51
|
Thompson AD, Balamuth F, Neville DN, Chapman LL, Levas MN, Kharbanda AB, Branda JA, Ladell MM, Loiselle C, Nigrovic LE. Sensitivity of Two-Tiered Lyme Disease Serology in Children With an Erythema Migrans Lesion. J Pediatric Infect Dis Soc 2023; 12:553-555. [PMID: 37756491 DOI: 10.1093/jpids/piad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023]
Abstract
In our prospective cohort of 192 children with a physician-diagnosed erythema migrans (EM) lesion, two-tier Lyme disease serology had higher sensitivity in children with multiple EM lesions (76.8% multiple lesions vs. 38.1% single EM; difference 38.7%, 95% confidence interval 24.8%-50.4%). The diagnosis of cutaneous Lyme disease should be based on careful physical examination rather than laboratory testing.
Collapse
Affiliation(s)
- Amy D Thompson
- Division of Emergency Medicine, Nemours Children's Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA
| | - Fran Balamuth
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Desiree N Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura L Chapman
- Division of Pediatric Emergency Medicine, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Meagan M Ladell
- Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Claire Loiselle
- Department of Research, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
52
|
Porwancher R, Levin A, Trevejo R. Immunoblot Criteria for Diagnosis of Lyme Disease: A Comparison of CDC Criteria to Alternative Interpretive Approaches. Pathogens 2023; 12:1282. [PMID: 38003747 PMCID: PMC10674374 DOI: 10.3390/pathogens12111282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/26/2023] Open
Abstract
The current Centers for Disease Control and Prevention (CDC) interpretive criteria for serodiagnosis of Lyme disease (LD) involve a two-tiered approach, consisting of a first-tier EIA, IFA, or chemiluminescent assay, followed by confirmation of positive or equivocal results by either immunoblot or a second-tier EIA. To increase overall sensitivity, single-tier alternative immunoblot assays have been proposed, often utilizing antigens from multiple Borrelia burgdorferi strains or genospecies in a single immunoblot; including OspA and OspB in their antigen panel; requiring fewer positive bands than permitted by current CDC criteria; and reporting equivocal results. Published reports concerning alternative immunoblot assays have used relatively small numbers of LD patients and controls to evaluate novel multi-antigen assays and interpretive criteria. We compared the two most commonly used alternative immunoblot interpretive criteria (labeled A and B) to CDC criteria using data from multiple FDA-cleared IgG and IgM immunoblot test kits. These single-tier alternative interpretive criteria, applied to both IgG and IgM immunoblots, demonstrated significantly more false-positive or equivocal results in healthy controls than two-tiered CDC criteria (12.4% and 35.0% for Criteria A and B, respectively, versus 1.0% for CDC criteria). Due to limited standardization and high false-positive rates, the presently evaluated single-tier alternative immunoblot interpretive criteria appear inferior to CDC two-tiered criteria.
Collapse
Affiliation(s)
- Richard Porwancher
- Section of Allergy, Immunology, and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Princeton Infectious Diseases Associates, LLC, Plainsboro, NJ 08536, USA
| | - Andrew Levin
- Kephera Diagnostics, LLC, Framingham, MA 01702, USA;
| | - Rosalie Trevejo
- Epidemiologist, Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR 97232, USA;
| |
Collapse
|
53
|
Rich SM, Siegel EL, Xu G. What a Tick Can Tell a Doctor: Using the Human-Biting Tick in the Clinical Management of Tick-Borne Disease. J Clin Med 2023; 12:6522. [PMID: 37892661 PMCID: PMC10607280 DOI: 10.3390/jcm12206522] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
With expanding concern about ticks, there is a general sense of uncertainty about the diagnosis and treatment of tick-borne diseases. The diagnosis process is often based on clinical judgment in conjunction with laboratory testing and can be pathogen specific. Treatments may require disease-dependent approaches, and co-infections complicate or increase the severity of the clinical picture. Measuring exposure indices in the tick has become popular among providers and their patients, though this practice is not universally understood, and certain public health agencies have voiced concerns regarding interpretation and rigor of testing. As many providers subscribe to or recommend these services to aid in pretest risk and exposure assessments, this work sought to clarify the role of pathogen testing human-biting ticks as a complement to the diagnostic pipeline and raises points that must be addressed through future research and interdisciplinary conversation. Future work is needed to develop quality control oversight for tick testing laboratories. Studies on the integration of tick testing with human cases to see how these services affect health outcomes are also needed. Alongside these, improvements in the quality and availability of diagnostics are of critical importance.
Collapse
Affiliation(s)
- Stephen M. Rich
- Laboratory of Medical Zoology, Department of Microbiology, University of Massachusetts, Amherst, MA 01002, USA; (E.L.S.); (G.X.)
| | | | | |
Collapse
|
54
|
Boegle AK, Narayanaswami P. Infectious Neuropathies. Continuum (Minneap Minn) 2023; 29:1418-1443. [PMID: 37851037 DOI: 10.1212/con.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article discusses the clinical manifestations and management of infectious peripheral neuropathies. LATEST DEVELOPMENTS Several infectious etiologies of peripheral neuropathy are well-recognized and their treatments are firmly established. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with several central and peripheral nervous system manifestations, including peripheral neuropathies. Additionally, some COVID-19 vaccines have been associated with Guillain-Barré syndrome. These disorders are an active area of surveillance and research. Recent evidence-based guidelines have provided updated recommendations for the diagnosis and treatment of Lyme disease. ESSENTIAL POINTS Infectious agents of many types (primarily bacteria and viruses) can affect the peripheral nerves, resulting in various clinical syndromes such as mononeuropathy or mononeuropathy multiplex, distal symmetric polyneuropathy, radiculopathy, inflammatory demyelinating polyradiculoneuropathy, and motor neuronopathy. Knowledge of these infections and the spectrum of peripheral nervous system disorders associated with them is essential because many have curative treatments. Furthermore, understanding the neuropathic presentations of these disorders may assist in diagnosing the underlying infection.
Collapse
|
55
|
Shafquat M, Angulo FJ, Pilz A, Moïsi JC, Stark JH. The Incidence of Lyme Borreliosis Among Children. Pediatr Infect Dis J 2023; 42:867-874. [PMID: 37406218 PMCID: PMC10501351 DOI: 10.1097/inf.0000000000004040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND First recognized in children in the United States, Lyme borreliosis (LB) is the most prevalent tickborne illness in North America and Europe. However, the incidence of LB in children, including geographic variation and difference from that in adults, is incompletely described. METHODS We compiled surveillance data from public health agency websites reporting age-stratified LB case data, which was combined with census data to derive incidence estimates. Additional incidence estimates were obtained through a systematic literature review. RESULTS We identified 18 surveillance systems and 15 published studies for derivation of LB incidence in children. National incidence of >10 cases in children per 100,000 per year were estimated for the United States and parts of Eastern, Western and Northern Europe. However, there was substantial variation in incidence among countries in some European regions. National incidence estimates from the literature largely aligned with estimates from surveillance. Surveillance-reported pediatric incidence was lower than adult incidence in adults in 8 countries, similar to adult incidence in 3 countries, and higher than adult incidence in 1 country. Among all pediatric age strata, the 5-9 years of age stratum had the highest proportion of pediatric cases in most countries. CONCLUSIONS As pediatric LB represents a substantial proportion of overall LB incidence across countries in Europe and North America, LB prevention and control efforts should target pediatric as well as adult populations. However, better data are needed to fully characterize the difference in incidence across geographic regions.
Collapse
Affiliation(s)
- Madiha Shafquat
- From the Vaccines, Antivirals, and Evidence Generation, Medical Affairs, Pfizer Biopharma Group, Collegeville, Pennsylvania
| | - Frederick J. Angulo
- From the Vaccines, Antivirals, and Evidence Generation, Medical Affairs, Pfizer Biopharma Group, Collegeville, Pennsylvania
| | - Andreas Pilz
- Vaccines, Antivirals, and Evidence Generation, Medical Affairs, Pfizer Biopharma Group, Vienna, Austria
| | - Jennifer C. Moïsi
- Vaccines, Antivirals, and Evidence Generation, Medical Affairs, Pfizer Biopharma Group, Paris, France
| | - James H. Stark
- From the Vaccines, Antivirals, and Evidence Generation, Medical Affairs, Pfizer Biopharma Group, Collegeville, Pennsylvania
| |
Collapse
|
56
|
Finck C, Gambron T, Benchimol L, Camby S, Morsomme D. Case report: Successive ipsilateral and contralateral laryngeal nerve palsy as probable manifestation of neuroborreliosis. Heliyon 2023; 9:e20869. [PMID: 37876487 PMCID: PMC10590778 DOI: 10.1016/j.heliyon.2023.e20869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
Neuroborreliosis is part of advanced stage of Lyme disease and often characterized by damage to the cranial and/or peripheral nerves. Involvement of one or both recurrent nerves is rare. Diagnosis is often difficult and based on a set of clinical manifestations, biological arguments, and cerebrospinal fluid (CSF) analysis. A 70-year-old man was referred to our Voice Clinic with a 3-month history of dysphonia caused by right vocal fold paralysis (VFP) without any cutaneous symptoms of tick bite or erythema migrans in the previous weeks and normal initial radiological examination (neck and thorax CT). Methylprednisolone had already been prescribed but without any clinical improvement. Late biological investigation 3 months after initial symptoms of VFP showed high IgG (93 U/mL; reference <10 U/mL) against Borrelia burgdorferi (BB), which was confirmed by two immunoblot markers (VIsE, p39 antigens). Therefore, a possible manifestation of Lyme disease with involvement of the right inferior laryngeal nerve was suspected, namely Lyme neuroborreliosis. However, given the spontaneous recovery of the patient after 7 months without any adapted antimicrobial regimen treatment, the diagnosis of neuroborreliosis was not confirmed by a lumbar puncture. Nineteen months later, the patient presented again for the same symptomatology but as left VFP. High IgG (68 U/mL) and IgM (>6, reference <0.90) levels against BB were confirmed by immunoblot. Subsequently, lumbar puncture was performed and revealed IgG against BB at 46.1 UA/mL (reference<5.5 UA/mL) in the CSF, with an extremely high IgG intrathecal synthesis antibody index (281.33, positive if > 1.5). Intrathecal antibody synthesis is the gold standard for Lyme neuroborreliosis demonstrating a specific immune response to BB in the central nervous system, but with the limitation of persistence for years after eradication. Our patient did not exhibit pleocytosis in the CSF. Therefore, two criteria of the European Federation of Neurological Societies (EFNS) guidelines are fulfilled for possible neuroborreliosis. Doxycycline treatment led to rapid recovery in less than 8 weeks and normal mobility of the left vocal fold. Because of this very uncommon clinical presentation with two successive episodes of VFP for no other obvious reason and serological evidence from the serum and CSF during the second episode, we consider it possible that the first episode of VFP could also have been a manifestation of neuroborreliosis. This case is the first report of possible relapse of laryngeal palsy successively on the right, and then the left side as a manifestation of Lyme neuroborreliosis.
