What is Borrelia Burgdorferi?
B. burgdorferi sl (a total of 12 species) belongs to the genus Borrelia, family Spirochaetaceae. According to current knowledge, four species are pathogenic to humans: B. burgdorferi sensu stricto (ss), B.garinii, and B.afzelii B.spielmanii. These are gram-negative spiral bacteria, a culture of bacteria is possible in special media. Presumably, the transition takes place in round body for spirochetal survival in the tissue has a significant role.
Borrelia Burgdorferi epidemiology
Lyme disease occur in the northern hemisphere and are widely used in all German regions. The transmission of pathogens carried by a tick bite (Ixodes ricinus, Ixodes vulgo). Pathogen reservoirs are small rodents, birds and deer. Adult ticks are about 20% infected nymphs and larvae of 10 to 20% to about 1%. The period of tick activity is dependent on the weather from about March to October. About 1.5 to 6% of people with tick bites show a seroconversion (infection), at 0.3 to 1.4% is expected to overt disease. After contact with infected ticks, a seroconversion developed in 20 to 30% of cases. In the eastern states, including Berlin, the number of reported infections has risen to 2006 with 6241 infections in the ensuing years has declined moderately. Transmission from human to human is not known, not even during pregnancy or through breast milk.
Borrelia Burgdorferi pathogenesis
The transmission of the pathogen occurs in the late act of sucking for 24 to 48h. After penetrating into the bloodstream pathogens show a tropism, are primarily affected skin, myocardium, synovial fluid and nerve tissue. The name derives from the Lyme disease Lyme, Connecticut (USA). Similar to syphilis, the disease course in three will be divided overlapping stages, with a remission is possible in each of the stages.
Stage I (after a few weeks and months): erythema (chronicum) migrans skin. Beginning z.T. with an initial papule, followed by a sharply demarcated, painless, non-itching erythema which spreads centrifugally and fades away in the middle. Partly uncharacteristic symptoms such as fever, headache (meningism), myalgia, arthralgia, and conjunctivitis Lympknotenschwellungen. Antibodies are detectable at 20 to 50% of patients. Early neuroborreliosis with facial palsy, lymphocytic meningitis (mainly as a manifestation of head pain, and photophobia, nausea, vomiting and mortality was 0.6%, mainly in children between 5 and 15 years), encephalitis, radiculitis.
Stage II (after weeks and months): Garin Bujadoux-Bannwarth syndrome (lymphocytic meningoradiculitis) with burning radicular pain, asymmetric flaccid paralysis and unsystematically distributed, often combined with sensory deficits, which can last for weeks or months. Cranial nerves are affected, mainly consist-or bilateral facial paralysis. In rare cases, with a participation of the Optic nerve and blindness results. On the skin it comes in rare cases as a manifestation of Borrelia Lymphozytom (Lymphocytoma cutis benigna other types) in the form of a livid reddish tumor (earlobe, nipple or scrotum). Manifestations may occur as the heart myocardium, and peri-carditis, atrioventricular conduction disturbances are possible up to a complete block and ST-T changes, atrial fibrillation, ventricular extrasystoles, tachycardia, impaired ventricular function through to heart failure. Antibodies are detectable at 70 to 90% of patients.
Stage III (months to years): Acrodermatitis chronica atrophicans (ACA) Herxheimer with atrophy of the skin ("cigarette paper-thin"), antibodies are not detectable in all patients. Lyme arthritis is a relapsing or chronic mono-or oligoarticular disease, are affected ankles, elbows, fingers, toes and wrist joints as well as TMJ. In rare cases, the infection manifests as a chronic encephalomyelitis with para-and tetra paresis. Antibodies are detectable at 90 to 100% of those affected, usually only IgG.
Involvement of the eyes in all three stages in the form of uveitis or optic neuritis described. Hotly debated the existence of a so-called "post-Lyme syndrome" is.
Borrelia Burgdorferi diagnosis
In typical manifestations (skin, neurological symptoms, heart, joints) is primarily driven by the differential diagnosis of Lyme disease, which is backed by one antibody detection (serum, CSF or serum-CSF pairs to determine the indigenous production of specific antibodies in CSF). It should be noted, however, that a negative serology does not always rule out Lyme disease. As an ELISA screening test is recommended despite lower sensitivity of immunoblot as confirmatory test. The cultivation of the pathogen (CSF, skin biopsy) is possible but time-consuming and subject to special laboratories. An alternative is Nukleinsaureamplifikationsmethoden (eg PCR) is particularly suitable is the investigation of joint aspirates or synovial, since there obviously can not be cultured Borrelia survive even after therapy. The same applies to endomyocardial biopsies in patients with new onset dilated cardiomyopathy.
Borrelia Burgdorferi prevention and treatment
Prevention by exposure prophylaxis, after appropriate exposure, the body should be examined for ticks, depending removed earlier, the lower the risk of transmission. See http://www.ndrugs.com for medications. A vaccine is not available.
Treatment in the early phase is an easy mission by amoxicillin or doxycycline, orally for few weeks. However, the recommended regimen in late stages include parenteral ceftriaxone, analgesics to control the severe pain, and anti-inflammatory drugs, usually required for months.
It is crucial for early diagnosis and subsequent treatment with doxycycline (DOXYHEXAL etc.) over 10 to 21 days. Alternatively, can be administered amoxicillin (amoxicillin-ratiopharm, etc.). In later stages of the disease, with cardiac involvement in long-standing arthritis and neurological symptoms is a treatment with ceftriaxone (Rocephin, etc.) displayed for three weeks, an additional subsequent therapy with oral amoxicillin for another 100 days does not lead to better treatment success. As an alternative to doxycycline could in refractory cases, administration of tigecycline (Tygacil) are trying to effect on the spirochetal round body. In refractory arthritis and negative PCR, the administration of nonsteroidal anti-inflammatory drugs, possibly in combination with hydroxychloroquine (QUENSYL) is recommended. In endemic areas, the use of prophylactic antibiotics after tick bite may be useful. An obligation exists only in some states.