Borrelia

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

Of medical importance are among others the species:

• Borrelia burgdorferi sensu lato:
  • Borrelia sensu stricto: pathogen of Lyme borreliosis (detection in about 60% of patients)
  • Borrelia garinii: causative agent of Lyme borreliosis and polymeningoradiculitis (detection in about 7% of patients)
  • Borrelia afzelii: causative agent of Lyme disease and acrodermatitis chronica atrophicans (detected in about 90% of patients)
  • Borrelia bavariensis: pathogen of Lyme borreliosis (detection in about 2% of patients)
  • Borrelia spielmanii; (very rare)
• Borrelia recurrentis: pathogen of epidemic recurrent fever.
• Borrelia duttonii: pathogen of endemic recurrent 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, pathogen of early summer meningoencephaltitis
• Babesia, protozoa parasitizing in erythrocytes, the causative agent of babesiosis, a malaria-like disease
• Anaplasma phagocytophilum, an intracellular Gram-negative bacterium of the genus Rickettsiales, pathogen of human granulocytic anaplasmosis(Ehrlichiosis)
• B. miyamotoi, pathogen 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 could be assigned to the clinical stages of the disease (see also Borrelia antigen structure).

• Early stage: the IgM antibody response is directed against the outer membrane protein C (Osp C = 0uter surface protein C) and/or flagellin protein (FlaB: cross-reaction with spirochetes and flagellated bacteria).
• As the Borrelia infection progresses, other proteins are included in the immune response. A chromosomally encoded Borrelia protein p100 (synonym: p94 / p83) is found as a marker for the late stage of Lyme disease, as is OspA. It is generally accepted that in clinical routine an antigen mixture instead of purified single Borrelia antigens is useful. The antigen mixture should contain proteins like 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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