First serological detection of Borrelia spp. in dogs in western Cuba / Primeira detecção sorológica de Borrelia spp. em cães na região oeste de Cuba

Abstract This study aimed to verify the presence of IgG antibodies against Borrelia burgdorferi sensu lato (s.l) in domestic dogs in western Cuba. Serum samples were analyzed by indirect enzyme-linked immunosorbent assay (ELISA), using crude antigens of a B. burgdorferi strain of North American origin. To verify the presence of Borrelia spp., deoxyribonucleic acid (DNA) extracted from individual blood samples was analyzed by nested-PCR, with markers targeted for amplification of portions of the flagellin B gene (flaB) present in Borrelia spirochetes. Ticks were also collected through inspection of the animals. Sera from 93 of 176 (52.84%) dogs were reactive to the indirect ELISA. Geographic prevalence varied from 54.35% (25/46) in Boyeros, 44.44% (20/45) in Cotorro, 66.67% (22/33) in Habana del Este, and 50% (26/52) in San José de las Lajas. There was no statistical difference between these tested variables. No blood samples analyzed were positive for the Borrelia flaB gene.

Resumo Este estudo teve como objetivo confirmar a presença de anticorpos IgG contra Borrelia burgdorferi sensu lato (s.l) em cães na região oeste de Cuba. As amostras de soro foram analisadas por ensaio de imunoabsorção enzimática (ELISA) indireto, usando-se antígenos brutos de uma cepa de B. burgdorferi de origem norte-americana. Para confirmar a presença de Borrelia spp., o ácido desoxirribonucleico (DNA), extraído de amostras individuais de sangue, foi analisado por PCR, utilizando-se marcadores direcionados para a amplificação de porções do gene da flagelina B (flaB) presente nas espiroquetas de Borrelia. Os carrapatos também foram coletados através da inspeção dos animais. Os soros de 93 de 176 (52,84%) cães foram reativos ao ELISA indireto. A prevalência geográfica variou de 54,35% (25/46) em Boyeros, 44,44% (20/45) em Cotorro, 66,67% (22/33) em Habana del Este e 50% (26/52) em San José de las Lajas. Não houve diferença estatística entre essas variáveis testadas. Nenhuma amostra de sangue analisada foi positiva para o gene Borrelia flaB.

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: 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.

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)

Brazilian borreliosis with special emphasis on humans and horses

Abstract Borreliosis caused by Borrelia burgdorferi sensu lato is a cosmopolitan zoonosis studied worldwide; it is called Lyme disease in many countries of the Northern Hemisphere and Lyme-like or Baggio-Yoshinari Syndrome in Brazil. However, despite the increasing number of suspect cases, this disease is still neglected in Brazil by the medical and veterinary communities. Brazilian Lyme-like borreliosis likely involves capybaras as reservoirs and Amblyomma and Rhipicephalus ticks as vectors. Thus, domestic animals can serve as key carriers in pathogen dissemination. This zoonosis has been little studied in horses in Brazil. The first survey was performed in the state of Rio de Janeiro, and this Brazilian Borreliosis exhibits many differences from the disease widely described in the Northern Hemisphere. The etiological agent shows different morphological and genetic characteristics, the disease has a higher recurrence rate after treatment with antibiotics, and the pathogen stimulates intense symptoms such as a broader immune response in humans. Additionally, the Brazilian zoonosis is not transmitted by the Ixodes ricinus complex. With respect to clinical manifestations, Baggio-Yoshinari Syndrome has been reported to cause neurological, cardiac, ophthalmic, muscle, and joint alterations in humans. These symptoms can possibly occur in horses. Here, we present a current panel of studies involving the disease in humans and equines, particularly in Brazil.

Lyme disease in Haryana, India.

Lyme disease is a multiorgan animal‑borne disease caused by the spirochete Borrelia burgdorferi. This case series highlights its presence in Haryana, a nonendemic zone. The first case was a 27‑year‑old housewife who presented with an annular erythematous patch with a central papule following an insect bite on the left upper arm. The second case was a 32‑year‑old farmer who gave a history of insect bite on the right arm followed by the development of an erythematous patch with a central blister. The third case, a 17‑year‑old boy presented with a history of tick bite over right thigh and a typical bull’s eye lesion with central ulceration. These cases were managed with oral doxycycline 100 mg twice daily for 14 days. The fourth case was a 7‑year‑old boy with typical erythema migrans on the right check and neck while the fifth case, a 30‑year‑old housewife, presented with an erythematous patch with a central papule on the right buttock. These patients were treated with oral amoxycillin 25 mg/kg, thrice daily for 14 days. All patients showed IgM antibodies to B. burgdorferi. Treatment led to clearance of lesions in all the patients. Lyme borreliosis was diagnosed in these patients based on the history of established exposure to tick bites, presence of classic signs and symptoms, serology and the response to treatment.

