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Abstract(s)
Introdução: A borreliose de Lyme é uma doença infecciosa multissistémica que se assume como emergente em Portugal. A apresentação atípica no nosso país, provavelmente associada à infecção por Borrelia lusitaniae, tem dificultado o diagnóstico correcto desta espiroquetose. Justifica-se, pelo motivo enunciado, um maior nível de suspeição perante manifestações inespecíficas da doença. A morfeia é uma dermatose cuja associação com a infecção por Borrelia burgdorferi sensu lato tem sido alvo de investigação sistemática, mas não está ainda esclarecida. O objectivo do presente trabalho consiste na determinação da possibilidade de uma correlação entre a morfeia e a borreliose de Lyme na região da Guarda. Métodos: Este estudo observacional descritivo foi realizado com o intuito de avaliar retrospectivamente uma amostra de dez doentes com morfeia seguidos no Serviço de Dermatologia da Unidade Local de Saúde da Guarda. Os dados necessários foram obtidos mediante revisão dos processos clínicos e entrevista dos doentes. Foi efectuada uma análise estatística descritiva através do cálculo de medidas como frequências, percentagens e médias.
Resultados e Discussão: Os dez doentes da amostra estudada eram naturais e residentes no distrito da Guarda, região em que a presença de Ixodes ricinus já foi referida e onde foram detectados alguns casos seropositivos para borreliose de Lyme. O enquadramento epidemiológico efectuado permitiu verificar que a localização das habitações e respectivas características, o contacto com animais e as ocupações profissionais e recreativas condicionam a exposição dos doentes a ambientes propícios à mordedura de carraça, ainda que a mesma tenha sido assinalada em apenas dois casos. Relativamente à informação clínica, constatou-se, nalguns doentes, a existência de sintomatologia acompanhante das lesões de morfeia, sugerindo a possível associação destas a outras manifestações eventualmente relacionadas com a referida espiroquetose. Não foram encontrados antecedentes de sinais clínicos específicos de borreliose de Lyme ou de outras patologias causadas por mordedura de carraça. Testes serológicos de rastreio foram os únicos exames complementares de diagnóstico solicitados para avaliação da possível infecção por Borrelia burgdorferi sensu lato nestes doentes. Conclusões: A verificação da exposição dos doentes a factores de risco para mordedura de carraça e as informações clínicas obtidas permitem confirmar a necessidade de investigar de forma sistemática, por métodos complementares de diagnóstico adequados que deverão ir para além dos testes de rastreio, a origem borreliana da esclerodermia circunscrita.
Introduction: Lyme borreliosis is a multisystem infectious disease believed to be emerging in Portugal. The atypical presentation in our country, possibly related to the infection with Borrelia lusitaniae, has lead to difficulties in diagnosing this spirochetosis. Therefore, a higher level of suspicion is required when evaluating non-specific manifestations of the disease. Although still not clarified, morphea is a dermatosis which linkage to Borrelia burgdorferi sensu lato infection has been open to systematic investigation. The aim of the present research is to determine the possibility of a correlation between morphea and Lyme borreliosis, in Guarda region. Methods: This observational descriptive study was designed to retrospectively evaluate a sample of ten patients with morphea followed up at the Unidade Local de Saúde da Guarda Dermatology Department. The data was collected by reviewing clinical files and by patients’ interviewing. A descriptive statistical analysis was performed through the calculus of measures like frequencies, percentages and means. Results and Discussion: All patients were born and are living in Guarda district, where Ixodes ricinus has already been identified and some Lyme borreliosis’ seropositive cases have been detected. An epidemiological approach lead to the findings that the location and characteristics of the houses, the contact with animals and the professional and recreational activities of the patients expose them to environmental risk for tick bites, even if bites were recalled in only two cases. Concerning clinical information, symptoms accompanying the morphea lesions and coexistence with other manifestations potentially associated with the studied spirochetosis were present in some cases. There was no previous history of specific signs of Lyme borreliosis or other vector-borne diseases. Serologic first-tier testing was the only diagnostic modality used to assess the possible infection with Borrelia burgdorferi sensu lato in these patients. Conclusions: Exposure to risk factors for tick bites and the clinical data determine the need for further investigation of a borrelian etiology for localized scleroderma in these patients, by the use of appropriate laboratory examinations.
Introduction: Lyme borreliosis is a multisystem infectious disease believed to be emerging in Portugal. The atypical presentation in our country, possibly related to the infection with Borrelia lusitaniae, has lead to difficulties in diagnosing this spirochetosis. Therefore, a higher level of suspicion is required when evaluating non-specific manifestations of the disease. Although still not clarified, morphea is a dermatosis which linkage to Borrelia burgdorferi sensu lato infection has been open to systematic investigation. The aim of the present research is to determine the possibility of a correlation between morphea and Lyme borreliosis, in Guarda region. Methods: This observational descriptive study was designed to retrospectively evaluate a sample of ten patients with morphea followed up at the Unidade Local de Saúde da Guarda Dermatology Department. The data was collected by reviewing clinical files and by patients’ interviewing. A descriptive statistical analysis was performed through the calculus of measures like frequencies, percentages and means. Results and Discussion: All patients were born and are living in Guarda district, where Ixodes ricinus has already been identified and some Lyme borreliosis’ seropositive cases have been detected. An epidemiological approach lead to the findings that the location and characteristics of the houses, the contact with animals and the professional and recreational activities of the patients expose them to environmental risk for tick bites, even if bites were recalled in only two cases. Concerning clinical information, symptoms accompanying the morphea lesions and coexistence with other manifestations potentially associated with the studied spirochetosis were present in some cases. There was no previous history of specific signs of Lyme borreliosis or other vector-borne diseases. Serologic first-tier testing was the only diagnostic modality used to assess the possible infection with Borrelia burgdorferi sensu lato in these patients. Conclusions: Exposure to risk factors for tick bites and the clinical data determine the need for further investigation of a borrelian etiology for localized scleroderma in these patients, by the use of appropriate laboratory examinations.
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Keywords
Morfeia Borreliose de Lyme Borreliose de Lyme - Borrelia burgdorferi Borreliose de Lyme - Epidemiologia Esclerodermia
Citation
Publisher
Universidade da Beira Interior