DÄ internationalArchive31-32/2009Lyme Disease—Current State of Knowledge: Different Symptoms

Correspondence

Lyme Disease—Current State of Knowledge: Different Symptoms

Dtsch Arztebl Int 2009; 106(31-32): 524. DOI: 10.3238/arztebl.2009.0524a

Haufs, M G

LNSLNS There are four different species of human pathogen Borrelia in Europe (in central Europe, mainly Borrelia afzelii and Borrelia garinii), whereas the United States has only one (Borrelia burgdorferi). The vectors (ticks) on the two continents also differ. The result is that manifestations of disease or constellations of symptoms of borreliosis in Germany/Europe occasionally significantly differ from the US (1). Acrodermatitis chronica atrophicans, comparatively common in these parts, is almost unknown in the US, as is borrelial lymphocytoma. Erythema migrans, arthritis, neuroborreliosis, and other manifestations often take a different clinical course in the US as they do in Europe. Because of these differences—some of them very pronounced—different preventive approaches (2) have been developed: In the US, a vaccine that was actually successful and effective against B burgdorferi was taken off the market in 2001 because of side effects and lacking economic viability. Currently, antibiotic treatment with a single dose of 200 mg doxycyclin, orally administered within 72 hours after the tick bite, seems promising in the US—in contrast to Germany. In terms of differential diagnoses and therapeutic strategy, the undifferentiated term "Lyme borreliosis" for all tickborne borrelioses, which was adopted perhaps slightly too uncritically from the Anglo-American literature, is confusing. For this reason, in 2003, I proposed a differentiation of currently (still) unified terminology into distinct variants of the infectious disease (3), such as has been the case for the different forms of hepatitis for a long time. But more is required: an interdisciplinary consensus (guideline) for borreliosis is needed in order to provide more detailed definitions of the occurring clinical entities of this infection with its many facets, which is often the subject of controversial discussions or used as an exclusion diagnosis, and to put this on a more differentiated footing.
DOI: 10.3238/arztebl.2009.0524a


Dr. med. Dr. rer. nat. Michael G. Haufs
Gluckweg 31, 48147 Münster, Germany
michaelhaufs@gmx.de
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Hengge U, Tannapfel A, Tyring SK, Erbel R, Arendt G, Ruzicka T: Lyme borreliosis. Lancet Infect Dis 2003; 3: 489–500.
2.
Hayes EB, Piesman J: How we can prevent Lyme disease? N Engl J Med 2003; 348: 2424–30.
3.
Haufs MG: Preventing Lyme disease. N Engl J Med 2003; 349: 1192.
4.
Nau R, Christen H, Eiffert H: Lyme disease—current state of knowledge [Lyme-Borreliose – aktueller Kenntnisstand]. Dtsch Arztebl Int 2009; 106: 72–81.
1. Hengge U, Tannapfel A, Tyring SK, Erbel R, Arendt G, Ruzicka T: Lyme borreliosis. Lancet Infect Dis 2003; 3: 489–500.
2. Hayes EB, Piesman J: How we can prevent Lyme disease? N Engl J Med 2003; 348: 2424–30.
3. Haufs MG: Preventing Lyme disease. N Engl J Med 2003; 349: 1192.
4. Nau R, Christen H, Eiffert H: Lyme disease—current state of knowledge [Lyme-Borreliose – aktueller Kenntnisstand]. Dtsch Arztebl Int 2009; 106: 72–81.