Lyme Disease

Abstract

Lyme disease (LD) is caused by the spirochete, Borrelia burgdorferi sensu lato complex. Humans are infected by a tick bite to the skin. This disease is a non-contagious infectious disease. It has been known since the 19th century. LD has a worldwide distribution. It is endemic in Europe, North and South America. There are case reports since 1990 in Turkey. The clinical presentation varies depending on the stage of the disease. Lyme disease is classified into three stages: early localized disease, early disseminated disease, and late disease. The main manifestation of the early stage of the disease is erythema migrans (EM). The disease affects many systems. In all of the clinical presentations, most patients with Lyme disease have resolution of their clinical symptoms when treated with appropriate antimicrobials but recurrence, chronic Lyme borreliosis or post-Lyme syndrome can also be seen. The diagnosis of LD is based on epidemiological, clinical and laboratory findings. Treatment depends on the stage of the disease. Doxycycline, amoxicillin azithromycin, cefuroxime axetil, erythromycin, ceftriaxone, cefotaxime and crystalline penicillin are used for treatment. LD can be prevented by reducing contact with ticks. There is no vaccine for the disease.

Keywords

• Lyme disease, tick, zoonosis

Lyme Disease

Öz

Lyme hastalığı (LH) Borrelia burgdorferi sensu lato complex adı verilen spiroketler tarafından oluşturulur. İnsanlar kene ısırığı ile enfekte olur. Hastalık insanlar arasında bulaşıcı değildir. Ondokuzuncu yüzyıldan beri bilinen hastalık tüm Dünya’da yaygındır ve Avrupa, Kuzey Amerika ve Güney Amerika’da endemiktir. Türkiye’de 1990’dan beri olgu sunuları yapılmaktadır. Hastalığın kliniği evresine göre değişir. Hastalık üç evreye ayrılır: erken lokalize hastalık, erken yaygın hastalık ve geç hastalık. Erken evrenin ana bulgusu eritema migranstır. Hastalık pek çok sistemi tutabilir. Klinik tabloya bağlı olmaksızın hastaların çoğunun semptomları uygun antibiyotik tedavisi ile düzelir. Ancak rekürrens, kronik Lyme borreliyozu veya post-Lyme sendromu da görülebilir. Hastalığın tanısı; epidemiyolojik, klinik ve laboratuvar bulgular ile konur. Tedavi hastalığın evresine bağlıdır. Doksisiklin, amoksisilin, azitromisin, sefuroksim aksetil, eritromisin, seftriakson, sefotaksim ve kristalize penisilin tedavide kullanılabilir. Kene teması azaltılarak hastalıktan korunulabilir. Hastalığın aşısı yoktur

Anahtar Kelimeler

• Lyme hastalığı, kene, zoonozlar

Kaynakça

1. Murray TS, Shapiro ED. Lyme Disease. Clin Lab Med 2010;30:311-328.
2. Steere AC. Lyme disease. N Engl J Med 2001;345:115.
3. Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T. Lyme disease: review. Arch Med Sci 2012;8:978-982.
4. Coumou J, van der Poll T, Speelman P, Hovius JW. Tired of Lyme borreliosis. Lyme borreliosis in the Netherlands. Neth J Med 2011;69:101-111.
5. Steere AC, Grodzicki RL, Kornblatt AN, et al. The spirochetal etiology of Lyme disease. N Engl J Med 1983;308:733-740.
6. Santos M, Haddad Jşnior V, Ribeiro-Rodrigues R, Talhari S. Lyme borreliosis. An Bras Dermatol 2010 ;85:930-938.
7. Yemişen M, Mete B, Balkan İİ. Lyme disease. [Article in Turk- ish]. J Exp Clin Med 2012;29:169-174.
8. Radolf JD, Caimano MJ, Stevenson B, Hu LT. Of ticks, mice and men: understanding the dual-host lifestyle of Lyme dis- ease spirochaetes. Nat Rev Microbiol 2012;10:87-99.

