An atlas of human vector-borne microbe interactions reveals pathogenicity mechanisms.

Vector-borne diseases are a leading cause of death worldwide and pose a substantial unmet medical need. Pathogens binding to host extracellular proteins (the "exoproteome") represents a crucial interface in the etiology of vector-borne disease. Here, we used bacterial selection to elucidate host-microbe interactions in high throughput (BASEHIT)-a technique enabling interrogation of microbial interactions with 3,324 human exoproteins-to profile the interactomes of 82 human-pathogen samples, including 30 strains of arthropod-borne pathogens and 8 strains of related non-vector-borne pathogens. The resulting atlas revealed 1,303 putative interactions, including hundreds of pairings with potential roles in pathogenesis, including cell invasion, tissue colonization, immune evasion, and host sensing. Subsequent functional investigations uncovered that Lyme disease spirochetes recognize epidermal growth factor as an environmental cue of transcriptional regulation and that conserved interactions between intracellular pathogens and thioredoxins facilitate cell invasion. In summary, this interactome atlas provides molecular-level insights into microbial pathogenesis and reveals potential host-directed targets for next-generation therapeutics.

Assessment of the hypothetical protein BB0616 in the murine infection of Borrelia burgdorferi.

bb0616 of Borrelia burgdorferi, the Lyme disease pathogen, encodes a hypothetical protein of unknown function. In this study, we showed that BB0616 was not surface-exposed or associated with the membrane through localization analyses using proteinase K digestion and cell partitioning assays. The expression of bb0616 was influenced by a reduced pH but not by growth phases, elevated temperatures, or carbon sources during in vitro cultivation. A transcriptional start site for bb0616 was identified by using 5' rapid amplification of cDNA ends, which led to the identification of a functional promoter in the 5' regulatory region upstream of bb0616. By analyzing a bb0616-deficient mutant and its isogenic complemented counterparts, we found that the infectivity potential of the mutant was significantly attenuated. The inactivation of bb0616 displayed no effect on borrelial growth in the medium or resistance to oxidative stress, but the mutant was significantly more susceptible to osmotic stress. In addition, the production of global virulence regulators such as BosR and RpoS as well as virulence-associated outer surface lipoproteins OspC and DbpA was reduced in the mutant. These phenotypes were fully restored when gene mutation was complemented with a wild-type copy of bb0616. Based on these findings, we concluded that the hypothetical protein BB0616 is required for the optimal infectivity of B. burgdorferi, potentially by impacting B. burgdorferi virulence gene expression as well as survival of the spirochete under stressful conditions.

Population dynamics of the Lyme disease bacterium, Borrelia burgdorferi, during rapid range expansion in New York State.

Recent changes in climate and human land-use have resulted in alterations of the geographic range of many species, including human pathogens. Geographic range expansion and population growth of human pathogens increase human disease risk. Relatively little empirical work has investigated the impact of range changes on within-population variability, a contributor to both colonization success and adaptive potential, during the precise time in which populations are colonized. This is likely due to the difficulties of collecting appropriate natural samples during the dynamic phase of migration and colonization. We systematically collected blacklegged ticks (Ixodes scapularis) across New York State (NY), USA, between 2006 and 2019, a time period coinciding with a rapid range expansion of ticks and their associated pathogens including Borrelia burgdorferi, the etiological agent of Lyme disease. These samples provide a unique opportunity to investigate the population dynamics of human pathogens as they expand into novel territory. We observed that founder effects were short-lived, as gene flow from long-established populations brought almost all B. burgdorferi lineages to newly colonized populations within just a few years of colonization. By 7 years post-colonization, B. burgdorferi lineage frequency distributions were indistinguishable from long-established sites, indicating that local B. burgdorferi populations experience similar selective pressures despite geographic separation. The B. burgdorferi lineage dynamics elucidate the processes underlying the range expansion and demonstrate that migration into, and selection within, newly colonized sites operate on different time scales.

