Lyme borreliosis

Awareness of non-communicable diseases in women: a cross-sectional study

Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.

Synovial Tissue Biopsy Collection by Rheumatologists: Ready for Clinical Implementation?

Synovial tissue from arthritis patients is increasingly used for both basic pathophysiological and clinical translational research. This development has been spurred by the development of biotechnological techniques for analysis of complex tissues and the validation of ultrasound guided biopsies for easier tissue sampling. This increasing use of synovial tissue raises questions on standardization of methodologies for tissue processing and cellular & molecular analyses. Furthermore, it raises the question if synovial tissue biopsy analysis may be more widely implemented in clinical practice, what are the methodological hurdles for implementation and what are the lessons that can be learned from previous experience. This will be the focus of this review.

Omics and bioinformatics applied to vaccine development against Borrelia

Borrelia burgdorferi is an extracellular spirochete that causes Lyme disease. Currently, no effective vaccine is available for humans and animals except for dogs. In the present study, an extensive bioinformatics pipeline was established to predict new candidates that can be used for vaccine development including building the protein-protein interaction network based on orthologues of experimentally verified protein-protein interaction networks, elucidation of the proteins involved in the immune response, selection of the topologically-interesting proteins and their prioritization based on their antigenicity. Proteomic network analysis yielded an interactome network with 120 nodes with 97 interactions. Proteins were selected to obtain a subnet containing only the borrelial membrane proteins and immune-related host proteins. This strategy resulted in the selection of 15 borrelial targets, which were subjected to extensive bioinformatics analysis to predict their antigenic properties. Based on the strategy applied in this study the proteins encoded by erpX (ErpX proteins, UniProt ID: H7C7L6), erpL (ErpL protein, UniProt ID: H7C7M3) and erpY (ErpY protein, UniProt ID: Q9S0D9) are suggested as a novel set of vaccine targets to control Lyme disease. Moreover, five different tools were used to validate their antigenicity regarding B-cells. The combination of all these proteins in a vaccine should allow improved protection against Borrelia infection.

Promising alternatives for one-tier testing of Lyme borreliosis

A main focus of human health studies is the early detection of infectious diseases to enable more rapid treatment and prevent disease transmission. Diagnosis of Lyme borreliosis has been always challenging because of the lack of specific, but simple assay formats. Two-tiered testing has been recommended by US Centers for Disease Control and Prevention to provide more specific results for diagnosis of Lyme disease. However, such a technique is time consuming and is not well suited for early stage detection. Therefore, many tests were proposed as alternatives to overcome these drawbacks. Simple assays, which are mainly performed in one-tier manner, could be conducted with better performance than the two-tiered testing. Proposed assays utilize both newly identified antigens and new platforms to improve detection performance. These assays can be classified into those based on employing a single antigen and assays based on using multiple antigens. In addition to assays to this type of assays, immunoassays on borreliosis-related biomarkers are available. We report here the most recent assays developed over the last 10 years, for detection of Lyme borreliosis in body fluids.

An estimate of Lyme borreliosis incidence in Western Europe†

Background

Lyme borreliosis (LB) is the most common zoonotic disease transmitted by ticks in the USA and Europe. This review aims to estimate the regional burden of LB in Western Europe. Data from previous publications will be used to calculate the mean incidence. The mean incidence rates will then be combined to estimate the regional burden and a population-weighted regional burden of disease based on the standardized incidence rate from the included studies and the total population at risk.

Methods

Reviews and surveillance reports identified by the initial database search were assessed for eligibility first by their title and abstract and subsequently by a more detailed review of the source by two independent authors for the most recent data regarding LB. Eleven sources of incidence data were included in the review representing 17 countries in total. Incidence estimates were calculated from reported values and population data.

Results

Countries in Western Europe have a large variance in the incidence rates. The highest reported incidences for LB were reported in southern Sweden with 464/100 000 and the lowest in Italy of 0.001/100 000. The unweighted mean for the included data provided an incidence rate of 56.3/100 000 persons per year, equating to ∼232 125 cases in 1 year throughout the region. The calculated population-weighted average incidence rate for the regional burden of LB in Western Europe was 22.05 cases per 100 000 person-years.

