The other great imitator among infectious diseases: Leptospirosis.

INTRODUCTION: Leptospirosis is a worldwide zoonosis responsible for highly diverse clinical presentations with a wide range of severity. Variable environment exposures to infected urines of rodents have been described. OBSERVATION: We report five cases of serologically confirmed leptospirosis leading to hospitalization in an intensive care unit (ICU) of a French center. These patients displayed neurological, respiratory, and abdominal presentation of leptospirosis with variable level of severity. Either professional, leisure related, or daily living exposures have been retrieved. CONCLUSION: These cases underline the diversity of clinical presentation and environmental exposure of this infectious disease. They highlight the interest of an exhaustive anamnesis with collection of professional activity, environmental exposures, and leisure activities.

Chronic Diarrhea Due to Intestinal Spirochaetosis in an HIV-Positive Patient: Case Report and Literature Review

Intestinal spirochaetosis refers to the colonization of the colorectal epithelium by anaerobic spirochetes of the genus Brachyspira. It is more frequently identified in developing countries or when sanitation conditions are suboptimal. It can affect anyone, although it is more common in gay men, particularly those infected with the human immunodeficiency virus (HIV). Its most common symptom is chronic watery diarrhea. A colonoscopy may be expected. We present the clinical case of a young male patient with chronic diarrhea of several years of evolution resolved by specific treatment. In addition, a review of the literature on this disease is provided.

La espiroquetosis intestinal se define como la colonización del epitelio colorrectal por espiroquetas anaerobias del género Brachyspira. Se identifica con mayor frecuencia en países en vías de desarrollo o cuando las condiciones de salubridad son subóptimas. Puede afectar a cualquier persona, aunque es más común en hombres homosexuales particularmente infectados por virus de la inmunodeficiencia humana (VIH). Su síntoma más frecuente es la diarrea crónica acuosa. La colonoscopia puede ser normal. Se presenta el caso clínico de un paciente masculino joven con diarrea crónica de varios años de evolución que se resuelve al brindar tratamiento específico. Además, se realiza, una revisión de la literatura sobre esta enfermedad.

The incidence of Jarisch-Herxheimer reactions and associated risk factors in pregnant women and nonpregnant women: A retrospective chart review at a university hospital in Japan.

AIMS: Jarisch-Herxheimer reactions (JHR) is a transient adverse event that occurs during initial antimicrobial treatment for syphilis patients, and is known to develop uterine contractions and fetal distress in pregnant women complicated with syphilis. The aim of this study is to identify risk factors for JHR in patients with syphilis, and to clarify whether pregnancy status is a risk factor for JHR, and to describe the characteristics of pregnant women who develop JHR. METHODS: This was a retrospective chart review in a singleton university hospital in Japan. We collected data of syphilis patients who were diagnosed and treated at department of obstetrics and gynecology, dermatology between January 2010 and May 2022. There were no validated diagnostic criteria for JHR, we defined JHR as one or more of the following in addition to raised body temperature (≧38.0°C) within 24 h of initial antibiotic treatment: headache, chills, myalgias, tachycardia (≧110 bpm), new rash. RESULTS: There were 30 syphilis patients. Of whom nine (30%) were pregnant women and all their neonates were not diagnosed with congenital syphilis. Five patients (17%) developed JHR at the time of initial treatment (JHR group, n = 5). There was no difference between JHR group and non-JHR group (n = 25) in pregnancy status. Secondary syphilis was an only significant risk factor for JHR. Two pregnant women with JHR were both treated for secondary syphilis in the third trimester of pregnancy. CONCLUSION: Pregnancy status was not a risk factor for JHR in syphilis patients. Further research is needed.

