Summary " This study represents the first serologic report of antiborrelial antibodies in Cuba. It suggests that Lyme borreliosis is present and that new cases can be expected in our country. Further laboratory studies are necessary for a more accurate diagnosis of this emerging infectious disease in Cuba."
LETTERS To the Editor: Lyme disease is the most common vector-borne disease in the United States and parts of Eurasia (1). It represents a considerable emerging infectious disease threat because of its consequences to human health and the difficulties in preventing and controlling it (2,3).
In Cuba, Lyme borreliosis has never been reported. However, in the last 20 years ixodid ticks, mainly Amblyomma cajennenses, have been found in the human population in the Cuban village of Las Terrazas, Pinar del Río. These ixodid bites were frequent and widespread, especially in children, many of whom were hospitalized without a confirmatory laboratory diagnosis. Affected persons had symptoms associated with Lyme disease such as erythematous macules or papules, fever, fatigue, malaise, headache, arthralgias, myalgias, meningitis, peripheral radiculoneuropathies, and myocarditis (4).
A Cuban researcher, a specialist in ixodid ticks, was bitten several times by the ticks; dermatologic and neurologic symptoms compatible with
Lyme disease (skin lesions, hyperesthesia with loss of reflexes, loss of muscular coordination, and fecal incontinence) developed. Borreliosis was not diagnosed at this stage; the diagnosis was either myeloradiculitis or Guillain-Barré syndrome. Three years later, a serologic diagnosis of Lyme disease was made by indirect immunofluorescence in a laboratory in the Czech Republic (5).
During 1998, serum samples from 14 persons who lived in the village Las Terrazas and had epidemiologic and clinical evidence of Lyme disease, were studied in our laboratory.
We used an immunoglobulin (Ig) G and IgM�``enzyme-linked immunoabsorbent assay (ELISA) kit (Enzygnost Borreliosis, Behring, Marburg, Germany), in which each strip contained wells coated with inactivated borrelial antigen (detergent extract from strain isolate PKo [Borrelia afzelii]), to detect specific antibodies to B. burgdorferi complex. The assays were performed according to the manufacturer’s instructions. In our study, five serum samples had positive IgM titers and one near the cutoff value by IgM and IgG.
ELISA has been widely used to detect antibodies to B. burgdorferi; however, this assay is not standardized, which results in different levels of sensitivity and specificity. Falsepositive results may occur, especially when serum samples are obtained from persons with other illnesses (6).
To study possible cross-reactions with other infectious illnesses, different serologic tests were applied to the positive serum samples by using ELISA. One sample was weakly reactive to human leptospirosis (indirect hemagglutination assay with erythrocyte- sensitive substance antigen [Labiofam, Havana, Cuba]), but no samples were reactive to syphilis (rapid plasma reagin [Imefa, Havana, Cuba] and hemagglutination of Treponema pallidum [Oxoid, Diagnostic Reagents, Basingstoke, UK]). No indication of other infectious diseases was found.
All serum samples positive by ELISA were also analyzed by IgG and IgM Western blotting in the spirochete laboratory at the University of Trieste, Italy. The Western blotting was performed with a protein profile from whole�``cell strain PKo and by applying the criteria of positivity described by Hauser et al. (7). Two serum samples showed clear IgM antibody bands to 41- and 23-kDa proteins. No IgG bands were observed. This test reportedly is more sensitive than ELISA for IgM detection (6).
We investigated the clinical manifestations of the patients with positive Western blotting. We found that one of the patients had been bitten several times by ticks and had an erythematous rash around the different bite sites; the rashes reddened and expanded over the course of a few days, with partial central clearing.
The patient also had fever, hepatosplenomegaly, adenopathies, joint pain, and some nonspecific symptoms. He was given erythromycin before the laboratory results were confirmed and had a satisfactory recovery. In similar situations, repeat testing would be highly advisable. This was the same patient with low levels of antibodies to Leptospira. Investigating the symptoms of the other patient was not possible. The presence of IgM antibodies is frequently confirmed in the early stage of Lyme disease (6). The patient’s history of being bitten by an A. cajennenses tick, clinical manifestations of Lyme borreliosis, and specific antibodies to B. burgdorferi complex suggest the diagnosis of Lyme disease.
A. cajennenses has not been reported as a vector for Lyme disease.
However, it is very abundant and aggressive in Cuba, and bites from this species are common. The genus Ixodes, the main vector of B. burgdorferi sensu lato, has not been reported in the area of the study. Several articles describe a new species in the United States, B. lonestari. B. lonestari in A. americanum has been confirmed in humans with erythema migrans (8,9).
No serologic test is available for antibodies to B. lonestari. That we found antiborrelial-complex antibodies may suggest the presence of a new species in this antigenic complex containing cross-reactive antigens, but many other studies are necessary to confirm it. This study represents the first serologic report of antiborrelial antibodies in Cuba. It suggests that Lyme borreliosis is present and that new cases can be expected in our country. Further laboratory studies are necessary for a more accurate diagnosis of this emerging infectious disease in Cuba.
