Doença de lyme-símile brasileira ou síndrome baggioyoshinari: zoonose exótica e emergente transmitida por carrapatos

Abstract

Lyme disease (LD) is a frequent zoonosis found in the Northern Hemisphere and is considered an infectious disease caused by spirochetes belonging to Borrelia burgdorferi sensu lato complex, transmitted by ticks of the Ixodes ricinus group. In 1992, the first cases resembling LD were described in Brazil in siblings who, after a tick bite episode, developed symptoms as erythema migrans, general flu-like symptoms and arthritis. Careful analysis of Brazilian LD-like illness casuistry showed that epidemiological, clinical and laboratorial features in the country were very different from those exhibited by North American and Eurasian LD patients. Human blood-suckers Ixodes ricinus complex ticks were absent at risk areas; the disease is recurrent in the country; Borrelia burgdorferi was never isolated in Brazil and specific serologic tests have shown little positivity with inconsistent results. Furthermore, peripheral blood analysis of patients on electron microscopy exhibited structures resembling Mycoplasma spp, Chlamydia spp and spirochete-like microorganisms. In fact, they were assumed to be latent forms of spirochetes (L form or cell wall deficient bacteria) adapted to survive at inhospitable conditions in vertebrate and invertebrate hosts. For these reasons, the Brazilian zoonosis was named Baggio-Yoshinari Syndrome (BYS) and defined as: ¨Exotic and emerging Brazilian infectious disease, transmitted by ticks not belonging to the Ixodes ricinus complex, caused by latent spirochetes with atypical morphology, which originates LD-like symptoms, except for occurrence of relapsing episodes and auto-immune disorders¨. Research conducted at the laboratory of Investigations in Rheumatology

Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas"

“…Patients with BYS display many subjective symptoms as those related to chronic fatigue, fibromyalgia, cognitive disturbance or emotional, labor and social disabilities. Additionally, these patients can mention present or past relevant psychiatric complaints (depression, panic syndrome, schizophrenia-like, suicidal attempt), cardiac (arrhythmias, cardiomegaly) or ocular symptoms (uveitis, optic neuritis, retinal arteritis, papilledema) 47 . Also, skin lesions are not restricted to the presence of EM or annular secondary lesion.…”

“…These young patients presented fever, erythema migrans (EM) and arthritis, and the diagnosis was confirmed at the LIM-17 HCFMUSP Lab by ELISA and Westernblotting (WB) assays, using B. burgdorferi sensu stricto antigens of North American origin, originally isolated from the tick Ixodes scapularis. Since then, many other cases were reported, all of them exhibiting similar clinical features of LD, including presence of EM and systemic articular, neurological and cardiac symptoms 5,11,34,41,42,43,45,47 .…”

“…Furthermore, in most of cases, antibiotic treatment is not efficient to cease recurrent disease symptoms. Allergic manifestations including acquired angioedema, have been also described along the disease progression 17,42,45,47 .…”

“…Laboratorial assays to diagnose Brazilian LD-like illness is a very complex question, since antibodies against B. burgdorferi sensu lato identified by ELISA or Western-blotting procedures offer low sensitivity and specificity 42,47 . In this respect, when both assays are employed together in Brazilian patients, the positivity reaches only 65% of cases, while in a normal control group the frequency is around 16% 25 .…”

Parasitismo em aves silvestres residentes e migratórias da Ilha da Marambaia, Estado do Rio de Janeiro1

“…foram observadas ninfas de Amblyomma sp., o que evidencia uma correlação como hospedeiro e vetor, também comentada por Barros-Battesti et al (2000), Mantovani et al (2007) e Yoshinari et al (2010). No mundo, as investigações incriminam o gênero Ixodes como vetor dessa espiroqueta, a exemplo, Olsén et al (1995) O estudo parasitológico de aves silvestres deve ser ampliado para outras regiões e o seu conhecimento dará maiores subsídios para outras pesquisas, voltadas principalmente para a preservação das mesmas em ambiente por elas escolhidos como seu habitat.…”