Seroprevalencia de leptospirosis y brucelosis en búfalos de agua (Bubalus bubalis) en Tierralta Córdoba, Colombia

En la producción zootécnica, la brucelosis y la leptospirosis ocasionan problemas reproductivos y son una limitante en salud y en producción animal. El objetivo fue determinar la presencia de anticuerpos contra Leptospira spp. y Brucella abortus, en una población bufalera, en el municipio de Tierralta, Córdoba. Se realizó un estudio descriptivo de corte transversal, que incluyó un total de 144 búfalos de la raza Murrah, destinados al doble propósito. Para el diagnóstico de Leptospira spp., se implementó la prueba de aglutinación microscópica, con 13 serogrupos, 19 serovares pertenecientes a 5 especies de Leptospira patógenas y para brucelosis Rosa de Bengala y C-Elisa. La seroprevalencia para Leptospira spp. fue del 87,5 %, el serogrupo Mini fue el de mayor frecuencia, pero Grippotyphosa presentó el mayor título. El 16,67 % de los búfalos evaluados presentaron títulos iguales o superiores a 1:800, asociados con infección actual o reciente. La alta seroprevalencia, se puede deber a las características ambientales de la zona, que brinda las condiciones favorables para el crecimiento y el mantenimiento de este patógeno que, sumado al comportamiento de los búfalos de revolcarse, los hace propensos a las infecciones con bacterias del género Leptospira sp., porque a menudo, las fuentes de agua están contaminadas por este patógeno. La seroprevalencia contra B. abortus por Rosa de Bengala y Elisa-C fue del 2,08 %. Todos los títulos determinados corresponden a procesos infecciosos. No hubo signos clínicos de enfermedad y la carencia de registros productivos no permitió determinar el efecto sobre los parámetros reproductivos.

In animal production, brucellosis and leptospirosis cause reproductive problems and limit animal health and production. The objective was to determine the presence of antibodies against Leptospira spp. and Brucella abortus in a buffalo population in the municipality of Tierralta, Cordoba. A descriptive, transversal study was carried out including a population of 144 Murrah´s breed buffalos destined for beef and milk production. For the Leptospira spp. diagnostic, was used a rapid slide agglutination test with 13 serogrups and 19 serovars belonging to 5 pathogenic Leptospira species was implemented and for Brucella abortus Rose Bengal and C-Elisa was used. Seroprevalence of Leptospira spp. was 87,5 %, serogrup Mini was the most frequent, but Grippotyphosa showed the higher titer. The 16,67 % of the buffaloes evaluated presented titles equal to or above than 1:800 associated with current or recent infection. High seroprevalence may be due to environmental characteristics of the zone, which gives favorable conditions for the growth and maintenance of this pathogen, these factors in conjunction with the habit of wallowing makes them prone to suffering infections caused by bacteria of the genera Leptospira sp. since water sources are often contaminated. Seroprevalence against B. abortus by Rose-Bengal and C-Elisa was 2,08 %, the determined titers correspond to infectious processes. There were no clinical manifestations of disease and the effects on reproductive parameters were not determined because of the lack of productive registries.

The Current State of Knowledge on Baggio-Yoshinari Syndrome (Brazilian Lyme Disease-like Illness): Chronological Presentation of Historical and Scientific Events Observed over the Last 30 Years.

Baggio-Yoshinari Syndrome (BYS) is an emerging Brazilian tick-borne infectious disease that clinically mimics Lyme Disease (LD) present in the Northern Hemisphere. LD is caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex and transmitted by Ixodid ticks of complex Ixodes rticinus. On the contrary, BYS is transmitted by hard Ixodid ticks of the genera Amblyomma, Rhipicephalus and Dermacentor. In 1992, the first cases of BYS were described in patients that developed EM rash, flu-like symptoms and arthritis after tick bite episodes. Since these findings, research in BYS has been developing for more than 30 years and shows that its epidemiological, clinical and laboratorial features are different from LD. Borrelia burgdorferi was never isolated in Brazil. In addition, specific serologic tests have shown little positivity. Furthermore, peripheral blood analysis of patients using electron microscopy exhibited structures resembling spirochete-like microorganisms or the latent forms of spirochetes (L form or cell wall deficient bacteria). For these reasons, Brazilian zoonosis was defined as an exotic and emerging Brazilian infectious disease, transmitted by ticks not belonging to the Ixodes ricinus complex, caused by latent spirochetes belonging to the B. burgdorferi sensu lato complex with atypical morphology. The Brazilian ecosystem, combined with its ticks and reservoir biodiversity, possibly contributed to the origin of this new zoonosis, which emerged as a result of the passage of B. burgdorferi through exotic vectors and reservoirs.

