Control of Ixodes scapularis (Acari: Ixodidae) with topical self-application of permethrin by white-tailed deer inhabiting NASA, Beltsville, Maryland

We report the first successful area-wide reduction of Ixodes scapularis by using minimal amounts of permethrin self-applied by free-ranging white-tailed deer in as little as 3 y of nearly continuous treatment. The study to control all active stages of L. scapularis Say was initiated in April 1995, at the Goddard Space Flight Center, National Aeronautics and Space Administration (NASA), Beltsville, Maryland (treated location), and the Patuxent Wildlife Research Center, Laurel, Maryland (non-treated location). The locations had similar flora and fauna, and pre-treatment sampling (April to October 1995) of deer, plots, and mice for I. scapularis indicated nearly similar tick populations at both locations. After pre-treatment sampling, 4 deer '4-poster' stations were placed at NASA, while the control area received none. Ten percent permethrin, supplied to 4 roller covers on each station, was passively transferred to the head, neck, and ears of free-ranging deer feeding at the stations. This treatment resulted in elimination of adult I. scapularis on sampled deer (100% control) by the 2nd y of treatment and reductions of immature tick stages on mice. During the 3rd y of treatment, adult, nymphal, and larval questing ticks were reduced by 91-100% from sampled plots, and nymphal and larval ticks were reduced by 70-95% on sampled mice.

Longitudinal evaluation of an educational intervention for preventing tick bites in an area with endemic lyme disease in Baltimore County, Maryland

The authors attempted to determine whether a targeted educational intervention in an area with endemic Lyme disease could increase knowledge, positive attitudes, and reported behaviors related to tick bite prevention and consequently decrease tick bites, as measured by a biomarker of tick bites. Between April and September of 1999, 317 subjects in Baltimore County, Maryland, were randomized to receive either tick-related or general health-related educational materials bimonthly through the mail. At each of three clinic visits, participants completed a self-administered questionnaire and provided a serum sample. Anti-recombinant tick calreticulin antibody (ARTCA), measured in ng/ micro l, was used as a biomarker of tick bites. Linear and logistic regression analyses were used to determine 1) whether the educational intervention was associated with a change in knowledge, attitudes, and behaviors (KAB) and 2) whether change in KAB predicted change in ARTCA levels. Proportions of desired responses increased significantly among intervention subjects versus the comparison group on KAB measures related to examining the body for ticks and insect repellent use. Levels of ARTCA were low among all study subjects. Only six of 37 models exhibited a significant relation between change in a KAB variable and change in ARTCA levels over time. The behavioral intervention was associated with an increase in the KAB measures in the intervention group, but this change was not associated with change in ARTCA levels.

Inhibition of interleukin-17 prevents the development of arthritis in vaccinated mice challenged with Borrelia burgdorferi

We showed that Borrelia burgdorferi-vaccinated interferon gamma-deficient (IFN-gamma(0)) mice challenged with the Lyme spirochete developed a prominent chronic severe destructive osteoarthropathy. The immune response underlying the development of the severe destructive arthritis involves interleukin-17 (IL-17). Treatment of vaccinated IFN-gamma(0) mice challenged with B. burgdorferi with anti-IL-17 antibody delayed the onset of swelling of the hind paws but, more importantly, inhibited the development of arthritis. Histopathologic examination confirmed that treatment with anti-IL-17 antibody prevented the destructive arthropathy seen in vaccinated and challenged IFN-gamma(0) mice. Similar preventive results were obtained when vaccinated and challenged IFN-gamma(0) mice were treated with anti-IL-17 receptor antibody or sequentially with anti-IL-17 antibody followed by anti-IL-17 receptor antibody. By contrast, treatment of vaccinated and challenged IFN-gamma(0) mice with recombinant IL-17 (rIL-17) did not alter the development and progression of arthritis found in vaccinated and challenged IFN-gamma(0) mice without treatment with rIL-17. Therapeutic intervention may be a realistic approach to prevent arthritis, especially if IL-17 is involved in the perpetuation of chronic or intermittent arthritis.

