Oligoarthritis Caused by Borrelia bavariensis, Austria, 2014

Figure

Mateusz Markowicz

, Stefan Ladstätter, Anna M. Schötta, Michael Reiter, Gerhard Pomberger, and Gerold Stanek

Author affiliations: Medical University of Vienna, Vienna, Austria (M. Markowicz, A.M. Schötta, M. Reiter, G. Stanek); Donauspital, Vienna (S. Ladstätter, G. Pomberger)

Abstract

A case of Lyme oligoarthritis occurred in an 11-year-old boy in Vienna, Austria. DNA of Borrelia bavariensiswas detected by PCR in 2 aspirates obtained from different joints. Complete recovery was achieved after a 4-week course with amoxicillin. Lyme arthritis must be considered in patients from Europe who have persisting joint effusions.

Thumbnail of Comparison of frequency of clinical manifestations in Lyme borreliosis cases between the United States and 2 countries in Europe. Data from the United States are based on 154,405 patients identified during 2001–2010 by Centers for Disease Control and Prevention surveillance (1). Cases in Europe are represented by data from southern Sweden (1,471 patients, 1992–1993) (2) and Slovenia (1,471 patients, 2000) (3). The category Lyme neuroborreliosis includes all neurologic manifestations

Figure. Comparison of frequency of clinical manifestations in Lyme borreliosis cases between the United States and 2 countries in Europe. Data from the United States are based on 154,405 patients identified during...

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.

Acknowledgment

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.

References

Centers for Disease Control and Prevention. Clinical manifestations of confirmed Lyme disease cases—United States, 2001–2010 [cited 2014 Dec 11]. http://www.cdc.gov/lyme/stats/chartstables/casesbysymptom.html
Berglund J, Eitrem R, Ornstein K, Lindberg A, Ringér A, Elmrud H, An epidemiologic study of Lyme disease in southern Sweden. N Engl J Med.1995;333:1319–27. DOI PubMed
Strle F, Stanek G. Clinical manifestations and diagnosis of lyme borreliosis. Curr Probl Dermatol. 2009;37:51–110.PubMed
Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379:461–73. DOI PubMed
Huppertz HI, Michels H. Pattern of joint involvement in children with Lyme arthritis. Br J Rheumatol. 1996;35:1016–8. DOI PubMed
Tsao JI, Wootton JT, Bunikis J, Luna MG, Fish D, Barbour AG. An ecological approach to preventing human infection: vaccinating wild mouse reservoirs intervenes in the Lyme disease cycle. Proc Natl Acad Sci U S A. 2004;101:18159–64. DOI PubMed
Leschnik MW, Khanakah G, Duscher G, Wille-Piazzai W, Hörweg C, Joachim A, Species, developmental stage and infection with microbial pathogens of engorged ticks removed from dogs and questing ticks. Med Vet Entomol. 2012;26:440–6. DOI PubMed
Wilhelmsson P, Fryland L, Börjesson S, Nordgren J, Bergström S, Ernerudh J, Prevalence and diversity of Borrelia species in ticks that have bitten humans in Sweden. J Clin Microbiol. 2010;48:4169–76. DOI PubMed
Margos G, Vollmer SA, Cornet M, Garnier M, Fingerle V, Wilske B, A new Borrelia species defined by multilocus sequence analysis of housekeeping genes. Appl Environ Microbiol. 2009;75:5410–6. DOI PubMed
Michel H, Wilske B, Hettche G, Göttner G, Heimerl C, Reischl U, An ospA-polymerase chain reaction/restriction fragment length polymorphism-based method for sensitive detection and reliable differentiation of all European Borrelia burgdorferi sensu lato species and OspA types. Med Microbiol Immunol. 2004;193:219–26. DOI PubMed
Eiffert H, Karsten A, Thomssen R, Christen HJ. Characterization of Borrelia burgdorferi strains in Lyme arthritis. Scand J Infect Dis. 1998;30:265–8.DOI PubMed
Vasiliu V, Herzer P, Rössler D, Lehnert G, Wilske B. Heterogeneity of Borrelia burgdorferi sensu lato demonstrated by an ospA-type-specific PCR in synovial fluid from patients with Lyme arthritis. Med Microbiol Immunol. 1998;187:97–102. DOI PubMed
van der Heijden IM, Wilbrink B, Rijpkema SG, Schouls LM, Heymans PH, van Embden JD, Detection of Borrelia burgdorferi sensu stricto by reverse line blot in the joints of Dutch patients with Lyme arthritis. Arthritis Rheum. 1999;42:1473–80. DOI PubMed
Jaulhac B, Heller R, Limbach FX, Hansmann Y, Lipsker D, Monteil H, Direct molecular typing of Borrelia burgdorferi sensu lato species in synovial samples from patients with Lyme arthritis. J Clin Microbiol. 2000;38:1895–900.PubMed
Steere AC, Angelis SM. Therapy for Lyme arthritis: strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum. 2006;54:3079–86.DOI PubMed