Unexpected Reason for Non-healing Oral Ulcers: Syphilis.

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and characterized by a complex and variable clinical presentation. Cases of unexpected oral syphilis presenting as non-healing ulcers are uncommonly reported. We report 3 cases (one female and two males, aged 35, 35, and 56 years, respectively) in which patients presented with non-healing oral ulcers. Biopsies revealed surface ulceration and a significant neutrophilic infiltrate rather than the more conventional plasma cell infiltrate seen with most reported syphilis infections, potentially leading to an inaccurate diagnosis. Treponema pallidum immunohistochemistry highlighted spirochetes within the epithelium, with additional diagnostic confirmation by serum T. pallidum particle agglutination assay. Sexual history documentation by the clinician with nonspecific oral ulcers is paramount to aiding diagnosis and leading to proper management. Further, it is important to perform immunohistochemistry for T. pallidum in oral biopsies from non-healing ulcers, especially when clinical history raises the differential diagnosis or when other clinical manifestations may support this consideration.

Novel Borrelia genotypes in bats from the Macaregua Cave, Colombia.

Bats have been implicated as reservoirs of relapsing fever group spirochaetes since the beginning of the last century. Recently, bat-associated spirochaetes have been reported as human pathogens. In 1968, a spirochaete was detected in blood of the bat Natalus tumidirostris captured inside the Macaregua cave, Colombia. Data on this microorganism were never published again. The aim of this study was to evaluate the presence of Borrelia DNA in blood from bats of Macaregua cave. We performed molecular analyses using a genus-specific real-time PCR targeting the 16S rRNA to detect DNA of Borrelia in blood samples from 46 bats captured in the Macaregua cave. Positive samples were submitted to a battery of PCRs aiming to amply Borrelia 16S rRNA, flaB, glpQ, p66, ospC, clpA, clpX, nifS, pepX, pyrG, recG, rplB and uvrA genes. Seventeen samples were positive for Borrelia after real-time PCR. With the exception of flaB gene, attempts to amplify further loci were unsuccessful. Nucleotide and amino acid divergences of four flaB haplotypes characterized from blood of Carollia perspicillata showed Borrelia burgdorferi sensu lato (Bbsl) as the most closely related group. A phylogenetic tree including 74 sequences of the genus confirmed this trend, since Borrelia genotypes detected in bats from Macaregua formed a monophyletic group basally positioned to Bbsl. Our results suggest that Borrelia genotypes characterized from bats roosting in the Macaregua cave might constitute a new taxon within the genus. This is the first molecular characterization of a Borrelia sp. in Colombia.

Clinical characterization of patients with severe leptospirosis in a tertiary hospital in Cali, Colombia, 2010-2016 / Caracterización clínica de la leptospirosis grave en un hospital de alta complejidad de Cali, Colombia, 2010-2016

Introduction: Leptospirosis is an endemic bacterial infection in Colombia. Its clinical course can be variable and occasionally fatal. There are few studies in the country about severe cases of leptospirosis. Objectives: To describe the demographic and clinical characteristics of patients with a diagnosis of leptospirosis, and their management in a high complexity hospital. Materials and methods: This was a descriptive retrospective study of patients with a serologic diagnosis of leptospirosis between 2010 and 2016. Results: We analyzed 87 patients, 74% of them were men, and 84% were older than 18 years; 35% had a comorbidity, the most common being arterial hypertension (16%) and diabetes mellitus (9%). The most frequent symptoms were fever, nausea, fatigue, myalgia, arthralgia, and abdominal pain. The majority of patients required hospitalization in general wards (61%), with a median stay of six days; 34% required management in the intensive care unit, with a median stay of five days. Mortality was 1.1% (n=1). All patients received treatment with either ceftriaxone or doxycycline. Conclusions: There is a risk of leptospira infections having a late diagnosis given their unspecific clinical presentation, which generates a high number of differential diagnoses. The early management in the intensive care unit could decrease the incidence of complications and the mortality of patients with leptospirosis.

