Manifestations Of Lyme Borreliosis Research Articles

The AxBioTick Study: Borrelia Species and Tick-Borne Encephalitis Virus in Ticks, and Clinical Responses in Tick-Bitten Individuals on the Aland Islands, Finland.

The AxBioTick study was initiated to investigate the prevalence of ticks and tick-borne pathogens and their impact on antibody and clinical responses in tick-bitten individuals on the Aland Islands. This geographical area is hyperendemic for both Lyme borreliosis (LB) and Tick-borne encephalitis (TBE). Blood samples and ticks were collected from 100 tick-bitten volunteers. A total of 425 ticks was collected, all determined to Ixodes ricinus using molecular tools. Of them 20% contained Borrelia species, of which B. garinii and B. afzelii were most common. None contained the TBE virus (TBEV). Blood samples were drawn in conjunction with the tick bite, and eight weeks later. Sera were analyzed for Borrelia- and TBEV-specific antibodies using an ELISA and a semiquantitative antibody assay. In total 14% seroconverted in Borrelia C6IgG1, 3% in TBEV IgG, and 2% in TBEV IgM. Five participants developed clinical manifestations of LB. The high seroprevalence of both Borrelia (57%) and TBEV (52%) antibodies are likely attributed to the endemic status of the corresponding infections as well as the TBE vaccination program. Despite the similar prevalence of Borrelia spp. detected in ticks in other parts of Europe, the infection rate in this population is high. The AxBioTick study is continuing to investigate more participants and ticks for co-infections, and to characterize the dermal immune response following a tick bite.

A Retrospective Database Study of Lyme Borreliosis Incidence in Poland from 2015 to 2019: A Public Health Concern.

Background: In Poland, Lyme borreliosis (LB) has been subject to mandatory public health surveillance since 1996 and, in accordance with EU regulations, Lyme neuroborreliosis has been reported to the European Centre for Disease Prevention and Control since 2019. In this study, the incidence, temporal trends, and geographic distribution of LB and its manifestations in Poland are described for the period 2015-2019. Methods: This retrospective incidence study of LB and its manifestations in Poland was based on data sent to the National Institute of Public Health-National Institute of Hygiene-National Research Institute (NIPH-NIH-NRI) by district sanitary epidemiological stations using the electronic Epidemiological Records Registration System and data from the National Database on Hospitalization. Incidence rates were calculated using population data from the Central Statistical Office. Results: During 2015-2019, Poland reported 94,715 cases of LB with an overall average incidence of 49.3 cases per 100,000 population. Cases increased from 2015 (11,945) to 2016 (20,857) and then remained stable through 2019. Hospitalization due to LB also rose during these years. LB was more common among women (55.7%). Erythema migrans and Lyme arthritis were the most common manifestations of LB. The highest incidence rates occurred among >50-year-olds, with a peak in 65-69-year-olds. The highest number of cases was recorded in the third and fourth quarters of the year (July-December). Incidence rates in the eastern and northeastern regions of the country were higher than the national average. Conclusions: LB is endemic in all regions of Poland, and many regions reported high incidence rates. Large variations in spatially granular incidence rates highlight the need for targeted prevention strategies.

1354. Incidence, time trends and geographic distribution of Lyme neuroborreliosis in Denmark using public surveillance data, 2015-2019

