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Borrelia (USA)

Lyme disease or Borreliosis is the most common tick borne disease in North America. The disease is caused by the spirochete Borrelia burgdorferi sensu lato which is transmitted by the bite of ticks from the genus Ixodes. Whilst in North America the vast majority of infections are caused by B. burgdorferi sensu stricto, in Europe B. afzelii and garinii are the most dominant strains.

Lyme disease is a multisystem disease whose symptoms may be nonspecific and confused with those of juvenile rheumatoid arthritis, lupus erythematosis multiple sclerosis, rheumatic fever, Reiter’s Syndrome, myocarditis and viral meningitis.

Symptoms of early onset: Erythema Migrans (EM) lesion is the most common and develops in 60 – 70% of cases within a days/weeks of a tick bite. It typically radiates slowly in a circular pattern (5-50 cm in dia) around the tick bite and generally clears within a few weeks. The lesion is not a reliable basis for the clinical diagnosis of Lyme disease. As many as 80% of tick bites go unrecognized. Other typical symptoms include: headache, malaise, myalgia, fever, arthralgia, fatigue and lymphadenopathy.

Later stage symptoms: These are divided into 2 groups:

(1) Neurological, Cardiac and Musculoskeletal Involvement: Symptoms appear weeks/months following initial infection and are usually characterized by dizziness, weakness and irregular heartbeat, meningitis and facial palsy.

(2) Arthritic Symptoms. Generally affects the large joints with pain and swelling. The arthritic attacks may be recurrent.

Isolation of B. burgdorferi by direct culture cannot be relied upon for laboratory diagnosis of B. burgdorferi infection. Serologic methods are most commonly used for presumptive diagnosis of infection. EIA is considered a more sensitive screen while Western Blot is useful for characterizing the specificity of the antibody response to B. burgdorferi (not possible with EIA).

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