Collapse
Affiliation(s)
- Camille Finck
- ENT Department, University Hospital of Liege, Belgium
- Faculty of Medecine, Uliege, Belgium
- Faculty of Psychology and Sciences of Education, Umons, Belgium
| | | | - Lionel Benchimol
- ENT Department, University Hospital of Liege, Belgium
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, Belgium
| | | | - Dominique Morsomme
- ENT Department, University Hospital of Liege, Belgium
- Faculty of Psychology, Speech and Language Therapy and Education, University of Liege, Belgium
| |
Collapse
|
57
|
Cocoros NM, Kluberg SA, Willis SJ, Forrow S, Gessner BD, Nutt CT, Cane A, Petrou N, Sury M, Rhee C, Jodar L, Mendelsohn A, Hoffman ER, Jin R, Aucott J, Pugh SJ, Stark JH. Validation of Claims-Based Algorithm for Lyme Disease, Massachusetts, USA. Emerg Infect Dis 2023; 29:1772-1779. [PMID: 37610117 PMCID: PMC10461665 DOI: 10.3201/eid2909.221931] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Compared with notifiable disease surveillance, claims-based algorithms estimate higher Lyme disease incidence, but their accuracy is unknown. We applied a previously developed Lyme disease algorithm (diagnosis code plus antimicrobial drug prescription dispensing within 30 days) to an administrative claims database in Massachusetts, USA, to identify a Lyme disease cohort during July 2000-June 2019. Clinicians reviewed and adjudicated medical charts from a cohort subset by using national surveillance case definitions. We calculated positive predictive values (PPVs). We identified 12,229 Lyme disease episodes in the claims database and reviewed and adjudicated 128 medical charts. The algorithm's PPV for confirmed, probable, or suspected cases was 93.8% (95% CI 88.1%-97.3%); the PPV was 66.4% (95% CI 57.5%-74.5%) for confirmed and probable cases only. In a high incidence setting, a claims-based algorithm identified cases with a high PPV, suggesting it can be used to assess Lyme disease burden and supplement traditional surveillance data.
Collapse
|
58
|
Kanjana K, Strle K, Lochhead RB, Pianta A, Mateyka LM, Wang Q, Arvikar SL, Kling DE, Deangelo CA, Curham L, Barbour AG, Costello CE, Moon JJ, Steere AC. Autoimmunity to synovial extracellular matrix proteins in patients with postinfectious Lyme arthritis. J Clin Invest 2023; 133:e161170. [PMID: 37471146 PMCID: PMC10471169 DOI: 10.1172/jci161170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUNDAutoimmune diseases often have strong genetic associations with specific HLA-DR alleles. The synovial lesion in chronic inflammatory forms of arthritis shows marked upregulation of HLA-DR molecules, including in postinfectious Lyme arthritis (LA). However, the identity of HLA-DR-presented peptides, and therefore the reasons for these associations, has frequently remained elusive.METHODSUsing immunopeptidomics to detect HLA-DR-presented peptides from synovial tissue, we identified T cell epitopes from 3 extracellular matrix (ECM) proteins in patients with postinfectious LA, identified potential Borreliella burgdorferi-mimic (Bb-mimic) epitopes, and characterized T and B cell responses to these peptides or proteins.RESULTSOf 24 postinfectious LA patients, 58% had CD4+ T cell responses to at least 1 epitope of 3 ECM proteins, fibronectin-1, laminin B2, and/or collagen Vα1, and 17% of 52 such patients had antibody responses to at least 1 of these proteins. Patients with autoreactive T cell responses had significantly increased frequencies of HLA-DRB1*04 or -DRB1*1501 alleles and more prolonged arthritis. When tetramer reagents were loaded with ECM or corresponding Bb-mimic peptides, binding was only with the autoreactive T cells. A high percentage of ECM-autoreactive CD4+ T cells in synovial fluid were T-bet-expressing Th1 cells, a small percentage were RoRγt-expressing Th17 cells, and a minimal percentage were FoxP3-expressing Tregs.CONCLUSIONAutoreactive, proinflammatory CD4+ T cells and autoantibodies develop to ECM proteins in a subgroup of postinfectious LA patients who have specific HLA-DR alleles. Rather than the traditional molecular mimicry model, we propose that epitope spreading provides the best explanation for this example of infection-induced autoimmunity.FUNDINGSupported by National Institute of Allergy and Infectious Diseases R01-AI101175, R01-AI144365, and F32-AI125764; National Institute of Arthritis and Musculoskeletal and Skin Diseases K01-AR062098 and T32-AR007258; NIH grants P41-GM104603, R24-GM134210, S10-RR020946, S10-OD010724, S10-OD021651, and S10-OD021728; and the G. Harold and Leila Y. Mathers Foundation, the Eshe Fund, and the Lyme Disease and Arthritis Research Fund at Massachusetts General Hospital.
Collapse
Affiliation(s)
- Korawit Kanjana
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Klemen Strle
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert B. Lochhead
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Annalisa Pianta
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura M. Mateyka
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Wang
- Center for Biomedical Mass Spectrometry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sheila L. Arvikar
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David E. Kling
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cameron A. Deangelo
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucy Curham
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan G. Barbour
- Department of Microbiology and Molecular Genetics, University of California, Irvine, Irvine, California, USA
| | - Catherine E. Costello
- Center for Biomedical Mass Spectrometry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - James J. Moon
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen C. Steere
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
59
|
Xi D, Thoma A, Rajput-Ray M, Madigan A, Avramovic G, Garg K, Gilbert L, Lambert JS. A Longitudinal Study of a Large Clinical Cohort of Patients with Lyme Disease and Tick-Borne Co-Infections Treated with Combination Antibiotics. Microorganisms 2023; 11:2152. [PMID: 37763996 PMCID: PMC10536678 DOI: 10.3390/microorganisms11092152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
The rising prevalence of tick-borne infections (TBIs) necessitates further attention. This study retrospectively investigated the types of TBIs, symptoms, and if combination antibiotics were helpful within a patient cohort at an infectious disease clinic in Ireland. In this chart audit of 301 individuals (184 female, 117 male) tested for TBIs, 140 (46.51%) had positive antibody responses for TBIs from an ELISA (enzyme-linked immunoassay) that was based on a modified two-tiered testing protocol. A total of 93 (66.43%) patients had positive antibody responses to one TBI: 83 (59.29%) for Borrelia, 7 (5.00%) for Rickettsia, and 1 (0.71%) each for either Babesia, Bartonella, or Ehrlichia. The remaining 47 (33.57%) patients were infected with multiple TBIs. These patients were treated with combination antibiotics and monitored at two subsequent follow-ups. Only 2 of 101 patients (1.98%) had discontinued treatment by the second follow-up. In the first follow-up with 118 patients, 70 (59.32%) reported pain and 48 (40.68%) had neurological symptoms. In the next follow-up of 101 patients, 41 (40.59%) had pain while 30 (29.70%) had neurological symptoms. There were statistically significant reductions in the incidence of pain (41.43%) and neurological (37.50%) symptoms between follow-ups. Thus, our study demonstrates that combination antibiotics effectively relieve TBI symptoms with good patient tolerance.
Collapse
Affiliation(s)
- David Xi
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (A.T.); (A.M.); (G.A.)
| | - Abbie Thoma
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (A.T.); (A.M.); (G.A.)
| | - Minha Rajput-Ray
- Curaidh Clinic: Innovative Solutions for Pain, Chronic Disease and Work Health, Perthshire PH2 8EH, UK;
| | - Anne Madigan
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (A.T.); (A.M.); (G.A.)
| | - Gordana Avramovic
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (A.T.); (A.M.); (G.A.)
| | - Kunal Garg
- Te?ted Oy, 40100 Jyväskylä, Finland; (K.G.); (L.G.)
| | | | - John S. Lambert
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland; (D.X.); (A.T.); (A.M.); (G.A.)
- Infectious Diseases Department, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
- Infectious Diseases Department, The Rotunda Hospital, D01 P5W9 Dublin, Ireland
| |
Collapse
|
60
|
Wang G, Zhuge J, Wormser GP. Frequency of Positive Polymerase Chain Reaction (PCR) Testing for Borrelia burgdorferi on Whole Blood Samples That Tested Positive for Babesia microti by PCR from an Endemic Area for Both Infections in New York State. Pathogens 2023; 12:1066. [PMID: 37624026 PMCID: PMC10459504 DOI: 10.3390/pathogens12081066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
Because both Babesia microti and Borrelia burgdorferi can be transmitted by the bite of a single coinfected Ixodes scapularis tick, an attempt was made to determine the frequency with which whole blood samples that tested positive for B. microti infection by polymerase chain reaction (PCR) would also test positive by PCR for B. burgdorferi infection. Over a 7-year period from 2013 to 2019, 119 different patients tested positive for B. microti infection by PCR on at least one blood sample. Among the 118 patients with a positive B. microti PCR blood sample that could also be tested by a qualitative PCR for B. burgdorferi, only one patient tested positive (0.85%, 95% CI 0.02 to 4.6%). Routine PCR testing of every B. microti PCR-positive blood specimen to detect B. burgdorferi coinfection appears to have a low yield, even in a highly endemic geographic area for both of these infections.
