Encefalitis aguda con síndrome cerebeloso secundario a neuroborreliosis

La enfermedad de Lyme es la infección transmitida por garrapatas más común en Norteamérica y Europa. Sin embargo, en América Latina se han reportado pocos datos. Borrelia burgdorferi es capaz de invadir el sistema nervioso central causando la neuroborreliosis de Lyme. Se comunica el caso de una mujer joven con encefalitis y síndrome cerebeloso, una presentación poco frecuente, que se manifestó con cefalea, marcha atáxica, nistagmo y ptosis palpebral. Se realizó el diagnóstico con serología positiva por Western blot para Borrelia burgdorferi en suero. Recibió tratamiento con mejoría clínica. El diagnóstico de neuroborreliosis es difícil, ya que no existen hallazgos neurológicos o de imagen específicos. Se recomienda tener un mayor nivel de vigilancia epidemiológica en Latinoamérica, así como los antecedentes recreativos o viajes, que deben incluirse en la historia clínica para mejorar la aproximación diagnóstica.

Lyme disease is the most common tick-borne disease in North America and Europe. However, in Latin America, few data have been reported. Borrelia burgdorferi is capable of invading the central nervous system causing Lyme neuroborreliosis. This is a case report of a female with encephalitis and cerebellar syndrome, a rare manifestation, presented with generalized headache ataxic gait, nystagmus and palpebral ptosis. Serologic diagnosis was made for Borrelia burgdorferi and treatment was initiated with clinical improvement. Neuroborreliosis is a very difficult diagnosis, since there are no neurologic or imaging findings specific. It is recommended to physicians to have an enhanced level of surveillance in Latin America, as well as recreational/travel history of the patient, which should be included in the clinical record to improve the diagnostic approach.

Epidemiological investigation of Lyme disease in animals in Xinjiang Uygur Autonomous Region,China / 中国生物制品学杂志

@#ObjectiveTo investigate the epidemiology of Lyme disease and analyze the genotypes of Borrelia burgdorferi in five kinds of host animals of ticks in four cities of Xinjiang Uygur Autonomous Region,China.MethodsA total of 814 serum samples were collected from cattle,sheep,goats,horses and dogs in Urumqi,Ili,Changji and Kashgar Cities,and determined for IgG antibody against Lyme disease. A total of 135 ticks in the above-mentioned cities were collected,from which DNAs were extracted and used as template for amplification of the 5S-23S rRNA spacer fragments of B. burgdorferi by nested PCR. The positive samples were sequenced,and the results were compared with those of 5S-23S rRNA spacer of B. burgdorferi reported in GenBank by BLAST,and a phylogenetic tree was constructed by MEGA X software.ResultsThe IgG antibody positive rates against Lyme disease in Urumqi,Ili,Changji and Kashgar Cities were 23. 6%,2. 4%,2. 7% and 0 respectively,which showed significant difference（χ2= 48. 481,P < 0. 001）. However,the positive rates in cattle,sheep,goats,dogs and horses were 1. 1%,4. 4%,18. 7%,60. 5% and 0 respectively,which showed sig-nificant difference（χ2= 129. 03,P <0. 001）. Of the 135 tick DNA samples,24 were positive for B.burgdorferi,indicating a carrier rate of 17. 78%. Phylogenetic analysis showed that the genotypes B.garinii accounted for 75%,while B.afzelii accounted for 16. 67%,and B.burgdorferi accounted for 8. 33%.ConclusionThere are Lyme diseases in cattle,sheep,goats and dogs in Urumqi,Kashgar and Ili Cities of Xinjiang Uygur Autonomous Region,China,of which the major genotype is B.garinii. The study provides a scientific basis for prevention and control of Lyme disease in Xinjiang.

