Abstract
Lyme borreliosis, leptospirosis, and relapsing fever are multisystemic zoonoses caused by spirochetes. The causative bacteria are Borrelia burgdorferi sensu lato (transmission by Ixodes ticks), Leptospira interrogans (infection in water and damp soil after excretion by infected animals), and relapsing fever borreliae transmitted by ticks (endemic relapsing fever) or lice (epidemic relapsing fever). In Lyme borreliosis, the skin is the organ most frequently affected (>85%). There are three forms of dermatoborrelioses: erythema migrans, Borrelia lymphocytoma, and acrodermatitis chronica atrophicans. In leptospirosis and relapsing fever, 50–60% of patients develop nonspecific macular/papular exanthemas, sometimes with a petechial character. Leptospirosis and relapsing fever can occur in phases or episodes of high fever and cause severe symptoms in numerous organs. In the diagnosis of the latter two, direct pathogen detection is of key importance. In Lyme borreliosis, serology is routinely used, but the possibility of false-positive or false-negative findings must be kept in mind. Oral doxycycline is the drug of choice for the treatment of Lyme borreliosis, mild leptospirosis, and relapsing fever. Severe leptospirosis and relapsing fever are treated intravenously with benzylpenicillin.
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References
Lyme Borreliosis
Azagi T, Hoornstra D, Kremer K, Hovius JWR, Sprong H (2020) Evaluation of disease causality of rare Ixodes ricinus-borne infections in Europe. Pathogens 9:150
Cardenas-de la Garza JA, De la Cruz-Valadez E, Ocampo-Candiani J, Welsh O (2019) Clinical spectrum of Lyme disease. Eur J Clin Microbiol Infect Dis 38:201–208
Eldin C, Raffetin A, Bouiller K, Hansmann Y, Roblot F, Raoult D, Parola P (2019) Review of European and American guidelines for the diagnosis of Lyme borreliosis. Med Mal Infect 49:121–132
Glatz M, Resinger A, Semmelweis K et al (2015) Clinical spectrum of skin manifestations of Lyme borreliosis in 204 children in Austria. Acta Derm Venereol 95:565–571
Hofmann H, Fingerle V, Hunfeld KP, Huppertz HI, Krause A, Rauer S, Ruf B, Consensus Group (2017) Cutaneous Lyme borreliosis: guidelines of the German Dermatology Society. Ger Med Sci 15:Doc14. https://doi.org/10.3205/000255. eCollection 2017
Kullberg BJ, Vrijmoeth HD, van de Schoor F, Hovius JW (2020) Lyme borreliosis: diagnosis and management. BMJ 369:m1041
Madison-Antenucci S, Kramer LD, Gebhardt LL, Kauffman E (2020) Emerging tick-borne diseases. Clin Microbiol Rev 33(2):e00083-18
Marques A, Schwartz I, Wormser GP, Wang Y, Hornung RL, Demirkale CY, Munson PJ, Turk SP, Williams C, Lee CR, Yang J, Petzke MM (2017) Transcriptome assessment of erythema migrans skin lesions in patients with early Lyme disease reveals predominant interferon signaling. J Infect Dis 217:158–167
Müllegger RR, Glatz M (2008) Skin manifestations of Lyme borreliosis: diagnosis and management. Am J Clin Dermatol 9:355–368
Rebman AW, Aucott JN (2020) Post-treatment Lyme disease as a model for persistent symptoms in Lyme disease. Front Med (Lausanne) 7:57
Smith GN, Moore KM, Hatchette TF, Nicholson J, Bowie W, Langley JM (2020) Committee opinion no. 399: management of tick bites and Lyme disease during pregnancy. J Obstet Gynaecol Can 42:644–653
Steere AC, Strle F, Wormser GP, Hu LT, Branda JA, Hovius JWR, Li X, Mead PS (2016) Lyme borreliosis. Nat Rev Dis Primers 2:16090
Talagrand-Reboul E, Raffetin A, Zachary P, Jaulhac B, Eldin C (2020) Immunoserological diagnosis of human borreliosis: current knowledge and perspectives. Front Cell Infect Microbiol 19:241
Tolkki L, Hokynar K, Meri S, Panelius J, Puolakkainen M, Ranki A (2018) Granuloma annulare and morphea: correlation with Borrelia burgdorferi infections and chlamydia-related bacteria. Acta Derm Venereol 98:355–360
Torbahn G, Hofmann H, Rücker G, Bischoff K, Freitag MH, Dersch R, Fingerle V, Motschall E, Meerpohl JJ, Schmucker C, Torbahn G et al (2018) Efficacy and safety of antibiotic therapy in early cutaneous Lyme borreliosis: a network meta-analysis. JAMA Dermatol 154:1292–1303
Leptospirosis