Abstract Background Lyme neuroborreliosis (LNB) is a potentially severe manifestation of Lyme borreliosis (LB), a spirochetal tick-borne infectious disease caused by Borrelia burgdorferi. We describe the incidence, time trends and geographic distribution of LNB in Denmark, with the aim to inform public health policy, including the potential use of new vaccines under development. Methods Based on the case definition for LNB (clinical diagnosis of LB plus detection of antibodies in blood and cerebral spinal fluid [confirmed case], OR clinical symptoms compatible with LNB and detection of antibodies in blood [probable case]), we obtained cases reported by laboratories and physicians (2015–2019) from the online platform maintained by the Statens Serum Institut (SSI). The LNB incidence (per 100,000 persons) was calculated by dividing LNB cases by the population data (denominator) obtained from Statistics Denmark. Results Between 2015 and 2019, laboratories reported annually 162 to 200 LNB cases, while physicians reported 48 to 68 cases (Figure). The annual LNB incidence notified by laboratories ranged from 2.8 (95% CI: 2.4‒3.3) to 3.4 (95% CI: 3.0‒4.0) per 100,000 persons for the 5 study years. The average annual LNB incidence per 100,000 persons for 5 Danish regions ranged from 2.3 to 3.3; for 11 provinces, from 1.9 to 7.6; and for 98 municipalities, from 0 to 22.1. Incidence peaks occurred in persons 5‒14 and 65‒74 years of age. Higher incidences were observed among males versus females in all age groups. LNB cases were reported throughout the year, with peaks in July to September. Number of LNB cases and annual incidence (per 100,000 population) notified by (A)physicians and (B) laboratories Conclusion LNB incidence in Denmark is moderate with no evidence of decline. Cases occurred across all regions but were focally concentrated among residents of some municipalities. By analyzing and reporting spatially granular data, we could identify areas with the highest LNB incidence. This may assist policy makers with assessing the efficiency of geographically targeted versus national prevention interventions, including vaccines should these be licensed. To this end, expanding the current surveillance system to include other manifestations of LB would be valuable to better understand geographic endemicity. Disclosures Jozica Skufca, Epidemiologist, p95: Paid by Pfizer to perform the study Nick DeSmedt, Masters in Computer Engineering, P95: P95 was paid by Pfizer to perform the study Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Andrew Vyse, Ph.D., Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Maxim Blum, Ph.D., P95: Paid by Pfizer to perform the study Margarita Riera, MD, MPH, P95: Paid by Pfizer to perform the study Bradford Gessner, MD, MPH, Pfizer: Stocks/Bonds Mette Skovdal, Ph.D., Pfizer Denmark: Stocks/Bonds James Stark, Ph.D., Pfizer: Stocks/Bonds.

Incidence of Lyme neuroborreliosis in Denmark: Exploring observed trends using public surveillance data, 2015–2019

Lyme neuroborreliosis (LNB) can be a serious manifestation of Lyme borreliosis. We describe the incidence, time trends and geographic distribution of LNB in Denmark.We obtained LNB cases reported by laboratories and physicians (2015–2019) from the online platform maintained by the Statens Serum Institut (SSI) (2021b). The LNB incidence (per 100,000 persons) was calculated by dividing LNB cases by the population data (denominator) obtained from Statistics Denmark (2021).Between 2015 and 2019, laboratories reported annually 162 to 200 LNB cases, while physicians reported 48 to 68 cases. The annual LNB incidence notified by laboratories ranged from 2.8 (95% CI: 2.4‒3.3) to 3.4 (95% CI: 3.0‒4.0) per 100,000 persons for the 5 study years. The average annual LNB incidence per 100,000 persons for 5 Danish regions ranged from 2.3 to 3.3; for 11 provinces, from 1.9 to 7.6; and for 98 municipalities, from 0 to 22.1. Incidence peaks occurred in persons 5‒14 and 65‒74 years of age. Higher incidences were observed among males versus females in all age groups. LNB cases were reported throughout the year, with peaks in July to September.Notified LNB incidence in Denmark was moderate with no evidence of decline. Cases occurred across all regions but were focally concentrated among residents of some municipalities. Expanding the current surveillance system to include other manifestations of LB would be valuable to better understand geographic endemicity to inform targeted preventive measures.

Borrelial lymphocytoma.

