So, having talked at length about Lyme disease
which is what we most often experience as a Borreliella
there are other forms of Borreliella that we do need to be
typically associated with Borreliella recurrentis or a
related species in the Borrelia family.
These entities are known as Relapsing fevers or sometimes
tick associated or vector associated relapsing fever.
Borreliella recurrentis, as you see there, is associated
with a lice or louse borne epidemic relapsing fever
and patients typically have a single relapse and then they’ll
Other tick borne relapsing fevers, however, may have
multiple relapses which keep going on and going on.
The febrile phase of the relapsing fever is typically an
very high fevers. Temperature is associated with shaking
chills, the rigors and the muscle aches.
So again, you may be thinking that just sounds like the
really bad flu I had last winter.
Well, yes, you're right. So the febrile phase almost is like
very severe flu like illness
and it lasts similar to the flu from three to seven days.
Then the patients breathe a sigh of relief.
They have entered the afebrile, the clinically healthy stage
and this lasts for about a week
and then unfortunately the same thing happens again -
the febrile symptoms return just as bad as they were before.
In the Borreliella recurrentis it's typically a single
and the tick associated illness it's ongoing relapses as the
Borreliella organism undergoes small antigenic changes
in its outer structure each time of which triggers a
separate and new immune reaction.
So you're basically blessed or cursed with ongoing trigger
of the immune system because of this.
I mentioned before that one can do dark field microscopy
but it’s very difficult to find the organism even in biopsy
of a primary lesion for Lyme disease
and in the recurring fevers there's nothing specific to
So one can actually perform for Borreliella burgdorferi to
diagnose Lyme disease
an enzyme immunoassay looking for both immunoglobulin M and
antibodies and confirm those with Western blot analysis.
In this schematic, you can see on the far right of the
schematic the typical bands,
what you're seeing is positive for an IgG, immunoglobulin G,
to Borreliella burgdorferi
and then compare the different lanes of the patient one
and match up how many of the bands occur in correlation with
the known bands,
the known positive bands for Borreliella burgdorferi.
And there are standards established in the states for the
Centers for Disease Control
and the other parts of the world as well in which one has
two or more positive IgM bands
and three or more positives specific IgG bands and that
constitutes a positive diagnosis
so very important to make the accurate and proper diagnosis
so that the treatment can be appropriately administered.
For the recurring fevers, however, it’s easier to do a
Wright stain or a Giemsa stain of a blood smear.
Serologic tests as noted by the slide are useless,
again, because the Borreliella undergoes antigenic variation
so one would never be able to make a single antibody
to cover all the different potential types of variating
Sparky's can be identified in tissue biopsies
using silver stains such as
the worth and star stain
by immunofluorescence assays using conjugate antibodies or
PCR test is especially useful as it can be
done in multiple different types of
specimens, including blood, cerebrospinal
fluid or tissues.
Cultures are rarely performed as they
typically require sending the specimen out to
a specialized laboratory, which takes time
and is a difficult,
It is also possible to perform animal
inoculation as a last resort
if culture is not available or the PCR is not available
with animal inoculation, typically the organism or specimen
patient is inoculated
into immuno deficient mice, and then
hopefully the mouse develops bacteremia and
then the mouse's blood specimen is subjected
diagnostic mechanisms such as the culturing.
So, that is what we know about Borrelliella burgdorferi as
the cause of Lyme disease recurrentis
and other types of Borreliella causing recurring fevers all
these are vector associated,
all these are unfortunate things that you come
across in the woods
when all you simply want is a peaceful walk through the
woods with your dog.