Innate and Th1/Th17 adaptive immunity in acute and convalescent Brazilian borreliosis disease

ABSTRACT Introduction: Brazilian borreliosis (BB) disease is an infectious disease transmitted by ticks that mimics Lyme disease (LD) from the Northern Hemisphere. The BB clinical picture is characterized by a pathognomonic skin lesion (migratory erythema) and joint, neurological, cardiac and psychiatric symptoms. Innate and Th1/Th17 adaptive immunity seem to play an important role in the pathogenesis of Lyme disease. Objective: The aim of this study was to characterize the role of innate and Th1/Th17 adaptive immunity in BB patients with acute (<3 months) and convalescent (>3 months) disease. Methods: Fifty BB patients (28 with acute and 22 with convalescent disease) without treatment and 30 healthy subjects were evaluated. Levels of 20 cytokines or chemokines associated with innate and Th1/Th17 adaptive immunity were analyzed using Luminex (Millipore Corp., Billerica, MA). Results: Overall, BB patients had increased levels of IL-8 (6.29 vs 2.12 p = 0.002) and MIP-1α/CCL3 (5.20 vs 2.06, p = 0.030), associated with innate immunity, and MIP3B/CCL19 (Th1; 297.86 vs 212.41, p = 0.031) and IL-17A (Th17; 3.11 vs 2.20, p = 0.037), associated with adaptive immunity, compared with the levels of healthy controls. When comparing acute BB vs. convalescent BB subjects vs. healthy controls, IL-1β, IL-8 and MIP-1α/CCL3 (innate mediators) levels were highest in patients in the acute phase of disease (p < 0.05). TNF-α was associated with disseminated symptoms and with humoral reactivity against Borrelia burgdorferi. IL-10 was significantly correlated with IL-6 (r = 0.59, p = 0.003), IL-8 (r = 0.51, p < 0.001), MIP-1α/CCL3 (r = 0.42, p < 0.001) and MIP-3β/CCL19 (r = 0.40, p = 0.002) in all BB patients. Conclusions: This is the first study describing that innate and Th1/Th17 adaptive immunity play a crucial role in BB disease. Furthermore, innate mediators are particularly important in acute BB disease, and TNF-α is associated with evolution of BB symptoms.

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.

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.

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.

Evaluation of Six Recombinant Proteins for Serological Diagnosis of Lyme Borreliosis in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>In this study, we evaluated the diagnostic efficiency of six recombinant proteins for the serodiagnosis of Lyme borreliosis (LB) and screened out the appropriate antigens to support the production of a Chinese clinical ELISA (enzyme-linked immunosorbent assay) kit for LB.</p><p><b>METHODS</b>Six recombinant antigens, Fla B.g, OspC B.a, OspC B.g, P39 B.g, P83 B.g, and VlsE B.a, were used for ELISA to detect serum antibodies in LB, syphilis, and healthy controls. The ELISA results were used to generate receiver operating characteristic (ROC) curves, and the sensitivity and specificity of each protein was evaluated. All recombinant proteins were evaluated and screened by using logistic regression models.</p><p><b>RESULTS</b>Two IgG (VlsE and OspC B.g) and two IgM (OspC B.g and OspC B.a) antigens were left by the logistic regression model screened. VlsE had the highest specificity for syphilis samples in the IgG test (87.7%, P<0.05). OspC B.g had the highest diagnostic value in the IgM test (AUC=0.871). Interactive effects between OspC B.a and Fla B.g could reduce the specificity of the ELISA.</p><p><b>CONCLUSION</b>Three recombinant antigens, OspC B.g, OspC B.a, and VlsE B.a, were useful for ELISAs of LB. Additionally, the interaction between OspC B.a and Fla B.g should be examined in future research.</p>

Borrelia burgdorferi sensu lato in humans in a rural area of Paraná State, Brazil

This study describes the detection of Borrelia garinii and Borrelia burgdorferi sensu stricto (s.s.) in Brazilian individuals using PCR and DNA sequencing. Our results suggest that these species are emerging pathogens in this country, and additional studies are necessary to determine the epidemiological characteristics of this disease in Brazil.