9. Aslan Başbulut E, Gözalan A, Sönmez C, et al. Seropreva- lence of Borrelia burgdorferi and Tick-Borne Encephalitis Virus in a Rural Area of Samsun, Turkey. [Article in Turkish]. Mikrobiyol Bul 2012;46:247-256.
10. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet 2012;379:461-473.
11. Brisson D, Baxamusa N, Schwartz I, Wormser GP. Biodiver- sity of Borrelia burgdorferi Strains in Tissues of Lyme Dis- ease Patients. PloS One 2011;6:e22926.
12. Steere AC. Borrelia burgdorferi (Lyme Disease, Lyme Bor- reliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 7th ed. Philadelphia: El- sevier Churchill Livingstone, 2009:3071-3081.
13. Schnarr S, Franz JK, Krause A, Zeidler H. Infection and mus- culoskeletal conditions: Lyme borreliosis. Best Pract Res Clin Rheumatol 2006;20:1099-1118.
14. Strle F. Lyme borreliosis in Slovenia. Zentralbl Bakteriol 1999;289: 643-652.
15. Smith R, O’Connell S, Palmer S. Lyme disease surveil- lance in England and Wales, 1986-1998. Emerg Infect Dis 2000;6:404-407
16. Stanek G, Strle F. Lyme borreliosis. Lancet 2003;362:1639- 1647.
17. Letrilliart L, Ragon B, Hanslik T, Flahault A. Lyme disease in France: a primary care-based prospective study. Epidemiol Infect 2005;133:935-942.
18. Bulut C, Tufan ZK, Altun S, Altınel E, Kınıklı S, Demiröz AP. An overlooked disease of tick bites: Lyme disease. [Article in Turkish]. Mikrobiyol Bul 2009;42:487-492.
19. Köksal İ, Saltoğlu N, Bingul T, Ozturk H. Bir Lyme Hastalığı Olgusu. A case of Lyme Disease. [Article in Turkish] J Ankem 1990;4: 284.
20. Çakır N, Akandere Y, Hekim N, et al. Türkiye’de iki Lyme olgu- su. Two cases with Lyme Disease in Turkey. [Article in Turk- ish] Journal of Istanbul Chamber of Medicine 1991;4:839-41.
21. Mutlu G, Gültekin M, Ergin Ç, et al. Antalya yöresinde Bor- relia burgdorferi antikorlarının ve vektörlerinin araştırılması. Investigation of Borrelia burgdorferi antibodies and vectors in Antalya region. [Article in Turkish] Mikrobiyol Bült 1995;29:1- 6.
22. Tunger O, Buke M. Lyme disease: status in Izmir region. Turk J Infection 1995; 9:345-349.
23. Göral G, Kılıçturgay K, Aydın L. Antibody prevalance against B. burgdorferi in some villages in the province of Bilecik. Turk J Med Sci 1997;27:51-53.
24. Demirci M, Arda M. Borrelia burgdorferi ve Lyme hastalığı. Borrelia burgdorferi and Lyme Disease [Article in Turkish] Anadolu Tıp Dergisi 2000;2:77-83.
25. Smith BG, Cruz AI Jr, Milewski MD, Shapiro ED. Lyme Dis- ease and the Orthopaedic Implications of Lyme Arthritis. J Am Acad Orthop Surg 2011;19:91-100.
26. Ertel SH, Nelson RS, Cartter ML. Effect of Surveillance Meth- od on Reported Characteristics of Lyme Disease, Connecti- cut, 1996-2007. Emerg Infec Dis 2012;18: 242-247.
27. Centers for Disease Control and Prevention. Lyme disease- United States, 2001-2002. MMWR Morb Mortal Wkly Rep 2004;53:365-369.
28. Bacon RM, Kugeler KJ, Mead PS; Centers for Disease Con- trol and Prevention (CDC). Surveillance for Lyme disease- -United States, 1992-2006. MMWR Surveill Summ. 2008; 57:1-9.
29. Armed Forces Health Surveillance Center. Images in Health Surveillance: Tickborne Disease Vectors and Lyme Disease Clinical Diagnosis MSMR 212;19:14-15.
30. Derdáková M, Lencáková D. Association of genetic variability within the Borrelia burgdorferi sensu lato with the ecology, epidemiology of Lyme borreliosis in Europe. Ann Agric Envi- ron Med 2005;12:165-172.
31. Huppertz HI, Bartmann P, Heininger U, et al. Rational diag- nostic strategies for Lyme borreliosis in children and ado- lescents: recommendations by the Committee for Infectious Diseases and Vaccinations of the German Academy for Pedi- atrics and Adolescent Health. Eur J Pediatr 2012;171:1619- 1624.
32. Steere AC. Lyme disease. N Engl J Med 1989;321:586-596.
33. Steere AC, Coburn J, Glickstein L. The emergence of Lyme disease. J Clin Invest 2004;113:1093-1101.
