BORRELIOSIS
Phylogeny
• Phylum – Spirochete
• Named after French Biologist Amedee Borrel
• 36 known species
• 05 pathogenic :
– B. bur...
Introduction
• 1900s, manifestation first reported in Europe
– associated it with tick bites (TBD)
• 1975 - outbreak in Ly...
Structure
• slender helical shaped bacteria
• Gram negative
• Motile
• Extracellular pathogen
• Aerobic or microaerophilic
Transmission
• Vector-borne disease – N Am / EU
• Rodents / Deer - black-legged tick (Ixodes scapularis) or
Western black-...
Exposure Risk
• Residential exposure to infected ticks during
property maintenance, recreation, and leisure
activity
• Out...
Ixodes sp
• a
Life Cycle
• aa
Pathogenesis
• Initial Inoculation
• Expression of Osp A / C
• Binding to TLR – 1 / 2
• Immunological Cascade
• Humoral (I...
Clinical Features
• aa
ACA ; BLC
Erythema Chronicum
Migrans (ECM)
• 90% develop ECM at the site of inoculation
• 1–36 (average 9) days after the bite
• loc...
• aa
Acrodermatitis Chronica
Atrophica (ACA)
• Syn – Herxheimer’s Disease
• late cutaneous manifestation of dissemination
• 01 ...
• aa
DDx
• aa
DDx
Diagnosis
SEROLOGY
AB-based
• ELISA
• Western Blot
AG-based
• NAAT (PCR / bDNA / TMA / NASBA)
DIRECT ISOLATION
Stains (WSS...
HPE
ECM
• Focal epidermal spongiosis and parakeratosis can be
seen
• Tightly cuffed Dermal perivascular lymphocytic
infilt...
HPE
• aa
Dr.T.V.Rao MD 21
THANK YOU
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Borrelia by aseem

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Borrelia by aseem

  1. 1. BORRELIOSIS
  2. 2. Phylogeny • Phylum – Spirochete • Named after French Biologist Amedee Borrel • 36 known species • 05 pathogenic : – B. burgdorferi sensu stricto – Arthitogenic – B. burgdorferi sensu lato Lyme’s – B. garinii – Neurogenic – B. afzelii - Cutaneous manifestations – B. recurrentis – Relapsing Fever
  3. 3. Introduction • 1900s, manifestation first reported in Europe – associated it with tick bites (TBD) • 1975 - outbreak in Lyme, Connecticut - ‘JRA’ • 1982 - Spirochetes from midgut of the black-legged tick (Ixodes scapularis erst dammimi) and named Borrelia burgdorferi after American scientist Willy Burgdorfer • Commonest tick-borne infection (US) - >16000 / yr
  4. 4. Structure • slender helical shaped bacteria • Gram negative • Motile • Extracellular pathogen • Aerobic or microaerophilic
  5. 5. Transmission • Vector-borne disease – N Am / EU • Rodents / Deer - black-legged tick (Ixodes scapularis) or Western black-legged tick (Ixodes pacificus) • Transmits B. burgdorferi while feeding on an uninfected host – the spirochetes are present in the midgut and migrate during blood feeding to the salivary glands, from which they are transmitted to the host via saliva. • B. burgdorferi cannot penetrate intact skin
  6. 6. Exposure Risk • Residential exposure to infected ticks during property maintenance, recreation, and leisure activity • Outdoor occupations • Forestry • Landscaping
  7. 7. Ixodes sp • a
  8. 8. Life Cycle • aa
  9. 9. Pathogenesis • Initial Inoculation • Expression of Osp A / C • Binding to TLR – 1 / 2 • Immunological Cascade • Humoral (Ig M / G) • Complement
  10. 10. Clinical Features • aa ACA ; BLC
  11. 11. Erythema Chronicum Migrans (ECM) • 90% develop ECM at the site of inoculation • 1–36 (average 9) days after the bite • local spread of the spirochaete  ring formation EXPANDING @ few cms / wk • Zone of clearing behind the advancing ring producing a target-like morphology (BULL’S EYE LESIONS) • LAN + Constitutional Symptoms
  12. 12. • aa
  13. 13. Acrodermatitis Chronica Atrophica (ACA) • Syn – Herxheimer’s Disease • late cutaneous manifestation of dissemination • 01 or more years after the original infection • Hands, feet, knees and elbows • begins as an erythematous plaque, which slowly enlarges and gradually becomes violaceous and atrophic (‘tissue paper atrophy’) • Spirochaetes have occasionally been cultured
  14. 14. • aa
  15. 15. DDx • aa
  16. 16. DDx
  17. 17. Diagnosis SEROLOGY AB-based • ELISA • Western Blot AG-based • NAAT (PCR / bDNA / TMA / NASBA) DIRECT ISOLATION Stains (WSS / DIETERLE / GS / WGS ) HPE 17
  18. 18. HPE ECM • Focal epidermal spongiosis and parakeratosis can be seen • Tightly cuffed Dermal perivascular lymphocytic infiltrate may contain Plasma Cells ACA • Epidermal Atrophy • liquefaction degeneration of the basal layer and telangiectasia of the papillary dermis • Diffuse Dermal perivascular lymphocytic infiltrate containing Plasma Cells • Warthin–Starry stain identified spirochaetes in 40% of cases of both morphologies
  19. 19. HPE
  20. 20. • aa
  21. 21. Dr.T.V.Rao MD 21
  22. 22. THANK YOU

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