Borrelia burgdorferi

Borrelia burgdorferi
Scientific classification
Kingdom: Bacteria Phylum: Spirochaetes Class: Spirochaetes Order: Spirochaetales Genus: Borrelia Species: B. burgdorferi
Binomial name
Borrelia burgdorferi

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This page is about microbiologic aspects of the organism(s).  For clinical aspects of the disease, see Lyme disease.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Main article: Lyme disease microbiology

Overview

Borrelia burgdorferi is species of bacteria of the spirochete class of the genus Borrelia. B. burgdorferi is predominant in North America, but also exists in Europe, and is the agent of Lyme disease.

It is a zoonotic, vector-borne disease transmitted by ticks and is named after the researcher Willy Burgdorfer who first isolated the bacterium in 1982. B. burgdorferi is one of the few pathogenic bacteria that can survive without iron, having replaced all of its iron-sulphur cluster enzymes with enzymes that use manganese, thus avoiding the problem many pathogenic bacteria face in acquiring iron.

B. burgdorferi infections have been linked to non-Hodgkin lymphomas.

Gallery

• 
  Histopathology showing Borrelia burgdorferi spirochetes in Lyme disease. From Public Health Image Library (PHIL).
• 
  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).
• 
  “Corkscrew-shaped” bacteria known as Borrelia burgdorferi, which is the pathogen responsible for causing Lyme disease (400x mag). From Public Health Image Library (PHIL).
• 
  Facial palsy caused by an infection by the bacterial spirochete Borrelia burgdorferi, and was subsequently diagnosed with Lyme disease. From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture. From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture. From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture. From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture. From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture.From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture. From Public Health Image Library (PHIL).
• 
  Borrelia burgdorferi bacteria derived from a pure culture. From Public Health Image Library (PHIL).

Treatment

Antimicrobial regimen

• 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 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)

• 1.4 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 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)

See Also

• Allen Steere
• Jorge Benach

External Links

• NCBI Borrelia Taxonomy Browser
• Borrelia Microbe Wiki Page
• Borrelia burgdoferi B31 Genome Page

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