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Laison EKE, Hamza Ibrahim M, Boligarla S, Li J, Mahadevan R, Ng A, Muthuramalingam V, Lee WY, Yin Y, Nasri BR. Identifying Potential Lyme Disease Cases Using Self-Reported Worldwide Tweets: Deep Learning Modeling Approach Enhanced With Sentimental Words Through Emojis. J Med Internet Res 2023; 25:e47014. [PMID: 37843893 PMCID: PMC10616745 DOI: 10.2196/47014] [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] [Received: 03/13/2023] [Revised: 07/26/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Lyme disease is among the most reported tick-borne diseases worldwide, making it a major ongoing public health concern. An effective Lyme disease case reporting system depends on timely diagnosis and reporting by health care professionals, and accurate laboratory testing and interpretation for clinical diagnosis validation. A lack of these can lead to delayed diagnosis and treatment, which can exacerbate the severity of Lyme disease symptoms. Therefore, there is a need to improve the monitoring of Lyme disease by using other data sources, such as web-based data. OBJECTIVE We analyzed global Twitter data to understand its potential and limitations as a tool for Lyme disease surveillance. We propose a transformer-based classification system to identify potential Lyme disease cases using self-reported tweets. METHODS Our initial sample included 20,000 tweets collected worldwide from a database of over 1.3 million Lyme disease tweets. After preprocessing and geolocating tweets, tweets in a subset of the initial sample were manually labeled as potential Lyme disease cases or non-Lyme disease cases using carefully selected keywords. Emojis were converted to sentiment words, which were then replaced in the tweets. This labeled tweet set was used for the training, validation, and performance testing of DistilBERT (distilled version of BERT [Bidirectional Encoder Representations from Transformers]), ALBERT (A Lite BERT), and BERTweet (BERT for English Tweets) classifiers. RESULTS The empirical results showed that BERTweet was the best classifier among all evaluated models (average F1-score of 89.3%, classification accuracy of 90.0%, and precision of 97.1%). However, for recall, term frequency-inverse document frequency and k-nearest neighbors performed better (93.2% and 82.6%, respectively). On using emojis to enrich the tweet embeddings, BERTweet had an increased recall (8% increase), DistilBERT had an increased F1-score of 93.8% (4% increase) and classification accuracy of 94.1% (4% increase), and ALBERT had an increased F1-score of 93.1% (5% increase) and classification accuracy of 93.9% (5% increase). The general awareness of Lyme disease was high in the United States, the United Kingdom, Australia, and Canada, with self-reported potential cases of Lyme disease from these countries accounting for around 50% (9939/20,000) of the collected English-language tweets, whereas Lyme disease-related tweets were rare in countries from Africa and Asia. The most reported Lyme disease-related symptoms in the data were rash, fatigue, fever, and arthritis, while symptoms, such as lymphadenopathy, palpitations, swollen lymph nodes, neck stiffness, and arrythmia, were uncommon, in accordance with Lyme disease symptom frequency. CONCLUSIONS The study highlights the robustness of BERTweet and DistilBERT as classifiers for potential cases of Lyme disease from self-reported data. The results demonstrated that emojis are effective for enrichment, thereby improving the accuracy of tweet embeddings and the performance of classifiers. Specifically, emojis reflecting sadness, empathy, and encouragement can reduce false negatives.
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Affiliation(s)
- Elda Kokoe Elolo Laison
- Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | | | - Srikanth Boligarla
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Jiaxin Li
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Raja Mahadevan
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Austen Ng
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | | | - Wee Yi Lee
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Yijun Yin
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Bouchra R Nasri
- Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
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Boligarla S, Laison EKE, Li J, Mahadevan R, Ng A, Lin Y, Thioub MY, Huang B, Ibrahim MH, Nasri B. Leveraging machine learning approaches for predicting potential Lyme disease cases and incidence rates in the United States using Twitter. BMC Med Inform Decis Mak 2023; 23:217. [PMID: 37845666 PMCID: PMC10578027 DOI: 10.1186/s12911-023-02315-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Lyme disease is one of the most commonly reported infectious diseases in the United States (US), accounting for more than [Formula: see text] of all vector-borne diseases in North America. OBJECTIVE In this paper, self-reported tweets on Twitter were analyzed in order to predict potential Lyme disease cases and accurately assess incidence rates in the US. METHODS The study was done in three stages: (1) Approximately 1.3 million tweets were collected and pre-processed to extract the most relevant Lyme disease tweets with geolocations. A subset of tweets were semi-automatically labelled as relevant or irrelevant to Lyme disease using a set of precise keywords, and the remaining portion were manually labelled, yielding a curated labelled dataset of 77, 500 tweets. (2) This labelled data set was used to train, validate, and test various combinations of NLP word embedding methods and prominent ML classification models, such as TF-IDF and logistic regression, Word2vec and XGboost, and BERTweet, among others, to identify potential Lyme disease tweets. (3) Lastly, the presence of spatio-temporal patterns in the US over a 10-year period were studied. RESULTS Preliminary results showed that BERTweet outperformed all tested NLP classifiers for identifying Lyme disease tweets, achieving the highest classification accuracy and F1-score of [Formula: see text]. There was also a consistent pattern indicating that the West and Northeast regions of the US had a higher tweet rate over time. CONCLUSIONS We focused on the less-studied problem of using Twitter data as a surveillance tool for Lyme disease in the US. Several crucial findings have emerged from the study. First, there is a fairly strong correlation between classified tweet counts and Lyme disease counts, with both following similar trends. Second, in 2015 and early 2016, the social media network like Twitter was essential in raising popular awareness of Lyme disease. Third, counties with a high incidence rate were not necessarily related with a high tweet rate, and vice versa. Fourth, BERTweet can be used as a reliable NLP classifier for detecting relevant Lyme disease tweets.
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Affiliation(s)
| | - Elda Kokoè Elolo Laison
- Department of Social and Preventive Medicine, École de Santé Publique, University of Montreal, Montréal, Canada
| | - Jiaxin Li
- Harvard Extension School, Harvard University, Cambridge, USA
| | - Raja Mahadevan
- Harvard Extension School, Harvard University, Cambridge, USA
| | - Austen Ng
- Harvard Extension School, Harvard University, Cambridge, USA
| | - Yangming Lin
- Harvard Extension School, Harvard University, Cambridge, USA
| | - Mamadou Yamar Thioub
- Department of Social and Preventive Medicine, École de Santé Publique, University of Montreal, Montréal, Canada
| | - Bruce Huang
- Department of Decision Sciences, HEC Montréal, Montréal, Canada
| | - Mohamed Hamza Ibrahim
- Department of Social and Preventive Medicine, École de Santé Publique, University of Montreal, Montréal, Canada
- Department of Mathematics, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Bouchra Nasri
- Department of Social and Preventive Medicine, École de Santé Publique, University of Montreal, Montréal, Canada.
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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.
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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
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Gutierrez-Hoffmann M, Fan J, O’Meally RN, Cole RN, Florea L, Antonescu C, Talbot CC, Tiniakou E, Darrah E, Soloski MJ. The Interaction of Borrelia burgdorferi with Human Dendritic Cells: Functional Implications. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 211:612-625. [PMID: 37405694 PMCID: PMC10527078 DOI: 10.4049/jimmunol.2300235] [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: 04/03/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
Dendritic cells bridge the innate and adaptive immune responses by serving as sensors of infection and as the primary APCs responsible for the initiation of the T cell response against invading pathogens. The naive T cell activation requires the following three key signals to be delivered from dendritic cells: engagement of the TCR by peptide Ags bound to MHC molecules (signal 1), engagement of costimulatory molecules on both cell types (signal 2), and expression of polarizing cytokines (signal 3). Initial interactions between Borrelia burgdorferi, the causative agent of Lyme disease, and dendritic cells remain largely unexplored. To address this gap in knowledge, we cultured live B. burgdorferi with monocyte-derived dendritic cells (mo-DCs) from healthy donors to examine the bacterial immunopeptidome associated with HLA-DR. In parallel, we examined changes in the expression of key costimulatory and regulatory molecules as well as profiled the cytokines released by dendritic cells when exposed to live spirochetes. RNA-sequencing studies on B. burgdorferi-pulsed dendritic cells show a unique gene expression signature associated with B. burgdorferi stimulation that differs from stimulation with lipoteichoic acid, a TLR2 agonist. These studies revealed that exposure of mo-DCs to live B. burgdorferi drives the expression of both pro- and anti-inflammatory cytokines as well as immunoregulatory molecules (e.g., PD-L1, IDO1, Tim3). Collectively, these studies indicate that the interaction of live B. burgdorferi with mo-DCs promotes a unique mature DC phenotype that likely impacts the nature of the adaptive T cell response generated in human Lyme disease.
