ABSTRACT Introduction: Brazilian borreliosis (BB) disease is an infectious disease transmitted by ticks that mimics Lyme disease (LD) from the Northern Hemisphere. The BB clinical picture is characterized by a pathognomonic skin lesion (migratory erythema) and joint, neurological, cardiac and psychiatric symptoms. Innate and Th1/Th17 adaptive immunity seem to play an important role in the pathogenesis of Lyme disease. Objective: The aim of this study was to characterize the role of innate and Th1/Th17 adaptive immunity in BB patients with acute (<3 months) and convalescent (>3 months) disease. Methods: Fifty BB patients (28 with acute and 22 with convalescent disease) without treatment and 30 healthy subjects were evaluated. Levels of 20 cytokines or chemokines associated with innate and Th1/Th17 adaptive immunity were analyzed using Luminex (Millipore Corp., Billerica, MA). Results: Overall, BB patients had increased levels of IL-8 (6.29 vs 2.12 p = 0.002) and MIP-1α/CCL3 (5.20 vs 2.06, p = 0.030), associated with innate immunity, and MIP3B/CCL19 (Th1; 297.86 vs 212.41, p = 0.031) and IL-17A (Th17; 3.11 vs 2.20, p = 0.037), associated with adaptive immunity, compared with the levels of healthy controls. When comparing acute BB vs. convalescent BB subjects vs. healthy controls, IL-1β, IL-8 and MIP-1α/CCL3 (innate mediators) levels were highest in patients in the acute phase of disease (p < 0.05). TNF-α was associated with disseminated symptoms and with humoral reactivity against Borrelia burgdorferi. IL-10 was significantly correlated with IL-6 (r = 0.59, p = 0.003), IL-8 (r = 0.51, p < 0.001), MIP-1α/CCL3 (r = 0.42, p < 0.001) and MIP-3β/CCL19 (r = 0.40, p = 0.002) in all BB patients. Conclusions: This is the first study describing that innate and Th1/Th17 adaptive immunity play a crucial role in BB disease. Furthermore, innate mediators are particularly important in acute BB disease, and TNF-α is associated with evolution of BB symptoms.

Abstract Borreliosis caused by Borrelia burgdorferi sensu lato is a cosmopolitan zoonosis studied worldwide; it is called Lyme disease in many countries of the Northern Hemisphere and Lyme-like or Baggio-Yoshinari Syndrome in Brazil. However, despite the increasing number of suspect cases, this disease is still neglected in Brazil by the medical and veterinary communities. Brazilian Lyme-like borreliosis likely involves capybaras as reservoirs and Amblyomma and Rhipicephalus ticks as vectors. Thus, domestic animals can serve as key carriers in pathogen dissemination. This zoonosis has been little studied in horses in Brazil. The first survey was performed in the state of Rio de Janeiro, and this Brazilian Borreliosis exhibits many differences from the disease widely described in the Northern Hemisphere. The etiological agent shows different morphological and genetic characteristics, the disease has a higher recurrence rate after treatment with antibiotics, and the pathogen stimulates intense symptoms such as a broader immune response in humans. Additionally, the Brazilian zoonosis is not transmitted by the Ixodes ricinus complex. With respect to clinical manifestations, Baggio-Yoshinari Syndrome has been reported to cause neurological, cardiac, ophthalmic, muscle, and joint alterations in humans. These symptoms can possibly occur in horses. Here, we present a current panel of studies involving the disease in humans and equines, particularly in Brazil.

Resumo O presente estudo investigou evidência sorológica de agentes transmitidos por carrapatos em gambás em oito municípios do Estado de São Paulo, Brasil. Amostras de soro de 109 gambás (91 Didelphis aurita e 18 Didelphis albiventris) foram testadas para detecção de anticorpos contra Rickettsia rickettsii (cepa Taiaçu, ponto de corte 1:64) Ehrlichia canis (cepa São Paulo, ponto de corte 1:40), pela reação de imunofluorescência indireta (RIFI); e contra Borrelia burgdorferi (cepa G39/40) pelo teste imunoenzimático (ELISA). A presença de anticorpos anti-R. rickettsii, anti-E. canis e anti-B. burgdorferi foi detectada em 32 (29,35%), 16 (14,67%) e 30 (27,52%) gambás, respectivamente. Os títulos finais variaram de 64 a 1.024 para R. rickettsii, de 40 a 160 para E. canis, e de 400 a >51.200 para B. burgdorferi. Esses resultados sugerem que os gambás foram expostos a agentes relacionados à Rickettsia spp., Ehrlichia spp., e B. burgdorferi no Estado de São Paulo. Neste estudo salienta a necessidade de novas pesquisas sobre esses agentes nessas áreas de trabalho, devido à ocorrência da Febre Maculosa e da Síndrome Baggio-Yoshinari em humanos no Estado de São Paulo, Brasil.

