Lyme borreliosis (see also stages)

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

Ticks (Ixodes ricinus) transmit Borrelia, thread-like, coiled spirochetes, leading to an infectious disease with a variety of symptoms.

• Mostly found in Europe and America.
• Up to 30-40% of all ticks are infected with Borrelia.
• In Switzerland, approx. 10000 people contract Lyme disease per year.
• In Germany, an incidence of 100-150 infections / 100000 / year is assumed.
• Seasonal infections occur from May-July.

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

3 stages

• Stage I (localised early infection of the skin).
• Stage II (disseminated early infection).
• Stage III (late infection with organ manifestation).

• Stage I:
  • Erythema chronicum migrans.
  • Ggl. pruritus.
  • Borrelia lymphocytoma.
• Stage II:
  • Partially asymptomatic.
  • In some cases, flu-like symptoms begin only a few days after the onset of erythema chronicum migrans.
  • Locoregional lymph node adenopathy.
  • If applicable, red. AZ, febrile temperatures, cephalgias.
  • Multiple erythema migrantia.
  • Unspecific exanthema.
  • Borrelia lymphocytoma.
  • Meningopolyneuritis Garin-Bujadoux-Bannwarth: cephalgias, possibly meningitis or encephalitis, unilateral radiculitis (painful paralyses) and cranial nerve palsies.
  • Arthralgias, myalgias, 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).
  • Fibromyalgias.
  • Chronic pain syndrome.
  • Neurological symptoms are observed mainly 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 may be skipped.
  • Post-infectious Lyme disease syndrome (post Lyme disease):
  • Continuing illness with myalgias and arthralgias after resolution of symptoms and adequate antibiotic therapy.

• Anamnesis: tick bite remembered? Erythema migrans remembered?
• In about 60% of patients, circulating immune complexes can also be detected.
• Borrelia serology (antibodies are not detectable from the beginning).
• IgM: Detectable after 2 weeks in 50% of patients, after >4 weeks in 80%.
• IgG: Detectable after 2-3 months.
• Clinical>pathogen detection (serum, CSF, synovial fluid, tissue)
• Blood culture.
• If necessary, CSF puncture (CSF serum index).
• If necessary, detection of Borrelia in joint fluid.
• If necessary, biopsy with pathogen detection.
• Stage II: long-term ECG, neurological presentation.

Plasma cell-rich, perivascular infiltrates are typical.

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