Lünemann J D, Krause A
Universitätsklinikum Charité, Medizinische Klinik m.S. Rheumatologie und Klinische Immunologie, 10098 Berlin, Germany.
Z Rheumatol. 2003 Apr;62(2):148-54. doi: 10.1007/s00393-003-0428-8.
Of the ten different species of Borrelia (B.) burgdorferi sensu lato which have been characterized to date, only B. burgdorferi sensu stricto, B. garinii and B. afzelii have been identified as pathogenic in humans. It was suggested that different species possess different organotropisms and may preferentially cause distinct clinical manifestations of Lyme disease. Molecular analyses revealed a strong association of B. afzelii with the late cutaneous manifestation acrodermatitis chronica atrophicans, whereas B. garinii was predominantly identified in clinical samples from patients with neuroborreliosis. PCR-based analyses of samples from European patients with Lyme arthritis had given controversial results, but B. burgdorferi sensu stricto appears to be the major pathogen. The identity of the infecting species seems to be a major determinant in the pathogenesis of Lyme arthritis, although its complex immunopathological background and its clinical heterogeneity clearly indicate concomitant factors. Thus, characterization of the infecting organism at the species level on the one hand and linkage of clinical data with pathogenetically relevant immune parameters on the other, shall lead to a more precise understanding of the pathogenesis and the individual clinical course of Lyme borrelioses.
在迄今已鉴定出的十种不同的伯氏疏螺旋体狭义种中，只有狭义伯氏疏螺旋体、伽氏疏螺旋体和阿氏疏螺旋体被确定为人类致病病原体。有人提出，不同的物种具有不同的嗜器官性，可能会优先导致莱姆病的不同临床表现。分子分析显示，阿氏疏螺旋体与晚期皮肤表现慢性萎缩性肢端皮炎密切相关，而伽氏疏螺旋体主要在神经型伯氏疏螺旋体病患者的临床样本中被鉴定出来。对欧洲莱姆关节炎患者样本进行的基于聚合酶链反应的分析结果存在争议，但狭义伯氏疏螺旋体似乎是主要病原体。尽管莱姆关节炎的发病机制有复杂的免疫病理背景且临床存在异质性，这显然表明还有其他伴随因素，但感染物种的身份似乎是莱姆关节炎发病机制中的一个主要决定因素。因此，一方面在物种水平上对感染生物体进行鉴定，另一方面将临床数据与发病机制相关的免疫参数联系起来，将有助于更精确地理解莱姆疏螺旋体病的发病机制和个体临床病程。