Abstract This work involved a serological investigation of tick-borne pathogens in opossums in eight municipalities of the state of São Paulo, Brazil. Serum samples from 109 opossums (91 Didelphis aurita and 18 Didelphis albiventris) were tested to detect antibodies to Rickettsia rickettsii (Taiaçu strain, 1:64 cut-off) and Ehrlichia canis (São Paulo strain, 1:40 cut-off), by indirect immunofluorescence assay (IFA); and against Borrelia burgdorferi (strain G39/40) by enzyme-linked immunosorbent assay (ELISA). The presence of antibodies to anti-R. rickettsii, anti-E. canis and anti-B. burgdorferi was detected in 32 (29.35%), 16 (14.67%) and 30 (27.52%) opossums, respectively. Opossum endpoint titers ranged from 64 to 1,024 for R. rickettsii, from 40 to 160 for E. canis, and from 400 to >51,200 for B. burgdorferi. These serological results suggest that opossums have been exposed to Rickettsia spp., Ehrlichia spp., and B. burgdorferi-related agents in the state of São Paulo. Our study underscores the need for further research about these agents in this study area, in view of the occurrence of Spotted Fever and Baggio-Yoshinari Syndrome disease in humans in the state of São Paulo, Brazil.

Descrevemos o primeiro caso brasileiro de Riquetsiose branda, agravada por monoartrite em joelho, em adulto jovem picado por carrapato na perna esquerda na região de Camburi, localizada no município de São Sebastião, sul da região costeira do estado de São Paulo, Mata Atlântica, Brasil. O paciente apresentou uma escara de inoculação no local da picada do carrapato, associada ao aumento ganglionar em virilha esquerda, febre, poliartralgia, cefaleia e erupção macular. Vinte dias após o episódio da picada de carrapato, o paciente apresentou monoartrite em joelho direito. O diagnóstico de Riquetsiose branda foi estabelecido pela análise imunológica sequencial em amostras de soro e líquido sinovial, tendo sido empregada a técnica de imunofluorescência (IF) indireta para anticorpos reativos contra Rickettsia parkeri e Rickettsia rickettsii. A Riquetsiose branda é uma zoonose emergente, que deve ser investigada pelos médicos, incluindo reumatologistas, em pacientes que apresentem erupção macular, febre e, eventualmente, artrite, após visita ao sul da região costeira da Mata Atlântica no Brasil.

We describe the first Brazilian case of mild Rickettsiosis, complicated by knee monoarthritis, in young adult bitten by a tick on his left leg in Camburi zone, located in São Sebastião municipality, southern coastal region of the State of São Paulo, in the Atlantic rainforest region, Brazil. The patient developed inoculation eschar at the tick bite site associated with enlarged lymph nodes in the left groin, fever, polyarthralgia, headache and macular rash. Twenty days after tick bite episode, he displayed monoarthritis in his right knee. The diagnosis of mild Rickettsiosis was established by sequential immunological analysis in serum and synovial fluid, using the indirect immunofluorescence (IF) assay for antibodies reactive with Rickettsia parkeri and Rickettsia rickettsii. The mild Rickettsiosis is an emerging zoonosis, that must be investigated by physicians, including rheumatologists, in patients that present macular rash, fever and eventually arthritis, after visiting the southern coastal Atlantic rainforest region in Brazil.

O principal objetivo do estudo foi avaliar a presença de infecção por Borrelia burgdorferi em vertebrados domésticos e silvestres e ectoparasitas em áreas endêmicas do estado de Minas Gerais, Brasil. Um total de 445 amostras de soro foram examinadas por ELISA, onde usou-se a cepa americana G39/40 de Borrelia burgdorferi e 3.821 amostras de carrapatos foram testados pela reação em cadeia da polimerase (PCR). Anticorpos anti -B. burgdorferi foram encontrados em 30 amostras de soro (6,74%); três marsupiais (7,69%), três em roedores (2,80%), em nove cães (6,25%) e 15 em cavalos (9,68%). Nested-PCR realizada em amostras de DNA obtidas a partir de carrapatos coletados demonstraram resultados negativos. Apesar das tentativas para amplificar o DNA de B. burgdorferi a partir de carrapatos não tenha sido bem sucedido, a presença de soroatividade em vertebrados sugere a possibilidade de espécies de Borrelia circulando nestas regiões. Mais pesquisas são necessárias para fornecer informações sobre a presença de Borrelia em território brasileiro e sua associação com a Síndrome de Baggio-Yoshinari.

