Oligoarthritis Caused by Borrelia bavariensis, Austria, 2014 - Volume 21, Number 6—June 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 6—June 2015
Oligoarthritis Caused by Borrelia bavariensis, Austria, 2014
Lyme borreliosis is a tickborne disease caused by certain species of spirochetes of the Borrelia burgdorferi sensu lato (s.l.) complex. In Europe, several genospecies of B. burgdorferi s.l. cause the disease, whereas in North America, B. burgdorferi sensu stricto is the only agent of Lyme borreliosis. This difference causes variability in clinical manifestations (Figure). According to surveillance by the US Centers for Disease Control and Prevention, Lyme arthritis occurs in 30% of Lyme borreliosis patients in the United States (1), whereas in Europe, arthritis is reported in only 3%–7% of patients, as assessed in a few epidemiologic studies (2,3). Direct comparison of the frequencies of clinical manifestations is difficult because of possible differences in case definitions.
In most cases, diagnosis of Lyme arthritis is made on the basis of the clinical picture supported by serologic testing. PCR testing of synovial fluid or synovial tissue samples is the most reliable method for direct identification of the pathogen (4). Cultivation of the pathogen from these materials is difficult, and recovery has been reported only anecdotally.
Lyme arthritis usually affects 1 or several large joints, most commonly the knee (3). Several studies, mostly of serologic testing and clinical picture, have shown different patterns of joint involvement in children (5). Therefore, it is difficult to distinguish Lyme arthritis from other forms of arthritic diseases, particularly juvenile idiopathic arthritis, on the basis of clinical signs and symptoms. Both diseases may present with oligoarticular involvement with symmetrically or unilaterally occurring joint effusions. We report a case of Lyme oligoarthritis in an 11-year-old boy from Vienna, Austria.
Dr. Markowicz is a medical specialist in general medicine and hygiene and microbiology at the Institute for Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria, and a member of the European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis. His primary research interests are clinical microbiology and infectious diseases with special focus on Lyme borreliosis.
We are grateful to the Institute for Laboratory Medicine and the Institute for Pathology and Bacteriology of Donauspital, Vienna, for providing results of several investigations.
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