First report of canine borreliosis seroprevalence in a middle-altitude tropical urban area (Medellín-Colombia) / Primer reporte de seroprevalencia de borreliosis canina en una ciudad localizada en una altitud media en la región tropical (Medellín, Colombia) / Primeiro relato de soroprevalência de borreliose canina em uma cidade localizada a uma altitude média na região tropical (Medellín, Colombia)

Anamnesis: A one year old French Bulldog male, affected by gastrointestinal symptoms and abdominal pain, with no response to the established therapeutic schedule was attended. Clinical and laboratory findings: The most significant finding was thrombocytopenia and seropositive for Borrelia burgdorferi by IDEXX 4S Snap test. Treatment approach: treatment was established with tetracycline and doxycycline. Eight months later the dog showed signs of polyarthritis and received a second antibiotic treatment with remission of the disease and sero-reversion. Conclusions: This case is of epidemiological relevance because it is the first time canine borreliosis is evidenced by serology in dogs from an urban setting, suggesting the disease is moving on toward middle altitude and urban areas. Clinical signs and treatment schedule are reviewed.

Anamnesis: un perro de la raza Bulldog francés de un año de edad, fue llevado a consulta por tener síntomas gastrointestinales, sin respuesta al tratamiento previo. Hallazgos clínicos y de laboratorio: el perro presentó trombocitopenia y serología positiva a Borrelia burgdorferi por IDEXX 4S Snap test. Tratamiento: El tratamiento se instauró con tetraclina y doxiciclina. A los 8 meses el perro mostró poliartritis y continuaba seropositivo, por lo cual recibió un segundo esquema con antibióticos que resulto en remisión de los signos y serorreversión. Conclusiones: este caso es de relevancia epidemiológica por ser la primera vez que se diagnostica la borreliosis canina en un área rural por serología, lo que sugiere que la enfermedad se puede estar desplazando hacia centros urbanos y mayores altitudes. En la discusión se revisan los signos clínicos y el esquema de tratamiento de la enfermedad en caninos.

História: A consulta foi realizada a cão do raça buldogue francês de um ano, ter sintomas gastrointestinais, sem resposta ao tratamento anterior. Os achados clínicos e laboratoriais: o cão tem trombocitopenia e sorologia positiva para Borrelia burgdorferi pelo IDEXX 4S Snap test. Tratamento: o tratamento foi iniciado com tetraciclina e doxiciclina. Aos 8 meses, o cão tem artrite e manteve-se soropositivo, pelo qual recebeu um segundo esquema de antibiótico o que resultou em remissão dos sinais e sero-reversão. Conclusões: neste caso, é de importância epidemiológica por ser o primeiro borreliose canina diagnosticado sorologicamente em uma área rural, o que sugere que a doença está se deslocando para os centros urbanos e as altitudes mais elevadas. Na seção de discussão dos sinais clínicos e esquema de tratamento da doença em cães são tratados.

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.

Actualización acerca de Borrelia burgdorferi sensu lato y enfermedad de Lyme / Update on Borrelia burgdorferi sensu lato and Lyme disease

Introducción: Borrelia burgdorferi sensu lato es el agente etiológico de la enfermedad de Lyme, zoonosis emergente de difícil diagnóstico, prevención y control, reportada fundamentalmente en el hemisferio norte. Objetivo: facilitar información actualizada acerca de Borrelia burgdorferi. Métodos: se realizó una revisión de la literatura científica y especializada sobre los principales aspectos relacionados con este agente y su enfermedad; como son las características de las borrelias y el ciclo de vida, epidemiología, manifestaciones clínicas en humanos, diagnóstico de laboratorio, definición actual de caso, tratamiento, profilaxis, prevención y control. Resultados: se expone información actualizada y valiosa sobre los temas seleccionados, útil para el personal interesado en las enfermedades infecciosas transmitidas por vectores. Se muestra además información sobre los estudios realizados en Cuba. Conclusiones: se aporta información de utilidad para el manejo epidemiológico, clínico y microbiológico de casos con sospechas de la infección por Borrelia burgdorferi sensu lato