Borrelial lymphocytoma is arare cutaneous manifestation of early localized European Lyme borreliosis. It manifests as anodule or plaque with adiameter of up to afew centimeters. The lesion is, as arule, solitary. It is more common in children than in adults and, in contrast to erythema migrans and acrodermatitis chronica atrophicans, has male predominance. Atick bite has been reported in approximately one half of patients; the tick bite is usually at the site or in the vicinity of the later borrelial lymphocytoma. The predilection site for the development of lesions is the breast in adults and the ear lobe in children. Borrelial lymphocytoma is frequently associated with erythema migrans, but rarely with other manifestations of Lyme borreliosis, and is predominantly caused by Borrelia afzelii. At presentation, approximately half of the patients with borrelial lymphocytoma have measurable serum borrelial antibodies and, in about one third, spirochetes can be cultivated from the skin lesion. A14-day antibiotic therapy, as recommended for patients with erythema migrans, is highly successful. Posttreatment duration of aborrelial lymphocytoma is positively associated with the pretreatment duration of the lesion and with patient age, while treatment failure is associated with the clinical signs of disseminated Lyme borreliosis at presentation. Substantial improvements in knowledge on borrelial lymphocytoma and laboratory diagnostics in recent decades have contributed to earlier diagnosis and treatment. Consequently, borrelial lymphocytoma is usually amild disease with agood prognosis.

Borelis Pro phytomedicine for the complex treatment of Lyme borreliosis in children

IntroductionLyme disease, also known as Lyme borreliosis (LB) (tick (Ixodes)borne borreliosis) is a transmissible, natural-focal disease characterized by damage of the skin, nervous system, heart.Material and methodsUnder observation were 68 children – residents of Ternopil region, who applied to Ternopil Regional Children Hospital, and whose age range was 8–17 years. Two schemes of complex treatment of patients were tested: the 1st – patients received Doxycycline (Unidox Solutab®), tablets 100 mg, 10 pcs. 2 time/day after meals for 14 days at a dose 4 mg/ kg; the 2nd – patients received the treatment regimen like the 1st group and phytomedicine “Boreliss pro” capsules, 28.56g, 60 pcs. (Duo Life Boreliss Pro., Poland) 1 capsule 2 time/day after meals for 14 days.ResultsResults showed that was significantly (p < 0.05) lower severity of LB in patients who received antibacterial therapy in combination with doxycycline hydrochloride and phytomedicine “Boreliss pro” (1 caps. 2 times/day, after meals), compared with individuals in another group, on the 30th day after treatment. Complex therapy of patients by phytomedicine “Boreliss pro” causes a decrease of pro-inflammatory levels of cytokines IL-1β in the serum.ConclusionsComprehensive treatment of patients with an erythematous form of LB by phytomedicine “Boreliss pro” contributes to a significantly (p < 0.05) faster disappearance of clinical manifestations of LB, shortening the duration of doxycycline hydrochloride use, and reducing the likelihood of side effects from this drug.

Tick-transmitted co-infections among erythema migrans patients in a general practice setting in Norway: a clinical and laboratory follow-up study

BackgroundErythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than Borrelia, and the impact of co-infection on the clinical manifestations and disease duration.MethodsSkin biopsies from 139/188 EM patients were analyzed using PCR for Neoehrlichia mikurensis, Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Follow-up sera from 135/188 patients were analyzed for spotted fever group (SFG) Rickettsia, A. phagocytophilum and Babesia microti antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8/188) or EM duration of ≥ 21 days (69/188) were analyzed, using PCR, for A. phagocytophilum, Rickettsia spp., Babesia spp. and N. mikurensis. Day 14 sera were tested for TBEV IgG.ResultsWe detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG Rickettsia and A. phagocytophilum were detected in 11/135 and 8/135, respectively. Three patients exhibited both SFG Rickettsia and A. phagocytophilum antibodies, albeit negative PCR. No antibodies were detected against B. microti. 2/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection.ConclusionsCo-infection with N. mikurensis, A. phagocytophilum, SFG Rickettsia, Babesia spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG Rickettsia and A. phagocytophilum in some patients, no clinical implications could be demonstrated.

Perceptions, Representations, and Experiences of Patients Presenting Nonspecific Symptoms in the Context of Suspected Lyme Borreliosis.

