Epidemiology of Lyme Disease in a Highly Endemic European Zone

Background and objective: Lyme disease, also known as Lyme borreliosis (LB), is a tick-borne infectious disease caused by the spirochete bacteria Borrelia. The risk of infection depends on the geographical area, ecological factors, and human behavior. Clinical manifestations of Lyme borreliosis have a wide range, but the most frequent clinical symptom, which is also a diagnostic symptom, is a skin rash called erythema migrans (EM). The disease is very common worldwide. In Lithuania, the disease frequency is 99.9 cases per 100,000 population (Centre for Communicable Diseases and AIDS, Lithuania, 2017). The main aim of this study was to obtain the baseline characteristics of the disease regarding the infected Lithuanian population. Materials and Methods: We analyzed data from the Centre for Communicable Diseases and AIDS about all Lyme disease (A69.2) diagnosed patients over a three-year period (from 2014 to 2016) in Lithuania. Results: In 2014–2016, 7424 (crude incidence rate 85.4) cases with LB were diagnosed in Lithuania. Most of them (4633 (62.4%)) were identified in women. Older people were more likely to suffer from LB. Urban residents were 2.6 times more often affected that those living in villages. Tick bites were primarily observed in high season months, from May to September (90%), with the highest peak in July. There was a higher number of observed tick bites (p = 0.003) in the urban residents. Erythema migrans occurred in 75.6% LB cases, while other symptoms did not exceed a quarter of all LB cases. There were 7353 (99.6%) cases where LB was confirmed via clinical symptoms and/or laboratory tests. Also, 1720 (23.2%) patients were tested for LB immunoglobulins. Conclusions: This study found a high incidence of Lyme disease in Lithuania. We elucidated the baseline characteristics regarding the infected Lithuanian population which may ease medical clinicians’ work on new Lyme diagnoses

Clinical syndromes and epidemiological factors of Lyme disease in Lithuania

Lyme disease is the most common tick-borne infectious disease in Europe. The pathogen is the gram-negative bacterium spirocheta Borrelia burgdorferi (B. burgdorferi). More than 20 genotypes of this bacterium are isolated, four of which are pathogenic to humans and result in the development of LL: B. burgdorferi sensu strictu (B. burgdorferi ss), B. afzelii, B. garinii, B. bavariensis. Each of these genotypes is associated with different clinical manifestations of Lyme disease. B. burgdorferi ss is associated with joint damage, B. afzelii is associated with neurological changes, B. garinii is associated with dermatological damage. The global prevalence of these B. burgdorferi genotypes varies, B. burgdorferii ss is found in North America, but can also be found in Europe, and B. afzelii and B. garinii are prevalent in Europe and Asia. Since the manifestations of the disease are diverse, this disease is faced by doctors of many specialties. Therefore, it is very important to know how the disease manifests itself in our country, to single out individuals of the risk group. This doctoral dissertation provides a detailed overview of Lyme disease factors in Lithuania, includes data on epidemiological disease factors and clinical manifestations of the disease

Laimo ligos klinikiniai sindromai ir epidemiologiniai rodikliai Lietuvoje

Lyme disease is the most common tick-borne infectious disease in Europe. The pathogen is the gram-negative bacterium spirocheta Borrelia burgdorferi (B. burgdorferi). More than 20 genotypes of this bacterium are isolated, four of which are pathogenic to humans and result in the development of LL: B. burgdorferi sensu strictu (B. burgdorferi ss), B. afzelii, B. garinii, B. bavariensis. Each of these genotypes is associated with different clinical manifestations of Lyme disease. B. burgdorferi ss is associated with joint damage, B. afzelii is associated with neurological changes, B. garinii is associated with dermatological damage. The global prevalence of these B. burgdorferi genotypes varies, B. burgdorferii ss is found in North America, but can also be found in Europe, and B. afzelii and B. garinii are prevalent in Europe and Asia. Since the manifestations of the disease are diverse, this disease is faced by doctors of many specialties. Therefore, it is very important to know how the disease manifests itself in our country, to single out individuals of the risk group. This doctoral dissertation provides a detailed overview of Lyme disease factors in Lithuania, includes data on epidemiological disease factors and clinical manifestations of the disease

Lyme Disease among Patients at an Ambulatory Unit in a Highly Endemic Country: Lithuania