The main of the study was to evaluate the presence of Borrelia burgdorferi infection in domestic and wild vertebrates and ectoparasites in endemic areas from the state of Minas Gerais, Brazil. A total of 445 serum samples were examined by ELISA, which used the Borrelia burgdorferi strain G39/40 U.S. source and 3,821 tick samples were tested by polymerase chain reaction (PCR). B. burgdorferi antibodies were found in 30 serum samples (6.74%); three in marsupials (7.69%), three in rodents (2.80%), nine in dogs (6.25%), and 15 in horses (9.68%). Nested-PCR performed in DNA samples obtained from collected ticks demonstrated negative results. Although attempts to amplify B. burgdorferi DNA from ticks had been not successful, the presence of seroreactive vertebrates suggests the possibility the Borrelia species circulating in these regions. Further research is required to provide information on the presence of Borrelia in Brazilian territory and its association with Baggio-Yoshinari syndrome.

A borreliose humana brasileira, também conhecida como Síndrome de Baggio-Yoshinari (SBY), é uma enfermidade infecciosa própria do território brasileiro, transmitida por carrapatos não pertencentes ao complexo Ixodes ricinus, causada por espiroqueta do gênero Borrelia e que apresenta semelhanças clínicas e laboratoriais com a Doença de Lyme (DL). A SBY distingue-se da DL por apresentar evolução clínica prolongada, com episódios de recorrência e importante disfunção autoimune. Descreveremos o caso de uma paciente jovem, que desenvolveu progressivamente durante cerca de um ano oligoartrite de grandes articulações, seguida de distúrbio do cognitivo, meningoencefalite e eritema nodoso. O diagnóstico foi firmado devido à concomitância de queixas articulares e neurológicas com sorologia positiva para Borrelia burgdorferi sensu stricto. A paciente foi medicada com ceftriaxone 2 g/EV/dia por 30 dias, seguido de dois meses de doxiciclina 100 mg duas vezes ao dia. Houve remissão dos sintomas e normalização dos exames sorológicos para a borreliose. A SBY é uma zoonose emergente descrita apenas no Brasil, cuja frequência tem crescido bastante, e que, em razão das importantes diferenças nos aspectos epidemiológicos, clínicos e laboratoriais em relação à DL, merece especial atenção da classe médica do país. Trata-se de zoonose camuflada e de difícil diagnóstico, mas este deve ser perseguido com tenacidade, pois a enfermidade responde aos antibióticos no estágio inicial, podendo evoluir com sequelas neurológicas e articulares nos casos reconhecidos tardiamente ou recorrentes.

The Brazilian human borreliosis, also known as Baggio-Yoshinari Syndrome (BYS), is a tickborne disease but whose ticks do not pertain to the Ixodes ricinus complex. It is caused by Borrelia burgdorferi sensu lato microorganisms and resembles clinical and laboratory features of Lyme disease (LD). BYS is also distinguished from LD by its prolonged clinical evolution, with relapsing episodes and autoimmune dysfunction. We describe the case of a young female who, over one year, progressively presented with oligoarthritis, cognitive impairment, menigoencephalitis and erythema nodosum. Diagnosis was established by means of the clinical history and a positive serology to Borrelia burgdorferi sensu strictu. The patient received Ceftriaxone 2 g IV/day during 30 days, followed by 2 months of doxicycline 100 mg bid. Symptoms remitted and the Borrelia serology tests returned to normality. BYS is a new disease described only in Brazil, which has a raising frequency and deserves the attention from the country´s medical board because of clinical, epidemiological and laboratory differences from LD. Despite the fact that it is a hard-to-diagnose zoonosis, it is important to pursuit an early diagnosis because the symptoms respond well to antibiotics or it might be resistant to treatment and may evolve to a chronic phase with both articular and neurological sequelae.

