Clinical and epidemiological features of Lyme borreliosis in Bulgaria

Wiener klinische Wochenschrift - Tập 116 - Trang 42-46 - 2004
Iva Christova1, Radka Komitova2,3
1National Reference Laboratory for Lyme borreliosis, Department of Microbiology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
2Department of Infectious Diseases, Medical University, Plovdiv, Bulgaria
3Department of Infectious Diseases, Medical University, Sofia, Bulgaria

Tóm tắt

Data on disease expression and epidemiological characteristics of Lyme borreliosis in south-eastern Europe are scarce. To reveal features of Lyme borreliosis in Bulgaria, clinical data and epidemiological characteristics of 1257 patients reported between 1999 and 2002 were analysed. The most affected age group was 5–9 years, followed by 45–49 years, 50–54 years, and 10–14 years. Most of the patients (68%) lived in a rural area or were attacked by ticks during activities in a rural area. Lyme borreliosis cases occurred throughout the year with two peaks — one in June and second smaller one in September. The most common clinical manifestation was erythema migrans (EM), diagnosed in 868 (69.1%) of the patients. Rashes had a median diameter of 11 cm and were predominantly located on lower extremities. Forty-four per cent of the rashes consisted of homogenous erythema and 56% had central clearing. Multiple EM was detected in 4.3% of the EM cases. Neuroborreliosis was the second most common presentation of Lyme borreliosis, diagnosed in 19% of the patients. Lyme arthritis was found in 8% of the patients. Heart and ocular manifestations were recorded in 1.1% and 0.9% of the patients, respectively. Borrelial lymphocytoma and acrodermatitis chronica atrophicans were very rare (0.3%). Twenty-seven patients (2.1%) had multiple organ involvement. The results of the study show that the epidemiology and clinical manifestations of Lyme borreliosis in Bulgaria are similar to those in the majority European countries but possess some distinguishing characteristics.

Tài liệu tham khảo

Steere AC (2001) Lyme disease. N Engl J Med 345: 115–125

Baranton G, Postic D, Saint Giron I, Boerlin P, Piffaretti JC, Assous M, et al (1992) Delineation ofBorrelia burgdorferi sensu stricto,Borrelia garimi sp. nov., and group VS461 associated with Lyme borreliosis. Int J Syst Bacteriol 42: 378–383

Le Fleche A, Postic D, Girardet K, Peter O, Baranton G (1997) Characterization ofBorrelia lusitaniae sp. nov. by 16S ribosomal DNA sequence analysis. Int J Syst Bacteriol 47: 921–925

Wang G, Van Dam AP, Le Fleche A, Postic D, Peter O, Baranton G, et al (1997) Genetic and phenotypic analysis ofBorrelia valaisiana sp. nov. (Borrelia genomic groups VS116 and M19). Int J Syst Bacteriol 47: 926–932

Postic D, Ras NM, Lane RS, Hendson M, Baranton G (1998) Expanded diversity among Californian borrelia isolates and description ofBorrelia bissettii sp. nov. (formerly Borrelia group DN127). J Clin Microbiol 36: 3497–3504

Assous M, Postic D, Paul G, Nevot P, Baranton G (1993) Western blot analysis of sera from Lyme borreliosis patients according to the genomic species of the Borrelia strains used as antigens. Eur J Clin Microbiol Infect Dis 12: 261–268

Van Dam AP, Kuiper H, Vos K, Widjojokusumo A, Jongh B-M, Spanjaard I, et al (1993) Different genospecies of Borrelia burgdorferi are associated with distinct clinical manifestations of Lyme borreliosis. Clin Infect Dis 17: 708–717

Balmelli T, Piffaretti GC (1995) Association between different clinical manifestations of Lyme disease and different species ofBorrelia burgdorferi sensu lato. Res Microbiol 146: 329–340

Mathiesen MJ, Hansen K, Axelsen N, Sorensen LH, Theisen M (1996) Analysis of the human antibody response to outer surface protein C (OspC) ofBorrelia burgdorferi sensu stricto,B. garinii andB. afzelii. Med Microbiol Immunol 185: 121–129

