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Unlu AM, Andersen NS, Larsen SL, Skarphedinsson S, Chrysidis S, Knudtzen FC, Lage-Hansen PR. Differentiating Lyme arthritis: a case-based review. Rheumatol Int 2024:10.1007/s00296-024-05618-0. [PMID: 38795123 DOI: 10.1007/s00296-024-05618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/10/2024] [Indexed: 05/27/2024]
Abstract
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.
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Affiliation(s)
- Ayse Mine Unlu
- Department of Rheumatology, University Hospital of Southern Denmark, Esbjerg, DK-6700, Denmark.
- Department of Rheumatology, Hospital South West Jutland, Esbjerg, DK-6700, Denmark.
| | - Nanna Skaarup Andersen
- Clinical Center for Emerging and Vectorborne Infections, Odense University Hospital, Odense, DK-5000, Denmark
- Department of Clinical Microbiology, Odense University Hospital, Odense, DK-5000, Denmark
- Clinical Microbiology research unit, University of Southern Denmark, Odense, Denmark
| | - Sanne Løkkegaard Larsen
- Clinical Center for Emerging and Vectorborne Infections, Odense University Hospital, Odense, DK-5000, Denmark
- Department of Clinical Microbiology, Odense University Hospital, Odense, DK-5000, Denmark
- Clinical Microbiology research unit, University of Southern Denmark, Odense, Denmark
| | - Sigurdur Skarphedinsson
- Clinical Microbiology research unit, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases Q, Odense University Hospital, Odense, DK-5000, Denmark
| | - Stavros Chrysidis
- Department of Rheumatology, University Hospital of Southern Denmark, Esbjerg, DK-6700, Denmark
| | - Fredrikke Christie Knudtzen
- Clinical Center for Emerging and Vectorborne Infections, Odense University Hospital, Odense, DK-5000, Denmark
- Department of Infectious Diseases Q, Odense University Hospital, Odense, DK-5000, Denmark
| | - Philip Rask Lage-Hansen
- Department of Rheumatology, University Hospital of Southern Denmark, Esbjerg, DK-6700, Denmark
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Deshpande G, Beetch JE, Heller JG, Naqvi OH, Kuhn KG. Assessing the Influence of Climate Change and Environmental Factors on the Top Tick-Borne Diseases in the United States: A Systematic Review. Microorganisms 2023; 12:50. [PMID: 38257877 PMCID: PMC10821204 DOI: 10.3390/microorganisms12010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
In the United States (US), tick-borne diseases (TBDs) have more than doubled in the past fifteen years and are a major contributor to the overall burden of vector-borne diseases. The most common TBDs in the US-Lyme disease, rickettsioses (including Rocky Mountain spotted fever), and anaplasmosis-have gradually shifted in recent years, resulting in increased morbidity and mortality. In this systematic review, we examined climate change and other environmental factors that have influenced the epidemiology of these TBDs in the US while highlighting the opportunities for a One Health approach to mitigating their impact. We searched Medline Plus, PUBMED, and Google Scholar for studies focused on these three TBDs in the US from January 2018 to August 2023. Data selection and extraction were completed using Covidence, and the risk of bias was assessed with the ROBINS-I tool. The review included 84 papers covering multiple states across the US. We found that climate, seasonality and temporality, and land use are important environmental factors that impact the epidemiology and patterns of TBDs. The emerging trends, influenced by environmental factors, emphasize the need for region-specific research to aid in the prediction and prevention of TBDs.
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Affiliation(s)
| | | | | | | | - Katrin Gaardbo Kuhn
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (G.D.); (J.E.B.); (J.G.H.); (O.H.N.)