Introduction: Borrelia burgdorferi sensu lato is the causative agent of Lyme disease, an emerging zoonosis, whose diagnosis, prevention and control are difficult and it is mainly reported in the northern hemisphere. Objective: to provide updated information about Borrelia burgdorferi. Methods: a review of scientific and specialized literature on the key aspects of this agent and the disease such as characteristics and life cycle of borrelias, epidemiology, clinical manifestations in humans, laboratory diagnosis, current case definition, treatment, prophylaxis, prevention and control. Results: current valuable information on selected items was set forth, which is useful for the personnel involved in vector-borne infectious diseases. Additionally, information about studies conducted in Cuba was provided. Conclusions: this paper offers updated information for the epidemiological, clinical and microbiological management of suspected cases of infection with Borrelia burgdorferi sensu lato

Borrelia burgdorferi em cão errante da região noroeste do estado do paraná - relato de caso / Borrelia burgdorferi en perro callejero de la región noroeste del estado de paraná - relato de caso / Borrelia burgdorferi in stray dog the northwest region of the state of paraná - case report

A doença de Lyme é uma enfermidade infecciosa, sistêmica e cosmopolita que acomete diferentes espécies de animais domésticos, silvestres e também o homem. É transmitida por carrapatos sendo provocada pela infecção de bactérias do complexo Borrelia burgdorferi do complexo sensu lato (s.l.). A transmissão das borrélias para o carrapato pode ocorrer de forma transovariana e/ou transestadial e a transmissão no hospedeiro ocorre pela saliva infectada. Os cães são importantes reservatórios de Borrelia burgdorferi, podendo ser isoladas espiroquetas de animais clinicamente sadios. O objetivo deste trabalho foi relatar a presença de anticorpos anti-Borrelia burgdorferi em um cão errante assintomático da região noroeste do estado do Paraná. Foi coletado sangue pela punção da veia jugular externa de um cão que possuía carrapatos fixados no corpo albergado em um abrigo privado localizado na região noroeste do estado do Paraná. Para a pesquisa de anticorpos anti-Borrelia burgdorferi do complexo sensu lato a amostra de soro foi submetida à imunofluorescência indireta (IFI). O resultado demonstrou a presença de anticorpos anti-Borrelia burgdorferi, o que sugere a presença da borreliose de Lyme nesse cão errante e possivelmente a circulação do agente etiológico no referido local.

Lyme disease is an infectious, systemic and cosmopolitan disease affecting different species of domestic and wild animals, as well as humans. It is a tick-borne infection caused by bacteria of the Borrelia burgdorferi of the sensu lato (sl) complex. The transmission of borrelias to the tick may occur by transovarian and/or transestadial route, and the transmission to the host occurs by infected saliva. Dogs are important reservoirs of Borrelia burgdorferi, and spirochetes can be isolated from clinically healthy animals. The aim of this study is to report the presence of anti-Borrelia burgdorferi antibodies in an asymptomatic stray dog in the Northwestern state of Parana. Blood was collected by puncture of the jugular vein of a dog that had ticks attached to its body housed in a private shelter located in the Northwestern region of the state of Parana. For the detection of anti-Borrelia burgdorferi antibodies of the sensu lato complex, the serum sample was subjected to indirect immunofluorescence (IIF). The result showed the presence of anti-Borrelia burgdorferi antibodies suggesting the presence of Lyme disease in the dog and possibly errant movement of the etiologic agent in that location.

