Description of Lyme disease-like syndrome in Brazil. Is it a new tick borne dise

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An emerging clinical entity that reproduces clinical manifestations

similar to those observed in Lyme disease (LD) has been recently under

discussion in Brazil. Due to etiological and laboratory

particularities it is named LD-like syndrome or LD imitator syndrome.

The condition is considered to be a zoonosis transmitted by ticks of

the genus Amblyomma, possibly caused by interaction of multiple

fastidious microorganisms originating a protean clinical picture,

including neurological, osteoarticular and erythema migrans-like

lesions. When peripheral blood of patients with LD-like syndrome is

viewed under a dark-field microscope, mobile uncultivable

spirochete-like bacteria are observed. PCR carried out with specific

or conservative primers to recognize Borrelia burgdorferi sensu

stricto or the genus Borrelia has been negative in ticks and in

biological samples. Two different procedures, respectively involving

hematoxylin and eosin staining of cerebrospinal fluid and electron

microscopy analysis of blood, have revealed spirochetes not belonging

to the genera Borrelia, Leptospira or Treponema. Surprisingly,

co-infection with microorganisms resembling Mycoplasma and Chlamydia

was observed on one occasion by electron microscopy analysis. We

discuss here the possible existence of a new tick-borne disease in

Brazil imitating LD, except for a higher frequency of recurrence

episodes observed along prolonged clinical follow-up.