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Szaroz D, Kulkarni M, Robayo González CX, Zinszer K. Study protocol for a scoping review of Lyme disease prediction methodologies. BMJ Open 2024; 14:e071402. [PMID: 38772589 PMCID: PMC11110606 DOI: 10.1136/bmjopen-2022-071402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 03/27/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION In the temperate world, Lyme disease (LD) is the most common vector-borne disease affecting humans. In North America, LD surveillance and research have revealed an increasing territorial expansion of hosts, bacteria and vectors that has accompanied an increasing incidence of the disease in humans. To better understand the factors driving disease spread, predictive models can use current and historical data to predict disease occurrence in populations across time and space. Various prediction methods have been used, including approaches to evaluate prediction accuracy and/or performance and a range of predictors in LD risk prediction research. With this scoping review, we aim to document the different modelling approaches including types of forecasting and/or prediction methods, predictors and approaches to evaluating model performance (eg, accuracy). METHODS AND ANALYSIS This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines. Electronic databases will be searched via keywords and subject headings (eg, Medical Subject Heading terms). The search will be performed in the following databases: PubMed/MEDLINE, EMBASE, CAB Abstracts, Global Health and SCOPUS. Studies reported in English or French investigating the risk of LD in humans through spatial prediction and temporal forecasting methodologies will be identified and screened. Eligibility criteria will be applied to the list of articles to identify which to retain. Two reviewers will screen titles and abstracts, followed by a full-text screening of the articles' content. Data will be extracted and charted into a standard form, synthesised and interpreted. ETHICS AND DISSEMINATION This scoping review is based on published literature and does not require ethics approval. Findings will be published in peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
- Daniel Szaroz
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
| | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Claudia Ximena Robayo González
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
| | - Kate Zinszer
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
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2
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Kim L, Lashnits E, Breitschwerdt EB, Elam A, Grade N, Miller J, Shikhman AR. Antibodies to Borrelia burgdorferi and Bartonella species in serum and synovial fluid from people with rheumatic diseases. Microbiol Spectr 2024; 12:e0165323. [PMID: 38483477 PMCID: PMC10986562 DOI: 10.1128/spectrum.01653-23] [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: 04/19/2023] [Accepted: 02/03/2024] [Indexed: 04/06/2024] Open
Abstract
Vector-borne infections may underlie some rheumatic diseases, particularly in people with joint effusions. This study aimed to compare serum and synovial fluid antibodies to B. burgdorferi and Bartonella spp. in patients with rheumatic diseases. This observational, cross-sectional study examined paired synovial fluid and serum specimens collected from 110 patients with joint effusion between October 2017 and January 2022. Testing for antibodies to B. burgdorferi (using CDC criteria) and Bartonella spp. via two indirect fluorescent antibody (IFA) assays was performed as part of routine patient care at the Institute for Specialized Medicine (San Diego, CA, USA). There were 30 participants (27%) with positive two-tier B. burgdorferi serology and 26 participants (24%) with IFA seroreactivity (≥1:256) to B. henselae and/or B. quintana. Both B. burgdorferi IgM and IgG were detected more frequently in synovial fluid than serum: 27% of patients were either IgM or IgG positive in synovial fluid, compared to 15.5% in serum (P = 0.048). Conversely, B. henselae and B. quintana antibodies were detected more frequently in serum than synovial fluid; overall only 2% of patients had positive IFA titers in synovial fluid, compared to 24% who had positive IFA titers in serum (P < 0.001). There were no significant associations between B. burgdorferi or Bartonella spp. seroreactivity with any of the clinical rheumatological diagnoses. This study provides preliminary support for the importance of synovial fluid antibody testing for documenting exposure to B. burgdorferi but not for documenting exposure to Bartonella spp. IMPORTANCE This study focuses on diagnostic testing for two common vector-borne diseases in an affected patient population. In it, we provide data showing that antibodies to B. burgdorferi, but not Bartonella spp., are more commonly found in synovial fluid than serum of patients with joint effusion. Since Lyme arthritis is a common-and sometimes difficult to diagnose-rheumatic disease, improving diagnostic capabilities is of utmost importance. While our findings are certainly not definitive for changes to practice, they do suggest that synovial fluid could be a useful sample for the clinical diagnosis of Lyme disease, and future prospective studies evaluating this claim are warranted.
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Affiliation(s)
- Lisa Kim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin Lashnits
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Edward B. Breitschwerdt
- Intracellular Pathogens Research Laboratory and Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Amanda Elam
- Galaxy Diagnostics, Research Triangle, North Carolina, USA
| | - Neenah Grade
- Galaxy Diagnostics, Research Triangle, North Carolina, USA
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Jaenson TGT, Gray JS, Lindgren PE, Wilhelmsson P. Coinfection of Babesia and Borrelia in the Tick Ixodes ricinus-A Neglected Public Health Issue in Europe? Pathogens 2024; 13:81. [PMID: 38251388 PMCID: PMC10818971 DOI: 10.3390/pathogens13010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Ixodes ricinus nymphs and adults removed from humans, and larvae and nymphs from birds, have been analysed for infection with Babesia species and Borrelia species previously in separately published studies. Here, we use the same data set to explore the coinfection pattern of Babesia and Borrelia species in the ticks. We also provide an overview of the ecology and potential public health importance in Sweden of I. ricinus infected both with zoonotic Babesia and Borrelia species. Among 1952 nymphs and adult ticks removed from humans, 3.1% were PCR-positive for Babesia spp. Of these Babesia-positive ticks, 43% were simultaneously Borrelia-positive. Among 1046 immatures of I. ricinus removed from birds, 2.5% were Babesia-positive, of which 38% were coinfected with Borrelia species. This study shows that in I. ricinus infesting humans or birds in Sweden, potentially zoonotic Babesia protozoa sometimes co-occur with human-pathogenic Borrelia spp. Diagnostic tests for Babesia spp. infection are rarely performed in Europe, and the medical significance of this pathogen in Europe could be underestimated.
