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Lymphadenosis benigna cutis resulting from Borrelia infection (Borrelia lymphocytoma).

Swelling and erythema of the right pinna developed in a 7-year-old girl. Six months later a biopsy specimen showed a dense, diffuse lymphoplasmacytic infiltrate involving most of the dermis except for a thin Grenz zone. The appearance was consistent with lymphocytoma cutis. She had been bitten by a tick on the right ear in Switzerland 6 weeks before the onset of the lesion. Serologic tests by enzyme-linked immunosorbent assay for Borrelia burgdorferi, done 6 and 11 months after the bite, yielded optical density readings of 1.04 and 0.65, respectively; indirect immunofluorescence yielded titers of 1:256 and 1:128. A Borrelia-like organism was identified by a modified Steiner stain; immunohistochemistry was noncontributory. The spirochetal origin of lymphadenosis benigna cutis is briefly reviewed.

Antibodies, Bacterial↗

Asymptomatic Borrelia-seropositive individuals display the same incidence of Borrelia-specific interferon-gamma (IFN-gamma)-secreting cells in blood as patients with clinical Borrelia infection.

Borrelia Lyme disease is a complex disorder that sometimes becomes chronic. There are contradictory reports of experimental Borrelia infections regarding which type of T cell cytokine responses, i.e. Th1 or Th2, are needed to eradicate the Borrelia spirochaetes. In human borreliosis a predominance of Borrelia-specific Th1-like responses has been shown. In this study, spontaneous, as well as Borrelia-specific, secretion of IFN-gamma (Th1) and IL-4 (Th2) in Borrelia-seropositive healthy asymptomatic individuals (n = 17) was investigated in peripheral blood by a sensitive ELISPOT assay, and compared with previously reported responses in patients with clinical Borrelia infection (n = 25). The seropositive asymptomatic individuals displayed the same predominance of Borrelia-specific IFN-gamma-secreting cells as the patients with clinical Borrelia infection. Interestingly, the proportion of spontaneously IL-4-secreting cells, reflecting the unstimulated in vivo secretion, was lower in the seropositive asymptomatic individuals compared with patients with chronic Borrelia infections (n = 13, P = 0.02), whereas no such difference was found compared with subacute Borrelia infections (n = 12). These findings indicate that IFN-gamma secretion alone is not sufficient to eliminate Borrelia spirochaetes in humans, although IFN-gamma may still have a beneficial role in borreliosis acting in concert with other mechanisms.

Adult↗

Mosaic pattern of Borrelia infection in a continuous population of the tick Ixodes ricinus (Acari: Ixodidae).

An array of 12 20 x 20 m quadrats in a mixed forest near Poteply, Central Bohemia, Czech Republic, was investigated for the abundance and spatial distribution of host-questing Ixodes ricinus nymphs and their infection with borreliae. Tick densities were estimated by flagging and their borrelia infection status was determined by direct immunofluorescence. While the tick population appeared to be continuous and homogeneous based on quadrat counts, their infection with borreliae evinced a mosaic pattern. The nymphal infection rates ranged between 1.6 and 10.5% (mean = 6.0%) with significant differences between adjacent quadrats. Home ranging of small rodents (Apodemus flavicollis and Clethrionomys glareolus) inhabiting the forest seems to be responsible for the spatial pattern of borrelial infection.

Animals↗

[Diffuse fasciitis after Borrelia infection--a case report].

Diffuse fasciitis (DF) [diffuse fasciitis with eosinophilia-Shulman's syndrome] has occasionally been linked to a precedent infection with Borrelia burgdorferi. Here, we report on another case of DF in a 25 year old male, in whom Borrelia burgdorferi infection as possible inciting agent could be identified based on the patient's history and laboratory data. Efforts to microscopically demonstrate spirochetes or to amplify Borrelia-DNA by nested PCR in lesional tissue failed after antibiotic treatment had already been initiated. Although only a few cases of Borrelia associated diffuse fasciitis have been reported in the literature, the link between typical signs and symptoms as well as laboratory findings of Borrelia infection and the onset of diffuse fasciitis, starting at the primary site of EM, provide indirect evidence for a causative role of Borrelia burgdorferi as a potential infectious agent for DF.