Karpagam KB, Ganesh B (2020) Leptospirosis: a neglected tropical zoonotic infection of public health importance – an updated review. Eur J Clin Microbiol Infect Dis 39:835–846
Lam JY, Low GK, Chee HY (2020) Diagnostic accuracy of genetic markers and nucleic acid techniques for the detection of Leptospira in clinical samples: a meta-analysis. PLoS Negl Trop Dis 14(2):e0008074. https://doi.org/10.1371/journal.pntd.0008074. eCollection 2020 Feb
Marquez A, Djelouadji Z, Lattard V, Kodjo A (2017) Overview of laboratory methods to diagnose leptospirosis and to identify and to type leptospires. Int Microbiol 20:184–193
Naing C, Reid SA, Aung K (2017) Comparing antibiotic treatment for leptospirosis using network meta-analysis: a tutorial. BMC Infect Dis 17(1):29. https://doi.org/10.1186/s12879-016-2145-3
Senavirathna I, Rathish D, Agampodi S (2020) Cytokine response in human leptospirosis with different clinical outcomes: a systematic review. BMC Infect Dis 20(1):268
Sun AH, Liu XX, Yan J (2020) Leptospirosis is an invasive infectious and systemic inflammatory disease. Biom J 43:24–31
Relapsing Fever
Barbour AG (2020) Clinical features, diagnosis, and management of relapsing fever. In: Sexton DJ, Kaplan SL (eds) UpToDate. UpToDate, Inc., Waltham, MA. https://www.uptodate.com/contents/clinical-features-diagnosis-and-management-of-relapsing-fever. Accessed 11 January 2019
Binenbaum Y, Ben-Ami R, Baneth G et al (2020) Single dose of doxycycline for the prevention of TBRF. Clin Infect Dis 71(7):1768–1771. https://doi.org/10.1093/cid/ciaa034
Butler T (2017) The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis. Am J Trop Med Hyg 96:46–52
Cutler SJ (2015) Relapsing fever borreliae: a global review. Clin Lab Med 35:847–865. https://doi.org/10.1016/j.cll.2015.07.001
Talagrand-Reboul E, Boyer PH, Bergström S, Vial L, Boulanger N (2018) Relapsing fevers: neglected tick-borne diseases. Front Cell Infect Microbiol 8:98. https://doi.org/10.3389/fcimb.2018.00098
Warrell DA (2019) Louse-borne relapsing fever (Borrelia recurrentis infection). Epidemiol Infect 147:e106. https://doi.org/10.1017/S0950268819000116
First Describer
Afzelius A (1910) Erythema migrans. Verhandlungen der dermatologischen Gesellschaft zu Stockholm 1909. Arch Dermatol Syph 101:404
Bäfverstedt B (1943) Über Lymphadenosis benigna cutis. Acta Derm Venereol (Stockh) 24(Suppl):1–202
Bannwarth A (1941) Chronische lymphocytäre Meningitis, entzündliche Polyneuritis und “Rheumatismus”. Arch Psychiatr Nervenkrankh 113:284–376
Buchwald A (1883) Ein Fall von diffuser idiopathischer Hautatrophie. Arch Dermatol Syph 10:553–556
Burckhardt JL (1911) Zur Frage der Follikel- und Keimzentrenbildung in der Haut. Frankf Z Pathol 6:352–359
Burgdorfer W, Barbour AG, Hayes SF et al (1982) Lyme disease – a tickborne spirochetosis? Science 216:1317–1319
Craigie D (1843) Notice of a febrile disorder which has prevailed in Edinburgh during the summer of 1843. Edinburgh Med Surg J 60:410–418
Garin C, Bujadoux A (1922) Paralysis par les tiques. J Med Lyon 71:765–767
Herxheimer K, Hartmann K (1902) Über Acrodermatitis chronica atrophicans. Arch Dermatol Syph 61(57–76):255–300
Lipschütz B (1913) Über eine seltene Erythemform (Erythema chronicum migrans). Arch Dermatol Syph 118:349–356
Obermeier OHF (1873) Vorkommen feinster, eine Eigenbewegung zeigender Fäden im Blute von Recurrenskranken. Zentralbl Med Wiss 11:145–147
Rutty J (1770) A chronological history of the weather and seasons and of the prevailing diseases in Dublin. Robinson and Roberts, Dublin, pp 75–90
Steere AC, Malawista SE, Snydman DR et al (1977) Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum 20:7–17
Weil A (1886) Über eine eigenthümliche, mit Milztumor, Icterus und Nephritis einhergehende, acute Infectionskrankheit. Dtsch Arch Klin Med 39:209–232
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Müllegger, R. (2021). Lyme Borreliosis and Other Nonvenereal Spirochetal Infections. In: Plewig, G., French, L., Ruzicka, T., Kaufmann, R., Hertl, M. (eds) Braun-Falco´s Dermatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58713-3_14-1
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DOI: https://doi.org/10.1007/978-3-662-58713-3_14-1
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