A Multiplex PCR assay for a differential diagnostic of rickettsiosis, Lyme disease and scrub typhus

Background & objectives: Coexistence of tick-borne diseases in some regions in Latin America makes the diagnosis difficult due to shared initial signs and symptoms. Rickettsiosis, Lyme disease and recently, scrub typhus are gaining more importance. The objective of this study is to develop a multiplex-PCR assay for a differential diagnosis of rickettsiosis, Lyme disease and scrub typhus. Methods: By using bibliographic and bioinformatic analysis, we identify candidate regions to perform the multiplexPCR assay for Rickettsia sp., Borrelia burgdorferi and Orientia tsutsugamushi as well as identify optimal melting temperature and sensibility analysis. Results: We identified specific primer pairs for Rickettsia sp, Borrelia burgdorferi and Orientia tsutsugamushi with different PCR fragment length but a common melting temperature, 58°C. Interpretation & conclusion: We successfully developed a Multiplex PCR assay for differential diagnosis of rickettsiosis, Lyme disease and scrub typhus that could be a rapid and easy option in clinical and epidemiological practice.Laboratorio de Enfermedades Infecciosas y Parasitarias 1. Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Autónoma de Yucatán. Yucatán, Mexico

Laboratorio de Enfermedades Emergentes y Re-emergentes. Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”. Universidad Autonoma de Yucatan. Yucatán, Mexico

Detección de anticuerpos tipo igg contra borrelia burgdorferi, y factores asociados a la enfermedad de lyme en población canina, de los municipios honda-Tolima, la mesa y Chia-Cundinamarca. detección de anticuerpos tipo igg contra borrelia burgdorferi en población canina / Detection of IgG-type antibodies against Borrelia Burgdorferi, and factors associated with Lyme disease in the canine population, of the municipalities Honda-Tolima, La Mesa and Chia-Cundinamarca

Borrelia burgdorferi, is the spirochete responsible for causing Lyme disease in man and different animals. Objective. Detect specific IgG type antibodies against Borrelia burgdorferi, in canines using the immunofluorescence technique and its correlation with other factors associated with Lyme disease. Methods. Blood was taken for IgG detection against Borrelia burgdorferi sl; Peripheral blood smear of the canines and hemolymph of the ticks to search for spirochetes with Wright staining and finally classification of the ticks using morphometric keys. Results. In the serological test, on average 69.0% of the canines sampled gave positive results in the different titrations. Bacterial structures were spirally visualized both in the peripheral blood of the canines and in the hemolymph of the ticks. The vector found was classified as Rhipicephalus sanguineus, until now not reported in the scientific literature as a carrier of Borrelia, nor associated with the disease.

Bilateral diaphragmatic paralysis and Lyme neuroborreliosis. Ten-years of follow-up / Parálisis diafragmática bilateral y neuroborreliosis de Lyme. Diez años de seguimiento

Abstract Borrelia burgdorferi infection (Lyme disease) is one of the few identifiable causes of neuralgic amyotrophy (AN). Bilateral diaphragmatic paralysis is considered rare in borreliosis, and the pattern of long-term recovery of diaphragm function is also uncertain. Transdiaphragmatic pressure is the gold standard for diagnosing bilateral diaphragmatic paralysis, a study that has been reported on a few occasions. We pres ent a case of AN associated with borrelia infection and bilateral diaphragmatic paralysis that provides a detailed follow-up of the spirometric evolution, the maximum static pressures in the mouth, and the transdiaphragmatic pressure from the onset of symptoms and in the long term. This case allows us to know one of the possible evolutionary profiles of diaphragmatic dysfunction in AN due to borreliosis.

Resumen La infección por Borrelia burgdorferi (enfermedad de Lyme) es una de las pocas causas identificables de amiotrofia neurálgica. La parálisis diafragmática bilateral es considerada rara en la borreliosis y el patrón de recuperación a largo plazo de la función del diafragma también es incierto. La presión transdiafragmática es el patrón de oro para el diagnóstico de parálisis diafragmática bilateral, un estudio que ha sido informado en pocas ocasiones. Se presenta un caso de amiotrofia neurálgica asociado a infección por Borrelia y parálisis diafrag mática bilateral, que aporta un seguimiento detallado de la evolución espirométrica, de las presiones estáticas máximas en la boca y de la presión transdiafragmática desde el inicio de los síntomas y a largo plazo. Este caso permite conocer uno de los posibles perfiles evolutivos de la disfunción diafragmática en la amiotrofia neurálgica por borreliosis.