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Affiliation(s)
- Maria Gutierrez-Hoffmann
- Lyme Disease Research Center, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
- Division of Rheumatology, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
| | - Jinshui Fan
- Division of Rheumatology, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
| | - Robert N. O’Meally
- Mass Spectrometry and Proteomics Facility,
Department of Biological Chemistry, Johns Hopkins University School of Medicine,
Baltimore, MD 21205, USA
| | - Robert N. Cole
- Mass Spectrometry and Proteomics Facility,
Department of Biological Chemistry, Johns Hopkins University School of Medicine,
Baltimore, MD 21205, USA
| | - Liliana Florea
- Department of Genetic Medicine, Johns Hopkins
University, School of Medicine, Baltimore, MD 21205, USA
| | - Corina Antonescu
- Department of Genetic Medicine, Johns Hopkins
University, School of Medicine, Baltimore, MD 21205, USA
| | - C. Conover Talbot
- Institute for Basic Biomedical Sciences, Johns
Hopkins University, School of Medicine, Baltimore, MD 21205, USA
| | - Eleni Tiniakou
- Division of Rheumatology, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
| | - Erika Darrah
- Lyme Disease Research Center, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
- Division of Rheumatology, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
| | - Mark J. Soloski
- Lyme Disease Research Center, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
- Division of Rheumatology, Johns Hopkins University,
School of Medicine, Baltimore, MD 21224, USA
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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.
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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
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Jin L, Jiang BG, Yin Y, Guo J, Jiang JF, Qi X, Crispell G, Karim S, Cao WC, Lai R. Interference with LTβR signaling by tick saliva facilitates transmission of Lyme disease spirochetes. Proc Natl Acad Sci U S A 2022; 119:e2208274119. [PMID: 36383602 PMCID: PMC9704693 DOI: 10.1073/pnas.2208274119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Lyme spirochetes have coevolved with ticks to optimize transmission to hosts using tick salivary molecules (TSMs) to counteract host defenses. TSMs modulate various molecular events at the tick-host interface. Lymphotoxin-beta receptor (LTβR) is a vital immune receptor and plays protective roles in host immunity against microbial infections. We found that Ltbr knockout mice were more susceptible to Lyme disease spirochetes, suggesting the involvement of LTβR signaling in tick-borne Borrelia infection. Further investigation showed that a 15-kDa TSM protein from Ixodes persulcatus (I. persulcatus salivary protein; IpSAP) functioned as an immunosuppressant to facilitate the transmission and infection of Lyme disease spirochetes. IpSAP directly interacts with LTβR to block its activation, thus inhibiting the downstream signaling and consequently suppressing immunity. IpSAP immunization provided mice with significant protection against I. persulcatus-mediated Borrelia garinii infection. Notably, the immunization showed considerable cross-protection against other Borrelia infections mediated by other ixodid ticks. One of the IpSAP homologs from other ixodid ticks showed similar effects on Lyme spirochete transmission. Together, our findings suggest that LTβR signaling plays an important role in blocking the transmission and pathogenesis of tick-borne Lyme disease spirochetes, and that IpSAP and its homologs are promising candidates for broad-spectrum vaccine development.
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Affiliation(s)
- Lin Jin
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
- College of Veterinary Medicine, Shanxi Agricultural University, Taigu 030801, Shanxi, China
| | - Bao-Gui Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100101, China
| | - Yizhu Yin
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
| | - Jingya Guo
- Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Jia-Fu Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100101, China
| | - Xiaopeng Qi
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
| | - Gary Crispell
- Cell and Molecular Biology, School of Biological, Environmental, and Earth Sciences, University of Southern Mississippi, Hattiesburg, MS 39406
| | - Shahid Karim
- Cell and Molecular Biology, School of Biological, Environmental, and Earth Sciences, University of Southern Mississippi, Hattiesburg, MS 39406
| | - Wu-Chun Cao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100101, China
| | - Ren Lai
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
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Sosa JP, Ferreira Caceres MM, Agadi K, Pandav K, Mehendale M, Mehta JM, Go CC, Matos WF, Guntipalli P, Belizaire MPE. Diseases Transmitted by the Black-Legged Ticks in the United States: A Comprehensive Review of the Literature. Cureus 2021; 13:e17526. [PMID: 34471586 PMCID: PMC8403000 DOI: 10.7759/cureus.17526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/05/2022] Open
Abstract
The black-legged tick is endemic to the midwestern, northeastern, western, south-eastern, and southern regions of the United States. There has been an increased burden of black-legged ticks in humans in recent years. COVID-19 pandemic has further heightened this burden. We thereby reviewed the literature to discuss the seasonality, infections, and clinical spectrum of diseases transmitted by the black-legged ticks. We also discuss the reported delay in the diagnosis of these diseases during the pandemic situation, the alpha-gal syndrome, the importance of prompt diagnosis, and early medical intervention with an aim to increase awareness of the black-legged tick-borne diseases.
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Affiliation(s)
- Juan P Sosa
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | | | - Kuchalambal Agadi
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - Krunal Pandav
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - Meghana Mehendale
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - Jayati M Mehta
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | | | | | - Prathima Guntipalli
- Division of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
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Liotta L, Luchini A. Unconventional Approaches to Direct Detection of Borreliosis and Other Tick Borne Illnesses: A Path Forward. JOURNAL OF CELLULAR IMMUNOLOGY 2021; 3:164-172. [PMID: 34414392 PMCID: PMC8372993 DOI: 10.33696/immunology.3.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lance Liotta
- George Mason University, Manassas, Virginia, USA
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9
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Lyme arthritis: linking infection, inflammation and autoimmunity. Nat Rev Rheumatol 2021; 17:449-461. [PMID: 34226730 PMCID: PMC9488587 DOI: 10.1038/s41584-021-00648-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 02/06/2023]
Abstract
Infectious agents can trigger autoimmune responses in a number of chronic inflammatory diseases. Lyme arthritis, which is caused by the tick-transmitted spirochaete Borrelia burgdorferi, is effectively treated in most patients with antibiotic therapy; however, in a subset of patients, arthritis can persist and worsen after the spirochaete has been killed (known as post-infectious Lyme arthritis). This Review details the current understanding of the pathogenetic events in Lyme arthritis, from initial infection in the skin, through infection of the joints, to post-infectious chronic inflammatory arthritis. The central feature of post-infectious Lyme arthritis is an excessive, dysregulated pro-inflammatory immune response during the infection phase that persists into the post-infectious period. This response is characterized by high amounts of IFNγ and inadequate amounts of the anti-inflammatory cytokine IL-10. The consequences of this dysregulated pro-inflammatory response in the synovium include impaired tissue repair, vascular damage, autoimmune and cytotoxic processes, and fibroblast proliferation and fibrosis. These synovial characteristics are similar to those in other chronic inflammatory arthritides, including rheumatoid arthritis. Thus, post-infectious Lyme arthritis provides a model for other chronic autoimmune or autoinflammatory arthritides in which complex immune responses can be triggered and shaped by an infectious agent in concert with host genetic factors.
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Vinayaraj EV, Gupta N, Sreenath K, Thakur CK, Gulati S, Anand V, Tripathi M, Bhatia R, Vibha D, Dash D, Soneja M, Kumar U, Padma MV, Chaudhry R. Clinical and laboratory evidence of Lyme disease in North India, 2016-2019. Travel Med Infect Dis 2021; 43:102134. [PMID: 34216802 DOI: 10.1016/j.tmaid.2021.102134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lyme disease is endemic to parts of the Americas, Europe and Asia. However, only a handful of sporadic cases have been reported from India. In this study, we systematically evaluated the clinical and epidemiological features of Lyme disease in North India. METHOD All samples were tested by using the standard two-tiered testing algorithm (STTA). Paired serum and cerebrospinal fluid (CSF) were used for demonstrating Borrelia burgdorferi specific intrathecal IgG antibody synthesis (AI). In addition, a commercial tick-borne bacterial flow chip (TBFC) system and a real-time PCR were also used to detect Borrelia species and Anaplasma phagocytophilum in patients who were positive by STTA. RESULTS The diagnosis of Lyme disease was confirmed in 18 (7.14%) of the 252 clinically suspected cases by STTA. Neurological involvement was reported in 14 (77.78%) patients, whereas joint and heart involvement was reported in five (27.78%) and three (16.67%) patients, respectively. Lymphocytic pleocytosis (median 37.5 cells/mm3; range 12-175 cells/mm3) in the CSF was seen in 11 of 14 Lyme neuroborreliosis (LNB) patients. Intrathecal production of Borrelia specific IgG antibodies was demonstrated in 9 (64.28%, n = 14) patients, a highly specific finding for neuroborreliosis. Two patients (11.11%) were also found to be co-infected with human granulocytic anaplasmosis. CONCLUSIONS The results of this study show clinical and laboratory evidence of endemic Lyme disease in North India and thus, highlight the importance for travel medicine practitioners and physicians to evaluate for Lyme disease in patients with compatible symptoms and a history of travel to tick risk areas.