34. Mora P, Carta A. Ocular manifestations of Lyme borreliosis in Europe. Int J Med Sci 2009;6:124-125.
35. Nigrovic LE, Thompson AD, Fine AM, Kimia A. Clinical pre- dictors of Lyme disease among children with a peripheral facial palsy at an emergency department in a Lyme disease- endemic area. Pediatrics 2008; 122:e1080-1085.
36. Steere AC, Batsford WP, Weinberg M, et al. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med 1980;93:8-16.
37. Marcus LC, Steere AC, Duray PH, Anderson AE, Mahoney EB. Fatal pancarditis in a patient with coexistent Lyme dis- ease and babesiosis: Demonstration of spirochetes in the myocardium Ann Intern Med 1985;103:374-376.
38. Shapiro ED, Gerber MA. Lyme disease. Clin Infect Dis 2000;31:533-542.
39. Rees DH, Axford JS. Lyme arthritis. Ann Rheum Dis 1994;53:553-556.
40. Kullberg BJ, Berende A, van der Meer JW. The challenge of Lyme disease: tired of the Lyme wars. Neth J Med 2011;69:98-100.
41. Aucott JN, Seifter A, Rebman AW. Probable late lyme dis- ease: a variant manifestation of untreated Borrelia burgdor- feri infection BMC Infect Dis 2012;12:173.
42. Wormser GP, Brisson D, Liveris D, et al. Borrelia burgdorferi genotype predicts the capacity for hematogenous dissemina- tion during early Lyme disease. J Infect Dis 2008;198:1358- 1364.
43. Zajkowska J, Lewczuk P, Strle F, Stanek G. Lyme Borreliosis: From Pathogenesis to Diagnosis and Treatment. Clin Dev Immunol 2012;2012:231657
44. Wormser GP, Nadelman RB, Dattwyler RJ, et al. Practice guidelines for the treatment of Lyme disease. The Infectious Diseases Society of America. Clin Infect Dis 2000; 31Suppl 1: 1-14.
45. Branda JA, Aguero-Rosenfeld ME, Ferraro MJ, et al. 2-tiered antibody testing for early and late Lyme disease using only an immunoglobulin G blot with the addition of a VlsE band as the second-tier test. Clin Infect Dis 2010;50:20-26.
46. Nadelman RB, Hanincová K, Mukherjee P, et al. Differentia- tion of Reinfection from Relapse in Recurrent Lyme Disease. N Engl J Med 2012;367:1883-1890.
47. Barclay SS, Melia MT, Auwaerter PG. Misdiagnosis of Late- Onset Lyme Arthritis by Inappropriate Use of Borrelia burg- dorferi Immunoblot Testing with Synovial Fluid. Clin Vaccine Immunol 2012;19:1806-1809.
48. Wormser GP, Bittker S, Cooper D, et al. Comparison of the yields of blood cultures using serum or plasma from patients with early Lyme disease. J Clin Microbiol 2000;38:1648-1650.
49. Kułakowska A, Zajkowska JM, Ciccarelli NJ, et al. Depletion of Plasma Gelsolin in Patients with Tick-Borne Encephalitis and Lyme Neuroborreliosis. Neurodegener Dis 2011;8:375-380.
50. Schutzer SE, Angel TE, Liu T, et al. Distinct Cerebrospinal Fluid Proteomes Differentiate Post-Treatment Lyme Disease from Chronic Fatigue Syndrome. PLoS ONE 2011;6:e17287.
51. Doğancı L, Baylan O. Lyme Hastalığı (Lyme Borreliyozu). [Article in Turkish]. In: Willke Topçu A, Söyletir G, Doğanay M, eds. İnfeksiyon Hastalıkları ve Mikrobiyolojisi. İstanbul: Nobel Tıp Kitabevleri, 2002:701-712.
52. Girschick HJ, Morbach H, Tappe D. Treatment of Lyme bor- reliosis. Arthritis Res Ther 2009;11:258.
53. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-1134.
54. Poland GA. Vaccines against Lyme Disease: What Hap- pened and What Lessons Can We Learn?. Clin Infect Dis 2011;52(S3):S253-S258.
55. Plotkin SA. Correcting a Public Health Fiasco: The Need for a New Vaccine against Lyme Disease. Clin Infect Dis 2011;52(S3):S271-S275.
56. Volkman DJ. Comment on: Efficacy of antibiotic prophy- laxis for the prevention of Lyme disease: an updated sys- tematic review and meta-analysis. J Antimicrob Chemother 2010;65:2271.
57. Warshafsky S, Lee DH, Francois LK, et al. Efficacy of an- tibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis. J Antimicrob Chemother 2010;65:1137-1144.