Panuveítis asociada a la enfermedad de Lyme en un paciente colombiano. Reporte de caso / Panuveitis due to Lyme disease in a Colombian patient: Case report

RESUMEN La enfermedad de Lyme es una zoonosis transmitida por la picadura de garrapatas del género Ixodes sp. Ha sido descrita con más frecuencia en zonas endémicas de países meridionales. Sus manifestaciones clínicas son muy variables y se presentan de acuerdo con el estadio clínico de la enfermedad, teniendo así el compromiso ocular un espectro clínico muy variado que incluye manifestaciones desde la superficie ocular hasta la inflamación del segmento posterior. Se presenta el caso de un paciente de 72 años con un viaje reciente a los Estados Unidos (EE. UU.), atendido en la consulta particular por un oftalmólogo supraespecialista en uveítis de la ciudad de Medellín. El paciente hacía un mes refería una disminución de la agudeza visual (AV) en su ojo izquierdo y al examen oftalmológico presentó signos clínicos de panuveítis no granulomatosa asociada a un edema macular y vasculitis retinal. Se confirmó la enfermedad de Lyme en fase tardía por la presencia de anticuerpos en sangre por Western blot. Se realizó tratamiento exitoso con antibióticos (doxiciclina), con recuperación de la AV y la mejoría completa de los signos inflamatorios intraoculares.

SUMMARY Lyme Disease is a zoonosis transmitted by arthropods that has been described with more frequency in endemic zones of meridional countries. Its clinical manifestations vary according to the clinical stage of the disease. The eye can be affected in many forms including the involvement of the ocular surface and the posterior segment, with more severe inflammation of the retina and the choroid. We present a case of a 72-year male with a recent trip to EEUU who complained of decreasing vision in his left eye had clinical signs of non-granulomatous panuveitis with macular edema and retinal vasculitis. Lyme disease was confirmed with positive antibodies in blood and Western blot test, and the patient was successfully treated using oral Doxycycline. His visual acuity improved and had a resolution of the intraocular inflammation after the specific treatment.

Enfermedad de Lyme en la Ciudad de México / Lyme disease in Mexico City

Resumen: Se comunica el caso de una paciente de 29 años de edad, originaria y residente de la Ciudad de México, que inició su padecimiento con dolor en el segundo dedo de la mano izquierda posterior a una visita al bosque de Aragón, que progresó con náusea y diarrea, así como artralgias incapacitantes con predominio en las manos y los pies sin eritema multiforme en la mano. A su ingreso al hospital tuvo marcadores de inflamación de 19 x 103/μL leucocitos y proteína C reactiva de 28 mg/dL, que se elevaron durante su estancia hospitalaria; ante la falta de respuesta al tratamiento médico y múltiples pruebas negativas se decidió realizar Western Blot para ricketsias con lo que se obtuvo resultado positivo para Borrelia burgdorferi, con lo que se estableció el diagnóstico definitivo de borreliosis de Lyme; la paciente recibió tratamiento adecuado y tuvo mejoría clara. La enfermedad de Lyme es una zoonosis transmitida por las garrapatas del género Ixodes causadas por la espiroqueta Borrelia burgdorferi. La Ciudad de México no se ha reportado como zona endémica por lo que comunicamos este caso.

Abstract: This paper reports the case of a 29-year-old female patient, who was originally from Mexico City and began her condition with pain in the second finger of left hand after a visit to the Aragon forest in Mexico City, progressing with nausea and diarrhea, as well as incapacitating arthralgias with predominance in hands and feet without erythema multiforme in hand. Upon admission, she had inflammation markers of 19 x 103/μL leukocytes and C-reactive protein of 28 mg/dL, which were elevated during her hospital stay; due to the lack of response to medical treatment and multiple negative tests, a Western Blot test for ricketsias was done obtaining a positive result for Borrelia burgdorferi, establishing the definitive diagnosis of Lyme borreliosis, receiving adequate treatment and presenting clear improvement. Lyme disease is a zoonosis transmitted by the ticks of the genus Ixodes caused by the spirochete Borrelia burgdorferi. Mexico City has not been reported as an endemic area, which is why we report this case.