Conclusions

LB is a continually emerging disease and the most common zoonotic infection in Western Europe approaching endemic proportions in many European countries. The population-weighted incidence rate has been estimated by this study to be 22.04/100 000 person-years. Concordant and well-conducted surveillance and disease awareness should continue to be encouraged to monitor LB, as tick numbers and activity are increasing, leading to greater risks of infection.

When a patient suspected with juvenile idiopathic arthritis turns out to be diagnosed with an infectious disease - a review of Lyme arthritis in children

The Lyme arthritis is a common manifestation of infection with Borrelia burgdorferi spirochete. Despite its infectious background, the inflammation clinically and histopatologically resembles juvenile idiopathic arthritis. As it affects a considerable number of Lyme disease patients, it should be routinely considered in differential diagnosis. Development of arthritis is partially dependent on spirochetal factors, including the ribosomal spacer type and the sequence of outer surface protein C. Immunological background involves Th1-related response, but IL-17 provides an additional route of developing arthritis. Autoimmune mechanisms may lead to antibiotic-refractory arthritis. The current diagnostic standard is based on a 2-step testing: ELISA screening and immunoblot confirmation. Other suggested methods contain modified two-tier test with C6 ELISA instead of immunoblot. An initial 28-day course of oral antibiotics (doxycycline, cefuroxime axetil or amoxicillin) is a recommended treatment. Severe cases require further anti-inflammatory management. Precise investigation of new diagnostic and therapeutic approaches is advisable.

Lyme disease: a case report of a 17-year-old male with fatal Lyme carditis

Lyme disease is a systemic infection commonly found in the northeastern, mid-Atlantic, and north-central regions of the United States. Of the many systemic manifestations of Lyme disease, cardiac involvement is uncommon and rarely causes mortality. We describe a case of a 17-year-old adolescent who died unexpectedly after a 3-week viral-like syndrome. Postmortem examination was remarkable for diffuse pancarditis characterized by extensive infiltrates of lymphocytes and focal interstitial fibrosis. In the cardiac tissue, Borrelia burgdorferi was identified via special stains, immunohistochemistry, and polymerase chain reaction. The findings support B. burgdorferi as the causative agent for his fulminant carditis and that the patient suffered fatal Lyme carditis. Usually, Lyme carditis is associated with conduction disturbances and is a treatable condition. Nevertheless, few cases of mortality have been reported in the literature. Here, we report a rare example of fatal Lyme carditis in an unsuspected patient.

Lyme disease as an underlying cause of supraspinatus tendinopathy in an overhead athlete

BACKGROUND AND PURPOSE

Supraspinatus tendinopathy is a common cause of shoulder pain seen in overhead athletes, but there appear to be no published cases that present Lyme disease as the underlying cause of tendinopathy. Lyme disease is diagnosed primarily by clinical signs and symptoms and then supported by laboratory tests, including enzyme-linked immunosorbant assay (ELISA) and Western blot testing. This case demonstrates the importance of a physical therapist's input and clinical role in reaching the correct diagnosis in an athlete with Lyme disease who had a diagnosis of rotator cuff impingement and tendinitis.

CASE DESCRIPTION

A 34-year-old male tennis player was seen for physical therapy for right shoulder impingement and tendinitis diagnosed by an orthopedic surgeon. He was unable to participate in sporting activities due to impairments in strength and pain. Initial examination revealed distal supraspinatus impingement and tendinopathy.

OUTCOMES

The patient was not progressing with commonly accepted interventions and began to have "arthritis-like" shoulder pain in the uninvolved left shoulder. Suspicious of an underlying condition, the physical therapist informed the physician of the patient's updated status and referred the patient to the physician to discuss the current symptoms in therapy. After testing, the patient was diagnosed with chronic Lyme disease and underwent antibiotic therapy.