Evidence of Borrelia in wild and domestic mammals from the state of Minas Gerais, Brazil / Evidência de Borrelia em mamíferos silvestres e domésticos no Estado de Minas Gerais, Brasil

The main of the study was to evaluate the presence of Borrelia burgdorferi infection in domestic and wild vertebrates and ectoparasites in endemic areas from the state of Minas Gerais, Brazil. A total of 445 serum samples were examined by ELISA, which used the Borrelia burgdorferi strain G39/40 U.S. source and 3,821 tick samples were tested by polymerase chain reaction (PCR). B. burgdorferi antibodies were found in 30 serum samples (6.74%); three in marsupials (7.69%), three in rodents (2.80%), nine in dogs (6.25%), and 15 in horses (9.68%). Nested-PCR performed in DNA samples obtained from collected ticks demonstrated negative results. Although attempts to amplify B. burgdorferi DNA from ticks had been not successful, the presence of seroreactive vertebrates suggests the possibility the Borrelia species circulating in these regions. Further research is required to provide information on the presence of Borrelia in Brazilian territory and its association with Baggio-Yoshinari syndrome.

O principal objetivo do estudo foi avaliar a presença de infecção por Borrelia burgdorferi em vertebrados domésticos e silvestres e ectoparasitas em áreas endêmicas do estado de Minas Gerais, Brasil. Um total de 445 amostras de soro foram examinadas por ELISA, onde usou-se a cepa americana G39/40 de Borrelia burgdorferi e 3.821 amostras de carrapatos foram testados pela reação em cadeia da polimerase (PCR). Anticorpos anti -B. burgdorferi foram encontrados em 30 amostras de soro (6,74%); três marsupiais (7,69%), três em roedores (2,80%), em nove cães (6,25%) e 15 em cavalos (9,68%). Nested-PCR realizada em amostras de DNA obtidas a partir de carrapatos coletados demonstraram resultados negativos. Apesar das tentativas para amplificar o DNA de B. burgdorferi a partir de carrapatos não tenha sido bem sucedido, a presença de soroatividade em vertebrados sugere a possibilidade de espécies de Borrelia circulando nestas regiões. Mais pesquisas são necessárias para fornecer informações sobre a presença de Borrelia em território brasileiro e sua associação com a Síndrome de Baggio-Yoshinari.

Meningoencefalite linfomonocitária crônica, oligoartrite e eritema nodoso: relato de síndrome de Baggio-Yoshinari de longa e recorrente evolução / Chronic lymphomonocytic meningoencephalitis, oligoarthritis and erythema nodosum: report of Baggio-Yoshinari syndrome of long and relapsing evolution

A borreliose humana brasileira, também conhecida como Síndrome de Baggio-Yoshinari (SBY), é uma enfermidade infecciosa própria do território brasileiro, transmitida por carrapatos não pertencentes ao complexo Ixodes ricinus, causada por espiroqueta do gênero Borrelia e que apresenta semelhanças clínicas e laboratoriais com a Doença de Lyme (DL). A SBY distingue-se da DL por apresentar evolução clínica prolongada, com episódios de recorrência e importante disfunção autoimune. Descreveremos o caso de uma paciente jovem, que desenvolveu progressivamente durante cerca de um ano oligoartrite de grandes articulações, seguida de distúrbio do cognitivo, meningoencefalite e eritema nodoso. O diagnóstico foi firmado devido à concomitância de queixas articulares e neurológicas com sorologia positiva para Borrelia burgdorferi sensu stricto. A paciente foi medicada com ceftriaxone 2 g/EV/dia por 30 dias, seguido de dois meses de doxiciclina 100 mg duas vezes ao dia. Houve remissão dos sintomas e normalização dos exames sorológicos para a borreliose. A SBY é uma zoonose emergente descrita apenas no Brasil, cuja frequência tem crescido bastante, e que, em razão das importantes diferenças nos aspectos epidemiológicos, clínicos e laboratoriais em relação à DL, merece especial atenção da classe médica do país. Trata-se de zoonose camuflada e de difícil diagnóstico, mas este deve ser perseguido com tenacidade, pois a enfermidade responde aos antibióticos no estágio inicial, podendo evoluir com sequelas neurológicas e articulares nos casos reconhecidos tardiamente ou recorrentes.

