Unveiling the Mysteries of Lyme Disease

Türkiye'de Lyme Borreliozis'in Epidemiyolojisi
Epidemiology of Lyme Borreliosis in Türkiye
Ömer ORKUNa,b
aAnkara Üniversitesi Veteriner Fakültesi, Parazitoloji AD, Ankara, Türkiye
bAnkara Üniversitesi Veteriner Fakültesi, Keneler ve Kene Kaynaklı Hastalıklar Araştırma Laboratuvarı, Ankara, Türkiye
Orkun Ö. Türkiye'de Lyme borreliozis'in epidemiyolojisi. Haykır Solay A, editör. Tüm Bilinmeyenleri ile Lyme Hastalığı. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.19-28.
Article Language: TR
ÖZET
 Lyme borreliozis insanlarda çeşitli klinik belirtilerle seyredebilen ve Borrelia burgdorferi sensu lato kompleksi içerisinde yer alan patojenik genotürler tarafından oluşturulan kene kaynaklı bakteriyel bir enfeksiyondur. Epidemiyolojik açıdan Lyme hastalığının coğrafik dağılımı Ixodes soyunda yer alan vektör kene türleri tarafından belirlenir. Hastalık özellikle kuzey yarım kürede yaygın olarak seyretmekle beraber Türkiye'de ise vektör I. ricinus'un dağılımı ile uyumlu olarak özellikle ülkenin kuzeyinde görülmektedir. Türkiye'de bugüne kadar varlığı bildirilen Lyme borreliozis etkenleri; B. afzelii, B. garinii, B. burgdorferi s.s., B. lusitaniae, B. valaisiana ve B. spielmanii genotürleridir. Ana vektör I. ricinus türü başlıca Karadeniz ve Trakya bölgeleri ile Akdeniz, Ege ve Marmara kıyılarında yaygın görülen ve sıklıkla insanları enfeste eden bir kene türü olmasına rağmen Lyme borreliozis'in Türkiye'deki epidemiyolojisi üzerine yapılan araştırmalar ve güncel veriler oldukça kısıtlıdır. Bu durum Lyme borreliozis'in Türkiye'de ihmal edilen bir hastalık olduğunu işaret etmektedir. Rapor edilen sınırlı sayıdaki çalışmalarda konfirme edilmiş insan ve hayvan pozitiviteleri ile enfekte vektör kene verileri açık bir şekilde göstermektedir ki B. burgdorferi s.l. genotürleri başlıca Türkiye'nin kuzeyindeki yüksek nemli orman içi doğal odaklarda aktif bir şekilde sirküler haldedir. Bundan dolayı I. ricinus'un dağılım gösterdiği bölgelerdeki ilgili türün insan enfestasyonlarında Lyme borreliozis göz önüne alınarak gerekli durumlarda akut fazda etkenin varlığını doğru bir şekilde saptayacak valide edilmiş konfirmasyona dayalı erken tanı teknikleri devreye sokulmalıdır. Ayrıca pozitif vakalarda uzun vadeli klinik seyirde yardımcı olacak genotür bazında identifikasyonların da yapılması faydalı olacaktır. Bunun yanında gerek lokal gerek bölgesel gerekse de ülke bazında Lyme borreliozis'in yayılışı ve yoğunluğunu ortaya koyacak vektör-konak-rezervuar üçlüsünü araştıran epidemiyolojik araştırmalara önemle ihtiyaç vardır. Elde edilecek yüksek çözünürlüklü epidemiyolojik veriler kullanılarak risk hesaplamaları ile bölgesel gereklilikler ortaya çıkarılabilecek ve dolayısıyla tek sağlık konseptinde efektif mücadele stratejileri üretme imkânı bulunacaktır. Ayrıca elde edilecek detaylı epidemiyolojik veriler ile son zamanlarda Türkiye'de de baş gösteren Lyme borreliozis ile alakalı dezenformasyon ve misenformasyonla da mücadele edecek bilimsel veriler elde edilmiş olacaktır.

Anahtar Kelimeler: Borrelia burgdorferi sensu lato; epidemiyoloji; Ixodes ricinus; kene kaynaklı hastalıklar; Lyme borreliozis; tek sağlık
ABSTRACT
 Lyme borreliosis is a tick-borne bacterial infection caused by pathogenic genotypes within the Borrelia burgdorferi sensu lato complex, which can present with various clinical symptoms in humans. Epidemiologically, the geographical distribution of Lyme disease is determined by vector ticks in the genus Ixodes. While the disease is particularly widespread in the northern hemisphere, in Türkiye it is mainly observed in the north of the country, consistent with the distribution of the vector I. ricinus. To date, the presences of B. afzelii, B. garinii, B. burgdorferi s.s., B. lusitaniae, B. valaisiana, and B. spielmanii genospecies have been reported from Türkiye. Although the main vector, I. ricinus, is a widely prevalent tick species in the Black Sea and Thrace regions with the Mediterranean, Aegean, and Marmara costs and frequently infests humans, researches and current data on the epidemiology of Lyme borreliosis in Türkiye are quite limited. This situation indicates that Lyme borreliosis is a neglected disease in Türkiye. Confirmed human and animal positivity with infected vector tick data from the limited number of studies clearly indicate that B. burgdorferi s.l. genospecies are actively circulating in the natural foci within high humidity forests mainly in the northern parts of Türkiye. Therefore, Lyme borreliosis should be taken into account in human infestations with I. ricinus in regions where it is distributed, and early diagnostic techniques based on validated confirmation should be put in place to accurately detect the presence of the causative agent in the acute phase, if necessary. Also, in positive cases, it would be useful to perform genospecies-based identifications that will help in the longterm clinical course of the infection. At this stage, there is a significant need for future epidemiological studies investigating the vector-host-reservoir cycle that will reveal the prevalence of Lyme borreliosis at the level of local, regional, and national. By using the high-resolution epidemiological data to be obtained, risk calculations and regional requirements will be revealed, and therefore it will be possible to produce effective struggle strategies within the concept of one health. Additionally, the detailed epidemiological data to be obtained will also be used effectively to combat disinformation and misinformation related to Lyme borreliosis, which has recently emerged in Türkiye.

Keywords: Borrelia burgdorferi sensu lato; epidemiology; Ixodes ricinus; tick-borne diseases; Lyme borreliosis; one health

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