Aspects of Lyme Borreliosis PDF
Preview Aspects of Lyme Borreliosis
Dedicated to our wives Eva and Dale K. Weber· W. Burgdorfer (Eds.) . Coeditor: G. Schierz Aspects of Lyme Borreliosis With 42 Tables and 138 Illustrations Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest Dr.med.K1aus Weber Dermatologist in Private Practice Rosenstr.6 8000 Munchen 2 Germany Willy Burgdorfer, Ph.D., M.D. (h.c.) Laboratory of Vectors and Pathogens Rocky Mountain Laboratories Hamilton, MT 59840 USA ISBN-13:978-3-642-77616-8 e-ISBN-13: 978-3-642-77614-4 DOl: 1O.l 007/978-3-642-77614-4 This work is subject of copyright. All rights are reserved, whether the whole or part of the mate rial is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1993 Softcover reprint of the hardcover I st edition 1993 Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting: Fotosatz Reiter, Berchtesgaden 27/3145-543210 -Printed on acid-free paper Preface The story of Lyme borreliosis started in Europe at the end of the last century and is still continuing today. The aim of this book is to present current knowledge of Lyme borreliosis primarily as it occurs in Europe. Despite providing such a regional view, observations made in the United States of America and elsewhere are also considered. Thus "Aspects of Lyme Borreliosis" may serve within these limits as a presentation of the disease in general. The various stages of preparation in completing this book included sending invita tions to authors from different departments and even different countries as far as this was practicable, and arranging manuscript evaluation by one or two anonymous reviewers and at least one of the editors. Dr. W. Burgdorfer was mainly responsible for editing the nonclinical part, and Dr.K. Weber for editing the clinical part. The clinical chapters, when feasible follow a specific outline. The term "Lyme borreliosis" has only recently been introduced. European authors describing aspects of this disease fmd themselves, therefore, to a certain extent, in a nomenclatural dilemma (see Chap. 7). The majority of the authors of this book elected to use the designation "Lyme borreliosis" rather than "erythema migrans borre1iosis" or both terms concomitantly. We are deeply indebted to our fellow authors for their contributions. Our gratitude is also extended to the reviewers and to Mrs. U. Perschau-lendreizig und Mrs. K. Baade in the editorial office. April 1992 Klaus Weber Willy Burgdoifer List of Contributors Aberer, Elisabeth, ll. Universitats-Hautklinik Wien, AlserstraBe 4, 1090 Wien, Austria Aeschlimann, A., University of Neuchatel, Zoological Institute, Chantemerle 22, 2007 Neuchatel, Switzerland Asbrink, Eva, Department of Dermatology, Karolinska Institute at S6dersjukhuset, 11883 Stockholm, Sweden Ballmer, P.E., Department of Internal Medicine, University of Bern, Inselspital, 3010 Bern, Switzerland Btichner, S.A., Dermatologische Universitatsklinik, Kantonsspital Basel, Petersgraben 4, 4031 Basel, Switzerland Burgdorfer, W., Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Laboratory of Vectors and Pathogens, Hamilton, MT 59840, USA Christen, H.-J., Kinderklinik und Poliklinik, Universitat G6ttingen, Robert-Koch StraBe 40, W-3400 G6ttingen, Germany Detmar, U., Dermatologist in Private Practice, HauptstraBe 12, 8939 Bad W6rishofen, Germany Duray, P.H., Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, Mass. 02115, USA Gem, Lise, University of Neuchatel, Zoological Institute, Chantemerle 22, 2007 Neuchatel, Switzerland Hanefeld, F., Kinderklinik und Poliklinik, Universitat G6ttingen, Robert-Koch-StraBe 40, W-3400 G6ttingen, Germany Hassler, D., General Practioner in Private Practice, Untere Hofstatt 3, 7527 Kraichtal, Germany Hayes, S.F., Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Laboratory of Vectors and Pathogens, Hamilton, MT 59840, USA Herzer, P., Medizinische Poliklinik der Universitat Mtinchen, PettenkoferstraBe 8a, 8000 Miinchen 2, Germany Hovmark, A., Department of Dermatology, Karolinska Institute at SOdersjukhuset, 11883 Stockholm, Sweden Kaudewitz, P., Dermatologische Klinik und Poliklinik, Universitat Mtinchen, FrauenlobstraBe 9-11, 8000 Mtinchen 2, Germany Kohlhepp, W., Neurologische Klinik, Universitat Wtirzburg, Josef-Schneider-StraBe 