Did Garin and Bujadoux Actually Report a Case of Lyme Radiculoneuritis?

The major epidemiologic, microbiologic, immunologic, and clinical aspects of Lyme disease that form the basis for a newly developed vaccine that may become available soon for human use

Working together, two major pharmaceutical companies have developed a Lyme disease vaccine consisting of recombinant-derived outer surface protein A (OspA) of the etiologic agent Borrelia burgdorferi. Multiple clinical trials have shown the vaccine to have good safety and efficacy results, and it is hoped that it would become available for human use at least by the year 2025 after receiving approval from the U.S. Food and Drug Administration. There are still challenges left to ensure that the vaccine has, at most, minimal side effects. Also, because the previously developed Lyme disease vaccine was discontinued in 2002 after four years of distribution, due in part, for frivolous reasons having little or no scientific basis, that even led to legal entanglements involving the vaccine manufacturer and some of the medical personnel overseeing the clinical trials, there will be concerns that this newly developed one could be subject again to some of the same unnecessary scrutiny rendering its implementation suboptimal. Initially this review will focus on the key epidemiological, microbiologic, immunologic and clinical aspects of Lyme disease that provide the foundation for developing this type of vaccine that could have a serious impact on the prevalence of this and even certain other tick-transmitted infections.

Neuroborreliosis Presenting as Guillain-Barré Syndrome

Lyme disease (LD) is the most common vector-borne disease in the United States. The early localized disease presents with erythema migrans and nonspecific constitutional symptoms. A neurological manifestation of LD (neuroborreliosis) is only seen in 10-15% of LD cases, and it typically presents as cranial neuritis or painful radiculitis. We report a case of a 33-year-old male who presented with progressive ascending bilateral lower extremities weakness with paresthesia in hands and feet following an upper respiratory tract infection and an abdominal rash. Cerebrospinal fluid (CSF) analysis revealed albuminocytologic dissociation. An electrodiagnostic study showed prolonged distal motor latency, conduction block, and absent F-wave response. Magnetic resonance imaging of the lumbar spine revealed enhancement of the cauda equina nerve roots. After a lack of improvement with intravenous immunoglobulin for presumed Guillain-Barré syndrome (GBS), Lyme serologies were sent and showed positive Lyme antibodies in serum and CSF as well as positive western blot IgM followed by IgG seroconversion a week later. The patient was started on IV ceftriaxone and doxycycline for four weeks with significant improvement in his symptoms. This is a rare case of LD presenting as GBS. Lyme can have diverse neurologic manifestations and should be considered in the differential diagnosis of GBS in the appropriate settings.

Melting pot of tick-borne zoonoses: the European hedgehog contributes to the maintenance of various tick-borne diseases in natural cycles urban and suburban areas

Background

European hedgehogs (Erinaceus europaeus) are urban dwellers and host both Ixodes ricinus and Ixodes hexagonus. These ticks transmit several zoonotic pathogens like Borrelia burgdorferi (sensu lato), Anaplasma phagocytophilum, Rickettsia helvetica, Borrelia miyamotoi and “Candidatus Neoehrlichia mikurensis”. It is unclear to what extent hedgehogs in (sub) urban areas contribute to the presence of infected ticks in these areas, which subsequently pose a risk for acquiring a tick-borne disease. Therefore, it is important to investigate to what extent hedgehogs contribute to the enzootic cycle of these tick-borne pathogens, and to shed more light at the mechanisms of the transmission cycles involving hedgehogs and both ixodid tick species.

Methods

Engorged ticks from hedgehogs were collected from (sub) urban areas via rehabilitating centres in Belgium. Ticks were screened individually for presence of Borrelia burgdorferi (sensu lato), Borrelia miyamotoi, Anaplasma phagocytophilum, Rickettsia helvetica and “Candidatus Neoehrlichia mikurensis” using PCR-based methods. Infection rates of the different pathogens in ticks were calculated and compared to infection rates in questing ticks.

Results

Both Ixodes hexagonus (n = 1132) and Ixodes ricinus (n = 73) of all life stages were found on the 54 investigated hedgehogs. Only a few hedgehogs carried most of the ticks, with 6 of the 54 hedgehogs carrying more than half of all ticks (624/1205). Borrelia miyamotoi, A. phagocytophilum, R. helvetica and B. burgdorferi genospecies (Borrelia afzelii, Borrelia bavariensis and Borrelia spielmanii) were detected in both I. hexagonus and I. ricinus. Anaplasma phagocytophilum, R. helvetica, B. afzelii, B. bavariensis and B. spielmanii were found significantly more in engorged ticks in comparison to questing I. ricinus.

Conclusions

European hedgehogs seem to contribute to the spread and transmission of tick-borne pathogens in urban areas. The relatively high prevalence of B. bavariensis, B. spielmanii, B. afzelii, A. phagocytophilum and R. helvetica in engorged ticks suggests that hedgehogs contribute to their enzootic cycles in (sub) urban areas. The extent to which hedgehogs can independently maintain these agents in natural cycles, and the role of other hosts (rodents and birds) remain to be investigated.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-017-2065-0) contains supplementary material, which is available to authorized users.