Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20933139&retmode=ref&cmd=prlinks

Excerpt:

Lyme borreliosis (LB), synonymous with the often-used term Lyme
disease, is an infectious disease caused by the spirochetal
bacterium Borrelia burgdorferi. LB is the most frequent
vector-borne disease in humans in the Northern Hemisphere.
In animals, clinically apparent disease is found primarily in
dogs. Severe polyarthritis, fever and lameness in dogs are
reported from the main endemic areas of North America: the New
England States, and eastern parts of the United States; several
cases of LB are also seen in California and the Midwest. Because
of the difficulties in finding sufficient indicative clinical
signs, additional information (detailed case history, laboratory
testing for antibodies) is especially important to make the
clinical diagnosis of Lyme borreliosis. This article reviews the
etiology, diagnosis, therapy, and prevention of LB.
Copyright (c) 2010 Elsevier Inc. All rights reserved.

Excrept:

Lyme borreliosis is a zoonosis characterized by great clinical polymorphism.
We report 2 cases in patients who presented ocular manifestations: one
anterior uveitis in an adult, which resolved under treatment, and one
posterior uveitis in a child, whose initial ophthalmologic examination
already showed retinal fibrous scars including the macular area. Lyme
disease is on the long list of causes that must be discussed in cases of
uveitis. The diagnosis is based on a series of epidemiological, clinical,
and biological arguments with Western Blot serological profile analysis.
Treatment is based especially on intravenous antibiotics. Copyright (c) 2010

Excerpt:

If insufficiently treated, Lyme borreliosis can evolve into an
inflammatory disorder affecting skin, joints, and the CNS. Early
innate immunity may determine host responses targeting infection.
Thus, we sought to characterize the immediate cytokine storm
associated with exposure of PBMC to moderate levels of live
Borrelia burgdorferi. Since
Th17 cytokines are connected to host defense against
extracellular bacteria, we focused on interleukin (IL)-17 and
IL-22. Here, we report that, despite induction of inflammatory
cytokines including IL-23, IL-17 remained barely detectable in
response to B. burgdorferi. In contrast, T cell-dependent
expression of IL-22 became evident within 10 h of exposure to the
spirochetes. This dichotomy was unrelated to interferon-? but to
a large part dependent on caspase-1 and IL-1 bioactivity derived
from monocytes. In fact, IL-1? as a single stimulus induced IL-22
but not IL-17. Neutrophils display antibacterial activity against
B. burgdorferi, particularly when opsonized by antibodies. Since
neutrophilic inflammation, indicative of IL-17 bioactivity, is
scarcely observed in Erythema migrans, a manifestation of skin
inflammation after infection, protective and antibacterial
properties of IL-22 may close this gap and serve essential
functions in the initial phase of spirochete infection.

Among the 20 tick species described in Switzerland, Ixodes ricinus, the most
frequent one, is implicated in the transmission of pathogenic agents. Lyme
borreliosis and tick-borne encephalitis (TBE) are the major tick-borne
diseases transmitted to human. 
**Presently 5 Borrelia species, belonging to the group Borrelia burgdorferi,
are recognized as human pathogens**. 
The risks of infection depend on the stage of the vector, the multiple
hosts, the pathogenic agent, as well as human behavior in nature. 
The detection of other pathogenic agents in ticks: Anaplasma, Babesia and
Rickettsia predispose to infections or co-infections. Results of
sero-epidemiologic studies suggest human infections. Active surveillance by
physicians is necessary and clinical studies are required to evaluate the
importance of these infections in Switzerland.

Excerpt:

A 54-year-old American woman presented with an episode of syncope. This had
occurred against a background of several days of dizziness and palpitations.
Her medical history included Bell’s palsy, which had been diagnosed three
weeks earlier. On examination, she had a resting bradycardia of 31 beats per
minute and her electrocardiogram demonstrated third-degree atrioventricular
(AV) block.
She was referred to cardiology for consideration of permanent pacemaker
implantation. Given her facial nerve palsy and AV block, a diagnosis of Lyme
borreliosis was suspected. Within 48 hours of initiation of ceftriaxone, she
reverted to sinus rhythm, albeit with a marked first-degree AV block.
Subsequent serology confirmed the diagnosis. Reversible causes of complete
AV block should always be considered and appropriate therapy may avoid the
need for permanent pacemaker insertion.