Background: Some subjective symptoms may be reported at all stages of Lyme borreliosis (LB) and may persist for several months after treatment. Nonspecific symptoms without any objective manifestation of LB are sometimes attributed by patients to a possible tick bite. The aim of our study was to explore the perceptions, representations, and experiences that these patients had of their disease and care paths. Methods: We performed a qualitative study through individual interviews (October 2017–May 2018), based on grounded theory, following the COREQ checklist. A balanced sample of patients with diverse profiles was recruited at consultations with general practitioners and infectious disease physicians. Results: Twelve patients were interviewed. Data saturation was reached at the twelfth interview. For codes, 293 were identified, and classified into 5 themes: (1) the experience of disabling nonspecific symptoms, especially pain, causing confusion and fear, (2) long and difficult care paths for the majority of the patients, experienced as an obstacle course, (3) a break with the previous state of health, causing a negative impact on every sphere of the patient’s life, (4) empowerment of the patients and the self-management of their disease, and (5) the strong expression of a desire for change, with better listening, greater recognition of the symptoms, and simpler care paths. Conclusions: This study allows for the understanding of a patient’s behaviours and the obstacles encountered, the way they are perceived, and the necessary solutions. The patients’ expectations identified here could help physicians better understand the doctor–patient relationship in these complex management situations, which would reduce the burden of the disease. The current development of specialised reference centres could help meet the patients’ demands and those of family physicians.

Modern condition of the problem of Lime Burreliosis of animals (systematic review)

Lyme borreliosis (LB) is the most common tick-borne disease in the temperate climate of the Northern Hemisphere. LB is caused by spirochetes, which are grouped in the complex Borrelia burgdorferi sensu lato, vectors – Ixodidae mites, dozens of species of small mammals and birds actas reservoir hosts, and the role of reservoirs of domestic animals, such as dogs and cats, is not excluded. Although the ecology and epidemiology of the disease have been extensively studied in Europe and North America, there is considerable uncertainty regarding the study of Lyme borreliosis in veterinary medicine. Search, selection andanalysis of scientific data on the research topic were carried out according to acceptable rules for systematic reviews of the literature. The scientometric database Web of Science Core Collection, the database of scientific articles Pub Med and the database Scientific Periodicals of Ukraine were used. Seventy-four scientific articles were used for the article, which contained the necessary set of data and met the set goal. The article highlights the main issues of the etiology of the disease, which describes the characteristics of the pathogen, its properties, genotypic composition of Borrelia, which cause Lyme disease, the spread of pathogenic genotypes of Borrelia in Europe and Ukraine. The connection of Lyme borreliosis spread with ecological factors, climatic changes and anthropogenic impact on biocenoses and biotopes, the role of vectors and reservoir hosts in the spread of LB is described. Data on the prevalence and degree of infection of Ixodes mites with Borrelia, as well as the spread of LB among the population of Europe and Ukraine are presented. The seroprevalence of each of the animal species (dogs, cats, horses, ruminants), clinical manifestations of LB, if documented and indicators of LB prevalence among animals in Europe and Ukraine, as well as currently known treatments, prevention and diagnosis of LB animals are considered. Key words: Borrelia Burgdorferi Sensu Lato, Lyme Diseases Etiology, Ixodidae.

First Data on Human Lyme Borreliosis in Kosovo: Prospective Evaluation of the Disease from a Tick Bite Perspective.