Collapse
Affiliation(s)
- Guiqing Wang
- Department of Pathology, New York Medical College, Valhalla, NY 10595, USA;
| | - Jian Zhuge
- Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Gary P. Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA
| |
Collapse
|
61
|
Lemieux JE, Huang W, Hill N, Cerar T, Freimark L, Hernandez S, Luban M, Maraspin V, Bogovič P, Ogrinc K, Ruzič-Sabljič E, Lapierre P, Lasek-Nesselquist E, Singh N, Iyer R, Liveris D, Reed KD, Leong JM, Branda JA, Steere AC, Wormser GP, Strle F, Sabeti PC, Schwartz I, Strle K. Whole genome sequencing of human Borrelia burgdorferi isolates reveals linked blocks of accessory genome elements located on plasmids and associated with human dissemination. PLoS Pathog 2023; 19:e1011243. [PMID: 37651316 PMCID: PMC10470944 DOI: 10.1371/journal.ppat.1011243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/13/2023] [Indexed: 09/02/2023] Open
Abstract
Lyme disease is the most common vector-borne disease in North America and Europe. The clinical manifestations of Lyme disease vary based on the genospecies of the infecting Borrelia burgdorferi spirochete, but the microbial genetic elements underlying these associations are not known. Here, we report the whole genome sequence (WGS) and analysis of 299 B. burgdorferi (Bb) isolates derived from patients in the Eastern and Midwestern US and Central Europe. We develop a WGS-based classification of Bb isolates, confirm and extend the findings of previous single- and multi-locus typing systems, define the plasmid profiles of human-infectious Bb isolates, annotate the core and strain-variable surface lipoproteome, and identify loci associated with disseminated infection. A core genome consisting of ~900 open reading frames and a core set of plasmids consisting of lp17, lp25, lp36, lp28-3, lp28-4, lp54, and cp26 are found in nearly all isolates. Strain-variable (accessory) plasmids and genes correlate strongly with phylogeny. Using genetic association study methods, we identify an accessory genome signature associated with dissemination in humans and define the individual plasmids and genes that make up this signature. Strains within the RST1/WGS A subgroup, particularly a subset marked by the OspC type A genotype, have increased rates of dissemination in humans. OspC type A strains possess a unique set of strongly linked genetic elements including the presence of lp56 and lp28-1 plasmids and a cluster of genes that may contribute to their enhanced virulence compared to other genotypes. These features of OspC type A strains reflect a broader paradigm across Bb isolates, in which near-clonal genotypes are defined by strain-specific clusters of linked genetic elements, particularly those encoding surface-exposed lipoproteins. These clusters of genes are maintained by strain-specific patterns of plasmid occupancy and are associated with the probability of invasive infection.
Collapse
Affiliation(s)
- Jacob E. Lemieux
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Weihua Huang
- New York Medical College, Valhalla, New York, United States of America
- East Carolina University, Greenville, North Carolina, United States of America
| | - Nathan Hill
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Tjasa Cerar
- University of Ljubljana, Ljubljana, Slovenia
| | - Lisa Freimark
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Sergio Hernandez
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Matteo Luban
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Vera Maraspin
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Petra Bogovič
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | | | - Pascal Lapierre
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Erica Lasek-Nesselquist
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Navjot Singh
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Radha Iyer
- New York Medical College, Valhalla, New York, United States of America
| | - Dionysios Liveris
- New York Medical College, Valhalla, New York, United States of America
| | - Kurt D. Reed
- University of Wisconsin, Madison, Wisconsin, United States of America
| | - John M. Leong
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - John A. Branda
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Allen C. Steere
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gary P. Wormser
- New York Medical College, Valhalla, New York, United States of America
| | - Franc Strle
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pardis C. Sabeti
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Harvard University, Cambridge, Massachusetts, United States of America
- Harvard T.H.Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ira Schwartz
- New York Medical College, Valhalla, New York, United States of America
| | - Klemen Strle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| |
Collapse
|
62
|
Sanes JT, Costello CE, Steere AC. Heightened Proinflammatory Glycosylation of Borrelia burgdorferi IgG Antibodies in Synovial Fluid in Patients With Antibiotic-Refractory Lyme Arthritis. Arthritis Rheumatol 2023; 75:1263-1274. [PMID: 36716113 PMCID: PMC10313735 DOI: 10.1002/art.42465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Terminal glycans on the Fc portion of IgG antibodies are critical for antibody-triggered, proinflammatory or antiinflammatory responses. We undertook this study to compare glycan profiles of total IgG1 and Borrelia burgdorferi (Bb)-specific IgG1 antibodies in patients with oral antibiotic-responsive or antibiotic-refractory Lyme arthritis (LA). METHODS Following affinity-column processing, glycan profiles of IgG antibodies were determined in serum and synovial fluid (SF) samples of 21 LA patients using glycoblotting with hydrazide glycan enrichment and determination of glycan structure by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. Correlations between glycan profiles and treatment outcomes were analyzed. RESULTS Compared with patients with antibiotic-refractory LA, those with antibiotic-responsive LA had total and Bb-specific IgG1 antibody glycans with less intense inflammatory profiles, containing lower percentages of N-acetylglucosamine (GlcNAc) and bisecting GlcNAc and higher percentages of galactose and fucose. In contrast, patients with antibiotic-refractory LA prior to receiving IV antibiotic therapy had total IgG1 and Bb IgG1 antibodies with maximal, minimally opposed, proinflammatory glycan profiles, containing high percentages of GlcNAc and bisecting GlcNAc, intermediate percentages with galactose and fucose, and low percentages with N-acetylneuraminic acid (sialic acid). Patients with refractory LA who were first seen with synovitis after receiving IV antibiotic therapy still had Bb IgG1 antibodies with strongly inflammatory glycan profiles, but their inflammatory potential appeared to be waning. CONCLUSION Patients with oral antibiotic-responsive LA had Bb IgG1 antibodies with more balanced proinflammatory/antiinflammatory glycan profiles, whereas patients with antibiotic-refractory LA had Bb IgG1 antibodies with maximal, minimally opposed, proinflammatory glycan profiles. Among patients with antibiotic-refractory LA, antibodies with this unbalanced inflammatory glycan profile may have a role in sustaining maladaptive joint inflammation.
Collapse
Affiliation(s)
- Jurgen T Sanes
- Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine E Costello
- Department of Biochemistry, Center for Biomedical Mass Spectrometry, Boston University School of Medicine, Boston, Massachusetts
| | - Allen C Steere
- Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
63
|
Dumic I, Person E, Igandan O, Adetimehin O, Nordstrom CW, Williams C, Shweta F. Anaplasma phagocytophilum Community-Acquired Pneumonia: Case Report and Literature Review. Microorganisms 2023; 11:1483. [PMID: 37374985 DOI: 10.3390/microorganisms11061483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Anaplasma phagocytophilum is an emerging, Gram-negative, and obligate intracellular pathogen that is infrequently implicated as a causative agent of community-acquired pneumonia. In this paper, we report about an immunocompetent patient from the community who presented with fever, cough, and shortness of breath. Chest X-ray and CT showed bilateral lung infiltrates. Extensive workup for other common and uncommon causes of pneumonia was positive for anaplasmosis. The patient recovered completely with doxycycline therapy. In our literature review, we find that in 80% of reported cases of anaplasmosis pneumonia, empiric treatment did not contain doxycycline, which in some cases led to acute respiratory distress syndrome. Clinicians in tick-borne disease endemic regions should be aware of this unusual presentation of anaplasmosis in order to be able to select appropriate antimicrobial regimens and initiate timely management.
Collapse
Affiliation(s)
- Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Emily Person
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Oladapo Igandan
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Omobolanle Adetimehin
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Charles W Nordstrom
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Christopher Williams
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Pulmonary Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Fnu Shweta
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Infectious Disease, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| |
Collapse
|
64
|
Abstract
PURPOSE OF REVIEW The aim of this article is to review the recent guidelines and literature regarding the diagnosis and the treatment of common pediatric musculoskeletal infections: septic arthritis, osteomyelitis, pyomyositis, and Lyme disease. RECENT FINDINGS In the last decade, a better understanding of the causative organisms of common bacterial infections, including Kingella , leads to prompt targeted antimicrobial coverage in all musculoskeletal infections. Prompt diagnosis and treatment continues to be the mainstay in the treatment of children with osteoarticular infections. Efforts to improve early detection have lead to improving rapid lab diagnostic testing; however, more advanced diagnostics such as arthrocentesis for septic arthritis and MRI for osteomyelitis and pyomyositis, remain the gold standard. Shorter and narrowed antibiotic courses, with appropriate transition to outpatient oral treatment provide effective infection clearance and reduction in complications of disease. SUMMARY Advances in diagnostics, including pathogen identification as well as imaging continues to improve our ability to diagnose and treat these infections, although still lack ability to provide definitive diagnosis without more invasive nor advanced techniques.
Collapse
Affiliation(s)
- Megan Hannon
- Division of Emergency Medicine
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
65
|
Fuchs S. Outpatient Treatment of Lyme Disease. Pediatr Emerg Care 2023; 39:351-354. [PMID: 37115992 DOI: 10.1097/pec.0000000000002945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
ABSTRACT Lyme disease, also called Lyme borreliosis, is caused by the spirochete Borrelia burgdorferi sensu stricto (B burgdorferi) in the Upper Atlantic Coast and Borrelia mayonii in the Upper Midwest and West Coast. It can cause a range of manifestations including erythema migrans, cranial nerve palsies, meningitis, carditis, and arthritis. Recent guidelines advocate for outpatient treatment for many of these conditions. Scenarios will be presented that outline treatment of these manifestations.
