Chapter 17 Lyme Borreliosis

Abstract

Publisher Summary This chapter describes the persistent infection, immunopathological reactions, and autoimmunity of Lyme Borreliosis (LB). LB is an infectious multi-system disease, caused by Borrelia burgdorferi , a spirochete. B. burgdorferi organisms are subdivided into several genotypes associated with different though overlapping clinical syndromes. Lyme arthritis (LA) is the most frequent late manifestation in children. LA is also considered a rheumatic disease, but with a favorable outcome; there are few or no other rheumatic diseases that enter into remission in 85% after one or two short courses of antibiotics. LA is the most frequent bacterial infection associated arthritis. Chronic LA may be a human model of chronic inflammatory joint disease with a known etiology. Risk factors are female gender, age >10 years and treatment with systemic or intraarticular steroids prior to initiation of antibiotic treatment. Chronic arthritis following infection with B.burgdorferi is attributed to several factors including persistent infection, immunopathological reactions to components of B. burgdorferi and autoimmunity. Clarification of its pathogenesis may provide clues to the pathogenesis of other chronic inflammatory joint diseases including rheumatoid arthritis and juvenile idiopathic arthritis.