OspA immunization decreases transmission of Borrelia burgdorferi spirochetes from infected Peromyscus leucopus mice to larval Ixodes scapularis ticks

Recombinant outer surface protein A (OspA) vaccination of wild animal reservoirs has potential application for reducing Borrelia burgdorferi transmission in nature and subsequent risk of human infection. As a major reservoir host, the white-footed mouse (Peromyscus leucopus) is a candidate for a vaccination program designed to reduce infection prevalence in vector ticks. In this study we characterized the effect of various levels of immunization with recombinant OspA-glutathione transferase fusion protein on transmission dynamics from infected P. leucopus to larval ticks. Control mice were vaccinated with glutathione transferase alone. All mice were experimentally infected with B. burgdorferi before vaccination. The immune responses of the immunized mice were assessed by enzyme-linked immunosorbent assay for antibodies to OspA. Transmission of B. burgdorferi from infected mice was determined by xenodiagnosis with uninfected larval ticks. Spirochetes in ticks were counted by direct immunofluorescence assay. The concentration of antibody to OspA increased with each OspA vaccination but most markedly after the first and second vaccinations. In comparison with control mice, there was reduced transmission by OspA-vaccinated mice to uninfected ticks. One, two, or three doses of OspA reduced infection prevalence in xenodiagnostic ticks by 48%, 92%, or 99% and the numbers of spirochetes per tick by 84%, 98%, or 99%, respectively. This study suggests that vaccination of P. leucopus with OspA could reduce transmission to the tick vector in nature despite prior infection of the reservoir host.

[Infestation of ticks with Borrelia, and Lyme borreliosis in Germany]

Currently, borreliosis is the most common tick-borne infectious disease in Europe and the USA. In Europe, three species of Borrelia are known to be pathogenic for humans, each of which apparently give rise to different clinical symptoms. Diagnosis is based in particular on the clinical presentation and history of exposure, and, as a rule, is confirmed by serological methods. It must, however, be remembered that the humoral immune response may appear relatively late, so at an early stage, patients are still serologically negative. Depending on the stage involved, oral or peroral antibiotic treatment is applied--however, eradication of the pathogen is unsuccessful in some cases. In future, adjuvant immunotherapy might close the therapeutic gap.

Lyme disease (Lyme borreliosis)

Lyme borreliosis (Lyme disease) is a systemic infectious disease with a wide spectrum of symptoms affecting the skin, the heart, and the nervous and musculoskeletal systems. Lyme borreliosis is caused by the spirochaete Borrelia burgdorferi and transmitted by ticks. The disease occurs in endemic pockets with an incidence of from 50 to more than 100 cases per 100,000 inhabitants. Despite increasing knowledge about the virulence factors of the spirochaetes and the immune response of the host, many aspects of the pathogenesis, for example of chronic treatment-resistant disease, are still a matter of debate. The diagnosis is based on clinical findings and confirmed by serology. Diagnostic problems arise from patients with non-specific symptoms and a positive IgG serology. In about 80% of the patients, the disease can be cured by adequate antibiotic therapy. Evidence-based guidelines for treatment have been recently published. The only vaccine to prevent Lyme disease, licensed in the USA, has been discontinued due to disappointing sales despite good efficacy and tolerability.

Use of a C6 ELISA test to evaluate the efficacy of a whole-cell bacterin for the prevention of naturally transmitted canine Borrelia burgdorferi infection