Collapse
Affiliation(s)
- Susan Fuchs
- From the Professor of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, IL and Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| |
Collapse
|
66
|
Wormser GP, McKenna D, Morgan T, Scavarda C, Cooper D, Visintainer P. A Prospective Study to Characterize Symptoms and Symptom Severity in Adult Patients with Extracutaneous Manifestations of Lyme Disease: Extracutaneous Lyme Disease. Am J Med 2023:S0002-9343(23)00241-3. [PMID: 37062457 DOI: 10.1016/j.amjmed.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Systematic assessments of the presence and severity of particular symptoms over time are relatively uncommon for Lyme disease patients in the United States, and especially for Lyme disease patients with extracutaneous manifestations (ECLD). METHODS Symptoms and symptom severity of 12 particular symptoms were evaluated in a prospective study at baseline and at 12 months for 35 adult Lyme disease patients with ECLD, 91.4% of whom were already started on antibiotic therapy, and compared with 52 adult Lyme disease patients with erythema migrans, who were untreated at study entry. RESULTS No significant difference in the frequency of having at least 1 symptom out of the 12 evaluated was found between the 2 groups at either the baseline visit or the 12 month evaluation. Demographic variables were also similar between the 2 study groups, except that the ECLD patients were significantly less likely to be Caucasian, 24/35 (68.6%) of the ECLD cases vs 48/52 (92.3%) of the erythema migrans cases, p=0.008. CONCLUSION Lyme disease patients with ECLD had a similar frequency of symptoms at baseline compared to patients with erythema migrans . ECLD subjects, however, were significantly less like to be Caucasian raising the question of whether a preceding erythema migrans skin lesion may have been missed in persons with a darker skin color. An important limitation of our study, however, is that we did not record skin color per se, which should be considered for future studies.
Collapse
Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595.
| | - Donna McKenna
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
| | - Tyler Morgan
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
| | - Carol Scavarda
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
| | - Denise Cooper
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
| | | |
Collapse
|
67
|
Govil S, Capitle E, Lacqua A, Khianey R, Coyle PK, Schutzer SE. Common Neurologic Features of Lyme Disease That May Present to a Rheumatologist. Pathogens 2023; 12:pathogens12040576. [PMID: 37111462 PMCID: PMC10146759 DOI: 10.3390/pathogens12040576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Lyme disease, caused by Borrelia burgdorferi (Bb) infection, has a broad spectrum of clinical manifestations and severity. Patients with possible Lyme disease may seek out or be referred to rheumatologists. Today, the most common reason to engage a rheumatologist is due to complaints of arthralgia. After skin, neurologic manifestations of Lyme disease are now among the most common. Therefore, it is important for rheumatologists to be aware of clues that suggest neurologic Lyme disease and prompt help from a neurologist experienced with Lyme disease.
Collapse
Affiliation(s)
- Swati Govil
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| | - Eugenio Capitle
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| | - Alexandra Lacqua
- Department of Medicine, Florida Atlantic University, Boca Raton, FL 33486, USA
| | - Reena Khianey
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| | - P K Coyle
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Steven E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| |
Collapse
|
68
|
Chung MK, Caboni M, Strandwitz P, D'Onofrio A, Lewis K, Patel CJ. Systematic comparisons between Lyme disease and post-treatment Lyme disease syndrome in the U.S. with administrative claims data. EBioMedicine 2023; 90:104524. [PMID: 36958992 PMCID: PMC10114153 DOI: 10.1016/j.ebiom.2023.104524] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Post-treatment Lyme disease syndrome (PTLDS) is used to describe Lyme disease patients who have the infection cleared by antibiotic but then experienced persisting symptoms of pain, fatigue, or cognitive impairment. Currently, little is known about the cause or epidemiology of PTLDS. METHODS We conducted a data-driven study with a large nationwide administrative dataset, which consists of more than 98 billion billing and 1.4 billion prescription records between 2008 and 2016, to identify unique aspects of PTLDS that could have diagnostic and etiologic values. We defined PTLDS based on its symptomatology and compared the demographic, longitudinal changes of comorbidity, and antibiotic prescriptions between patients who have Lyme with absence of prolonged symptoms (APS) and PTLDS. FINDINGS The age and temporal distributions were similar between Lyme APS and PTLDS. The PTLDS-to-Lyme APS case ratio was 3.42%. The co-occurrence of 3 out of 19 chronic conditions were significantly higher in PTLDS versus Lyme APS-odds ratio and 95% CI for anemia, hyperlipidemia, and osteoarthrosis were 1.46 (1.11-1.92), 1.39 (1.15-1.68), and 1.62 (1.23-2.12) respectively. We did not find significant differences between PTLDS and Lyme APS for the number of types of antibiotics prescribed (incidence rate ratio = 1.009, p = 0.90) and for the prescription of each of the five antibiotics (FDR adjusted p values 0.72-0.95). INTERPRETATION PTLDS cases have more codes corresponding to anemia, hyperlipidemia, and osteoarthrosis compared to Lyme APS. Our finding of hyperlipidemia is consistent with a dysregulation of fat metabolism reported by other researchers, and further investigation should be conducted to understand the potential biological relationship between the two. FUNDING Steven & Alexandra Cohen Foundation, Global Lyme Alliance, and the Pazala Foundation; National Institutes of Health R01ES032470.
Collapse
Affiliation(s)
| | | | | | | | - Kim Lewis
- Northeastern University, Boston, MA, USA.
| | | |
Collapse
|
69
|
Najam US, Sheikh A. An Atypical Case of Lyme Disease Presenting With Lyme Carditis. Cureus 2023; 15:e35907. [PMID: 37033550 PMCID: PMC10081685 DOI: 10.7759/cureus.35907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
Lyme carditis is a rare but serious manifestation of Lyme disease presenting in the early disseminated stage of the disease often after a diagnosis has already been discovered. The classic case of Lyme disease presents a patient who had been participating in outdoor activities in a Lyme-endemic region and was found to have a tick bite. These patients often present in the early localized stage, within the first 1-2 weeks with the well-recognized erythema-migrans rash or with generalized flu-like symptoms. Here we describe a case of a 70-year-old male who presented to the hospital without any typical Lyme disease prodrome but instead with generalized symptoms of progressive orthopnea and dyspnea on exertion. His original diagnoses were not of infectious origin however after incidentally being found to have a second degree, Mobitz type 1 atrioventricular (AV) block; Lyme tests were ordered, and a diagnosis was confirmed. This incidence shows the importance of having a Lyme disease diagnosis when regionally appropriate for patients who may present with no other signs or symptoms other than an AV block. As in this case, after a diagnosis has been made the management becomes the treatment of the infection rather than the treatment of the symptoms themselves.
Collapse
|
70
|
Bruinsma RA, Zomer TP, Skogman BH, van Hensbroek MB, Hovius JW. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr 2023; 182:1965-1976. [PMID: 36856886 DOI: 10.1007/s00431-023-04811-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
Lyme neuroborreliosis (LNB) is a manifestation of Lyme disease involving the central and peripheral nervous system. It is caused by the spirochete Borrelia burgdorferi, transmitted by tick bites to a human host. Clinical signs of LNB develop after the dissemination of the pathogen to the nervous system. The infection occurs in children and adults, but the clinical manifestations differ. In adults, painful meningoradicultis is the most common manifestation of LNB, while children often present with facial nerve palsy and/or subacute meningitis. Subacute headache can be the only manifestation of LNB in children, especially during the summer months in Lyme disease-endemic regions. Non-specific symptoms, such as loss of appetite, fatigue or mood changes, may also occur, especially in young children. A high level of suspicion and early recognition of the various clinical manifestations presented by children with LNB is essential to minimize delay in diagnosis and optimize management. This review provides an overview of the spectrum of clinical manifestations, and discusses diagnosis, antibiotic treatment, and clinical outcome of LNB in children.
Collapse
Affiliation(s)
- R A Bruinsma
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.,Department of Pediatrics, Gelre Hospital, Apeldoorn, the Netherlands
| | - T P Zomer
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.
| | - B H Skogman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - M Boele van Hensbroek
- Department of Pediatrics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J W Hovius
- Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam UMC Medical Centers, location AMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
71
|
Stupica D, Collinet-Adler S, Blagus R, Gomišček A, Cerar Kišek T, Ružić-Sabljić E, Velušček M. Treatment of erythema migrans with doxycycline for 7 days versus 14 days in Slovenia: a randomised open-label non-inferiority trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:371-379. [PMID: 36209759 DOI: 10.1016/s1473-3099(22)00528-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lyme borreliosis is the most prevalent vector-borne disease in Europe and the USA. Doxycycline for 10 days is the primary treatment recommendation for erythema migrans. To reduce potentially harmful antibiotic overuse by identifying shorter effective treatments, we aimed to assess whether oral doxycycline for 7 days is non-inferior to 14 days in adults with solitary erythema migrans. METHODS In this randomised open-label non-inferiority trial, we enrolled patients with a solitary erythema at the University Medical Centre in Ljubljana, Slovenia. Patients were excluded if they were pregnant or lactating, immunosuppressed, allergic to doxycycline, or had received antibiotics with anti-borrelial activity within 10 days preceding enrolment or had additional manifestations of Lyme borreliosis Adults were randomly allocated 1:1 to receive oral doxycycline 100 mg twice a day for 7 days or 14 days. The primary efficacy endpoint was the difference in proportion of patients with treatment failure, defined as persistent erythema, new objective signs of Lyme borreliosis, or borrelial isolation on skin re-biopsy at 2 months, in a per-protocol analysis (the population that completed the assigned doxycycline regimen according to the study protocol and did not receive any other antibiotics with anti-borrelial activity until the 2-month visit). The non-inferiority margin was 6 percentage points. Safety was assessed in all randomly assigned patients who followed the study protocol and were evaluable at the 14-day visit. This study is registered with ClinicalTrials.gov, NCT03153267. FINDINGS Between July 3, 2017, and Oct 2, 2018, we enrolled 300 patients (150 per group: median age 56 years [IQR 47-65]; 126 [45%] of 300 male; skin culture positive 72 [30%] of 239 assessed). 295 patients completed antibiotic therapy as per protocol and 294 (98%) patients were evaluable 2 months post-enrolment. Five (3%) of 147 patients from the 7-day group versus 3 (2%) of 147 patients from the 14-day group (one patient did not attend the 2-month visit and was unreachable by telephone) had treatment failure manifesting as persistence of erythema (difference 1·4 percentage points; upper limit of one-sided 95% CI 5·2 percentage points; p=0·64). No patients developed new objective manifestations of Lyme borreliosis during follow-up or had positive repeat skin biopsies. Two (1%) of 150 patients in the 7-day and one (1%) of 150 patients in the 14-day group discontinued therapy due to adverse events. INTERPRETATION Our data support 7 days of oral doxycycline for adult European patients with solitary erythema migrans, permitting less antibiotic exposure than current guideline-driven therapy. FUNDING Slovenian Research Agency and the University Medical Centre Ljubljana.
