This book is a compact clinical introduction to Lyme borreliosis for physicians of all specialties who care for patients with suspected B. burgdorferi infection, whether in hospital or general practice. The book provides a great deal of practice-oriented information on symptomatology, diagnosis, treatment, and prophylaxis with a special emphasis on the situation in Europe. At the same time, it describes contemporary scientific knowledge in as much detail as is required in order to understand the pathogenetic relationships and their relevance to medical care. The authors are members of an interdisciplinary expert group of epidemiologists, biologists, microbiologists, and clinicians who have been working in the area of tick-borne diseases for many years. The personal experience of each of the authors, accumulated through their daily work with patients in special clinics or by confrontation with complicated questions in basic research, epidemiology, and laboratory diagnostics of Lyme borreliosis, represents an important mainstay of the book. Written from the perspective of clinical management and practical problem-solving, this topical monograph will assist clinicians in meeting diagnostic challenges and providing appropriate medical aid to patients with Lyme borreliosis.
Author(s): Klaus-Peter Hunfeld, Jeremy Gray
Publisher: Springer
Year: 2022
Language: English
Pages: 235
City: Cham
Contents
Introduction
1: Characteristics of Borrelia burgdorferi sensu lato
1.1 Introduction
1.2 Borrelia Genomics and Cell Biology
1.3 The Borrelia burgdorferi Sensu Lato Species Complex
1.4 Ecology and Transmission Cycles
1.4.1 Infection of Ticks by Borrelia burgdorferi s.l.
1.5 Geographic Ranges of the Lyme Borreliosis Spirochetes
1.6 Molecular Typing of B. burgdorferi s.l.
1.7 Outlook
References
2: Tick Ecology and the Eco-Epidemiology of Borrelia burgdorferi sensu lato
2.1 Introduction
2.2 The Tick Life Cycle
2.3 The Feeding Process
2.4 Tick Development
2.5 Seasonal Activity
2.6 Tick Habitats
2.7 Factors Affecting Tick Abundance
2.7.1 Weather and Climate
2.7.2 Hosts
2.8 Transmission and Circulation of Borrelia burgdorferi sensu lato
2.8.1 The Transmission Process
2.8.2 Tick and Spirochaete Reservoir Hosts
2.9 Environmental Measures for Prevention of Lyme Borreliosis
References
3: Pathogenesis and Immune Defense
3.1 Introduction
3.2 Pathogenesis
3.2.1 Factors Involved in Host Adaptation and Tissue Colonization of B. burgdorferi s.l.
3.2.1.1 The GAG-Binding and Complement-Targeting Surface Protein BBK32
3.2.1.2 The Decorin-Binding Proteins DbpA and DbpB
3.2.1.3 The Glycosaminoglycan-Binding Protein Bgp
3.2.1.4 The Pore-Forming and Integrin-Binding Protein P66
3.2.1.5 The Fibronectin-Binding Proteins RevA and RevB
3.2.1.6 The Laminin-Binding Proteins ErpX, BmpA, and BB0406
3.2.2 Factors Involved in Dissemination and Persistence of B. burgdorferi
3.2.2.1 OspC, a Multi-Functional Protein Involved in Early Dissemination
3.2.2.2 Host-Derived Factors Involved in Dissemination of B. burgdorferi
3.2.3 Immune Evasion Factors of B. burgdorferi
3.2.3.1 Antigenic Variation and the VlsE System of B. burgdorferi s.l.
3.2.3.2 Complement Evasion and Complement Regulator-Acquiring Surface Proteins (CRASP)
3.3 Immune Defense and Host Response
3.3.1 Adaptive Immunity to B. burgdorferi s.l.
3.3.1.1 Role of B Cells and Antibody Responses in Lyme Disease
3.3.1.2 Role of T Cells in Lyme Disease
3.3.1.3 Induction of Cytokines and Other Mediators
3.3.1.4 Recognition of Borrelia by Human Host Cells
3.3.1.5 Persistent Infection of Borrelia and Post-Lyme Disease Syndrome
3.3.1.6 Candidates for Lyme Disease Vaccine Development
References
4: The History, Epidemiology, Clinical Manifestations and Treatment of Lyme Borreliosis
4.1 Introduction
4.2 History of Lyme Borreliosis
4.3 Epidemiology
4.4 Clinical Manifestations of Lyme Borreliosis
4.4.1 Skin Manifestations
4.4.1.1 Erythema Migrans
4.4.1.2 Borrelial Lymphocytoma
4.4.1.3 Acrodermatitis Chronica Atrophicans
4.4.2 Lyme Neuroborreliosis
4.4.3 Lyme Carditis
4.4.4 Lyme Arthritis
4.4.5 Eye Involvement
4.4.6 Lyme Borreliosis During Pregnancy
4.4.7 Lyme Borreliosis in Immunocompromised Patients
4.4.8 Chronic Lyme Borreliosis and “Chronic Lyme”
4.4.9 Laboratory Support in the Diagnosis of Lyme Borreliosis
4.4.10 Treatment
4.5 Concluding Statement
References
5: Special Aspects of Lyme Borreliosis in the United States
5.1 Introduction
5.2 The Area of Risk for Lyme Borreliosis Is Expanding in the United States
5.3 Differences in Lyme Borrelia Species between United States and Europe
5.4 Differences in Clinical Features between the United States and Europe
5.4.1 Erythema Migrans
5.4.2 EM Versus STARI
5.4.3 “Summer Flu”