A commercially available C6 ELISA kit was used to detect antibodies induced by natural infection with Borrelia burgdorferi in dogs that lived in an area endemic for Lyme disease. Rates of infection were determined both for nonvaccinated dogs and those that had been vaccinated with a whole-cell B. burgdorferi bacterin (Lyme Vax, Fort Dodge Animal Health) before 6 months of age and were boostered annually. Vaccinated dogs had an infection rate of 5% (8 of 163), whereas 64% (25 of 39) of the non-vaccinated dogs were positive for B. burgdorferi antibodies. The preventable fraction, determined by comparing infection rates in unvaccinated and vaccinated dogs, was 92.2% (95% confidence interval: 84.3% to 96.3%). In addition, screening of nonvaccinated dogs at six Connecticut clinics (Middletown, Portland, Essex, Old Lyme, Durham, and Marlborough) with the C6 ELISA test revealed infection rates ranging from 41% to 73%, demonstrating a high level of infected dogs in the area. It was concluded that emphasis should be placed on vaccinating young dogs at risk for Lyme disease before they are exposed to infected ticks. Results of this study support the value of immunization with this whole-cell Lyme disease bacterin for dogs at risk for infection by B. burgdorferi.

Artificial-infection protocols allow immunodetection of novel Borrelia burgdorferi antigens suitable as vaccine candidates against Lyme disease

Vaccination with recombinant outer surface protein A (OspA) from Borrelia burgdorferi provides excellent antibody-mediated protection against challenge with the pathogen in animal models and in humans. However, the bactericidal antibodies are ineffective in the reservoir host, since OspA is expressed by spirochetes only in the vector, but rarely, if at all, in mammals. Using an artificially generated immune serum (anti-10(8) spirochetes) with high protective potential for prophylactic and therapeutic treatment, we have now isolated from an expression library of B. burgdorferi (strain ZS7) three novel genes, zs7.a36, zs7.a66 and zs7.a68. All three genes are located, together with ospA/B, on the linear plasmid lp54, and are expressed in vitro and in ticks. At least temporarily two of them, ZS7.A36 and ZS7.A66, are also expressed during infection. The respective natural antigens are poorly immunogenic ininfected normal mice but elicited antibodies in Lyme disease patients. We show that recombinant preparations of ZS7.A36, ZS7.A66 and ZS7.A68 induce functional antibodies in rabbits capable of protecting immunodeficient mice against subsequent experimental infection. These findings suggest that all three recombinant antigens represent potential candidates for a "second generation" vaccine to prevent and/or cure Lyme disease.

[The recurrence of Lyme arthritis]

Lyme arthritis is a frequent manifestation of Borrelia burgdorferi sensu lato infection. The relapses of Lyme arthritis are observed despite effective antibiotic therapy of acute Lyme disease.

THE AIM

This study was undertaken in order to determine the efficacy and tolerability of antibiotic treatment of Lyme arthritis with oral doxycycline and intravenous ceftriaxone and to evaluate the relapse rate of the arthritis after treatment.

PATIENTS

The study group consisted of 64 patients. Twenty five were treated orally with doxycycline (Doxycyclini hyclas) 0.2 g/day and 39 were treated intravenously with ceftriaxone (Ceftriaxonum natricum) 2.0 g/day; treatment duration in both groups was 28 days.

RESULTS

The symptoms of arthritis were most often seen in knee joints--45 patients (70%), then in shoulder joints--20 patients (31%), less frequently in ankle joints, elbow joints. In all patients remission of symptoms was seen after the treatment. The relapse of arthritis was seen slightly more frequently among patients treated with doxycycline 36% (9/25) than among those treated with ceftriaxone--23% (9/35), p = 0.402. The relapse was observed most often among patients older then 50 years.

CONCLUSIONS

The relapse of Lyme arthritis was seen in about 28% of patients, mainly older than 50 years it and did not depend on the antibiotic administered.

[Borrelia in ticks biting humans and prevention of Lyme borreliosis]

We examined by dark field microscopy 195 of 209 Ixodes ricinus ticks that were removed from humans in the Czech Republic (mainly in southern Moravia) during 1997-2001. The majority of the ticks were nymphs (62%), 31% were females and 7% larvae; 10.7% of the nymphs, 20.3% of the females but no larvae were found to be infected with B. burgdorferi s.l., the agent of Lyme borreliosis (LB). This observation supports for Central Europe the conclusions drawn from North America about nymphal ixodid ticks as the most important vector stage in transmission of LB. In the course of the year, we found the highest proportion of infected nymphal and female ticks taken off humans in June. The detection of borreliae in a human-biting tick is an important step that enables the general practitioner to prescribe prophylactic antimicrobial treatment and to reduce significantly the risk of Lyme disease in the patient.