Adult↗

[Borrelia infections from a dermatological viewpoint].

Erythema migrans (EM), Borrelia lymphocytoma (BL) and acrodermatitis chronica atrophicans (ACA) are the established dermatological manifestations of borrelia infection, a complex multiorganic disease. Analogous to syphilis Borrelia infection can be classified by three stages, at which stage I (localized infection) and II (disseminated infection) are manifestations of early infection and stage III (persistent infection) a symptom of late infection. At all stages skin manifestations can be present, the above mentioned as stage-marker as well as other non-specific polymorphous skin lesions which sometimes appear at stage II. Because of its frequent (60-80%) occurrence in all borrelia infections EM has a pathognomonic importance for borrelia infection. In diagnosis serology is currently the only practical laboratory aid. False negative and false positive results must be considered. Treatment of choice is ceftriaxone, penicillin G (or amoxycillin) or tetracycline. Prophylactic antibiotic therapy for tick bites is not recommended. Congenital borrelia infections seem to be unusual, but it is likely that they can occur and cause different adverse fetal outcome or abortion.

Acrodermatitis↗

[Acute acral ischemia in all fingers possibly due to a Borrelia infection].

Acute interruption of circulation in the distal fingers can be both expression of an embolic event as well as the first manifestation of a vasculitis or collagenosis. The search for its cause is frequently difficult. In many cases a specialized analysis of the coagulation system as well as diagnostics such as ultrasound scan of the heart or a systematic antibody scanning do not reveal the origin of an embolus or the underlying disorder. On the basis of a case-report we would like to focus on a possible context between an infection of Borrelias stage III and consecutive deterioration of peripheral arterial perfusion in the fingers. Besides Jo-1- and positive sceleton-muscle-antibodies there were no serological and clinical indications for an autoimmune disease. It was possible to avoid acral necrosis by means of an antibiotic, immunosuppressive and rheological therapeutic concept. We recommend to control the borellia-antibody-level in cases of obscure threatening peripheral necrosis caused by arterial perfusion stop.

Acute Disease↗

Clinical manifestations of Borrelia infections of the nervous system.

Clinical, treatment and laboratory parameters were analyzed in 46 consecutive Swedish patients with Borrelia infections of the nervous system. The importance of age in the clinical symptoms, the wide spectrum of disease, and the chronic behaviour of the Borrelia infection of the nervous system was stressed, as well as the benefit of high-dose intravenous antibiotics, especially penicillin G. Borrelia infection of the nervous system can imitate other diseases. When associated with meningitis it can mimic psychosomatic disorders, when associated with radiculoneuritis it may imitate herniated discs and when central nervous involvement of the Borrelia infection occurs, it can mimic a non-infectious, thrombotic or haemorrhagic cerebro-vascular disease.

Adolescent↗

[The exploratory activity of the Borrelia-infected taiga tick Ixodes persulcatus].

The infection with Borrelia burgdorferi s. l. increases the questing activity of adults and nymphs of the taiga tick Ixodes persulcatus. High temperature inhibits the moving and questing activities of the infected ticks in a greater extent than that in the non-infected ones. Than more borreliae per a specimen of tick are present, the more tick's activity is affected.

Animals↗

Epidemiology of borrelia infections in Austria.

