Lyme borreliosis in Finland in 1986-1988

Lyme Borreliosis in Finland, 1995-2014

We investigated the epidemiology of Lyme borreliosis (LB) in Finland for the period 1995–2014 by using data from 3 different healthcare registers. We reviewed data on disseminated LB cases from the National Infectious Diseases Register (21,051 cases) and the National Hospital Discharge Register (10,402 cases) and data on primary LB (erythema migrans) cases from the Register for Primary Health Care Visits (11,793 cases). Incidence of microbiologically confirmed disseminated LB cases increased from 7/100,000 population in 1995 to 31/100,000 in 2014. Incidence of primary LB cases increased from 44/100,000 in 2011 to 61/100,000 in 2014. Overall, cases occurred predominantly in women, and we observed a bimodal age distribution in all 3 registers. Our results clearly demonstrate that the geographic distribution of LB has expanded in Finland and underscore the importance of LB as an increasing public health concern in Finland and in northern Europe in general.

Diagnosis and clinical characteristics of ocular Lyme borreliosis

PURPOSE

To establish a diagnosis, in a group of patients we studied the characteristics of ocular Lyme borreliosis.

METHODS

During a two-year period, 236 patients with prolonged external ocular inflammation, uveitis, retinitis, optic neuritis, or unexplained neuro-ophthalmic symptoms were examined for Lyme borreliosis. Antibodies to Borrelia burgdorferi were measured by indirect ELISA and western blot. Cerebrospinal fluid was also analyzed by polymerase chain reaction.

RESULTS

Ocular Lyme borreliosis was diagnosed in ten patients on the basis of medical history, clinical findings, and serologic test results. Results of ELISA disclosed that five patients were seropositive, two patients showed borderline reactivity, and three patients were seronegative. Four of the five patients with borderline or negative results by ELISA had a positive result by western blot analysis. In one seropositive patient, polymerase chain reaction verified a gene of B. burgdorferi endoflagellin from the vitreous and cerebrospinal fluid specimen. In five of the six patients with known onset of the Borrelia infection, the ocular disorder appeared as a late manifestation. Abnormalities of the posterior segment of the eye, such as vitreitis, retinal vasculitis, neuroretinitis, choroiditis, and optic neuropathy were seen in six patients. Bilateral paralytic mydriasis, interstitial keratitis, episcleritis, and anterior uveitis were seen in one patient each.

CONCLUSIONS

Late-phase ocular Lyme borreliosis is probably underdiagnosed because of weak seropositivity or seronegativity in ELISA assays. Ocular borrelial manifestations show characteristics resembling those seen in syphilis.

Prevalence of Borrelia burgdorferi in selected tick populations in Finland

The purpose of the studies was to determine the prevalence of Borrelia burgdorferi sensu lato in selected populations of Ixodes ricinus in Finland and to secure strains of the spirochete for further characterization. 1,210 Ixodes ricinus ticks (399 females, 419 males and 392 nymphs) were collected during June to August 1992 by flagging from 8 sites in 3 regions. The frequency of B. burgdorferi infection was determined by isolation in BSK II medium. The species identity of most of the isolates was confirmed with the immunofluorescence method. 67 B. burgdorferi strains were isolated from 8 sites; the prevalence ranged from 2.8% to 7.9%. The overall isolation percentage for adult male ticks was 6.4% (7.5% for females, 5.3% for males); for nymphs, 3.8%. No statistically significant association of the prevalence was observed with either pasture or off-pasture habitats nor with specific geographic region/regions. Prevalence figures were roughly of the same magnitude in areas and parts of the country known to differ in their incidence of human borreliosis. An additional 294 ticks, mainly engorged females, were collected from places outside the main study sites. Of the 7 positive ticks 3 were engorged females, originating from a cow, a dog and a cat, respectively. The results in general demonstrate that tick populations in various parts of Finland quite commonly harbour B. burgdorferi.