Presentation Meeting 6 Nyman 1

Lyme BorreliosisDag NymanMedimar, ÅlandLyme Borreliosis is------A multisystemic vector-borne, inflam-•matory infectious diseaseCaused by the immune-defence to spirochetes of the•Borrelia burgdorferi s.l. complexThe most common vector-borne infectious disease in•North-EuropeBorrelia burgdorferi s.l. and othersB. b. sensu stricto•B. afzelii•B. garinii•B. bavariensis•B. spielmanii, valaisana•B. miyamotoi•Other – TBE, Anaplasma, Rickettsia SFG, Tularemia, Candidatus•Neoehrlichia mikurensisTicks are the vectorsI. ricinus I. persulcatusWhy a borreliosis clinic?Epidemiology•Diagnostics and differential diagnostics•Treatment•Chronic infection•Persisting symptoms•Ticks in EuropeECDC 2015Reported borreliosis 2000-2011Serology based incidence!(IHW Finland)P-value <0.0001Incidence rate ratio 1.4495% CI for ratio 1,324 to 1,568Clinical borreliosis 2000 -2012 Åland600Ca. 2000/100000/år500400300LB N2001000Borrelia prevalence and species in ticks, Åland IslandsNo.No. (%) of ticks containing Borrelia species determined by nucleotide sequencing(%) No. (%)Tick of ofstage ticks positive B. a B. g B. v B. b B. m B. s B. l Mixed UT178 24777 86 (48) 42 (24) 14 (8) 4 (2) 2 (1) 5 (3) -- 1(1)(23) (13)Adult 5--male (1)118 35 4Adult 10 (28) 11 (30) 5 (14) 3 (8) 1 (3) 1 (3)(15) (30) (11)female587 143 2076 (53) 31 (21) 9 (6) 1 (1) 1 (1) 4 (3) 1 (1)(74) (24) (14)Nymph67--(8)LarvaWilhelmsson 2013Borrelia in ticks from EstoniaIxodes ricinus 8.2% (2293)•Ixodes persulcatus 9.7% (2833)•Total 4.7 - 24.2 % regional variation•The most prevalent genospecies was B. afzelii which was detected in•53.5% of Borrelia-positive ticks, followed by B. garinii and B.valaisiana with 26.2% and 5.5%, respectively.Geller et al. Parasites & Vectors 2013 6:202Borreliosis in EuropeYear 2001 2002 2003 2004 2005Country Incidence [cases] Incidence [cases] Incidence [cases] Incidence [cases] Incidence [cases]Slovenia 163 [3232] 169 [3359] 177 [3524] 193 [3849] 206 [4123]Austria - - - - - - - - 135 -Netherlands 74 [12000] - - - - - - 103 [17000]Lithuania 33 [1153] 26 [894] 106 [3688] 50 [1740] 34 [1161]Finland 13 [691] 17 [884] 14 [753] 22 [1135] 24 [1236]Latvia 16 [379] 14 [328] 31 [714] 31 [710] 21 [493]Estonia 25 [342] 23 [319] 42 [562] 36 [480] 21 [281]DiagnosisClinical picture•- early, late- localized, disseminated- organ involvedLaboratory verification•- which test when- diagnostic performanceBUILDING A DIAGNOSIS NBDiagnosticP NB 1.0 decision 0.95Treatment0.8decision0.640.60.470.40.20.170.0340.012Odds/LR+ 0.012 * 2.82 * 6.0 * 4.29 * 1.9 * 12.5Step Clinical I S-C6Ab Clinical II Csf-cells Csf-ABI Csf-CXCL13Nyman 2014Do not be afraid of the nature!