From April 1984 to July 1985 873 cases of Borrelia infections were registered at the Hygiene Institute of the University of Vienna. 2609 serum samples of these patients were investigated for antibodies against B. burgdorferi by means of IFA- and ELISA-tests. Erythema chronicum migrans (ECM) was recognized in 60.9% of patients, neurological abnormalities were recorded in 23.4% of which the majority manifested themselves as polyradiculitis and meningopolyneuritis (MPN). Acrodermatitis chronica atrophicans (ACA) was recognized in 11.5%. A small number of patients suffered from Lymphadenosis cutis benigna (LCB), arthritis and cardiac abnormalities. Sixty percent of patients were females and 40% males. Infections were found in all age groups ranging from 2-83 years in females and 1-85 years in males. Tick- or insect-bites prior to the onset of illness were reported by 47.2% and 15.6% of patients, respectively. The main vector is the hard tick Ixodes ricinus. Flying insects from the family tabanidae, i.e. Chrysops caecutiens and Haematopota species, must also be considered as transmitters. Antibodies to B. burgdorferi were found in 22.3%, 93.6% and 100% of sera from patients with ECM, MPN and ACA, respectively. Six of 11 patients with LCB and all with arthritis and cardiac abnormalities showed serologic reactivity. Geographically, Borrelia infections are distributed in all states of Austria. The seasonal distribution of cases show a peak in July and August, but the onset of clinical manifestation could be observed throughout the year. These results present Austria as an area where tick- or insect-borne Borrelia infections are very frequent and endemic in all Austrian states.

Acrodermatitis↗

[Chronic erythema migrans and tick-transmitted meningopolyneuritis (Garin-Bujadoux-Bannwarth): Borrelia infections?].

Antibodies against Borrelia duttoni using indirect immunofluorescence could be demonstrated in 6 patients with erythema chronicum migrans and in 8 persons with tick-borne meningopolyneuritis. Significant increases of IgG and IgM antibody titres in the course of the disease and IgG antibodies in the CSF indicate recent contact with Borrelia duttoni or a closely related agent. Demonstration by fluorescence serology of spirochaetaceae in Ixodes ricinus in two sites of infection equally indicate such an aetiology. The immunofluorescence test for patient sera used here improves the diagnosis of erythema chronicum migrans infection and of its various organ manifestations. Results are similar to those in Lyme disease in the United States.

Adolescent↗

[Acute Borrelia infection. Unilateral papillitis as isolated clinical manifestation].

BACKGROUND: Borrelia burgdorferi is the cause of erythema chronicum migrans and Lyme disease. Ticks like Ixodes ricinus are responsible for transmission. Frequently, the tick bite is not noticed by the patient. Eye manifestations, such as keratoconjunctivitis, scleritis, chronic uveitis, vitritis, chorioretinitis, optic nerve disease, orbital myositis and paresis of the eye muscles, often occur after a long period of time and vary greatly. PATIENTS AND METHODS: We present below the case reports of a man 38 years old and a woman of 31, each with manifestation of an ocular Borrelia infection (papillitis and panuveitis, respectively). RESULTS: By antibody-screening with the ELISA technique and Western Blot analysis we were able to prove the serological infection. After specific antibiotic therapy, ocular inflammation improved rapidly, as did visual acuity. The papillitis only healed partially. CONCLUSIONS: In case of therapy-resistant inflammation of the eye we have to exclude general infections because cortisone therapy alone may result in worsening the condition. VECP can be used effectively in the differential diagnosis of papilloedemas. Early diagnosis and therapy of an acute Borrelia infection restrict the extent of the lesions and prevent ocular and general late manifestations. Seronegative values in subjects strongly suspected of having Lyme disease do not necessarily exclude the diagnosis of Lyme disease.

Borrelia burgdorferi Group↗

Borrelia infection and vertigo.

73 patients with vertigo were studied regarding serum antibodies to Borrelia spirochete antigen, using an indirect immunofluorescence method. Ten patients (14%) had serological evidence of Borrelia infection. All 10 patients had severe, incapacitating vertigo. Four of the Borrelia patients had positional vertigo and all 10 had positional nystagmus when tested using ENG. Five of them had unilateral caloric weakness. Five patients had abnormal oculomotor tests. Borrelia infection is an etiological factor which should be considered in patients suffering from vertigo especially if positional nystagmus is present.

