Clinical and laboratory evidence of Lyme disease in North India, 2016–2019,Travel Medicine and Infectious Disease

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Clinical and laboratory evidence of Lyme disease in North India, 2016–2019
Travel Medicine and Infectious Disease ( IF 6.3 ) Pub Date : 2021-06-30 , DOI: 10.1016/j.tmaid.2021.102134
E V Vinayaraj ₁ , Nitin Gupta ₂ , K Sreenath ₁ , Chandan Kumar Thakur ₁ , Sheffali Gulati ₃ , Vaishakh Anand ₃ , Manjari Tripathi ₄ , Rohit Bhatia ₄ , Deepti Vibha ₄ , Deepa Dash ₄ , Manish Soneja ₅ , Uma Kumar ₆ , M V Padma ₄ , Rama Chaudhry ₁

Affiliation

Background

Lyme disease is endemic to parts of the Americas, Europe and Asia. However, only a handful of sporadic cases have been reported from India. In this study, we systematically evaluated the clinical and epidemiological features of Lyme disease in North India.

Method

All samples were tested by using the standard two-tiered testing algorithm (STTA). Paired serum and cerebrospinal fluid (CSF) were used for demonstrating Borrelia burgdorferi specific intrathecal IgG antibody synthesis (AI). In addition, a commercial tick-borne bacterial flow chip (TBFC) system and a real-time PCR were also used to detect Borrelia species and Anaplasma phagocytophilum in patients who were positive by STTA.

Results

The diagnosis of Lyme disease was confirmed in 18 (7.14%) of the 252 clinically suspected cases by STTA. Neurological involvement was reported in 14 (77.78%) patients, whereas joint and heart involvement was reported in five (27.78%) and three (16.67%) patients, respectively. Lymphocytic pleocytosis (median 37.5 cells/mm³; range 12–175 cells/mm³) in the CSF was seen in 11 of 14 Lyme neuroborreliosis (LNB) patients. Intrathecal production of Borrelia specific IgG antibodies was demonstrated in 9 (64.28%, n = 14) patients, a highly specific finding for neuroborreliosis. Two patients (11.11%) were also found to be co-infected with human granulocytic anaplasmosis.

Conclusions

The results of this study show clinical and laboratory evidence of endemic Lyme disease in North India and thus, highlight the importance for travel medicine practitioners and physicians to evaluate for Lyme disease in patients with compatible symptoms and a history of travel to tick risk areas.

中文翻译：

2016-2019 年印度北部莱姆病的临床和实验室证据

背景

莱姆病是美洲、欧洲和亚洲部分地区的地方病。然而，印度仅报告了少数零星病例。在这项研究中，我们系统地评估了北印度莱姆病的临床和流行病学特征。

方法

所有样品均使用标准的两层测试算法 (STTA) 进行测试。配对的血清和脑脊液 (CSF) 用于证明伯氏疏螺旋体特异性鞘内 IgG 抗体合成 (AI)。此外，商业蜱传细菌流动芯片（TBFC）系统和实时 PCR 也被用于检测STTA 阳性患者的疏螺旋体属和嗜噬细胞无形体。

结果

252 例临床疑似病例中有 18 例（7.14%）被 STTA 确诊为莱姆病。14 名 (77.78%) 患者报告了神经系统受累，而分别报告了 5 名 (27.78%) 和 3 名 (16.67%) 患者的关节和心脏受累。在 14 名莱姆神经疏螺旋体病 (LNB) 患者中，有 11 名观察到 CSF中的淋巴细胞增多（中值 37.5 个细胞/mm ³；范围为 12-175 个细胞/mm ³）。9 名 (64.28%, n = 14) 患者鞘内产生疏螺旋体特异性 IgG 抗体，这是神经疏螺旋体病的高度特异性发现。还发现两名患者（11.11%）同时感染了人类粒细胞无形体病。