The Brazilian human borreliosis, also known as Baggio-Yoshinari Syndrome (BYS), is a tickborne disease but whose ticks do not pertain to the Ixodes ricinus complex. It is caused by Borrelia burgdorferi sensu lato microorganisms and resembles clinical and laboratory features of Lyme disease (LD). BYS is also distinguished from LD by its prolonged clinical evolution, with relapsing episodes and autoimmune dysfunction. We describe the case of a young female who, over one year, progressively presented with oligoarthritis, cognitive impairment, menigoencephalitis and erythema nodosum. Diagnosis was established by means of the clinical history and a positive serology to Borrelia burgdorferi sensu strictu. The patient received Ceftriaxone 2 g IV/day during 30 days, followed by 2 months of doxicycline 100 mg bid. Symptoms remitted and the Borrelia serology tests returned to normality. BYS is a new disease described only in Brazil, which has a raising frequency and deserves the attention from the country´s medical board because of clinical, epidemiological and laboratory differences from LD. Despite the fact that it is a hard-to-diagnose zoonosis, it is important to pursuit an early diagnosis because the symptoms respond well to antibiotics or it might be resistant to treatment and may evolve to a chronic phase with both articular and neurological sequelae.

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.

Lyme disease in the state of Tocantins, Brazil: report of the first cases

Lyme disease is an underdiagnosed zoonosis in Brazil. There are no cases registered in the state of Tocantins, the newest Brazilian state. The cases of three patients in contact with rural areas in three Tocantins' districts are herein described, and the Brazilian literature is reviewed.

Prevalence of antibodies to Borrelia burgdorferi sensu stricto in humans from a Cuban village

Lyme disease has not been officially reported in Cuba. However, clinical cases have been serologically reported. Seroprevalence survey of Borrelia burgdorferi sensu stricto antibodies in humans in the country has not been conducted. OBJECTIVE: To estimate the prevalence of borrelial antibodies in inhabitants of a village with historically high level of tick infestation. METHODS: Serum specimens from 247 persons randomly selected from the population of the village were examined by IgG Western blot using B31 strain for estimating the prevalence of antibodies profile. RESULTS: A seroprevalence value interval (95 percent CI) of 0.6 percent-7.2 percent was estimated for the studied population. The prevalent borrelial protein bands on immunoblots were 41, 72, 90/93, 34, 47, 60, 58, 56, 65/66 and 31 kDa in a decreasing order of significance. CONCLUSION: These results support the previous serological findings, suggesting the presence of this borreliosis in Cuba.

Enfermedad de Lyme, una entidad a tener en cuenta / Lyme’s disease, a disease to be concerned with

La enfermedad de Lyme es causada por la bacteria Borrelia burgdorferi. Ciertas garrapatas son portadoras de esas bacterias y las adquieren cuando pican a ratones o venados infectados con la enfermedad. Actualmente se ha informado de casos en la mayor parte de los Estados Unidos. A continuación se presenta el caso de un paciente con enfermedad de Lyme inmunológicamente confirmado con IgM positiva contra Borrelia burgdorferi, con eritema característico en escarapela que cubre el hombro izquierdo.

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.

Doença de lyme-símile brasileira ou síndrome baggioyoshinari: zoonose exótica e emergente transmitida por carrapatos: [revisão] / Brazilian lyme-like disease or baggio-yoshinari syndrome: exotic and emerging brazilian tick-borne zoonosis: [review]

