Project Management Of Lyme Disease Through Monitoring Of Seroprevalence Of Anti-Borrelia Antibodies In Macedonian Patients

Lyme disease is a worldwide zoonotic disease and the most common tick-borne illness in Europe and North America. It is caused by at least three species of bacteria belonging to the genus Borrelia (Borrelia afzelii and Borrelia garinii cause most European cases, whereas Borrelia burgdorferi - is more frequent in North America). Borrelia is transmitted to humans by bite of infected ticks belonging to a few species of the genus Ixodes. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash - erythema migrans. If left untreated, infection can spread to joints, heart, and nervous system. There are very little data about the seroprevalence in our population, furthermore the relation to clinical data has not been previously studied. IFA is a standard test for antibody detection of B burgdorferi sensu lato, since cultural growth of the organism from skin samples and blood is very difficult. The aim of this paper is to find correlation between Lyme disease and tick bites in Macedonian patients. It was done through determining the seroprevalence of Borrelia IgG and IgM antibodies using IFA test and relating that data to reported tick bites. The study was conducted on a sample of 240 patients, after suspected or observed tick bite. Serum samples were collected in a four years period (June 2009-June 2013). Borrelia specific IFA test - RIDA®FLUOR Borrelia burgdorferi (sensulato), R-biopharm, Germany, was performed for IgG and IgM antibody detection. The positive titer was 1:16 for IgM and 1:32 for IgG. The sera were taken at least 10 days after confirmed or suspected thick bite. All patients also answered a short questionnaire regarding the history of a thick bite and previous treatment. Seropositive were 45/240 (18,8%) patients. Concomitant Borrelia IgG and IgM seropositivity was noted in 9 cases, and only IgG or only IgM seropositive were 21 and 15 patients, respectively. A tick bite 10 -60 days prior the testing had been noted in 62/240 (25,8%) patients. The ticks were removed in hospital settings in approximately two thirds of the patients. Seropositivity in either or both classes of antibodies in patients who reported a thick bite was 28,9% (13/45). Erythema migrans as a symptom was noted in 9 patients, all of them reporting a thick bite and being IgG positive. Approximately 50% of the patients bitten by a thick received antibiotic therapy. Having in mind that B burgdorferi in this area is being tested for only few years, the results demonstrate IgG and/or IgM antibody seropositivity of 18,8%, whereas approximately one third of those cases were associated with a tick bite. Very few of those seropositive patients reported any previous symptoms. Those findings suggest that exposure to B burgdorferi does occur in our population, mostly without giving rise to clinical manifestations of Lyme disease. The need of applying precise testing and treatment protocols is obligatory. Further seroprevalence studies on human, as well as on animals are needed in order to create a correlation between seroprevalence of anti- Borelia antibodies with tick bites, which ultimately means better health protection of the population.