O objetivo do estudo foi avaliar o perfil epidemiológico, clínico e laboratorial dos pacientes com Síndrome Baggio-Yoshinari (SBY), internados no Instituto de Infectologia Emilio Ribas, São Paulo, Brasil, no período de julho de 1990 a julho de 2006. SBY é uma nova doença transmitida por carrapatos, causada pela Borrelia burgdorferi sensu lato, que se assemelha a Doença de Lyme (DL), exceto pelas particularidades epidemiológicas, clínicas e laboratoriais. A partir dos registros de 60 pacientes com sorologia positiva para B. burgdorferi pelos métodos de ELISA e Western-blotting, 19 casos foram diagnosticados como SBY, de acordo com critérios adotados pelo LIM-17 HCFMUSP, laboratório de referência para a pesquisa de SBY no Brasil. Os outros 41 pacientes restantes foram classificados como tendo infecções diversas ou processos auto-imunes. O início dos sintomas no grupo SBY variou de um dia a seis anos. Quatro dos 19 pacientes foram incluídos na fase aguda da doença e 15 na fase latente. Os sintomas gerais inespecíficos foram identificados em quase todos os casos, com altas freqüências de febre (78,9%) e linfoadenomegalia (36,8%). Seis pacientes tiveram lesões de pele (31,5%); seis artralgia ou artrite (31,5%) e oito sintomas neurológicos (42%). Curiosamente, dois pacientes apresentaram anticorpos para B. burgdorferi exclusivamente no líquido cefalorraquidiano. Uma vez que a SBY é uma zoonose emergente brasileira e seu diagnóstico é complexo, todo o conhecimento novo sobre SBY deve ser difundido para os médicos brasileiros, com o objetivo de ensiná-los a diagnosticar esta surpreendente doença transmitida por carrapatos, evitando-se a sua progressão para sequelas crônicas irreversíveis.

The aim of this study was to evaluate the epidemiological, clinical and laboratorial profile of patients with Baggio-Yoshinari Syndrome (BYS), who underwent internment at the Instituto de Infectologia Emilio Ribas in São Paulo, Brazil, during the period from July 1990 to July 2006. BYS is a new Brazilian tick-borne disease caused by Borrelia burgdorferi sensu lato microorganisms that resembles features of Lyme disease (LD), except for its epidemiological, clinical and laboratorial particularities. From 60 patients' records with positive serology to B. burgdorferi done by ELISA and Western-blotting methods, 19 cases were diagnosed as having BYS, according to criteria adopted at LIM-17 HCFMUSP, the Brazilian Reference Laboratory for the research of BYS. The other 41 remaining patients displayed miscellaneous infections or auto-immune processes. The beginning of symptoms in BYS group varied from one day to six years, from the onset of the disease. Four of 19 patients were included in acute disease stage, and 15 in latent. General unspecific symptoms were identified in almost all cases, with high frequencies of fever (78.9%) and lymphadenomegaly (36.8%). Six patients had skin lesions (31.5%); six arthralgia or arthritis (31.5%) and eight neurological symptoms (42%). Interestingly, two patients showed antibodies directed to B. burgdorferi exclusively in cerebrospinal fluid. Since BYS is a new emergent Brazilian zoonosis and its diagnosis is sometimes complex, all the new knowledge about BYS must be scattered to Brazilian Medical specialists, aiming to teach them how to diagnose this amazing tick-borne disease and to avoid its progression to chronic irreversible sequels

The aim of the present paper was to evaluate cyst formation and growth parameters of Borrelia garinii in a range of media differing in formulation and cost. A qualitative assessment of morphology and motility of B. garinii was conducted. All media were prepared aseptically and used in test tubes or Petri dishes. For each medium, the initial spirochete concentration was standardized to 10³ spirochets/mL. The following culture media were suitable to grow B. garinii: Barbour-Stoenner-Kelly, brain heart infusion and PMR. Growth was minimal at six weeks post-inoculation and maximum spirochete density was observed between 9-12 weeks. Often, the cultures developed cysts of different sizes, isolated or in groups, with a spiraled portion of variable sizes, mainly in unfavorable culture media. Brazilian Lyme disease-like illness, also known as Baggio-Yoshinari syndrome (BYS), is a new and interesting emerging tick-borne disease, caused by Borrelia burgdorferi sensu lato spirochetes, only during its cystic forms. It has been assumed that the peculiar clinical and laboratory features of BYS are consequential to the absence of a human sucker Ixodes ricinus complex tick at risk areas in Brazil, supporting the concept that the borrelia phenotypic expression pattern is modified as it is transmitted through the host.