Does host complement kill Borrelia burgdorferi within ticks?

The Lyme disease spirochete, Borrelia burgdorferi, inhabits the gut lumen of the tick vector. At this location the spirochete is exposed to host blood when a tick feeds. We report here on studies that were done with normal and complement-deficient (C3-knockout) mice to determine if the host complement system killed spirochetes within the vector. We found that spirochete numbers within feeding nymphs were not influenced by complement, most likely because host complement was inactivated within the vector. The Lyme disease outer surface protein A (OspA) vaccine is a transmission-blocking vaccine that targets spirochetes in the vector. In experiments with mice hyperimmunized with OspA, complement was not required to kill spirochetes within nymphs and to block transmission from nymphs to the vaccinated host. However, host complement did enhance the ability of OspA antibody to block larvae from acquiring spirochetes. Thus, the effects of OspA antibody on nymphal transmission and larval acquisition appear to be based on different mechanisms.

An open-label, nonrandomized, single-center, prospective extension, clinical trial of booster dose schedules to assess the safety profile and immunogenicity of recombinant outer-surface protein A (OspA) Lyme disease vaccine

BACKGROUND

An efficacy trial of an outer-surface protein A (OspA) Lyme disease vaccine demonstrated tolerability and efficacy against laboratory-confirmed Lyme disease after a primary series of 3 doses at 0, 1, and 12 months.

OBJECTIVES

This extension of the efficacy study assessed the immunogenicity and tolerability of booster vaccinations administered at 24 and/or 36 months after the first vaccination.

METHODS

This open-label, nonrandomized, single-center, prospective extension, clinical trial was conducted in the general community in New Haven, Connecticut, where Lyme disease is endemic. Blood samples (to determine anti-OspA titer) were collected before administration of the booster doses at months 24 and 36, and at 1 and 12 months after each booster dose was administered. Immune response was assessed via total immunoglobulin G (IgG) anti-OspA antibody titers and the proportion of subjects with titers >or=1400 EL.U/mL. Adverse events (AEs) were recorded by the study volunteers on diary cards.

RESULTS

A total of 318 volunteers (173 women and 145 men) received at least 1 booster dose of Lyme disease vaccine, administered at 12 or 24 months after the third vaccination of the primary series (months 24 and 36, in relation to the primary series). Eighty-eight subjects of those who received a month-24 booster received a second booster dose at month 36 (12 months after the first booster). Overall, the mean age of the volunteers was 55 years (range, 19 to 73 years). The demographic characteristics of the groups were similar. Most AEs were limited induration and were rated by investigators and subjects as mild to moderate in severity. Administration of I or 2 booster doses did not elicit any patterns of AEs different from those reported in the efficacy trial. After the first booster dose, all volunteers had an anamnestic response and positive test results for total IgG antibody. Geometric mean titers increased at least 12-fold 1 month after the first booster dose at month 24 or 36. More than 96% of volunteers had titers>1400 EL.U/mL and 100% had titers >400 EL.U/mL (minimum seroprotective level) 1 month after the booster dose at month 24 or 36.

CONCLUSIONS

All booster doses were well tolerated, and the incidence of AEs did not increase after the second booster dose. The immune response generated after the 3-dose primary series waned; booster doses administered at 12 and/or 24 months after the primary series increased antibody levels above seroprotective levels.

Purification of periplasmic flagellar antigen from Borrelia microtti

Borrelia microtti and Borrelia persica are 2 Iranian strains of Borrelia found in western Asia and responsible for relapsing fever. The outer surface antigens of Borrelia undergo variations which are responsible for the relapsing phenomenon. The fixed flagellar antigen is required for diagnosis as the variant antigens cannot be used in serological methods of diagnosis. The fixed flagellar antigen was purified for the first time from the Iranian strain of Borrelia microtti using detergent treatment and shearing in an omnimixer. Periplasmic flagella were extracted, as confirmed by electron microscopy. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis revealed a band corresponding to 42 kDa. Indirect haemagglutination kits were designed using the pure flagella and the complete sonicate of Borrelia and showed 98% sensitivity and 95% specificity.

