Borrelia

Borrelia
Scientific classification
Kingdom: Bacteria Phylum: Spirochaetes Class: Spirochaetes Order: Spirochaetales Family: Spirochaetaceae Genus: Borrelia
Species
Borrelia afzelii Borrelia anserina Borrelia burgdorferi Borrelia garinii Borrelia hermsii Borrelia recurrentis Borrelia valaisiana etc.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Borrelia is a genus of bacteria of the spirochete class. It is a zoonotic, vector-borne disease transmitted primarily by ticks and some by lice, depending on the species. There are 37 known species of Borrelia.

Borreliosis (Lyme disease)

Main article: Lyme disease

Of the 37 known species of Borrelia, 12 of these species are known to cause Lyme disease or borreliosis and are transmitted by ticks. The major Borrelia species causing Lyme disease are Borrelia burgdorferi, Borrelia afzelii, Borrelia garinii and Borrelia valaisiana.

Relapsing fever

Main article: Relapsing fever

Other Borrelia species cause relapsing fever such as Borrelia recurrentis, caused by the human body louse. No animal reservoir of B. recurrentis exists. Lice that feed on infected humans acquire the Borrelia organisms that then multiply in the gut of the louse. When an infected louse feeds on an uninfected human, the organism gains access when the victim crushes the louse or scratches the area where the louse is feeding. B. recurrentis infects the person via mucous membranes and then invades the bloodstream.

Other tick-borne relapsing infections are acquired from other species, such as Borrelia hermsii or Borrelia Parkeri, which can be spread from rodents, and serve as a reservoir for the infection, via a tick vector. Borelia hermsii and Borrelia recurrentis cause very similar diseases although the disease associated with Borrelia hermsii has more relapses and is responsible for more fatalities, while the disease caused by B. recurrentis has longer febrile and afebrile intervals and a longer incubation period.

Gallery

• 

  "Black-legged ticks", Ixodes scapularis, also referred to as I. dammini, are found on a wide rage of hosts. From Public Health Image Library (PHIL).

• 

  Female “Lone star tick” From Public Health Image Library (PHIL).

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  Dorsal view of the “soft tick” Carios kelleyi. From Public Health Image Library (PHIL).

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  Dorsal view of the “soft tick” Carios kelleyi. From Public Health Image Library (PHIL).

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  White tail deer during a Lyme disease field investigation. From Public Health Image Library (PHIL).

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  White-footed mouse, Peromyscus leucopus, which is a host of ticks thatare known to carry the bacteria, Borrelia burgdorferi, responsible for Lyme disease. From Public Health Image Library (PHIL).

Treatment

Antimicrobial Regimen

• Borrelia recurrentis

• 1. Tick-Borne Relapsing Fever

• Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days
• Alternative regimen: Erythromycin 500 mg PO qid for 5-10 days
• Note: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days

• 2. Louse-Borne Relapsing Fever

• Preferred regimen: Tetracycline 500 mg PO single dose
• Alternative regimen: Erythromycin 500 mg PO single dose

• Borrelia burgdorferi

• Lyme disease

• 1. Early Lyme Disease

• 1.1 Erythema migrans

• 1.1.1 Adult

• Preferred regimen (1): Doxycycline 100 mg PO bid for 10-21 days
• Preferred regimen (2): Amoxicillin 500 mg PO tid for 14-21 days
• Preferred regimen (3): Cefuroxime axetil 500 mg bid for 14-21 days
• Alternatie regimen (1): Azithromycin 500 mg PO qd for 7–10 days
• Alternatie regimen (2): Clarithromycin 500 mg PO bid for 14–21 days (if the patient is not pregnant)

• Alternatie regimen (3): Erythromycin 500 mg PO qid for 14–21 days

• 1.1.2 Pediatric

• 1.1.2.1 children <8 years of age

• Preferred regimen (1): Amoxicillin 50 mg/kg PO per day in 3 divided doses (maximum of 500 mg per dose)

