Giancarla Gauditano

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.

Características clínico-epidemiológicas da doença Lyme-símile em crianças

BACKGROUND: To determine the prevalence, age distribution, seasonality and clinical characteristics of Lyme-simile disease in Brazilians less than 15 years of age. METHODS. From July, 1998 to November, 2000, a cross-sectional study was conducted in 333 patients with skin rash and fever. Paired blood samples were collected for identification of the pathogens. Only 193 samples which were negative for other pathogens (Parvovirus B19 Human, Herpesvirus 6 Human, Measles, Rubella, Dengue, Scarlet fever and Enterovirus), were tested for borreliosis by Enzyme-Linked Immunosorbent Assay and Western-blotting. Other clinical, socioeconomic, demographic and climatic variables were studied. RESULTS: Prevalence of the disease was 6.2%(12/193). Of the variables studied, there was predominance in: <6 years old (83.2%); females (66.7%); being from the city of Franco da Rocha (58.3 %); and a summer/fall seasonality. The duration of care was 4 days. Signs and symptoms with statistical significance were itching; absence of lip notch and ocular pain; irritability and good clinical condition. Other clinical data presented were: pruritus (90%), irritability (80%) and fever (?38oC) (58.3%) with a duration of 1 to 3 days. Erythema was maculo-papular (40%), urticaria-like (25%) and scarlatiniform (16.7%), occurring predominately on the trunk (60%). There were no primary clinical evidences of Lyme-simile disease in the patients under study. The sensitivity and specificity of the clinical diagnosis as opposed to the laboratory diagnosis was zero. There was no initial clinical suspicion of the disease in the 10 cases studied and followed up for two years that showed no evidence of cardiologic or neurological complications. This is the first study of Lyme-simile in Brazilian children. CONCLUSION: Prevalence of Lyme-simile disease was low, and it was not remembered at the initial diagnosis of those with skin rash. However, practical knowledge is necessary, demanding increased medical attention.

Chronic lymphomonocytic meningoencephalitis, oligoarthritis and erythema nodosum: report of Baggio- Yoshinari syndrome of long and relapsing evolution☆

The Brazilian human borreliosis, also known as Baggio-Yoshinari Syndrome (BYS), is a tickborne disease but whose ticks do not pertain to the Ixodes ricinus complex. It is caused by Borrelia burgdorferi sensu lato microorganisms and resembles clinical and laboratory features of Lyme disease (LD). BYS is also distinguished from LD by its prolonged clinical evolution, with relapsing episodes and autoimmune dysfunction. We describe the case of a young female who, over one year, progressively presented with oligoarthritis, cognitive impairment, menigoencephalitis and erythema nodosum. Diagnosis was established by means of the clinical history and a positive serology to Borrelia burgdorferi sensu strictu. The patient received Ceftriaxone 2 g IV/day during 30 days, followed by 2 months of doxicycline 100 mg bid. Symptoms remitted and the Borrelia serology tests returned to normality. BYS is a new disease described only in Brazil, which has a raising frequency and deserves the attention from the country´s medical board because of clinical, epidemiological and laboratory differences from LD. Despite the fact that it is a hard-to-diagnose zoonosis, it is important to pursuit an early diagnosis because the symptoms respond well to antibiotics or it might be resistant to treatment and may evolve to a chronic phase with both articular and neurological sequelae.