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] Template:Seealso

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

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  Histopathology showing Borrelia burgdorferi spirochetes in Lyme disease. 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).

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  “Corkscrew-shaped” bacteria known as Borrelia burgdorferi, which is the pathogen responsible for causing Lyme disease (400x mag). From Public Health Image Library (PHIL).

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  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).

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  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)

Lyme neuroborreliosis

• 1. Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines

• 1.1 Early neurologic disease

• 1.1.1 Cranial nerve palsy (adult)

• Preferred regimen (1): Amoxicillin 500 mg PO tid for 14 (14–21) days

• Preferred regimen (2): Doxycycline 100 mg PO bid for 14 (14–21) days

• Preferred regimen (3): Cefuroxime 500 mg PO bid for 14 (14–21) days
• Alternative regimen (1): Azithromycin 500 mg PO qd for 7–10 days

• Alternative regimen (2): Clarithromycin 500 mg PO bid for 14–21 days (not for pregnant)

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

• 1.1.2 Cranial nerve palsy (pediatric)

• Preferred regimen (1): Amoxicillin 50 mg/kg/day PO tid (Maxmum, 500 mg/dose) for 14 (14–21) days

• Preferred regimen (2): Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h (Maxmum, 100 mg/dose) for 14 (14–21) days

• Preferred regimen (3): Cefuroxime 30 mg/kg/day PO q12h (Maxmum, 500 mg/dose) for 14 (14–21) days
• Alternative regimen (1): Azithromycin 10 mg/kg/day PO (Maxmum, 500 mg/dose) for 7–10 days

• Alternative regimen (2): Clarithromycin 7.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days

• Alternative regimen (3): Erythromycin 12.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days

• 1.1.3 Meningitis or radiculopathy (adult)

• Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
• Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days

• Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
• Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.

• 1.1.4 Meningitis or radiculopathy (pediatric)

• Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days
• Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6-8h (Maxmum, 6 g/day) for 14 (10–28) days

• Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
• Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered

• 1.2 Late neurologic disease

• 1.2.1 Central or peripheral nervous system disease (adult)

• Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
• Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days

• Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days

• 1.2.2 Central or peripheral nervous system disease (pediatric)

• Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days.
• Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6–8h (Maxmum, 6 g/day) for 14 (10–28) days

• Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days

• 2. American Academy of Neurology (AAN) Practice Parameter

• 2.1 Meningitis

• Preferred regimen (1): Ceftriaxone 2 g IV q24h for 14 days

• Preferred regimen (2):Cefotaxime 2 g IV q8h for 14 days

• Preferred regimen (3):Penicillin G 18–24 MU/day q4h for 14 days
• Alternative regimen: Doxycycline 100–200 mg BID for 14 days
• Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day

• 2.2 Any neurologic syndrome with CSF pleocytosis

• Preferred regimen (1): Ceftriaxone 2 g IV q24h for 14 days

• Preferred regimen (2): Cefotaxime 2 g IV q8h for 14 days

• Preferred regimen (3): Penicillin G 18–24 MU/day IV q4h for 14 days
• Alternative regimen: Doxycycline 100–200 mg BID for 14 days
• Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day

• 2.3 Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)

• Preferred regimen: Doxycycline 100–200 mg BID for 14 days
• Alternative regimen (1): Ceftriaxone 2 g IV q24h for 14 days

• Alternative regimen (2): Cefotaxime 2 g IV q8h for 14 days

• Alternative regimen (3): Penicillin G 18–24 MU/day IV q4h for 14 days
• Pediatric regimen: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day

• 2.4 Encephalomyelitis

• Preferred regimen (1): Ceftriaxone 2 g IV q24h for 14 days

• Preferred regimen (2): Cefotaxime 2 g IV q8h for 14 days

• Preferred regimen (3): Penicillin G 18–24 MU/day q4h for 14 days
• Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day

• 2.5 Encephalopathy

• Preferred regimen (1): Ceftriaxone 2 g IV q24h for 14 days

• Preferred regimen (2): Cefotaxime 2 g IV q8h for 14 days

• Preferred regimen (3): Penicillin G 18–24 MU/day q4h for 14 days
• Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day

• 2.6 Post-treatment Lyme syndrome

• Preferred regimen: symptomatic management
• Note: Antibiotic therapy is not indicated.

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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