Purpose: Lyme borreliosis (LB) occurs throughout Europe. No clinical and seroprevalence studies for LB in Kosovo have been publicly available thus far. Therefore, this study aimed to investigate LB from a tick bite perspective in the Pristina region, Kosovo. Methods: This single-center prospective observational study enrolled consecutive adult participants (≥18 years of age) with tick bite (embedded tick in the skin), who were examined at the Clinic of Infectious Diseases, Pristina, between January 2015 and August 2018. At the first visit related to the index tick bite, ticks (the complete ticks or parts of the ticks) were removed from the skin, blood samples were taken for serological tests, and antibiotic treatment was started when deemed necessary. The complete, undamaged ticks removed were proceeded for entomological identification. Participants were followed up at 2 months (serological tests were repeated) and 6 months after the index event for the development of clinical manifestations of LB and/or seroconversion against Borrelia burgdorferi. Results: A total of 380 subjects were included in the study. Most cases were seen in May and June in all study years. All 117 preserved ticks were identified as Ixodes ricinus. Immunoglobulin G seroprevalence among subjects during the first visit in the study was 28/380 (7.4%). Erythema migrans (EM) was clinically diagnosed in 74/380 patients (19.5%, 95% confidence interval 15.6-23.8). Only 15 clinically diagnosed EM (in seronegative patients) were serologically confirmed with seroconversion (2 months later), 3.9% of all subjects included in the study. There were three cases with clinical manifestation between the second and third visit: EM recidivans, multiple erythema, or several nonspecific systemic symptoms. Doxycycline and amoxicillin were mainly used for the treatment of borrelial skin lesions. Conclusion: This assessment can help indicate the need for disease awareness and reinforce the importance of primary prevention measures, early diagnosis, and appropriate treatment.

Facial palsy as a manifestation of early neuroborreliosis (clinical case)

Lyme borreliosis is a tick-borne transmitted infectious disease caused by the spirochete Borrelia burgdorferi sensu lato and spread by the bite of ticks of the genus Ixodes. Lyme neuroborreliosis is a clinical manifestation of Lyme borreliosis, which affects the central nervous system and peripheral nervous system in up to 15% of the affected patients. Nerve structures are affected by spirochetes both in acute and late phase of the disease. The clinical course of neuroborreliosis is highly variable. Although at least 80% of European patients present with facial nerve palsy and radiculitis, symptoms of neuroborreliosis may be quite unspecific or even mimic other neurological diseases. Idiopathic peripheral facial palsy has long been considered as the most common cause of prosopoparesis, but modern diagnosis significantly narrow the range of cases of unknown genesis. Neuroborreliosis is difficult to diagnose, especially when prosopoparesis is the only clinical manifestation, so practitioners should be mindful of possible etiology to avoid misdiagnosis. The article presents a clinical case of early neuroborreliosis in a woman of 57 years who manifested with peripheral facial palsy. The author describes in detail the course of the disease (the appearance of new symptoms on the background of standard medical therapy (poor response), the presence of additional criteria (erythema migrans, lymphocytoma (rarely), arthralgia), diagnosis (specific immunological examination of blood to Borrelia burgdorferi sensu lato). Antibiotic therapy made it possible to achieve complete recovery of facial nerve function and avoid future complications.

Neurootological manifestations of Lyme borreliosis

Introduction: The incidence of tick-borne diseases in Poland and Europe is increasing which is considered to be due to climate warming which promotes the growth of tick populations. Lyme borreliosis is the most prevalent leptospirosis in the US and Europe. Due to the potential for serious complications and the lack of specific prevention, diagnostic vigilance is essential so as to ensure early diagnosis and implementation of treatment. The main pathogen-transmitting vector is the tick species Ixodex ricinus. The suborder of ticks (Ixodida) belongs to the Acari subclass of arachnids. The natural reservoir of B. burgdorferi consists of small and medium-sized mammals and birds. Around ¾ of patients with Lyme disease report complaints and present disease symptoms within in the head and neck. The symptoms are diverse and may occur at all stages of the disease. These include headaches, neck pain and stiffness, sore throat, dizziness, cervical lymphadenopathy, otalgia, tinnitus, sudden hearing loss, and facial muscle paresis. Despite numerous papers being published on neurological manifestations of Lyme disease, the issues regarding the location of damage within the course of the auditory pathway and the balance system remain unanswered. In some cases hearing disorders may be due to central damage while others may be due to peripheral damage. Objective: The article provides an overview of reports on the clinical course and manifestation of Lyme borreliosis.

A Practical Approach to the Diagnosis of Lyme Borreliosis: From Clinical Heterogeneity to Laboratory Methods.

Clinical evaluation of Lyme Borreliosis (LB) is the starting point for its diagnosis. The patient's medical history and clinical symptoms are fundamental for disease recognition. The heterogeneity in clinical manifestations of LB can be related to different causes, including the different strains of Borrelia, possible co-infection with other tick transmitted pathogens, and its interactions with the human host. This review aims at describing the heterogeneous symptoms of Lyme Borreliosis, as well as offering a practical approach for recognition of the disease, both in terms of clinical features and diagnostic/research tools.