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Goren A, Mysterud A, Jore S, Viljugrein H, Bakka H, Vindenes Y. Demographic patterns in Lyme borreliosis seasonality over 25 years. Zoonoses Public Health 2023; 70:647-655. [PMID: 37458418 DOI: 10.1111/zph.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
Lyme borreliosis, the most common vector-borne disease in Europe and North America, is attracting growing concern due to its expanding geographic range. The growth in incidence and geographic spread is largely attributed to climate and land-use changes that support the tick vector and thereby increase disease risk. Despite a wide range of symptoms displayed by Lyme borreliosis patients, the demographic patterns in clinical manifestations and seasonal case timing have not been thoroughly investigated and may result from differences in exposure, immunity and pathogenesis. We analysed 25 years of surveillance data from Norway, supplemented by population demography data, using a Bayesian modelling framework. The analyses aimed to detect differences in case seasonality and clinical manifestations of Lyme borreliosis across age and sex differentiated patient groups. The results showed a bimodal pattern of incidence over age, where children (0-9 years) had the highest incidence, young adults (20-29 years) had low incidence and older adults had a second incidence peak in the ages 70-79 years. Youth (0-19 years) presented with a higher proportion of neuroborreliosis cases and a lower proportion of arthritic manifestations compared to adults (20+ years). Adult males had a higher overall incidence than adult females and a higher proportion of arthritis cases. The seasonal timing of Lyme borreliosis consistently occurred around 4.4 weeks earlier in youth compared to adults, regardless of clinical manifestation. All demographic groups exhibited a shift towards an earlier seasonal timing over the 25-year study period, which appeared unrelated to changes in population demographics. However, the disproportionate incidence of Lyme borreliosis in seniors requires increased public awareness and knowledge about this high-risk group as the population continues to age concurrently with disease emergence. Our findings highlight the importance of considering patient demographics when analysing the emergence and seasonal patterns of vector-borne diseases using long-term surveillance data.
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Affiliation(s)
- Asena Goren
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway
| | - Atle Mysterud
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway
| | - Solveig Jore
- Zoonotic, Food & Waterborne Infections, The Norwegian Public Health Institute, Oslo, Norway
| | - Hildegunn Viljugrein
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway
- Norwegian Veterinary Institute, Ås, Norway
| | | | - Yngvild Vindenes
- Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway
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Goren A, Viljugrein H, Rivrud IM, Jore S, Bakka H, Vindenes Y, Mysterud A. The emergence and shift in seasonality of Lyme borreliosis in Northern Europe. Proc Biol Sci 2023; 290:20222420. [PMID: 36809802 PMCID: PMC9943644 DOI: 10.1098/rspb.2022.2420] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Climate change has had a major impact on seasonal weather patterns, resulting in marked phenological changes in a wide range of taxa. However, empirical studies of how changes in seasonality impact the emergence and seasonal dynamics of vector-borne diseases have been limited. Lyme borreliosis, a bacterial infection spread by hard-bodied ticks, is the most common vector-borne disease in the northern hemisphere and has been rapidly increasing in both incidence and geographical distribution in many regions of Europe and North America. By analysis of long-term surveillance data (1995-2019) from across Norway (latitude 57°58'-71°08' N), we demonstrate a marked change in the within-year timing of Lyme borreliosis cases accompanying an increase in the annual number of cases. The seasonal peak in cases is now six weeks earlier than 25 years ago, exceeding seasonal shifts in plant phenology and previous model predictions. The seasonal shift occurred predominantly in the first 10 years of the study period. The concurrent upsurgence in case number and shift in case timing indicate a major change in the Lyme borreliosis disease system over recent decades. This study highlights the potential for climate change to shape the seasonal dynamics of vector-borne disease systems.
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Affiliation(s)
- Asena Goren
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway
| | - Hildegunn Viljugrein
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway.,Norwegian Veterinary Institute, PO Box 64, NO-1431 Ås, Norway
| | - Inger Maren Rivrud
- Norwegian Institute for Nature Research (NINA), Sognsveien 68, NO-0855 Oslo, Norway
| | - Solveig Jore
- Zoonotic, Food and Waterborne Infections, The Norwegian Public Health Institute, PO Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Haakon Bakka
- Norwegian Veterinary Institute, PO Box 64, NO-1431 Ås, Norway
| | - Yngvild Vindenes
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway
| | - Atle Mysterud
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway.,Norwegian Institute for Nature Research (NINA), PO Box 5685 Sluppen, NO-7485 Trondheim, Norway
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