DISCUSSION

Many active patients spend time in the outdoors, increasing their risk of exposure to a vector for Borrelia burgdorferi. Physical therapists spend a larger portion of time with patients than other health care professionals and due to this extended contact and musculoskeletal knowledge are able to recognize atypical musculoskeletal disorders or musculoskeletal manifestations of unusual pathologies, including Lyme disease.

[Lyme borreliosis]

Lyme borreliosis is a multi-system infectious disease that primarily affects the skin, nervous system, heart, and joints. It is caused by the tick-borne spirochete Borrelia burgdorferi sensu lato. Diagnosis is made on the basis of clinical symptoms and supported by a positive serology. Antibiotic therapy should be started immediately after the diagnosis has been established and is administered according to stage and symptoms of the disease. Doxycycline, amoxicillin, and ceftriaxone are the antibiotics of choice. Early Lyme disease is almost always cured by one antibiotic course that also prevents subsequent disease manifestations. After antibiotic therapy of late disease manifestations, symptoms resolve only slowly and remission is usually achieved after weeks or even months. Chronic or therapy-resistant disease courses and residual symptoms after therapy are rare.

Recognition and management of common ectoparasitic diseases in travelers

This review article summarizes the ectoparasitic diseases likely to be seen by a Western dermatologist. The article aims to cover both endemic diseases and those likely to present in the returning traveler. Tungiasis is due to the gravid sand flea (Tunga penetrans) embedding into the stratum corneum of a human host. As the flea is a ground dweller, lesions are usually present on the feet and are classically periungual. The sand flea is eventually shed spontaneously but to reduce the infection risk, early surgical removal is recommended. Infestation by the Diptera species of fly causes myiasis, which may be primary, secondary, or accidental. The botfly (Dermatobia hominis) is one of the causes of primary myiasis covered in this article. Traditionally, botfly larvae are forced to partially emerge by occluding the breathing apparatus, following which manual extraction can occur. Alternatively, the larvae can be surgically removed. The common bed bug (Cimex lectularius) has experienced a resurgence over the past 10 years. Bites are typically arranged in clusters or a linear fashion and vary from urticated wheals to hemorrhagic blisters. Treatment is symptomatic with antihistamines and topical corticosteroids. In addition, bed bugs need to be eradicated from furniture and soft furnishings. Ticks are part of the Arachnid class of joint-legged animals and can transmit a variety of infections. This article briefly discusses Mediterranean spotted fever, Rocky Mountain spotted fever, and Lyme disease as well as describing tick avoidance measures. Scabies (Sarcoptes scabiei var hominis) is highly contagious and widely distributed around the world. It is common in the returning traveler and can require a high index of suspicion to diagnose. The treatment of choice in the US, UK, and Australia is permethrin 5% dermal cream, applied on two occasions, 1 week apart.

Serodiagnosis of Lyme borreliosis infection using surface plasmon resonance

BACKGROUND

Label-free biosensors are ideally suited for the direct monitoring of binding events without the need for additional labeling substances; however, their application in the field of serodiagnosis is not trivial. The major problem is the unspecific adsorption of blood serum components to the sensor surface.

METHODS

A surface plasmon resonance (SPR) sensor has been used for the direct detection of Lyme borreliosis specific antibodies in blood serum. The combination of an optimal dilution factor with the addition of suitable detergents minimizes the unspecific adsorption. Serum samples from healthy donors and infected patients have been analyzed and the results were compared with a certified immunoassay and a western blot.

RESULTS

A serum dilution of 1:20 in HBS-buffer with 0.05% Tween20 and 1 mg/mL carboxymethyl dextran reduces unspecific adsorption significantly and enables the identification of antibodies against the OspC/pepC10 antigen pair with a sensitivity of 92% and that against the VlsE/C6 pair with 81% sensitivity; the specificities are 82% and 86% respectively. Positive hits in the western blot could also be determined in the SPR-assay with a correlation of 96.5%.

CONCLUSION

The presented optical label-free technique has the potential for a precise and fast identification of pathogen-specific antibodies without the need for a secondary labeling antibody.