Description of Lyme disease-like syndrome in Brazil. Is it a new tick borne disease or Lyme disease variation?

An emerging clinical entity that reproduces clinical manifestations similar to those observed in Lyme disease (LD) has been recently under discussion in Brazil. Due to etiological and laboratory particularities it is named LD-like syndrome or LD imitator syndrome. The condition is considered to be a zoonosis transmitted by ticks of the genus Amblyomma, possibly caused by interaction of multiple fastidious microorganisms originating a protean clinical picture, including neurological, osteoarticular and erythema migrans-like lesions. When peripheral blood of patients with LD-like syndrome is viewed under a dark-field microscope, mobile uncultivable spirochete-like bacteria are observed. PCR carried out with specific or conservative primers to recognize Borrelia burgdorferi sensu stricto or the genus Borrelia has been negative in ticks and in biological samples. Two different procedures, respectively involving hematoxylin and eosin staining of cerebrospinal fluid and electron microscopy analysis of blood, have revealed spirochetes not belonging to the genera Borrelia, Leptospira or Treponema. Surprisingly, co-infection with microorganisms resembling Mycoplasma and Chlamydia was observed on one occasion by electron microscopy analysis. We discuss here the possible existence of a new tick-borne disease in Brazil imitating LD, except for a higher frequency of recurrence episodes observed along prolonged clinical follow-up.

Description of Lyme disease-like syndrome in Brazil: is it a new tick borne disease or Lyme disease variation?

An emerging clinical entity that reproduces clinical manifestations similar to those observed in Lyme disease (LD) has been recently under discussion in Brazil. Due to etiological and laboratory particularities it is named LD-like syndrome or LD imitator syndrome. The condition is considered to be a zoonosis transmitted by ticks of the genus Amblyomma, possibly caused by interaction of multiple fastidious microorganisms originating a protean clinical picture, including neurological, osteoarticular and erythema migrans-like lesions. When peripheral blood of patients with LD-like syndrome is viewed under a dark-field microscope, mobile uncultivable spirochete-like bacteria are observed. PCR carried out with specific or conservative primers to recognize Borrelia burgdorferi sensu stricto or the genus Borrelia has been negative in ticks and in biological samples. Two different procedures, respectively involving hematoxylin and eosin staining of cerebrospinal fluid and electron microscopy analysis of blood, have revealed spirochetes not belonging to the genera Borrelia, Leptospira or Treponema. Surprisingly, co-infection with microorganisms resembling Mycoplasma and Chlamydia was observed on one occasion by electron microscopy analysis. We discuss here the possible existence of a new tick-borne disease in Brazil imitating LD, except for a higher frequency of recurrence episodes observed along prolonged clinical follow-up.

Search for Borrelia sp. in ticks collected from potential reservoirs in an urban forest reserve in the State of Mato Grosso do Sul, Brazil: a short report.

A total of 128 ticks of the genus Amblyomma were recovered from 5 marsupials (Didelphis albiventris) - with 4 recaptures - and 17 rodents (16 Bolomys lasiurus and 1 Rattus norvegicus) captured in an urban forest reserve in Campo Grande, State of Mato Grosso do Sul, Brazil. Of the ticks collected, 95 (78.9%) were in larval form and 22 (21.1%) were nymphs; the only adult (0.8%) was identified as A. cajennense. Viewed under dark-field microscopy in the fourth month after seeding, 9 cultures prepared from spleens and livers of the rodents, blood of the marsupials, and macerates of Amblyomma sp. nymphs revealed spiral-shaped, spirochete-like structures resembling those of Borrelia sp. Some of them showed little motility, while others were non-motile. No such structures could be found either in positive Giemsa-stained culture smears or under electron microscopy. No PCR amplification of DNA from those cultures could be obtained by employing Leptospira sp., B. burgdorferi, and Borrelia sp. primers. These aspects suggest that the spirochete-like structures found in this study do not fit into the genera Borrelia or Leptospira, requiring instead to be isolated for proper identification.

Search for Borrelia sp. in ticks collected from potential reservoirs in an urban forest reserve in the State of Mato Grosso do Sul, Brazil: a short report

A total of 128 ticks of the genus Amblyomma were recovered from 5 marsupials (Didelphis albiventris) - with 4 recaptures - and 17 rodents (16 Bolomys lasiurus and 1 Rattus norvegicus) captured in an urban forest reserve in Campo Grande, State of Mato Grosso do Sul, Brazil. Of the ticks collected, 95 (78.9 percent) were in larval form and 22 (21.1 percent) were nymphs; the only adult (0.8 percent) was identified as A. cajennense. Viewed under dark-field microscopy in the fourth month after seeding, 9 cultures prepared from spleens and livers of the rodents, blood of the marsupials, and macerates of Amblyomma sp. nymphs revealed spiral-shaped, spirochete-like structures resembling those of Borrelia sp. Some of them showed little motility, while others were non-motile. No such structures could be found either in positive Giemsa-stained culture smears or under electron microscopy. No PCR amplification of DNA from those cultures could be obtained by employing Leptospira sp., B. burgdorferi, and Borrelia sp. primers. These aspects suggest that the spirochete-like structures found in this study do not fit into the genera Borrelia or Leptospira, requiring instead to be isolated for proper identification

Oviposition and eclosion periods of Ixodes didelphidis Fonseca and Aragão, 1951 (Acari: Ixodidae) under laboratory conditions.

