Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 1;11(4):917.
doi: 10.3390/microorganisms11040917.

Lyme Neuroborreliosis-Significant Local Variations in Incidence within a Highly Endemic Region in Sweden

Per-Olof Nilsson  1 , Ivar Tjernberg  2
Affiliations

Lyme Neuroborreliosis-Significant Local Variations in Incidence within a Highly Endemic Region in Sweden

Per-Olof Nilsson et al. Microorganisms. .

Abstract

The aim of this study was to perform a detailed epidemiological overview of Lyme neuroborreliosis (LNB) 2008-2021 in a highly Lyme borreliosis-endemic area in Sweden using a geographic information system (GIS). Diagnosis of LNB was based on clinical symptoms and analysis of cerebrospinal fluid (CSF) according to European guidelines. From laboratory databases and medical records, we detected all patients with CSF pleocytosis and intrathecal anti-Borrelia antibody production and listed clinical features. The distribution of LNB cases within Kalmar County, Sweden was investigated using GIS. In total, 272 cases of definite LNB were confirmed with an average yearly incidence of 7.8/100,000. Significant differences in incidence were noted between children 0-17 years (16/100,000) and adults 18+ years (5.8/100,000) (p < 0.001), between rural (16/100,000) and urban areas (5.8/100,000) (p < 0.001) and between selected municipalities (p < 0.001). Distinct clinical differences in presentation of LNB were also noted between children and adults. Thus, the incidence of LNB varies significantly locally and in relation to age, and clinical presentation shows differences between children and adults. Surveillance of LNB and knowledge of local epidemiological conditions may facilitate preventive measures.

Keywords: Lyme neuroborreliosis; epidemiology; geographic information system; incidence.

PubMed Disclaimer

Conflict of interest statement

I.T. reports participation in the advisory board and personal fees from Pfizer Inc outside the submitted work. P.-O.N. reports no conflicts of interest.

Figures

Figure 1
Figure 1
(a–c). Lyme neuroborreliosis distribution 2008–2021, number of cases. (a): Cases annually 2008–2021. (b): Age distribution 2008–2021. (c): Case distribution by month 2008–2021.
Figure 2
Figure 2
Lyme neuroborrelisos case distribution with topographical overlay within Kalmar County, Sweden.
Figure 3
Figure 3
Confirmed Lyme neuroborreliosis cases grouped according to urban or rural area status. Figure 3. Definite Lyme neuroborreliosis cases in Kalmar County 2008–2021 grouped by living in urban or rural areas, with 162 cases in urban areas and 110 in rural areas. The municipalities within Kalmar County are shown in grey.
Figure 4
Figure 4
Definite cases of Lyme neuroborreliosis grouped by children and adults. Figure 4. Definite Lyme neuroborreliosis cases in Kalmar County 2008–2021 grouped by children (0–17 years) and adults (18+ years). The municipalities within Kalmar County are shown in grey.
Figure 5
Figure 5
Mean annual incidence in each municipality.
See this image and copyright information in PMC

References

    1. Dumic I., Severnini E. “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease. Can. J. Infect. Dis. Med. Microbiol. 2018;2018:5719081. doi: 10.1155/2018/5719081. - DOI - PMC - PubMed
    1. Stanek G., Strle F. Lyme borreliosis-from tick bite to diagnosis and treatment. FEMS Microbiol. Rev. 2018;42:233–258. doi: 10.1093/femsre/fux047. - DOI - PubMed
    1. Trevisan G., Cinco M., Trevisini S., di Meo N., Chersi K., Ruscio M., Forgione P., Bonin S. Borreliae Part 1: Borrelia Lyme Group and Echidna-Reptile Group. Biology. 2021;10:1036. doi: 10.3390/biology10101036. - DOI - PMC - PubMed
    1. Carlsson H., Ekerfelt C., Henningsson A.J., Brudin L., Tjernberg I. Subclinical Lyme borreliosis is common in south-eastern Sweden and may be distinguished from Lyme neuroborreliosis by sex, age and specific immune marker patterns. Ticks Tick Borne Dis. 2018;9:742–748. doi: 10.1016/j.ttbdis.2018.02.011. - DOI - PubMed
    1. Ogrinc K., Maraspin V. Nervous system involvement in Lyme borreliosis. Open Dermatol. J. 2016;10:44–54. doi: 10.2174/1874372201610010044. - DOI