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Erythema Migrans in Primary Health Care

Bennet, Louise LU orcid (2005)
Abstract
Lyme borreliosis (LB) is the most common vector-borne disease in the northern hemisphere, and southern Sweden is a highly endemic area. In over 70% of the cases, LB is represented by the non-disseminated cutaneous form erythema migrans (EM). This thesis has its focus on EM from a primary health care perspective in southern Sweden, including aspects on epidemiology, the clinical picture, gender differences and the climate.



In paper III, an annual mean incidence rate over 460 cases of EM per 100,000 inhabitants was found in the county of Blekinge. Over 98% of the cases were treated in primary health care and almost every second case occurred during the vacation months of July and August. In paper I, individuals in southern... (More)
Lyme borreliosis (LB) is the most common vector-borne disease in the northern hemisphere, and southern Sweden is a highly endemic area. In over 70% of the cases, LB is represented by the non-disseminated cutaneous form erythema migrans (EM). This thesis has its focus on EM from a primary health care perspective in southern Sweden, including aspects on epidemiology, the clinical picture, gender differences and the climate.



In paper III, an annual mean incidence rate over 460 cases of EM per 100,000 inhabitants was found in the county of Blekinge. Over 98% of the cases were treated in primary health care and almost every second case occurred during the vacation months of July and August. In paper I, individuals in southern Sweden treated and recovered from EM were followed during a period of 5 years. Annually, 1% were 'reinfected', i.e. had a new infection with LB during the follow-up. This is significantly higher than the prevalence of LB in the area in 1992-1993 of 0.07% (p < 0.001), indicating that individuals with a former infection are at a higher risk of LB.



In paper IV studying patients with EM, where genospecies were confirmed by PCR, 74% of the patients were infected with B. afzelii and 26% were infected with B. garinii. B. garinii seemed to cause more intense local and systemic inflammatory reactions than B. afzelii. Totally, 45% (38/85) of the lesions were annular, 46% (39/85) were non-annular and 9% (8/85) were atypical. An interaction between gender and genospecies was found that has not been described before. Men to a higher extent than women developed annular EM while women more often developed non-annular EM, if infected with B. afzelii. Surprisingly, time duration from tick bite to diagnosis was not found to have an effect on the clinical appearance of the EM.



In paper II, antibiotic treatment of EM with pcV and doxycycline was found to be highly effective and no cases of disseminated LB were found in patients followed for 5 years.



The incidence rate of EM was significantly higher in women than men (506/100,000 vs 423/100,000 p < 0.001) and especially women over 50 years were affected (paper III). Additionally, significantly more women than men were reinfected, 6% and 1%, respectively (p < 0.01). All infected women were over the age of 44 years and they were tick-bitten to the same extent as the men (paper I). Immunological differences might have an impact on, and explain, the observed gender differences.



The seasonal incidence rates of EM varied considerably. Different climate factors were found to influence the EM incidence rates (paper III). (Less)
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author
supervisor
opponent
  • Professor Mölstad, Sigvard, Linköpings Universitet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
primary health care, ticks, gender, climate, Medicine (human and vertebrates), Medicin (människa och djur), serology, Immunology, serologi, Immunologi, transplantation, Infections, Infektioner, General practice, medicinsk utbildning, medical training, Allmän medicinsk utövning, Lyme borreliosis, erythema migrans, incidence, Borrelia afzelii, Borrelia garinii
pages
104 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Lilla Aulan, Medicinskt Forskningscentrum, ingång 59, Universitetssjukhuset MAS, Malmö,
defense date
2005-12-09 13:00:00
ISBN
91-85481-14-9
language
English
LU publication?
yes
additional info
L Bennet and J Berglund. 2002. Reinfection with Lyme borreliosis: A retrospective follow-up study in southern Sweden. Scand J Infect Dis, vol 34 pp 183-6.
L Bennet, S Danell and J Berglund. 2003. Clinical outcome of erythema migrans after treatment with phenoxymethyl penicillin. Scand J Infect Dis, vol 35 pp 129-31.
L Bennet, A Halling and J Berglund. 2006. Increased incidence of Lyme borreliosis in southern Sweden following mild winters and during warm humid summers. Eur J Clin Microbiol Infect Dis., pp 426–432. Springer
L Bennet, CJ Fraenkel, U Garpmo, A Halling, M Ingman, K Ornstein, L Stjernberg and J Berglund. 2006. Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii - effect of the patient's sex. Wiener Klinische Wochenschrift, vol 118 Springer
id
2ee86e6e-b823-4133-a741-0a38d7c1e917 (old id 545642)
date added to LUP
2016-04-01 17:06:20
date last changed
2022-01-15 02:34:41
@phdthesis{2ee86e6e-b823-4133-a741-0a38d7c1e917,
  abstract     = {{Lyme borreliosis (LB) is the most common vector-borne disease in the northern hemisphere, and southern Sweden is a highly endemic area. In over 70% of the cases, LB is represented by the non-disseminated cutaneous form erythema migrans (EM). This thesis has its focus on EM from a primary health care perspective in southern Sweden, including aspects on epidemiology, the clinical picture, gender differences and the climate.<br/><br>
<br/><br>
In paper III, an annual mean incidence rate over 460 cases of EM per 100,000 inhabitants was found in the county of Blekinge. Over 98% of the cases were treated in primary health care and almost every second case occurred during the vacation months of July and August. In paper I, individuals in southern Sweden treated and recovered from EM were followed during a period of 5 years. Annually, 1% were 'reinfected', i.e. had a new infection with LB during the follow-up. This is significantly higher than the prevalence of LB in the area in 1992-1993 of 0.07% (p &lt; 0.001), indicating that individuals with a former infection are at a higher risk of LB.<br/><br>
<br/><br>
In paper IV studying patients with EM, where genospecies were confirmed by PCR, 74% of the patients were infected with B. afzelii and 26% were infected with B. garinii. B. garinii seemed to cause more intense local and systemic inflammatory reactions than B. afzelii. Totally, 45% (38/85) of the lesions were annular, 46% (39/85) were non-annular and 9% (8/85) were atypical. An interaction between gender and genospecies was found that has not been described before. Men to a higher extent than women developed annular EM while women more often developed non-annular EM, if infected with B. afzelii. Surprisingly, time duration from tick bite to diagnosis was not found to have an effect on the clinical appearance of the EM.<br/><br>
<br/><br>
In paper II, antibiotic treatment of EM with pcV and doxycycline was found to be highly effective and no cases of disseminated LB were found in patients followed for 5 years.<br/><br>
<br/><br>
The incidence rate of EM was significantly higher in women than men (506/100,000 vs 423/100,000 p &lt; 0.001) and especially women over 50 years were affected (paper III). Additionally, significantly more women than men were reinfected, 6% and 1%, respectively (p &lt; 0.01). All infected women were over the age of 44 years and they were tick-bitten to the same extent as the men (paper I). Immunological differences might have an impact on, and explain, the observed gender differences.<br/><br>
<br/><br>
The seasonal incidence rates of EM varied considerably. Different climate factors were found to influence the EM incidence rates (paper III).}},
  author       = {{Bennet, Louise}},
  isbn         = {{91-85481-14-9}},
  keywords     = {{primary health care; ticks; gender; climate; Medicine (human and vertebrates); Medicin (människa och djur); serology; Immunology; serologi; Immunologi; transplantation; Infections; Infektioner; General practice; medicinsk utbildning; medical training; Allmän medicinsk utövning; Lyme borreliosis; erythema migrans; incidence; Borrelia afzelii; Borrelia garinii}},
  language     = {{eng}},
  publisher    = {{Department of Clinical Sciences, Lund University}},
  school       = {{Lund University}},
  title        = {{Erythema Migrans in Primary Health Care}},
  url          = {{https://lup.lub.lu.se/search/files/4876321/545643.pdf}},
  year         = {{2005}},
}