A Case of Lyme Disease Followed by Post-Treatment Lyme Disease Syndrome

( Sung Ha Lim ),( Eung Ho Choi ) 대한피부과학회 2021 大韓皮膚科學會誌 Vol.59 No.10

Lyme disease caused by Borrelia species is transmitted via infected tick bites. Erythema migrans, a typical skin lesion on the tick-bitten site, is a hallmark of Lyme disease. A 63-year-old female presented an erythematous, semi-circular patch in the left inguinal area. It disappeared spontaneously without treatment. However, after 3 months, an erythematous patch with a diameter of 1 cm recurred on the left thigh. B. burgdorferi antibody testing revealed positive results. At the second visit, doxycycline was prescribed, and the skin lesion was resolved. However, the patient exhibited persistent systemic symptoms, including arthralgia and fatigue, and was diagnosed with post-treatment Lyme disease syndrome (PTLDS). The PTLDS prognosis is associated with delayed diagnosis. Thus, antibiotic treatment should be promptly initiated after suspecting Lyme disease to minimize the associated systemic symptoms. PTLDS diagnosis should be followed by proper medical care to alleviate the symptoms. (Korean J Dermatol 2021;59(10):801∼804)

Lyme Disease and YouTubeTM: A Cross-Sectional Study of Video Contents

Corey H. Basch,Lindsay A. Mullican,Kwanza D. Boone,Jingjing Yin,Alyssa Berdnik,Marina E. Eremeeva,Isaac Chun-Hai Fung 질병관리본부 2017 Osong Public Health and Research Persptectives Vol.8 No.4

Objectives: Lyme disease is the most common tick-borne disease. People seek health information on Lyme disease from YouTubeTM videos. In this study, we investigated if the contents of Lyme disease-related YouTubeTM videos varied by their sources. Methods: Most viewed English YouTubeTM videos (n = 100) were identified and manually coded for contents and sources. Results: Within the sample, 40 videos were consumer-generated, 31 were internet-based news, 16 were professional, and 13 were TV news. Compared with consumer-generated videos, TV news videos were more likely to mention celebrities (odds ratio [OR], 10.57; 95% confidence interval [CI], 2.13–52.58), prevention of Lyme disease through wearing protective clothing (OR, 5.63; 95% CI, 1.23–25.76), and spraying insecticides (OR, 7.71; 95% CI, 1.52–39.05). Conclusion: A majority of the most popular Lyme disease-related YouTubeTM videos were not created by public health professionals. Responsible reporting and creative video-making facilitate Lyme disease education. Partnership with YouTubeTM celebrities to co-develop educational videos may be a future direction.

A case of lyme disease presenting with erythema migrans

( Jae In Lee ),( Dong Hyek Jang ),( Joo Yoon Bae ),( Hong Lim Kim ),( Mi Youn Park ),( Hye Jung Jung ),( Ji Young Ahn ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Lyme disease is a spirochetal infection, which is transmitted by the bite of infected Ixodes ticks. The clinical manifestations of Lyme disease can generally be divided into three phases : early localized, early disseminated, and late disease. Early localized Lyme disease is characterized by the appearance of erythema migrans(EM). EM usually occurs within one month following the tick bite. Early disseminated disease is characterized by multiple EM lesions and/or neurologic and/or cardiac findings. Late Lyme disease is typically associated with intermittent or persistent arthritis involving one or a few large joints, especially the knee. A 61 year old man presented with round erythematous patch on his abdomen to our dermatologic clinic. The lesion occurred 1 week ago and he was felt being bitten by an insect. The patient complained of pain, pruritus and a heating sensation. Laboratory tests showed a mild elevation of CRP and ESR. The skin biopsy from a papule which is suspected to be bitten by an insect showed a suspected mouth of a tick. And the skin biopsy from the erythema in the periphery lesion revealed mild acanthosis in the epidermis and cellular infiltration in the dermis, composed of lympho-histiocytes, neutrophils and eosinophils. He was treated by doxycycline and the lesion disappeared after twenty days. We report this rare case of Lyme disease in Korea.

