H. Kuiper

Lyme borreliosis in Dutch forestry workers

Serum samples from 127 Dutch forestry workers and 127 matched controls were tested for antibodies against Borrelia burgdorferi in an indirect immunofluorescence assay (IFA). Those of the forestry workers were also tested by Western blotting. The forestry workers were examined clinically for evidence of Lyme borreliosis without the examiner or the workers knowing the results of the laboratory tests. Seroprevalence of B. burgdorferi antibodies among forestry workers (25/127) was significantly higher than among controls matched for age and place of residence (8/127), odds ratio 3.7 (95% CI 1.5-9.7). Of the 25 sera of forestry workers positive in the IFA, 23 reacted with at least five bacterial polypeptides in the Western blot test. According to adapted CDC criteria, seven forestry workers (6%) were classified as being a case of Lyme borreliosis. In only one of them had the diagnosis been made before this investigation. Five persons had a history of erythema migrans, one of arthritis, and one of persistent infection. We conclude that Lyme borreliosis is an occupational disease among forestry workers in the Netherlands, with a three-fold higher seroprevalence than among matched controls. The disease, often not diagnosed among this high-risk group, warrants more attention to achieve early recognition and to prevent late complications.

One year follow-up study to assess the prevalence and incidence of Lyme borreliosis among Dutch forestry workers.

A one-year serological and clinical follow-up study was conducted to assess the prevalence and incidence of asymptomatic and symptomatic infection withBorrelia burgdorferi among 151 Dutch forestry workers. The prevalence of antibodies toBorrelia burgdorferi among the forestry workers and among office employees as control group was compared. Antibodies toBorrelia burgdorferi were detected by enzyme immunoassay. Forestry workers were examined physically at the start of the study. Clinical follow-up of forestry workers whose first blood sample was positive and of persons showing seroconversion was done by telephone interview. If Lyme borreliosis was suspected, clinical and laboratory data were obtained. The seroprevalence was significantly higher among forestry workers (28 %) than among controls (5 %). Of 127 forestry workers who were examined, 7 (18 %) of the 39 seropositive persons but none of the seronegative persons had a history of Lyme borreliosis. None of 32 asymptomatic seropositive forestry workers had developed Lyme borreliosis one year later. The incidence of infection withBorrelia burgdorferi as demonstrated by seroconversion among 95 initially seronegative forestry workers was 5%. None of them had Lyme borreliosis. Infection withBorrelia burgdorferi among forestry workers is frequent but seems to take a benign course.

Solitary erythema migrans : a clinical, laboratory and epidemiological study of 77 Dutch patients

Regional variations in the clinical spectrum of Lyme borreliosis have been described previously. These may be related to strain variations, or reflect selection bias. We compared the clinical and epidemiological profiles of Dutch patients presenting with solitary erythema migrans alone, with the profiles in other European studies, and studies from the U.S.A., and cultured Borrelia burgdorferi from erythema migrans to identify the genospecies.

Evaluation of central nervous system involvement in Lyme borreliosis patients with a solitary erythema migrans lesion

To determine whether early dissemination ofBorrelia burgdorferi to the central nervous system occurs in stage I of Lyme borreliosis, neurological and cerebrospinal fluid examination was performed in 48 consecutive patients in whom the only sign of infection was a solitary erythema migrans lesion. Long-term follow-up after treatment with tetracycline was carried out by telephone interview. At presentation, neurological findings were normal in all 48 patients. Cerebrospinal fluid samples were obtained from 29 (60 %) patients. Mild pleocytosis and mild impairment of the blood-brain barrier were present in four and one of these patients, respectively. No significant amount of tumor necrosis factor or interleukin 6 was found in the cerebrospinal fluid samples. Culture results of 13 cerebrospinal fluid samples were negative.Borrelia burgdorferi DNA was only detected by the polymerase chain reaction in one of two aliquots of the cerebrospinal fluid sample of one patient. None of 46 patients who were interviewed 12 to 51 (median 25) months after antibiotic treatment developed manifestations consistent with disseminated or chronic Lyme borreliosis. Thus, no compelling evidence was found for the presence of asymptomatic central nervous system involvement in patients with clinically localized Lyme borreliosis.

Seroconversion for Lyme borreliosis Among Dutch Military

Few prospective studies for Lyme borreliosis (LB) have been conducted among subjects at risk to acquire this disease during their work when wearing well-defined protective clothing against tick-bites. We prospectively compared the rate of seroconversion and the occurrence of clinical manifestations of LB among 2 groups of Dutch military. The at risk-group worked predominantly outdoors, and the control-group conducted predominantly indoor activities. During outdoor work, the at risk-group wore long sleeves, long trousers, closed around the ankles and high boots. Initial serum samples from 2158 military were collected immediately after entering the service. From 932 military (at risk-group: 469, control-group: 463) a second sample was drawn 9 to 12 months later. Sera were tested for IgG and IgM antibodies by ELISA. Four persons (0.9%) in the at risk-group and 10 persons (2.2%) in the control-group seroconverted for IgG and/or IgM antibodies against B. burgdorferi. This difference was not statistically significant. Only 1 person who had seroconverted had noticed an erythema migrans. In conclusion, military performing outdoor activities have a low risk for infection with B. burgdorferi, most likely because they wear protective clothing. Among seroconverted persons clinical manifestations of Lyme borreliosis occurred rarely.

Improved Detection of Immunoglobulin M in Sera of Erythema Migrans Patients by Western Blotting with a Local Borrelia Burgdorferi Skin Isolate

Lyme borreliosis (LB) is a multi-system disorder, which occurs in temperate zones and is caused by the tick-borne spirochaete Borrelia burgdorferi.1 The clinical symptoms of LB can be differentiated in manifestations of early and late infection. The early infection comprises two stages, the localized stage which is marked by the development of an Erythema Migrans (EM) around the site of the tick bite, and the disseminated stage which is commonly characterized by meningopolyneuritis, multiple skin lesions, arthralgias, bouts of arthritis or carditis. Months to years after onset, persisting infection can result in symptoms such as chronic arthritis, encephalomyelitis or acrodermatitis chronica atrophicans.2