Elenice Mantovani

Novel Spotted Fever Group Rickettsiosis, Brazil

We report a clinical case of spotted fever group rickettsiosis acquired in São Paulo, Brazil. Definitive diagnosis was supported by seroconversion between acute-phase and convalescent-phase serum samples. Molecular analysis of skin samples indicated the agent was a novel spotted fever group strain closely related to Rickettsia africae, R. parkeri, and R. sibirica.

Amplification of the flgE gene provides evidence for the existence of a Brazilian borreliosis

INTRODUCTION The symptoms of Brazilian borreliosis resemble the clinical manifestations of Lyme disease (LD). However, there are differences between the two in terms of epidemiological and laboratory findings. Primers usually employed to diagnose LD have failed to detect Borrelia strains in Brazil. OBJECTIVE We aimed to identify the Brazilian Borrelia using a conserved gene that synthesizes the flagellar hook (flgE) of Borrelia burgdorferi sensu lato. METHOD Three patients presenting with erythema migrans and positive epidemiological histories were recruited for the study. Blood samples were collected, and the DNA was extracted by commercial kits. RESULTS The gene flgE was amplified from DNA of all selected patients. Upon sequencing, these positive samples revealed 99% homology to B. burgdorferi flgE. CONCLUSION These results support the existence of borreliosis in Brazil. However, it is unclear whether this borreliosis is caused by a genetically modified B. burgdorferi sensu stricto or by a new species of Borrelia spp.

Neurological manifestations in Baggio-Yoshinari Syndrome (Brazilian Lyme disease-like syndrome)

INTRODUCAO: A doenca de Lyme (DL) e uma doenca de picada de carrapato, causado pela espiroqueta Borrelia burgdorferi sensu lato, transmitida por carrapatos do complexo Ixodes ricinus, que promove multiplas manifestacoes clinicas sistemicas. No Brasil, uma sindrome diferente e descrita e mimetiza sintomas de DL, mas tambem se manifesta com alta frequencia de episodios recorrentes e manifestacoes alergicas e imunologicas. E transmitida pelo carrapato Amblyomma cajennense e o agente etiologico e uma espiroqueta nao cultivavel de forma atipica. Devido a essas particularidades, esta zoonose emergente tem sido denominada sindrome brasileira semelhante a doenca de Lyme ou sindrome de Baggio-Yoshinari (SBY). OBJETIVO: Descrever o espectro da manifestacao neurologica da SBY. PACIENTES: Foram analisados 30 pacientes com SBY e sintomas neurologicos. RESULTADOS: A media de idade dos pacientes foi de 34,2 ± 13,3 anos (6 a 63 anos); 20 eram mulheres e 10 homens. Um alto numero de episodios recorrentes (73,6%) e disturbios psiquiatricos e psicossociais graves (20%) foram caracteristicas tipicas. Eritema migrans similar ao visto em hemisferio norte foi identificado em 43,3% dos pacientes no inicio da doenca. A recorrencia das lesoes cutâneas diminuiu com a progressao da doenca. Sintomas articulares (artrite) aconteceram em aproximadamente metade dos pacientes com SBY no inicio e durante o episodio de recidiva. CONCLUSOES: A SBY e considerada uma nova doenca transmitida por carrapato no Brasil que difere da classica DL observada no hemisferio norte. A SBY reproduz sintomas neurologicos observados na DL, exceto pela presenca adicional de recorrencia de episodios e uma tendencia de causar manifestacoes neurologicas cronicas e articulares.

Growth, cysts and kinetics of Borrelia garinii (Spirochaetales: Spirochaetacea) in different culture media

The aim of the present paper was to evaluate cyst formation and growth parameters of Borrelia garinii in a range of media differing in formulation and cost. A qualitative assessment of morphology and motility of B. garinii was conducted. All media were prepared aseptically and used in test tubes or Petri dishes. For each medium, the initial spirochete concentration was standardized to 10(3) spirochets/mL. The following culture media were suitable to grow B. garinii: Barbour-Stoenner-Kelly, brain heart infusion and PMR. Growth was minimal at six weeks post-inoculation and maximum spirochete density was observed between 9-12 weeks. Often, the cultures developed cysts of different sizes, isolated or in groups, with a spiraled portion of variable sizes, mainly in unfavorable culture media. Brazilian Lyme disease-like illness, also known as Baggio-Yoshinari syndrome (BYS), is a new and interesting emerging tick-borne disease, caused by Borrelia burgdorferi sensu lato spirochetes, only during its cystic forms. It has been assumed that the peculiar clinical and laboratory features of BYS are consequential to the absence of a human sucker Ixodes ricinus complex tick at risk areas in Brazil, supporting the concept that the borrelia phenotypic expression pattern is modified as it is transmitted through the host.