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Affiliation(s)
- E V Vinayaraj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India; Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Kumar Thakur
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Paediatric Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishakh Anand
- Department of Paediatric Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
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11
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Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1-e48. [PMID: 33417672 DOI: 10.1093/cid/ciaa1215] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
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Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Yngve T Falck-Ytter
- Case Western Reserve University, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | | | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Baldwin
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Kiran K Belani
- Childrens Hospital and Clinical of Minnesota, Minneapolis, Minnesota, USA
| | - William R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David B Clifford
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Peter J Krause
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | | | | | - Amy A Pruitt
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Rips
- Consumer Representative, Omaha, Nebraska, USA
| | | | | | | | - Allen C Steere
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franc Strle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Sundel
- Boston Children's Hospital Boston, Massachusetts, USA
| | - Jean Tsao
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Lawrence S Zemel
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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12
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Fiore V, Rakusa J, Fehr T, Wick J. [CME: Musculoskeletal Manifestations of Lyme Disease]. PRAXIS 2021; 110:231-236. [PMID: 33849286 DOI: 10.1024/1661-8157/a003665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME: Musculoskeletal Manifestations of Lyme Disease Abstract. Lyme disease is the most common vector-borne illness in Switzerland and Lyme arthritis the most prevalent manifestation of late-stage Lyme disease. It presents as a monoarthitis or oligoarthritis in large joints, often involving the knee. Such a clinical presentation, together with positive Lyme serologies or polymerase chain reactions from synovial fluid/tissue, is considered diagnostic. If there is no tick bite or erythema migrans in the patient's history the diagnosis can be challenging due to the many differential diagnoses. The initial treatment is a prolonged course of oral antibiotics.
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Affiliation(s)
| | | | - Thomas Fehr
- Innere Medizin, Kantonsspital Graubünden, Chur
| | - Jürg Wick
- Innere Medizin, Kantonsspital Graubünden, Chur
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13
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Petrulionienė A, Radzišauskienė D, Paulauskas A, Venalis A. Lyme Disease among Patients at an Ambulatory Unit in a Highly Endemic Country: Lithuania. ACTA ACUST UNITED AC 2021; 57:medicina57020184. [PMID: 33669940 PMCID: PMC7924869 DOI: 10.3390/medicina57020184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background and objectives: Lyme disease is the most common tick-borne infectious disease in Europe, caused by the spirocheta bacteria of Borrelia burgdorferi. Several genospecies of B. burgdorferi are pathogenic to humans. B. burgdorferi sensu stricto, which is prevalent in North America, causes reactive arthritis, whereas B. garinii and B. afzelii, common in Europe, can affect the skin, heart, or nervous system; it has been shown that the clinical symptoms of the disease may be very different. The objective of this study was to identify the baseline characteristics of Lyme disease and to elucidate the frequency of different Lyme disease syndromes in Lithuania. Materials and Methods: Patients who were diagnosed with Lyme disease during an ambulatory visit to the Center of Infectious Diseases, Vilnius University Santaros clinics, from 2014 to 2016, were enrolled in this study. A retrospective material analysis was conducted. Results: In total, 1005 patients were enrolled with the following prevalence of clinical syndromes: erythema migrans (EM), 945 (94.02%); Lyme arthritis, 32 (3.18%); neuroborreliosis, 23 (2.28%); Lyme carditis, 4 (0.39%); and acrodermatitis, 1 (0.09%). Erythema migrans was dominant among middle-aged women, with a rash appearing mainly on the lower extremities. Lyme arthritis mainly manifested among middle-aged women as an oligoarthritis, mostly affecting the knee joint. Neuroborreliosis was seen more often in middle-aged women than men and the main symptom was nervus facialis neuropathy. Lyme carditis, manifested as an atrioventricular block, with a male/female ratio of 3:1, and the median age was 51. Acrodermatitis was diagnosed in a 61-year-old woman, as a painful, red rash on the hand. Conclusions: According to the prevalence of B. garinii and B. afzelii in Europe, previously it was thought that Lyme disease presented as erythema migrans, and less frequently as neuroborreliosis; however, this study revealed that other syndromes may also be seen. In addition, we revealed that the longer it takes for erythema migrans to appear, the greater the likelihood of Lyme arthritis developing.
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Affiliation(s)
- Agnė Petrulionienė
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-6401-9811
| | - Daiva Radzišauskienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | | | - Algirdas Venalis
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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14
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Arthritis and Diagnostics in Lyme Disease. Trop Med Infect Dis 2021; 6:tropicalmed6010018. [PMID: 33572912 PMCID: PMC7931108 DOI: 10.3390/tropicalmed6010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
The diagnosis of Lyme disease, caused by Borrelia burgdorferi, is clinical but frequently supported by laboratory tests. Lyme arthritis is now less frequently seen than at the time of its discovery. However, it still occurs, and it is important to recognize this, the differential diagnoses, and how laboratory tests can be useful and their limitations. The most frequently used diagnostic tests are antibody based. However, antibody testing still suffers from many drawbacks and is only an indirect measure of exposure. In contrast, evolving direct diagnostic methods can indicate active infection.
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15
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Reifert J, Kamath K, Bozekowski J, Lis E, Horn EJ, Granger D, Theel ES, Shon J, Sawyer JR, Daugherty PS. Serum Epitope Repertoire Analysis Enables Early Detection of Lyme Disease with Improved Sensitivity in an Expandable Multiplex Format. J Clin Microbiol 2021; 59:e01836-20. [PMID: 33148704 PMCID: PMC8111119 DOI: 10.1128/jcm.01836-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Widely employed diagnostic antibody serology for Lyme disease, known as standard two-tier testing (STTT), exhibits insufficient sensitivity in early Lyme disease, yielding many thousands of false-negative test results each year. Given this problem, we applied serum antibody repertoire analysis (SERA), or next-generation sequencing (NGS)-based serology, to discover IgG and IgM antibody epitope motifs capable of detecting Lyme disease-specific antibodies with high sensitivity and specificity. Iterative motif discovery and bioinformatic analysis of epitope repertoires from subjects with Lyme disease (n = 264) and controls (n = 391) yielded a set of 28 epitope motifs representing 20 distinct IgG antibody epitopes and a set of 38 epitope motifs representing 21 distinct IgM epitopes, which performed equivalently in a large validation cohort of STTT-positive samples. In a second validation set from subjects with clinically defined early Lyme disease (n = 119) and controls (n = 257), the SERA Lyme IgG and IgM assay exhibited significantly improved sensitivity relative to STTT (77% versus 62%; Z-test; P = 0.013) and improved specificity (99% versus 97%). Early Lyme disease subjects exhibited significantly fewer reactive epitopes (Mann-Whitney U test; P < 0.0001) relative to subjects with Lyme arthritis. Thus, SERA Lyme IgG and M panels provided increased accuracy in early Lyme disease in a readily expandable multiplex assay format.
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Affiliation(s)
| | | | | | - Ewa Lis
- Serimmune Inc., Goleta, California, USA
| | | | - Dane Granger
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester Minnesota, USA
| | - John Shon
- Serimmune Inc., Goleta, California, USA
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16
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Bernard Q, Hu LT. Innate Immune Memory to Repeated Borrelia burgdorferi Exposure Correlates with Murine In Vivo Inflammatory Phenotypes. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2020; 205:3383-3389. [PMID: 33168577 PMCID: PMC7725865 DOI: 10.4049/jimmunol.2000686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/07/2020] [Indexed: 01/02/2023]
Abstract
Borrelia burgdorferi, the causative agent of Lyme disease, is transmitted by the bite of an infected tick. Once inoculated into the host dermis, it disseminates to various organs including distant skin sites, the heart, the joint and the nervous system. Most humans will develop an early skin manifestation called erythema migrans at the tick bite site. This can be followed by symptoms such as carditis, neuritis, meningitis, or arthritis if not treated. A specific mouse strain, C3H/HeN develops arthritis with B. burgdorferi infection whereas another strain, C57BL/6, develops minimal to no arthritis. Neither strain of mice show any skin signs of rash or inflammation. Factors that determine the presence of skin inflammation and the joint arthritis susceptibility in the host are only partially characterized. We show in this study that murine fibroblast-like synoviocytes display trained immunity, a program in some cells that results in increased inflammatory responses if the cell has previously come in contact with a stimulus, and that trained immunity in fibroblast-like synoviocytes tested ex vivo correlates with Lyme arthritis susceptibility. Conversely, skin fibroblasts do not exhibit trained immunity, which correlates with the absence of skin symptoms in these mice. Moreover, we demonstrate that the trained phenotype in FLS is affected by the cell environment, which depends on the host genetic background. Future studies expanding this initial report of the role of trained immunity on symptoms of B. burgdorferi infection may provide insight into the pathogenesis of disease in murine models.