5.4.4 Lyme Neuroborreliosis
5.4.5 Lyme Arthritis
5.4.6 Asymptomatic Infections
5.4.7 Other Clinical and/or Demographic Differences: United States Versus Europe
5.5 Laboratory Testing for Lyme Borreliosis in the United States
5.5.1 Intrathecal Production of Antibodies Against B. burgdorferi—Testing in the United States
5.6 Some Differences in Treatment Recommendations between the United States and Europe
5.6.1 Postexposure Chemoprophylaxis United States Versus Europe
5.7 Coinfections United States Versus Europe
5.8 Chronic Lyme Disease United States Versus Europe
5.9 Conclusion
References
6: Laboratory Diagnosis of Lyme borreliosis
6.1 Introduction
6.2 Direct Detection of B. burgdorferi s.l.
6.2.1 Direct Detection of Borrelia in Ticks
6.2.2 Xenodiagnostic Approaches
6.2.3 Direct Microscopy and Borrelia Antigen Detection from Clinical Samples
6.2.4 Culture of B. burgdorferi s.l. Directly from Clinical Samples
6.2.5 Molecular Biological Detection Methods
6.2.5.1 PCR Followed by Electrospray Ionization Mass Spectrometry (ESI MS)
6.2.5.2 Sensitivity of Molecular Diagnostics
6.2.5.3 Problems with Standardizing Molecular Testing
6.2.5.4 Genetic Typing Methods for Amplicons and Isolates
6.3 Indirect Detection of the Pathogen (Serological Testing)
6.3.1 Epidemiological Considerations for Adequate Serodiagnostics
6.3.2 Advantages and Limitations of Current Serological Test Strategies
6.3.3 Relevant Immunodominant Antigens of B. burgdorferi s.l.
6.3.4 Screening and Confirmatory Tests
6.3.5 Multiplex Fluorescence Immunoassays (MFI)
6.3.6 Interpretation of Serological Test Results
6.3.6.1 Interpreting Screening Test Results
6.3.6.2 Interpreting Confirmatory Test Results
6.3.6.3 Interpreting Positive Confirmatory Immunoblot Results
6.3.7 Laboratory Diagnosis of Lyme Neuroborreliosis (LNB)
6.3.7.1 Serology
6.3.7.2 CXCL13 as a Lyme Neuroborreliosis Marker
6.4 Quality Assurance
6.5 Non-recommended Diagnostic Tests
6.6 Conclusion
References
7: Prophylactic Measures Against Lyme borreliosis Including Future Perspectives
7.1 Introduction
7.2 Tick Control in the Human Population
7.2.1 Personal Protection
7.2.1.1 Mechanical Protection and Adequate Behavior
7.2.1.2 Repellents
7.2.1.3 Body Checking
7.2.2 Collective Measures: Management of Anthropogenic Environments
7.3 Control of Ticks on Animals
7.3.1 Domestic Animals
7.3.2 Wild Animals
7.3.2.1 Treatment of Hosts
7.3.2.2 Rodent Vaccination to Reduce Borrelia Infection
7.3.2.3 Control of Deer Populations
7.4 Control of Ixodes Ticks in the Environment
7.4.1 Biological Control of Ticks
7.4.1.1 Parasitoids
7.4.1.2 Fungi
7.4.1.3 Nematodes
