Borrelia by aseem

Borrelia by aseem

  1. Aseem Sharma
    Borrelia by aseem
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    Borrelia by aseem
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    • 1. BORRELIOSIS
    • 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. 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. Structure • slender helical shaped bacteria • Gram negative • Motile • Extracellular pathogen • Aerobic or microaerophilic
    • 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. Exposure Risk • Residential exposure to infected ticks during property maintenance, recreation, and leisure activity • Outdoor occupations • Forestry • Landscaping
    • 7. Ixodes sp • a
    • 8. Life Cycle • aa
    • 9. Pathogenesis • Initial Inoculation • Expression of Osp A / C • Binding to TLR – 1 / 2 • Immunological Cascade • Humoral (Ig M / G) • Complement
    • 10. Clinical Features • aa ACA ; BLC
    • 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. • aa
    • 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. • aa
    • 15. DDx • aa
    • 16. DDx
    • 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. 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. HPE
    • 20. • aa
    • 21. Dr.T.V.Rao MD 21
    • 22. THANK YOU
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