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Affiliation(s)
- Quentin Bernard
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111
| | - Linden T Hu
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111
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17
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Abstract
Lyme disease (Lyme borreliosis) is a tick-borne, zoonosis of adults and children caused by genospecies of the Borrelia burgdorferi sensu lato complex. The ailment, widespread throughout the Northern Hemisphere, continues to increase globally due to multiple environmental factors, coupled with increased incursion of humans into habitats that harbor the spirochete. B. burgdorferi sensu lato is transmitted by ticks from the Ixodes ricinus complex. In North America, B. burgdorferi causes nearly all infections; in Europe, B. afzelii and B. garinii are most associated with human disease. The spirochete's unusual fragmented genome encodes a plethora of differentially expressed outer surface lipoproteins that play a seminal role in the bacterium's ability to sustain itself within its enzootic cycle and cause disease when transmitted to its incidental human host. Tissue damage and symptomatology (i.e., clinical manifestations) result from the inflammatory response elicited by the bacterium and its constituents. The deposition of spirochetes into human dermal tissue generates a local inflammatory response that manifests as erythema migrans (EM), the hallmark skin lesion. If treated appropriately and early, the prognosis is excellent. However, in untreated patients, the disease may present with a wide range of clinical manifestations, most commonly involving the central nervous system, joints, or heart. A small percentage (~10%) of patients may go on to develop a poorly defined fibromyalgia-like illness, post-treatment Lyme disease (PTLD) unresponsive to prolonged antimicrobial therapy. Below we integrate current knowledge regarding the ecologic, epidemiologic, microbiologic, and immunologic facets of Lyme disease into a conceptual framework that sheds light on the disorder that healthcare providers encounter.
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Affiliation(s)
- Justin D. Radolf
- Department of Medicine, UConn Health, Farmington, CT 06030, USA
- Department of Pediatrics, UConn Health, Farmington, CT 06030, USA
- Departments of Genetics and Genome Sciences, UConn Health, Farmington, CT 06030, USA
- Departments of Molecular Biology and Biophysics, UConn Health, Farmington, CT 06030, USA
- Department of Immunology, UConn Health, Farmington, CT 06030, USA
| | - Klemen Strle
- Division of Infectious Diseases, Wadsworth Center, NY Department of Health, Albany NY, 12208, USA
| | - Jacob E. Lemieux
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Franc Strle
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
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18
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Gutierrez-Hoffmann MG, O'Meally RN, Cole RN, Tiniakou E, Darrah E, Soloski MJ. Borrelia burgdorferi-Induced Changes in the Class II Self-Immunopeptidome Displayed on HLA-DR Molecules Expressed by Dendritic Cells. Front Med (Lausanne) 2020; 7:568. [PMID: 33043033 PMCID: PMC7524959 DOI: 10.3389/fmed.2020.00568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023] Open
Abstract
The MHC class II antigen processing and presentation pathway has evolved to derive short amino acid peptides from proteins that enter the endocytic pathway, load them onto MHC class II molecules and display them on the surface of antigen presenting cells for recognition by CD4+ T cells. Under normal circumstances, peptides bound to MHC class II molecules are derived from host (self) proteins and not recognized by T cells due to tolerance mechanisms. Pathogens induce significant changes in the biology of antigen presenting cells, including upregulation of MHC processing and presentation. We therefore hypothesized that exposure to pathogens may alter the repertoire of self-peptides bound to MHC class II molecules. To test this hypothesis, we isolated monocyte-derived dendritic cells from healthy subjects, exposed them to the TLR-2 agonist lipoteichoic acid or live Borrelia burgdorferi, the causative agent of Lyme disease, and isolated and characterized HLA-DR associated peptides using mass spectrometry. Our results show that lipoteichoic acid-stimulated, B. burgdorferi-stimulated and unstimulated monocyte-derived dendritic cells largely derive their self-peptides from similar overlapping sets of host proteins. However, lipoteichoic acid and B. burgdorferi stimulation promote the processing and presentation of new sets of HLA-DR associated self-peptides derived from unique protein sources. Examination of processes and compartments these proteins reside in, indicate that activation of monocyte-derived dendritic cells changes the range of host self-proteins available for processing and presentation on MHC class II molecules. These findings reveal that the HLA-DR-bound self-immunopeptidome presented by mo-DCs is dynamic in nature and changes with activation state reflective of cellular function. In addition, among the repertoire of self-peptides bound to HLA-DR are several epitopes known to be recognized by autoreactive T cells. These studies are relevant to our basic understanding of pathogen-induced changes in monocyte-derived dendritic cell function, and the mechanisms involved in infection-induced autoimmune illnesses such as Lyme arthritis.
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Affiliation(s)
- Maria G. Gutierrez-Hoffmann
- Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert N. O'Meally
- Mass Spectrometry and Proteomics Facility, Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert N. Cole
- Mass Spectrometry and Proteomics Facility, Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eleni Tiniakou
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erika Darrah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark J. Soloski
- Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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Affiliation(s)
- Allen C Steere
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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20
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Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis. Proc Natl Acad Sci U S A 2019; 116:13498-13507. [PMID: 31209025 PMCID: PMC6613144 DOI: 10.1073/pnas.1904170116] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Lyme disease, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in North America. If early infection is untreated, it can result in late-stage manifestations, including arthritis. Although antibiotics are generally effective at all stages of the disease, arthritis may persist in some patients for months to several years despite oral and intravenous antibiotic treatment. Excessive, dysregulated host immune responses are thought to play an important role in this outcome, but the underlying mechanisms are not completely understood. This study identifies the B. burgdorferi peptidoglycan, a major component of the cell wall, as an immunogen likely to contribute to inflammation during infection and in cases of postinfectious Lyme arthritis. Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi. A common late-stage complication of this disease is oligoarticular arthritis, often involving the knee. In ∼10% of cases, arthritis persists after appropriate antibiotic treatment, leading to a proliferative synovitis typical of chronic inflammatory arthritides. Here, we provide evidence that peptidoglycan (PG), a major component of the B. burgdorferi cell envelope, may contribute to the development and persistence of Lyme arthritis (LA). We show that B. burgdorferi has a chemically atypical PG (PGBb) that is not recycled during cell-wall turnover. Instead, this pathogen sheds PGBb fragments into its environment during growth. Patients with LA mount a specific immunoglobulin G response against PGBb, which is significantly higher in the synovial fluid than in the serum of the same patient. We also detect PGBb in 94% of synovial fluid samples (32 of 34) from patients with LA, many of whom had undergone oral and intravenous antibiotic treatment. These same synovial fluid samples contain proinflammatory cytokines, similar to those produced by human peripheral blood mononuclear cells stimulated with PGBb. In addition, systemic administration of PGBb in BALB/c mice elicits acute arthritis. Altogether, our study identifies PGBb as a likely contributor to inflammatory responses in LA. Persistence of this antigen in the joint may contribute to synovitis after antibiotics eradicate the pathogen. Furthermore, our finding that B. burgdorferi sheds immunogenic PGBb fragments during growth suggests a potential role for PGBb in the immunopathogenesis of other Lyme disease manifestations.
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21
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Hilliard KA, Brown CR. Treatment of Borrelia burgdorferi-Infected Mice with Apoptotic Cells Attenuates Lyme Arthritis via PPAR-γ. THE JOURNAL OF IMMUNOLOGY 2019; 202:1798-1806. [PMID: 30700583 DOI: 10.4049/jimmunol.1801179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022]
Abstract
Infection of mice with Borrelia burgdorferi causes an inflammatory arthritis that peaks 3-4 wk postinfection and then spontaneously resolves. Although the recruitment of neutrophils is known to drive the development of arthritis, mechanisms of disease resolution remain unclear. Efficient clearance of apoptotic cells (AC) is likely an important component of arthritis resolution. In this article, we show the number of AC increases in the joints of B. burgdorferi-infected mice around day 21 postinfection and peaks around day 28. Injection of AC directly into the ankles of B. burgdorferi-infected mice limited ankle swelling but had no effect on spirochete clearance or arthritis severity scores. In vitro, addition of AC to bone marrow macrophage cultures decreased B. burgdorferi-induced TNF-α and KC and increased IL-10. In addition, phagocytosis of B. burgdorferi and neutrophil migration to LTB4 were inhibited by AC. Exogenous AC caused an increase in peroxisome proliferator-activated receptor-γ (PPAR-γ) expression both in vitro and in vivo during B. burgdorferi infection. The PPAR-γ agonist rosiglitazone elicited similar changes in macrophage cytokine production and neutrophil migration as exogenous AC. Addition of the PPAR-γ antagonist GW 9662 abrogated the effects of AC in vitro. Injection of rosiglitazone directly into the tibiotarsal joints of B. burgdorferi-infected mice decreased ankle swelling and immune cell recruitment, similar to the injection of AC. These results suggest that clearance of AC plays a role in the resolution of inflammation during experimental Lyme arthritis through the activation of PPAR-γ. PPAR-γ agonists, such as rosiglitazone, may therefore be effective treatments for inducing arthritis resolution.