• Preferred regimen (2): Cefuroxime axetil 30 mg/kg PO per day in 2 divided doses（maximum, 500 mg per dose)

• 1.1.2.2 children ≥8 years of age

• Preferred regimen (1): Doxycycline 4 mg/kg PO per day in 2 divided doses（maximum, 100 mg per dose）
• Preferred regimen (2): Azithromycin 10 mg/kg PO qd (maximum, 500 mg qd)

• Preferred regimen (3): Clarithromycin 7.5 mg/kg PO bid (maximum, 500 mg per dose)

• Preferred regimen (4): Erythromycin 12.5 mg/kg PO qid (maximum, 500 mg per dose)

• 1.2 When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis

• Preferred regimen: Amoxicillin-Clavulanate 500 mg PO tid
• Pediatric regimen: Amoxicillin-Clavulanate 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose)

• 1.3 Lyme meningitis and other manifestations of early neurologic Lyme disease

• 1.3.1 Adult

• Preferred regimen: Ceftriaxone 2 g IV q24h for 10–28 days
• Alternative regimen (1): Cefotaxime 2 g IV q8h
• Alternative regimen (2): Penicillin G 18–24 MU q4h (for patients with normal renal function)
• Alternative regimen (3): Doxycycline 200–400 mg PO per day in 2 divided doses for 10–28 days

• 1.3.2 Pediatric

• Preferred regimen (1): Ceftriaxone 50–75 mg/kg IV single dose (maximum, 2 g)
• Preferred regimen (2): Cefotaxime 150–200 mg/kg IV per day divided into 3 or 4 doses (maximum, 6 g per day)
• Alternative regimen (1): Penicillin G 200,000–400,000 units/kg IV qd divided into doses given q4h (for normal renal function) (maximum, 18–24 MU qd)
• Alternative regimen (2): Doxycycline 4–8 mg/kg PO qd in 2 divided doses (maximum, 100–200 mg per dose) (≥8 years old)

• 1.4 Lyme carditis

• Preferred regimen: Ceftriaxone 2 g IV q24h for 10–28 days
• Note: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)

• 1.5 Borrelial lymphocytoma

• Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)

• 2. Late Lyme Disease

• 2.1 Lyme arthritis

• Preferred regimen (1): Doxycycline 100 mg PO bid

• Preferred regimen (2): Amoxicillin 500 mg PO tid
• Alternative regimen: Cefuroxime axetil 500 mg PO bid for 28 days
• Pediatric regimen: Amoxicillin 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose); Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum,500 mg per dose); (≥8 years of age) Doxycycline 4 mg/ kg per day in 2 divided doses (maximum, 100 mg per dose)
• Note: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4 weeks course of Ceftriaxone IV

• 2.2 patients with arthritis and objective evidence of neurologic disease

• Preferred regimen: Ceftriaxone IV for 2–4 weeks
• Alternative regimen (1): Cefotaxime IV

• Alternative regimen (1): Penicillin G IV
• Pediatric regime: Ceftriaxone; Cefotaxime; Penicillin G IV

• 2.3 Late neurologic Lyme disease

• Preferred regimen: Ceftriaxone IV for 2 to 4 weeks
• Alternative regimen (1): Cefotaxime IV

• Alternative regimen (2): Penicillin G IV
• Pediatric regimen: Ceftriaxone; Cefotaxime; Penicillin G

• 2.4 Acrodermatitis chronica atrophicans

• Preferred regimen (1): Doxycycline 100 mg PO bid for 21 days
• Preferred regimen (2): Amoxicillin 500 mg PO tid for 21 days
• Preferred regimen (3): Cefuroxime axetil 500 mg PO bid for 21 days

• 3. Post–Lyme Disease Syndromes

• Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)

External links

• Borrelia Microbe Wiki Page
• NCBI Borrelia Taxonomy Browser