[The clinical picture and course of the nonerythematous form of ixodid tick-borne borreliosis]

The territory of the Perm region is highly endemic in Ixodes (B. garinii and B. afzelii)-borne borreliosis. The clinical manifestations of erythema-less Ixodes-borne borreliosis were studied in the 1991-1994 epidemiological seasons. A total of 54 patients were examined in the acute stage of infection and 4-6 months later. There were common symptoms of damage to the central nervous system in early infection and pronounced signs of damage to the central and peripheral nervous systems in the late period which was characterized by cardiovascular diseases as disturbances of automatism functions, conduction, diffuse and local muscle changes.

Association between different clinical manifestations of Lyme disease and different species of Borrelia burgdorferi sensu lato

Borrelia burgdorferi sensu lato, the aetiological agent of Lyme disease, has been subdivided into three species: B. burgdorferi sensu stricto, B. garinii and B. afzelii. We and other authors have hypothesized an association between the three species of B. burgdorferi sensu lato and some of the different clinical manifestations of Lyme disease. In order to demonstrate this hypothesis, we analysed twenty-nine isolates cultured from patients with different symptoms. The method used was multilocus enzyme electrophoresis: twelve genetic loci were characterized on the basis of the electrophoretic mobility of their products, and twenty-eight distinctive allele profiles (electrophoretic types) were distinguished, among which mean genetic diversity per locus was 0.649. Cluster analysis of a matrix of genetic distances between paired electrophoretic types revealed three primary divisions separated at genetic distances greater than 0.7 and corresponding to the three species of B. burgdorferi sensu lato. Ten strains obtained from skin of patients with erythema chronicum migrans (the primary stage of the disease) were assigned to the three different species. All the six strains isolated from patients with acrodermatitis chronica atrophicans were of the species B. afzelii, which was not found to be associated with another chronic manifestation of Lyme disease. Arthritis was caused prevalently by B. burgdorferi sensu stricto, and neuroborreliosis by B. burgdorferi sensu stricto and B. garinii. In conclusion, our results confirm the association between some of the different chronic manifestations of the disease and the species of B. burgdorferi sensu lato.

[Serologic diagnosis of Lyme disease in patients with undifferentiated arthritis. Diagnostic problems]

BACKGROUND

Arthritis is a frequent manifestation of Lyme disease. The diagnosis of this disease is especially supported by serological techniques which however have false positives or negatives. The aim of this study was to establish the frequency of serologies positive to Borrelia burgdorferi in patients with non-filiated arthritis and in other well defined rheumatic diseases.

METHODS

A prospective study was performed to detect antibodies (AB) versus Borrelia burgdorferi in 43 patients with undifferentiated arthritis and in 100 patients with articular disease of precise diagnosis (rheumatoid arthritis, systemic lupus erythematosus, psoriasis arthropathy, and reactive arthritis/Reiter's syndrome). The technique was performed by indirect immunofluorescence and was repeated by enzymoimmunoassay in doubtful or positive results. Titers greater than 1/256 were considered as positive.

RESULTS

Positive serology was found in two patients with undifferentiated arthritis and in one patient with Reiter's syndrome. None of the three patients referred the antecedent of erythema chronicum migrans. Positive serology was not observed in any of the patients with rheumatoid arthritis, systemic lupus erythematosus or psoriatic arthritis.

CONCLUSIONS

A small proportion of patients with undifferentiated arthritis or Reiter's syndrome presented positive serology at low titers versus Borrelia burgdorferi with the interpretation of these results being difficult. The frequency of seropositivity in rheumatoid arthritis and systemic lupus erythematosus is very low.

Seroprevalence survey of borreliosis in children with chronic arthritis in British Columbia, Canada

A seroprevalence survey using an indirect immunofluorescence assay (IFA) for IgG antibodies to Borrelia hermsii and Borrelia burgdorferi was conducted for varied pediatric chronic arthritis patients and a nonrheumatic control group in the province of British Columbia, Canada. Overall, a higher rate of sera with IFA titers > or = 1/256 was found for B. hermsii (36.6%) compared to B. burgdorferi (12.5%). There were no significant differences among the arthritis subgroups and controls for the distribution of IFA titers for either organism. IgG immunoblotting of selected high titered sera to either borrelia species confirmed the lack of specificity of the IFA assay. Serological tests for borreliosis should be cautiously interpreted in children with chronic arthritis.