A Doença de Lyme (DL) é uma zoonose frequente no hemisfério Norte e considerada uma enfermidade infecciosa causada por espiroquetas do complexo Borrelia burgdorferi sensu lato e transmitida pela picada de carrapatos do grupo Ixodes ricinus. Os primeiros casos semelhantes à DL no Brasil foram descobertos, em 1992, em irmãos que após serem picados por carrapatos desenvolveram eritema migratório, sintomas gripais e artrite. Criteriosa análise da casuística brasileira, mostrou que os aspectos epidemiológicos, clínicos e laboratoriais no país, divergiam bastante dos exibidos pelos pacientes com DL nos Estados Unidos da América e Eurásia. Não foram encontrados carrapatos do complexo Ixodes ricinus hematófago ao homem nas áreas de risco; a enfermidade no país é recorrente; a Borrelia burgdorferi jamais foi isolada no Brasil e os ensaios sorológicos específicos exibem positividade baixa e oscilante. Além disso, o exame do sangue periférico dos pacientes quando analisados à microscopia eletrônica exibe estruturas sugestivas de Mycoplasma spp, Chlamydia spp e bacteroides. Na verdade, estas estruturas podem representar as formas latentes das espiroquetas (forma L ou bactérias desprovidas de parede), adaptadas a sobreviver em condições inóspitas em hospedeiros vertebrados e invertebrados. Assim, a zoonose presente no país recebeu a denominação de Síndrome Baggio-Yoshinari e definida como: "Enfermidade infecciosa nova e emergente brasileira, transmitida por carrapatos não pertencentes ao complexo Ixodes ricinus, causada por espiroquetas na sua morfologia atípica e latente, que origina manifestações clínicas semelhantes às observadas na DL, exceto pela ocorrência de recidivas clínicas e desordens autoimunes".

Lyme disease (LD) is a frequent zoonosis found in the Northern Hemisphere and is considered an infectious disease caused by spirochetes belonging sensu lato to the Borrelia burgdorferi complex transmitted by ticks of the Ixodes ricinus group. In 1992, first cases similar to LD were described in Brazil, when brothers, after a tick bite episode developed symptoms , as erythema migrans, general flu-like symptoms and arthritis. Careful analysis of Brazilian LD-like illness casuistry showed that epidemiological, clinical and laboratorial features in the country were very different from those exhibited by North American and Eurasian LD patients. Human blood-suckers Ixodes ricinus complex ticks were absent at risk areas; the disease is recurrent in the country; Borrelia burgdorferi was never isolated in Brazil and specific serologic tests have shown little positivity with inconsistent results. Furthermore, peripheral blood analysis of patients on electron microscopy exhibited structures resembling Mycoplasma spp, Chlamydia spp and spirochete-like microorganisms. In fact, they were assumed to be latent forms of spirochetes (L form or cell wall deficient bacteria) adapted to survive at inhospitable conditions in vertebrate and invertebrate hosts. For these reasons, the Brazilian zoonosis was named Baggio-Yoshinari Syndrome (BYS) and defined as: "Exotic and emerging Brazilian infectious disease, transmitted by ticks not belonging to the Ixodes ricinus complex, caused by latent spirochetes with atypical morphology, which originates LD-like symptoms, except for occurrence of relapsing episodes and auto-immune disorders".

Implicações clínicas da doença de Lyme em região facial: revisão da literatura / Clinical implications of the disease of Lyme in facial area: literature revision: literature review

Doença de Lyme (DL) é uma alteração inflamatória sistêmica resultante da ação direta e da resposta imune à espiroqueta Borrelia burgdoferi transmitida pela inoculação na corrente circulatória por carrapato do gênero Ixodes, sendo mais comumente encontrada na América do Norte, Europa e Ásia. Essa enfermidade pode levar a manifestações neurológicas periféricas e faciais, tais como paralisia de Bell, alterações oftalmológicas, desordens na articulação temporo-mandibular além de parestesia de nervos alveolares superiores e inferiores. No Brasil, o diagnóstico da DL é primeiramente baseado na apresentação clínica, com o eritema migrans cutâneo, e informações epidemiológicas do paciente. O reconhecimento das primeiras manifestações da DL por profissionais de saúde é essencial para o correto tratamento antibiótico impedindo a progressão da doença, sendo também relevante orientações preventivas para aqueles que vivem ou trabalham em áreas endêmicas.

Lyme disease (LD) is a systemic inflammatory changes resulting from direct action and the immune response to the spirochete Borrelia burgdoferi transmitted by inoculation of the flow of the genus Ixodes tick and is most commonly found in North America, Europe and Asia. This disease can lead to facial and peripheral neurological manifestations, such as Bell’s palsy, eye changes, disorders in the temporo-mandibular joint in addition to paresthesia of superior and inferior alveolar nerves. In Brazil, the diagnosis of LD is primarily based on clinical presentation, the erythema migrans skin, and epidemiological information of the patient. Recognition of the onset of the DL by health professionals is essential for the correct antibiotic treatment preventing the progression of the disease, and also relevant preventive guidelines for those living or working in endemic areas.