Brazilian borreliosis with special emphasis on humans and horses

Borreliosis caused by Borrelia burgdorferi sensu lato is a cosmopolitan zoonosis studied worldwide; it is called Lyme disease in many countries of the Northern Hemisphere and Lyme-like or Baggio-Yoshinari Syndrome in Brazil. However, despite the increasing number of suspect cases, this disease is still neglected in Brazil by the medical and veterinary communities. Brazilian Lyme-like borreliosis likely involves capybaras as reservoirs and Amblyomma and Rhipicephalus ticks as vectors. Thus, domestic animals can serve as key carriers in pathogen dissemination. This zoonosis has been little studied in horses in Brazil. The first survey was performed in the state of Rio de Janeiro, and this Brazilian Borreliosis exhibits many differences from the disease widely described in the Northern Hemisphere. The etiological agent shows different morphological and genetic characteristics, the disease has a higher recurrence rate after treatment with antibiotics, and the pathogen stimulates intense symptoms such as a broader immune response in humans. Additionally, the Brazilian zoonosis is not transmitted by the Ixodes ricinus complex. With respect to clinical manifestations, Baggio-Yoshinari Syndrome has been reported to cause neurological, cardiac, ophthalmic, muscle, and joint alterations in humans. These symptoms can possibly occur in horses. Here, we present a current panel of studies involving the disease in humans and equines, particularly in Brazil.

Evidence of Borrelia in wild and domestic mammals from the state of Minas Gerais, Brazil

The main of the study was to evaluate the presence of Borrelia burgdorferi infection in domestic and wild vertebrates and ectoparasites in endemic areas from the state of Minas Gerais, Brazil. A total of 445 serum samples were examined by ELISA, which used the Borrelia burgdorferi strain G39/40 U.S. source and 3,821 tick samples were tested by polymerase chain reaction (PCR). B. burgdorferi antibodies were found in 30 serum samples (6.74%); three in marsupials (7.69%), three in rodents (2.80%), nine in dogs (6.25%), and 15 in horses (9.68%). Nested-PCR performed in DNA samples obtained from collected ticks demonstrated negative results. Although attempts to amplify B. burgdorferi DNA from ticks had been not successful, the presence of seroreactive vertebrates suggests the possibility the Borrelia species circulating in these regions. Further research is required to provide information on the presence of Borrelia in Brazilian territory and its association with Baggio-Yoshinari syndrome.

Anti-Collagen Type V Antibody in Systemic Sclerosis: A Possible Useful Tool to Asses Disease Activity

Introduction: Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular injury, autoimmunity and tissue fibrosis. Usually collagen type V (V Col) is found hidden between the heterotypical fibers. It was discovered in the rheumatology department at the University of Sao Paulo (FMUSP) that deposition of this collagen occurs, however with anomalous morphology in SSc patient’s tissue, suggesting that V Col is an important molecule in fibrosis and autoimmunity process. The V Col molecule, which has atypical morphology aspect, exposed after a nonspecific inflammatory damage could result in formation of immune complexes (V Col - anti-V Col), whose deposition on the vascular endothelium, would cause a vascular damage, allowing the influx of cells of innate immunity into the extracellular matrix, resulting in an enzymatic degradation of the heterotypical fibers, with exposure of more V Col and perpetuation of the disease. Objectives: Assess whether there is a correlation between anti-V Cols presence in the serum of patients with SSc and indexes of activity, severity and quality of life measured by sHAQ. Methods: Were evaluated 60 patients with SSc diagnostic during the period of January to December 2014. Were applied Medsger severity criteria, Valentini activity criteria and health assessment questionnaire in SSc (sHAQ) in the patients, at initial assessment (baseline) and after 6 months, correlating the presence of anti-V Col with the clinical and laboratory manifestations found. Results: Most patients were female (98.3%) and had the limited form of the disease (43.3%), average age 51 years, white, average duration of nine years of disease and modified Rodnan Skin Score of 13.08. The main clinical manifestations observed in each organic system of patients were: skin thickening in the hands (78.3%), Raynauds phenomenon (100%), arthritis (33.3%), esophageal involvement (71.7%), interstitial lung disease (45%), pulmonary arterial hypertension (PAH) (19.4%) and scleroderma renal crisis (SRC) (1.7%). The most significant laboratory abnormalities were elevation of inflammatory markers in 41.7% of patients (ESR and CRP), CPK elevation (15%), low complement (C3 and C4) (3.3%), antinuclear antibody (95%), anti-centromere (41.7%), anti-DNA topoisomerase I antibody (26.7%), anti-RNA polymerase III (11.7%), anti-U1-RNP (16.7%) and anti-Ro (SSA) in 11.7% of patients. The anti-V Col was detected in 5 cases (8.3%) and showed statistical correlation with disease activity and scleroderma renal crisis, besides tendency to association with PAH; however, did not correlate with the severity index of disease or any other clinical manifestation, or with specific SSc antibodies. Conclusions: We suggest that disease activity in SSc patients could be determined by serological analysis, to detect the presence of V Col antibodies in the serum of patients with SSc, facilitating the approach of this serious disease. We suggest further studies with larger number of patients in order to confirm the usefulness of this new marker of disease activity in systemic sclerosis.