Recommendations for test performance and interpretation from the Second National Conference of serologic diagnosis of Lyme disease (1995) MMWR Morb Mortal Wkly Rep 44: 590–591

Stanek G, O’Connel S, Cimmino M, Aberer E, Kristoferitsch W, Granström M, et al (1996) European Union concerted action on risk assessment in Lyme borreliosis: clinical case definitions for Lyme borreliosis. Wien Klin Wochenschr 108: 741–747

Christova I, Tasseva E (1999) Lyme borreliosis in Bulgaria — evaluation criteria for western blot. First Balkan Conference of Microbiology, Plovdiv, Bulgaria, October 5–9, 1999. Abstract book, p 148

Stanek G, Flamm H, Groh V, Hirschl A, Kristoferitsch W, Neumann R, et al (1987) Epidemiology of borrelia infections in Austria. Zentalbl Bakteriol Mikrobiol Hyg [A] 263: 442–449

Strle F, Videčnik J, Zorman P, Cimperman J, Lotrič-Furlan S, Maraspin V (2002) Clinical and epidemiological findings for patients with erythema migrans. Wien Klin Wochenschr 114: 493–497

Anda P, Rodriguez I, de la Loma A, Fernandez MV, Lozano A (1993) A serological survey and review of clinical Lyme borreliosis in Spain. Clin Infect Dis 16: 310–319

Tasseva E, Christova I (2000) Comparative study on prevalence and infection with borreliae of ixodid ticks in parks of Sofia. Infectology 37: 21–26 (in Bulgarian)

Berglund J, Eitrem R, Ornstein K, Lindberg A, Ringner Å, Elmrud H, et al (1995) An epidemiologic study of Lyme disease in southern Sweden. N Engl J Med 333: 1319–1324

Cimmino MA, Fumarola D, Sambri V, Accardo S (1992) The epidemiology of Lyme borreliosis in Italy. Microbiologica 15: 419–424

O’Connel S (1995) Lyme disease in the United Kingdom. Bri Med J 320: 303–308

Lesnyak O, Laikovskaya E, Kufko I, Bruinink H, Baranova N, Rijpkema S (1998) Disease expression of Lyme borreliosis in northeastern France. Zentralbl Bakteriol 288: 111–119

Dhote R, Basse-Guerineau AL, Beaumesnil V, Christoforov B, Assous MV (2000) Full spectrum of clinical, serological, and epidemiological features of complicated forms of Lyme borreliosis in the Paris, France, area. Eur J Clin Microbiol Infect Dis 19: 809–815

Lipsker D, Hansmann Y, Limbach F, Clerc C, Tranchant C, Grunenberger F, et al (2001) Disease expression of Lyme borreliosis in northeastern France. Eur J Microbiol Infect Dis 20: 225–230

Cimmino MA (1998) Relative frequency of Lyme borreliosis and of its clinical manifestations in Europe. European Community Concerted Action on Risk Assessment in Lyme borreliosis. Infection 26: 298–300

Arnez M, Pleterski-Rigler D, Ahcan J, Ruzic-Sabljic E, Strle F (2001) Demographic features, clinical characteristics and laboratory findings in children with multiple erythema migrans in Slovenia. Wien Klin wochenschr 113: 98–101

Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL (1996) Lyme disease in children in southeastern Connecticut. N Engl J Med 335: 1270–1274

Cimperman J, Maraspin V, Lotric-Furlan S, Ruzic-Sabljic E, Avsic-Zupanc T, Strle F (2002) Double infection with tick borne encephalitis virus and Borrelia burgdorferi sensu lato. Wien Klin Wochenschr 114: 620–622

Cizman M, Avsic-Zupanc T, Petrovec M, Ruzic-Sabljic E, Pokorn M (2000) Seroprevalence of ehrlichiosis, Lyme borreliosis and tick-borne encephalitis infections in children and young adults in Slovenia. Wien Klin Wochenschr 112: 842–845

Steere AC (1989) Lyme disease. N Engl J Med 321: 586–596

Spach DH, Liles WC, Campbell GH, Quick RE, Anderson DH, Fritsche TR (1993) Tick-borne diseases in the United States. N Engl J Med 329: 936–947

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Wiener klinische Wochenschrift

Tập 116

42-46

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