Reinfektion bei Erythema-migrans-Krankheit

Abstract

Two patients received oral penicillin for erythema migrans disease (EMD) in 1973 and 1977. Five and seven years later, respectively, they developed EMD for a second time after being bitten by ticks. The first and second erythema migrans lesions appeared in different places. Tests of sera evaluated for antibodies to Borrelia burgdorferi before (in one case), during and after the second episode of EMD remained negative (patient 1) or yielded an at least four-fold rise of IgG antibody titers, but did not become positive (patient 2). These cases provide evidence that reinfection in EMD may occur without a significant elevation of specific antibody titers.

Reinfection in Patients with Lyme Disease

“…Reinfection occurs regularly in patients from both the United States and Europe who are observed for 11 year after treatment of an initial episode of erythema migrans (table 1) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. It is notable that the rate at which second episodes of erythema migrans occur in closely observed cohorts may exceed the incidence of Lyme disease in the general population, even in the same region of high endemicity where the study group originates.…”

“…In contrast, persons acquiring Lyme disease in Europe may be infected with one of several different species [2]. A surprising number of patients sustain a second (and sometimes even another subsequent) episode of early Lyme disease after the first episode has resolved [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Although reinfection is well-recognized, there is little detailed information on the clinical and laboratory manifestations.…”

Variable VlsE Is Critical for Host Reinfection by the Lyme Disease Spirochete

“…Although persistent infection can last from months to years due to avoidance of the host immune response by the pathogen, early infection can usually be cleared with antibiotic treatment. Surprisingly, reinfection occurs fairly regularly in post-treatment patients that have successfully cleared initial infection, suggesting that individuals treated for early Lyme disease continue to remain at risk for reinfection [5], [6], [7], [8], [9], [10], [11], [12], [13]. The incidence of reinfection has been shown to be as high as 15% over a five-year study period (a rate of 3% per year), and clinical manifestations seem to be identical to those of initial infection [6].…”

Abstract

“…Even though specific antibodies to B. burgdorferi persist long after the actual infection, Lyme borreliosis does not confer lasting immunity. Erythema migrans, arthritis, and meningitis have been observed as manifestations of reinfection with B. burgdoferi; the patients had been treated with antibiotics for Lyme borreliosis from two to 20 years previously (126,234,289,338).…”