La enfermedad de Lyme es infecciosa, sistémica y cosmopolita, que acomete diferentes especies de animales domésticos, silvestres y también el hombre. Es transmitida por garrapatas, siendo provocada por la infección de bacterias del complexo Borrelia burgdorferi del complexo sensu lato (s.1.). La transmisión de las borrelias en la garrapata puede ocurrir de forma transovarial y/o transestadial, y la transmisión ocurre en el hospedero por la saliva infectada. Los perros son importantes reservatorios de Borrelia burgdorferi, pudiendo ser aisladas espiroquetas de animales clínicamente sanos. El objetivo de este estudio fue relatar la presencia de anticuerpos anti-Borrelia burgdorferi en un perro callejero asintomático de la región noroeste del estado de Paraná. Se recolectó sangre por punción de la vena yugular externa de un perro que tenía garrapatas fijadas en el cuerpo, en un abrigo privado localizado en la región noroeste del estado de Paraná. Para la investigación de anticuerpos anti-Borrelia burgdorferi del complexo sensu lato, la muestra de suero fue sometida a la inmunofluorescencia indirecta (IFI). El resultado demostró la presencia de anticuerpos anti-Borrelia burgdorferi, lo que sugiere la presencia de borreliosis de Lyme en este perro callejero y posiblemente la circulación del agente etiológico en el referido local.

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

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

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

Borreliosis, fiebre recurrente causada por espiroquetas. Informe de un caso / Borreliosis: recurrent fever due to spirochetes. Case report

Introducción. Las fiebres recurrentes son un grupo complejo de enfermedades causadas por diversas espiroquetas del género Borrelia, que el hombre adquiere por piquetes de piojos o garrapatas. El propósito de este trabajo es presentar un caso con esta enfermedad. Caso Clínico. Paciente femenino de 12 años de edad, que presentó inicialmente fiebre, cefalea, adenitis cervical y exantema toracoabdominal. La fiebre fue recurrente durante tres meses, con periodos 3 a 5 días e intervalos afebriles de 15 a 21 días. Los resultados de los exámenes de laboratorio fueron negativos para los anticuerpos anti Borrelia burgdorferi. En el frotis de sangre se identificaron espiroquetas. Fue tratada con diversos esquemas de antibióticos y, finalmente, con doxiciclina. Su evolución fue satisfactoria, y tres meses después aún se encuentra asintomática. Conclusiones. En el presente caso se consideró prudente, entre los diagnósticos diferenciales, incluir la posibilidad de fiebre recurrente atribuida a espiroquetemia. La dificultad para establecer el diagnóstico nos muestra la importancia de tener en mente este tipo de infecciones.

Background. Relapsing fever is a complex group of diseases caused by spirochetes of the genus Borrelia transmitted to humans by lice or ticks. The purpose of this study is to present a case of relapsing fever. Case report. A 12-year-old girl with no relevant clinical history was admitted with fever, headache, cervical adenitis, and thoracoabdominal exanthema. She had relapsing fever for 3 to 5 days with 15- to 21-day-intervals of apyrexia during the past 3 months. Laboratory exams were normal or negative including antibodies for Borrelia burdorferi. Peripheral blood smear showed spirochetes. She was treated with various antibiotics and finally doxycycline was added with a good response. The patient is asymptomatic and without sequelae 3 months after treatment. Conclusion. In the case we reported, relapsing fever due to spirochetemia was made during the differential diagnosis. Due to the difficulty in identification, it is important to have a clinical suspicion of this type of infection.

Uso de la reacción en cadena de la polimerasa para Borrelia burgdorferi en lesiones de esclerodermia localizada (morfea), en pacientes venezolanos / Using the polymerase chain reaction to Borrelia burgdorferi infection in localized scleroderma injure (morphea), in venezuelan patients

Borrelia burgdorferi es el agente causal de Borreliosis de Lyme, una enfermedad infecciosa multisistémica transmitida al humano por la picadura de garrapatas del género Ixodes. En los últimos años se ha postulado una posible asociación entre ésta espiroqueta y esclerodermia localizada (morfea). Sin embargo, los datos publicados no han proporcionado pruebas inequívocas de tal asociación. En Suramérica, incluida Venezuela (estado Zulia) se han detectado pruebas serológicas positivas en pacientes con morfea. El objetivo de este estudio fue buscar evidencia definitiva de la infección por Borrelia burgdorferi en pacientes con morfea, mediante la detección del ADN bacteriano en muestras de piel. En los 21 pacientes la PCR resultó negativa. La ausencia de amplificación de la secuencia blanco seleccionada en las muestras estudiadas no apoyan una asociación entre la infección por Borrelia burgdorferi y las lesiones escleróticas de morfea, pero tampoco descartan la posibilidad de una relación entre morfea y una genoespecie desconocida del complejo Borrelia burgdorferi sensu lato, entre morfea y una especie diferente de Borrelia o entre morfea y otra espiroqueta, como agente etiológico de la lesión en la localidad.

