Arthritis as manifestation of Lyme disease in England

Direct molecular typing of Borrelia burgdorferi sensu lato species in synovial samples from patients with lyme arthritis

Since Lyme arthritis was first described in the United States, it has now been reported in many countries of Europe. However, very few strains of the causative bacterium, Borrelia burgdorferi, have been isolated from synovial samples. For this reason, different molecular direct typing methods were developed recently to assess which species could be involved in Lyme arthritis in Europe. We developed a simple oligonucleotide typing method with PCR fragments from the flagellin gene of B. burgdorferi sensu lato, which is able to differentiate seven different Borrelia species. Among 10 consecutive PCR-positive patients with Lyme arthritis from the northeastern France, two species were identified in synovial samples: B. burgdorferi sensu stricto in 9 cases and B. garinii in 1 case. Conversely, all B. burgdorferi sensu lato species detected in 10 consecutive PCR-positive biopsies from a second set of patients with erythema migrans from the same geographical area were identified as either B. afzelii or B. garinii (P < 0.001). These results indicate that B. burgdorferi sensu stricto is the principal but not the only Borrelia species involved in Lyme arthritis in northeastern France.

Serologic evidences suggesting the presence of Borrelia burgdorferi infection in Mexico

BACKGROUND

Lyme disease is the most common vector-borne human disease in Europe and the United States. In Mexico, clinical cases suggestive of Lyme borreliosis have been reported; however, infection was not confirmed by serologic or microbiologic tests.

METHODS

To study the prevalence of IgG antibodies against Borrelia burgdorferi among Mexican persons, a community-based sero-survey including all states of Mexico was done. A sample of 2,890 sera representing individuals of all ages and all socioeconomic levels was studied. Antibodies anti-B. burgdorferi were determined by enzyme-linked immunosorbent assay (ELISA) using a whole-cell sonicated extract of B. burgdorferi strain B31. Serum specimens positive for ELISA were further studied by Western blot (WB). A serum sample was considered positive by WB if at least three of the following protein bands were recognized: 18, 24, 28, 29, 31, 34, 39, 41, 45, 58, 62, 66, and 93 kDa. Some WB positive specimens were further confirmed with an immunodot-blot (IDB) test using recombinant and purified B. burgdorferi proteins.

RESULTS

Of the 2,890 specimens, 34 were positive for ELISA; nine of these 34 were confirmed as positive by WB. Four of the nine WB positive sera were tested by IDB and all four were positive. The prevalence of WB confirmed cases in the sample studied was 0.3%. Positive specimens were from residents of the northeastern and central areas of Mexico.

CONCLUSIONS

The serological evidences of this study suggest that Borrelia burgdorferi infection is present in the Mexican population. This finding should be confirmed by documenting the infection in clinical cases and in tick vectors.

Antibodies to arthritis-associated microbes in inflammatory joint diseases

IgM, IgG and IgA class antibodies against Yersinia, Salmonella, Campylobacter and Borrelia were determined by enzyme-linked immunosorbent assay (ELISA) in a group of 340 unselected patients with a recent inflammatory joint disease. The control group consisted of 340 and 100 healthy blood donors using Borrelia-ELISA and other ELISAs, respectively. Of all the patients, 27.4% had increased antibody levels against at least one of the microbes tested. The prevalence of positive antibody levels was highest in Yersinia antibodies (17.9%). The corresponding figures for Salmonella, Campylobacter and Borrelia were 7.0, 6.2 and 1.8%, respectively. Patients with entero-arthritis or clinically typical reactive arthritis who had not had gastrointestinal or urogenital symptoms previously had the highest prevalence of the microbial antibodies (67.6 and 40.7%, respectively). These findings indicate that arthritis may often have a reactive etiopathogenesis without recognized gastrointestinal infection, emphasizing the importance of microbial serology in the differential diagnosis.