Introducción. La leptospirosis es una infección bacteriana endémica en Colombia. Su curso clínico puede ser variable y, en ocasiones, fatal. Hay pocos estudios en el país sobre los casos graves de esta enfermedad. Objetivo. Describir las características demográficas y clínicas de los pacientes con diagnóstico de leptospirosis grave hospitalizados en salas generales o atendidos en la unidad de cuidados intensivos de un hospital de cuarto nivel. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de los pacientes adultos y niños con diagnóstico serológico de leptospirosis entre el 2010 y el 2016. Resultados. Se analizaron las historias clínicas de 87 pacientes, 74 % de los cuales correspondía a hombres y, el 84 %, a mayores de 18 años. El 35 % tenía alguna comorbilidad y la hipertensión arterial sistémica (16 %) y la diabetes mellitus (9 %) fueron las más comunes. Los síntomas más frecuentes fueron: fiebre, náuseas, astenia, mialgias, artralgias y dolor abdominal. El 34 % requirió atención en la unidad de cuidados intensivos, con una mediana de estancia de 5 días. El 61 % requirió hospitalización en sala general, con una mediana de estancia de 6 días. Todos los casos recibieron tratamiento antibiótico con ceftriaxona o doxiciclina. La tasa de letalidad fue del 1,1 % (n=1). Conclusiones. La infección por Leptospira spp. tiene el riesgo de diagnosticarse de manera tardía por su presentación clínica inespecífica, lo que implica considerar un gran número de diagnósticos diferenciales. La atención temprana de los pacientes con cuadros graves de esta enfermedad en la unidad de cuidados intensivos, puede evitar una mayor incidencia de complicaciones y disminuir la mortalidad.

Caracterización clínica de la leptospirosis grave en un hospital de alta complejidad de Cali, Colombia, 2010-2016 / Clinical characterization of patients with severe leptospirosis in a tertiary hospital in Cali, Colombia, 2010-2016

Resumen Introducción. La leptospirosis es una infección bacteriana endémica en Colombia. Su curso clínico puede ser variable y, en ocasiones, fatal. Hay pocos estudios en el país sobre los casos graves de esta enfermedad. Objetivo. Describir las características demográficas y clínicas de los pacientes con diagnóstico de leptospirosis grave hospitalizados en salas generales o atendidos en la unidad de cuidados intensivos de un hospital de cuarto nivel. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de los pacientes adultos y niños con diagnóstico serológico de leptospirosis entre el 2010 y el 2016. Resultados. Se analizaron las historias clínicas de 87 pacientes, 74 % de los cuales correspondía a hombres y, el 84 %, a mayores de 18 años. El 35 % tenía alguna comorbilidad y la hipertensión arterial sistémica (16 %) y la diabetes mellitus (9 %) fueron las más comunes. Los síntomas más frecuentes fueron: fiebre, náuseas, astenia, mialgias, artralgias y dolor abdominal. El 34 % requirió atención en la unidad de cuidados intensivos, con una mediana de estancia de 5 días. El 61 % requirió hospitalización en sala general, con una mediana de estancia de 6 días. Todos los casos recibieron tratamiento antibiótico con ceftriaxona o doxiciclina. La tasa de letalidad fue del 1,1 % (n=1). Conclusiones. La infección por Leptospira spp. tiene el riesgo de diagnosticarse de manera tardía por su presentación clínica inespecífica, lo que implica considerar un gran número de diagnósticos diferenciales. La atención temprana de los pacientes con cuadros graves de esta enfermedad en la unidad de cuidados intensivos, puede evitar una mayor incidencia de complicaciones y disminuir la mortalidad.

