Lyme borreliosis and skin

Abstract

Lyme disease is a multisystem illness which is caused by the strains of spirochete Borrelia burgdorferi sensu lato and transmitted by the tick, Ixodes. Though very commonly reported from the temperate regions of the world, the incidence has increased worldwide due to increasing travel and changing habitats of the vector. Few cases have been reported from the Indian subcontinent too. Skin manifestations are the earliest to occur, and diagnosing these lesions followed by appropriate treatment, can prevent complications of the disease, which are mainly neurological. The three main dermatological manifestations are erythema chronicum migrans, borrelial lymphocytoma and acrodermatitis chronica atrophicans. Many other dermatological conditions including morphea, lichen sclerosus and lately B cell lymphoma, have been attributed to the disease. Immunofluorescence and polymerase reaction tests have been developed to overcome the problems for diagnosis. Culture methods are also used for diagnosis. Treatment with Doxycycline is the mainstay of management, though prevention is of utmost importance. Vaccines against the condition are still not very successful. Hence, the importance of recognising the cutaneous manifestations early, to prevent systemic complications which can occur if left untreated, can be understood. This review highlights the cutaneous manifestations of Lyme borreliosis and its management.

Lyme disease in Haryana, India

“…[4] Clinically, Lyme borreliosis is divided into three stages: early localized disease, early disseminated disease, and chronic disease. Erythema migrans is a prominent clinical feature of early disease seen in 60-70% of cases appearing as an erythematous, growing annular plaque.…”

“…[11] No specific species of ticks causing Lyme borreliosis in India have been recognized; however, Ixodes ticks are present in the Himalayan region of India and an isolated case report of Lyme disease from south India identified the Haemophysalis species of ticks. [4] The possible reason for emergence of Lyme borreliasis in Haryana, a state in northern India, could be the exposure of individuals to ticks in the fields as the population is predominantly rural. Another reason could be the favorable temperature for the mite, as they quest most actively from spring to autumn in microenvironments with more than 85% relative humidity.…”

“…[3] A literature search revealed only a few previously reported cases of Lyme disease from India. [4] This case series illustrates a rare clustering of five cases over a period of 3 months in a nonendemic region, Rohtak, Haryana.…”

A STING from a Tick : Epidemiology, Ecology and Clinical Aspects of Lyme Borreliosis

“…The nodule consists of a dense lymphocytic infiltration as a result of Borrelia infection and its regional specificity suggests that the BL-causing spirochetes prefer lower host body temperatures (Vasudevan & Chatterjee, 2013). Patients may also present with BL and a simultaneous or precedent EM (Strle et al, 1992).…”

Two Brothers with Multiple Cranial Nerve Palsies

“…There are isolated case reports of its presentation in India as neuroretinitis from South India [1], an acute febrile illness from Bhopal [2] and isolated dermatological manifestations [3]. In a seroprevalence study of B burgdorferi infection in NorthEastern states of India [4], 13 % of 500 cases were positive for B burgdorferi specific IgG.…”