Borreliose

ZUSAMMENFASSUNG

Die Lyme-Borreliose mit sehr unterschiedlichen Krankheitsmanifestationen wird durch verschiedene Erreger des Genus Borrelia verursacht. Borrelien werden (in Deutschland) durch die Schildzecke Ixodes ricinus übertragen. Einblicke in die Pathophysiologie erlauben ein besseres Verständnis von Krankheitsmanifestation, Diagnostik und Therapie der Borreliose. Abhängig vom jeweiligen Erreger (Spezies und Genotyp) können sich die Bakterien lokal vermehren oder auch in unterschiedliche Organe verteilen. Durch verschiedene Mechanismen entziehen sich Borrelien dem Zugriff durch unser Immunsystem, was zu einer starken jedoch ineffizienten Immunantwort führen kann. Die Symptome werden fast ausschließlich durch diese Immunantwort verursacht, was die Lyme-Borreliose zu einer wichtigen Differenzialdiagnose in der Rheumatologie macht. Neben der Klinik, Diagnostik und Therapie der Lyme-Borreliose befasst sich dieser Beitrag mit der Pathophysiologie, was über ein besseres Verstehen der Erkrankung zu Fehlervermeidung im klinischen Alltag führen dürfte.

ABSTRACT

Lyme disease is caused by different bacterial species of the genus borrelia resulting in an infection with a plethora of different symptoms. The disease vector, in Germany, is the tick Ixodes ricinus. Knowledge of the pathophysiology of Lyme disease can help explain the clinical manifestations, diagnosis, and therapy of Lyme disease. Whether Lyme disease remains a local infection in the skin, or spreads to different organs, depends heavily on the species and genotype of the infecting bacteria. Borrelia can evade the immune system due to a multitude of strategies; this can result in a strong, however, inefficient response by the immune system. The symptoms of Lyme disease are almost exclusively caused by this errant immune response. As a result, Lyme disease is an important differential diagnosis for the field of rheumatology. This article describes not only the clinical manifestations, diagnosis, and treatment of Lyme disease, but also the pathophysiology. With this better understanding of the pathophysiology common errors in the diagnosis and treatment of Lyme disease can be prevented.

