Lyme arthritis in Southern Norway--an endemic area for Lyme borreliosis.

BACKGROUND: Despite Southern Norway is an endemic area for Lyme borreliosis there is a lack of data on Lyme arthritis (LA). In the literature controversies exist if acute LA can develop into chronic arthritis. Our objective was to identify and characterize patients with LA in Southern Norway and explore disease course after antibiotic treatment. METHODS: Patients aged 20 years or older with arthritis and a positive serology for Borrelia burgdorferi infection (IgG and/or IgM) suspected of having LA were consecutively recruited either from general practitioners or from hospital departments. RESULTS: From January 2007 to December 2010 a total of 27 patients were assessed. Mean (range) age was 56 years (41-80) and mean symptom duration prior to inclusion was 11.2 weeks (1 day-2 years). Definite LA was diagnosed in 16 patients, probable LA in 5 patients and 6 patients were concluded to have other arthritis disorders. Among the 21 LA patients 20 had mono-arthritis (knee 18, ankle 2) and 1 had polyarthritis.All LA patients responded favourable to antibiotic treatment and none of the patients developed chronic arthritis after long term follow up, not even in LA patients who had intraarticular glucocorticosteroid (GC) injection prior to antibiotic treatment. CONCLUSIONS: Our data shows that LA in Southern Norway is a benign disease which successfully can be treated with antibiotics even in patients treated with GC prior to antibiotics.

Prevalence and genotypes of Borrelia burgdorferi sensu lato infection in Ixodes ricinus ticks in southern Norway.

From April to October 2007, host-seeking Ixodes ricinus ticks were collected from 4 locations in southern Norway: Farsund, Mandal, Søgne and Tromøy. Two hundred and ten larvae, 1130 nymphs and 449 adults were investigated for infection with Borrelia burgdorferi sensu lato (s.l.) by real-time polymerase chain reaction (PCR) amplification of the 16S rRNA gene. The total percentage of B. burgdorferi s.l. in nymphal and adult ticks was determined to be 31.3% in Farsund, 25.2% in Mandal, 22.3% in Søgne and 22.1% in Tromøy. Larvae were pooled in groups of 10 before analysis, and Borrelia infection was detected in 1 of the 21 larvae pools. B. burgdorferi s.l. were genotyped by melting curve analysis after real-time PCR amplification of the hbb gene, or by direct sequencing of the PCR amplicon generated from the rrs (16S)-rrl (23S) intergenetic spacer. The most prevalent B. burgdorferi genospecies identified were B. afzelii (61.6%), followed by B. garinii (23.4%) and B. burgdorferi sensu stricto (10.6%). B. valaisiana (4.5%) was identified in Norwegian ticks for the first time. Mixed infections were observed in 0.3% of the infected ticks. A higher prevalence of B. burgdorferi s.l. was found in the present study than what has been reported in previous Nordic studies.

Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial.

BACKGROUND: Use of intravenous penicillin and ceftriaxone to treat Lyme neuroborreliosis is well documented, although oral doxycycline could be a cost-effective alternative. We aimed to compare the efficacy of oral doxycycline with intravenous ceftriaxone for the treatment of Lyme neuroborreliosis. METHODS: From April, 2004, to October, 2007, we recruited consecutive adult patients from nine hospitals in southern Norway into a non-inferiority trial. Inclusion criteria were neurological symptoms suggestive of Lyme neuroborreliosis without other obvious causes, and presence of any of the following: a CSF white-cell count of more than five per mL; intrathecal production of specific Borrelia burgdorferi antibodies; or acrodermatitis chronicum atrophicans. Patients were randomly allocated to receive 200 mg oral doxycycline or 2 g intravenous ceftriaxone once per day for 14 days, in a double-blind, double-dummy design. A composite clinical score (range 0 to 64, 0=best) was based on standardised interviews and clinical neurological examination. The primary outcome was reduction in clinical score at 4 months after the start of treatment. Analysis was per protocol. This trial is registered with ClinicalTrials.gov, number NCT00138801. FINDINGS: Of 118 patients who underwent randomisation, 102 completed the study (mean clinical score at baseline 8.5 [SD 4.1]). 4 months after the start of treatment, mean score improvement in the doxycycline group (n=54) was 4.5 (95% CI 3.6 to 5.5) points and that in the ceftriaxone group (n=48) was 4.4 (3.4 to 5.4) points (95% CI for difference between groups -0.9 to 1.1; p=0.84). 26 (48%) patients in the doxycycline group and 16 (33%) in the ceftriaxone group had total recovery (95% CI for difference between groups -4% to 34%; p=0.13). Side-effects possibly related to treatment were reported in 21 (37%) and 26 (46%) patients in these groups, respectively (-28% to 9%; p=0.30). Three patients discontinued ceftriaxone treatment owing to adverse events. INTERPRETATION: Oral doxycycline is as efficient as intravenous ceftriaxone for the treatment of European adults with Lyme neuroborreliosis.

Borrelia burgdorferi sensu lato detected in skin of Norwegian mountain hares (Lepus timidus) without signs of dissemination.

The mountain hare (Lepus timidus) population in southern Norway appears to be in decline. Necropsy and laboratory examinations of 36 hares found dead or diseased during 2007-2009 in Vest- and Aust-Agder counties showed that disease and deaths were attributed to multiple causes, with no specific etiology emerging as a cause for population decline. To investigate whether Borrelia burgdorferi sensu lato (s.l.) infection is associated with mortality in mountain hares, tissues and ticks collected from hares were investigated for infection with the spirochete. Borrelia burgdorferi s.l. DNA was not detected in samples from internal organs, whereas Borrelia afzelii, B. burgdorferi sensu stricto (s.s.), and the not-yet-defined Borrelia sp. SV1 were found in skin samples from hares and in adult and nymphal Ixodes ricinus feeding on hares. Only B. burgdorferi s.s. and Borrelia sp. SV1 were detected in larvae feeding on hares. Our results indicate that disseminated Borrelia infection in hares rarely occurs and, presumably, does not play a central role in the suspected population decline. The results also suggest that the mountain hare to some degree functions as a transmission host for B. burgdorferi s.s. and Borrelia sp. SV1.