How do host population dynamics impact Lyme disease risk dynamics in theoretical models?

Lyme disease is the most common wildlife-to-human transmitted disease reported in North America. The study of this disease requires an understanding of the ecology of the complex communities of ticks and host species involved in harboring and transmitting this disease. Much of the ecology of this system is well understood, such as the life cycle of ticks, and how hosts are able to support tick populations and serve as disease reservoirs, but there is much to be explored about how the population dynamics of different host species and communities impact disease risk to humans. In this study, we construct a stage-structured, empirically-informed model with host dynamics to investigate how host population dynamics can affect disease risk to humans. The model describes a tick population and a simplified community of three host species, where primary nymph host populations are made to fluctuate on an annual basis, as commonly observed in host populations. We tested the model under different environmental conditions to examine the effect of environment on the interactions of host dynamics and disease risk. Results show that allowing for host dynamics in the model reduces mean nymphal infection prevalence and increases the maximum annual prevalence of nymphal infection and the density of infected nymphs. Effects of host dynamics on disease measures of nymphal infection prevalence were nonlinear and patterns in the effect of dynamics on amplitude in nymphal infection prevalence varied across environmental conditions. These results highlight the importance of further study of the effect of community dynamics on disease risk. This will involve the construction of further theoretical models and collection of robust field data to inform these models. With a more complete understanding of disease dynamics we can begin to better determine how to predict and manage disease risk using these models.

Ixodes scapularis density and Borrelia burgdorferi prevalence along a residential-woodland gradient in a region of emerging Lyme disease risk.

The environmental risk of Lyme disease, defined by the density of Ixodes scapularis ticks and their prevalence of Borrelia burgdorferi infection, is increasing across the Ottawa, Ontario region, making this a unique location to explore the factors associated with environmental risk along a residential-woodland gradient. In this study, we collected I. scapularis ticks and trapped Peromyscus spp. mice, tested both for tick-borne pathogens, and monitored the intensity of foraging activity by deer in residential, woodland, and residential-woodland interface zones of four neighbourhoods. We constructed mixed-effect models to test for site-specific characteristics associated with densities of questing nymphal and adult ticks and the infection prevalence of nymphal and adult ticks. Compared to residential zones, we found a strong increasing gradient in tick density from interface to woodland zones, with 4 and 15 times as many nymphal ticks, respectively. Infection prevalence of nymphs and adults together was 15 to 24 times greater in non-residential zone habitats. Ecological site characteristics, including soil moisture, leaf litter depth, and understory density, were associated with variations in nymphal density and their infection prevalence. Our results suggest that high environmental risk bordering residential areas poses a concern for human-tick encounters, highlighting the need for targeted disease prevention.

Parálisis facial periférica: otra forma de presentación de enfermedad de Lyme / Peripheral facial paralysis, a presentation of Lyme disease

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Epidemiología de la enfermedad de Lyme en un área sanitaria del noroeste de España / Epidemiology of Lyme disease in a healthcare area in north-west Spain

Objetivo: Valorar la influencia de algunos factores de riesgo sobre la tasa de incidencia de la enfermedad Lyme y describir las principales manifestaciones clínicas de esta. Métodos: Se realizó un estudio retrospectivo sobre esta enfermedad (2006-2013), en una zona del noroeste de España, incluyendo solo los pacientes que cumplían los criterios de vigilancia epidemiológica de los Centers for Disease Control and Prevention de los Estados Unidos. Resultados: La tasa de incidencia varió entre 2,64 y 11,61 por 100.000 habitantes y año. Hubo diferencias significativas respecto al hábitat, la edad y la zona de residencia. Los pacientes presentaron manifestaciones neurológicas (67,59%), dermatológicas (47,22%), reumatológicas (15,74%) o cardiacas (13,88%), solas o combinadas. Conclusiones: El incremento de esta enfermedad en el noroeste de España y las diferencias observadas entre las distintas zonas de una misma área sanitaria hacen necesario plantear estudios epidemiológicos que permitan aumentar el índice de sospecha diagnóstica e implementar medidas de prevención eficaces (AU)