Excerpt:

In North America, Lyme borreliosis (LB) is a tick-borne disease caused by
infection with the spirochete Borrelia burgdorferi. We studied the genetic
diversity of LB spirochetes in north-coastal Californian residents.
Spirochete DNA was detected in 23.7% (27/114) of study subjects using a PCR
protocol optimized for increased sensitivity in human sera. Californians
were most commonly infected with B. burgdorferi ospC genotype A, a globally
widespread spirochete associated with high virulence in LB patients.
Sequence analysis of rrf-rrl and p66 loci in 11% (3/27) of PCR-positive
study subjects revealed evidence of infection with an organism closely
related to B. bissettii. This spirochete, heretofore associated with LB only
in Europe, is widely distributed among ticks and wildlife in North America.
Further molecular testing of sera from residents in LB-endemic areas is
warranted to enhance our understanding of the geographic distribution and
frequency of occurrence of B. bissettii-like infections.

Excerpt:

RESULTS: A total of 4,664 patients were tested. The IgM and IgG
seropositivity rates were 9.2% and 3.3%, respectively.
Questionnaires from 2,643 (57%) patients were available for
analysis. Erythema migrans (EM) was suspected in 38% of patients,
Lyme arthritis/disseminated disease in 23% and early
neuroborreliosis in 13%. Age 0-15 years and suspected EM were
significant predictors of IgM seropositivity, whereas suspected
acrodermatitis was a predictor of IgG seropositivity. LB was
suspected in 646 patients with arthritis, but only 2.3% were IgG
seropositive. This is comparable to the level of seropositivity
in the background population indicating that Lyme arthritis is a
rare entity in Denmark, and *the low pretest probability should
alert general practitioners to the possibility of false positive
LB serology*. 
Significant predictors for treating the patient were a reported
tick bite and suspected EM.

CONCLUSIONS: A detailed description of the utilization of
serology for Lyme borreliosis with rates of seropositivity
according to clinical symptoms is presented. Low rates of
seropositivity in certain patient groups indicate a low pretest
probability and there is a notable risk of false positive
results. 38% of all patients tested were suspected of EM,
although this is not a recommended indication due to a low
sensitivity of serological testing.

A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs. Dermatologic examination revealed erythemateous livid discoloration on both feet and legs. There were reticular varices, corona flebectatia paraplantaris medialis and minimal pitting oedema. Serology tested positive in both patients for Borrelia and they both recalled tick bites. A third patient, a 73-year-old woman, was referred because of erythema and maculae located at her lower legs and positive Borrelia serology. Pathologic examination was typical for acrodermatitis chronica atrophicans, a late skin manifestation of Lyme borreliosis. In all patients, symptoms improved after treatment with doxycycline for four weeks. A lack of familiarity with this skin condition may lead to unnecessary vascular investigations and considerable delay in adequate treatment.

Excerpt:

Lyme borreliosis is a multisystem disease and when involves the
nervous system it is termed neuroborreliosis. The symptomatology
of peripheral neuroborreliosis is rich and varied. The early
symptoms are asymmetric polyradiculopathies and paralysis of the
cranial nerves (most commonly facial nerve). Thereafter, there
are multifocal mononeuropathies and
sensory-motorpolyneuropathies. Difficulties in making a correct
diagnosis can result from the long time lag between tick bite and
the occurrence of neurological symptoms. In the treatment the
most important role play antibiotics. 
CASE REPORTS: We report the cases of three patients with symptoms
of damage to various structures of the peripheral nervous system
in the course of Borrelia burgdorferi infection. In all cases,
clinical improvement was obtained after treatment with
antibiotics, which further confirms the diagnosis of
neuroborreliosis. 
CONCLUSIONS: About neuroborreliosis
as a cause of peripheral neuropathy we should always think in the
case of vague symptoms of peripheral nervous system lesions in
patients with potential exposure to tick bites. Peripheral
neuropathies may occur a long interval from the tick bite and are
not always preceded by other forms of the disease.

Excerpt:

We report an unusual case of human babesiosis in Finland in a
53-year-old man with no history of splenectomy. He had a
rudimentary spleen, coexisting Lyme borreliosis, exceptional dark
streaks on his extremities, and subsequent disseminated
aspergillosis. He was infected with Babesia divergens, which
usually causes bovine babesiosis in Finland.