A Doença de Lyme (DL) é uma zoonose frequente no hemisfério Norte e considerada uma enfermidade infecciosa causada por espiroquetas do complexo Borrelia burgdorferi sensu lato e transmitida pela picada de carrapatos do grupo Ixodes ricinus. Os primeiros casos semelhantes à DL no Brasil foram descobertos, em 1992, em irmãos que após serem picados por carrapatos desenvolveram eritema migratório, sintomas gripais e artrite. Criteriosa análise da casuística brasileira, mostrou que os aspectos epidemiológicos, clínicos e laboratoriais no país, divergiam bastante dos exibidos pelos pacientes com DL nos Estados Unidos da América e Eurásia. Não foram encontrados carrapatos do complexo Ixodes ricinus hematófago ao homem nas áreas de risco; a enfermidade no país é recorrente; a Borrelia burgdorferi jamais foi isolada no Brasil e os ensaios sorológicos específicos exibem positividade baixa e oscilante. Além disso, o exame do sangue periférico dos pacientes quando analisados à microscopia eletrônica exibe estruturas sugestivas de Mycoplasma spp, Chlamydia spp e bacteroides. Na verdade, estas estruturas podem representar as formas latentes das espiroquetas (forma L ou bactérias desprovidas de parede), adaptadas a sobreviver em condições inóspitas em hospedeiros vertebrados e invertebrados. Assim, a zoonose presente no país recebeu a denominação de Síndrome Baggio-Yoshinari e definida como: "Enfermidade infecciosa nova e emergente brasileira, transmitida por carrapatos não pertencentes ao complexo Ixodes ricinus, causada por espiroquetas na sua morfologia atípica e latente, que origina manifestações clínicas semelhantes às observadas na DL, exceto pela ocorrência de recidivas clínicas e desordens autoimunes".

Lyme disease (LD) is a frequent zoonosis found in the Northern Hemisphere and is considered an infectious disease caused by spirochetes belonging sensu lato to the Borrelia burgdorferi complex transmitted by ticks of the Ixodes ricinus group. In 1992, first cases similar to LD were described in Brazil, when brothers, after a tick bite episode developed symptoms , as erythema migrans, general flu-like symptoms and arthritis. Careful analysis of Brazilian LD-like illness casuistry showed that epidemiological, clinical and laboratorial features in the country were very different from those exhibited by North American and Eurasian LD patients. Human blood-suckers Ixodes ricinus complex ticks were absent at risk areas; the disease is recurrent in the country; Borrelia burgdorferi was never isolated in Brazil and specific serologic tests have shown little positivity with inconsistent results. Furthermore, peripheral blood analysis of patients on electron microscopy exhibited structures resembling Mycoplasma spp, Chlamydia spp and spirochete-like microorganisms. In fact, they were assumed to be latent forms of spirochetes (L form or cell wall deficient bacteria) adapted to survive at inhospitable conditions in vertebrate and invertebrate hosts. For these reasons, the Brazilian zoonosis was named Baggio-Yoshinari Syndrome (BYS) and defined as: "Exotic and emerging Brazilian infectious disease, transmitted by ticks not belonging to the Ixodes ricinus complex, caused by latent spirochetes with atypical morphology, which originates LD-like symptoms, except for occurrence of relapsing episodes and auto-immune disorders".

Relata-se inusitado achado de micro-organismos, semelhantes às espiroquetas, móveis e de diferentes morfologias e tamanhos, identificados pela microscopia de campo escuro, no sangue de animais do Centro de Bioterismo da Faculdade de Medicina da USP. As bactérias não crescem em meios habituais de cultivo, são pouco coradas pelo Giemsa e derivados da prata, e as provas sorológicas e moleculares foram negativas para Borrelia e Leptospira. A microscopia eletrônica revelou presença de micro-organismos com morfologia de Mycoplasma e, devido à sua mobilidade, sugeriu-se a presença de Mollicutes do gênero Spiroplasma. Visualizaram-se micro-organismos com mesmas características em 15 dos 26 funcionários (57,6%) do Centro de Bioterismo da FMUSP; contudo, exames clínicos e laboratoriais indicaram que os indivíduos estavam saudáveis. Estudos adicionais desenvolvidos na Disciplina de Reumatologia da FMUSP mostraram que, aproximadamente, 94% dos pacientes com Síndrome Baggio-Yoshinari (SBY) e 20% dos indivíduos normais também exibiam as mesmas estruturas identificadas no Centro de Bioterismo. A microscopia eletrônica realizada com amostras de pacientes com SBY mostrou bactérias que apresentam semelhanças com Mycoplasma, Chlamydia e Bacteroides. Visto que as sorologias e os testes moleculares foram negativos para estes contaminantes e com base em publicações da literatura médica, sugeriu-se que estes agentes infecciosos latentes fossem bactérias na sua apresentação L, que são definidas como bactérias despojadas de parede celular, assumindo, assim, morfologia de Mycoplasma, sendo, na maioria dos casos, inofensivas aos hospedeiros. Concluímos que os "espiroquetídeos" visualizados em animais e funcionários do Centro de Bioterismo seriam bactérias na forma L, não patogênicas, provenientes de contaminantes do meio ambiente, infecções regulares habituais ou oriundos de micro-organismos endógenos da flora saprofítica normal. Ao contrário, os "espiroquetídeos" identificados na SBY, ao preservarem a capacidade de invadir células in vitro, são potencialmente patogênicos e relacionados com a etiologia da SBY. Interpretamos a SBY como zoonose nova e particular ao território brasileiro, causada por espiroquetas adaptadas às formas latentes, possivelmente provenientes de mutações bacterianas em resposta às condições ecológicas e geográficas próprias do país.