Schlüsselwörter

Lyme-Borreliose - Lyme-Arthritis - Antibiotika-refraktäre Lyme-Arthritis

Keywords

Lyme disease - Lyme arthritis - antibiotic-refractary Lyme arthritis

• Literatur

• 1 Bockenstedt LK, Wormser GP. Unraveling Lyme Disease.. Arthritis Rheumatol 2014; 66: 2313-2323
• 2 Steere AC, Strle F, Wormser GP. et al Lyme borreliosis.. Nat Rev Dis Primers 2016; 02: 16090
• 3 Hanincova K, Mukherjee P, Ogden NH. et al Multilocus Sequence Typing of Borrelia burgdorferi Suggests Existence of Lineages with Differential Pathogenic Properties in Humans.. PLoS One 2013; 08: e73066
• 4 Wormser GP, Brisson D, Liveris D. et al Borrelia burgdorferi genotype predicts the capacity for hematogenous dissemination during early Lyme disease.. J Infect Dis 2008; 198: 1358-1364
• 5 Enkelmann J, Böhmer M, Fingerle V. et al Incidence of notified Lyme borreliosis in Germany, 2013–2017. Sci Rep 2018; 08: 14976
• 6 Auwaerter PG, Bakken JS, Dattwyler RJ. et al Antiscience and ethical concerns associated with advocacy of Lyme disease.. Lancet Infect Dis 2011; 11: 713-719
• 7 Lager M, Dessau RB, Wilhelmsson P. et al Serological diagnostics of Lyme borreliosis: comparison of assays in twelve clinical laboratories in Northern Europe.. Eur J Clin Microbiol Infect Dis 2019; 38: 1933-1945
• 8 Bacon RM, Kugeler KJ, Mead PS. et al Surveillance for Lyme disease--United States, 1992–2006. MMWR Surveill Summ 2008; 57: 1-9
• 9 Steere AC. Lyme Disease.. New England Journal of Medicine 2001; 345: 115-125
• 10 Piesman J, Gern L. Lyme borreliosis in Europe and North America.. Parasitology 2004; 129 Suppl S191-220
• 11 Strle F, Lusa L, Ružić-Sabljić E. et al Clinical Characteristics Associated with Borrelia burgdorferi Sensu Lato Skin Culture Results in Patients with Erythema Migrans.. PLOS ONE 2013; 08: e82132
• 12 Huppertz HI, Böhme M, Standaert SM. et al Incidence of Lyme Borreliosis in the Würzburg Region of Germany.. European Journal of Clinical Microbiology & Infectious Diseases 1999; 18: 697-703
• 13 Wilking H, Stark K. Trends in surveillance data of human Lyme borreliosis from six federal states in eastern Germany, 2009–2012. Ticks and Tick-borne Diseases 2014; 05: 219-224
• 14 Samuels DS. Gene Regulation in Borrelia burgdorferi.. Annual Review of Microbiology 2011; 65: 479-499
• 15 Bockenstedt LK, Wooten RM, Baumgarth N. Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes.. Curr Issues Mol Biol 2021; 42: 145-190
• 16 Bockenstedt LK, Wooten RM, Baumgarth N. Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes.. Curr Issues Mol Biol 2021; 42: 145-190
• 17 Tunev SS, Hastey CJ, Hodzic E. et al Lymphoadenopathy during Lyme Borreliosis Is Caused by Spirochete Migration-Induced Specific B Cell Activation.. PLOS Pathogens 2011; 07: e1002066
• 18 Wormser GP, Bittker S, Cooper D. et al Comparison of the Yields of Blood Cultures Using Serum or Plasma from Patients with Early Lyme Disease.. J Clin Microbiol 2000; 38: 1648-1650
• 19 Li X, McHugh GA, Damle N. et al Burden and Viability of Borrelia burgdorferi in Skin and Joints of Patients With Erythema Migrans or Lyme Arthritis.. Arthritis Rheum 2011; 63: 2238-2247
• 20 Leeflang MMG, Ang CW, Berkhout J. et al The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis.. BMC Infect Dis 2016; 16: 140
• 21 Zhang J-R, Hardham JM, Barbour AG. et al Antigenic Variation in Lyme Disease Borreliae by Promiscuous Recombination of VMP-like Sequence Cassettes.. Cell 1997; 89: 275-285
• 22 Mullegger RR. Dermatological manifestations of Lyme borreliosis.. Eur J Dermatol 2004; 14: 296-309
• 23 Barthold SW, Beck DS, Hansen GM. et al Lyme borreliosis in selected strains and ages of laboratory mice.. J Infect Dis 1990; 162: 133-138
• 24 Hansen K, Lebech A-M. The clinical and epidemiological profile of lyme neuroborreliosis in denmark 1985–1990 A prospektive study of 187 patients with Borrelia Burgdorferii specific intrathecal antibodyproduction.. Brain 1992; 115: 399-423
• 25 Steere AC, Schoen RT, Taylor E. The clinical evolution of Lyme arthritis.. Ann Intern Med 1987; 107: 725-731
• 26 Barthold SW, Hodzic E, Tunev S. et al Antibody-mediated disease remission in the mouse model of lyme borreliosis.. Infect Immun 2006; 74: 4817-4825
• 27 Asbrink E, Brehmer-Andersson E, Hovmark A. Acrodermatitis chronica atrophicans--a spirochetosis. Clinical and histopathological picture based on 32 patients; course and relationship to erythema chronicum migrans Afzelius.. Am J Dermatopathol 1986; 08: 209-219
• 28 Peripheral neuropathy in acrodermatitis chronica atrophicans – a late Borrelia manifestation. E Kindstrand E, Nilsson BY, Hovmark A. et al Stand: Acta Neurol Scand. 1997; 95 (06) 338-345
• 29 Goettner G, Schulte-Spechtel U, Hillermann R. et al Improvement of Lyme Borreliosis Serodiagnosis by a Newly Developed Recombinant Immunoglobulin G (IgG) and IgM Line Immunoblot Assay and Addition of VlsE and DbpA Homologues.. J Clin Microbiol 2005; 43: 3602-3609
• 30 Eiffert H, Hanefeld F, Thomssen R. et al Reinfection in Lyme borreliosis.. Infection 1996; 24: 437-439
• 31 Hilton E, Tramontano A, DeVoti J. et al Temporal study of immunoglobin M seroreactivity to Borrelia burgdorferi in patients treated for Lyme borreliosis.. J Clin Microbiol 1997; 35: 774-776
• 32 Kalish RA, McHugh G, Granquist J. et al Persistence of Immunoglobulin M or Immunoglobulin G Antibody Responses to Borrelia burgdorferi 10–20 Years after Active Lyme Disease.. Clinical Infectious Diseases 2001; 33: 780-785
• 33 Jutras BL, Lochhead RB, Kloos ZA. et al Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis.. PNAS 2019; 116: 13498-13507
• 34 Wormser GP, Dattwyler RJ, Shapiro ED. et al The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America.. Clinical Infectious Diseases 2006; 43: 1089-1134