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Oligoarthritis Caused by Borrelia bavariensis, Austria, 2014 - Volume 21, Number 6—June 2015 - Emerging Infectious Disease journal - CDC

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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

Mateusz MarkowiczComments to Author , 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)


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.


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.


  1. 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
  2. Berglund JEitrem ROrnstein KLindberg ARingér AElmrud HAn epidemiologic study of Lyme disease in southern Sweden. N Engl J Med.1995;333:131927DOIPubMed
  3. Strle FStanek GClinical manifestations and diagnosis of lyme borreliosis. Curr Probl Dermatol2009;37:51110.PubMed
  4. Stanek GWormser GPGray JStrle FLyme borreliosis. Lancet2012;379:46173DOIPubMed
  5. Huppertz HIMichels HPattern of joint involvement in children with Lyme arthritis. Br J Rheumatol1996;35:10168DOIPubMed
  6. Tsao JIWootton JTBunikis JLuna MGFish DBarbour AGAn ecological approach to preventing human infection: vaccinating wild mouse reservoirs intervenes in the Lyme disease cycle. Proc Natl Acad Sci U S A2004;101:1815964DOIPubMed
  7. Leschnik MWKhanakah GDuscher GWille-Piazzai WHörweg CJoachim ASpecies, developmental stage and infection with microbial pathogens of engorged ticks removed from dogs and questing ticks. Med Vet Entomol2012;26:4406DOIPubMed
  8. Wilhelmsson PFryland LBörjesson SNordgren JBergström SErnerudh JPrevalence and diversity of Borrelia species in ticks that have bitten humans in Sweden. J Clin Microbiol2010;48:416976DOIPubMed
  9. Margos GVollmer SACornet MGarnier MFingerle VWilske BA new Borrelia species defined by multilocus sequence analysis of housekeeping genes. Appl Environ Microbiol2009;75:54106DOIPubMed
  10. Michel HWilske BHettche GGöttner GHeimerl CReischl UAn 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 Immunol2004;193:21926DOIPubMed
  11. Eiffert HKarsten AThomssen RChristen HJCharacterization of Borrelia burgdorferi strains in Lyme arthritis. Scand J Infect Dis1998;30:2658.DOIPubMed
  12. Vasiliu VHerzer PRössler DLehnert GWilske BHeterogeneity of Borrelia burgdorferi sensu lato demonstrated by an ospA-type-specific PCR in synovial fluid from patients with Lyme arthritis. Med Microbiol Immunol1998;187:97102DOIPubMed
  13. van der Heijden IMWilbrink BRijpkema SGSchouls LMHeymans PHvan Embden JDDetection of Borrelia burgdorferi sensu stricto by reverse line blot in the joints of Dutch patients with Lyme arthritis. Arthritis Rheum1999;42:147380DOIPubMed
  14. Jaulhac BHeller RLimbach FXHansmann YLipsker DMonteil HDirect molecular typing of Borrelia burgdorferi sensu lato species in synovial samples from patients with Lyme arthritis. J Clin Microbiol2000;38:1895900.PubMed
  15. Steere ACAngelis SMTherapy for Lyme arthritis: strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum2006;54:307986.DOIPubMed



DOI: 10.3201/eid2106.141516

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