REINFECTION WITH BORRELIA-BURGDORFERI IN AN IMMUNOCOMPETENT PATIENT

A 54-year-old patient with an intact immune system developed Lyme dise ase three times within 4 years. The first time an erythema migrans occ urred, which was successfully treated with oral doxycyclin (100 mg twi ce daily for 20 days). Specific antibodies were subsequently demonstra ted. Re-infection nonetheless occurred a year later, again as erythema migrans. Oral doxocyclin in higher dosage (three times 100 mg daily f or 20 days) failed to prevent generalization of the infection with rig or, head and neck aches, myalgia, fatigue and subfebrile temperatures. There was a marked increase in Borrelia-specific antibody titre. Pare nteral treatment with cefotaxim (twice daily 3 g for 12 days) was cura tive. But 2 years later yet another re-infection occurred with classic erythema migrans, which regressed under doxocyclin. - The course of t he disease in this case demonstrates that Borrelia-specific antibodies do not always protect against re-infection. This may have consequence s for the possible development of a vaccine.