Musculoskeletal manifestations of Lyme borreliosis - a review.

Lyme borreliosis (LB) is a zoonotic disease caused by Gram-negative bacteria Borrelia burgdorferi sensu lato. The majority of reported cases of LB originate in the northern hemisphere, mostly in the US and Europe. One of the typical manifestations of LB are musculoskeletal symptoms; they may appear in any of the three LB stages. The diagnosis is based on clinical manifestations and confirmed by serological tests. One course of antibiotic therapy is sufficient for LB to dissipate in most cases, although for some patients, the symptoms subside gradually even after completion of therapy. Patients who have been demonstrated to have specific antibodies but are symptomless should not be treated. In instances where the advised treatment proved to be unsuccessful, patients should be referred to rheumatologist for additional diagnostics. The goal of this review is to update physicians on current scientific knowledge on musculoskeletal manifestations of LB.

ELISPOT assays and their diagnostic potential in Lyme disease and Lyme neuroborreliosis.

ELISPOT assays and their diagnostic potential in Lyme disease and Lyme neuroborreliosis.

Psychosis in Borrelia burgdorferi infection - part I: epidemiology, pathogenesis, diagnosis and treatment of neuroborreliosis.

Borreliosis is a multisystem, bacterial, zoonotic infectious disease with diversified spectrumof symptoms, which may also include psychotic disorders. Clinical picture of the disease is often unspecific, which makes the diagnosis relatively difficult. Uncharacteristic process of borreliosis is a result of complex molecular strategies used by spirochetes to infect, disseminate and survive in host organism. Part I of the article is focused on the current knowledge about pathogenesis of Lyme Borreliosis (LB), especially neuroborreliosis. Additionally, epidemic situation in Poland and in Europe was presented. Also, typical clinical manifestations of LB were described. In the article, the crucial pathogenic cell mechanisms were depicted. The processes of infection and dissemination of Borrelia in host were presented. The most important strategies of evading the response of host immune system were also discussed. These mechanisms are probable cause of the chronic and uncharacteristic clinical picture of the disease, as they significantly impair host immune response to bacteria. Also, there were presented molecular processes of neural cells impairment, which may lead to observed clinical symptoms of neuroborreliosis. Furthermore, diagnostic methods, treatment guidelines and some of diagnostic problems were discussed.

Combining primary care surveillance and a meta-analysis to estimate the incidence of the clinical manifestations of Lyme borreliosis in Belgium, 2015–2017

Lyme borreliosis (LB) is an important tick-borne disease which can cause a broad range of symptoms mainly affecting the skin, the nervous system and the joints. This study aims to estimate the incidence of the different clinical manifestations of LB in Belgium. The incidence of erythema migrans (EM) was estimated through the network of sentinel general practices at 97.6/100,000 inhabitants (uncertainty interval [UI] 82.0–113.0) for the period 2015–2017. This result was used to estimate the incidence of other LB manifestations based on their proportional distribution (ratios) to EM reported in the neighboring countries of Belgium. To estimate these ratios, we performed a systematic review of studies published between February 1, 2008 and January 31, 2018 and pooled the results using a random effects meta-analysis. Six studies were retained in the systematic review, and the meta-analysis estimated the occurrence ratios for Lyme neuroborreliosis/EM, Lyme arthritis/EM and other manifestations/EM at 0.024 (95% confidence interval [CI] 0.016–0.037), 0.022 (95% CI 0.020–0.024) and 0.014 (95% CI 0.012–0.016) respectively. Applying these ratios to the EM incidence in Belgium resulted in an incidence estimation of 2.4/100,000 inhabitants (95% UI 1.5–3.7) for Lyme neuroborreliosis, 2.1/100,000 (95% UI 1.7–2.6) for Lyme arthritis and 1.4/100,000 (95% UI 1.1–1.7) for other less frequent manifestations. Some of these LB manifestations, other than EM, are more severe, hence these estimates are essential to assess the health burden and economic cost of LB which would be highly relevant for patients, healthcare providers and policymakers. As both over- and underestimation of different clinical LB manifestations remain possible due to characteristics of the primary surveillance systems and the disease itself, future studies to validate these estimates would be of great value.