Abstract Introduction: Leptospirosis is an endemic bacterial infection in Colombia. Its clinical course can be variable and occasionally fatal. There are few studies in the country about severe cases of leptospirosis. Objectives: To describe the demographic and clinical characteristics of patients with a diagnosis of leptospirosis, and their management in a high complexity hospital. Materials and methods: This was a descriptive retrospective study of patients with a serologic diagnosis of leptospirosis between 2010 and 2016. Results: We analyzed 87 patients, 74% of them were men, and 84% were older than 18 years; 35% had a comorbidity, the most common being arterial hypertension (16%) and diabetes mellitus (9%). The most frequent symptoms were fever, nausea, fatigue, myalgia, arthralgia, and abdominal pain. The majority of patients required hospitalization in general wards (61%), with a median stay of six days; 34% required management in the intensive care unit, with a median stay of five days. Mortality was 1.1% (n=1). All patients received treatment with either ceftriaxone or doxycycline. Conclusions: There is a risk of leptospira infections having a late diagnosis given their unspecific clinical presentation, which generates a high number of differential diagnoses. The early management in the intensive care unit could decrease the incidence of complications and the mortality of patients with leptospirosis.

A Rare Case of Neurosyphilis with Ocular Involvement in a Patient with HIV Infection and New Onset Syphilis.

Neurosyphilis (NS) is more frequently seen in patients with human immunodeficiency virus (HIV) infection, especially those not on antiretroviral therapy or with a low CD4 cell count. Ocular syphilis is an unusual and early form of neurosyphilis. Lumbar puncture should be considered in all HIV infected patients who present with neurologic or ocular disease. A 47-year-old homosexual male with HIV-1 infection, on antiretroviral therapy (last CD4 cell count 1022 cells/µL) presented to our emergency department with a five-day history of headache, blurry vision, pain and redness of the left eye. He had unprotected anal sex with a new partner four months before presentation. Based on the fundoscopy findings as well as the cerebrospinal fluid (CSF) analysis on initial evaluation, a repeat serum rapid plasma reagin (RPR) along with microhemagglutination assay for treponema pallidum (MHA-TP) were done due to high suspicion of syphilis, even though an RPR five months prior to this visit was negative. Both RPR and MHA-TP were positive and the patient was treated for neurosyphilis. The patient's symptoms as well as the RPR titers improved significantly thereafter. A high index of suspicion for neurosyphilis should be maintained in HIV-infected patients presenting with ocular symptoms even if they are compliant with retroviral therapy with good CD4 cell counts. Physicians must be mindful of this uncommon presentation and consider a lumbar puncture in any patient with suspicion of neurosyphilis for prompt diagnosis and treatment to avoid further neurological complications.

Hemorragia digestiva e insuficiencia hepática aguda por leptospirosis: una entidad que no debemos olvidar / Gastrointestinal bleeding and acute hepatic failure by leptospirosis: an entity that should not be forgotten

La leptospirosis es una enfermedad causada por la espiroqueta Leptospira. Se trata de una zoonosis de distribución mundial, con predominio en los trópicos. En España no es frecuente pero sí se observan casos en zonas más húmedas o con presencia de ríos, lagos o estanques, como son Cataluña, Andalucía o la Comunidad Valenciana, donde se relaciona con los arrozales. Los transmisores son múltiples animales como vacas o ratas, contagiándose el ser humano mediante contacto directo con estos animales o su orina, o bien de forma indirecta al consumir o estar en contacto con agua contaminada por la orina de éstos. Las manifestaciones clínicas son muy variables, siendo asintomática o poco sintomática en la mayoría de los pacientes. Aunque no ocurre siempre, la leptospirosis cursa con una primera fase con fiebre, mialgias, afectación renal o hemorragia de distintos órganos, seguida de una segunda fase con presencia de ictericia por afectación hepática. La enfermedad de Weil es una forma de leptospirosis grave caracterizada por afectación hepática con ictericia e insuficiencia renal aguda, asociada a una considerable mortalidad. El diagnóstico se basa en técnicas serológicas y detección de DNA mediante PCR. El tratamiento consta de medidas de soporte y antibioticoterapia. Presentamos un paciente con enfermedad de Weil y hemorragia digestiva por leptospirosis, con una evolución clínica fulminante, y hacemos hincapié en la necesidad de tener presente esta entidad, especialmente en ambientes epidemiológicos favorables como el de este paciente, con el fin de lograr un diagnóstico precoz.

Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates. The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.

Bacterial infection and Alzheimer's disease: a meta-analysis.

The possibility of an infectious etiology for Alzheimer's disease (AD) has been repeatedly postulated over the past three decades. We provide the first meta-analysis to address the relationship between bacterial infection and AD. Studies examining the association between AD and spirochetal bacteria or Chlamydophila pneumoniae (Cpn) were identified through a systematic search of the databases MEDLINE, EMBASE, PubMed, and Google Scholar. Data combined from 25 relevant, primarily case-control studies demonstrated a statistically significant association between AD and detectable evidence of infection of either bacterial group. We found over a ten-fold increased occurrence of AD when there is detectable evidence of spirochetal infection (OR: 10.61; 95% CI: 3.38-33.29) and over a four-fold increased occurrence of AD in a conservative risk estimate (OR: 4.45; 95% CI: 2.33-8.52). We found over a five-fold increased occurrence of AD with Cpn infection (OR: 5.66; 95% CI: 1.83-17.51). This study shows a strongly positive association between bacterial infection and AD. Further detailed investigation of the role of bacterial infection is warranted.

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.

Erratum: A phylogenomic and molecular signature based approach for characterization of the Phylum Spirochaetes and its major clades: proposal for a taxonomic revision of the phylum.

[This corrects the article on p. 217 in vol. 4, PMID: 23908650.].

Amplification of the flgE gene provides evidence for the existence of a Brazilian borreliosis / Amplificação do gene flgE fornece evidência para a existência de uma borreliose brasileira

INTRODUCTION: The symptoms of Brazilian borreliosis resemble the clinical manifestations of Lyme disease (LD). However, there are differences between the two in terms of epidemiological and laboratory findings. Primers usually employed to diagnose LD have failed to detect Borrelia strains in Brazil. OBJECTIVE: We aimed to identify the Brazilian Borrelia using a conserved gene that synthesizes the flagellar hook (flgE) of Borrelia burgdorferi sensu lato. METHOD: Three patients presenting with erythema migrans and positive epidemiological histories were recruited for the study. Blood samples were collected, and the DNA was extracted by commercial kits. RESULTS: The gene flgE was amplified from DNA of all selected patients. Upon sequencing, these positive samples revealed 99% homology to B. burgdorferi flgE. CONCLUSION: These results support the existence of borreliosis in Brazil. However, it is unclear whether this borreliosis is caused by a genetically modified B. burgdorferi sensu stricto or by a new species of Borrelia spp.

INTRODUÇÃO: Os sintomas da borreliose brasileira se assemelham às manifestações clínicas da Doença de Lyme (DL), porém, existem diferenças epidemiológicas e laboratoriais entre essas enfermidades. Primers normalmente utilizados para diagnosticar a DL não conseguiram detectar cepas de borrelia no Brasil. OBJETIVO: O objetivo desse trabalho foi identificar a borrelia brasileira usando um gene conservado que sintetiza o gancho flagelar (flgE) da Borrelia burgdorferi sensu lato. MÉTODO: Três pacientes com eritema migratório e epidemiologia positiva foram recrutados para o estudo. Amostras de sangue foram coletadas, e o DNA foi extraído por kits comerciais. RESULTADOS: O gene flgE foi amplificado a partir do DNA de todos os pacientes selecionados. Após o sequenciamento, essas amostras positivas revelaram homologia de 99% para B. burgdorferi. CONCLUSÃO: Estes resultados reforçam a existência de borreliose no Brasil. No entanto, não está claro se esta borreliose é causada por uma variante geneticamente modificada da B. burgdorferi sensu stricto ou por uma nova espécie de Borrelia spp.