Manifestações neuroftalmológicas associadas a doença de Lyme / Neuro-ophthalmological manifestations associated with Lyme disease

Resumo A doença de Lyme é uma infecção sistêmica causada pela espiroqueta Borrelia burgdorferi e transmitida pelo carrapato do gênero Ixodes sp. e espécie Amblyomma cajennense. A doença costuma se manifestar em três estágios clínicos distintos, que podem variar de acordo com as características de cada hospedeiro. O objetivo deste trabalho é relatar o caso de uma paciente de 33 anos com doença de Lyme que apresentou como manifestações neuroftalmológicas diplopia, lagoftalmo paralítico e ceratite punctata, com exames laboratoriais negativos. Embora a espiroqueta Borrelia burgdorferi tenha maior tropismo pelos tecidos da pele, sistema nervoso e articulações, o acometimento ocular não deve ter sua importância diminuída, sendo descrito neste relato de caso, que abordou os aspectos mais pertinentes à doença para auxiliar seu diagnóstico e tratamento.

Abstract Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi and transmitted by the tick of the genus Ixodes sp. and species Amblyomma cajennense. The disease usually manifests itself in three distinct clinical stages, which may vary according to the characteristics of each host. The objective of this paper is to report the case of a 33-year-old patient with Lyme disease who presented as neuro-ophthalmological manifestations diplopia, paralytic lagophthalmos and punctate keratitis, with negative laboratory tests. Although the spirochete Borrelia burgdorferi has a greater tropism in the tissues of the skin, nervous system and joints, the ocular involvement should not be diminished, being described in this case report, which approached the most pertinent aspects to the disease to aid its diagnosis and treatment.

Enfermedad de Lyme en el Perú. Una revisión clínica y epidemiológica / Lyme disease in Perú. A clinical and epidemiological review

RESUMEN Esta es una revisión crítica y organizada de la información disponible y actualizada acerca de la enfermedad de Lyme y la infección por Borrelia en el Perú. Varios estudios de serología contra Borrelia burgdorferi, y de casos de enfermedad de Lyme han sido reportados en el Perú en las pasadas dos décadas. Nueva información sugiere la existencia de nuevas especies de Borrelia burgdorferi sensu lato en Sudamérica, y posiblemente en el Perú. Futuros estudios genéticos y microbiológicos en esta parte del continente, no sólo en casos con Western blot indeterminado, sino también en vectores y posibles reservorios, son necesarios para medir la extensión de estas nuevas especies de Borrelia y su implicancia clínica.

ABSTRACT This is a critical and organized review of all the available and updated information on Lyme disease and Borrelia infection in Peru. Several studies of positive serology to Borrelia burgdorferi and several cases of Lyme disease have been reported in Peru in the last two decades. New information suggests that new species of Borrelia burgdorferi sensu lato do exist in South America, and possibly in Peru. Future genetic and microbiology studies in this part of the continent, not only in cases with an indeterminate Western blot but in vectors and possible reservoirs as well, are necessary to measure the extent and clinical implications of these new Borrelia species

Enfermedad de Lyme adquirida en el estado de Morelos, México / Lyme disease acquired at Morelos, Mexico

Resumen Se comunica el caso de un paciente que refirió mordeduras por garrapatas 18 meses previos en las piernas y el cuello durante su estancia en Tequesquitengo, en el estado de Morelos, los siguientes meses continuó con cansancio, mareo, dolores musculares, artritis, pérdida de peso y alteraciones en la memoria reciente. Se establecieron diagnósticos diferenciales y se realizó estudio de Western Blot para B. burgdorferi, con lo que se estableció el diagnóstico de manifestaciones tardías de la enfermedad de Lyme. Esta enfermedad es una zoonosis trasmitida por las garrapatas Ixodes; cerca de 300,000 casos ocurren cada año en Estados Unidos. La manifestación clínica más común en la forma temprana lo constituye el eritema migratorio, puede haber manifestaciones neurológicas y cardiacas. Es posible que fenómenos multifactoriales, como los cambios climáticos, favorezcan la extensión de esta zoonosis fuera del tradicional territorio estadounidense. Debemos tener presente en nuestra práctica clínica las manifestaciones de la enfermedad de Lyme para su diagnóstico y tratamiento oportunos, cualquiera que siga siendo su incidencia geográfica.

