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.

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.

Seroprevalence of Borrelia burgdorferi in occupationally exposed persons in the Belgrade area, Serbia

Lyme disease (LD) is a natural focal zoonotic disease caused by Borrelia burgdorferi, which is mainly transmitted through infected Ixodes ricinus tick bites. The presence and abundance of ticks in various habitats, the infectivity rate, as well as prolonged human exposure to ticks are factors that may affect the infection risk as well as the incidence of LD. In recent years, 20% to 25% of ticks infected with different borrelial species, as well as about 5,300 citizens with LD, have been registered in the Belgrade area. Many of the patients reported tick bites in city’s grassy areas. The aim of this study was to assess the seroprevalence of B. burgdorferi in high-risk groups (forestry workers and soldiers) in the Belgrade area, and to compare the results with healthy blood donors. A two-step algorithm consisting of ELISA and Western blot tests was used in the study. Immunoreactivity profiles were also compared between the groups. The results obtained showed the seroprevalence to be 11.76% in the group of forestry workers, 17.14% in the group of soldiers infected by tick bites and 8.57% in the population of healthy blood donors. The highest IgM reactivity was detected against the OspC protein, while IgG antibodies showed high reactivity against VlsE, p19, p41, OspC, OspA and p17. Further investigations in this field are necessary in humans and animals in order to improve protective and preventive measures against LD.

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.

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.

Búsqueda de la espiroqueta borrelia burgdorferi sensu lato mediante PCR en garrapatas ixoideas chilenas silvestres / Search for the spirochete borrelia burgdorferi senso lato by polymerase chain reaction in Chilean ticks

Background: Lyme disease is a tick-borne human disease caused by the spirochete Borrelia burgdorferi. Main vectors of Lyme disease are ticks of the Ixodes and Amblyomma genera. Cases with clinical manifestations of Lyme disease and favorable responses to antimicrobial agents have been reported in Chile, some of them with erythema migrans, the hallmark of B burgdorferi infection. Aim: To detect the presence of B burgdorferi in Chilean ticks. Material and methods : A total of 62 ticks were recollected from wild rodents and cervidae in the Southern region of Chile. Infected and non infected ticks of the species Ixodes ricimus, were used as controls. Insects were homogenised and B burgdorferi was detected using classical and nested polymerase chain reactions. Results : B burgdorferi was not detected in the studied ticks. Conclusions: Although all the elements required for the enzootic cycle of B burgdorferi are present in Chile, its direct detection in Chilean ticks using the nested polymerase chain reaction assay was negative

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.

Borrelioses, agentes e vetores / Borrelioses, agents and vectors: a review

As borrelioses säo enfermidades infecciosas determinadas por espiroquetas do gênero Borrelia, agentes transmissíveis, principalmente, por carrapatos aos animais e/ou ao homem. Nesta revisäo säo apresentadas e discutidas as enfermidades determinadas por borrélias, bem como as características gerais das espiroquetas, os aspectos relacionados a transmissäo por artrópodes, as enfermidades nos animais domésticos e silvestres, quanto aos aspectos biológicos e patológicos, a doença de Lyme como principal zoonose do grupo, a associaçäo de borrélia com outros agentes hematozoários e os métodos diagnósticos e a epidemiologia comparativa entre dados obtidos no Brasil com os de outros países. Estas borrelioses possuem características patológicas, clínicas e epidemiológicas variadas de acordo à regiäo fisiográfica, devido à existência de distintas espécies, genoespécies e cepas; estes aspectos variam ainda em funçäo dos artrópodes vetores, da interaçäo vetor-patógeno e dos ecossistemas distintos.

Contribuicao ao conhecimento da borreliose de Lyme no Brasil / Contribution to the knowledge of Lyme borreliosis in Brazil

Entre 1989 a 1995 identificamos 25 casos de borreliose de Lyme confirmados pela sorologia no Brasil. Trata-se de zoonose causada pela espiroqueta Borrelia burgdorferi e transmitida pela picada de carrapatos Ixodideos. Pacientes contrairam a enfermidade visitando litoral ou zonas rurais, e aproximadamente 50 por cento dos casos tiveram contacto com carrapatos. O aspecto distintivo da enfermidade e a presenca do eritema migratorio. A borreliose no Brasil pode cursar de diferentes modos, podendo simular quadro gripal, doencas reumatologicas como artralgias, artrites ou fadiga cronica e queixas neurologicas como neurites cranianas ou perifericas e encefalite (agitacao, depressao, disturbios de sono e comportamento)

Estudo epidemiologico da doenca de Lyme no Brasil / Epidemiological study of Lyme's disease in Brazil

A doenca de Lyme, uma espiroquetose transmitida por carrapatos, foi inicialmente relatada nos Estados Unidos da America em 1977, por Allen C. Steere, que descreveu a doenca no estado de Conecticut. Posteriormente, seguiu-se relatos da doenca nao somente em outros estados americanos, bem como em outros paises e continentes, como Canada, Uniao Sovietica, Japao, China, Australia e no Leste Europeu. Com o intuito de se realizar a pesquisa desta doenca no Brasil criou-se uma equipe multidisciplinar para realizacao deste projeto com a participacao de microbiologistas, entomologistas e clinicos da area reumatologica, pertencentes ao quadro da Universidade de Sao Paulo. O presente trabalho tem por objetivo descrever a elaboracao e a evolucao e uma infraestrutura para esta pesquisa, incluindo montagem de laboratorios para pesquisa imunologica, sorologica e cultura para borrelias, cooperacao com diferentes instituicoes nacionais de saude, elaboracao de pesquisa de campo, bem como mostrar os resultados preliminares encontrados por esta equipe.