Clinical and serologic features of Lyme borreliosis in Russia.

OBJECTIVE

To describe clinical and serologic features of Lyme borreliosis, particularly the joint abnormalities, in Russian patients.

METHODS

Physicians were invited to refer patients with past or present erythema migrans to the Rheumatology Institute in Moscow; field studies were done of residents in an area endemic for Lyme borreliosis, and a serosurvey was conducted of patients with nonspecific neurologic, cardiac, or joint symptoms. Serologic testing was done by ELISA and Western blotting using a strain of Borrelia afzelii, a member of the B. burgdorferi sensu lato complex, recovered from ticks from the field study site.

RESULTS

Of 86 patients with erythema migrans, neurologic abnormalities developed in 26 (30%), cardiac involvement in 5 (6%), arthritis or arthralgia in 35 (41%), and acrodermatitis in 2 (2%). Joint involvement was usually characterized by one or a few brief episodes of joint swelling or pain in one large joint at a time. However, 69 of the 86 patients (80%) received antibiotic therapy early in the infection. The majority of patients with active infection had elevated levels of IgM or IgG antibody to B. afzelii by ELISA, and those with late infection often had IgG reactivity with > or = 5 spirochetal proteins, particularly the 37, 39, 41, 60, and 93 kDa antigens. In a serosurvey of 75 patients with facial palsy, atrioventricular block, or arthritis or arthralgia of uncertain cause, 6 had IgG reactivity with > or = 5 spirochetal proteins.

CONCLUSION

Lyme borreliosis in Russia is similar to that in other parts of Europe. Brief episodes of arthritis or arthralgia were a common feature of the illness.