Clinical features of Lyme borreliosis in humans in Bulgaria
Bulgarian study on clinical manifestations of 1257 patients with Lyme borreliosis, diagnosed by physicians and confirmed in laboratory (except for erythema migrans), showed that the most common clinical presentation is erythema migrans (EM), diagnosed in 868 (69.1%) of the patients, almost uniformly as a sole presentation and rarely as a part of multisystem involvement.
Rashes had a median diameter of 11 cm (5-35 cm). The erythema rash was homogenous in 44% and with central clearing and peripheral border in 56%. In 14.7% of the patients, atypical rashes with a vesicular or ulcerated center were found. Flu-like symptoms, such as fever, headache, myalgia, arthralgia, fatigue, neck stiffness, were the most common signs associated with EM. Fever was found on physical examination in 133 (15.3%) of the EM patients. In parallel with EM, lymphadenopathy was detected in 284 (32.7%) of the EM cases. In addition, multiple EM was detected in 59 (6.8%) of the patients.After EM, the second most frequent presentation of Lyme disease in Bulgaria is neuroborreliosis. It is usually presented as radiculoneuritis as a sole presentation (found in 72% of the patients with neuroborreliosis in Bulgaria) and much rarely manifested as cranial neuritis (mainly in children), myelitis, meningoradiculoneu- ritis, or encephalopathy.
The third most common presentation of Lyme disease in Bulgaria is Lyme arthritis. In the same study, it was diagnosed in 101 (8%) of the patients with Lyme borreliosis. Lyme arthritis was mainly presented by brief attacks of arthritis and rarely as chronic arthritis.
Rare manifestations of Lyme borreliosis in Bulgaria are those affecting heart and eyes (found in 1.1 and 0.9%, respectively). Very rare syndromes are borrelial lymphocytoma and acrodermatitis chronica atrophicans (0.3%).
Multiple organ involvement was found in 2.1% of the patients. Most commonly it was presented as neurological disorders and skin lesions or arthritis.
In addition, the highest proportion of the patients with Lyme borreliosis is in children aged 5-9. The disease shows two peaks in the seasonal distribution of the cases. Neuroborreliosis is a more frequent presentation than Lyme arthritis in Bulgaria.
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