Borrelia burgdorferi is the causative agent of Lyme Borreliosis, an infectious multisystemic disease transmitted to humans by the Ixodes ticks bite. A possible association of Borrelia burgdorferi with localized scleroderma has been postulated. However, published data do not provide unequivocal results. Previus serologic analysis of patients with localized scleroderma in South American countries (including Venezuela), have been reported as yielding some reactivity. The present study looked for evidence of Borrelia burgdorferi infection in venezuelan patients with localized scleroderma, using the polymerase chain reaction to analyze 21 skin samples of patients with this skin condition. The results were negative in all the samples studied. Our data do not support an association of Borrelia burgdorferi infection and the sclerotic lesions of localized scleroderma; but do not rule out the possibility of a relationship between localized scleroderma and an unknown geno-specie of Borrelia burgdorferi sensu lato complex, a different Borrelia specie or a different spirochetal organism, as the etiological agents of the skin lesions in this area.

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.

A Case of Lyme Disease with Various General Symptoms / 대한피부과학회지

Lyme borreliosis is a multi-systemic tick-borne infectious disease caused by the spirochaete, Borrelia burgdorferi. It has many non-specific symptoms affecting the skin, eye, musculoskeletal system, cardiovascular system, and central and peripheral nervous system. Typical cutaneous manifestations of lyme borreliosis include erythema chronicum migrans, borrelia lymphocytoma appearing a few weeks after the tick bite, and acrodermatitis chronica atrophicans developing a few years after. The diagnosis is based on clinical findings with detection of specific Ig M and Ig G antibodies to Borrelia burgdorferi. A 50-year old woman presented with an erythematous to violaceous annular patch with central scaly hyperpigmented patch on the right arm and an erythematous indurated patch on the right thigh for a month. She did not recall a deer tick bite. She had severe arthralgia on the right shoulder and myalgia on the right thigh at the first visit. Three months later, she complained of chest pain, and mild dyspnea on exertions. Serologic examinations revealed increased levels of Ig M and Ig G antibodies to borrelial antigen via ELISA, and Western blot test for Borrelia burgdorferi was positive. Her general symptoms as well as skin lesions subsided with an antibiotics (Doxycycline) and steroid therapy over 4 weeks.

Borrelia theileri: observação em carrapatos do gênero Boophilus microplus no município de Guaíba, RS, Brasil / Borrelia theileri: observation on Boophilus microplus ticks in Guaiba, RS, Brazil

Espiroquetas da espécie Borrelia theileri identificadas em uma estirpe de carrapatos Boophilus microplus provenientes do município de Guaíba, RS. A observação ocorreu no exame de hemolinfa de fêmeas adultas com 10 dias pós-repleçâo, corada por Giemsa. Não foram observadas espiroquetas em ovos provenientes de teleóginas infectadas. A detecção da estirpe infectada sugere a presença de borreliose em rebanhos bovinos, fato que eventualmente pode interferir em resultados de diagnóstico ou tornar-se motivo de preocupação em produtos derivados de sangue bovino tais como vacinas vivas contra anaplasmose e babesiose bovina.

Spirochetes of species Borrelia theileri were identifica in afield-strain of the caule tick Boophilus microplus, in Guaíba, RS, Brazil. Hemolymph smears from females 10 days post-repletion were collected by gentty section of the tarsal-metatarsaijoint, and dropped onto a microscope slide, and stained by Giemsa. No spirochetes were observed in eggs squashed and stained by Giemsa from the same infected strain. The detection of B. microplus adult females infected with Borrelia theileri suggesfs the likely presence of borreliosis in bovine heras what might eventually interfere with the interpretation of diagnosis results or become cause for concern in blood products such as anaplasmosis and babesiosis live vaccines.