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Affiliation(s)
- Kinsey A Hilliard
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO 65211
| | - Charles R Brown
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO 65211
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22
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Eickhoff JC, Collamer AN. Autoimmunity Mimics: Infection and Malignancy. Prim Care 2018; 45:343-360. [PMID: 29759128 DOI: 10.1016/j.pop.2018.02.012] [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: 10/16/2022]
Abstract
Musculoskeletal rheumatic syndromes are commonly encountered in the primary care setting. A plethora of commonly encountered and rare infectious agents can produce osteoarticular and soft tissue manifestations. Likewise, malignancies may manifest rheumatic symptoms via direct tumor invasion or paraneoplastic effects. Awareness of these diseases and their clinical risk factors should result in improved screening and earlier recognition and intervention, leading to improved long-term outcomes and overall patient care.
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Affiliation(s)
- Jeffrey C Eickhoff
- Rheumatology Service, U.S. Navy, Medical Corps, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
| | - Angelique N Collamer
- Rheumatology Service, U.S. Air Force, Medical Corps, Walter Reed National Military Medical Center, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA
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Abstract
Lyme disease (LD) is the most common tick-borne disease in the Northern Hemisphere. As the most prevalent vector-borne disease in the USA, LD affects 300,000 human cases each year. LD is caused by inoculation of the bacterial spirochete, Borrelia burgdorferi sensu lato, from an infected tick. If not treated quickly and completely, the bacteria disseminate from the tick's biting site into multiple organs including the joints, heart, and brain. Thus, the best outcome from medical intervention can be expected with early detection and treatment with antibiotics, prior to multi-organ dissemination. In the absence of a characteristic rash, LD is diagnosed using serological testing involving enzyme-linked immunosorbent assay (ELISA) followed by western blotting, which is collectively known as the two-tier algorithm. These assays detect host antibodies against the bacteria, but are hampered by low sensitivity, which can miss early LD cases. This review discusses the application of some current assays for diagnosing LD clinically, thus providing a foundation for exploring newer techniques being developed in the laboratory for more sensitive detection of early LD.
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Affiliation(s)
- Eunice Chou
- Vassar College in Poughkeepsie, NY SUNY Downstate Medical School and SUNY Polytechnic Institute
| | - Yi-Pin Lin
- University in Ithaca, NY and postdoctoral training from Tufts University in Boston, MA
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Jarosz AC, Badawi A. Metabolites of prostaglandin synthases as potential biomarkers of Lyme disease severity and symptom resolution. Inflamm Res 2018; 68:7-17. [PMID: 30121835 PMCID: PMC6314976 DOI: 10.1007/s00011-018-1180-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023] Open
Abstract
Background Lyme disease or Lyme borreliosis (LB) is the commonest vector-borne disease in the North America. It is an inflammatory disease caused by the bacterium Borrelia burgdorferi. The role of the inflammatory processes mediated by prostaglandins (PGs), thromboxanes and leukotrienes (LTs) in LB severity and symptoms resolution is yet to be elucidated. Objectives We aim to systematically review and evaluate the role of PGs and related lipid mediators in the induction and resolution of inflammation in LB. Methods We conducted a comprehensive search in PubMed, Ovid MEDLINE(R), Embase and Embase Classic to identify cell-culture, animal and human studies reporting the changes in PGs and related lipid mediators of inflammation during the course of LB. Results We identified 18 studies to be included into this systematic review. The selected reports consisted of seven cell-culture studies, seven animal studies, and four human studies (from three patient populations). Results from cell-culture and animal studies suggest that PGs and other lipid mediators of inflammation are elevated in LB and may contribute to disease development. The limited number of human studies showed that subjects with Lyme meningitis, Lyme arthritis (LA) and antibiotic-refractory LA had increased levels of an array of PGs and lipid mediators (e.g., LTB4, 8-isoPGF2α, and phospholipases A2 activity). Levels of these markers were significantly reduced following the treatment with antibiotics or non-steroidal anti-inflammatory drugs. Conclusion Dysregulation of prostaglandins and related lipid mediators may play a role in the etiology of LB and persistence of inflammation that may lead to long-term complications. Further investigation into the precise levels of a wide range of PGs and related factors is critical as it may propose novel markers that can be used for early diagnosis. Electronic supplementary material The online version of this article (10.1007/s00011-018-1180-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alicia Caroline Jarosz
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, FitzGerald Building, 150 College Street, Toronto, ON, M5S3E2, Canada
| | - Alaa Badawi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, FitzGerald Building, 150 College Street, Toronto, ON, M5S3E2, Canada.
- Public Health Risk Sciences Division, Public Health Agency of Canada, 180 Queen Street West, Toronto, ON, M5V 3L7, Canada.
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Abstract
: Lyme disease is recognized as the most common vector-borne disease in the United States. Surveillance data indicate both increasing numbers of Lyme disease cases and geographic expansion of areas where the causative spirochete, Borrelia burgdorferi, can be found. With prompt diagnosis and appropriate treatment in the acute stage, most patients will recover fully. Without treatment, however, the infecting pathogen remains within the body, often producing long-term complications, including musculoskeletal, neurologic, and cardiovascular effects. The authors describe early and late manifestations of Lyme disease, the appropriate use of diagnostic tests, the recommended treatment, and strategies for preventing tick-borne diseases nurses can share with patients.
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A Case of Undetected Neuroborreliosis in a 75-Year-Old Chinese Male. Case Rep Infect Dis 2018; 2018:6764894. [PMID: 30026993 PMCID: PMC6031206 DOI: 10.1155/2018/6764894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/09/2018] [Accepted: 05/28/2018] [Indexed: 11/20/2022] Open
Abstract
Lyme disease is a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto that manifests with characteristic symptoms in patients. Patients are identified based on their clinical symptoms and then diagnosed through enzyme-linked immunosorbent assay (ELISA), Western blot, and blood culture techniques. Here, we present the case of a 75-year-old, Northeast suburban resident complaining of unstable gait, high fevers, malaise, myalgia, and confusion. This patient's symptoms were nonspecific, and his lab titers and blood cultures were repeatedly negative during his stay. It was only late in the course of his treatment that blood titers and cerebrospinal fluid analysis were positive for Lyme IgG and IgM. He was treated with intravenous doxycycline and prescribed oral doxycycline on discharge, resulting in a full recovery. We express the need for physicians to consider Lyme disease in endemic patients presenting with nonspecific systemic signs.
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Rimoldi SG, Merli S, Bestetti G, Giacomet V, Cislaghi G, Grande R, Zanzani S, Pagani C, Trevisan G, De Faveri E, Gismondo MR, Ruzić-Sabljić E. Occurrence of Lyme disease infection in a non-endemic area in Northern Italy. GIORN ITAL DERMAT V 2018; 155:320-324. [PMID: 29600690 DOI: 10.23736/s0392-0488.18.05941-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Italy, the incidence of human tick-borne disease has increased over the last decades. Since 2015 a multidisciplinary group has been established in Sacco Hospital for the management of the patients affected by Lyme disease (LD). A retrospective evaluation (2015-2017) was performed for LD in non-endemic areas. METHODS Retrospective analysis of all 1000 samples for 800 patients screened for LD antibodies at the Sacco Hospital in 3 years (2015-2017). Clinical and epidemiological data were collected and compared with the serological results. RESULTS Among the 800 patients screened, 134 of them were diagnosed with borreliosis during 2015 (37 cases), 2016 (31 cases) and 2017 (66 cases). Localized LD was diagnosed 100 out of 134 cases (69%): in most of them (N.=63) erythema migrans has been documented; in 37 out of 100 it was not possible to detect it. In only three cases, patients complained of different clinical symptoms such as headache, arm and facial pain respectively. 23 out of 134 cases (16%) showed a persistence of serological positivity and symptoms with osteomuscular involvement and fatigue, despite the therapy (late LD). In that same study 11 out of 134 patients (7%) received a diagnosis of neuroborreliosis. CONCLUSIONS Our data reported a high percentage of LD infection (19%) in a non-endemic area. The definition of a Multidisciplinary Working Group and a clinical care pathway allowed a better clinical management of LD cases treated in Sacco Hospital, Milan.
