Carlberg H, Naito S
Department of Dermatology, University of Tsukuba, Japan.
J Dermatol. 1991 Mar;18(3):125-42. doi: 10.1111/j.1346-8138.1991.tb03056.x.
The skin diseases Erythema (chronicum) migrans (ECM, EM), Lymphadenosis benigna cutis (LABC), and Acrodermatitis chronica atrophicans (ACA) have long been described in northern Europe, and dermatologists are very familiar with these manifestations, which have been successfully treated with penicillin for about 40 years without the causative agent being known. Certain neurologic symptoms could be linked to tickbites during the 1920's and later also to EM. In 1977, Steere et al. reported a new form of inflammatory arthritis, mainly in school children in the community of Lyme, Connecticut, U.S.A., which they could also associate with preceding erythema and tickbites. Five years later, Burgdorfer was able to isolate Borrelia spirochetes from Ixodes ticks, which are known to be vectors of Lyme disease as well as of EM and ACA. The following year, Borrelia spirochetes were also isolated from Ixodes ticks and from skin lesions of patients in Sweden and Germany. These findings resulted in a large number of reports of new discoveries related to this infection, which is now known under the names of tick-borne or Lyme borreliosis and, in the U.S., also as Lyme disease or Lyme arthritis. It has proven to be a great imitator disease, mainly through its involvement of the neurological system, and to be far more widespread than previously thought. The full course of the disease is not yet known, however it is clinically, like another spirochetosis, syphilis, divided into early and late stages. Manifestations involve mainly the skin, the joints, the nervous system (Neuroborreliosis), and the heart. Antibiotic treatment is effective, especially in the early stages. Like syphilis, the disease can be self-healing without treatment. People who are exposed to ticks should be aware of the risk of contracting this disease, also in Japan where Ixodes ticks have been shown to be carriers of Borrelia spirochetes. Cases, particularly of EM, but also with neurological symptoms, have already been diagnosed in Hokkaido, Honshu, Shikoku, and Kyushu. As Lyme borreliosis is now proven to exist in Japan, it is beneficial for dermatologists to know about the various presentations of this disease. This paper will briefly summarize the historical background, the clinical stages, the diagnosis, and the treatment of Lyme borreliosis, with a summary of the present situation in Japan.
皮肤疾病慢性游走性红斑（ECM，EM）、良性皮肤淋巴腺病（LABC）和慢性萎缩性肢端皮炎（ACA）在北欧早就有记载，皮肤科医生对这些表现非常熟悉，它们用青霉素成功治疗了约40年，而致病因子却一直不明。20世纪20年代，某些神经症状可能与蜱叮咬有关，后来也与慢性游走性红斑有关。1977年，Steere等人报告了一种新的炎症性关节炎形式，主要发生在美国康涅狄格州莱姆镇社区的学童中，他们也将其与先前的红斑和蜱叮咬联系起来。五年后，Burgdorfer能够从硬蜱中分离出疏螺旋体，已知硬蜱是莱姆病以及慢性游走性红斑和慢性萎缩性肢端皮炎的传播媒介。次年，在瑞典和德国，也从硬蜱和患者的皮肤病变中分离出了疏螺旋体。这些发现引发了大量关于这种感染的新发现报告，这种感染现在被称为蜱传或莱姆疏螺旋体病，在美国也被称为莱姆病或莱姆关节炎。事实证明，它是一种极易误诊的疾病，主要是因为它会累及神经系统，而且其分布范围比以前认为的要广泛得多。该病的整个病程尚不清楚，不过在临床上，它与另一种螺旋体病梅毒一样，分为早期和晚期。其表现主要累及皮肤、关节、神经系统（神经型莱姆病）和心脏。抗生素治疗有效，尤其是在早期。与梅毒一样，该病未经治疗也可自愈。接触蜱的人应该意识到感染这种疾病的风险，在日本也是如此，日本已证明硬蜱是疏螺旋体的携带者。在北海道、本州、四国和九州，已经诊断出了病例，特别是慢性游走性红斑病例，也有出现神经症状的病例。由于现在已证明日本存在莱姆疏螺旋体病，皮肤科医生了解这种疾病的各种表现是有益的。本文将简要总结莱姆疏螺旋体病的历史背景、临床分期、诊断和治疗，并概述日本的现状。