Neurogenic Bladder in Lyme Disease

김미화,김원찬,Dong-Su Park 대한배뇨장애요실금학회 2012 International Neurourology Journal Vol.16 No.4

Lyme disease is a multi-systemic, tick-borne infectious disease caused by a spirochete, Borrelia burgdorferi. Various urologic symptoms are associated with Lyme disease, which can be primary or late manifestations of the disease. Although voiding dysfunction is a rarely reported symptom in patients with Lyme disease, it is one of the most disabling complications of Lyme disease. Korea is not an endemic area of Lyme disease, thus, fewer cases have been reported. Herein, we report a case of a 32-yearold man with rapidly progressive bilateral ptosis, dysphagia, spastic paraparesis, and voiding difficulty in whom Lyme disease was diagnosed through serologic tests for antibodies and Western blot testing. A urodynamic study demonstrated detrusor areflexia and bulbocavernosus reflex tests showed delayed latency, indicating demyelination at S2-S4 levels. He received a 4-week course of intravenous ceftriaxone (2 g/day). The patient has recovered from the bilateral ptosis and spastic paraparesis but still suffers from neurogenic bladder.

A case of lyme disease with systemic manifestations

( Sung Ha Lim ),( Eung Ho Choi ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

Lyme disease is caused by the infection of Borrelia burgdorferi that is transmitted by the bite of infected ticks. Erythema migrans, a typical skin lesion that appears on the tick-bitten site, is a hallmark of Lyme disease. A 63-year-old female presented an erythematous semi-circular patch on the left inguinal area. The lesion disappeared spontaneously without treatment. After 3 months, an erythematous patch with a diameter of 1cm was recurred on the left thigh. Punch biopsy and serologic tests were performed for B. burgdorferi antibody. Histopathology showed perivascular lymphocytic infiltration in the dermis. The results of the B. burgdorferi antibody test were positive in both indirect fluorescence analysis and western blot. At the second visit, doxycycline was prescribed and the skin lesion resolved. However, the patient complained of persistent systemic symptoms such as arthralgia and fatigue for several months. Lyme disease in Korea has been designated as a third-level legal infectious disease. When Lyme disease is suspected, laboratory testing including B. burgdorferi antibody should be performed, and antibiotics treatment should be initiated from the initial visit to minimize related systemic symptoms. Even if the initial test was negative, follow-up tests are recommended to confirm the diagnosis.

2011∼2018년 라임병의 역학적 특성 연구

서충원 대한임상검사과학회 2019 대한임상검사과학회지(KJCLS) Vol.51 No.4

Lyme disease is a national notifiable infectious disease as of September 2018. The number of cases of Lyme disease has recently been increasing. This study analyzed the epidemiological features and clinical symptoms of domestic and imported. From 2011 to December 31, 2018, of the 119 cases, 48 confirmed cases, 63 probable cases, and 8 suspected cases. 70 cases (58.8%) were reported in Korea and 49 cases (41.2%) of imported. In addition, 91 cases (76.5%) were reported during the summer~autumn season (June∼November). In 2017, the highest number of 31 cases. The time needed to make a diagnosis was 2.8±14.7 days for domestic occurrences versus 1.4±4.5 days for those cases that infection occurred imported. Among the clinical symptoms, fever and rash were statistically significant (P<0.001). Clinical trials included early localized 31 cases (52.1%), early disseminated 43 cases (35.3%), and late disseminated 15 cases (12.6%). The estimated regions of infection in Korea were Chungnam 12 cases (17.1%), Gyeonggi 12 cases (17.1%), and Gangwon 8 cases (11.4%), Patient care is also considered to be very important as this disease occurs of all ages. Therefore, the promotion of preventive education and identification of epidemiological features are of paramount importance and should be implemented. The study’s findings can be used as basic data for the prevention and management of patients with lyme disease. 라임병은 2010년 법정감염병 지정 이후 환자발생이 지속적으로 증가하고 있다. 첫 환자가 보고된 2011년부터 2018년 12 월 31일까지 신고된 환자 119명의 신고 자료 및 역학조사서를국내발생과 해외유입으로 구분하여 분석하였고, ArcGIS Pro 를 이용하여 추정 감염 지역에 대한 공간분석을 하였다. 2011년부터 2018년 12월 31일까지 국내발생은 70명(58.8%) 해외유입은 49명(41.2%)이다. 환자 발생은 2017년에 31명(26.0%), 계절은 여름∼가을(6∼11월)이 91명(76.5%)으로 가장 많았다. 진단일_신고일은 국내발생이 2.8±14.7일, 해외유입이 1.4± 4.5일로 차이를 보였고, 임상 증상 중 발열과 발진은 국내발생과해외유입이 통계적으로 유의하였다(P<0.001). 임상 경과는 초기 국소성 감염 61명(52.1%), 초기 파종성 감염 43명(35.3%), 만성 감염 15명(12.6%)이었다. 국내 추정 감염 지역은 충남 12 명(17.1%), 경기 12명(17.1%), 강원 8명(11.4%), 경남 7명(10.0%)으로 지역적인 차이를 보였고, 해외유입은 미국이 21명(42.9%), 유럽이 17명(34.7%)으로 가장 많았다. 라임병 환자는2016∼2018년이 환자수가 증가 하여 발생 지역이 확대된 것으로 추정된다. 해외유입도 증가하고 있어 환자 관리는 더욱 중요할 것으로 판단되며 전 연령에서 환자가 발생하고 있어 홍보 및예방교육과 역학적 특성 파악은 꾸준히 실시되어야 할 것이다.

