Lyme disease: Epidemiology and Cutaneous Clinical Presentations
Abstract
Lyme disease is the tick-borne disease with highest incidence in Europe and North America. Climate change seems to be modifying its geographic distribution, with spreading of endemic areas. Simultaneously, an increasingly number of cases is being diagnosed as the knowledge of its clinical presentations is growing.
Most individuals come to the Dermatology visit after a tick bite or with lesions diagnosed as erythema migrans. Other cutaneous clinical presentations, like borrelial lymphocytoma and acrodermatitis chronica atrophicans, are rare. In the presence of a tick bite, doctors should remove it from the body surface and perform clinical vigilance for a period of at least 30 days. Prophylactic antibiotic therapy is not recommended in Europe. Preventive measures as the use of protective clothing in endemic areas should be promoted.
The diagnosis of erythema migrans is clinical and first line antibiotic therapy is doxyxycline, which has a high success rate. Serologic tests are essential for the diagnosis of less common cutaneous presentations. Histopathologic examination of skin biopsies also supports the diagnosis. Prompt treatment allows faster and greater improvement, with less irreversible lesions.
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References
França I. Capítulo 1: Borreliose de lyme: uma introdução à doença. Trab Soc Port Dermatol Venereol. 2000; 58:11-39.
Rizzoli A, Hauffe H, Carpi G, Vourc'h G, Neteler M, Rosa R. Lyme borreliosis in Europe. Euro Surveill. 2011; 16:2–9.
Sehgal VN, Khurana A. Lyme disease/borreliosis as a systemic disease. Clin Dermatol. 2015; 33:542–50.
Casimiro E, Calheiros J, Santos FD, Kovats S. National assessment of human health effects of climate change in Portugal: approach and key findings. Environ Health
Persp. 2006:1950–6.
Bhate C, Schwartz RA. Lyme disease: part I. Advances and perspectives. J Am Acad Dermatol. 2011; 64:619-36.
Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011;17:69-79.
DellaSala DA,Middelveen M, Liegner KB, Luche-Thayer J. Lyme Disease Epidemic Increasing Globally Due to Climate Change and Human Activities. Reference Module
in Earth Systems and Environmental Sciences. Amsterdam: Elsevier; 2017.
Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012; 379):461-73.
David de Morais JA, Filipe AR, Núncio MS. Doença de Lyme em Portugal: caso clínico. Rev Port Doenç Infec.1989; 12: 261-74.
de Carvalho IL, Núncio MS. Laboratory diagnosis of Lyme borreliosis at the Portuguese National Institute of Health (1990-2004). Euro Surveill. 2006; 11:257-60.
Nunes M, Parreira R, Maia C, Lopes N, Fingerle V, Vieira ML. Molecular identification of Borrelia genus in questing hard ticks from Portugal: Phylogenetic characterization of two novel Relapsing Fever-like Borrelia sp. Infect Genet Evol. 2016; 40:266-74.
Le Fleche A, Postic D, Girardet K, Péter O, Baranton G. Characterization of Borrelia lusitaniae sp. nov. by 16S Ribosomal DNA Sequence Analysis. Int J Syst Bacteriol.
; 47: 921-25
Collares-Pereira M, Couceiro S, Franca I, Kurtenbach K, Schäfer SM, Vitorino L, et al. First Isolation of Borrelia lusitaniae from a Human Patient. J Clin Microbiol. 2004; 42:1316–8.
de Carvalho IL, Fonseca JE, Marques JG, Ullmann A, Hojgaard A, Zeidner N et al. Vasculitis-like syndrome associated with Borrelia lusitaniae infection. Clin Rheumatol.
; 27:1587-91.
David de Morais JA. Zoonoses emergentes em Portugal: epidemiologia e clínica. Rev Port Doenç Infec. 2009; 5:95-114
Silva MM, Santos AS, Formosinho P, Bacellar F. Carraças associadas a patologias infecciosas em Portugal. Acta Med Port. 2006; 19:39-48
Pereira A, Parreira R, Cotão AJ, Nunes M, Vieira ML, Azevedo F, et al. Tick-borne bacteria and protozoa detected in ticks collected from domestic animals and wildlife in central and southern Portugal. Ticks Tick Borne Dis. 2018; 9:225-34.
Norte AC, da Silva LP, Tenreiro PJ, Felgueiras MS, Araújo PM, Lopes PB. Patterns of tick infestation and their Borrelia burgdorferi s.l. infection in wild birds in Portugal. Ticks Tick Borne Dis. 2015; 6:743-50.
INE.pt [homepage na Internet] Lisboa: INE, Casos notificados de doenças de declaração obrigatória; Série 2015. [consultado 2018 Fev 10]. Disponível em: http://www.ine.pt
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic
anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; 43:1089-134.
Connally NP, Durante AJ, Yousey-Hindes KM, Meek JI, Nelson RS, Heimer R. Peridomestic Lyme disease prevention: results of a population-based case-control study. Am J Prev Med. 2009; 37:201-6.
Ecdc.europa.eu [homepage na Internet] Solna: European Centre for Disease Prevention and Control. Ixodes ricinus - current known distribution; Janeiro 2018. [consultado 2018 Fev 1]. Disponível em: https://ecdc.europa.eu
Collares-Pereira M, França I. Capítulo 6: Borreliose de Lyme: Ocorrência em Portugal. Trab Soc Port Dermatol Venereol. 2000; 58:107-17.
Hengge UR, Tannapfel A, Tyring SK, Erbel R, Arendt G, Ruzicka T. Lyme borreliosis. Lancet Infect Dis. 2003; 3(8):489-500.
França I. Capítulo 2: Manifestações cutâneas da borreliose de lyme: o estado da questão. Trab Soc Port Dermatol Venereol. 2000; 58:41-72.
Hofmann H, Fingerle V, Hunfeld KP, Huppertz HI, Krause A, Rauer S, et al. Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society. Ger Med Sci. 2017; 15:14.
Lenormand C, Jaulhac B, De Martino S, Barthel C, Lipsker D. Species of Borrelia burgdorferi complex that cause borrelial lymphocytoma in France. Br J Dermatol. 2009; 161:174-6.
CDC.gov [homepage na Internet] Atlanta: Centers for Disease Control and Prevention. Lyme Disease: Two-step Laboratory Testing Process; Março 2015. [consultado 2018 Jan 27]. Disponível em: https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/
Bhate C,Schwartz RA. Lyme disease: Part II. Management and prevention. J Am Acad Dermatol. 2011; 64:639-53.
Maraspin V, Cimperman J, Lotric-Furlan S, Ruzic-Sabljic E, Jurca T, Picken RN, et al. Solitary borrelial lymphocytoma in adult patients. Wien Klin Wochenschr. 2002;
:515-23.
Leeflang MM, Ang CW, Berkhout J, Bijlmer HA, Van Bortel W, Brandenburg AH, et al. The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis. BMC Infect Dis. 2016; 16:140.
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