We report the unusual finding of mobile spirochetal microorganisms with different morphologies and sizes, on dark-field microscopy of the blood of animals from the Vivarium of the Medical School of USP. The bacteria did not grow in common culture media, shows faint staining to Giemsa and silver-derived stains, and serologies and molecular tests were negative for Borrelia and Leptospira. Electron microscopy revealed the presence of microorganisms with Mycoplasma-like morphology and, due to its mobility, it was suggested that they represented Mollicutes of the genus Spiroplasma. Microorganisms with the same morphology were also observed in 15 out of 26 employees (57.6%) of the Vivarium of FMUSP; however, clinical and laboratorial exams indicated that those individuals were healthy. Additional studies undertaken at the Rheumatology Department of FMUSP demonstrated the presence of the same structures identified at the Vivarium in approximately 94% of the patients with Baggio-Yoshinary syndrome (BYS) and 20% of healthy individuals. Electron microscopy of the blood of BYS patients showed bacteria that shared similarities with Mycoplasma, Chlamydia, and Bacteroides. Since serologies and molecular tests were negative for those contaminants, and based on publications in the medical literature, it was suggested that those latent infectious agents were L-form bacteria, defined as cell wall deficient bacteria, assuming, therefore, Mycoplasma morphology and they are, for the most part, harmless to the host. We concluded that spirochetal microorganisms visualized in animals and employees of the Vivarium were non-pathogenic L-form bacteria from contaminants in the environment, regular infections, or endogenous microorganism from the normal saprophytic flora. On the other hand, spirochetal organisms identified in BYS, by preserving the capacity to invade cells in vitro, are potentially pathogenic and related to the etiology of BYS. We consider BYS as a novel Brazilian zoonosis caused by spirochetes adapted to their latent form, possibly due to bacterial mutations in response to ecologic and geographic conditions unique to Brazil.

INTRODUÇÃO: A doença de Lyme (DL) é uma doença de picada de carrapato, causado pela espiroqueta Borrelia burgdorferi sensu lato, transmitida por carrapatos do complexo Ixodes ricinus, que promove múltiplas manifestações clínicas sistêmicas. No Brasil, uma síndrome diferente é descrita e mimetiza sintomas de DL, mas também se manifesta com alta frequência de episódios recorrentes e manifestações alérgicas e imunológicas. É transmitida pelo carrapato Amblyomma cajennense e o agente etiológico é uma espiroqueta não cultivável de forma atípica. Devido a essas particularidades, esta zoonose emergente tem sido denominada síndrome brasileira semelhante à doença de Lyme ou síndrome de Baggio-Yoshinari (SBY). OBJETIVO: Descrever o espectro da manifestação neurológica da SBY. PACIENTES: Foram analisados 30 pacientes com SBY e sintomas neurológicos. RESULTADOS: A média de idade dos pacientes foi de 34,2 ± 13,3 anos (6 a 63 anos); 20 eram mulheres e 10 homens. Um alto número de episódios recorrentes (73,6%) e distúrbios psiquiátricos e psicossociais graves (20%) foram características típicas. Eritema migrans similar ao visto em hemisfério norte foi identificado em 43,3% dos pacientes no início da doença. A recorrência das lesões cutâneas diminuiu com a progressão da doença. Sintomas articulares (artrite) aconteceram em aproximadamente metade dos pacientes com SBY no início e durante o episódio de recidiva. CONCLUSÕES: A SBY é considerada uma nova doença transmitida por carrapato no Brasil que difere da clássica DL observada no hemisfério norte. A SBY reproduz sintomas neurológicos observados na DL, exceto pela presença adicional de recorrência de episódios e uma tendência de causar manifestações neurológicas crônicas e articulares.