Urinary Bladder Detrusor Dysfunction Symptoms in Lyme Disease

Basant K. Puri,Mussadiq Shah,Peter O. Julu,Michele C. Kingston,Jean A. Monro 대한배뇨장애요실금학회 2013 International Neurourology Journal Vol.17 No.3

Purpose: Symptoms of urinary bladder detrusor dysfunction have been rarely reported in Lyme disease. The aim was to carry out the first systematic study to compare the prevalence of such symptoms in a group of Lyme disease patients and a group of matched controls. Methods: A questionnaire relating to detrusor function was administered to 17 serologically positive Lyme disease patients and to 18 control subjects. Results: The two groups were matched in respect of age, sex, body mass, and mean arterial blood pressure. None of the 35 subjects was taking medication which might affect urinary function and none had undergone a previous operative procedure on the lower urinary tract. Six of the Lyme patients (35%) and none of the controls (0%) had symptoms of detrusor dysfunction (P<0.01). Conclusions: This first systematic controlled study confirms that Lyme disease is associated with urinary bladder detrusor dysfunction. Further evaluation of detrusor function is warranted in this disease.

Insight into the Pathogenesis of Lyme Disease

Shin, Ok Sarah The Korean Society for Microbiology 2014 Journal of Bacteriology and Virology Vol.44 No.1

Lyme disease is the most common vector-borne disease in the United States and Europe, caused by a tick-borne spirochete, Borrelia burgdorferi. Life cycle alternation between arthropod and mammals enhanced B. burgdorferi to adapt to two diverse niches. Although B. burgdorferi infection in these reservoir hosts appears asymptomatic, infection in human can typically cause inflammation in the skin, nervous system, musculoskeletal system and heart. In this review, we discuss the basic molecular characteristics and cell biology of B. burgdorferi and provide an overview of spirochete-induced activation of innate and adaptive immunity, resulting in particular immunopathology. Advancing understanding of the immune evasion mechanisms of B. burgdorferi provides important implications for ongoing research and clinical practice of Lyme disease.

Insight into the Pathogenesis of Lyme Disease

신옥 대한미생물학회 2014 Journal of Bacteriology and Virology Vol.44 No.1

Lyme disease is the most common vector-borne disease in the United States and Europe, caused by a tick-borne spirochete, Borrelia burgdorferi. Life cycle alternation between arthropod and mammals enhanced B. burgdorferi to adapt to two diverse niches. Although B. burgdorferi infection in these reservoir hosts appears asymptomatic, infection in human can typically cause inflammation in the skin, nervous system, musculoskeletal system and heart. In this review, we discuss the basic molecular characteristics and cell biology of B. burgdorferi and provide an overview of spirochete¬induced activation of innate and adaptive immunity, resulting in particular immunopathology. Advancing understanding of the immune evasion mechanisms of B. burgdorferi provides important implications for ongoing research and clinical practice of Lyme disease.

국내 진드기매개 질환의 현황과 전망

설형,김동민 대한의사협회 2017 대한의사협회지 Vol.60 No.6

The incidence of vector-borne infectious diseases is increasing due to developments in diagnostic techniques, as well as due to economic, environmental, and ecological factors such as global warming, increased rainfall, globalization, and urbanization. Tick-borne infectious diseases occurring in Korea include severe fever with thrombocytopenia syndrome, Lyme disease, anaplasmosis, and Japanese spotted fever. Various skin lesions, such as erythema migrans, tick bite sites, rash, and eschar, are associated with tick-borne infectious diseases. It is necessary to remove ticks immediately to prevent transmission of these tick-borne infectious diseases. Especially for conditions such as Lyme disease, at least 24 to 48 hours of tick attachment to the host is required for transmission of the causative pathogens to the host. Tick-borne diseases are acquired after outdoor activities and have nonspecific symptoms such as fever, headache, and chills, which make them difficult to identify without a diagnostic test. Rapid diagnosis and early treatment can reduce the otherwise significant morbidity and mortality associated with these conditions; therefore, therapy should not be delayed until laboratory confirmation is received.