Lyme borreliosis (early infection)

Lyme disease, tick borreliosis borreliosis, erythema migrans disease, Lyme borreliosis, Lyme disease, Borrelia burgdorferi infection, European tick borreliosis.

Early phase of Lyme borreliosis.

• It occurs mainly in Europe and America.
• Up to 30-40% of all ticks are affected by Borrelia.
• In Switzerland, about 10,000 people suffer from Lyme disease every year.
• In Germany an incidence of 100-150 infections/100'000/year is assumed.
• Infections occur seasonally from May to July.

• Pathogen 
  • Borrelia burgdorferi sensu lato (Europe).
  • Borrelia burgdorferi sensu stricto (North America).

3 stadiums

• Stage I (localized early infection of the skin).
• Stage II (disseminated early infection).
• Stage III (late infection with organ manifestation).
• Stage I erythema chronic: 
  • Erythema chronicum migrans.
  • Ggl. Pruritus.
  • Borrelia lymphocytoma.

• Stage II:
  • Partially asymptomatic.
  • In some cases, flu symptoms begin only a few days after the onset of erythema chronicum migrans.
  • Locoregional lymph nodeadenopathy.
  • Possibly reduced general condition, febrile temperatures, cephalgias.
  • Multiple erythema migrantia.
  • Nonspecific exanthema.
  • Borrelia lymphocytoma.
  • Meningopolyneuritis Garin-Bujadoux-Bannwarth: Cephalgias, possibly meningitis or encephalitis, unilateral radiculitis (painful paralysis) and cerebral nerve paralysis.
  • Arthralgia, myalgia, myo-/pericarditis.
  • Iritis, Chrioretinitis.
  • Carditis.
• Stage III

  • Acrodermatitis chronica atrophicans.

  • Acrodermatitis acuta.

  • Malignant B-cell lymphoma.

  • Peripheral neuropathy.

  • Subacute encephalopathy.

  • Chronic encephalomyelitis.

  • Recurrent chronic arthritis (arthritides are typical in patients from the USA).

  • Fibromyalgia.

  • Chronic pain syndrome.

  • Neurological symptoms are mainly observed in Europe.

  • Acrodermatitis chronica atrophicans (leading symptom).

  • Nodular panniculitis (rare).

  • Early summer meningoencephalitis in the context of a double infection (very rare).

  • Progressive encephalomyelitis.

  • CAVE: Stages can be skipped.

  • Postinfectious Lyme disease syndrome (post Lyme disease):

  • Continued feeling of illness with myalgia and arthralgia after

  • symptoms subside and adequate antibiotic therapy. 

• Medical history: Tick bite rememberable? Erythema migrans rememberable?
• Circulating immune complexes can also be detected in about 60% of patients.
• Borrelia serology (antibodies are not detectable from the beginning).
• IgM: After 2 weeks in 50% of patients, after >4 weeks in 80% detectable.
• IgG: Detectable after 2-3 months.
• Clinic>Pathogen detection (serum, cerebrospinal fluid, joint fluid, tissue)
• Blood culture.
• If necessary, cerebrospinal fluid puncture (cerebrospinal fluid-serum index).
• If necessary, detection of Borrelia in joint fluid.
• If necessary, biopsy with pathogen detection.
• Stage II: Long-term ECG, neurological presentation.

Perivascular infiltrates rich in plasma cells are typical.

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