Oviposition and eclosion periods for Ixodes didelphidis were observed under two temperatures (25 degrees C and 27 degrees C) and 90-95% humidity. Although there was a significant increase in the eclosion period (p<0.05) and a tendency to increase the oviposition period at 25 degrees C, there was neither significant differences in the interval (days), until maximum peak of eclosion nor in the number of emerging larvae during the peak nor the total number of emerged larvae. These temperature values are not critical for embryological development of the species. Because at 27 degrees C and under high humidity the oviposition and eclosion periods are shorter, and the percentage of emerged larvae is higher, we consider this to be the ideal temperature for laboratory studies.

Parasitism by Ixodes didelphidis and I. loricatus (Acari: Ixodidae) on small wild mammals from an Atlatic Forest in the State of Sao Paulo, Brazil.

From January 1995 to June 1996, ticks were studied in a fragment of Atlantic Forest in a residential area in the city of Itapevi, State of Sao Paulo, Brazil. Cases of human Lyme disease-like illness were registered in this area during the spring of 1992. The monthly relative density of ticks was determined and the influence of seasonal climatic conditions was evaluated as well as the relationship between ticks and hosts. Ticks (n = 88) were collected from small mammals captured (n = 134) in monthly trappings where the traps were operated for five consecutive days. Immature ticks (n = 42, 47.7%) were identified as Ixodes spp. The adult ticks (n = 46, 52.3%) were identified as Ixodes didelphidis Fonseca and Aragão (n = 19, 21.6%), I. loricatus Neumann (n = 26, 29.5%) and Amblyomma cajennense (F.) (n = 1, 1.1%). The monthly correlations between tick numbers and meteorological data were not significant. The correlation between the different stages of ticks and the two seasons (cold-dry and warm-rainy) indicated that both immature and adult ticks showed a seasonal pattern of abundance. The highest numbers of immature ticks were observed on rodents, during the cold-dry season (from April to September) with a peak in August 1995. Adults ticks were predominant during the warm-rainy season (from October to March) with a peak in January 1995. Adult ticks were only collected on marsupials.

[Outline of Lyme borreliosis in Brazil]. / Perfil da borreliose de Lyme no Brasil.

Since 1989, we have identified 25 patients with Lyme disease, 15 in early and 10 in latent stage, supporting its existence in Brazil, according to following reasons: 1) presence of clinical manifestations compatible with Lyme disease, with cutaneous, articular, nervous system and rarely cardiac envolvement; 2) presence of antibodies against Borrelia burgdorferi; 3) follow up of acute cases show sorologycal changes; 4) good antibiotic response at early stage of disease and only satisfactory in latent form; 5) mapping of risk areas, according to geographycal distribution of patients; 6) presence and identification of Ixodid ticks; 7) identification of micro-organism like borrelias in human, wild animals and ticks cultures, seen by dark field microscope; 8) sorology done in dogs and oxes, confirm existence of risk areas for Lyme disease.

[Lyme disease in Mato Grosso do Sul State, Brazil: report of three clinical cases, including the first of Lyme meningitis in Brazil]. / Doença de Lyme em Mato Grosso do Sul: relato de três casos clínicos, incluindo o primeiro relato de meningite de Lyme no Brasil.

The authors report the occurrence of the first three clinical cases of Lyme disease in Mato Grosso do Sul State, including the first case of Lyme meningitis in Brazil. These were identified by clinical and laboratorial criteria. Anti-Borrelia burgdorferi antibody search was carried out through ELISA and Western Blotting techniques, the former providing identification of IgG class antibodies alone, in one only of those cases. Through Immunoblotting, the following features were found in serum: 5 IgG and 2 IgM bands for the first case; 7 IgG and 2 IgM bands for the second; and 5 IgG and 6 IgM bands for the third. In the latter, presence fo specific antibodies was searched in liquor, due to lymphomonocitary meningitis occurrence, and one IgM band was detected. After antibiotic therapy, all patients exhibited significant clinical and laboratorial improvement in their conditions along with symptom regression to the present moment.