CLINICAL AND SEROLOGIC FEATURES OF LYME BORRELIOSIS IN RUSSIA

Objective. To describe clinical and serologic features of Lyme borreli osis, particularly the joint abnormalities, in Russian patients. Metho ds. Physicians were invited to refer patients with past or present ery thema migrans to the Rheumatology Institute in Moscow; field studies w ere done of residents in an area endemic for Lyme borreliosis, and a s erosurvey was conducted of patients with nonspecific neurologic, cardi ac, or joint symptoms. Serologic testing was done by ELISA and Western blotting using a strain of Borrelia afzelii, a member of the B. burgd orferi sensu late complex, recovered from ticks from the field study s ite. Results. Of 86 patients with erythema migrans, neurologic abnorma lities developed in 26 (30%), cardiac involvement in 5 (6%), arthritis or arthralgia in 35 (41%), and acrodermatitis in 2 (2%). Joint involv ement was usually characterized by one or a few brief episodes of join t swelling or pain in one large joint at a time. However, 69 of the 86 patients (80%) received antibiotic therapy early in the infection. Th e majority of patients with active infection had elevated levels of Ig M or IgG antibody to B. afzelii by ELISA, and those with late infectio n often had IgG reactivity with greater than or equal to 5 spirochetal proteins, particularly the 37, 39, 41, 60, and 93 kDa antigens. In a serosurvey of 75 patients with facial palsy, atrioventricular block, o r arthritis or arthralgia of uncertain cause, 6 had IgG reactivity wit h greater than or equal to 5 spirochetal proteins. Conclusion. Lyme bo rreliosis in Russia is similar to that in other parts of Europe. Brief episodes of arthritis or arthralgia were a common feature of the illn ess.