A Practical Approach to the Diagnosis of Lyme Borreliosis: From Clinical Heterogeneity to Laboratory Methods

Abstract

Clinical evaluation of Lyme Borreliosis (LB) is the starting point for its diagnosis. The patient's medical history and clinical symptoms are fundamental for disease recognition. The heterogeneity in clinical manifestations of LB can be related to different causes, including the different strains of Borrelia, possible co-infection with other tick transmitted pathogens, and its interactions with the human host. This review aims at describing the heterogeneous symptoms of Lyme Borreliosis, as well as offering a practical approach for recognition of the disease, both in terms of clinical features and diagnostic/research tools.

Borreliae Part 2: Borrelia Relapsing Fever Group and Unclassified Borrelia

“…The RF group has a more variable pathological spectrum, including RF transmitted by ticks and lice as well as the different and specific types of avian and bovine Borreliae . There is also a difference in the disease that separates these two types of spirochaetes: TBRF is characterized by high spirochetaemia, while Lyme borreliosis is characterized by tissue tropism (except for Borrelia mayonii ), in particular the skin, joints, and nervous system [ 92 ]. They also differ in vectors, usually Ixodes sp.…”

Quantitative multiplexed strategies for human Lyme disease serological testing

“…33 Of these, B. burgdorferi, B. garinii, and B. afzelii are most frequently associated with the typical presentation of Lyme borreliosis. 32,34 Different serological targets have been used to diagnose the infection in the US compared with Europe, 34 although a comprehensive test that incorporates all Lyme disease bacteria in a multiplexed assay would be useful to correctly diagnose individuals who have traveled in these areas.…”

Unconventional Approaches to Direct Detection of Borreliosis and Other Tick Borne Illnesses: A Path Forward

“…In striking contrast, no clinically accredited molecular test exists to detect molecules directly derived from Borreliosis. Nevertheless, treatment decisions concerning the diagnosis of acute and persistent Borreliosis are currently made based on Borreliosis serology testing and clinical evaluation of the patient’s medical history and symptoms [ 8 ]. Thus, diagnosis and management of Borreliosis is hampered by subjective tools and indirect markers of the disease.…”

“…Clinical manifestations of Lyme Borreliosis are heterogeneous, depending on different strains of Borrelia , possible co-infection with other tick-borne pathogens, and the host response [ 8 ]. Erythema migrans, a skin rash that is considered a typical sign of acute infection, varies substantially in shape, color, patterns, and homogeneity, and is influenced by age, sex, skin color, body location, and infection duration [ 9 ].…”