Clinical and diagnosis considerations of Lyme disease

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Roumanian archives of microbiology and immunology 06/2013; 72(2):135-63.
Source: PubMed


Numerous improvements have been made
along the years in the prevention, diagnosis and
treatment of Lyme borreliosis (LB). Nonetheless,
LB remains the most common human infection
transmitted by ticks in temperate regions of the
northern hemisphere [1,2]. Lyme borreliosis is a
multisystemic infection caused by the pathogenic
genospecies of the Borrelia burgdorferi sensu lato
(s.l.) complex, including B. burgdorferi sensu
stricto (s.s.), Borrelia garinii, Borrelia afzelii, Borrelia
bavariensis, and Borrelia spielmanii. All pathogenic
genospecies can cause erythema migrans
(EM), which is the classical target rash that is cha -
racteristic of Lyme disease but distinct genospecies
possess diferent organotropism, and may prefe -
rentially cause distinct clinical manifestations of
LB. B. burgdorferi s.s. is most commonly associated
with arthritis, B. garinii with neuroborreliosis,
and B. afzelii with cutaneous manifestations
of LB (EM, lymphocytoma borreliosis, and acrodermatitis
chronica atrophicans) [3]. B. burgdorferi
s.s. and B. afzelii may also be associated with neurological
manifestations, but at a lower rate than that
of B. garinii [4-6]. Approximately 60% of patients
with EM, treated with antibiotics, have long or
short episodes of arthritis caused by B. burgdorferi
s.s in North America [7]. By contrast, only
3-15% of patients with LB suffer from arthritis
in Europe [8], where B. garinii and B. afzelii are
the most commonly found genospecies. The average
Lyme borreliosis annual incidence is 37.77, the
ma ximum being registered in Slovenia, and the mi -
nimum value in Ireland (0.6) [9]. In some geo graphical
regions it has had an increase in the rates
of disease transmission and in the incidence implicitly
[10], so that LB should continue to be regarded
as an emerging disease. In Romania, according to data reported by the National Center for
Surveillance and Control of Communicable
Diseases (CNSCBT) of the National Institute of Pu -
blic Health (INSP), both institutions under the coordination
of the Ministry of Health, the incidence of
LB in 2011 was 2/100,000. B. burgdorferi sensu lato
(s.l.) genospecies circulating in Romania are:
B. burgdorferi s.s., B. afzelii and B. garinii [11].

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Available from: Ani Ioana Cotar, Jun 25, 2015
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    ABSTRACT: The diagnosis of Lyme borreliosis (LB) is very complex due to the diversity of clinical manifestations, very few being exclusive for Borrelia burgdorferi infection . In this context the diagnosis is based on clinical criteria (symptoms and clinical signs), exposure history and laboratory test results. Generally, the microbiological laboratory data are a major criterium for the clinical diagnosis of LB. The antibody detection methods are the main laboratory tests used to support a clinical diagnosis for most LB stages. In this study we investigated the detection specificity of antibodies against B. burgdorferi s.l by using three different Western blot (WB) tests to evaluate possible correlations between the clinical manifestations of LB and infecting B. burgdorferi genospecies in 26 Romanian patients with positive ELISA results for LB. Each of WB tests allows detection of specific antibodies against one of three B. burgdorferi s.l genospecies responsible for LB cases in Romanian patients, represented by B. afzelii, B. garinii and B. burgdorferi sensu stricto. The results of our study showed that both IgG and especially IgM antibodies cross-react mainly with antigens of B. garinii and B. afzelii, no specific correlation can be done between genospecies of B. burgdorferi s.l involved in infection and clinical manifestations of patients with clinical suspicion of LB. Therefore the WB tests used for the confirmation of ELISA results in the serum and cerebrospinal fluid (CSF) samples of patients suspected of LB must allow the simultaneous detection of the antibodies against antigens of all three B. burgdorferi s.l genospecies. It is also recommended the use of the latest generation of WB kits, which contain not only the antigens purified from three strains of B. burgdorferi genospecies, but also the antigens that are expressed during in vivo infection, obtained by recombinant DNA technology.
    Full-text · Article · Aug 2013