Lyme borreliosis (disseminated and late infection)

Disseminated and late infection of Lyme disease.

• 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.
• Seasonally, 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, reduced general condition, 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 can be skipped.
    • Post-infectious Lyme disease syndrome (post Lyme disease):
    • Persistent feeling of illness with myalgias and arthralgias after symptoms have subsided 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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