Lyme Disease among Patients at an Ambulatory Unit in a Highly Endemic Country: Lithuania

Differentiating Lyme arthritis: a case-based review

The incidence or prevalence of Lyme arthritis (LA) in Denmark is unknown and assumed very low. No published cases of polymerase chain reaction (PCR)-confirmed LA from Denmark exist. Clinically, LA does not differ from other rheumatic oligoarthritic disorders posing a differential diagnostic challenge. To review the incidence and prevalence of LA to our knowledge and to present a case series of PCR-confirmed LA cases from Denmark. We conducted a systematic literature review via MEDLINE and EMBASE to explore incidence and prevalence rates of LA. Additionally, we present six cases of patients diagnosed with LA in Denmark. Our literature review identified 23 studies reporting prevalence or incidence, yet only ten studies provided estimates ranging from 1.1 to 280/100.000 in the general population. Our case series identified six patients with LA from a localized region in Southern Denmark; all confirmed by Borrelia-specific real-time PCR from synovial fluid. The diagnostic delay was up to 38 months. All patients except one had a history of previous tick bites; none had erythema migrans lesions. All presented with recurrent arthritis in the knee joint, and two had arthritis in the wrist. The literature review showed an incidence of LA ranging from 1.1 to 15.8 per 100.000 in Europe. Our case series suggests a potentially higher prevalence of LA in Denmark than previously believed. Lack of tick exposure history, antibody assessments and test of Borrelia burgdorferi sensu lato DNA in synovial fluid might lead to misdiagnosed cases potentially explaining the assumed low incidence of LA in Denmark.

Ectoparasitic mites, ticks (Acari: Trombidiformes, Mesostigmata, Ixodida) and insects (Insecta: Psocodea, Siphonaptera) of ground-dwelling small mammals in the Baltic States. An annotated checklist

This paper presents an annotated checklist of 77 species of ectoparasitic mites, ticks (Acari: Trombidiformes, Mesostigmata, Ixodida) and insects (Insecta: Psocodea, Siphonaptera) found on ground-dwelling small mammals in the Baltic States (Estonia, Latvia, Lithuania). Eight species of five genera of chigger mites (Trombidiformes: Trombiculidae), 26 species of eight genera of laelapid mites (Mesostigmata: Laelapidae), six species of two genera of ixodid ticks (Ixodida: Ixodidae), 11 species of three genera of blood-sucking lice (Psocodea: Hoplopleuridae, Pediculidae, Polyplacidae) and 26 species of 15 genera of fleas (Siphonaptera: Ceratophyllidae, Ctenophthalmidae, Hystrichopsyllidae, Pulicidae) were recorded on ground-dwelling small mammals in the Baltic States. Neotrombicula japonica (Tanaka, Kaiwa, Teramura & Kagaya), Neotrombicula vulgaris (Schluger), Miyatrombicula muris (Oudemans), Hoplopleura edentula Fahrenholz and Polyplax hannswrangeli Eichler are recorded for the first time in the Baltic States.