Abstract

Background: Lyme disease represent an emergent zoonosis caused by the spirochete Borrelia burgdorferi. The disease is transmitted from animals to humans by hematophagous insects, primarily ticks. The question of the existence of chronic borreliosis in children and adults is today a stumbling block in diagnostics and therapy at the global level. Objective: The aim of this article is to answer the questions: is the diagnosis of Lyme disease complicated and is Borrelia burgdorferi the cause of chronic Lyme disease in children and adults. Methods: A retrospective-prospective clinical study of outpatients treated and monitored in a private infectious disease clinic over 13 years from January 1, 2013 – November 30, 2025 was conducted. The study was clinical, descriptive and analytical, and was conducted in three phases; the first retrospective and two prospective phases. The diagnosis of the disease was made on the basis of anamnestic-epidemiological data, clinical picture, clinical findings of new clinical markers and the course of the disease, and verified by serological detection of specific antibodies using ELISA, WB methods, detection of antibodies to protein sequences by Immunoblot0m, and detection of Borrelia burgdorferi bacteria in serum using a light microscope in a dark field. Results: In the investigated period, a total of 1,095 patients with Lyme disease symptoms were treated. Of that number, 120 children and 975 adults were treated. M : F = 436 : 659. The average age of children was 10.7 years, and of adults 50.1 years. 11.62% of patients had an acute and subacute phase of the disease, the rest were chronic patients with Lyme disease, children and adults. Out of 105 patients who were examined for Borrelia by light microscopy in the dark field, Borrelia was confirmed in 31 patients before therapy and in 19 relapses. In 21 patients before the therapy, as expected, Borrelia was not found in the blood, nor in 46 controls after the therapy, which was carried out intermittently for more than 50 days. In 3 patients, who had a slow recovery, Borrelia was found in the blood after 30 and 80 days of intermittent therapy. Conclusion: Lyme borreliosis is a persistent infection and in susceptible individuals it has a chronic remitting course. Diagnosis of the disease is simple if an individual approach is adopted, an adequate history is taken, new clinical markers are found on the skin and confirmed by the detection of antibodies to the Borrelia protein sequences in Immunoblot. The confirmatory test is the detection of Borrelia by light microscopy in the dark field. Chronic borreliosis in children and adults and vertical transmission from mother to child are unquestionable.

Key words: Lyme disease, chronic borreliosis, vertical transmission, diagnostics