Multilocus sequence typing of clinical Borreliella afzelii strains: population structure and differential ability to disseminate in humans

BackgroundLyme borreliosis in humans results in a range of clinical manifestations, thought to be partly due to differences in the pathogenicity of the infecting strain. This study compared European human clinical strains of Borreliella afzelii (previously named Borrelia afzelii) using multilocus sequence typing (MLST) to determine their spatial distribution across Europe and to establish whether there are associations between B. afzelii genotypes and specific clinical manifestations of Lyme borreliosis. For this purpose, typing was performed on 63 strains, and data on a further 245 strains were accessed from the literature.ResultsAll 308 strains were categorized into 149 sequence types (STs), 27 of which are described here for the first time. Phylogenetic and goeBURST analyses showed short evolutionary distances between strains. Although the main STs differed among the countries with the largest number of strains of interest (Germany, the Netherlands, France and Slovenia), the B. afzelii clinical strains were less genetically structured than those previously observed in the European tick population. Two STs were found significantly more frequently in strains associated with clinical manifestations involving erythema migrans, whereas another ST was found significantly more frequently in strains associated with disseminated manifestations, especially neuroborreliosis.ConclusionsThe MLST profiles showed low genetic differentiation between B. afzelii strains isolated from patients with Lyme borreliosis in Europe. Also, clinical data analysis suggests the existence of lineages with differential dissemination properties in humans.

Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome \u2013 a prospective cohort study

BackgroundErythema migrans (EM) is the most common manifestation of Lyme borreliosis (LB), caused by the spirochete Borrelia burgdorferi sensu lato. The infection can disseminate into the nervous system and cause Lyme neuroborreliosis (LNB), the second most frequent LB manifestation in children. The aim of this prospective cohort study is to describe the occurrence of EM among children with LNB and to evaluate possible differences in clinical characteristics or outcome between LNB patients with and without EM.MethodChildren being evaluated for LNB in southeast Sweden during the period 2010–2014 underwent a clinical examination, laboratory testing and filled out a questionnaire regarding duration and nature of symptoms, EM and the child’s health. Children were classified according to European guidelines for LNB. Clinical recovery was evaluated at a 2-month follow-up.ResultsThe occurrence of EM among children with LNB was 37 out of 103 (36%). Gender, age, observed tick bite, clinical features, duration of neurological symptoms or clinical outcome did not differ significantly between LNB patients with or without EM. However, facial nerve palsy was significantly more common among children with EM in the head and neck area.ConclusionEM occurred in 36% of children with LNB and the location on the head and neck was more common among children with facial nerve palsy. EM was not associated with other specific clinical characteristics or outcome. Thus, the occurrence of EM in children with LNB cannot be useful as a prognostic factor for clinical outcome. This aspect has not previously been highlighted but seems to be relevant for the paediatrician in a clinical setting.

Correlation of Reflectance Confocal Microscopy and Dermatopathology Findings in a Case of Acrodermatitis Chronica Atrophicans

Acrodermatitis chronica atrophicans (ACA) that is characterized by thin, papery dry, translucent, and alopecic patches with visible superficial veins is a late cutaneous manifestation of Lyme borreliosis. Clinical findings, a history of exposure to tick bite, and serology are helpful for the diagnosis of ACA and sometimes a biopsy is performed to rule out other infectious or inflammatory processes. In this study, we report reflectance confocal microscopy (RCM) findings in a case of ACA. RCM examination revealed a flattened surface with broadened skin folds, a flattened dermoepidermal junction with few papillae and less bright basal cells and multiple small bright reflecting spots in the dermis. To the best of our knowledge, this is the first description of the RCM findings in this disorder.