Borrelia

Gram-negative, irregular, spiral-shaped bacteria from the Spirochaetaceae family. They are named after the French bacteriologist Amédée Borrel.

Of medical importance are among others the species:

• Borrelia burgdorferi sensu lato:
  • Borrelia sensu stricto: causative agent of Lyme borreliosis (detected in about 60% of patients)
  • Borrelia garinii: causative agent of Lyme borreliosis and polymeningoradiculitis (detected in about 7% of patients)
  • Borrelia afzelii: causative agent of Lyme borreliosis and acrodermatitis chronica atrophicans (detected in about 90% of patients)
  • Borrelia bavariensis: causative agent of Lyme borreliosis (detected in about 2% of patients)
  • Borrelia spielmanii; (very rare)
• Borrelia recurrentis: causative agent of epidemic relapsing fever.
• Borrelia duttonii: causative agent of endemic relapsing fever.

Borrelia burgdorferi sensu lato is transmitted by the bite of infected ticks and is detectable in about 5-35% of the ticks in Germany depending on the area (e.g. in Southern Lower Saxony in spring 2007 in 25% of the ticks examined). Rodents and birds serve as pathogen reservoirs.

Determination of IgM/IgG antibodies against Borrelia using ELISA, IFT (indirect immunofluorescence test), in case of detection of anti-Borrelia antibodies additionally Western blot.

Antigen detection by PCR (blood, joint puncture, cerebrospinal fluid, skin biopsy, urine).

Pathogen detection from culture cultivation.

Ixodes ricinus can transmit other pathogens to humans besides Borrelia:

• TBE virus-a flavivirus, causative agent of early summer meningoencephalitis.
• Babesia, a protozoan parasitizing in erythrocytes, causative agent of babesiosis, a malaria-like disease.
• Anaplasma phagocytophilum, an intracellular Gram-negative bacterium of the genus Rickettsiales, causative agent of human granulocytic anaplasmosis(ehrlichiosis)
• B. miyamotoi, causative agent of relapsing fever.

The patterns of anti-Borrelia antibodies observed in infected humans show a high degree of variability. A number of important immunodominant Borrelia proteins have been assigned to the clinical stages of the disease (see also Borrelia antigen structure).

• Early phase: the IgM antibody response is directed against outer membrane protein C (Osp C = 0uter surface protein C) and/or flagellin protein (FlaB: cross-reaction with spirochetes and flagellated bacteria, among others).
• As the Borrelia infection progresses, other proteins become involved in the immune response. A chromosomally encoded Borrelia protein p100 (synonym: p94 / p83) has been found to be a marker for the late stage of Lyme disease, as has OspA. It is generally accepted that in clinical routine an antigen mixture is useful instead of purified single Borrelia antigens. The antigen mixture should contain proteins such as Osp C, BmpA = Borrelia membrane antigen = p39 antigen), p41 antigen and p100 antigen.
• A number of conserved Borrelia proteins, such as heat shock proteins and parts of flagellin have epitopes that are also found on other bacteria (this leads to false positive results).

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