Bilateral facial palsy caused by the Borrelia spirochete

A case of total left peripheral and partial right peripheral facial palsy caused by the Borrelia spirochete is presented. The diagnosis was confirmed by the history of the tick-bites and elevated titers of IgG in serum and cerebrospinal fluid.

Are CSF or serum ganglioside antibodies related to peripheral nerve demyelination in neuroborreliosis, Guillain-Barré syndrome, or chronic inflammatory demyelinating polyradiculoneuropathy?

Cerebrospinal fluid (CSF) and serum IgG and IgM antibodies to seven gangliosides were determined in patients with neuroborreliosis (NB) (n = 20), Guillain-Barré syndrome (GBS) (n = 13), and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (n = 10). The incidence of elevated antibodies was highest in NB and lowest in CIDP. Correlation between CSF and serum antibodies was only observed for IgG antibodies to GM1, GD1b and GT1b in GBS. The strong IgM antibody reactivity to gangliosides in the CSF of NB patients may be involved in the variety of neurological disorders attributed to Borrelia burgdorferi infection. Since one CIDP and three GBS patients had serologic evidence of prior or concurrent borrelia infection, this infection may belong to the infections that can trigger GBS or CIDP. The lack of specific ganglioside antibody patterns in these four patients suggests that ganglioside antibodies are not the link between Borrelia burgdorferi infection and the demyelination of peripheral nerves in GBS and CIDP.

Stroke in neuroborreliosis

A 20-year-old man suffered two thalamic infarctions during the course of neuroborreliosis and was successfully treated with intravenous ceftriaxone. Review of 11 additional cases of stroke and cerebral vasculitis in neuroborreliosis suggests that there is a meningovascular form of the infection with predilection for the posterior circulation and an association with the European strains of Borrelia burgdorferi.

Bovine borreliosis: comparison of simple methods for detection of the spirochaete in the blood

Natural Borrelia infection occurring in a calf was followed up using stained blood and buffy coat smears and direct observation of blood and buffy coat in order to compare these spirochaete detection methods. Direct examination of the platelet-plasma interface of the microhaematocrit capillary tubes after centrifugation allowed detection of two parasitaemias that were not seen in Giemsa stained blood smears. An ascending Babesia bigemina infection seemed to suppress the Borrelia parasitaemia. Spirochaetes were detected in five out of 37 Boophilus decoloratus ticks recovered from the infected calf. The blood and the haemolymph stages of Borrelia were measured. After treatment with oxytetracycline the spirochaete could no longer be detected.

Bacterial infection and human fetal wastage

Twenty-eight of 57 fetuses delivered after intrauterine death were found to have a variety of aerobic and facultative bacteria in the heart, anus, placenta, brain and cerebrospinal fluid. Subclinical maternal bacteremia, possibly originating in the urinary tract, appears to be a common cause of second- and third-trimester fetal demise.

Peripheral facial palsy caused by the Borrelia spirochete

Forty-three consecutive patients with peripheral facial palsy were examined to evaluate the incidence of facial palsy caused by the tick-borne Borrelia spirochete in a non-coastal area in the south of Sweden. Six (14%) of the patients were found to have a Borrelia infection. The incidence of Borrelia-induced facial palsy was 0.39/10,000 inhabitants, which is less than in neighbouring coastal areas but still high enough to cause serious concern when dealing with facial palsies. In contrast to Bell's palsy, a Borrelia infection can cause serious generalized illness if not properly treated. Negative Borrelia serology of the serum and the cerebrospinal fluid (CSF) and a normal CSF analysis did not exclude the Borrelia etiology. Tick bites, signs of polyneuropathy, meningeal symptoms and Borrelia-associated erythema proved to be important signs for the diagnosis.