[Neurologic problems in tick-borne diseases--clinical and diagnostic aspects]

Tick carried illnesses frequently lead towards neurological complications. The tick-borne encephalitis and borreliosis are the most frequently encountered illnesses having such aetiopathogenesis. In the study there are presented clinical aspects of tick-borne encephalitis and borreliosis with special consideration of various neurological symptomatology. Simultaneously there are discussed current diagnostic rules of the diseases, mainly on the basis of serologic investigation.

[Forest tick Ixodes ricinus (Ixodidae) in the foci of tick-borne borreliosis of the northwestern part of the Moscow region]

Monitoring studies during 1996-2001 have shown a natural foci of tick-borne borreliosis with high abundance of Ixodes ricinus and high infection rate with an agent: 19.5-38.4 tick individuals per 1 km of route, infection rate 18.0 +/- 1.7-22.5 +/- 1.5%. A risk to be infected with the Lyme disease in the ricinus focus of the tick-borne borreliosis during the epizootic season did not vary much during the period of study, 3.5-8.2 in different year, mean 6.0 infected ticks per 1 km of route.

Gamma interferon inhibits production of Anti-OspA borreliacidal antibody in vitro

The ability of a Lyme borreliosis vaccine to induce and maintain sustained levels of borreliacidal antibody is necessary for prolonged protection against infection with Borrelia burgdorferi. Vaccination against infection with B. burgdorferi could be improved by determining the mechanism(s) that influences the production of protective borreliacidal antibody. Borreliacidal antibody was inhibited in cultures of lymph node cells obtained from C3H/HeJ mice vaccinated with formalin-inactivated B. burgdorferi and cultured with macrophages and B. burgdorferi and treated with recombinant gamma interferon (rIFN-gamma). The suppression of production of outer surface protein A (OspA) borreliacidal antibody by rIFN-gamma was not affected by the time of treatment. In addition, treatment with rIFN-gamma inhibited the production of other anti-B. burgdorferi antibodies. By contrast, treatment of cultures of immune lymph node cells with anti-IFN-gamma marginally increased the production of borreliacidal antibody and enhanced the production of other antibodies directed against B. burgdorferi. These results show that IFN-gamma does not play a major role in the production of anti-OspA borreliacidal antibody. Additional studies are needed to determine which cytokine(s) will enhance production of borreliacidal antibody.

Sex-biased genetic structure in the vector of Lyme disease, Ixodes ricinus

We analyzed 725 Ixodes ricinus ticks (the principal vector of Lyme disease in Europe) collected in Switzerland in 1995 and 1996 (three and eight samples, respectively) and in Tunisia in 1996 (one sample) with five microsatellite markers. We found highly significant genetic differentiation between Swiss and Tunisian samples but detected almost no differentiation within Switzerland, even between those samples separated by the Alps. Interestingly, we found that I. ricinus females were more genetically related to one another than were males at a local scale, which would indicate a higher dispersal rate of immature males. Possible explanations for these findings in terms of sex-specific association of ticks with certain hosts (e.g., birds) and their epidemiological consequences are discussed.

Effective retrieval of Lyme disease information on the Web

The spirochetal infection Lyme disease, although now usually easily diagnosed and treated, has acquired an aura of ambiguity for many laypersons and medical professionals. The existence of controversy makes it difficult for infectious diseases physicians and scientists to readily obtain accurate information on Lyme disease by casually browsing the World Wide Web. Informative and current Web sites on the diagnosis, epidemiology, treatment, and prevention of Lyme disease can be found on-line, as can clear images of its clinical variants and of ticks. There are a handful of on-line resources on the biology of Borrelia and ticks, which can be tapped by the research community. These Web sites are described in the present article.