Collapse
Affiliation(s)
- Daša Stupica
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Stefan Collinet-Adler
- Department of Infectious Diseases, Park Nicollet/Health Partners, Methodist Hospital, Saint Louis Park, MN, USA
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia; Slovenia and Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | | | - Tjaša Cerar Kišek
- National Laboratory of Health, Environment and Food, Maribor, Slovenia
| | - Eva Ružić-Sabljić
- Institute for Microbiology and Immunology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maša Velušček
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
72
|
Nigrovic LE, Chun TH, Vargas SE, Caffrey AR, Halperin JJ, Race JA, Ott U, Morrison BL, Fuller BJ, VanBuren JM, Lyme Net P. Comparative effectiveness and complications of intravenous ceftriaxone compared with oral doxycycline in Lyme meningitis in children: a multicentre prospective cohort study. BMJ Open 2023; 13:e071141. [PMID: 36854594 PMCID: PMC9980370 DOI: 10.1136/bmjopen-2022-071141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Lyme disease is the most common vectorborne disease in the Northern hemisphere with more than 400 000 new cases in the USA annually. Lyme meningitis is an uncommon but potentially serious clinical manifestation of Lyme disease. Intravenous ceftriaxone had been the first-line treatment for Lyme meningitis, but is associated with a high rate of complications. Although efficacy and effectiveness (or real-world evidence) data for oral doxycycline are limited, practice guidelines were recently expanded to recommend either oral doxycycline or ceftriaxone as first-line treatments for Lyme meningitis. Our goal is to compare oral doxycycline with intravenous ceftriaxone for the treatment of Lyme meningitis on short-term recovery and long-term quality of life. METHODS AND ANALYSIS We are performing a prospective cohort study at 20 US paediatric centres located in diverse geographical range where Lyme disease is endemic. The clinical care team will make all antibiotic treatment decisions for children with Lyme meningitis, as per usual practice. We will follow enrolled children for 6 months to determine time of acute symptom recovery and impact on quality of life. ETHICS AND DISSEMINATION Boston Children's Hospital, the single Institutional Review Board (sIRB), has approved the study protocol with the other 19 enrolling sites as well as the Utah data coordinating centre relying on the Boston Children's Hospital sIRB. Once the study is completed, we will publish our findings in a peer-reviewed medical journal.
Collapse
Affiliation(s)
- Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Thomas H Chun
- Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Sara E Vargas
- Behavioral and Preventative Medicine, University of Rhode Island, Providence, RI, USA
| | - Aisling R Caffrey
- College of Pharmacy, University of Rhode Island, Providence, RI, USA
| | - John J Halperin
- Department of Neurology, Overlook Medical Center, Summit, New Jersey, USA
| | - Jonathan A Race
- Department of Pediatrics, University of Utah, Salt Lake, UT, USA
| | - Ulrike Ott
- Department of Pediatrics, University of Utah, Salt Lake, UT, USA
| | | | - Bethany J Fuller
- Department of Pediatrics, University of Utah, Salt Lake, UT, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah, Salt Lake, UT, USA
- University of Utah, Salt Lake, UT, USA
| | | |
Collapse
|
73
|
Lemieux JE, Huang W, Hill N, Cerar T, Freimark L, Hernandez S, Luban M, Maraspin V, Bogovic P, Ogrinc K, Ruzic-Sabljic E, Lapierre P, Lasek-Nesselquist E, Singh N, Iyer R, Liveris D, Reed KD, Leong JM, Branda JA, Steere AC, Wormser GP, Strle F, Sabeti PC, Schwartz I, Strle K. Whole genome sequencing of Borrelia burgdorferi isolates reveals linked clusters of plasmid-borne accessory genome elements associated with virulence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.26.530159. [PMID: 36909473 PMCID: PMC10002713 DOI: 10.1101/2023.02.26.530159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Lyme disease is the most common vector-borne disease in North America and Europe. The clinical manifestations of Lyme disease vary based on the genospecies of the infecting Borrelia burgdorferi spirochete, but the microbial genetic elements underlying these associations are not known. Here, we report the whole genome sequence (WGS) and analysis of 299 patient-derived B. burgdorferi sensu stricto ( Bbss ) isolates from patients in the Eastern and Midwestern US and Central Europe. We develop a WGS-based classification of Bbss isolates, confirm and extend the findings of previous single- and multi-locus typing systems, define the plasmid profiles of human-infectious Bbss isolates, annotate the core and strain-variable surface lipoproteome, and identify loci associated with disseminated infection. A core genome consisting of ∼800 open reading frames and a core set of plasmids consisting of lp17, lp25, lp36, lp28-3, lp28-4, lp54, and cp26 are found in nearly all isolates. Strain-variable (accessory) plasmids and genes correlate strongly with phylogeny. Using genetic association study methods, we identify an accessory genome signature associated with dissemination and define the individual plasmids and genes that make up this signature. Strains within the RST1/WGS A subgroup, particularly a subset marked by the OspC type A genotype, are associated with increased rates of dissemination. OspC type A strains possess a unique constellation of strongly linked genetic changes including the presence of lp56 and lp28-1 plasmids and a cluster of genes that may contribute to their enhanced virulence compared to other genotypes. The patterns of OspC type A strains typify a broader paradigm across Bbss isolates, in which genetic structure is defined by correlated groups of strain-variable genes located predominantly on plasmids, particularly for expression of surface-exposed lipoproteins. These clusters of genes are inherited in blocks through strain-specific patterns of plasmid occupancy and are associated with the probability of invasive infection.
Collapse
Affiliation(s)
- Jacob E Lemieux
- Massachusetts General Hospital, Harvard Medical School
- Broad Institute of MIT and Harvard
| | - Weihua Huang
- New York Medical College
- East Carolina University
| | - Nathan Hill
- Massachusetts General Hospital, Harvard Medical School
- Broad Institute of MIT and Harvard
| | | | | | | | - Matteo Luban
- Massachusetts General Hospital, Harvard Medical School
- Broad Institute of MIT and Harvard
| | | | | | | | | | | | | | | | | | | | | | - John M Leong
- Tufts University, Department of Molecular Biology and Microbiology
| | - John A Branda
- Massachusetts General Hospital, Harvard Medical School
| | | | | | | | - Pardis C Sabeti
- Massachusetts General Hospital, Harvard Medical School
- Broad Institute of MIT and Harvard
- Harvard University
- Harvard T.H.Chan School of Public Health
| | | | - Klemen Strle
- Massachusetts General Hospital, Harvard Medical School
- Wadsworth Center
| |
Collapse
|
74
|
Delaney SL, Murray LA, Fallon BA. Neuropsychiatric Symptoms and Tick-Borne Diseases. Curr Top Behav Neurosci 2023; 61:279-302. [PMID: 36512289 DOI: 10.1007/7854_2022_406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In North America, Lyme disease (LD) is primarily caused by the spirochetal bacterium Borrelia burgdorferi, transmitted to humans by Ixodes species tick bites, at an estimated rate of 476,000 patients diagnosed per year. Acute LD often manifests with flu-like symptoms and an expanding rash known as erythema migrans (EM) and less often with neurologic, neuropsychiatric, arthritic, or cardiac features. Most acute cases of Lyme disease are effectively treated with antibiotics, but 10-20% of individuals may experience recurrent or persistent symptoms. This chapter focuses on the neuropsychiatric aspects of Lyme disease, as these are less widely recognized by physicians and often overlooked. Broader education about the potential complexity, severity, and diverse manifestations of tick-borne diseases is needed.
Collapse
Affiliation(s)
- Shannon L Delaney
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA.
| | - Lilly A Murray
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA
| | - Brian A Fallon
- Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
75
|
Improving Lyme disease testing with data driven test design in pediatrics. J Pathol Inform 2023; 14:100300. [PMID: 36880026 PMCID: PMC9985057 DOI: 10.1016/j.jpi.2023.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Diagnostic advances have not kept pace with the expansion of Lyme disease caused by Borrelia burgdorferi and transmitted by ticks. Lyme disease clinical manifestations can overlap with many other diagnoses making Lyme disease a critical part of many differential diagnoses in endemic areas. Current diagnostic blood tests rely on a 2-tiered algorithm for which the second step is either a time-consuming western blot or a whole cell lysate immunoassay. Neither of these second step tests allow for rapid results of this critical rule out test. We hypothesized that using western blot confirmation information, we could create computational models to propose recombinant second-tier tests that would allow for more rapid, automated, and specific testing algorithms. We propose here a framework for assessing retrospective data to determine putative recombinant assay components. A retrospective pediatric cohort of 2755 samples submitted for Lyme disease screening was assessed using support vector machine learning algorithms to optimize tier 1 diagnostic thresholds for the Vidas IgG II assay and determine optimal tier 2 components for both a positive and negative confirmation test. In cases where the tier 1 screen was negative, but clinical suspicion was high, we found that 1 protein (L58) could be used to reduce false-negative results. For second-tier testing of screen positive cases, we found that 6 proteins could be used to reduce false-positive results (L18, L39M, L39, L41, L45, and L58) with a final machine learning classifier or 2 proteins using a final rules-based approach (L41, L18). This led to an overall accuracy of 92.36% for the proposed algorithm without a final machine learning classifier and 92.12% with integration of the machine learning classifier in the final algorithm when compared to the IgG western blot as the gold-standard. Use of this framework across multiple assays and institutions will allow for a data-driven approach to assay development to provide laboratories and patients with the improvements in turnaround time needed for this testing.
