Description of Lyme disease-like syndrome in Brazil: is it a new tick borne disease or Lyme disease variation?

Abstract

An emerging clinical entity that reproduces clinical manifestations similar to those observed in Lyme disease (LD) has been recently under discussion in Brazil. Due to etiological and laboratory particularities it is named LD-like syndrome or LD imitator syndrome. The condition is considered to be a zoonosis transmitted by ticks of the genus Amblyomma, possibly caused by interaction of multiple fastidious microorganisms originating a protean clinical picture, including neurological, osteoarticular and erythema migrans-like lesions. When peripheral blood of patients with LD-like syndrome is viewed under a dark-field microscope, mobile uncultivable spirochete-like bacteria are observed. PCR carried out with specific or conservative primers to recognize Borrelia burgdorferi sensu stricto or the genus Borrelia has been negative in ticks and in biological samples. Two different procedures, respectively involving hematoxylin and eosin staining of cerebrospinal fluid and electron microscopy analysis of blood, have revealed spirochetes not belonging to the genera Borrelia, Leptospira or Treponema. Surprisingly, co-infection with microorganisms resembling Mycoplasma and Chlamydia was observed on one occasion by electron microscopy analysis. We discuss here the possible existence of a new tick-borne disease in Brazil imitating LD, except for a higher frequency of recurrence episodes observed along prolonged clinical follow-up.

Evidence of Borrelia in wild and domestic mammals from the state of Minas Gerais, Brazil

“…Mantovani et al (2007) were unable to confirm whether this syndrome is caused by new Borrelia species or it is related to genetically modified Borrelia burgdorferi sensu lato microorganisms or other infectious agent.…”

Primary embryonic cells of Rhipicephalus microplus and Amblyomma cajennense ticks as a substrate for the development of Borrelia burgdorferi (strain G39/40)

“…However, the spirochete of Borrelia spp. has not been isolated yet, even after the attempts in samples of human material, ticks and wild animals (Costa et al, 2002;Mantovani et al, 2007) The tick Amblyomma americanum has been identified as the host of the Borrelia lonestari in southern United State (Barbour and Hayes, 1996) and Varela et al (2007) isolated B. lonestari from A. americanum and cultivated it in embryonic cells of Ixodes scapularis (ISE6). Munderloh and Kurtti (1995) observed that the adherence of B. burgdorferi to the cells of R. appendiculatus correlated with infectivity and viability.…”

“…The present study found adherence and development of spirochetes to the cells of R. microplus and A. cajennense. The development of this type of study is important because these ticks are involved in the transmission of spirochetes of the genus Borrelia in Brazil (Fonseca et al, 2005;Mantovani et al, 2007;Yoshinari et al, 2010). Rezende et al (2008) demonstrated the occurrence of Borrelia spp.…”

“…represent the most common human-biting tick in Brazil and include vectors for other zoonoses. Other tick species could also play a relevant role in the ecology and epidemiology of the Brazilian lyme disease-like or Bagio Yoshinari syndrome (Mantovani et al, 2007;Yparraguirre et al, 2007;Yoshinari et al, 2010).…”

“…The main tick species suspected of playing a role in the transmission of Borrelia spp. belong to the genera Rhipicephalus and Amblyomma (Mantovani et al, 2007;Yoshinari et al, 2010). However, there is a report of co-isolation of Borrelia spp.…”