Características clínico-epidemiológicas da doença Lyme-símile em crianças / Epidemiological characteristics of Lyme-like disease in children

OBJETIVO: Determinar a prevalência, distribuição etária, sazonalidade, características clínicas da doença Lyme-símile em menores de 15 anos. MÉTODOS: De julho/1998 a dezembro/2000 foi conduzido um estudo transversal em 333 pacientes, com exantema e febre. Foram coletadas amostras pareadas de sangue para a identificação de patógenos. Somente em 193 amostras, negativas aos outros patógenos (Parvovirus B19, Herpesvírus 6 humano, Sarampo, Rubéola, Dengue, Escarlatina e Enterovírus), foram realizadas a pesquisa da borreliose pelos métodos de Enzyme-Linked Immunosorbent Assay e Western-blotting. Outras variáveis clínicas, socioeconômicas, demográficas e climáticas foram estudadas. RESULTADOS: A prevalência da doença foi de 6,2 por cento(12/193). Das variáveis estudadas, houve predomínio em <6anos(83,2 por cento); sexo feminino (66,7 por cento); procedência da cidade de Franco da Rocha (58,3 por cento); com sazonalidade no outono-verão. O intervalo de atendimento foi de quatro dias. Sinais e sintomas com significância estatística: prurido, ausência da fissura labial e bom estado clínico. Outros dados presentes foram: irritabilidade (80 por cento); febre (?38ºC) (58,3 por cento) com duração de um a três dias. O exantema foi do tipo máculo-papular (33,3 por cento), urticariforme (25 por cento) e escarlatiniforme (16,7 por cento); predominando em tronco (60 por cento). Não houve apresentação clínica característica para diagnóstico da doença de Lyme-símile nestes pacientes. A sensibilidade e especificidade para o diagnóstico clínico contraposta com o diagnóstico laboratorial foi zero. O acompanhamento de 10 casos durante dois anos não evidenciou complicações cardiológicas ou neurológicas. Este é o primeiro estudo desta doença em crianças brasileiras. CONCLUSÃO: A prevalência da doença Lyme-símile foi baixa, não tendo sido lembrada no diagnóstico inicial dos exantemas, mas seu conhecimento é necessário, necessitando maior atenção médica.

BACKGROUND: To determine the prevalence, age distribution, seasonality and clinical characteristics of Lyme-simile disease in Brazilians less than 15 years of age. METHODS. From July, 1998 to November, 2000, a cross-sectional study was conducted in 333 patients with skin rash and fever. Paired blood samples were collected for identification of the pathogens. Only 193 samples which were negative for other pathogens (Parvovirus B19 Human, Herpesvirus 6 Human, Measles, Rubella, Dengue, Scarlet fever and Enterovirus), were tested for borreliosis by Enzyme-Linked Immunosorbent Assay and Western-blotting. Other clinical, socioeconomic, demographic and climatic variables were studied. RESULTS: Prevalence of the disease was 6.2 percent(12/193). Of the variables studied, there was predominance in: <6 years old (83.2 percent); females (66.7 percent); being from the city of Franco da Rocha (58.3 percent); and a summer/fall seasonality. The duration of care was 4 days. Signs and symptoms with statistical significance were itching; absence of lip notch and ocular pain; irritability and good clinical condition. Other clinical data presented were: pruritus (90 percent), irritability (80 percent) and fever (?38ºC) (58.3 percent) with a duration of 1 to 3 days. Erythema was maculo-papular (40 percent), urticaria-like (25 percent) and scarlatiniform (16.7 percent), occurring predominately on the trunk (60 percent). There were no primary clinical evidences of Lyme-simile disease in the patients under study. The sensitivity and specificity of the clinical diagnosis as opposed to the laboratory diagnosis was zero. There was no initial clinical suspicion of the disease in the 10 cases studied and followed up for two years that showed no evidence of cardiologic or neurological complications. This is the first study of Lyme-simile in Brazilian children. CONCLUSION: Prevalence of Lyme-simile disease was low, and it was not remembered at the initial diagnosis ...