Objective: To evaluate the influence of some risk factors on the incidence rate of Lyme disease and the main clinical manifestations. Methods: A retrospective study of Lyme disease (2006-2013) was performed in north-west Spain; we included only patients who fulfilled the epidemiological surveillance criteria defined by the Centers for Disease Control and Prevention. Results: The incidence rate varied between 2.64 and 11.61/100,000 inhabitants/year. Significant differences were found in relation to habitat, age and area of residence. Patients showed neurological (67.59%), dermatological (47.22%), rheumatological (15.74%) and cardiac (13.88%) manifestations, alone or combined. Conclusions: Due to the increase of the disease in north-west Spain and the differences observed between the different areas, epidemiological studies are needed that increase the index of diagnostic suspicion and lead to the implementation of effective prevention measures (AU)

Ensayo de infección artificial de garrapatas cubanas con Borrelia burgdorferi sensu stricto / Artificial infection assay of Cuban ticks with Borrelia burgdorferi sensu stricto

Como es conocido, Borrelia spp. constituye un grupo importante de patógenos bacterianos transmitidos por garrapatas, a excepción de Borrelia recurrentis que es transmitida por piojos del cuerpo. Estos microorganismos son los causantes de borreliosis o enfermedad de Lyme y fiebre recurrente.1El complejo B. burgdorferi sensu lato es causante de la enfermedad de Lyme, y el principal vector descrito lo constituyen las garrapatas duras del género Ixodes.2 Recientemente se ha reportado en México y Brasil la presencia de ADN de B. burgdorferi sensu stricto,3,4 una de las 19 genomaespecies del complejo, en garrapatas Amblyomma cajennense, pero se desconoce si esta especie es capaz de transmitir las borrelias a un nuevo hospedero. En Cuba, a partir de evidencias serológicas específicas de la infección por este agente y teniendo en cuenta las especies de ixódidos que prevalecen, así como sus características ecológicas y antropofílicas, las garrapatas A. cajennense y Rhipicephalus sanguineus se consideran vectores potenciales de las borrelias.5Sobre la base de los hallazgos e hipótesis anteriormente mencionados se hace necesario iniciar investigaciones para comprobar si otras especies diferentes de Ixodes spp. son capaces de transmitir las borrelias. Ello requiere contar con un método sencillo y eficaz que permita la infección artificial de ixódidos. Se han reportado disímiles estrategias con estos fines, entre las que se incluyen el empleo de cámaras de alimentación con membranas naturales o artificiales, la infusión por enema, la inoculación hemocélica y la alimentación por capilares...

Incidencia de la enfermedad de Lyme en España / Incidence of Lyme disease in Spain

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Neurological manifestations in Baggio-Yoshinari Syndrome (Brazilian Lyme disease-like syndrome) / Manifestação neurológica na síndrome de Baggio-Yoshinari (síndrome brasileira semelhante à doença de Lyme)