Abstract We present the case of a patient who referred tick bite 18 months previous in legs and neck during the stay in Tequesquitengo, Morelos state, continuing the following months with fatigue, dizziness, muscle aches, arthritis, weight loss and alterations in recent memory. Differential diagnoses and Western blotting were performed for B. burgdorferi, which established the diagnosis of late manifestations of Lyme disease. Lyme disease is a zoonosis transmitted by Ixodes ticks and occurs in approximately 300,000 cases annually in the United States. The most frequent clinical manifestation in the early form is the erythema migrans, being able to present neurological and cardiac manifestations. It is possible that multifactorial phenomena, such as climate changes, favor the extension of this zoonosis outside the traditional territory of North America. We must take into account in our clinical practice the manifestations of Lyme disease for its timely diagnosis and treatment, regardless of its geographical incidence.

Detección de Borrelia burgdorferi sensu lato en perros y sus garrapatas en comunidades rurales de Yucatán, México / Detection of Borrelia burgdorferi sensu lato in dogs and its ticks in rural communities of Yucatán, Mexico

Resumen Actualmente, el estudio de la borreliosis canina adquiere mayor relevancia, ya que el perro es considerado como un importante centinela del complejo Borrelia burgdorferi sensu lato, el cual podría desempeñar un papel clave en la dispersión de garrapatas de las áreas selváticas al ambiente doméstico. En México, la distribución y presencia de genoespecies patógenas de B. burgdorferi en perros y sus garrapatas aún no ha sido investigada. Por tal motivo, la presente investigación tiene como objetivo detectar y estimar la prevalencia de B burgdorferi s.l. en perros y sus garrapatas en dos comunidades rurales de Yucatán, México. En cada comunidad se visitaron 50 viviendas donde se estudiaron 144 muestras de sangre de perros por punción de la vena safena, así como la colecta de sus garrapatas. Se colectaron un total de 846 garrapatas de las especies Ixodes affinis (33 / 846), Rhipicephalus sanguineus sensu lato (786 / 846) y Amblyomma mixtum (27 / 846). Para detectar la presencia de B. burgdorferi s.l. en dichas muestras, se amplificó el gen conservado flaB y las lipoproteínas de membrana externa, ospC y p66, mediante el uso de la reacción en cadena de la polimerasa. La prevalencia obtenida en sangre de perros fue de 17.3 % (25 / 144) para flaB, 12.50 % (18 / 144) para el gen p66 y 1.38 % (2 / 144) para el gen ospC. De las garrapatas analizadas, R. sanguineus s.l. tuvo una prevalencia de infección de 0.89 %, A. mixtum de 5.88 % e I. affinis de 15.15 %, siendo esta última especie la que presentó mayor prevalencia. Dos perros y sus garrapatas I. affinis fueron positivos al gen flaB. Solamente una garrapata R. sanguineus s.l. fue positiva al gen p66 y ninguna especie de garrapata fue positiva al gen ospC. Este estudio confirma la existencia de B. burgdorferi s.l. en perros y sus garrapatas en comunidades rurales de Yucatán, México. La detección de Borrelia en perros podría ser un criterio importante para la evaluación del riesgo de borreliosis en humanos, ya que el perro puede emplearse como indicador epidemiológico para la identificación de nuevos focos de esta enfermedad.