Collapse
|
76
|
A systems biology approach to better understand human tick-borne diseases. Trends Parasitol 2023; 39:53-69. [PMID: 36400674 DOI: 10.1016/j.pt.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
Tick-borne diseases (TBDs) are a growing global health concern. Despite extensive studies, ill-defined tick-associated pathologies remain with unknown aetiologies. Human immunological responses after tick bite, and inter-individual variations of immune-response phenotypes, are not well characterised. Current reductive experimental methodologies limit our understanding of more complex tick-associated illness, which results from the interactions between the host, tick, and microbes. An unbiased, systems-level integration of clinical metadata and biological host data - obtained via transcriptomics, proteomics, and metabolomics - offers to drive the data-informed generation of testable hypotheses in TBDs. Advanced computational tools have rendered meaningful analysis of such large data sets feasible. This review highlights the advantages of integrative system biology approaches as essential for understanding the complex pathobiology of TBDs.
Collapse
|
77
|
Myszkowska-Torz A, Tomaszewski M, Kotowski M, Witczak C, Figlerowicz M, Mazur-Melewska K. Cutaneous Manifestations of Lyme Borreliosis in Children-A Case Series and Review. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010072. [PMID: 36676022 PMCID: PMC9864164 DOI: 10.3390/life13010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
The occurrence of skin lesions is the earliest symptom of Lyme disease, and the diagnosis of these lesions and appropriate treatment may prevent complications of the disease, which are mainly neurological. The cutaneous presentation in borreliosis is heterogeneous. There are typical lesions that constitute the basis for the diagnosis of Lyme disease, and atypical ones, which cause significant diagnostic difficulties especially when the patient does not remember the tick bite. This study aims to describe the heterogeneous skin symptoms of Lyme borreliosis, as well as offer a practical approach for the recognition of the disease. Based on pediatric cases from clinical practice, rare cutaneous presentations of Lyme disease at various stages of illness and therapy are presented. Diagnostic recommendations for recognizing individual forms are discussed.
Collapse
Affiliation(s)
- Agnieszka Myszkowska-Torz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Mateusz Tomaszewski
- Department of Orthodontics and Temporomanidbular Disorders, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Michał Kotowski
- Department of Pediatric Otolaryngology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Cezary Witczak
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Poznań, Poland
- Correspondence:
| |
Collapse
|
78
|
Baarsma ME, Claassen SA, van der Horst HE, Hovius JW, Sanders JM. Knowing the entire story – a focus group study on patient experiences with chronic Lyme-associated symptoms (chronic Lyme disease). BMC PRIMARY CARE 2022; 23:139. [PMID: 35655143 PMCID: PMC9160505 DOI: 10.1186/s12875-022-01736-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Healthcare providers frequently struggle to provide effective care to patients with chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system. This study is the first to use a combined medical and communication science approach, and aims to assess patients’ experiences with CLD & CLD-related care, identify themes and repertories in these patients’ narrations, and provide potential ways to improve communication with them.
Methods
Informed by the principles of ‘clean language’, we conducted focus groups with self-identified CLD patients (N = 15). We asked participants about their experiences with CLD and CLD-related healthcare. We performed thematic analyses using a bottom-up approach based in discourse analysis. We also sought to identify specific types of verbalizations (repertoires) across themes.
Results
Participants thematised a heterogeneous set of CLD-associated symptoms, which they frequently labelled as ‘invisible’ to others. Their illness significantly affected their daily lives, impacting their work, social activities, relationships with loved ones, hobbies and other means of participating in society. Negative experiences with healthcare providers were near-universal, also in patients with short-lived CLD-associated symptoms. Verbalizations were notable for frequent use of communicative modes that implicitly create common ground between participants and that give a certain validity to personal experiences (impersonal ‘you’ and other forms of presupposition).
Conclusion
Central themes found in CLD patients’ communication are 1. the experience of significant symptoms, 2. for which adequate relief is only rarely found from conventional medical practitioners, and 3. that are largely invisible to the outside world. Verbalizing these themes, patients use various repertoires for their shared experiences, such as a feeling of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner. Working with these repertoires will enable healthcare providers to establish a shared perspective with their CLD patients, thus engaging in more fruitful doctor-patient communication. We hypothesize that these findings are not unique to CLD, but may also be applicable to other conditions with an uncertain aetiology, such as Long COVID.
Collapse
|
79
|
Brummitt SI, Harvey DJ, Smith WA, Barker CM, Kjemtrup AM. Assessment of Physician Knowledge, Attitudes, and Practice for Lyme Disease in a Low-Incidence State. JOURNAL OF MEDICAL ENTOMOLOGY 2022; 59:2182-2188. [PMID: 36130173 DOI: 10.1093/jme/tjac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 06/15/2023]
Abstract
Lyme disease (LD), caused by the bacterium Borrelia burgdorferi, is transmitted to humans in California through the bite of infected blacklegged ticks (Ixodes pacificus). Overall, the incidence of LD in California is low: approximately 0.2 confirmed cases per 100,000 population. However, California's unique ecological diversity results in wide variation in local risk, including regions with local foci at elevated risk of human disease. The diagnosis of LD can be challenging in California because the prior probability of infection for individual patients is generally low. Combined with nonspecific symptoms and complicated laboratory testing, California physicians need a high level of awareness of LD in California to recognize and diagnose LD efficiently. This research addresses an under-studied area of physicians' knowledge and practice of the testing and treatment of LD in a low-incidence state. We assessed knowledge and practices related to LD diagnosis using an electronic survey distributed to physicians practicing in California through mixed sampling methods. Overall, responding physicians in California had a general awareness of Lyme disease and were knowledgeable regarding diagnosis and treatment. However, we found that physicians in California could benefit from further education to improve test-ordering practices, test interpretation, and awareness of California's disease ecology with elevated levels of focal endemicity, to improve recognition, diagnosis, and treatment of LD in California patients.
Collapse
Affiliation(s)
- Sharon I Brummitt
- Department of Medicine and Epidemiology, School of Veterinary Medicine, One Shields Avenue, University of California Davis, Davis, CA 95616, USA
| | - Danielle J Harvey
- Department of Public Health Sciences, School of Medicine, Medical Sciences 1C, One Shields Avenue, University of California Davis, Davis, CA 95616, USA
| | - Woutrina A Smith
- Department of Medicine and Epidemiology, School of Veterinary Medicine, One Shields Avenue, University of California Davis, Davis, CA 95616, USA
| | - Christopher M Barker
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, One Shields Avenue, University of California Davis, Davis, CA 95616, USA
| | - Anne M Kjemtrup
- California Department of Public Health, Vector-Borne Disease Section, 1616 Capitol Avenue, MS 7307, P.O. Box 997377, Sacramento, CA 95899, USA
| |
Collapse
|
80
|
Clarke DJB, Rebman AW, Fan J, Soloski MJ, Aucott JN, Ma'ayan A. Gene set predictor for post-treatment Lyme disease. Cell Rep Med 2022; 3:100816. [PMID: 36384094 PMCID: PMC9729821 DOI: 10.1016/j.xcrm.2022.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/24/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
Lyme disease (LD) is tick-borne disease whose post-treatment sequelae are not well understood. For this study, we enrolled 152 individuals with symptoms of post-treatment LD (PTLD) to profile their peripheral blood mononuclear cells (PBMCs) with RNA sequencing (RNA-seq). Combined with RNA-seq data from 72 individuals with acute LD and 44 uninfected controls, we investigated differences in differential gene expression. We observe that most individuals with PTLD have an inflammatory signature that is distinguished from the acute LD group. By distilling gene sets from this study with gene sets from other sources, we identify a subset of genes that are highly expressed in the cohorts but are not already established as biomarkers for inflammatory response or other viral or bacterial infections. We further reduce this gene set by feature importance to establish an mRNA biomarker set capable of distinguishing healthy individuals from those with acute LD or PTLD as a candidate for translation into an LD diagnostic.
Collapse
Affiliation(s)
- Daniel J B Clarke
- Department of Pharmacological Sciences, Mount Sinai Center for Bioinformatics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York, NY 10029, USA
| | - Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jinshui Fan
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark J Soloski
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Avi Ma'ayan
- Department of Pharmacological Sciences, Mount Sinai Center for Bioinformatics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York, NY 10029, USA.
| |
Collapse
|
81
|
Kaczmarek KA, Szwabe K, Urbanek I, Ptaszynski P, Strzelecki A, Wranicz JK, Cygankiewicz I. Prevalence of Lyme Carditis in Patients with Atrioventricular Blocks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14893. [PMID: 36429615 PMCID: PMC9690537 DOI: 10.3390/ijerph192214893] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
Infections with Borrelia may cause cardiac conduction system abnormalities, including atrioventricular blocks (AVBs). Therefore, we aimed to identify patients in whom Lyme carditis (LC) could be considered as the initial diagnosis among consecutive subjects who were referred for implantation of a permanent pacemaker due to symptomatic AVBs. To date, such a systematic evaluation has not been reported yet. Validation of the Suspicious Index for Lyme Carditis (SILC) in our study population was considered as an additional goal. We investigated consecutive patients with AVB admitted to our department for a pacemaker implantation. Serological diagnostic tests against Borrelia burgdorferi sensu lato (Bbsl) were performed in those with no obvious cardiac causes of AVB. The final study population consisted of 130 patients (80 M, mean age 67.4 ± 17.6). Lyme carditis was assumed as the initial diagnosis in 16 patients (12%) based on ABV and IgM Bbsl seropositivity. The patients with LC were younger and more frequently manifested constitutional symptoms of infection and fluctuating AVB. The highest prognostic value for identification of LC patients was obtained for the modified SILC, which included the following parameters: (1) age lower than 75 years; (2) risky outdoor activity and living in the countryside; (3) tick bite; (4) constitutional symptoms of Lyme disease; (5) erythema migrans; (6) male sex and (7) fluctuating atrioventricular block. We concluded that diagnostics for LC should be routinely considered in patients with advanced AVB. Modified SILC may identify the patients at risk of LC.
