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Early disseminated Lyme disease
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
The patient has Lyme disease, as characterized by the classic erythema migrans lesions on his skin. Lyme disease, a bacterial infection caused by the spirochete Borrelia burgdorferi (United States), Borrelia afzelii, and Borrelia garinii (Europe and Asia), is transmitted through the bite of the Ixodes deer tick and has three stages: Early localized disease—This is characterized by an erythema migrans rash at the site of a tick bite, generally within 2 weeks of the bite and may be accompanied by fever, headache, fatigue, arthralgias, and myalgias. Serologic testing for disease is often negative at this stage. (See also Case 79.)Early disseminated disease—This stage is characterized by multiple erythema migrans rashes as well as the systemic signs pictured occurring weeks to months after the initial tick bite. Meningitis, cranial nerve palsies (especially CN VII), and carditis (usually characterized by atrioventricular [AV] block) may occur in this stage of illness.Late disease—Occurs weeks to months after untreated initial infection. This is characterized by arthritis (>90% involving the knee). Fever is uncommon at this stage.
Communicable diseases
Published in Liam J. Donaldson, Paul D. Rutter, Donaldsons' Essential Public Health, 2017
Liam J. Donaldson, Paul D. Rutter
Lyme disease is already endemic in the United Kingdom. It was first described in 1975 in Old Lyme, Connecticut, when several children developed acute arthritis. The causal agent in North America is Borrelia burgdorferi, transmitted by the bite of the Ixodes tick, which lives on wild animals (especially deer). It is not transmissible person to person. In Europe and Asia, the main organisms causing Lyme disease are Borrelia afzelii and Borrelia garinii.
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Borreliosis is a tick-borne infection due to one of the several pathogenic borrelia that belong to the group of treponemas. The main vector in Europe is the tick Ixodes ricinus, whereas it is I. dammini in North America, but other ticks also harbor borrelias. Borrelia afzelii is mainly responsible for the European cases and B. burgdorferi is prevalent in North America. The different stages of cutaneous borreliosis have long been known in Europe as erythema chronicum migrans, benign lymphocytoma, or lympadenosis cutis benigna, now also called borrelioma, and acrodermatitis chronica atrophicans. The American type of borreliosis, known as Lyme disease, has a slightly different clinical course and extracutaneous manifestations. Specific nail lesions of borreliosis are not known although one case of painful nail discoloration was thought to be due to a Borrelia infection159 and nail root inflammation was reported in a patient suffering from neuroborreliosis due to B. garinii.160 However, acrodermatitis chronica atrophicans of Herxheimer (ACA) may also involve toes and fingers. An avascular area in the nail fold of a single finger was seen in a patient with ACA.161 Joint pain and swelling of the distal phalanges may occur.162 A case of photo-onycholysis induced by doxycycline given for the treatment of erythema chronicum migrans was described.163
The potential for CXCL13 in CSF as a differential diagnostic tool in central nervous system infection
Published in Expert Review of Anti-infective Therapy, 2020
Ilias Masouris, Matthias Klein, Uwe Ködel
The CSF CXCL13 levels may also vary between subspecies of the infectious agent. Three Borrelia subspecies are responsible for most LNB infections worldwide: Borrelia burgdorferi sensu stricto, Borrelia garinii, and Borrelia afzelii. The infectious agent has impact on the clinical course of the infection. For instance, the Bannwarth syndrome, the typical LNB manifestation in Europe, is mainly evoked by infection with Borrelia garinii, while Borrelia afzelii causes a more unspecific clinical feature with less radicular and meningeal symptoms [35,131,132]. These two subspecies are the most common pathogens in Europe, in North America however, Borrelia burgdorferi sensu stricto is the only pathogenic spirochete found and here, meningitis is the most common clinical LNB presentation. CSF abnormalities are more prominent and frequent in Borrelia garinii infections than Borrelia afzelii [132]. Thus, it is possible that the above-mentioned distinct features between the different subspecies may reflect in the immune response and further the expression of CXCL13. Since the isolation and detection of the Borrelia subspecies is not usually part of clinical routine, this could be a potential factor for variable CXCL13 CSF levels across studies.