Abstract In Mexico, the distribution and the presence of pathogenic genospecies of B. burgdorferi in dogs and their ticks has not been extensively investigated. The study of canine borreliosis is acquiring greater relevance, since the dog is considered to be an important sentinel for pathogens pertaining to the complex Borrelia burgdorferi sensu lato; in addition, dogs could be playing a key role in the spread of ticks from forested areas into the domestic environment. This study aimed to detect and estimate the prevalence of B. burgdorferi s.l. in dogs and their ticks in two rural communities of Yucatán, Mexico. In each community, 50 houses were visited, where 144 blood samples from dogs were studied by puncture of the saphenous vein, as well as the collection of their ticks. To detect the presence of B. burgdorferi s.l. in these samples, the conserved gene flaB, p66 and ospC were PCR amplified. A total of 144 dog blood samples, and 846 of ticks were obtained from the examined animals. Considering tick species, Rhipicephalus sanguineus sensu lato (786 / 846) was common, while Ixodes affinis (33 / 846), and Amblyomma mixtum (27 / 846) resulted less frequent. As per gene conservation, the prevalence of B. burgdorferi in canine blood was 17.3 % (25 / 144) to flaB, 12.50 % (18 / 144) for p66 and 1.38 % (2 / 144) for the ospC gene. Within the analyzed ticks, R. sanguineus s.l. had a prevalence of 0.89 %, A. mixtum 5.88 % and I. affinis 15.15 %, being this last species the one that presented higher prevalence. Two dogs and their ticks I. affinis were positive to the flaB gene. Only a tick R. sanguineus s.l. was positive to the gene p66 and no tick species was positive the ospC gene. This study confirmed the existence of B. burgdorferi s.l. in dogs and their ticks in rural communities of Yucatán, Mexico. The detection of Borrelia in dogs may be an important criterion for the evaluation of the risk of borreliosis in humans, since the dog can be used as an epidemiological indicator for the identification of new outbreaks of this disease. Rev. Biol. Trop. 66(1): 428-437. Epub 2018 March 01.

Horses as a Potential Reservoir of Lyme Borreliosis in Jeju-do, Korea / 예방의학회지

Lyme borreliosis (LB) is the most common tick-borne infectious disease in North America, and it was designated as a national notifiable infectious disease in Korea in December 2010. While no cases in Jeju-do were recorded from 2012 to 2016, a recent survey reported that the seroprevalence of Borrelia burgdorferi using enzyme-linked immunosorbent assays in horses in Jeju-do was 19.0% (95% confidence interval, 12.0 to 28.3%). This fact suggests that horses may be a potential reservoir of LB in Jeju-do and that individuals in close contact with horses may be a high-risk group. Thus, a serological study in this high-risk group is urgently needed.

Síndrome de Lyme crónico con manifestaciones neurológicas: a propósito de un caso / Chronic Lyme syndrome with neurological manifestations: A case report

RESUMEN El síndrome de Lyme crónico representa un término controversial que agrupa un conjunto de síntomas persistentes e inespecíficos, en su mayoría reumatológicos o neurológicos, dentro de los cuales se encuentra la enfermedad postLyme, cuya incidencia epidemiológica es baja, el conocimiento fisiopatológico es controversial y el abordaje diagnóstico se basa especialmente en la interpretación clínica, dirigiendo su enfoque terapéutico hacia la resolución sintomática. Se presenta un caso de una mujer de 17 años, con enfermedad de Lyme de reciente diagnóstico, de aparente evolución de 3 años, con diagnóstico previo de enfermedad desmielinizante, que consultó por deterioro neurológico. Se revisan consideraciones científicas sobre su aproximación clínica y principios terapéuticos, los cuales se contrastan con los aplicados.

SUMMARY Chronic Lyme syndrome represents a controversial term that groups together a set of persistent and nonspecific symptoms, mostly rheumatological and / or neurological, among which is the Post Lyme Disease, whose epidemiological incidence is low, pathophysiology is controversial and the diagnostic approach is based especially on clinical interpretation, directing its therapeutic approach towards symptomatic resolution. We present a case of a female patient of 17 years of age with Lyme disease of recent diagnosis of apparent evolution of 3 years, with previous diagnosis of demyelinating disease, who consulted for neurological deterioration. Scientific considerations on its clinical approach and therapeutic principles are reviewed, contrasting them with those applied.