Islay Rodríguez,* Carmen Fernández,* Marina Cinco,� Rodobaldo Pedroso,‡ and Omar Fuentes*
*Institute of Tropical Medicine Pedro Kourí, Havana, Cuba; � University of Trieste, Trieste, Italy; and ‡Medical Assistance Center of Las Terrazas Village, Cuba
References 1. Wormser GP. Vaccination as a modality to prevent Lyme disease. A status report. Infect Dis Clin North Am. 1999;13:135�``48.
2. Anderson JF. Preventing Lyme disease. Rheum Dis Clin North Am. 1989;15:757�``66.
3. Malouin R, Winch P, Leontsini E, Glass G, Simon D, Hayes EB, et al. Longitudinal evaluation of an educational intervention for preventing tick bites in an area with endemic Lyme disease in Baltimore County, Maryland. Am J Epidemiol. 2003;157:1039�``51.
4. Grandío O, Fernández A, Fernández M, Valera R, Fuentes O, Pelegrino J. Informe preliminar sobre investigaciones realizadas en el poblado “Las Terrazas”, Sierra del Rosario, sobre la existencia de la Enfermedad de Lyme. Rev Cubana Pediatría. 1988;60:773.
5. Rodríguez I, Pedroso R, Fernández C, Cinco M, Fuentes O. ¿Enfermedad de Lyme en Cuba? Presentación de posibles casos. Rev Cubana Med Trop. 2003;55:41�``3.
6. Engstrom SM, Shoop E, Johnson RC. Immunoblot interpretation criteria for serodiagnosis of early Lyme disease. J Clin Microbiol. 1995;33:419�``27.
7. Hauser U, Lehnert G, Wilske B. Validity of interpretation criteria for standardized Western blots (immunoblots) for serodiagnosis of Lyme borreliosis based on sera collected throughout Europe. J Clin Microbiol. 1999;37:2241�``7.
8. James AM, Liveris D, Wormser GP, Schwartz I, Montecalvo MA, Johnson BJ. Borrelia lonestari infection after a bite by an Amblyomma americanum tick. J Infect Dis. 2001;183:1810�``4.
9. Stromdahl EY, Williamson PC, Kollars TM, Evans SR, Barry RK, Vince MA, et al. Evidence of Borrelia lonestari DNA in Amblyomma americanum (Acari: Ixodiadae) removed from humans. J Clin Microbiol. 2003;41:5557�``62
+Address for correspondence: Islay Rodriquez, Laboratory of Spirochetes, Institute of Tropical Medicine “Pedro Kourí,” PO Box 601, Marianao 13, Havana City, Cuba; fax: 53-7- 204-6051; email: [email protected]
-------------------- Neil Posts: 697 | From Tucson, AZ USA | Registered: Apr 2002
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We are travelling to Cuba in April and my LLMD told me that he is currently treating patients who contracted Lyme while vacationing there.
I am happy to report that I will be traveling with a 10kg (22lbs) suitcase full of much needed medical supplies including abx. I will be sure to give the doctor who receives this suitcase lots of information about Lyme.
I also know a couple of people who have traveled to the Dominican and it appears that they contracted a very vicious strain of Babesia while there.
So much for going on vacation to get away from it all!
-------------------- The Canadian Lyme Disease Foundation www.canlyme.com Posts: 128 | From Canada | Registered: Sep 2006
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david1097
Frequent Contributor (1K+ posts)
Member # 3662
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It will be interesting to see if cuba adopts the IDSA/CDC method of diagnosis and treatment. On one hand they will be cost driven (ie minimize the cost of treatment so downplay the problem and abreviate the treatment, preferably to a non existent level) on the other hand I suspect that it would be politically unacceptable for cuban Dr's to adopt a "USA" based guideline. Maybe cuba will be the place to get proper treatment in the future(that is if you can get there legally)
Posts: 1184 | From north america | Registered: Feb 2003
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cuba is known to have excellent doctors, at least in certain specialties.
surely it's most cost effective to treat effectively, than to leave (or render) members of society permanantly disabled, their system may realize that quickly.
if cuba got a leg up on the science and treatment of lyme, they could easily shame the american medical/business handling of the health crisis.
mo
Posts: 8337 | From the other shore | Registered: Jul 2002
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CaliforniaLyme
Frequent Contributor (5K+ posts)
Member # 7136
posted
1: Rev Cubana Med Trop. 2003 Jan-Apr;55(1):41-3.
Lyme disease in Cuba? Report of possible cases
Rodriguez I, Pedroso R, Fernandez C, Cinco M, Fuentes O. Instituto de Medicina Tropical "Pedro Kouri", Autopista Novia del Mediodia, km 6 1/2, La Lisa, Apartado Postal 601, Marianao 13, Ciudad de La Habana, Cuba. [email protected]
Two possible cases of Lyme disease, which has not been reported in Cuba, but whose existence has been suspected for some years, are reported.
These cases that were bitten by ticks and presented signs and symptoms compatible with this disease, according to literature, were serologically confirmed by different laboratory techniques (indirect immunofluorescence, ELISA and Western Blotting).
The results suggest the presence of this borreliosis in Cuba.
PMID: 15849952
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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