Kutane und systemische Borreliose

Zusammenfassung

Die Borreliose mit ihren vielgestaltigen und stadienhaften Krankheitsbildern zählt zu den häufigsten Zoonosen der nördlichen Hemisphäre. Die pathogene Spirochäte Borrelia burgdorferi gelangt über den Speichel der Schildzecken (Ixodides) in die Haut des Menschen. Eine geschickte Regulation der oberflächlichen Lipoproteine ermöglicht dem Bakterium trotz der raschen und ausgeprägten Immunreaktion in vielen Fällen eine Streuung im Körper. Bleibt die Infektion unbehandelt und/oder bei Befall entsprechend immunologisch „anfälliger“ Personen können sich nach Latenzzeiten von Wochen bis Jahren kutane oder systemische Symptome manifestieren. Borrelien persistieren bevorzugt in immunologisch privilegierten Geweben, wie dem peripheren und zentralen Nervensystem und den Gelenken. Neben den klassischen Hautmanifestationen der Borreliose, wie dem Erythema migrans, dem Borrelien-Lymphozytom oder der Acrodermatitis chronica atrophicans, konnten in den letzten 20 Jahren Borrelien auch in Hautbiopsien anderer Hauterkrankungen, wie der Morphea, des Lichen sclerosus, des Granuloma anulare, der kutanen Sarkoidose, der Necrobiosis lipoidica und bei Fällen von kutanen B-Zell-Lymphomen nachgewiesen werden. Die Rolle der Keime in der Pathogenese letzterer Krankheitsbilder bietet Raum für Forschung und Diskussionen. Die antibiotische Therapie der Borreliose richtet sich nach Stadium und Hauptmanifestation der Symptomatik.

Abstract

Lyme disease with its manifold clinical presentations accounts for one of the most common zoonoses in the northern hemisphere. The pathogen Borrelia burgdorferi penetrates human skin through saliva that ticks excrete during feeding periods. Although a strong immune response is triggered immediately, a sophisticated mechanism that affects the regulation of the superficial antigen lipoproteins, allows the bacterium to spread within the body. If not treated correctly, cutaneous or systemic symptoms can manifest after weeks to years. Borrelia preferentially persists in immunologically privileged tissues such as the peripheral and central nervous system and the joints. Besides in erythema migrans, borrelial lymphomcytoma and acrodermatitis chronica atrophicans, borrelial spriochaetes could also be detected in ‘non classical’ skin disorders, such as morphea, lichen sclerosus, grannuloma anulare, cutaneous sarcoidosis, necrobiosis lipoidica and cases of cutaneous B cell lymphoma. The role of Borrelia in the pathogenesis of these latter diseases is discussed and gives room for further research. The antibiotic treatment for cutaneous and systemic borreliosis should be chosen according to main symptoms and clinical stage.

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