INTRODUÇÃO: A doença de Lyme (DL) é uma doença de picada de carrapato, causado pela espiroqueta Borrelia burgdorferi sensu lato, transmitida por carrapatos do complexo Ixodes ricinus, que promove múltiplas manifestações clínicas sistêmicas. No Brasil, uma síndrome diferente é descrita e mimetiza sintomas de DL, mas também se manifesta com alta frequência de episódios recorrentes e manifestações alérgicas e imunológicas. É transmitida pelo carrapato Amblyomma cajennense e o agente etiológico é uma espiroqueta não cultivável de forma atípica. Devido a essas particularidades, esta zoonose emergente tem sido denominada síndrome brasileira semelhante à doença de Lyme ou síndrome de Baggio-Yoshinari (SBY). OBJETIVO: Descrever o espectro da manifestação neurológica da SBY. PACIENTES: Foram analisados 30 pacientes com SBY e sintomas neurológicos. RESULTADOS: A média de idade dos pacientes foi de 34,2 ± 13,3 anos (6 a 63 anos); 20 eram mulheres e 10 homens. Um alto número de episódios recorrentes (73,6 por cento) e distúrbios psiquiátricos e psicossociais graves (20 por cento) foram características típicas. Eritema migrans similar ao visto em hemisfério norte foi identificado em 43,3 por cento dos pacientes no início da doença. A recorrência das lesões cutâneas diminuiu com a progressão da doença. Sintomas articulares (artrite) aconteceram em aproximadamente metade dos pacientes com SBY no início e durante o episódio de recidiva. CONCLUSÕES: A SBY é considerada uma nova doença transmitida por carrapato no Brasil que difere da clássica DL observada no hemisfério norte. A SBY reproduz sintomas neurológicos observados na DL, exceto pela presença adicional de recorrência de episódios e uma tendência de causar manifestações neurológicas crônicas e articulares.

INTRODUCTION: Lyme disease (LD) is a tick-borne disease, caused by Borrelia burgdorferi sensu lato spirochetes, transmitted by Ixodes ricinus complex ticks, which leads to multiple systemic clinical manifestations. In Brazil, a different syndrome is described that mimics LD symptoms, but that also manifests high frequencies of recurrent episodes and immune-allergic manifestations. It is transmitted by the Amblyomma cajennense tick and the etiological agent is an uncultivable spirochete with atypical morphology. Due to its particularities, this emerging zoonosis has been called Brazilian LD-like syndrome or Baggio-Yoshinari Syndrome (BYS). OBJECTIVE: To describe the neurological spectrum of BYS. PATIENTS: Thirty patients with neurological symptoms of BYS were analyzed. RESULTS: Mean age of patients was 34.2 ± 13.3 years old (6 to 63 years); 20 were females and 10 males. A high number of recurrent episodes (73.6 percent) and severe psychiatric or psycho-social disturbances (20 percent) were distinguishing features. Erythema migrans similar to those seen in the Northern hemisphere was identified in 43.3 percent of patients at disease onset. The recurrence of skin lesions diminished as the disease progressed. Articular symptoms (arthritis) happened in nearly half of patients at BYS onset and during relapsing episodes. CONCLUSIONS: The BYS is considered a new tick borne disease in Brazil that differs from classical LD observed in the Northern hemisphere. BYS replicates most of the neurological symptoms observed in LD, except for the additional presence of relapsing episodes and the tendency to cause chronic neurological and articular manifestations.

Ocorrência de anticorpos homólogos anti-Borrelia burgdorferi em eqüinos de propriedades dos municípios de Três Rios e Vassouras, estado do Rio de Janeiro / Occurrence of homologs antibodies against Borrelia burgdorferi in equines of properties from the municipalities of Três Rios and Vassouras, of Rio de Janeiro state

Borrelia burgdorferi é uma espiroqueta transmitida por carrapatos, de ampla distribuição geográfica, que acomete o homeme animais domésticos, tendo os animais silvestres como reservatórios. O presente estudo teve como objetivo relatar aocorrência de eqüinos soropositivos para B. burgdorferi, por meio de inquérito soroepidemiológico utilizando o ensaio deimunoadsorção enzimática (ELISA) indireto. Procedeu-se a análise sorológica de 747 soros de eqüinos, onde 431 pertenciamao município de Três Rios e 316 ao de Vassouras, ambos do estado do Rio de Janeiro. Um total de 212 (28,4%) animais forampositivos ao ensaio. O resultado observado foi similar aos descritos para animais no Brasil e Estados Unidos da América,tendo sido verificado que os animais apresentaram anticorpos homólogos anti-Borrelia burgdorferi stricto sensu, corroborandocom a ocorrência de Borrelia sp. em eqüinos no estado do Rio de Janeiro