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.

Passage of Borrelia burgdorferi through diverse Ixodid hard ticks causes distinct diseases: Lyme borreliosis and Baggio-Yoshinari syndrome

Baggio-Yoshinari syndrome is an emerging, tick-borne, infectious disease recently discovered in Brazil. This syndrome is similar to Lyme disease, which is common in the United States of America, Europe and Asia; however, Brazilian borreliosis diverges from the disease observed in the Northern Hemisphere in its epidemiological, microbiological, laboratory and clinical characteristics. Polymerase chain reaction procedures showed that Baggio-Yoshinari syndrome is caused by the Borrelia burgdorferi sensu stricto spirochete. This bacterium has not yet been isolated or cultured in adequate culture media. In Brazil, this zoonosis is transmitted to humans through the bite of Amblyomma and Rhipicephalus genera ticks; these vectors do not belong to the usual Lyme disease transmitters, which are members of the Ixodes ricinus complex. The adaptation of Borrelia burgdorferi to Brazilian vectors and reservoirs probably originated from spirochetes with atypical morphologies (cysts or cell-wall-deficient bacteria) exhibiting genetic adjustments, such as gene suppression. These particularities could explain the protracted survival of these bacteria in hosts, beyond the induction of a weak immune response and the emergence of serious reactive symptoms. The aim of the present report is to note differences between Baggio-Yoshinari syndrome and Lyme disease, to help health professionals recognize this exotic and neglected zoonosis.

Acerca de la enfermedad de Lyme en Cuba y su conocimiento en personal médico / About Lyme disease in Cuba and its knowledge by medical personnel

Introducción: La borreliosis de Lyme no ha sido notificada oficialmente en Cuba pero existen sospechas clínico-epidemiológicas y evidencias serológicas sugestivas de la infección por Borrelia burgdorferi sensu lato, su agente causal. Objetivo: Describir aspectos clínicos y epidemiológicos de pacientes que padecieron la enfermedad y explorar el nivel de conocimientos en personal médico. Métodos: Se realizó revisión documental de los Registros de Diagnóstico de la infección por B. burgdorferi sensu lato, entre 2007-2016, conservados en el Laboratorio Nacional de Referencia del Instituto de Medicina Tropical Pedro Kourí y se combinó con un estudio exploratorio del nivel de conocimientos sobre la enfermedad en personal médico. Resultados: Hubo incremento discreto en el número de muestras recepcionadas. El suero y el líquido cefalorraquídeo, fueron las muestras de elección para el diagnóstico, realizado por ensayos inmunoenzimáticos. Se confirmó la infección en 10,9 por ciento de las muestras de sueros recibidas. Las lesiones en piel, adenopatías regionales, parálisis faciales, dificultad para la marcha y otras, motivaron la sospecha clínica de esta enfermedad. Predominó el antecedente de picaduras por insectos o garrapatas. El 70 por ciento de los médicos encuestados plantearon conocer sobre la enfermedad de Lyme, pero de ellos solo el 46 por ciento reconoció al menos una de sus manifestaciones clínicas. Conclusiones: Los aspectos clínicos y epidemiológicos descritos, deben ser tomados en cuenta en pacientes con sintomatologías compatibles con la infección por B. burgdorferi sensu lato. Se requieren intervenciones educativas en el personal médico para un mejor reconocimiento clínico de esta entidad infecciosa y propiciar un mejor diagnóstico(AU)