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Affiliation(s)
- Sara G Rimoldi
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy -
| | - Stefania Merli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanna Bestetti
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vania Giacomet
- Unit of Pediatrics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Romualdo Grande
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sergio Zanzani
- Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - Cristina Pagani
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | | | - Maria R Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Eva Ruzić-Sabljić
- Laboratory for Boreliosis and Leptospirosis, University of Ljubljana, Ljubljana, Slovenia
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Hall CL, Lee VT. Cyclic-di-GMP regulation of virulence in bacterial pathogens. WILEY INTERDISCIPLINARY REVIEWS. RNA 2018; 9:10.1002/wrna.1454. [PMID: 28990312 PMCID: PMC5739959 DOI: 10.1002/wrna.1454] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 12/16/2022]
Abstract
Signaling pathways allow bacteria to adapt to changing environments. For pathogenic bacteria, signaling pathways allow for timely expression of virulence factors and the repression of antivirulence factors within the mammalian host. As the bacteria exit the mammalian host, signaling pathways enable the expression of factors promoting survival in the environment and/or nonmammalian hosts. One such signaling pathway uses the dinucleotide cyclic-di-GMP (c-di-GMP), and many bacterial genomes encode numerous proteins that are responsible for synthesizing and degrading c-di-GMP. Once made, c-di-GMP binds to individual protein and RNA receptors to allosterically alter the macromolecule function to drive phenotypic changes. Each bacterial genome encodes unique sets of genes for c-di-GMP signaling and virulence factors so the regulation by c-di-GMP is organism specific. Recent works have pointed to evidence that c-di-GMP regulates virulence in different bacterial pathogens of mammalian hosts. In this review, we discuss the criteria for determining the contribution of signaling nucleotides to pathogenesis using a well-characterized signaling nucleotide, cyclic AMP (cAMP), in Pseudomonas aeruginosa. Using these criteria, we review the roles of c-di-GMP in mediating virulence and highlight common themes that exist among eight diverse pathogens that cause different diseases through different routes of infection and transmission. WIREs RNA 2018, 9:e1454. doi: 10.1002/wrna.1454 This article is categorized under: RNA in Disease and Development > RNA in Disease.
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Affiliation(s)
- Cherisse L Hall
- Department of Cell Biology and Molecular Genetics, University of Maryland at College Park, College Park, MD, USA
| | - Vincent T Lee
- Department of Cell Biology and Molecular Genetics, University of Maryland at College Park, College Park, MD, USA
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Siitonen R, Pietikäinen A, Liljenbäck H, Käkelä M, Söderström M, Jalkanen S, Hytönen J, Roivainen A. Targeting of vascular adhesion protein-1 by positron emission tomography visualizes sites of inflammation in Borrelia burgdorferi-infected mice. Arthritis Res Ther 2017; 19:254. [PMID: 29166944 PMCID: PMC5700622 DOI: 10.1186/s13075-017-1460-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022] Open
Abstract
Background In the present study, we sought to evaluate the feasibility of targeting vascular adhesion protein-1 (VAP-1) by positron emission tomography (PET) for the longitudinal quantitative assessment of Borrelia burgdorferi infection-induced inflammation in mice. Methods Mice with B. burgdorferi infection-induced arthritis were studied. During a 7-week follow-up period, the progression of arthritis was monitored weekly with 68Ga-DOTA-Siglec-9 PET/computed tomography (CT) and measurement of tibiotarsal joint swellings. A subgroup of infected mice was treated with ceftriaxone. Finally, histopathological assessment of joint inflammation was performed and VAP-1 expression in joints were determined. Results Explicit joint swelling and 68Ga-DOTA-Siglec-9 uptake could be demonstrated in the affected joints from B. burgdorferi-infected mice. By contrast, no obvious accumulation of 68Ga-DOTA-Siglec-9 was detected in joints of uninfected mice. The maximum swelling and highest uptake in the affected joints were observed 4 weeks after the infection. 68Ga-DOTA-Siglec-9 uptake in joints correlated with joint swelling (P < 0.0001) and histopathological scoring of inflammation (P = 0.020). Despite short-term antibiotic treatment, the arthritis persisted, and the PET signal remained as high as in nontreated mice. Immunohistochemistry revealed strong-to-moderate expression of VAP-1 in the synovium of B. burgdorferi-infected mice, while only weak expression of VAP-1 was detected in uninfected mice. Conclusions The present study showed that 68Ga-DOTA-Siglec-9 can detect B. burgdorferi infection-induced arthritis in mice. Furthermore, longitudinal PET/CT imaging allowed monitoring of arthritis development over time.
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Affiliation(s)
- Riikka Siitonen
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
| | - Annukka Pietikäinen
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland.,Turku Doctoral Programme for Molecular Medicine, Turku, Finland
| | - Heidi Liljenbäck
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.,Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Meeri Käkelä
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
| | - Mirva Söderström
- Department of Pathology, Turku University Hospital, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Sirpa Jalkanen
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland.,MediCity Research Laboratory, University of Turku, Tykistönkatu 6, FI-20520, Turku, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland.,Microbiology and Genetics Department, Turku University Hospital, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland. .,Turku Center for Disease Modeling, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland. .,Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.
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Arvikar SL, Crowley JT, Sulka KB, Steere AC. Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease. Arthritis Rheumatol 2017; 69:194-202. [PMID: 27636905 DOI: 10.1002/art.39866] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/01/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe systemic autoimmune joint diseases that develop following Lyme disease, and to compare their clinical features with those of Lyme arthritis (LA). METHODS We reviewed records of all adult patients referred to our LA clinic over a 13-year period, in whom we had diagnosed a systemic autoimmune joint disease following Lyme disease. For comparison, records of patients enrolled in our LA cohort over the most recent 2-year period were analyzed. Levels of IgG antibodies to Borrelia burgdorferi and to 3 Lyme disease-associated autoantigens were measured. RESULTS We identified 30 patients who had developed a new-onset systemic autoimmune joint disorder a median of 4 months after Lyme disease (usually manifested by erythema migrans [EM]). Fifteen had rheumatoid arthritis (RA), 13 had psoriatic arthritis (PsA), and 2 had peripheral spondyloarthritis (SpA). The 30 patients typically had polyarthritis, and those with PsA or SpA often had previous psoriasis, axial involvement, or enthesitis. In the comparison group of 43 patients with LA, the usual clinical picture was monoarticular knee arthritis, without prior EM. Most of the patients with systemic autoimmune joint disorders were positive for B burgdorferi IgG antibodies, as detected by enzyme-linked immunosorbent assay, but had significantly lower titers and lower frequencies of Lyme disease-associated autoantibodies than patients with LA. Prior to our evaluation, these patients had often received additional antibiotics for presumed LA, without benefit. We prescribed antiinflammatory agents, most commonly disease-modifying antirheumatic drugs, resulting in improvement. CONCLUSION Systemic autoimmune joint diseases (i.e., RA, PsA, SpA) may follow Lyme disease. Development of polyarthritis after antibiotic-treated EM, previous psoriasis, or low-titer B burgdorferi antibodies may provide insight into the correct diagnosis.
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Pietikäinen A, Siitonen R, Liljenbäck H, Eskola O, Söderström M, Roivainen A, Hytönen J. In vivo imaging of Lyme arthritis in mice by [ 18F]fluorodeoxyglucose positron emission tomography/computed tomography. Scand J Rheumatol 2017. [PMID: 28649922 DOI: 10.1080/03009742.2017.1287306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Lyme borreliosis (LB) is a tick-borne infectious disease caused by Borrelia burgdorferi spirochaetes, which are able to disseminate from the tick-bite site to distant organs. Mouse models are widely used to study LB and especially Lyme arthritis (LA), but only a few whole-animal in vivo imaging studies on the pathogenesis of B. burgdorferi infection in mice have been published so far. The existing imaging techniques have their drawbacks and, therefore, novel tools to complement the array of available LB imaging methodologies are needed. METHOD The applicability of positron emission tomography combined with computed tomography (PET/CT) imaging was evaluated as a method to monitor LB and especially LA in the C3H/HeN mouse model infected with wild-type B. burgdorferi N40 bacteria. The imaging results were compared with the traditional LA analysis methods, such as tibiotarsal joint swelling and histopathological assessment of joint inflammation. RESULTS PET/CT imaging provided high-resolution images with quantitative information on the spatial and temporal distribution of the [18F]fluorodeoxyglucose ([18F]FDG) tracer in B. burgdorferi-infected mice. The [18F]FDG accumulated in the affected joints and activated lymph nodes of infected mice, while the tracer signal could not be visualized in these organs in uninfected control animals. Importantly, in vivo PET/CT imaging data were in agreement with the histopathological scoring of inflammation of mouse joints. CONCLUSION PET/CT imaging with [18F]FDG is a reliable method to longitudinally monitor the development and progression of B. burgdorferi infection-induced inflammation in vivo in mouse joints.