Collapse
Affiliation(s)
- Krzysztof A. Kaczmarek
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, 90-647 Lodz, Poland
| | - Katarzyna Szwabe
- Department of Laboratory Diagnostics and Clinical Biochemistry, Medical University of Lodz, 90-647 Lodz, Poland
| | - Irmina Urbanek
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, 90-647 Lodz, Poland
| | - Pawel Ptaszynski
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, 90-647 Lodz, Poland
| | - Aleksander Strzelecki
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, 90-647 Lodz, Poland
| | - Jerzy K. Wranicz
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, 90-647 Lodz, Poland
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Central University Hospital, Medical University of Lodz, 90-647 Lodz, Poland
| |
Collapse
|
82
|
Gu K, Boodman C, Orr P, Wuerz T. Early Lyme neuroborreliosis manifesting as brachial plexopathy and meningitis in Northwestern Ontario, Canada: A case report. Medicine (Baltimore) 2022; 101:e31576. [PMID: 36397409 PMCID: PMC9666210 DOI: 10.1097/md.0000000000031576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Lyme disease is a tick-borne disease caused by the spirochete B. burgdorferi, and patients often present with symptoms comparable to a viral-like illness. The diagnosis can be challenging given its wide range of manifestations and diagnostic testing can take days or longer. Here, we present a case of Lyme disease presenting as brachial plexopathy and meningitis. PATIENT CONCERNS A 76-years-old male presented to a tertiary-care hospital with left arm weakness and neck pain. DIAGNOSIS Our patient was diagnosed with Lyme neuroborreliosis and had positive serology, including enzyme immunoassay and Western blot. INTERVENTIONS Our patient received 17 days of ceftriaxone (2g IV daily) followed by oral doxycycline (100mg bid). OUTCOMES Over the subsequent year, our patient had eventual complete recovery in muscle strength and sensation, with slower improvement to the cervical neck and left arm pain. LESSONS Incidence of Lyme disease is increasing in North America, and the disease has a wide range of symptoms. Lyme neuroborreliosis (LNB) is 1 presentation and can present with early or late manifestations; clinicians should maintain a high index of suspicion and begin empiric treatment in individuals with a clinical syndrome consistent with LNB. Early LNB manifestations have onset within 6 months of infection and include cranial and peripheral neuropathy, radiculitis, and aseptic meningitis; late LNB encompasses a chronic encephalomyelitis.
Collapse
Affiliation(s)
- Kaien Gu
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada
- * Correspondence: Kaien Gu, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, GH415-820 Sherbrook Street, Winnipeg, Manitoba, Canada (e-mail: )
| | - Carl Boodman
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Pamela Orr
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada
- Departments of Community Health Sciences and Medical Microbiology, Max Rady College of Medicine, University of Manitoba, Canada
| | - Terence Wuerz
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Canada
- Departments of Community Health Sciences and Medical Microbiology, Max Rady College of Medicine, University of Manitoba, Canada
| |
Collapse
|
83
|
Bernardshaw E, Gynthersen RMM, Bremell D, Mens H, Stenør C, Lorentzen ÅR, Bodilsen J, Eikeland R, Lebech AM. Antibiotic therapy of neuroborreliosis: A survey among infectious disease specialists and neurologists in Norway, Sweden, and Denmark. Ticks Tick Borne Dis 2022; 13:102051. [PMID: 36228536 DOI: 10.1016/j.ttbdis.2022.102051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/05/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Neuroborreliosis (NB) is a prevalent tick-borne neuroinfection in Europe. To delineate current practice in antimicrobial management of adults with NB and to prioritize future trials needed to optimize treatment recommendations, a questionnaire-based survey was performed. METHODS A self-administered Internet-based survey of NB treatment practices among specialists in infectious diseases and neurology based in Norway, Sweden, and Denmark was carried out between October 2021 and February 2022. The participants were also asked to prioritize four pre-defined research questions for randomized controlled trials (RCTs) on therapy for NB. RESULTS In total, 290 physicians (45% female) from Norway (30%), Sweden (40%), and Denmark (30%) participated in the survey. Of the responders, 230 (79%) were infectious disease specialists and 56 (19%) were neurologists. The preferred antibiotic treatment for patients with early NB was oral doxycycline (n = 225, 78%). Intravenous (IV) penicillin, ceftriaxone, or cefotaxime for the full treatment course was favored by 12%. A preferred treatment duration of 10-14 days for patients with NB was reported by 245 respondents (85%), most common among participants from Sweden (97%). A total of 170 (59%) responders reported having local hospital guidelines on the treatment of NB, most often with recommendation of oral doxycycline (92%) for 10-14 days (90%) as first line treatment. The prioritization score for future RCTs was highest for adjunctive prednisone therapy in NB patients with facial palsy (median 5; IQR 4-6) and for placebo versus repeated antibiotics in patients with persistent symptoms after completed antibiotic therapy for NB (median 5, IQR 3-6). CONCLUSION In Sweden, all respondents preferred treating NB with oral doxycycline for 10-14 days, whereas 5% in Norway and 19% in Denmark still treat NB with IV antibiotics for the entire treatment course. RCTs to define the role of adjunctive prednisolone in NB patients with facial palsy and repeated antibiotics in patients with persistent symptoms are prioritized for future research.
Collapse
Affiliation(s)
- Emilie Bernardshaw
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark
| | - Rosa M M Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark.
| | - Daniel Bremell
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark
| | - Christian Stenør
- Department of Neurology, University hospital-Herlev Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Åslaug R Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; The Norwegian National Advisory Unit on Tick-borne Diseases, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Randi Eikeland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; The Faculty of health and sport sciences, University of Agder, Grimstad, Norway
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Rigshospitalet, Copenhagen 2100, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| |
Collapse
|
84
|
Clinical Evaluation of a Borrelia Modified Two-Tiered Testing (MTTT) Shows Increased Early Sensitivity for Borrelia burgdorferi But Not Other Endemic Borrelia Species in A High Incidence Region for Lyme Disease in Wisconsin. Diagn Microbiol Infect Dis 2022; 105:115837. [DOI: 10.1016/j.diagmicrobio.2022.115837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022]
|
85
|
Nour SI, Shabtaie SA, DeSimone CV. 46-Year-Old Man With Presyncope and Rash. Mayo Clin Proc 2022; 97:1942-1946. [PMID: 36202500 DOI: 10.1016/j.mayocp.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Shirin I Nour
- Resident in Internal Medicine, Fellow in Cardiovascular Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Samuel A Shabtaie
- Resident in Internal Medicine, Fellow in Cardiovascular Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Christopher V DeSimone
- Advisor to resident and fellow and Consultant in Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
86
|
De Larochellière E, Langley JM, Bata BM. Unilateral ptosis and mydriasis secondary to presumed Lyme neuroborreliosis. J AAPOS 2022; 26:278-280. [PMID: 36108883 DOI: 10.1016/j.jaapos.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/25/2022]
Abstract
We report a case of unilateral acute-onset ptosis and mydriasis in a girl 2 years and 7 months of age from an area endemic for Lyme disease. She lacked other signs of oculomotor nerve palsy. She tested positive for Borrelia burgdorferi and negative for Bartonella henselae on serology and was diagnosed with Lyme neuroborreliosis. The ptosis and mydriasis resolved after 1 week of oral doxycycline.
Collapse
Affiliation(s)
- Elianne De Larochellière
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia; Department of Ophthalmology, Université Laval, Québec, Quebec
| | - Joanne M Langley
- Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
| | - Bashar M Bata
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia.
| |
Collapse
|
87
|
Theel ES. Molecular Testing for Diagnosis of Early Lyme Disease. Am J Clin Pathol 2022; 158:325-326. [PMID: 35946458 DOI: 10.1093/ajcp/aqac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
88
|
Abstract
Lyme disease is now the most frequently reported vector-borne disease in the United States. The highest incidence is in children aged 5 to 9 years with a male predominance. The most common manifestation, erythema migrans, is sometimes not recognized, leading to risk of complications. Testing for Lyme disease should only be done if there is a consistent clinical syndrome with exposure in a Lyme-endemic area. Most forms of Lyme disease are successfully treated with short courses of oral therapy. Prevention and management of tick bites is important.
Collapse
Affiliation(s)
- Carol A McCarthy
- Department of Pediatrics, Division of Pediatric Infectious Disease, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA; Tufts University School of Medicine, Boston, MA, USA; Maine Medical Partners Pediatric Specialty Care, 887 Congress Street, Suite 310, Portland, ME 04102, USA.
| | - Jason A Helis
- Tufts University School of Medicine, Boston, MA, USA; Department of Pediatrics, Division of Pediatric Neurology, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA; Maine Medical Partners Neurology, 92 Campus Drive Suite B, Scarborough, ME 04074, USA
| | - Brian E Daikh
- Tufts University School of Medicine, Boston, MA, USA; Department of Medicine, Maine Medical Center; Rheumatology Associates, 51 Sewall Street, Portland, ME, USA
| |
Collapse
|
89
|
Rodino KG, Pritt BS. When to Think About Other Borreliae:: Hard Tick Relapsing Fever (Borrelia miyamotoi), Borrelia mayonii, and Beyond. Infect Dis Clin North Am 2022; 36:689-701. [PMID: 36116843 DOI: 10.1016/j.idc.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In North America, several hard tick-transmitted Borrelia species other than Borrelia burgdorferi cause human disease, including Borrelia miyamotoi, Borrelia mayonii, and possibly Borrelia bissettii. Due to overlapping clinical syndromes, nonspecific tickborne disease (TBD) testing strategies, and shared treatment approaches, infections with these lesser known Borrelia are likely under-reported. In this article, we describe the epidemiology, clinical manifestations, diagnosis, and treatment of these less common Borrelia pathogens.
Collapse
Affiliation(s)
- Kyle G Rodino
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Bobbi S Pritt
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
90
|
The Role of the Infectious Disease Consultation in Lyme Disease. Infect Dis Clin North Am 2022; 36:703-718. [PMID: 36116844 DOI: 10.1016/j.idc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A consultation regarding Lyme disease can be challenging for the infectious disease physician when the referral question centers on the use of prolonged or empirical antibiotic treatment of Lyme disease and associated tick-borne infections. Patients who have been infected with Borrelia burgdorferi, and many who have been misdiagnosed, are confronted with a seemingly endless array of misinformation that is not in keeping with the current understanding of the clinical spectrum of Lyme disease and its response to evidence-based treatment. Preparing for these conversations with a good grasp of the public beliefs regarding Lyme disease and its treatment can be beneficial.