Intestinal spirochetosis

The intestinal spirochetosis (IS) is a histologically defined by the presence of spirochetal microorganisms connected to the apical cell membrane of the colorectal epithelium. The disease is caused by a heterogeneous group of bacteria. In humans, Brachyspira aalborgi and Brachyspira pilosicoli are prevalent. The incidence ranges from 1% in developed countries to 34% in poorer areas. It affects 62.5% of colonized areas, as well as men who have intercourse with men (MSM) and those with the human immunodeficiency virus (HIV) infected. Clinical significance of such colonization is still not clear. Most infected people are asymptomatic. At the presence of gastrointestinal symptoms, treatment with metronidazole is effective. Due to unknown reasons, MSM and HIV-positive men are more likely to be symptomatic. Treponema pallidum infection must be excluded, since this agent may cause serious and permanent complications, and because the treatment is different. (AU)

A espiroquetose intestinal está definida histologicamente como a presença de micro-organismos da família spirochetaceae ligadas ao ápice das células do epitélio cólico. A doença pode ser provocada por um grupo heterogêneo de bactérias. Em humanos, a Brachyspira aalborgi e a Brachyspira pilosicoli predominam. A incidência varia desde 1%, nos países desenvolvidos, até 34% nas áreas mais pobres, atingindo taxas de colonização de 62,5%, em homens que fazem sexo com homens (HSH) e vírus da imunodeficiência humana (HIV) positivo. O significado clínico dessa colonização ainda é incerto e a maioria dos infectados permanece assintomática. Quando há sintomas gastrointestinais, o tratamento com metronidazol é efetivo. Por razões desconhecidas, HSH positivos para o HIV, apresentam mais infestação sintomática. A infecção pelo Treponema pallidum dever ser excluída, pois os tratamentos são diferentes e as complicações por essa última são mais graves e definitivas. (AU)

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".

Identificação do agente etiológico da Doença de Lyme-símile brasileira (Síndrome Baggio-Yoshinari) / Identification of the causative agent of Brazilian Lyme diseaselike illness (Baggio-Yoshinari Syndrome)

A Doença de Lyme-símile brasileira ou Síndrome Baggio-Yoshinari (SBY) é uma zoonose emergente, transmitida por carrapatos e até o momento, de descrição restrita ao território brasileiro. O agente etiológico da SBY era desconhecido até o presente trabalho. O objetivo principal do estudo foi identificar a etiologia da SBY. Foi selecionado 2 grupos de pacientes: grupo A (n=68) composto por pacientes com suspeita diagnóstica de SBY, a maioria na fase latente da doença; grupo B (n=10), composto por pacientes com diagnóstico de SBY, que apresentaram obrigatoriamente eritema migratório e que encontravam-se sintomáticos no momento da coleta. Foi utilizado também um grupo controle composto por indivíduos saudáveis e com epidemiologia negativa (n=50). Amostras de sangue foram coletadas para a realização de sorologias, culturas, análises microscópicas (óptica e eletrônica) e reação de cadeia da polimerase (PCR) para diferentes micro-organismos (Mycoplasma spp, Chlamydia spp e Borrelia spp). Além disso, foi realizado um estudo preliminar, através da PCR para Borrelia spp em 47 amostras de carrapatos oriundos de áreas de risco do Espírito Santo (sendo 17 Rhipicephalus microplus e 30 Rhipicephalus sanguineus), e amostras de sangue total de 27 bovinos e 26 equinos, animais estes oriundos da Universidade Federal Rural do Rio de Janeiro. Os resultados mostraram que a SBY não se trata de uma zoonose causada por um conjunto de micro-organismos como pensado inicialmente e sim pela Borrelia burgdorferi sensu lato. Descoberta essa que foi possível empregando-se novos primers amplificadores do principal gene envolvido na síntese do gancho flagelar da Borrelia, chamado flgE...

