycline or amoxicillin, and the treatment period is variable depending on the organ involved and the duration of the disease. A vaccine for the Lyme disease is approved for adults and commercially available in the Unites States. However, protection from tick bites by the use of protective clothing in risk areas and body inspection and removal of any attached ticks as soon as possible are the most important prophylactic methods. Chemoprophylaxis after a tick bite is also available.