7.4.2 Chemical Control of Ixodes by Acaricides
7.5 Vaccination Against Lyme borreliosis: What Is the Future?
7.5.1 Human Vaccine Comprising Borrelia Outer Surface Protein Antigens
7.5.2 Anti-tick Vaccine
7.6 Conclusions
References
8: Public Health Aspects of Lyme Borreliosis: The German Experience
8.1 Introduction
8.2 Surveillance of Lyme Borreliosis, Incidence Estimates, and Disease Burden
8.3 Associated Factors with Borrelia burgdorferi sensu lato (s.l.) Infections and Lyme Borreliosis Disease
8.4 Disease Prevention Through Promotion of Tick-Bite Avoidance, Early Removal, and Awareness of Disease Symptoms
8.5 Disease Prevention by Vaccination
8.6 Lyme Controversy, Evidence-Based Approaches to Both Public Health and the Practice of Medicine
References
9: Other Ixodes-Borne Diseases
9.1 Introduction
9.2 Borrelia miyamotoi
9.2.1 Bacterial Features
9.2.2 Ecology
9.2.3 Epidemiology
9.2.4 Clinical Manifestations
9.2.5 Laboratory Diagnosis
9.2.6 Treatment
9.3 Ixodes-Borne Anaplasmataceae
9.3.1 Anaplasma phagocytophilum
9.3.1.1 Bacterial Characteristics
9.3.1.2 Zoonotic Transmission and Hosts
9.3.1.3 Epidemiology
9.3.1.4 Pathogenesis and Host Response
9.3.1.5 Clinical Manifestations
9.3.1.6 Laboratory Diagnosis
9.3.1.7 Treatment
9.3.2 Candidatus Neoehrlichia mikurensis
9.3.2.1 Introduction-Bacterial Features
9.3.2.2 Ecology and Epidemiology
9.3.2.3 Clinical Manifestations
9.3.2.4 Laboratory Diagnosis
9.3.2.5 Treatment
9.4 Ixodes-Borne Rickettsiosis
9.4.1 Rickettsia helvetica
9.4.1.1 Clinical Picture
9.4.1.2 Ecology and Epidemiology
9.4.2 Rickettsia monacensis
9.4.3 Laboratory Diagnosis
9.5 Francisella tularensis
9.5.1 Bacterial Features
9.5.2 Tick Transmission of F. tularensis
9.5.3 Clinical Pictures
9.5.4 Laboratory Diagnosis
9.5.4.1 Direct Diagnosis
9.5.4.2 Indirect Diagnosis
9.5.4.3 Case Definitions
9.5.5 Treatment
9.6 Human Babesiosis
9.6.1 Etiologic Agents
9.6.2 Life Cycle, Zoonotic Transmission, and Hosts
9.6.3 Epidemiology
9.6.4 Clinical Manifestations
9.6.5 Laboratory Diagnosis
9.6.6 Treatment
9.7 Ixodid-Borne Flaviviruses
9.7.1 Virology
9.7.2 Ticks, Hosts, and Reservoirs
9.7.3 Pathogenesis and Host Response
9.7.4 TBE Virus
9.7.4.1 Epidemiology and Transmission
9.7.4.2 Clinical Manifestations
9.7.4.3 Laboratory Diagnosis
9.7.4.4 Treatment and Prevention
9.7.5 Louping Ill Virus
9.7.5.1 Epidemiology and Transmission
9.7.5.2 Laboratory Diagnosis
9.7.5.3 Treatment
9.7.6 Powassan Virus
9.7.6.1 Epidemiology and Transmission
9.7.6.2 Clinical Manifestations
9.7.6.3 Laboratory Diagnosis
9.7.6.4 Treatment
9.8 Human Co-infections by Several Ixodes-Borne Pathogens
References
