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Coxiella burnetii infection (Q fever) is a widespread zoonosis with low endemicity in Switzerland, therefore no mandatory public report was required. A cluster of initially ten human cases of acute Q fever infections characterized by prolonged fever, asthenia and mild hepatitis occurred in 2012 in the terraced vineyard of Lavaux. Epidemiological investigations based on patients’ interviews and veterinary investigations included environmental sampling as well as Coxiella-specific serological assay and molecular examinations (real-time PCR in vaginal secretions) of suspected sheep. These investigations demonstrated that 43% of sheep carried the bacteria whereas 30% exhibited anti-Coxiella antibodies. Mitigation measures, including limiting human contacts with the flock, hygiene measures, flock vaccination and a public official alert, have permitted the detection of four additional human cases and the avoidance of a much larger outbreak. Since November 2012, mandatory reporting of Q fever to Swiss public health authorities has been reintroduced. A close follow up of human cases will be necessary to identify chronic Q fever.

The most frequent clinical manifestation of borreliosis in Switzerland is erythema migrans, with about 2500 patients each year. Neurological manifestations are rare, mostly hyperalgesic radiculitis (Bannwarth syndrome), aseptic meningitis or cranial nerve involvement. We report the first Swiss patient with meningovasculitis due to neuroborreliosis, with recurrent multiple ischemic strokes in multiple vascular territories. The treatment with ceftriaxone stopped the progression, but the patient is still suffering from severe invalidating cognitive disorders. We also comment on the pathophysiology and review the literature of other clinical cases.

L’infezione da Borrelia burgdorferi (malattia o meglio borreliosi di Lyme) e una spirochetosi trasmessa da zecche ed e endemica, in focolai, in Nord America, Europa e Asia. Questa modalita di infestazione spiega la sua presentazione stagionale. Le manifestazioni cliniche sono a esordio focale, con estensione sistemica; gli organi piu interessati sono la cute, il cuore, il sistema muscoloscheletrico, il sistema nervoso, spesso con interessamento sequenziale. L’infezione precoce, evidenziata dall’eritema migrante, e seguita da uno stadio di disseminazione nelle settimane successive; i sintomi intermittenti possono persistere e provocare manifestazioni tardive osservate in media entro l’anno. In un paziente infetto tutti gli stadi possono essere presenti oppure puo non comparirne nessuno. I sintomi neurologici si verificano nello stadio piu precoce (radicolonevrite, neuropatie craniche, meningite, sintomi cerebrali minori, miosite) o tardivo (encefalomielite progressiva, encefalopatia, neuropatia assonale). Tra i casi europei e americani esistono numerose differenze, dovute alle specie genotipiche diverse di Borrelia burgdorferi nei due continenti. In effetti, la linfadenosi cutanea benigna, l’acrodermatite cronica atrofica e l’encefalomielite progressiva sono osservate quasi unicamente in Europa, perche Borrelia afzelii e garinii, non osservate nel Nord America, ne sono la probabile causa. La sierologia e la PCR (polymerase chain reaction) sono attualmente i mezzi a disposizione, che messi in relazione con i sintomi clinici, permettono di porre la diagnosi di borreliosi di Lyme. Esistono diversi antibiotici efficaci, che permettono un trattamento dell’infezione precoce; le manifestazioni tardive rispondono parzialmente alla terapia. Nessun vaccino e attualmente disponibile.

Resume Avant de chercher a combattre un parasite, il est indispensable de bien le connaitre. Plus de 800 especes de tiques ont ete recensees dans le monde entier. Elles parasitent des hotes tres varies et ont des modes de vie fort differents d’une espece de tique a l’autre. Il est extremement difficile de controler ces ectoparasites et les maladies qu’elles transmettent. A l’heure actuelle le controle de l’infestation des animaux domestiques repose essentiellement sur les acaricides, sous forme de bains, de sprays, de shampooing, de colliers ou de boules de ouate impregnes… Des croisements genetiques de differentes races de bovins permettent d’accroitre la resistance naturelle de ces animaux contre les tiques. Des vaccins anti-tiques sont actuellement commercialises en Australie et a Cuba pour le betail contre Boophilus microplus et des recherches se poursuivent pour le developpement d’autres vaccins anti-tiques. Dans le futur, des luttes specifiques integrees, prenant en compte les caracteristiques des especes de tiques impliquees, devraient ameliorer le controle de ces ectoparasites.

Resume Cette etude presente de maniere nouvelle et detaillee la complexite de la reponse immunologique a une borreliose de Lyme, telle que nous avons pu l'observer avec les immunoblots que nous avons mis au point. Elle s'efforce egalement de signaler les anticorps les plus caracteristiques de chaque stade de la maladie et illustre l'importance de l'echange d'information entre biologistes et cliniciens. Cette coordination permet de definir les meilleures strategies d'investigation et d'ameliorer la fiabilite des examens de laboratoire tout en reduisant leurs couts.

OBJECTIVE: To evaluate by species-specific immunoblots the association of Borrelia burgdorferi sensu stricto, B. garinii and B. afzelii with neuroborreliosis in Switzerland. METHODS: Borrelia strains isolated from the cerebrospinal fluid (CSF) of three children with neuroborreliosis were typed by phenotypic and genotypic analysis. The serologic reactions (IgG) of these three patients as well as those of 28 patients, including one of these three children, with confirmed neuroborreliosis were characterized and scored by immunoblots on the three individual Borrelia species antigens. Twenty patients with typical erythema migrans served as a control group. RESULTS: Phenotypic and genotypic analysis confirmed that all three CSF isolates were B. garinii. In the 28 patients with neuroborreliosis, the comparatively strongest reactions were as follows: 18 to B. garinii, three to B. burgdorferi sensu stricto and two to B. afzelii; five were inconclusive. In the control group (erythema migrans), the comparatively strongest reactions were as follows: six B. garinii, one to B. burgdorferi sensu stricto and five to B. afzelii; eight were indeterminate. CONCLUSIONS: Typing of these three CSF isolates and characterization by immunoblots of the antibody reactions of patients with neuroborreliosis give additional evidence of the association of B. garinii and neuroborreliosis. Our serologic results suggest that B. burgdorferi sensu stricto and B. afzelii are also responsible for some neuroborreliosis cases in Switzerland. Our immunoblots and the scoring system proved particularly useful for the serologic typing of patients with late Lyme borreliosis.

Summary Nine strains of Borrelia burgdorferi isolated from ticks in the canton of Valais (Switzerland) were characterized genotypically by determining restriction fragment length polymorphisms (RFLP) and plasmid profiles. The strains were also compared with respect to presence and electrophoretic mobility of the outer surface proteins OspA and OspB, and immunoreactivity of OspA and a 12 kD antigen. By both approaches, three different patterns were observed resulting in identical grouping of the strains. However, RFLP's allowed determination of relationships among strains within a group and have shown that geographic distribution does not correlate with genotype.