Background Lyme disease is the most common vector-borne infectionin some temperate regions of the Northern Hemisphere. However,for most areas of endemic disease reliable epidemiologic dataare sparse.
Methods Over a one-year period, we conducted a prospective,population-based survey of cases of Lyme disease in southernSweden. The diagnosis was made on the basis of the presenceof erythema migrans at least 5 cm in diameter or characteristicclinical manifestations such as arthritis, neuroborreliosis,and carditis.
Results We identified 1471 patients with Lyme disease, for anoverall annual incidence of 69 cases per 100,000 inhabitants.The incidence varied markedly according to geographic region,and there were several areas where disease was widely prevalent.The incidence varied according to age, with the highest ratesamong people 5 to 9 and 60 to 74 years of age, but not accordingto sex. The most frequent clinical manifestation was erythemamigrans (seen in 77 percent of all cases), followed by neuroborreliosis(16 percent) and arthritis (7 percent). Carditis was rare. Apreceding tick bite was reported by 79 percent of the patients.Bites in the head and neck region were more common among childrenthan among adults and were associated with an increased riskof neuroborreliosis.
Conclusions Lyme disease is very common in southern Sweden,with a relatively high frequency of neurologic complicationsand arthritis. With the exception of the low incidence of carditis,the pattern of disease we found in Sweden was similar to thatreported in the United States.
Source Information
From the Departments of Community Health Sciences (J.B.), Infectious Diseases (J.B., K.O., R.N.), and Medical Microbiology (C.S.), University of Lund, Lund; and the Departments of Infectious Disease Control in Blekinge County (R.E.), Halland County (A.L.), Kalmar County (Å. Ringnér), Kristianstad County (H.E.), Jönköping County (M.C.), and Kronoberg County (A. Runehagen) — all in Sweden.
Address reprint requests to Dr. Berglund at the Ronneby Health Center, Rosengatan 15, S-372 30 Ronneby, Sweden.
Schollkopf, C., Melbye, M., Munksgaard, L., Smedby, K. E., Rostgaard, K., Glimelius, B., Chang, E. T., Roos, G., Hansen, M., Adami, H.-O., Hjalgrim, H.
(2008). Borrelia infection and risk of non-Hodgkin lymphoma. Blood
111: 5524-5529
[Abstract][Full Text]
Stjernberg, L., Berglund, J.
(2005). Tick prevention in a population living in a highly endemic area. Scand J Public Health
33: 432-438
[Abstract]
Ruzic-Sabljic, E., Arnez, M., Logar, M., Maraspin, V., Lotric-Furlan, S., Cimperman, J., Strle, F.
(2005). Comparison of Borrelia burgdorferi Sensu Lato Strains Isolated from Specimens Obtained Simultaneously from Two Different Sites of Infection in Individual Patients. J. Clin. Microbiol.
43: 2194-2200
[Abstract][Full Text]
Hunfeld, K.-P., Ruzic-Sabljic, E., Norris, D. E., Kraiczy, P., Strle, F.
(2005). In Vitro Susceptibility Testing of Borrelia burgdorferi Sensu Lato Isolates Cultured from Patients with Erythema Migrans before and after Antimicrobial Chemotherapy. Antimicrob. Agents Chemother.
49: 1294-1301
[Abstract][Full Text]
Bunikis, J., Garpmo, U., Tsao, J., Berglund, J., Fish, D., Barbour, A. G.
(2004). Sequence typing reveals extensive strain diversity of the Lyme borreliosis agents Borrelia burgdorferi in North America and Borrelia afzelii in Europe. Microbiology
150: 1741-1755
[Abstract][Full Text]
Lipsker, D., Lieber-Mbomeyo, A., Hedelin, G.
(2004). How Accurate Is a Clinical Diagnosis of Erythema Chronicum Migrans? Prospective Study Comparing the Diagnostic Accuracy of General Practitioners and Dermatologists in an Area Where Lyme Borreliosis Is Endemic. Arch Dermatol
140: 620-621
[Full Text]
Ornstein, K., Ostberg, Y., Bunikis, J., Noppa, L., Berglund, J., Norrby, R., Bergstrom, S.
(2002). Differential Immune Response to the Variable Surface Loop Antigen of P66 of Borrelia burgdorferi Sensu Lato Species in Geographically Diverse Populations of Lyme Borreliosis Patients. CVI
9: 1382-1384
[Abstract][Full Text]
Ornstein, K., Berglund, J., Nilsson, I., Norrby, R., Bergström, S.
(2001). Characterization of Lyme Borreliosis Isolates from Patients with Erythema Migrans and Neuroborreliosis in Southern Sweden. J. Clin. Microbiol.
39: 1294-1298
[Abstract][Full Text]
Stjernberg, L., Berglund, J.
(2000). Garlic as an Insect Repellent. JAMA
284: 831-831
[Full Text]
Jaulhac, B., Heller, R., Limbach, F. X., Hansmann, Y., Lipsker, D., Monteil, H., Sibilia, J., Piémont, Y.
(2000). Direct Molecular Typing of Borrelia burgdorferi Sensu Lato Species in Synovial Samples from Patients with Lyme Arthritis. J. Clin. Microbiol.
38: 1895-1900
[Abstract][Full Text]
Blaauw, A. A. M., van Loon, A. M., Schellekens, J. F. P., Bijlsma, J. W. J.
(1999). Clinical evaluation of guidelines and two-test approach for Lyme disease. Rheumatology (Oxford)
38: 1121-1126
[Abstract][Full Text]
Wang, G., van Dam, A. P., Schwartz, I., Dankert, J.
(1999). Molecular Typing of Borrelia burgdorferi Sensu Lato: Taxonomic, Epidemiological, and Clinical Implications. Clin. Microbiol. Rev.
12: 633-653
[Abstract][Full Text]
Faul, J. L., Doyle, R. L., Kao, P. N., Ruoss, S. J.
(1999). Tick-Borne Pulmonary Disease: Update on Diagnosis and Management. Chest
116: 222-230
[Abstract][Full Text]
Gerber, M. A., Shapiro, E. D., Burke, G. S., Parcells, V. J., Bell, G. L., The Pediatric Lyme Disease Study Group,
(1996). Lyme Disease in Children in Southeastern Connecticut. NEJM
335: 1270-1274
[Abstract][Full Text]
Strle, F., Stanti-Pavlini, M.
(1996). Lyme Disease in Europe. NEJM
334: 803-803
[Full Text]
Previous
