[An overlooked disease of tick bites: Lyme disease]. / Kene isiriklarinda gözden kaçan bir hastalik: Lyme hastaligi.

ABSTRACT

The exact prevalence of Lyme disease caused by Borrelia burgdorferi is unknown in Turkey. However, B. burgdorferi seropositivity ranges between 6-44% among high risk groups. B. burgdorferi is transmitted to humans by the bite of infected ticks belonging to the genus Ixodes, which may be seen throughout our country. Since the Crimean-Congo Hemorrhagic Fever (CCHF) is attracting attentions to tick bites more than ever in Turkey, the patients with tick bites are followed up more cautiously and have been referred to central hospitals. In this study 4 patients who were referred to our center with prediagnosis of CCHF but later appeared to be Lyme cases, were presented. All of the cases were women, age ranging between 25-67 years old. The patients were from areas where there is high risk of CCHF. CCHF were ruled out in these patients by agent specific polymerase chain reaction and IgM results. All of the patients were clinically diagnosed as Lyme disease since they had lesions compatible with erythema migrans. B. burgdorferi total antibodies investigated by ELISA (Zeus Scientific Inc., USA) were found positive in all patients. Since Western blot method could not be performed, positive serologic results have not be confirmed. However, the diagnosis of Lyme disease was done according to Centers for Disease Control and Prevention (CDC) criteria and all of the cases have recovered following treatment with antibiotics (cefuroxime axetil or sulbactam ampicillin or amoxicillin clavulanic acid). When the increase in the incidence of arthropod-borne infections in our country is considered, it should be noted that tick-bite cases should also be evaluated in terms of Lyme disease besides CCHF. Differential diagnosis of these infections is of critical value since early appropriate therapy is important to prevent the development of serious complications in both of the disease settings.