Lyme Borreliosis is a widely distributed spirochetosis hosted by wild animals, which transmitted to domestic animals as wellas man by ticks. The present study aims to observe the occurrence level of positive tested equines to Borrelia burgdorferi, on twomunicipalities of Rio de Janeiro State, Brazil, by seroepidemiologic inquiry using the indirect Enzime-Linked ImmunosorbentAssay. A serologic analysis was performed on 747 equines serum specimens, which 431 were from Três Rios and 316 werefrom Vassouras municipality. For this test, 212 (28.4%) animals were positive. The results observed were similar to thosedescribed for animals in Brazil and United States of America, confirming that the animals of the studied municipalities showedanti Borrelia burgdorferi homologs antibodies

Dolor y distensión abdominal como manifestación inicial de la neuroborreliosis / Abdominal pain and wall distension as the onset form of neuroborreliosis

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Seroprevalencia de la enfermedad de Lyme en Navarra / No disponble

Fundamento y objetivo: Establecer la seroprevalencia de infección por Borrelia burgdorferi en Navarra (España). Pacientes y método: Se han analizado 1.429 sueros de un listado representativo de la población, aportado por el gobierno de Navarra, estratificado por tres variables: edad, sexo y área de salud, previo consentimiento informado.Resultados: La seroprevalencia global en Navarra de infección por Borrelia burgdorferi es de un 4,4%, habiendo encontrado como factor de riesgo la profesión de ganadero (13,2%) entre las variables analizadas (sexo, edad, contacto con animales, profesión, contacto con medio rural, recuerdo del antecedente de picadura de garrapata o tamaño de la población.) Conclusiones:En Navarra se dan las condiciones adecuadas para el mantenimiento y desarrollo de la enfermedad de Lyme, con una seroprevalencia global del 4,4%. No se han encontrado diferencias entre las diferentes zonas analizadas y sí, como factor de riesgo, la profesión de ganadero (AU)

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Eritemas anulares en la infancia / Annular Erythema of Infancy

Un gran número de entidades dermatológicas adoptan formas anulares. Algunas de ellas son más propias de la edad adulta o de niños mayores, mientras que otras característicamente aparecen en niños pequeños. Los eritemas anulares o figurados de la infancia son un grupo de dermatosis en los que la lesión primaria adopta una configuración de tipo anular, circinada oval o policíclica. Sus similitudes en la forma de presentación clínica, edad de aparición y duración de las lesiones hacen que se trate de entidades de difícil diagnóstico, en ocasiones únicamente distinguibles por sutiles diferencias en sus manifestaciones clínico-patológicas. Dentro de este grupo de enfermedades distinguimos una serie de cuadros clínicos con unas características peculiares, que permiten diferenciarlos entre sí y respecto a otras erupciones de carácter anular. A modo práctico, hemos clasificado los eritemas anulares de aparición en la infancia en entidades cuya etiología está claramente establecida y en entidades cuyos patrones de reacción son característicos, pero de etiología incierta (AU)

Many skin diseases appear as annular lesions. Some are more typical of adults or older children, whereas others usually appear in young children. Annular or figurate erythema of infancy comprises a group of dermatoses in which the primary lesion adopts an annular, oval circinate, or polycyclic pattern. Similarities in clinical presentation, age at onset, and duration of lesions mean that these conditions are difficult to diagnose; sometimes, they can only be identified by subtle differences in their clinicopathologic features. Clinical pictures enable us to distinguish one member of this group of diseases from another and also to differentiate them from other annular eruptions. For ease of description, we classify annular erythema of infancy into 2 types: conditions with a known etiology and conditions with characteristic reaction patterns but uncertain etiology (AU)