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Affiliation(s)
- A Pietikäinen
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland.,b Turku Doctoral Programme for Molecular Medicine , University of Turku , Turku , Finland
| | - R Siitonen
- c Turku PET Centre , Turku University Hospital and University of Turku , Turku , Finland
| | - H Liljenbäck
- c Turku PET Centre , Turku University Hospital and University of Turku , Turku , Finland.,d Turku Center for Disease Modeling , University of Turku , Turku , Finland
| | - O Eskola
- c Turku PET Centre , Turku University Hospital and University of Turku , Turku , Finland
| | - M Söderström
- e Department of Pathology and Forensic Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | - A Roivainen
- c Turku PET Centre , Turku University Hospital and University of Turku , Turku , Finland.,d Turku Center for Disease Modeling , University of Turku , Turku , Finland
| | - J Hytönen
- a Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland.,f Department of Clinical Microbiology and Immunology , Turku University Hospital , Turku , Finland
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A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations. Case Rep Infect Dis 2017; 2017:6598043. [PMID: 28512589 PMCID: PMC5420423 DOI: 10.1155/2017/6598043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/26/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022] Open
Abstract
Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient's symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.
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Lasky CE, Pratt CL, Hilliard KA, Jones JL, Brown CR. T Cells Exacerbate Lyme Borreliosis in TLR2-Deficient Mice. Front Immunol 2016; 7:468. [PMID: 27857714 PMCID: PMC5093308 DOI: 10.3389/fimmu.2016.00468] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/18/2016] [Indexed: 12/02/2022] Open
Abstract
Infection of humans with the spirochete, Borrelia burgdorferi, causes Lyme borreliosis and can lead to clinical manifestations such as arthritis, carditis, and neurological conditions. Experimental infection of mice recapitulates many of these symptoms and serves as a model system for the investigation of disease pathogenesis and immunity. Innate immunity is known to drive the development of Lyme arthritis and carditis, but the mechanisms driving this response remain unclear. Innate immune cells recognize B. burgdorferi surface lipoproteins primarily via toll-like receptor (TLR)2; however, previous work has demonstrated TLR2−/− mice had exacerbated disease and increased bacterial burden. We demonstrate increased CD4 and CD8 T cell infiltrates in B. burgdorferi-infected joints and hearts of C3H TLR2−/− mice. In vivo depletion of either CD4 or CD8 T cells reduced Borrelia-induced joint swelling and lowered tissue spirochete burden, whereas depletion of CD8 T cells alone reduced disease severity scores. Exacerbation of Lyme arthritis correlated with increased production of CXCL9 by synoviocytes, and this was reduced with CD8 T cell depletion. These results demonstrate T cells can exacerbate Lyme disease pathogenesis and prolong disease resolution possibly through dysregulation of inflammatory responses and inhibition of bacterial clearance.
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Affiliation(s)
- Carrie E Lasky
- Department of Veterinary Pathobiology, University of Missouri , Columbia, MO , USA
| | - Carmela L Pratt
- Department of Veterinary Pathobiology, University of Missouri , Columbia, MO , USA
| | - Kinsey A Hilliard
- Department of Veterinary Pathobiology, University of Missouri , Columbia, MO , USA
| | - John L Jones
- Department of Veterinary Pathobiology, University of Missouri , Columbia, MO , USA
| | - Charles R Brown
- Department of Veterinary Pathobiology, University of Missouri , Columbia, MO , USA
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Vázquez-López ME, Díez-Morrondo C, Sánchez-Andrade A, Pego-Reigosa R, Díaz P, Castro-Gago M. Manifestaciones articulares en enfermos de Lyme. ACTA ACUST UNITED AC 2016; 12:327-330. [DOI: 10.1016/j.reuma.2015.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 11/24/2022]
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Parallelisms and Contrasts in the Diverse Ecologies of the Anaplasma phagocytophilum and Borrelia burgdorferi Complexes of Bacteria in the Far Western United States. Vet Sci 2016; 3:vetsci3040026. [PMID: 29056734 PMCID: PMC5606591 DOI: 10.3390/vetsci3040026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/03/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Anaplasma phagocytophilum and Borrelia burgdorferi are two tick-borne bacteria that cause disease in people and animals. For each of these bacteria, there is a complex of closely related genospecies and/or strains that are genetically distinct and have been shown through both observational and experimental studies to have different host tropisms. In this review we compare the known ecologies of these two bacterial complexes in the far western USA and find remarkable similarities, which will help us understand evolutionary histories and coadaptation among vertebrate host, tick vector, and bacteria. For both complexes, sensu stricto genospecies (those that infect humans) share a similar geographic range, are vectored mainly by ticks in the Ixodes ricinus-complex, utilize mainly white-footed mice (Peromyscus leucopus) as a reservoir in the eastern USA and tree squirrels in the far west, and tend to be generalists, infecting a wider variety of vertebrate host species. Other sensu lato genospecies within each complex are generally more specialized, occurring often in local enzootic cycles within a narrow range of vertebrate hosts and specialized vector species. We suggest that these similar ecologies may have arisen through utilization of a generalist tick species as a vector, resulting in a potentially more virulent generalist pathogen that spills over into humans, vs. utilization of a specialized tick vector on a particular vertebrate host species, promoting microbe specialization. Such tight host-vector-pathogen coupling could also facilitate high enzootic prevalence and the evolution of host immune-tolerance and bacterial avirulence.
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Abstract
PURPOSE OF REVIEW We review the current evidence concerning the diagnosis of Lyme disease in children for application in the acute care setting. RECENT FINDINGS Recent studies suggest that Lyme disease incidence is substantially higher than previously described. Although efforts are ongoing to identify alternative testing strategies, two-tiered serologic testing remains the diagnostic standard in children with compatible clinical syndromes. Published clinical prediction rules can assist clinicians caring for children with potential Lyme disease. SUMMARY Two-tiered serologic testing remains the mainstay of the diagnosis of Lyme disease. To minimize the risk of a false positive test, serologic testing should be limited to those children with symptoms compatible with Lyme disease with potential exposure to ticks from endemic regions.
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Borrelia burgdorferi CheD Promotes Various Functions in Chemotaxis and the Pathogenic Life Cycle of the Spirochete. Infect Immun 2016; 84:1743-1752. [PMID: 27021244 DOI: 10.1128/iai.01347-15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/23/2016] [Indexed: 12/13/2022] Open
Abstract
Borrelia burgdorferi possesses a sophisticated chemotaxis signaling system; however, the roles of the majority of the chemotaxis proteins in the infectious life cycle have not yet been demonstrated. Specifically, the role of CheD during host colonization has not been demonstrated in any bacterium. Here, we systematically characterized the B. burgdorferi CheD homolog using genetics and biochemical and mouse-tick-mouse infection cycle studies. Bacillus subtilis CheD plays an important role in chemotaxis by deamidation of methyl-accepting chemotaxis protein receptors (MCPs) and by increasing the receptor kinase activity or enhancing CheC phosphatase activity, thereby regulating the levels of the CheY response regulator. Our biochemical analysis indicates that B. burgdorferi CheD significantly enhances CheX phosphatase activity by specifically interacting with the phosphatase. Moreover, CheD specifically binds two of the six MCPs, indicating that CheD may also modulate the receptor proteins. Although the motility of the cheD mutant cells was indistinguishable from that of the wild-type cells, the mutant did exhibit reduced chemotaxis. Importantly, the mutant showed significantly reduced infectivity in C3H/HeN mice via needle inoculation. Mouse-tick-mouse infection assays indicated that CheD is dispensable for acquisition or transmission of spirochetes; however, the viability of cheD mutants in ticks is marginally reduced compared to that of the wild-type or complemented cheD spirochetes. These data suggest that CheD plays an important role in the chemotaxis and pathogenesis of B. burgdorferi We propose potential connections between CheD, CheX, and MCPs and discuss how these interactions play critical roles during the infectious life cycle of the spirochete.
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Tomasini C. Cordoniform morphea: a clinicopathologic study of two cases presenting with the rope sign. J Cutan Pathol 2016; 43:613-622. [PMID: 26990496 DOI: 10.1111/cup.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/23/2016] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Morphea clinically presenting as cordoniform lesions has not been described previously in the literature. OBJECTIVE Our goal was to describe the clinicopathologic features of morphea presenting with cord-like cutaneous lesions. METHODS The clinical notes of 420 patients with a diagnosis of morphea seen during the previous 10 years were reviewed to identify any cases that had cordoniform lesions at presentation. RESULTS Two adult patients (one male and one female) were identified. Both patients presented with chronic, slightly burning, bilateral, erythematous, linear or curvilinear elevated cutaneous indurations on the lateral chest wall strikingly reminiscent interstitial granulomatous dermatitis with arthritis. Histopathologically, typical changes of deep morphea with a band-like involvement only of the lower part of the reticular dermis and the superficial hypodermis and a remarkable perineural arrangement of the lymphoplasmocytic infiltrate were observed. The presence of Borrelia in skin biopsy samples of both patients was shown by immunohistochemistry and focus floating microscopy. In one patient, the presence of Borrelia afzelii DNA in the cutaneous biopsy was shown by polymerase chain reaction. CONCLUSIONS Cordoniform morphea is an exceedingly unusual and previously undescribed clinicopathologic presentation of morphea where Borrelia infection may play a causal role.
