Medical Microbiology

Borrelia(RelapsingFever,LymeDisease) 327

pattern.ThepresentingsymptominstageIistheerythemachronicummi-

grans(Fig.4. 25 ).

Diagnosis.Directdetectionandidentificationofthepathogenbymeansof

microscopyandculturingtechniquesispossible,butladenwithuncertain-

ties.Inarecentdevelopment,thepolymerasechainreaction(PCR)isusedfor

directdetectionofpathogen-specificDNA.However,themethodofchoiceis

stilltheantibodytest(EIAorindirectimmunofluorescence,Westernblotting

iftheresultispositive).

Therapy.StagesIandII:amoxicillin,cefuroxime,doxycycline,oramacrolide.

StageIII:ceftriaxone.

Epidemiologyandprevention.Lymediseaseoccursthroughoutthenorthern

hemisphere.Therearesomeendemicfociwheretheinfectionismorefre-

quent.Thediseaseistransmittedbyvariousspeciesofticks,inEuropemostly

byIxodesricinus(sheeptick).InendemicareasofGermany,approximately

3 – 7 %ofthelarvaeand 10 – 34 %ofnymphsandadultticksareinfected

withB.burgdorferisensulato.TheannualincidenceofacuteLymedisease

(stageI)incentralEuropeis 20 – 50 casesper 100000 inhabitants.Wildani-

Table4. 12 ClinicalManifestationsofLymeDisease

Organ/organ

system

StageI StageII StageIII

Skin Erythema

migrans

Diffuseerythema

Lymphadenosis

benignacutis

(Lymphocytoma)

Acrodermatitis

chronicaatrophicans

Lymphatic

system

Local

lymphadenopathy

Regionallympha-

denopathy

Nervous

system

Lymphocytic

meningoradiculitis

Bannwarth,facialis

paresis,aseptic

meningitis

Chronicencephalo-

myelitis(raredelayed

complication)

Joints Briefattacksof

arthritis

Arthritis

Heart Carditis,

atrioventricularblock

Theclinicalpicturesinboldtyperepresenttheprimarydiseasemanifestationsofthe

threestages.

4

Kayser, Medical Microbiology © 2005 Thieme