Introduction: Lyme borreliosis has not been officially reported in Cuba but there are clinical-epidemiological suspicions and serological evidence that are suggestive of its causal agent: the infection by Borrelia burgdorferi sensu lato. Objective: To describe clinical and epidemiological aspects of patients who suffered from the disease and to explore the level of knowledge about it in medical personnel. Methods: A documentary review of the Diagnostic Records of B. burgdorferi sensu lato infection that are preserved in the National Reference Laboratory of Pedro Kourí Institute of Tropical Medicine was carried out from 2007 to 2016, and it was combined with an exploratory study of the knowledge´s level about the disease in medical personnel. Results: There was a slight increase in the number of samples received. Serum and cerebrospinal fluid were the samples chosen for a diagnosis that was performed by enzyme immunoassay. Infection was confirmed in 10.9 percent of the serum samples received. Skin lesions, regional lymphadenopathy, facial paralysis, difficulty for walking and others led to the clinical suspicion of this disease. It was predominant the antecedent of insect or tick bites. Seventy percent of the doctors surveyed said they knew about Lyme disease, but only 46 percent of them acknowledged at least one of its clinical manifestations. Conclusions: B. burgdorferi sensu lato infection should be taken into account in patients with symptoms compatible with Lyme disease. Educational interventions are required in the medical personnel for a better clinical recognition of this infectious entity and to promote a better diagnosis(AU)

Two Imported Cases of Babesiosis with Complication or Co-Infection with Lyme Disease in Republic of Korea

Babesiosis, caused by Babesia microti and B. divergens, is transmitted by Ixodid ticks. Symptoms of babesiosis vary from a mild flu-like illness to acute, severe, and sometimes fatal and fulminant disease. In Korea, 7 imported babesiosis cases and 1 endemic case have been reported. We report 2 cases of severe babesiosis initially mistaken as malaria. The first patient was complicated by shock and splenic infarction, the other co-infected with Lyme disease. As the population traveling abroad increases every year, physicians should be aware of babesiosis which mimics malaria, co-infection with other diseases, and its complications.

Optic neuritis and chorioretinitis as ocular manifestations of borreliosis in Brazil: three cases reported / Neurite óptica e coriorretinite como manifestações oculares da borreliose no Brasil: três casos relatados

Abstract Lyme disease is a systemic infection caused by a tick bite and transmission of the Borrelia burgdorferi spirochete. Species of tick vectors of the disease infest mainly wild or rural animals and rodents that may be asymptomatic reservoirs of the bacteria. Characteristic of the northern hemisphere, Lyme disease in Brazil takes on different characteristics, complicating diagnosis. This paper aims to describe three cases of Lyme-like disease in a city in the state of Bahia, Brazil, with ophthalmologic findings.

Resumo A doença de Lyme é uma infecção sistêmica causada pela picada do carrapato e transmissão da espiroqueta Borrelia burgdorferi. As espécies de carrapatos vetores da doença infestam, principalmente, animais silvestres, rurais e roedores que podem ser reservatórios assintomáticos da bactéria. Característica do hemisfério norte, a doença de Lyme no Brasil assume características distintas, dificultando seu diagnóstico. Esse trabalho tem por objetivo, descrever três casos da doença Lyme símile do Brasil, com achados oftalmológicos, em município do Estado da Bahia.

Lyme Disease and YouTubeTM: A Cross-Sectional Study of Video Contents

OBJECTIVES: Lyme disease is the most common tick-borne disease. People seek health information on Lyme disease from YouTube™ videos. In this study, we investigated if the contents of Lyme disease-related YouTube™ videos varied by their sources. METHODS: Most viewed English YouTube™ videos (n = 100) were identified and manually coded for contents and sources. RESULTS: Within the sample, 40 videos were consumer-generated, 31 were internet-based news, 16 were professional, and 13 were TV news. Compared with consumer-generated videos, TV news videos were more likely to mention celebrities (odds ratio [OR], 10.57; 95% confidence interval [CI], 2.13–52.58), prevention of Lyme disease through wearing protective clothing (OR, 5.63; 95% CI, 1.23–25.76), and spraying insecticides (OR, 7.71; 95% CI, 1.52–39.05). CONCLUSION: A majority of the most popular Lyme disease-related YouTube™ videos were not created by public health professionals. Responsible reporting and creative video-making facilitate Lyme disease education. Partnership with YouTube™ celebrities to co-develop educational videos may be a future direction.