Background and objective: Lyme disease, also known as Lyme borreliosis (LB), is a tick-borne infectious disease caused by the spirochete bacteria Borrelia. The risk of infection depends on the geographical area, ecological factors, and human behavior. Clinical manifestations of Lyme borreliosis have a wide range, but the most frequent clinical symptom, which is also a diagnostic symptom, is a skin rash called erythema migrans (EM). The disease is very common worldwide. In Lithuania, the disease frequency is 99.9 cases per 100,000 population (Centre for Communicable Diseases and AIDS, Lithuania, 2017). The main aim of this study was to obtain the baseline characteristics of the disease regarding the infected Lithuanian population. Materials and Methods: We analyzed data from the Centre for Communicable Diseases and AIDS about all Lyme disease (A69.2) diagnosed patients over a three-year period (from 2014 to 2016) in Lithuania. Results: In 2014–2016, 7424 (crude incidence rate 85.4) cases with LB were diagnosed in Lithuania. Most of them (4633 (62.4%)) were identified in women. Older people were more likely to suffer from LB. Urban residents were 2.6 times more often affected that those living in villages. Tick bites were primarily observed in high season months, from May to September (90%), with the highest peak in July. There was a higher number of observed tick bites (p = 0.003) in the urban residents. Erythema migrans occurred in 75.6% LB cases, while other symptoms did not exceed a quarter of all LB cases. There were 7353 (99.6%) cases where LB was confirmed via clinical symptoms and/or laboratory tests. Also, 1720 (23.2%) patients were tested for LB immunoglobulins. Conclusions: This study found a high incidence of Lyme disease in Lithuania. We elucidated the baseline characteristics regarding the infected Lithuanian population which may ease medical clinicians’ work on new Lyme diagnoses.

Background and objectives: Lyme disease is the most common tick-borne infectious disease in Europe, caused by the spirocheta bacteria of Borrelia burgdorferi. Several genospecies of B. burgdorferi are pathogenic to humans. B. burgdorferi sensu stricto, which is prevalent in North America, causes reactive arthritis, whereas B. garinii and B. afzelii, common in Europe, can affect the skin, heart, or nervous system; it has been shown that the clinical symptoms of the disease may be very different. The objective of this study was to identify the baseline characteristics of Lyme disease and to elucidate the frequency of different Lyme disease syndromes in Lithuania. Materials and Methods: Patients who were diagnosed with Lyme disease during an ambulatory visit to the Center of Infectious Diseases, Vilnius University Santaros clinics, from 2014 to 2016, were enrolled in this study. A retrospective material analysis was conducted. Results: In total, 1005 patients were enrolled with the following prevalence of clinical syndromes: erythema migrans (EM), 945 (94.02%); Lyme arthritis, 32 (3.18%); neuroborreliosis, 23 (2.28%); Lyme carditis, 4 (0.39%); and acrodermatitis, 1 (0.09%). Erythema migrans was dominant among middle-aged women, with a rash appearing mainly on the lower extremities. Lyme arthritis mainly manifested among middle-aged women as an oligoarthritis, mostly affecting the knee joint. Neuroborreliosis was seen more often in middle-aged women than men and the main symptom was nervus facialis neuropathy. Lyme carditis, manifested as an atrioventricular block, with a male/female ratio of 3:1, and the median age was 51. Acrodermatitis was diagnosed in a 61-year-old woman, as a painful, red rash on the hand. Conclusions: According to the prevalence of B. garinii and B. afzelii in Europe, previously it was thought that Lyme disease presented as erythema migrans, and less frequently as neuroborreliosis; however, this study revealed that other syndromes may also be seen. In addition, we revealed that the longer it takes for erythema migrans to appear, the greater the likelihood of Lyme arthritis developing.

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The clinical course of Lyme neuroborreliosis (LNB) is highly variable. Delayed diagnosis and treatment still remain actual challenges. Moreover, there is a lack of studies analyzing the factors associated with different LNB syndromes. We aimed to analyze clinical and epidemiological features of LNB in hospitalized adults. A retrospective study was performed in the years 2010–2021. A total of 103 patients were involved in the study, 100 with early, and three with late LNB. Patients with early LNB most often presented polyradiculitis (75/100, (75%)), which was also the most common initial neurological syndrome. Peripheral facial palsy was diagnosed in 53/100 (53%) patients, in 16/53 (30.2%) cases both facial nerves were affected. Encephalitis or myelitis was diagnosed in 14% of patients with LNB. A total of 76/103 (73.8%) patients were discharged with residual symptoms or signs. One patient presenting encephalomyelitis died because of bacterial complications. We found that female sex and untreated erythema migrans (EM) were associated with the development of isolated polyradiculitis, the absence of EM was associated with the development of peripheral facial palsy, and a fever of ≥ 38˚C and pleocytosis of ≥ 300x106/l were associated with encephalitis or myelitis in patients with early LNB.