Brazilian Lyme disease-like illness (BLDL) or Baggio-Yoshinari Syndrome (BYS) is an emerging zoonosis, transmitted by ticks and so far, restricted to the description of the Brazilian territory. The causative agent of BYS was unknown until now. The main objective of this study was to identify the etiology of BYS. We have selected two groups of patients: group A (n = 68) consisting of patients suspected of BYS, mostly in the latent stage of disease; group B (n = 10), composed of patients diagnosed with BYS, who had compulsorily erythema migrans and that were symptomatic at the time of blood collection. We also used a control group composed of healthy individuals with negative epidemiology (n = 50). Blood samples were collected, in which we performed serology, cultures, microscopic analysis (optical and electron) and polymerase chain reaction (PCR) for different microorganisms (Mycoplasma spp, Chlamydia spp and Borrelia spp). In addition, a preliminary study was conducted by PCR for Borrelia spp in 47 samples of ticks from risk areas at Espirito Santo State (being 17 Rhipicephalus microplus and 30 Rhipicephalus sanguineus), 27 cattle and 26 horses, being these animals from the Universidade Federal Rural do Rio de Janeiro. The results showed that BYS is not a zoonosis caused by a set of microorganisms as initially thought, but by Borrelia burgdorferi sensu lato. These findings were possible after employing new primers that are able to amplify portions of the main genes involved in the synthesis of the Borrelia flagellar hook protein, called flgE. We confirmed positivity for the flgE in 6 patients from group B, 2 ticks, a cow, and a horse, which showed 99% homology with the gene of Borrelia burgdorferi flagellar hook protein (flgE) deposited in GenBank (L43849)...

Saúde bucal da crianças de Goiânia: prevalência de doença gengival e presença de espiroquetas em placa subgengival de 300 crianças de 2 a 11 anos de idade com baixa condição socioeconômica / Children's oral health in Goiânia: prevalence of gingivitis disease and presence of spiroquets in subgengival plaque of 300 children aged 2-11 years with low social economic condition

A proposta desta investigação foi determinar a associação de gengivite - espiroquetas em placa subgengival de 300 crianças de 2 a 11 anos, com baixa condição socioecônomica, matriculadas em creches e escolas dos bairros da periferia de Goiânia. Materail e Método - As amostras subgengivais de 1.200 sítios, correspondendo a 4 sítios por criança, foram colhidas por intermédio de palitos de madeira e coradas pelo método de Fontana-Tribondeau para detectar a presença de espiroquetas. Para a análise clínica gengival foi aplicada a classificação do índice gengival (IG) segundo Loe. Resultados - Os dados mostraram que 53,75% das amostras apresentaram espiroquetas, sendo mais prevalentes nas crianças do sexo masculino. Os resultados foram submetidos à análise estatística de qui-quadrado com grau de significância de 5% e a frequência relativa observada de espiroquetas em função da variável idade, sugere uma tedência crescente estatisticamente significativa. Nas idades de 2-3 anos foi de 45,84%; 4-5 anos 51,27%; 6-7 anos 54,41%; 8-9 anos 54,84% e de 10-11 anos 70%. A idade das crianças também, influenciou de forma crescente quanto às proporções de espiroquetas em função dos sítios sangrantes das gengivas, com uma maior prevalência de 77,23% na faixa etária de 10-11 anos. Conclusão - A análise estatística da associação de espiroquetas em sítios sangrantes das gengivas com 94,69% em relação a não sangrantes sugere que essa correlação pode ser utilizada em crianças de baixa condição econômica como indicador de futuro dano periodontal.