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Borrelia burgdorferi

Thursday, November 16, 2017 1:04 PM

1. Case presentation
2. Biology of Borrelia burgdorferi
Bacteria, Genus - Borrelia, Class - Spirochete, Size - 10 to 20 m length, Microaerobic, Motile,
Neither Gram positive or Gram negative; considered a diderm, meaning that it has a double
membrane with an outer membrane that lacks LPS and a thin inner membrane of peptidoglycan.
3. The organism in the environment Where does it live and what is its reservoir? How is it
transmitted to humans?
It is most commonly found in the North East. The main reservoir are rodents, the Ixodes tick is the
vector, deer are an obligatory host in the ticks life cycle for mating, and humans are a dead end
host in which B. burgdorferi is transferred when feeding on blood for 24-48 hours.
4. Key virulence factors that are known to be involved in infection
OspA- major outer surface protein expressed that mediates binding to tick midgut cells
OspC- role in disease is unknown, antigenic variation causes this to be most prominent when the
bacterium is transmitted to animal hosts
Surface proteins bind fibronectin found in ECM (adhesion) and factor H (evasion of complement
system)
Can use host proteases to help spread throughout the body
Inflammation is caused by B burgdorferi double membrane proteins such as peptidoglycans (inner
membrane) and unknown proteins (outer membrane) which act as endotoxins
B. burgdorferi has the ability to inhibit immune responses which may assist in survival or play a
role in chronic disease
5. Host immune response
Classical complement pathway leads to opsonization and phagocytosis by macrophages and
neutrophils
Humoral immunity is the main response against B. burgdorferi, with development of IgM followed
by IgG antibodies, over weeks to months.
6. How is this infection treated? Why is it treated with this drug (or other modality)?
Treatment for stage 1 disease is Doxycycline, Amoxicillin, or Cefuroxime
For late stage disease with neurological or cardiovascular involvement - Ceftriaxone - because this
can cross the blood brain barrier
The response to treatment is typically slow, requiring the continuation of antimicrobials for 30 to
60 days.
7. Prevention is there a vaccine? What other preventative measures can be used?
Long sleeves and pants, and examining the skin carefully for ticks
If youve found youve been bitten by a tick, remove the head with tweezers within the first 48-72
hours
Prophylactic doxycycline can be used following a tick bite, followed by monitoring for a rash for
flu-like symptoms for the next 3 weeks

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