11, 8700 Wtirzburg, Germany de Koning, J., Laboratorium voor de Volksgezondheid in Friesland, Postbus 21020, 8900 JA Leeuwarden, The Netherlands Krampitz, H.E., Abteilung Infektions-und Tropenmedizin, Ludwig-Maximilians Universitat Mtinchen, Germany (deceased) List of Contributors VII Kristoferitsch, W., Neurologische Abteilung, SMZ-Ost-Krankenhaus, Langobarden straBe 122, 1220 Wien, Austria van der Linde, M.R., Department of Cardiology, Thoraxcenter, University Hospital of Groningen, Oostersinge159, 9713 EZ Groningen, The Netherlands Maciejewski, W., Stadtisches Krankenhaus Munchen-Schwabing, KtHner Platz, 8000 Munchen 440, Germany Marget, W., Kinderklinik:, Universitat Munchen, Editor-in-Chief, Infection, Munchner Str.l, 8000 Munchen 70, Germany Martin, R., Neurologische Klinik:, Universitat Tubingen, Hoppe-Seyler-StraBe 3, 7400 Tubingen, Germany Mayer-Berger, W., Klinische Abteilung IV, Klinik: Hohenried fur Herz-und Kreislaufkrankheiten, 8139 Bernried, Germany Meier, c., St. Gallische Hohenklinik: Walenstadtberg, 8881 Knoblisbuhl, Switzerland Mertens, H.G., Neurologische Klinik:, Universitat Wurzburg, Josef-Schneider-StraBe 11, 8700 Wurzburg, Germany Neubert, U., Dermatologische Klinik: und Poliklinik:, Universitat Munchen, FrauenlobstraBe 9-11, 8000 Munchen 2, Germany Pfister, H.-W., Neurologische Klinik: der Universitat Munchen, Klinikum GroBhadem, MarchioninistraBe 15,8000 Munchen 70, Germany Preac-Mursic, Vera, Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie der Ludwig-Maximilians-Universitat Munchen, PettenkoferstraBe 9a, 8000 Munchen 2, Germany Reimers, C.D., Friedrich Baur-Institut bei der Medizinischen Klinik: Innenstadt, Ludwig Maximilians-Universitat Munchen, ZiemssenstraBe lA, 8000 MUnchen 2, Germany Rufli, T., Dermatologische Universitatsklinik, Kantonsspital Basel, Petersgraben 4, 4031 Basel, Switzerland Satz, N., Medizinische Klinik:, Kantonsspital Winterthur, Winterthur, Switzerland Schierz G., Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikro biologie der Ludwig-Maximilians-Universitat Munchen, PettenkoferstraBe 9a, 8000 Munchen 2, Germany Schmutzhard, E., Klinik: fur Neurologie, Universitat Innsbruck, AnichstraBe 35, 6020 Innsbruck,Austria Schonherr, U., Augenklinik: mit Poliklinik der Universitat Erlangen-Numberg, Schwabachanlage 6, 8520 Erlangen, Germany SkOldenberg, Birgit, Department of Infectious Diseases, Karolinska Institute, Danderyd Hospital, 18288 Danderyd, Sweden Stanek, G., Hygiene-Institut der Universitat Wien, Kinderspitalgasse 15, 1095 Wien, Austria Strle, F., University Medical Center LjUbljana, Department of Infectious Diseases, Japljeva 2,61000 Ljubljana, Slovenia Weber, K., Dermatologist in Private Practice, RosenstraBe 6,8000 Munchen 2, Germany Wilske, Bettina, Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie der Ludwig-Maximilians-Universitat Munchen, Pettenk<;>ferstraBe 9a, 8000 Munchen 2, Germany Contents Preface .. v I History 1 History of Lyme Borreliosis in Europe K. WEBER and H.-W. PFISTER ..... 2 The Historical Road to the Discovery of Borrelia burgdorferi W. BURGDORFER . . . . . . . . . . . . . . . . . . . . . . . . 21 II Characteristics of Borrelia burgdorferi 3 Ultrastructure of Borrelia burgdorferi S.P. HAYES and W. BURGDORFER . 29 4 Biology of Borrelia burgdorferi V. PREAC-MuRSIC and B. WILSKE . 44 III Ecology and Histopathology of Lyme Borreliosis 5 The Ecology of Lyme Borreliosis in Europe L. GERN, W. BURGDORFER, A. AESCHLIMANN, and H.E. KRAMPITZ . 59 6 Histopathology of Human Lyme Borreliosis J. DE KONING and P.H. DURAY .................. . 70 IV Clinical Features of Lyme Borreliosis 7 Clinical Overview K. WEBER, H.-W. PFISTER, and C.D. REIMERS 93 8 Erythema Migrans and Early Signs and Symptoms K. WEBER, U. NEUBERT, and S.A. BUCHNER .... 105 9 Borrelial Lymphocytoma A. HOVMARK, E. ASBRINK, K. WEBER, and P. KAUOEWITZ 122 10 Lyme Carditis M.R. VAN DER LINDE and P.E. BALLMER ........ . 131 11 Early Neurological Involvement (Bannwarth's Syndrome) H.W. PFISTER, W. KRISTOFERITSCH, and C. MEIER 152 12 Joint Manifestations P. HERZER ............. . 168 13 Myalgia, Myositis, and Fasciitis C.D. REIMERS and E. SCHMUTZHARD 185 14 Acrodermatitis Chronica Atrophicans E. ASBRINK, A. HOVMARK, and K. WEBER 193 Contents IX 15 Chronic Central Nervous System Involvement R. MARTIN, W. KOHLHEPP, and H.G. MERTENS 205 16 Chronic Peripheral Neuropathy W. KRISTOFERITSCH ............. . 219 17 Lyme Borreliosis in Childhood and Pregnancy H.-J. CHRISTEN and F. HANEFELD ....... . 228 18 Localized Scleroderma and Lichen Sclerosus et Atrophicus: Manifestations of a Borrelia burgdorferi Infection? U. NEUBERT, E. ABERER, and T. RUFLI 240 19 Ocular Manifestations U. SCHONHERR and F. STRLE. . . . . . 248 20 Borrelial Dermatomyositis-like Syndrome U. DETMAR and W. MACIEJEWSKY ..... 259 V Microbiological Diagnosis of Lyme Borreliosis 21 Microbiological Diagnosis of Lyme Borreliosis B. WILSKE and V. PREAc-MURSIC ........................ 267 VI Therapy of Lyme Borreliosis 22 Antibiotic Susceptibility of Borrelia burgdorferi. In Vitro and In Vivo V. PREAc-MURSIC . . . . . . . . . . . 301 23 Therapy of Cutaneous Manifestations K. WEBER . . . . . . . . . . . . . 312 24 Therapy of Lyme Neuroborreliosis H.W. PFISTER, W. KRISTOFERITSCH, and B. SKOLDENBERG 328 25 Therapy of Joint Manifestations P. HERZER ............ . 340 26 Therapy of Lyme Carditis W. MAYER-BERGER, M.R. VAN DER LINDE, and D. HASSLER 344 27 Therapy of Tick Bite K. WEBER and W. BURGDORFER . . . . . 350 28 Critical Remarks on Antibiotic Therapy K. WEBER and W. MARGET . . . . . 352 VII Epidemiology of Lyme Borreliosis 29 Epidemiology of Lyme Borreliosis G. STANEK, N. SATZ, F. STRLE, and B. WILSKE 358 Subject Index . . 371 Color plates I-IV between pp 118 and 119 I History 1 History of Lyme Borreliosis in Europe K. WEBER and H.-W. PFISTER 1.1 Introduction Knowledge of Lyme borreliosis in Europe has roughly developed in three phases. Between 1883 and 1945, basic descriptions of dermatological and neurological mani festations were presented. The beneficial effect of penicillin and other antibiotics noted in the late 1940s and early 1950s gave a new impetus to the study of the cause and nature of these manifestations, especially the dermatological ones; this phase lasted until 1975. Following the first description of Lyme disease in 1977 and the discovery of the causative organism in the United States in 1982, a third and this time broader look into the disease and much of its surroundings ensued in Europe. 1.2 First Phase (1883-1945) Knowledge of the various dermatological and neurological manifestations developed mostly independently from each other during the first phase. 1.2.1 Acrodermatitis Chronica Atrophicans In 1883, Alfred Buchwald from Breslau, Germany, described "diffuse idiopathic skin atrophy" of 16 years duration in a 36-year-old man; some histologic features were pre sented. We now regard this report as the earliest description of acrodermatitis chronica atrophicans (ACA), a late manifestation of Lyme borreliosis. Until 1902, more than a dozen case reports appeared in the literature (cited in Herxheimer and Hartmann 1902). Buchwald and others reported on the atrophic phase of ACA, while a variety of authors described the first inflammatory phase of ACA shortly afterwards. In 1902, Karl Herxheirner and Kuno Hartmann combined these observations, added a further 12 patients of their own, and discussed at some length that acrodermatitis chronica atroph icans, a term introduced by them, develops from an early inflammatory phase into a late atrophic one. By about 1906, most of the important clinical signs associated with ACA had been desbribed, i.e., hair loss (Buchwald 1883), macular atrophy (Pellizari 1884), which was later called anetoderma by Jadassohn, sclerodermatous changes (Touton 1886; Rusch 1906), ulnar bands (Herxheimer and Hartmann 1902), and fibrous nodules (Herxheimer 1905, cited in Herxheirner and Schmidt 1910). Pospelow described atrophic ACA skin as resembling "crumpled cigarette paper" (1886). In a monograph on atrophic conditions of the skin, Finger and Oppenheim (1910) reported on 202 patients with atrophia cutis, 134 of whom can be regarded as having had ACA. Most of these patients were collected from the literature. The authors sum marized the findings on age, sex ratio and occupation, mentioned the rare involvement of the face, sole of the foot, palms, trunk, mucous membranes and the entire skin and
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