Prevalence of Borrelia burgdorferi in Ixodes ricinus ticks collected from moose (Alces alces) and roe deer (Capreolus capreolus) in southern Norway.

As part of a larger survey, ears from 18 roe deer (Capreolus capreolus) and 52 moose (Alces alces) shot in the 2 southernmost counties in Norway were collected and examined for Ixodes ricinus ticks. Seventy-two adult ticks, 595 nymphs, and 267 larvae from the roe deer, and 182 adult ticks, 433 nymphs, and 70 larvae from the moose were investigated for infection with Borrelia burgdorferi sensu lato (s.l.). The results showed the presence of B. burgdorferi s.l. DNA in 2.9% of the nymphs collected from roe deer and in 4.4% of the nymphs and 6.0% of the adults collected from moose. The spirochetes were not detected in adult ticks from roe deer, or in larvae feeding on roe deer or moose. In comparison, the mean infection prevalences in questing I. ricinus collected from the same geographical area were 0.5% infection in larvae, 24.5% in nymphs, and 26.9% in adults. The most prevalent B. burgdorferi genospecies identified in ticks collected from roe deer was B. afzelii (76.5%), followed by B. garinii (17.6%), and B. burgdorferi sensu stricto (5.9%). Only B. afzelii (76.7%) and B. garinii (23.3%) were detected in ticks collected from moose. The present study indicates a lower prevalence of B. burgdorferi infection in I. ricinus ticks feeding on roe deer and moose compared to questing ticks. This is the first study to report B. burgdorferi s.l. prevalence in ticks removed from cervids in Norway.

Borrelia burgdorferi sensu lato in Ixodes ricinus ticks collected from migratory birds in Southern Norway.

BACKGROUND: Borrelia burgdorferi sensu lato (s.l.) are the causative agent for Lyme borreliosis (LB), the most common tick-borne disease in the northern hemisphere. Birds are considered important in the global dispersal of ticks and tick-borne pathogens through their migration. The present study is the first description of B. burgdorferi prevalence and genotypes in Ixodes ricinus ticks feeding on birds during spring and autumn migration in Norway. METHODS: 6538 migratory birds were captured and examined for ticks at Lista Bird Observatory during the spring and the autumn migration in 2008. 822 immature I. ricinus ticks were collected from 215 infested birds. Ticks were investigated for infection with B. burgdorferi s.l. by real-time PCR amplification of the 16S rRNA gene, and B. burgdorferi s.l. were thereafter genotyped by melting curve analysis after real-time PCR amplification of the hbb gene, or by direct sequencing of the PCR amplicon generated from the rrs (16S)-rrl (23S) intergenetic spacer. RESULTS: B. burgdorferi s.l. were detected in 4.4% of the ticks. The most prevalent B. burgdorferi genospecies identified were B. garinii (77.8%), followed by B.valaisiana (11.1%), B. afzelii (8.3%) and B. burgdorferi sensu stricto (2.8%). CONCLUSION: Infection rate in ticks and genospecies composition were similar in spring and autumn migration, however, the prevalence of ticks on birds was higher during spring migration. The study supports the notion that birds are important in the dispersal of ticks, and that they may be partly responsible for the heterogeneous distribution of B. burgdorferi s.l. in Europe.

Tickborne encephalitis virus, Norway and Denmark.

Serum from 2 Norwegians with tickborne encephalitis (TBE) (1 of whom was infected in Denmark) and 810 Norwegian ticks were tested for TBE virus (TBEV) RNA by reverse transcription-polymerase chain reaction. Sequencing and phylogenetic analysis were performed. This is the first genome detection of TBEV in serum from Norwegian patients.

First human cases of tickborne encephalitis, Norway.

The first reported case of tickborne encephalitis (TBE) in Norway occurred in 1997. From 1997 to 2003, from zero to two cases of human TBE have been diagnosed per year in Norway, for a total of eight cases. Clinical TBE cases in dogs are not reported in Norway.

[Tick-borne encephalitis in Norway]. / Skogflåttencefalitt i Norge.

BACKGROUND: The first person reported with tick-borne encephalitis (TBE) in Norway fell ill in 1998; the second patient caught the disease in autumn 1999. Both had been to the island of Tromøy in Aust-Agder county. Searches for TBE antibodies were intensified in persons with encephalitis and a seroprevalence study was carried out. MATERIAL AND METHODS: Sera from persons with encephalitis were tested for IgM and IgG antibodies to TBE virus with enzyme immunoassay and a neutralization test. Stored sera from persons living on Tromøy in 1997-2000 were studied for IgG antibodies. RESULTS: We report three cases of TBE, two had encephalitis in September-October 2000. The third patient, with antibodies to TBE virus found by retrospective testing, had the disease in August 1997. IgG antibodies to TBE virus were found in 3 out of 126 (2.4%) samples from Tromøy. INTERPRETATION: We report the first case of TBE in Norway. Of the first five Norwegian cases, four had been on Tromøy before they fell ill, three of them as tourists. In previous studies, IgG antibodies to TBE virus were found in 0.3-0.4% of persons from different parts of Agder counties. The seroprevalence studies indicate that Tromøy may have a higher incidence of TBE than the rest of the two southern counties. Our results confirm that TBE occurs in the coastal area of southern Norway.