INTRODUCTION: Lyme disease (LD) is a tick-borne disease, caused by Borrelia burgdorferi sensu lato spirochetes, transmitted by Ixodes ricinus complex ticks, which leads to multiple systemic clinical manifestations. In Brazil, a different syndrome is described that mimics LD symptoms, but that also manifests high frequencies of recurrent episodes and immune-allergic manifestations. It is transmitted by the Amblyomma cajennense tick and the etiological agent is an uncultivable spirochete with atypical morphology. Due to its particularities, this emerging zoonosis has been called Brazilian LD-like syndrome or Baggio-Yoshinari Syndrome (BYS). OBJECTIVE: To describe the neurological spectrum of BYS. PATIENTS: Thirty patients with neurological symptoms of BYS were analyzed. RESULTS: Mean age of patients was 34.2 ± 13.3 years old (6 to 63 years); 20 were females and 10 males. A high number of recurrent episodes (73.6%) and severe psychiatric or psycho-social disturbances (20%) were distinguishing features. Erythema migrans similar to those seen in the Northern hemisphere was identified in 43.3% of patients at disease onset. The recurrence of skin lesions diminished as the disease progressed. Articular symptoms (arthritis) happened in nearly half of patients at BYS onset and during relapsing episodes. CONCLUSIONS: The BYS is considered a new tick borne disease in Brazil that differs from classical LD observed in the Northern hemisphere. BYS replicates most of the neurological symptoms observed in LD, except for the additional presence of relapsing episodes and the tendency to cause chronic neurological and articular manifestations.

INTRODUCTION/OBJECTIVES: Systemic sclerosis, or scleroderma, is a rheumatic disease characterized by autoimmunity, vasculopathy, and fibrosis of the skin and several internal organs. In the present study, our aim was to assess the skin alterations in animals with scleroderma during the first stages of disease induction. METHODS: To induce scleroderma, female New Zealand rabbits (n = 12) were subcutaneously immunized with 1 mg/ml of collagen V (Col V) in complete Freund's adjuvant, twice with a thirty-day interval. Fifteen days later, the animals received an intramuscular booster with type V collagen in incomplete Freund's adjuvant, twice with a fifteen-day interval. The control group was inoculated with 1 ml of 10 mM acetic acid solution diluted with an equal amount of Freund's adjuvant. Serial dorsal skin biopsies were performed at 7, 15, and 30 days and stained with H&E, Masson's trichrome and Picrosírius for morphological and morphometric analyses. RESULTS: Immunized rabbits presented a significant increase in collagen in skin collected seven days after the first immunization (p=0.05). CONCLUSION: The results from this experimental model may be very important to a better understanding of the pathogenic mechanisms involved in the beginning of human SSc. Therapeutic protocols to avoid early remodeling of the skin may lead to promising treatments for SSc in the future.

Doenças transmitidas por carrapatos vêm sendo um importante problema de saúde pública no mundo. A Febre Maculosa Brasileira (FMB) representa um sério risco epidemiológico devido às altas taxas de letalidade apresentadas. As capivaras são freqüentemente incriminadas como possíveis reservatórios no ciclo de transmissão da FMB. Nas últimas décadas o número desses animais cresceu intensamente e eles invadiram os espaços humanos. As capivaras intensificam o contato entre carrapatos e seres humanos na medida em que se apresentam muito infestadas por estes parasitos. O objetivo deste estudo é contribuir para o conhecimento do possível papel desempenhado por este roedor na epidemiologia da FMB em algumas áreas da região de Campinas, SP. Foi estudada a infecção das capivaras por rickettsias do grupo da FMB, por meio da análise das freqüências de anticorpos contra este grupo, nestes animais, e dados da vigilância epidemiológica de casos humanos. A freqüência desses anticorpos variou amplamente entre as localidades, entretanto, só foram encontrados soros com anticorpos com titulagem =64 naquelas onde havia notificação de casos humanos. Estes achados sugerem que a capivara poderá ser um animal sentinela. No entanto, devido à ocorrência de reação cruzada entre os microorganismos do grupo de FM estes resultados devem ser interpretados com cautela e são necessários métodos capazes de distinguir rickettsias patogênicas.

