Borrelia burgdorferi Infections in Bavarian Forest Workers A Follow‐up Study^a

Abstract

Erythema migrans borreliosis, the European equivalent of Lyme borreliosis, is endemic in Bavaria, situated in the Southeast of West Germany. It seems of particular interest to what extent a population group especially prone to tick bites by its occupation shows clinical and serological hints to an infection with Borrelia burgdorferi (Bb). In 1983 we examined 2 11 forest workers from different regions of Upper Bavaria clinically and tested their sera with regard to antibodies (Ab) against Bb by means of an indirect immunofluorescence assay.' Two and a half years (y) later 53 of initially 71 seropositive forest workers could be reexamined. The clinical course was determined utilizing a standard questionnaire and further clinical data applied by family doctors. Serum Ab titers were reevaluated; additionally syphilis serology was performed, and rheumatoid factors, antinuclear antibodies, and HLA phenotypes determined. Of the collective initially examined ( n = 21 1; age 17-68, median 49 y), 71 (33.6%) proved to be seropositive (reciprocal IgM and/or IgG titers 2 10). The percentage of seropositivity increased with rising age (median age of 7 1 seropositives 56 y, of 140 seronegatives 46.5).' IgG Ab were found in 84.5%, IgM Ab in 53%, IgG and IgM Ab in 38% of the 7 1 sera. Slight differences between seronegative and seropositive forest workers turned out in tick bite history (never bitten by tick 25% of the seronegatives, 10% of the seropositives; p = 0.01, Fisher's exact test), elevated erythrocyte sedimentation rates (7% in seronegatives vs. 16% in seropositives), in heart symptoms such as arrythmia, tachycardia, dycardia as well as in verified cardiac disease (9% in seronegatives vs. 14% in seropositives), manifest joint involvement (22% vs. 23.6%), nervous system disorders (6% vs. 7%) and in history of erythema migrans (0.7% vs. 2.8%). No actual cutaneous manifestations of erythema migrans borreliosis were observed in the initial collective. uThis investigation was in part supported by a grant (no. Ne 329/1-1) from Deutsche Forschungsgemeinschaft. 416

The polymerase chain reaction for the detection of borrelia burgdorferi in human body fluids

“…Indeed, this rate is decidedly better than the rates obtained with serologic testing in endemic populations, where seropositivity may approach 50% in asymptomatic subjects (35)(36)(37). It also compares favorably with the serologic false-positive rate of 15-30% that has been found in patients with certain rheumatic and infectious diseases (6,7).…”

One year follow-up study to assess the prevalence and incidence of Lyme borreliosis among dutch forestry workers

“…This patient probably had a reinfection, since erythema migrans occurs in general within three months (median period 2.5 weeks) after acquisition of Borrelia burgdorferi infection (18). We are aware of only three cases of Lyme borreliosis developing after established asymptomatic seropositivity (8,19,20). In two patients acrodermatitis chronica atrophicans (8,20) and in one patient radiculopathy and peripheral facial palsy developed two to four years after known seropositivity (21).…”

“…We are aware of only three cases of Lyme borreliosis developing after established asymptomatic seropositivity (8,19,20). In two patients acrodermatitis chronica atrophicans (8,20) and in one patient radiculopathy and peripheral facial palsy developed two to four years after known seropositivity (21). These cases suggest long-lastzng asymptomatic persistent infection but reinfection cannot be excluded among these persons who were at a high risk for tick bites.…”

Antibodies to Borrelia burgdorferi and tick salivary gland proteins in New Jersey outdoor workers.

“…[1][2][3][4][5] In 1988, we reported on a population of outdoor workers in New Jersey with an overall seroprevalence ofantibody toBorrelia buwgdorfer, the causative agent of Lyme disease, of 8.1% (56 of 689 workers had at least one positive serologic test). 4,5 Workers in this population who reported exposure to ticks on the job had a fivefold elevated risk of infection.…”

“…Study variables included counties of work and residence; self-reported number of ticks noted on skin or clothing and tick bites in the past week, month, 3 …”