BackgroundLyme disease is a tick born infectious disease caused by different genospecies of Borrelia bacteria (B. burgdorferi sensu strictu, B. afzelii and B. garinii). Disease clinical manifestation varies and belongs on the variety of Borrelia bacteria genospieces. In America Lyme arthritis dominates, which is caused by B.burgdorferi, while in Europe Lyme disease is caused by Borrelia afzelli or Borrelia garinii (less commonly by Borrelia burgdorferi) leading to usual disease manifestation as erythema migrans or neuroborreliosis. Lyme disease is very common disease in the world, approximately 300,000 people get Lyme disease each year in the United States (Centers for disease control and prevention US), in Lithuania disease frequency is 101.6 cases per 100 000 population (Center for Communicable Diseases and AIDS, Lithuania, 2016 year).ObjectivesTo investigate the frequency of Lyme arthritis in high disease endemic European country Lithuania. To find out with joint was most frequently affected.MethodsA retrospective, single center study was performed. We have analyzed the medical documents of adult patients, who were hospitalized to Infectious disease center (Vilnius, Lithuania), due to severe Lyme disease clinical manifestation, in 2014-2017 years.Results88 patients were enrolled (57 females, 31 males, age range 18-90 years, median age 57 years). Patients were divided into four groups according disease clinical manifestation: erythema migrans, neuroborreliosis, Lyme arthritis and carditis (atrioventricular block). The most frequently erythema migrans was observed (53 cases, 62, 35 percentages (%)), than neuroborreliosis (27 cases, 31, 76 percentages), following by Lyme arthritis (3 cases, 3, 53 percentages) and Lyme carditis (2 cases, 2, 35 percentages). Between Lyme arthritis patients inflamed joints were these: knee (one case), ankle (one case) and both - knee and ankle (one case). In two cases high laboratory markers (ESR 116; 23 mm/h, CRP 125; 50 mg/l) and high body temperature (38, 2; 39, 5 0 t) was documented.Conclusion2.35% of hospitalized Lyme infected patients reveal as Lyme arthritis. Inflamed joint were knee (50%) and ankle (50%). Despite the fact that it is used to think that Lyme arthritis occurs only (mostly) in America we can find it in Europe too, though its incidence is lowReferences[1] Sergamumo užkrečiamomis ligomis Lietuvoje apžvalga 2016. Užkrečiamų ligų ir AIDS centras. 96-98 pages. http://www.ulac.lt/uploads/downloads/leidiniai/Sergamumo_apzvalga_2016.pdf[2] Franc Strle, Gary P. Wormser, Linden T. Hu, John A. Branda, Joppe W. R. Hovius, Xin Li, and Paul S. Mead. Lyme borreliosis. Nat Rev Dis Primers 2, Article number: 16090 (2016).[3] Cardenas-de la Garza, J.A., De la Cruz-Valadez, E., Ocampo-Candiani, J. et al. Eur J Clin Microbiol Infect Dis (2018). https://doi.org/10.1007/s10096-018-3417-1Disclosure of InterestsNone declared

BackgroundLyme disease is a tick born infectious disease caused by different genospecies of Borrelia bacteria (B. burgdorferi sensu strictu (ss), B. afzelii and B. garinii). The signs and symptoms of Lyme disease vary, they usually appear in stages, but the stages can overlap. In early stage skin rash (erythema migrans) appears, which may be accompanied by fever, chills, fatigue, body aches, headache, neck stiffness, and swollen lymph nodes. Later signs and symptoms can be these: joint pain and inflammation, neurological problems or other less common syndromes - heart problems, eye inflammation, and liver inflammation. Lyme disease is very common disease in the world, approximately 300,000 people get Lyme disease each year in the United States (Centers for disease control and prevention US), in Lithuania disease frequency is 101.6 cases per 100 000 population (Center for Communicable Diseases and AIDS, Lithuania, 2016 year).ObjectivesTo investigate the frequency of rheumatic symptoms between Lyme diagnosed persons in Lithuania, based on epidemiological data.MethodsWe have analyzed data of Center for Communicable Diseases and Aids of Lithuania about Lyme diagnosed patients from 2014 to 2016 years.ResultsTotal number of cases was 7425. 2791 males, 4633 females, age range 1 - 91 years, median age 52 years. 996 patients found out as symptomatic. The rest were either asymptomatic either information about clinical disease manifestation was not known. Among symptomatic patients two rheumatic symptoms were observed: arthralgia (220 cases, 22,1%), 140 females, 80 males, age range 12 – 84 years, median age 58 years, and myalgia (78 cases, 7,8%), 44 females, 34 males, age range 15-80, median age 56. Other symptoms were erythema migrans (75.6%), headache (15.2%), general weakness (12.4%), fever (10, 1%), and head dizziness (6.4%).ConclusionIn total, almost 30 percentages (29, 91%) of symptoms were rheumatic. To conclude, joint pain and/or muscle pain can lead not only to systemic rheumatic diseases, but to infection diseases as well (for example: Lyme disease).References[1] Sergamumo užkrečiamomis ligomis Lietuvoje apžvalga 2016. Užkrečiamų ligų ir AIDS centras. 96-98 pages. http://www.ulac.lt/uploads/downloads/leidiniai/Sergamumo_apzvalga_2016.pdf[2] Franc Strle, Gary P. Wormser, Linden T. Hu, John A. Branda, Joppe W. R. Hovius, Xin Li, and Paul S. Mead. Lyme borreliosis. Nat Rev Dis Primers. 2017 Aug 3;3:17062. doi: 10.1038/nrdp.2017.62.[3] Lyme disease: summary of NICE guidance. BMJ2018;361:k1261.[4] Clinical spectrum of Lyme disease. Cardenas-de la Garza, J.A., De la Cruz-Valadez, E., Ocampo-Candiani, J. et al. Eur J Clin Microbiol Infect Dis (2018). https://doi.org/10.1007/s10096-018-3417-1Disclosure of InterestsNone declared