Collapse
|
91
|
Strle F, Wormser GP. Early Lyme Disease (Erythema Migrans) and Its Mimics (Southern Tick-Associated Rash Illness and Tick-Associated Rash Illness). Infect Dis Clin North Am 2022; 36:523-539. [PMID: 36116832 DOI: 10.1016/j.idc.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Erythema migrans, an expanding erythematous skin lesion that develops days to weeks following an Ixodes species tick bite, is the most common clinical manifestation of Lyme disease. Presentations in the United States differ somewhat from that in Europe, presumably because of the different etiologic agents. Diagnosis is based on the appearance of the skin lesion, rather than on laboratory testing. After treatment with an appropriate oral antibiotic for 10 to 14 days, the prognosis is excellent. Two conditions that cause a similar skin lesion following a tick bite, but are of unknown cause, are Southern tick-associated rash illness in the United States and tick-associated rash illness in Japan.
Collapse
Affiliation(s)
- Franc Strle
- University Medical Center Ljubljana, Japljeva 2, Ljubljana 1525, Slovenia.
| | - Gary P Wormser
- New York Medical College, 40 Sunshine Cottage Road, Skyline Office, Valhalla, NY 10595, USA
| |
Collapse
|
92
|
Abstract
Most patients with Lyme disease will fully recover with recommended antibiotic therapy. However, some patients report persisting nonspecific symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), depending on the degree to which the individual's symptoms impact their quality of life. PTLDs occur in a portion of patients diagnosed with chronic Lyme disease (CLD), a controversial term describing different patient populations, diagnosed based on unvalidated tests and criteria. Practitioners should review the evidence for the Lyme disease diagnosis and not overlook unrelated conditions. Current evidence shows that prolonged antibiotic therapy provides little benefit and carries significant risk. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and to understand CLD is needed.
Collapse
Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, BG 10 RM 12C118 MSC 1888 10 Center, Bethesda, MD 20892-1888, USA.
| |
Collapse
|
93
|
Abstract
Arthritis is the most common late manifestation of Borrelia burgdorferi infection in the United States, usually beginning months after the tick bite. In most patients with Lyme arthritis (LA) today, arthritis is the presenting manifestation of the disease. Patients have swelling and pain in one or a few large joints, especially the knee. Serologic testing is the mainstay of diagnosis. Responses to antibiotic treatment are generally excellent, although a small percentage of patients have persistent, postinfectious synovitis after 2 to 3 months of oral and IV antibiotics, which respond to anti-inflammatory therapies. Herein we review the clinical presentation, diagnosis, and management of LA.
Collapse
Affiliation(s)
- Sheila L Arvikar
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, CNY149 Room 8301, 149 13th Street, Charlestown, MA 02129, USA.
| | - Allen C Steere
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, CNY149 Room 8301, 149 13th Street, Charlestown, MA 02129, USA
| |
Collapse
|
94
|
Anaplasmosis-Induced Atrial Flutter Resolving With Antibiotic Therapy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
95
|
Abstract
The central or peripheral nervous systems may be involved in up to 15% of patients with untreated infection with B burgdorferi sensu lato, characteristic involvement including meningitis, cranial neuritis, and radiculoneuritis. Diagnosis, based on a logical combination of clinical context and antibody-based testing, is usually straightforward, as is treatment. Misconceptions about what does and does not constitute neurologic disease, and about laboratory testing in this infection, have resulted in widespread anxiety that a broad range of other disorders may be attributable to nervous system Lyme disease. This article will review the reasons for these misunderstandings and the arguments against them.
Collapse
Affiliation(s)
- John J Halperin
- Overlook Medical Center, Summit, NJ 07901, USA; Sidney Kimmel Medical College of Thomas Jefferson University.
| |
Collapse
|
96
|
Abstract
Lyme carditis is an uncommon manifestation of Lyme disease. Most cases present with heart block of varying degrees, but the spectrum of disease includes other transient arrhythmias and structural manifestations, such as myopericarditis or cardiomyopathy. Antibiotics hasten the resolution of Lyme carditis, and cardiac pacing can be an adjunctive therapy. Outcomes are generally good, but there are rare fatalities associated with Lyme carditis. The latter underscores the continued need for improved modes of prevention of Lyme disease and the importance of its early recognition and treatment.
Collapse
Affiliation(s)
- Richard V Shen
- Division of Infectious Diseases, Southcoast Physicians Group, 363 Highland Avenue, Fall River, MA 02720, USA.
| | - Carol A McCarthy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, 887 Congress Street, Suite 310, Portland, ME 04102, USA
| |
Collapse
|
97
|
Abstract
Standard 2-tier testing (STTT), incorporating a screening enzyme immunoassay (EIA) or an immunofluorescence assay (IFA) that reflexes to IgM and IgG immunoblots, has been the primary diagnostic test for Lyme disease since 1995. In 2019, the Food and Drug Administration approved a modified 2-tier test strategy using 2 EIAs: offering a faster, less expensive, and more sensitive assay compared with STTT. New technologies examine early immune responses to Borrelia burgdorferi have the potential to diagnose Lyme disease in the first weeks of infection when existing serologic testing is not recommended due to low sensitivity.
Collapse
Affiliation(s)
- Takaaki Kobayashi
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
98
|
Borrelial lymphocytoma. Wien Klin Wochenschr 2022:10.1007/s00508-022-02064-5. [PMID: 35943633 DOI: 10.1007/s00508-022-02064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 10/15/2022]
Abstract
Borrelial lymphocytoma is a rare cutaneous manifestation of early localized European Lyme borreliosis. It manifests as a nodule or plaque with a diameter of up to a few centimeters. The lesion is, as a rule, solitary. It is more common in children than in adults and, in contrast to erythema migrans and acrodermatitis chronica atrophicans, has male predominance. A tick bite has been reported in approximately one half of patients; the tick bite is usually at the site or in the vicinity of the later borrelial lymphocytoma. The predilection site for the development of lesions is the breast in adults and the ear lobe in children. Borrelial lymphocytoma is frequently associated with erythema migrans, but rarely with other manifestations of Lyme borreliosis, and is predominantly caused by Borrelia afzelii. At presentation, approximately half of the patients with borrelial lymphocytoma have measurable serum borrelial antibodies and, in about one third, spirochetes can be cultivated from the skin lesion. A 14-day antibiotic therapy, as recommended for patients with erythema migrans, is highly successful. Posttreatment duration of a borrelial lymphocytoma is positively associated with the pretreatment duration of the lesion and with patient age, while treatment failure is associated with the clinical signs of disseminated Lyme borreliosis at presentation. Substantial improvements in knowledge on borrelial lymphocytoma and laboratory diagnostics in recent decades have contributed to earlier diagnosis and treatment. Consequently, borrelial lymphocytoma is usually a mild disease with a good prognosis.
Collapse
|
99
|
Serological Analysis Identifies Consequential B Cell Epitopes on the Flexible Linker and C-Terminus of Decorin Binding Protein A (DbpA) from Borrelia burgdorferi. mSphere 2022; 7:e0025222. [PMID: 35876530 PMCID: PMC9429923 DOI: 10.1128/msphere.00252-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Decorin binding protein A (DbpA) is a surface adhesin of Borrelia burgdorferi, the causative agent of Lyme disease. While DbpA is one of the most immunogenic of B. burgdorferi’s nearly 100 lipoproteins, the B cell epitopes on DbpA recognized by humans following B. burgdorferi infection have not been fully elucidated. In this report we profiled ~270 B. burgdorferi-seropositive human serum samples for IgM and IgG reactivity with a tiled DbpA 18-mer peptide array derived from B. burgdorferisensu stricto strains B31 and 297. Using enzyme-linked immunosorbent assays (ELISA) and multiplex immunoassays (MIA), we identified 12 DbpA-derived peptides whose antibody reactivities were significantly elevated (generally <10-fold) in B. burgdorferi-seropositive sera, compared to those measured in a healthy cohort. The most reactive peptide (>80-fold IgG, 10-fold IgM) corresponded to residues 64 to 81, which map to an exposed flexible loop between DbpA’s α-helix 1 and α-helix 2. This loop, whose sequence is identical between strains B31 and 297, overhangs DbpA’s substrate binding pocket. A second strongly reactive antibody target (>80-fold IgG, 3 to 5-fold IgM) mapped to DbpA’s C-terminus, a lysine rich tail implicated in attachment to glycosaminoglycans. We postulate that antibody responses against these two targets on DbpA could limit B.burgdorferi’s ability to attach to and colonize distal tissues during the early stages of infection. IMPORTANCE The bacterium, Borrelia burgdorferi, is the causative agent of Lyme disease, the most reported tick-borne illness in the United States. In humans, clinical manifestations of Lyme disease are complex and can persist for months, even in the face of a robust antibody response directed against numerous B. burgdorferi surface proteins, including decorin binding protein A (DbpA), which is involved in the early stages of infection. In this study we employed ~270 serum samples from B. burgdorferi-seropositive individuals to better understand human antibody reactivity to specific regions (called epitopes) of DbpA and how such antibodies may function in limiting B. burgdorferi dissemination and tissue colonization.
Collapse
|
100
|
Divers TJ, Mongodin EF, Miller CB, Belgrave RL, Gardner RB, Fraser CM, Schutzer SE. Genomic hybrid capture assay to detect Borrelia burgdorferi: an application to diagnose neuroborreliosis in horses. J Vet Diagn Invest 2022; 34:909-912. [PMID: 35864735 DOI: 10.1177/10406387221112617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Antemortem diagnosis of neuroborreliosis in horses has been hindered by both the low sensitivity of PCR testing for Borrelia burgdorferi in CSF and the low specificity of serum:CSF ELISA ratios used to determine intrathecal antibody production against the bacterium. PCR testing of the CSF of an adult horse with acute neurologic disease for the B. burgdorferi flagellin gene was negative. However, we enriched B. burgdorferi DNA through nucleic acid hybrid capture, followed by next-generation sequencing, and identified B. burgdorferi in the CSF of the horse, confirming a diagnosis of neuroborreliosis.
Collapse
Affiliation(s)
- Thomas J Divers
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Emmanuel F Mongodin
- Institute of Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Claire M Fraser
- Institute of Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven E Schutzer
- Institute of Genome Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|