![]() The geographical area where the patient was bitten as well as the date are important elements that should be gathered from the patient. However, as it has been observed, in rare cases the tick can still be attached to the center of the EM ( 20, 21). Recognition of an EM rash is very important in LB as it is a hallmark symptom of LB, even when the patient does not recall the tick bite. The identification of pathogens within the tick defines a possibility, not the certainty of developing LB ( 19). It is also possible to submit the tick for identification and testing for different pathogens. Afterwards, it is important to inform the patient of the symptoms, which, in the case of Borrelia infection, may develop in days/weeks. ![]() In this case, the first step is to remove the tick with small tweezers or an ad hoc tool at the level of the rostrum. Patients sometimes seek medical assistance after a tick bite. Furthermore, a brief description of laboratory investigation tools is included at the end of the review. Figure 1, instead, shows an overview of possible overlapping scenarios defining LB. Some clinical aspects that can be helpful for a correct diagnosis of LB will be described hereafter. Depending on the case and genospecies, they can grow in several tissues ( 18), including skin, nervous and joint system, although less frequently LB can also affect eyes, heart, spleen, and other tissues.īased on the spatial variability of Borrelia, for an accurate diagnosis, it could be useful to know if the patient has visited other countries or continents. Spirochetes circulate in small amounts in the blood even in acute LB patients ( 16), with the exception of Borrelia mayonii which has been reported to cause high spirochetemia ( 14, 17). afzelii with chronic skin conditions such as acrodermatitis chronica atrophicans ( 10). burgdorferi sensu stricto is mostly associated with arthritis and neuroborreliosis, B. Although overlapping, distinct spectra of clinical manifestations have been recognized for the three main genospecies. The heterogeneity in terms of genospecies can mirror different clinical manifestations of LB due to host specialization and tissue tropism. The spatial distribution of the different genospecies allocates Borrelia burgdorferi sensu stricto in North America and five species in Europe and Asia, B. Specificity in terms of dominating hosts has been reported both across and within continents ( 12, 13). valaisiana ( 9), especially in Europe ( 11). In addition, four other genospecies have been occasionally detected in humans: B. garinii, have been systemically related to LB ( 4, 10). However, only three genospecies, namely Borrelia burgdorferi sensu stricto, B. burgdorferi sensu lato genospecies, directly associated with human LB. These ticks are possible vectors of Lyme Borreliosis (LB) as well as other pathogens, including viruses, intracellular bacteria, and Protozoa which can co-infect humans (LB co-infections) ( 8, 9). The main tick vector for Borrelia species in Europe is the Ixodes ricinus ( 2), in America the Ixodes scapularis and Ixodes pacificus ( 3– 5), while in Asia ( 6) and Russia ( 7) it is the Ixodes persulcatus. Lyme disease or Lyme borreliosis (LB) is an anthropozoonosis, caused by different genospecies of the Borrelia burgdorferi sensu lato complex. The genus Borrelia includes three Groups: Lyme Borreliosis (LB), Reptil Associated (REP), and Relapsing Fever (RF) Group ( 1).
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