Hassler D, Maiwald M
Hygiene-Institut der Universität Heidelberg.
Dtsch Med Wochenschr. 1994 Mar 11;119(10):338-42. doi: 10.1055/s-2008-1058700.
A 54-year-old patient with an intact immune system developed Lyme disease three times within 4 years. The first time an erythema migrans occurred, which was successfully treated with oral doxycycline (100 mg twice daily for 20 days). Specific antibodies were subsequently demonstrated. Re-infection nonetheless occurred a year later, again as erythema migrans. Oral doxycycline in higher dosage (three times 100 mg daily for 20 days) failed to prevent generalization of the infection with rigor, head and neck aches, myalgia, fatigue and subfebrile temperatures. There was a marked increase in Borrelia-specific antibody titre. Parenteral treatment with cefotaxime (twice daily 3 g for 12 days) was curative. But 2 years later yet another re-infection occurred with classic erythema migrans, which regressed under doxycycline. The course of the disease in this case demonstrates that Borrelia-specific antibodies do not always protect against re-infection. This may have consequences for the possible development of a vaccine.
一名免疫系统健全的54岁患者在4年内3次感染莱姆病。第一次出现游走性红斑，口服强力霉素（每日2次，每次100毫克，共20天）治疗成功。随后检测到特异性抗体。然而，一年后再次感染，同样表现为游走性红斑。高剂量口服强力霉素（每日3次，每次100毫克，共20天）未能阻止感染扩散，出现寒战、头颈部疼痛、肌痛、疲劳和低热。伯氏疏螺旋体特异性抗体滴度显著升高。静脉注射头孢噻肟（每日2次，每次3克，共12天）治愈了感染。但2年后又一次出现典型的游走性红斑再感染，在强力霉素治疗下症状消退。该病例的病程表明，伯氏疏螺旋体特异性抗体并不总能预防再次感染。这可能会对疫苗的研发产生影响。