Enfermedad de Lyme: la gran imitadora / No disponible

La enfermedad de Lyme es una enfermedad multiorgánica producida por la espiroqueta Borrelia burgdorferi y transmitida, en Europa, por la garrapata Ixodes ricinus. La manifestación característica en su estadio inicial es el eritema migratorio, y después de días o meses aparecerán los síntomas de la infección diseminada temprana, que pueden ser muy variables: cutáneos, neurológicos, articulares o cardíacos, entre otros. Al cabo de meses o años, unos pocos pacientes padecerán la infección tardía, manifestada por síntomas intermitentes o crónicos a nivel articular, dermatológico o neurológico. Presentamos aquí un caso de enfermedad de Lyme en su segunda fase (diseminada temprana), con afectación pluriorgánica y un complejo sintomático de predominio neurológico que incluye la peculiar presentación de una parálisis facial bilateral. La paciente, como sucede en la mayoría de los casos, no recordaba picadura de garrapata ni la presencia previa de lesión cutánea compatible con eritema migratorio

Lyme disease is a multiorganic disease produced by thespirochetes Borrelia burgdorferi and transmitted in Europe by the tick Ixodes ricinus. The characteristic manifestation in its initial stage is the erythema migrans and the symptoms of the early disseminated infection appear after days or months. They may be very variable: skin, neurological, joint or cardiac, among others. At the end of months or years, a few patients suffer late infection, manifested by intermittentor chronic symptoms on the joint, dermatological or neurological level. Herein, we present a case of Lyme disease in its second phase (early disseminated), with multiple organic involvement and symptomatic complex of neurological predominance that include the characteristic presentation of a bilateral facial palsy. The female patient, as occurs in most of the cases, did not remember having been bitten by a tick or of the previous presence of skin injury consistent with erythema migrans

Borreliosis. A propósito de un caso de enfermedad de Lyme / Borreliosis: apropos of a case of Lyme disease

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Neuroborreliosis y la población pediátrica: una revisión / Neuroborreliosis and the pediatric population: a review

Objetivo. Revisar la bibliografía médica relacionada conla neuroborreliosis, centrándose en la clínica que presenta tanto enlos adultos como en los niños, y destacar las diferencias entre losdos grupos, con especial atención a la población pediátrica. Desarrollo.Las manifestaciones neurológicas de la enfermedad afectana diferentes zonas del neuroaxis, central o periféricas, y se puedenpresentar con una sintomatología precoz o tardía, según el grupo deedad. Aunque la bibliografía recoge una amplia gama de alteracionesneurológicas, el síntoma más frecuente descrito en la poblaciónpediátrica es la cefalea, y el signo más común es la parálisis facial.La existencia de un proceso inmunológico con anticuerpos interreactivosy anticuerpos dirigidos contra las proteínas neuronales puedeser el factor etiológico. Dados los signos característicos en el líquidocefalorraquídeo, los análisis de éste y las pruebas serológicasde Borrelia burgdorferi –el agente causal–, deben realizarse en pacientes(sobre todo si se trata de niños) que han estado en una zonaendémica y presentan una afectación neurológica aguda con unaetiología desconocida. Si se instaura precozmente, el tratamientocon antibióticos logra buenos resultados, sobre todo en los niños.Conclusiones. La población infantil, comparada con los otros gruposde edad, ofrece el mayor riesgo de padecer la enfermedad deLyme. El cuadro tiende a ser más agudo en los pacientes más jóvenes,con afectación del sistema nervioso central y manifestación deuna respuesta inflamatoria en el líquido cefalorraquídeo y signos/síntomas de meningitis aséptica y parálisis del nervio facial; lospacientes más mayores presentan una afectación del sistema nerviosoperiférico, con una radiculopatía. A pesar de tener mayorincidencia de neuroborreliosis, la evolución clínica en la mayoríade los niños es más leve y corta que la que se describe en el caso delos adultos