Adult↗

Borrelia infection in patients with vertigo and sensorineural hearing loss.

Tick-borne Borrelia infection gives rise to symptoms from different organs. Neurologic manifestations are common. The aim of this study was to evaluate to what extent the cochleovestibular functions are involved in this disease. A total of 73 patients with vertigo were studied. The patients had Meniere-like conditions, positional vertigo or unilateral loss of the vestibular function. Antibodies in serum to the Borrelia spirochete were determined in the acute and convalescent periods. Ten patients, 14 per cent, had serological evidence of Borreliosis. All these patients had severe vertigo and four of them had sensorineural hearing loss, furthermore they had positional nystagmus and the nystagmus showed patterns of both central and/or peripheral vestibular lesions. Treatment with high doses of penicillin-G was favourable in five of the patients with vertigo and in one patient with sensorineural hearing loss. Borrelia infection is an etiological factor which should be considered in patients suffering from vertigo and/or sensorineural hearing loss of unknown origin.

Adult↗

Serum and cerebrospinal fluid examinations in the diagnosis of Borrelia infection in Bell's palsy.

Seventy-two consecutive patients with Bell's palsy were investigated for evidence of tick-borne Borrelia infection and to compare the merits of serum and cerebrospinal fluid examinations in the diagnosis of Borrelia infection. Serum was taken in the acute and convalescent stages from 72 patients, and cerebrospinal fluid was obtained from 35 of these. An enzyme-linked immunosorbent assay (ELISA) was used to analyse serum and cerebrospinal fluid samples for IgG and IgM antibodies against the Borrelia spirochete. The serum of 8 (11%) of the 72 patients was positive for IgG or both for IgG and IgM. Only 1 of the 35 patients presented an elevated titre of IgG and IgM in the cerebrospinal fluid as well as elevated IgG and IgM titres in the serum. The results, even if limited, indicate that screening of serum is sufficient to exclude Borrelia infection in cases of uncomplicated isolated acute peripheral facial palsy.

Acute Disease↗

Borrelia infection in children.

All children (less than or equal to 15 years) admitted during 1986 to Sachs Children's Hospital and presenting signs of facial palsy and/or meningitis, or with a history of known tick bite followed by headache, fatigue and muscle pain, were investigated for antibodies to Borrelia in serum and cerebrospinal fluid. (The hospital's catchment area has a high incidence of tick-borne Borrelia infections.) Significantly elevated antibody titre was found in 15 of the 33 patients, in three cases only in cerebrospinal fluid. Eight of the 15 children had facial palsy, which was concomitant with meningitis in six cases. Intravenous penicillin was given to all 15 patients with positive antibody titre, and additionally to three severely ill small children with facial palsy and meningitis. Furthermore, two cases of erythema chronicum migrans, which is considered pathognomonic for Borrelia infection, were treated with penicillin perorally. Cases of Borrelia infection occurred throughout the year, but with a peak in August. To emphasize the variety of symptoms, three cases are presented in some detail.

Adolescent↗

The mammalian host response to borrelia infection.

Tick-borne relapsing fever (RF) and Lyme disease (LD) are spirochetal infections of humans caused by different Borrelia species in endemic areas throughout the world. Our laboratory is studying the response of mammalian hosts to borrelia infection in RF and LD. For this, we use mice and non-human primates infected with B. burgdorferi sensu stricto strain N40 (N40) and the Oz1 strain of Borrelia turicatae (Bt), agents of LD and RF in North America, respectively. Our results have revealed that outbred non-human primates are significantly less susceptible than outbred mice to persistent infection with N40. In contrast, the majority of mice inoculated with the RF agent B. turicatae clear the infection, with the notable exception of residual brain or blood infection in up to 25% of cases. Little if any tissue injury occurs in immunocompetent animals with either LD or RF. In contrast, impairment of specific antibody production results in significant tissue injury, most notably in the heart, in both LD and RF. The inflammatory infiltrate is rich in plasma cells, activated macrophages and T cells, and there is significant deposition of antibody and complement, including membrane attack complex, in inflamed tissues and spirochetes. Significant loss of cardiomyocytes with apoptosis and caspase activation was observed in the heart of immunosuppressed non-human primates infected with N40 and in B cell-deficient mice infected with B. turicatae. Unlike the heart, the brain of B cell-deficient mice infected with B. turicatae showed prominent microglial activation but no detectable tissue injury. Tissues from immunosuppressed non-human primates infected with N40 produce large amounts of immunoglobulin and the B cell chemokine CXCL13, both of which significantly correlate with the spirochetal load. We conclude that the main response of mammalian hosts in LD and RF is the production of specific antibody to clear the infection. Failure of this response leads to persistent infection, which can lead to tissue injury, most notably in the heart.