Background and objectives: Lyme disease is the most common tick-borne infectious disease in Europe, caused by the spirocheta bacteria of Borrelia burgdorferi. Several genospecies of B. burgdorferi are pathogenic to humans. B. burgdorferi sensu stricto, which is prevalent in North America, causes reactive arthritis, whereas B. garinii and B. afzelii, common in Europe, can affect the skin, heart, or nervous system; it has been shown that the clinical symptoms of the disease may be very different. The objective of this study was to identify the baseline characteristics of Lyme disease and to elucidate the frequency of different Lyme disease syndromes in Lithuania. Materials and Methods: Patients who were diagnosed with Lyme disease during an ambulatory visit to the Center of Infectious Diseases, Vilnius University Santaros clinics, from 2014 to 2016, were enrolled in this study. A retrospective material analysis was conducted. Results: In total, 1005 patients were enrolled with the following prevalence of clinical syndromes: erythema migrans (EM), 945 (94.02%); Lyme arthritis, 32 (3.18%); neuroborreliosis, 23 (2.28%); Lyme carditis, 4 (0.39%); and acrodermatitis, 1 (0.09%). Erythema migrans was dominant among middle-aged women, with a rash appearing mainly on the lower extremities. Lyme arthritis mainly manifested among middle-aged women as an oligoarthritis, mostly affecting the knee joint. Neuroborreliosis was seen more often in middle-aged women than men and the main symptom was nervus facialis neuropathy. Lyme carditis, manifested as an atrioventricular block, with a male/female ratio of 3:1, and the median age was 51. Acrodermatitis was diagnosed in a 61-year-old woman, as a painful, red rash on the hand. Conclusions: According to the prevalence of B. garinii and B. afzelii in Europe, previously it was thought that Lyme disease presented as erythema migrans, and less frequently as neuroborreliosis; however, this study revealed that other syndromes may also be seen. In addition, we revealed that the longer it takes for erythema migrans to appear, the greater the likelihood of Lyme arthritis developing

Prevalence of conventional risk factors in patients with coronary heart disease

Extensive clinical and statistical studies have identified risk factors that increase the incidence of coronary heart disease. It is commonly suggested that more than 50% of patients with coronary heart disease lack any of the conventional risk factors. Objective. To determine the prevalence of four conventional risk factors among patients with coronary heart disease. Material and methods. We analyzed data of 606 patients with coronary heart disease (myocardial infarction, unstable and stable angina pectoris) hospitalized in the Clinics of Santariškės, Vilnius University Hospital, in 1997–2005. Results. Among patients with coronary heart disease, at least one of four conventional risk factors was present in 98% of patients. Hypertension was present in 47.7% of patients, diabetes – in 12.9%, dyslipidemia – 90.1%, and smoking – in 24.1% of patients. In younger patients (<55 years), only 2.3% of patients lacked any of four conventional risk factors. Two-thirds (66.5%) of younger patients with coronary heart disease had two and more risk factors. Conclusions. Considering the fact that patients with coronary heart disease often lack conventional risk factors, currently more attention is given to nontraditional risk factors as well as genetic causes of coronary heart disease. Nevertheless, the present study revealed that 98% of patients with coronary heart disease had at least one of four conventional risk factors. Among younger patients (younger than 55 years), conventional risk factors are identified very frequently. Thus, it can be concluded that in order to reduce the epidemic of coronary heart disease, much greater emphasis should be given to identify and to improve prevention of four conventional risk factors as well as the lifestyle of the patient

Trends in Cigarette Smoking among Middle-Aged Lithuanian Subjects Participating in the Primary Prevention Program between 2009 and 2016

Background and Objectives: The aim of the study was to evaluate trends in smoking among middle-aged men and women based on the data from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2016. Materials and Methods: A community-based cross-sectional study comprised 92373 Lithuanian adults (41.6% men and 58.4% women). We compared the prevalence of smoking, smoking cessation activity and smoking intensity by gender and age groups. Results: There was a statistically significant upward trend in the number of smoking subjects (average annual percent change (AAPC) 2.99%, p < 0.001). The number of smoking male subjects remained much higher than the number of smoking female subjects during the 2009–2016 period. The study showed a significant increase in the percentage of smoking quitters in the whole group (AAPC 7.22%, p < 0.001) and among men and women separately. There was no significant change in smoking intensity in groups of male and female smokers separately. Conclusions: The analysis showed that the prevalence of smoking in Lithuania is still increasing due to women smoking despite all the governmental tobacco control efforts to reduce it

Primary prevention strategy for cardiovascular disease in Lithuania

Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006. Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years. Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities