Lyme disease: New knowledge regarding its physiopathology, diagnosis, therapy and prevention

• Published in: Medicinski pregled Vol. 55; no. 5-6; pp. 207 - 212
• Main Authors: Vukadinov, Jovan, Sevic, Sinisa, Canak, Grozdana, Madle-Samardzija, Nadezda, Turkulov, Vesna, Doder, Radoslava
• Format: Journal Article
• Language: English
• Published: 2002
• ISSN: 0025-8105; 1820-7383
• DOI: 10.2298/MPNS0206207V

Introduction Lyme disease is a tick-borne disease caused by a spirochete Borrelia burgdorferi, which manifests as a multisystem disease of the skin nervous system, heart and joints. Recently it is the most common vector-borne disease in Yugoslavia. New epidemiological studies New epidemiological studies revealed that ticks can occasionally be infected not only by Borrelia burgdorferi, but also by some other microbes that can cause diseases in humans. Recently discovered the variable major protein-like sequence, antigenic variation of B. burgdorferi B 31 partly explains the ability of this organism to evade an active immune response. A key role in development of clinical symptoms associated with lyme disease belongs to the connection with ability of B. burgdorferi to induce and activate metallopeptidases and fibrinolytic enzymes, leading to extracellular matrix destruction. Diagnosis and treatment Diagnosis of Lyme borreliosis is made on the basis of clinical picture, exposure to ticks in endemic areas and serologic confirmation. It seems that polymerase chain reaction has little role in detection of B. burgdorferi in urine, blood, and spinal fluid samples, but it is most useful in evaluating the effectiveness of antibiotic therapy of Lyme arthritis. Infectious Diseases Society of America had prepared new guidelines for selective treatment of Lyme disease. Vaccination is still the best way of prevention for people living in high-risk areas. Medju bolestima za cije je prenosenje neophodan krpelj kao vektor, u nasim krajevima, sve veci znacaj ima lajmska bolest. Kako nova epidemioloska istrazivanja pokazuju da su krpelji cesto zarazeni i sa nekoliko razlicitih patoloskih agensa postoji potreba za aktivnim trazenjem moguce koinfekcije kod svakog slucaja ujeda krpelja. Sposobnost Borelije da izbegne imuni odgovor domacina delimicno se moze objasniti i nedavnim otkricem antigenskog varijabilnog sistema kod B. burgdorferi B31 koji je oznacen kao vls varijabilnom glavnom proteinu slicna sekvenca. Novo otkrice nacina na koji B. burgdorferi vezuje i aktivira proteoliticke enzime domacina znatno su pojasnili patofizioloske mehanizme invazije spiroheta. Dijagnostika bolesti je u prvom redu seroloska a terapija selektivna. Najbolji nacin prevencije je rano uklanjanje krpelja a u endemskim podrucjima savetuje se i vakcinacija.