Animals↗

Antinuclear antibodies are not increased in the early phase of Borrelia infection.

In the literature, there are case reports suggesting that Borrelia burgdorferi infection may induce autoimmune diseases dependent on antinuclear antibodies (ANA). The present study was undertaken in order to verify this possibility in a prospective manner. The study group comprised 78 consecutive patients (51 women and 27 men, median age 41.5 years) referred to our Department for the serologic diagnosis of Borrelia infection. The patients' sera were tested for Borrelia-specific IgM and IgG (Recombinant Antigen Enzyme Immunoassays, Biomedica). Antibodies against Borrelia were detected in 31 (39.7 %) persons. 15 persons (19.2 %) had positive IgM, another 15 (19.2 %)--positive IgG, and 1 person (3.2 %)--both IgM and IgG. Frequent positivity of IgM antibodies suggests that persons in the early phase of infection prevailed in the group. Tests for anti-dsDNA, anti-RNP, anti-Sm antibodies, and a screening test for systemic rheumatic diseases (ANA Rheuma Screen) were carried out using Varelisa Enzyme Immunoassays (Pharmacia and Upjohn). The spectrum of autoimmune diseases covered by these tests included SLE, MCTD, Sjogren's syndrome, scleroderma, polymyositis, and dermatomyositis. ANA were detected in 15 persons (19.2 %): anti-dsDNA in 7 (9.0 %), anti-RNP in 1 (1.3 %), anti-Sm in 2 (2.6 %), and ANA Rheuma Screen was positive in 6 persons (7.7 %). Statistical analysis of differences in the ANA frequency between Borrelia-positive and -negative groups was carried out using Fisher's exact chi-square test (both without and with gender and age matching). No significant differences were found between the groups. Based on the above results, we conclude that there is no increase in the frequency of antinuclear antibodies in the early phase of Borrelia infection.

Adolescent↗

[In vivo and in vitro detection of borrelia infection in morphea-like skin changes with negative Borrelia serology].

No decision has been made yet as to whether or not the origin of the circumscribed scleroderma (morphea) is spirochetal. We describe a morphea-like skin lesion that developed after a tick bite 10 years ago. The histological investigation showed sclerodermal characteristics and necrobiosis lipoidica of the granulomatous type as well. No antibodies directed against Borrelia burgdorferi could be detected absorbance by a flagellin ELISA or by Western blot analysis. The VDRL, TPHA and FTA absorbance test, Warthin-Starry staining, and cultivation of Borrelia from skin biopsies were negative. The application of a nested polymerase chain reaction (PCR), relying on a combination of flagellin-gene-specific primers, demonstrated for the first time the presence of Borrelia DNA in a morphealike skin lesion. Immunohistological examination of the skin by a monoclonal antibody directed against flagellin was positive. Furthermore, in vitro GM-CSF secretion and lymphocyte proliferation upon stimulation with Borrelia-antigen was elevated and decreased significantly after 3 weeks of treatment with tetracyclines. In this case PCR analysis, immunohistochemistry and cellular immune response confirmed an infection with Borrelia, although no serum antibodies against spirochetal antigens could be detected.

Adolescent↗