Aims. To review the medical literature on neuroborreliosis, in particular its clinical features in both adults andchildren, and highlight the differences between the two groups, with an emphasis on the pediatric population. Development.The neurologic manifestations of the disease variably affect different areas of the neuroaxis, central or peripheral, and canpresent with early or late symptomatology, depending on the age group. Although the literature includes a wide range ofneurologic abnormalities, the most frequent symptom reported in the pediatric population is headache, and the most commonsign being facial palsy. An immunologic process with cross-reacting antibodies and antibodies directed against neuronalproteins may exist as the causative factor. Because of characteristic cerebrospinal fluid (CSF) findings, CSF examination andserologic testing for Borrelia burgdorferi, the causative agent, should be performed in patients, particularly if a child, havingbeen in an endemic area, presenting with an acute neurologic disorder of unexplained etiology. Treatment with antibiotics, ifinitiated early-on, is curative, especially in children. Conclusions. The pediatric population carries the highest risk for Lymedisease relative to other age groups. Younger patients tend to be more acutely affected, with involvement primarily of thecentral nervous system, exhibiting an inflammatory response in the CSF and signs/symptoms of aseptic meningitis and facialnerve palsy, whereas older patients present with features of peripheral nervous system pathology, tipically with a radiculopathy.Despite having a greater incidence of neuroborreliosis, the clinical course in most children is milder and shorter thanthat reported for adults

Reactividad humoral contra Borrelia burgdorferi en pacientes con enfermedades dérmicas y reumáticas

La enfermedad de Lyme (EL) es, después del síndrome de inmunodeficiencia adquirida, la enfermedad infecciosa más estudiada en los Estados Unidos de América (EUA). En Colombia sólo se ha hecho una publicación de casos reumatológicos seropositivos para Borrelia burgdorferi. Con el objeto de ampliar la información sobre la entidad en nuestro medio, se realizó un estudio prospectivo en individuos con afecciones dérmicas y reumáticas sugestivas de EL, según los criterios del Centro de Control de Enfermedades Infecciosas de EUA, que consultaron a los servicios respectivos del Hospital Universitario San Vicente de Paul de Medellín. Se incluyeron 31 pacientes de los cuales 23 tenían enfermedades dérmicas y ocho enfermedades reumáticas. A todos se les determinó la inmunoglobulina G sérica contra tres proteínas de la membrana externa de B. burgdorferi, p100, p41 y p41/1. En todos los pacientes se buscaron anticuerpos anticardiolipina mediante la prueba VDRL. En 19 pacientes con enfermedades dérmicas se practicaron biopsias cutáneas para la investigación de la espiroqueta mediante la coloración de Warthin-Starry. Sólo se encontro un paciente con morfea localizada con reactividad serológica positiva para B. burgdorferib (reactividad para las tres proteínas de membrana), VDRL no reactivo, tinción de Warthin-Starry negativa y sin antecedentes de picadura de garrapata. En otros siete pacientes con morfea localizada y en tres con cuadros reumáticos, la reactividad serológica fue sugestiva (reactividad débil o incompleta). Los resultados obtenidos en este estudio sugieren la existencia de EL en Colombia. Se requieren estudios adicionales para aislar el microorganismo, tanto de pacientes como de vectores y definir el comportamiento eco-epidemiológico de la enfermedad en Colombia.

Borreliosis de Lyme: aproximaciones al diagnóstico de laboratorio / Laboratory diagnosis of Lyme borreliosis

Some direct methods that can be used for the diagnosis of Lyme borreliosis are the culture, direct visualization or the detection of microbial DNA using polymerase chain reactions, in body tissues or fluids. Unfortunately, all these methods have a low sensitivity. There is a wide assortment of tests and antigens for indirect diagnosis, and the most recommended are ELISA tests and Western blot. The main inconvenient of these tests are the existence of shared serologic reactions, the variability of immune response and the difficult interpretation of results. Therefore, we propose the following guidelines for the diagnosis of Lyme borreliosis: For sero-epidemiological studies and to diagnose infection, antibodies should be determined in subjects with a compatible clinical picture, using an ELISA test that must be positive in at least two separate samples. All positive ELISA results should be confirmed with Western blot analysis, that must be interpreted using established criteria. Polymerase chain reactions should be used when they are available