Diseases transmitted by ticks have been an important health problem all over the world. Brazilian Spotted Fever (BSF) stands for a serious epidemiological concern due to the high mortality rates pointed out. Capybaras are commonly incriminated as possible reservoirs in the BSF transmission cycle. In the last decades the numbers of these animals raised sharply and they have invaded human areas. They intensify the contact between ticks and humans beings. This study aim is to contribute to the possible role performed for this rodent in the BSF epidemiology in some areas located in Campinas region, São Paulo. Cabybaras infected by rickettsiae of BSF group were studied through the analysis of the frequencies of BSF-group rickettisae antibodies titer = 64 by indirect immunofluorescence test (IFA), and data from human cases epidemiological surveillance. The serum frequency positiveness varied greatly according to areas where animals were captured. However it was found serum positiviness only in the areas where human cases of BSF were reported. These findings suggest the capybara may be seen as sentinel animal. Due to presence of serological cross reactivity between microorganisms belonging to SF group, the results must be interpreted carefully and additional methods to distinguish pathogenic rickettsiae are required in our country.

A ocorrência de manifestações clínicas e laboratoriais semelhantes às encontradas na doença de Lyme e da coinfecção com a babesiose já foi demonstrada em trabalhos anteriores em adultos, porém não existem estudos desta natureza em crianças. OBJETIVO: Caracterizar o perfil clínico-epidemiológico da síndrome de Lyme-Símile em crianças do Estado de Mato Grosso do Sul e avaliar a prevalência dos anticorpos anti-Borrelia burgdorferi e anti-Babesia bovis no soro de pacientes que preencheram os critérios estabelecidos. MÉTODOS: 100 pacientes entre 9 meses e 16 anos de idade foram submetidos à pesquisa dos anticorpos pela técnica de ELISA e a soroprevalência foi comparada com um grupo-controle. RESULTADOS: Positividade para anticorpos anti-B. burgdorferi ocorreu em 27% dos pacientes com suspeita clínica, sendo 17% IgM e 12% IgG. As manifestações articulares ocorreram em 21 pacientes, as manifestações cutâneas em três pacientes e as manifestações neurológicas em três pacientes. A prevalência de anticorpos contra B. burgdorferi nos pacientes do grupo-controle foi de 15% (p < 0,05). Os anticorpos anti-B. bovis estiveram presentes em 24% dos pacientes suspeitos e em 3% do grupo-controle (p < 0,05). Concomitância dos anticorpos ocorreu em 10 pacientes com suspeita clínica e em nenhum controle. CONCLUSÃO: Os resultados deste estudo evidenciam a etiologia de caráter infeccioso e reacional das manifestações clínicas encontradas nos pacientes, podendo caracterizar uma síndrome, que possivelmente ocorra na presença de múltiplos microrganismos e está relacionada com carrapatos. Foi encontrada freqüência superior de anticorpos contra Borrelia e Babesia nos pacientes em relação aos controles. Embora pequena, essa diferença foi estatisticamente significante. Este achado não atesta que o quadro clínico dos pacientes seja causado por espécies de Borrelia ou Babesia, mas levantam a possibilidade de participação de algum agente infeccioso que possa estar relacionado a esses microrganismos. Os estudos devem prosseguir para melhorar a delineação desta síndrome em nosso meio, assim como isolar o agente etiológico.

The occurence of clinical and laboratory manifestations similar to the Lyme disease and the coinfection with babesiosis was already demonstraded in previous researches with adult patients. However, there are no studies in children. OBJECTIVE: To identify the clinical-epidemiological profile of the Lyme Simile Syndrome in children of the State of Mato Grosso do Sul and to evaluate the prevalence of antibodies against Borrelia burgdorferi and Babesia bovis in the serum of patients that had fulfilled the established criteria. METHODS: One hundred patients (age range: 9 months and 16 years-old) were screened for the presence of those antibodies, using ELISA, comparing to a control group. RESULTS: Antibodies against B. burgdoferi were found in 27% of the patients with a clinical picture. The articular manifestations occurred in 21 patients, cutaneous in 3 and neurological in 3. The prevalency in the control group was 15% (p < 0.05). The antibodies for Babesia bovis were present in 24% of suspect patients and in 3% of the control group (p < 0.05). Concomitance of the two antibodies occurred in 10 patients with clinical suspect and no one of control group. CONCLUSION: The results found in this study suggest the infective and reactive character of the clinical manifestations of the patients, which can characterize a Syndrome, which possibly occurs in the presence of multiple microorganisms that can be associated with tick-borne. It was found a higher frequency of antibodies against borrelia and babesia in patients in relation to the controls. Although small, this difference was statistically significant. This finding does not certify that the clinical features of patients is caused by species of borrelia or babesia, but raised the possibility of involvement of some infectious agent that could be related to these micro-organisms. The studies should continue in order to improve the delineation of this syndrome and to try the isolation of the etiologic agent in our State.