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Affiliation(s)
- Carlo Tomasini
- Dermatopathology Section, Azienda Ospedaliera Città della Salute d della Scienza, Turin, Italy
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Crowley JT, Strle K, Drouin EE, Pianta A, Arvikar SL, Wang Q, Costello CE, Steere AC. Matrix metalloproteinase-10 is a target of T and B cell responses that correlate with synovial pathology in patients with antibiotic-refractory Lyme arthritis. J Autoimmun 2016; 69:24-37. [PMID: 26922382 DOI: 10.1016/j.jaut.2016.02.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/26/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
Infection-induced autoimmunity is thought to be a contributing factor in antibiotic-refractory Lyme arthritis, but studies of autoimmunity have been hindered by difficulty in identifying relevant autoantigens. We developed a novel approach that begins with the identification of T cell epitopes in synovial tissue using tandem mass spectrometry. Herein, we identified an immunogenic HLA-DR-presented peptide (T cell epitope) derived from the source protein matrix metalloproteinase-10 (MMP-10) from the synovium of a patient with antibiotic-refractory arthritis. This finding provided a bridge for the identification of autoantibody responses to MMP-10, the "first autoimmune hit" in a subgroup of patients with erythema migrans, the initial skin lesion of the infection. Months later, after priming of the immune response to MMP-10 in early infection, a subset of patients with antibiotic-responsive or antibiotic-refractory arthritis had MMP-10 autoantibodies, but only patients with antibiotic-refractory arthritis had both T and B cell responses to the protein, providing evidence for a "second autoimmune hit". Further support for a biologically relevant autoimmune event was observed by the positive correlation of anti-MMP-10 autoantibodies with distinct synovial pathology. This experience demonstrates the power of new, discovery-based methods to identify relevant autoimmune responses in chronic inflammatory forms of arthritis.
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Affiliation(s)
- Jameson T Crowley
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Klemen Strle
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elise E Drouin
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Annalisa Pianta
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sheila L Arvikar
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Qi Wang
- Center for Biomedical Mass Spectrometry, Boston University School of Medicine, Boston, MA, United States
| | - Catherine E Costello
- Center for Biomedical Mass Spectrometry, Boston University School of Medicine, Boston, MA, United States
| | - Allen C Steere
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Spirochetal motility and chemotaxis in the natural enzootic cycle and development of Lyme disease. Curr Opin Microbiol 2015; 28:106-13. [PMID: 26519910 DOI: 10.1016/j.mib.2015.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 11/21/2022]
Abstract
Two-thirds of all bacterial genomes sequenced to-date possess an organelle for locomotion, referred to as flagella, periplasmic flagella or type IV pili. These genomes may also contain a chemotaxis-signaling system which governs flagellar rotation, thus leading a coordinated function for motility. Motility and chemotaxis are often crucial for infection or disease process caused by pathogenic bacteria. Although motility-associated genes are well-characterized in some organisms, the highly orchestrated synthesis, regulation, and assembly of periplasmic flagella in spirochetes are just being delineated. Recent advances were fostered by development of unique genetic manipulations in spirochetes coupled with cutting-edge imaging techniques. These contemporary advances in understanding the role of spirochetal motility and chemotaxis in host persistence and disease development are highlighted in this review.
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Pianta A, Drouin EE, Crowley JT, Arvikar S, Strle K, Costello CE, Steere AC. Annexin A2 is a target of autoimmune T and B cell responses associated with synovial fibroblast proliferation in patients with antibiotic-refractory Lyme arthritis. Clin Immunol 2015; 160:336-41. [PMID: 26187145 DOI: 10.1016/j.clim.2015.07.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 01/12/2023]
Abstract
In this study, autoantibody responses to annexin A2 were found in 11-15% of 278 patients with Lyme disease, including in those with erythema migrans (EM), an early sign of the illness, and in those with antibiotic-responsive or antibiotic-refractory Lyme arthritis (LA), a late disease manifestation. In contrast, robust T cell reactivity to annexin A2 peptides was found only in patients with responsive or refractory LA. In LA patients, annexin A2 protein levels, which were higher in the refractory group, correlated with annexin A2 antibody levels in sera and synovial fluid. In addition, in patients with antibiotic-refractory LA who had anti-annexin A2 antibodies, synovial tissue had intense staining for annexin A2 protein, greater synovial fibroblast proliferation and more tissue fibrosis. Thus, a subset of LA patients had T and B cell responses to annexin A2, and in the refractory group, annexin A2 autoantibodies were associated with specific pathologic findings.
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Affiliation(s)
- Annalisa Pianta
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, United States.
| | - Elise E Drouin
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Jameson T Crowley
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Sheila Arvikar
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Klemen Strle
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Catherine E Costello
- Center for Biomedical Mass Spectrometry, Boston University School of Medicine, Boston, United States
| | - Allen C Steere
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, United States
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Abstract
Lyme disease/borreliosis (LD) is a well-known arthropod-transmitted entity in the northern hemisphere. The incidence of LD is reportedly rising throughout the world, although better diagnostic facilities may be contributory. The disease distribution is expanding in Europe, with its presence being now documented at higher altitudes and latitudes. Borrelia burgdorferi sensu lato is the most important genospecies leading to LD, although newer ones continue to be discovered. The variations in clinical spectrum with genospecies involved are an interesting feature. The alteration in gene expression while the organism cycles between two very different hosts is intriguing and has been described. The disease presents in three stages-namely, the early localized, early disseminated, and late stage. Erythema chronicum migrans is the pathognomic early lesion, and its diagnosis is purely clinical; however, laboratory diagnosis is essential for later manifestations. Two-tier serologic testing using an enzyme-linked immunosorbent assay (ELISA) as the first tier and immunoglobulin M (IgM) and IgG immunoblot as the second, if ELISA is positive or equivocal, is the mainstay of diagnosis. Doxycycline is the cornerstone of treatment, whereas parenteral therapy, mainly with ceftriaxone, is indicated in a few specific scenarios.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, A/6 Panchwati, Delhi, 110 033, India.
| | - Ananta Khurana
- Department of Dermatology, 1 Dr RML Hospital and Postgraduate Institute of Medical Education and research (PGIMER), New Delhi
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Abstract
Infections with several types of viral and bacterial pathogens are able to cause arthritic disease. Arthropod vectors such as ticks and mosquitoes transmit a number of these arthritis-causing pathogens, and as these vectors increase their global distribution, so too do the diseases they spread. The typical clinical manifestations of infectious arthritis are often similar in presentation to rheumatoid arthritis. Hence, care needs to be taken in the diagnoses and management of these conditions. Additionally, clinical reports suggest that prolonged arthropathies may result from infection, highlighting the need for careful clinical management and further research into underlying disease mechanisms.
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Affiliation(s)
- Lara J Herrero
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, QLD 4222, Australia.
| | - Adam Taylor
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, QLD 4222, Australia.
| | - Stefan Wolf
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, QLD 4222, Australia.
| | - Suresh Mahalingam
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, QLD 4222, Australia.
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Infection of Interleukin 17 Receptor A-Deficient C3H Mice with Borrelia burgdorferi Does Not Affect Their Development of Lyme Arthritis and Carditis. Infect Immun 2015; 83:2882-8. [PMID: 25939508 DOI: 10.1128/iai.00533-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 12/12/2022] Open
Abstract
Recently, a number of studies have reported the presence of interleukin 17 (IL-17) in patients with Lyme disease, and several murine studies have suggested a role for this cytokine in the development of Lyme arthritis. However, the role of IL-17 has not been studied using the experimental Lyme borreliosis model of infection of C3H mice with Borrelia burgdorferi. In the current study, we investigated the role of IL-17 in the development of experimental Lyme borreliosis by infecting C3H mice devoid of the common IL-17 receptor A subunit (IL-17RA) and thus deficient in most IL-17 signaling. Infection of both C3H and C3H IL-17RA(-/-) mice led to the production of high levels of IL-17 in the serum, low levels in the heart tissue, and no detectable IL-17 in the joint tissue. The development and severity of arthritis and carditis in the C3H IL-17RA(-/-) mice were similar to what was seen in wild-type C3H mice. In addition, development of antiborrelia antibodies and clearance of spirochetes from tissues were similar for the two mouse strains. These results demonstrate a limited role for IL-17 signaling through IL-17RA in the development of disease following infection of C3H mice with B. burgdorferi.
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