Uma longa jornada para entender a Borrelia burgdorferi no Brasil

Abstract

A t the end of my fellowship at TUFTS School of Medicine in 1989, my sponsor Dr Allen C Steere, suggested me to look for Lyme disease (LD) in Brazil. I remember his words "It is like to search for a needle in a pottle of hay ¨. Certainly, he didn´t know how hard could be this task. He offered me some reagents and a tube containing culture of Borrelia burgdorferi G 39/40 to start my research in Brazil. During all this long research period I received financial support by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). My first step was to contact an entomologist and fortunately I met Dr Domingos Baggio, a kind man who tried to teach me about ticks. In this sense, we travelled to suspected geographical regions, looking for suspected cases of LD in Brazil and also collecting ticks for analysis. At that time, nobody knew about LD in Brazil. So, we started to publish review article and to inform brazilian physicians about possibility of existence of this emerging tick borne disease in the country. Fortunately, we identified first cases in 1992, in brothers, who became ill after tick bite episode, in a wooded region of Atlantic Forest at Itapevi city, São Paulo State. The boys had fever, erythema migrans (EM) and arthritis and serology for Borrelia burgdorferi (ELISA and Western-blotting) done at our Laboratory was positive in both. After the description of these cases many others were identified. However, careful analysis of the patients revealed that LD in Brazil was different from that described in North hemisphere. Despite of presence of all clinical manifestations of LD in our country, we observed that symptoms were relapsing and serology for Borrelia burgdorferi (ELISA) showed low and transient positivity. Furthermore, western blotting results revealed occurrence of few bands and never fulfilled Center for Disease Control and Prevention (CDC) criteria for LD. We never obtained positive culture for B. burgdorferi in BSK medium, even when skin biopsies from A long journey to understand Borrelia burgdorferi in Brazil

Conferencias magistrales

“…Since the etiological agent has never been isolated in Brazil and electron microscopy analysis reveals the presence of atypical cystic structures (Mantovani et al, 2007), it is assumed that SBY is caused by borrelias, an atypical morphology. This hypothesis justifies all the particularities seen in Brazilian zoonoses, like low immune response to B. burgdorferi, occurrence of relapsing symptoms and autoimmunity (Yoshinari, 2009; Gauditano and Yoshinari, 2009;Yoshinari et al, 2009). …”

“…In Brazil, other ticks not belonging to genus Ixodes, like Amblyomma spp., R. sanguineus and R. microplus are incriminated as disease transmitters (Mantovani et al, 2007; Mantovani, 2009;Yoshinari 2009). Also the coexistence of antibodies against Babesia was documented in patients with SBY in the municipality of Itapevi, São Paulo, showing the possibility of both diseases being related to the same vector (Yoshinari et al, 2003).…”

“…Recent studies show that the genetic and protein variability in spirochetes can be influenced by geographical and biodiversity conditions (Malawista et al, 2000; Derdáková et al, 2005; Kurtenbach et al, 2006). In this sense, the existence of vectors, different from I. ricinus complex in Brazil, is considered as the main causative factor for the emergence of cystic forms of B. burgdorferi in the country (Yoshinari et al, 2009).…”

“…Recent studies show that the genetic and protein variability in spirochetes can be influenced by geographical and biodiversity conditions (Malawista et al, 2000; Derdáková et al, 2005; Kurtenbach et al, 2006). In this sense, the existence of vectors, different from I. ricinus complex in Brazil, is considered as the main causative factor for the emergence of cystic forms of B. burgdorferi in the country (Yoshinari et al, 2009).Over the past two decades, some groups have worked on the clinical and laboratorial characterization of emerging tick-borne zoonoses in the Brazilian territory (Bonoldi, 2009). These researches include the re-study and/or the identification of vectors involved in disease transmission among wild and domestic animals and the analysis of therapeutic response in humans.…”

Estudo laboratorial de agentes infecciosos transmitidos por carrapatos em pacientes com doença de Lyme-símile brasileira (síndrome Baggio-Yoshinari)

“…Nos Estados Unidos da América, sessenta por cento dos pacientes com DL apresentam comprometimento articular (Steere et al, 1987). No Brasil, Yoshinari et al (1999) (Engstrom et al, 1995).. (Yoshinari, 2009). Quarenta e oito pacientes (68,6%) com SBY foram positivos ao visualizarmos estruturas semelhantes aos espiroquetídeos na microscopia de campo escuro.…”