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Affiliation(s)
- Thomas G. T. Jaenson
- Evolutionary Biology Centre, Department of Organismal Biology, Uppsala University, Norbyvägen 18d, SE-752 36 Uppsala, Sweden;
| | - Jeremy S. Gray
- UCD School of Biology and Environmental Science, University College Dublin, D04 N2E5 Dublin, Ireland;
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- Department of Clinical Microbiology, Region Jönköping County, SE-551 11 Jönköping, Sweden
| | - Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- Department of Clinical Microbiology, Region Jönköping County, SE-551 11 Jönköping, Sweden
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Horowitz RI, Fallon J, Freeman PR. Comparison of the Efficacy of Longer versus Shorter Pulsed High Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome with Bartonellosis and Associated Coinfections. Microorganisms 2023; 11:2301. [PMID: 37764145 PMCID: PMC10537894 DOI: 10.3390/microorganisms11092301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/27/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Twenty-five patients with relapsing and remitting Borreliosis, Babesiosis, and bartonellosis despite extended anti-infective therapy were prescribed double-dose dapsone combination therapy (DDDCT), followed by one or several courses of High Dose Dapsone Combination Therapy (HDDCT). A retrospective chart review of these 25 patients undergoing DDDCT therapy and HDDCT demonstrated that 100% improved their tick-borne symptoms, and patients completing 6-7 day pulses of HDDCT had superior levels of improvement versus 4-day pulses if Bartonella was present. At the completion of treatment, 7/23 (30.5%) who completed 8 weeks of DDDCT followed by a 5-7 day pulse of HDDCT remained in remission for 3-9 months, and 3/23 patients (13%) who recently finished treatment were 1 ½ months in full remission. In conclusion, DDDCT followed by 6-7 day pulses of HDDCT could represent a novel, effective anti-infective strategy in chronic Lyme disease/Post Treatment Lyme Disease Syndrome (PTLDS) and associated co-infections, including Bartonella, especially in individuals who have failed standard antibiotic protocols.
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Affiliation(s)
- Richard I. Horowitz
- Lyme and Tick-Borne Diseases Working Group, New York State Department of Health, Albany, NY 12224, USA
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA; (J.F.); (P.R.F.)
| | - John Fallon
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA; (J.F.); (P.R.F.)
| | - Phyllis R. Freeman
- Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA; (J.F.); (P.R.F.)
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Trouillas P, Franck M. Complete Remission in Paralytic Late Tick-Borne Neurological Disease Comprising Mixed Involvement of Borrelia, Babesia, Anaplasma, and Bartonella: Use of Long-Term Treatments with Antibiotics and Antiparasitics in a Series of 10 Cases. Antibiotics (Basel) 2023; 12:1021. [PMID: 37370340 DOI: 10.3390/antibiotics12061021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to demonstrate that severe neurological motor deficits in the context of late tick-borne disease with mixed microorganism involvement are eligible for long-term combined antibiotic/antiparasitic treatments. The inclusion criteria were: 1. neurological limb paralysis with a disability score >4 according to the EDSS Kurtzke disability scale; 2. serological tests pointing to an involvement of the main tick-borne microorganisms Borrelia burgdorferi s.l., Babesia, Anaplasma, and Bartonella; 3. a general disease for more than 6 months with fatigue, pain and subjective cognitive deficit. The patients were administered long-term treatments with repeated cycles (at least three) of 35-day IV ceftriaxone and repeated oral regimens of azithromycin-doxycycline and azithromycin-doxycycline-rifampicin. For Babesia, repeated courses of atovaquone-azithromycin were administered. Ten patients had intractable or severe motor deficits before treatment in the context of Borrelia (two cases) Borrelia-Babesia (four cases), Borrelia-Babesia-Anaplasma (two cases), Borrelia-Babesia-Anaplasma-Bartonella (one case) and Babesia-Anaplasma (one case). For several months, five had been in wheelchairs, and four had been walking with sticks. Seven patients out of 10 (70%) showed complete remission after a mean active treatment duration of 20.1 + 6.6 months, with a mean number of 4 ceftriaxone cycles. Three patients showed an initial remission but suffered secondary antibiotic/antiparasitic-resistant motor recurrences. Among the nine patients with Borrelia serologic positivity, treatments obtained complete remission in seven cases (77%). The findings of this ten-case series suggest the usefulness of long-term antibiotic/antiparasitic treatments in patients with severe late tick-borne neurological deficits with highly significant elements of tick-borne involvement.
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Affiliation(s)
| | - Michel Franck
- ADNucleis Biological Laboratory, 69290 Grézieu la Varenne, France
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Taber R, Pankowski A, Ludwig AL, Jensen M, Magsamen V, Lashnits E. Bartonellosis in Dogs and Cats, an Update. Vet Clin North Am Small Anim Pract 2022; 52:1163-1192. [DOI: 10.1016/j.cvsm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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The Role of the Infectious Disease Consultation in Lyme Disease. Infect Dis Clin North Am 2022; 36:703-718. [PMID: 36116844 DOI: 10.1016/j.idc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A consultation regarding Lyme disease can be challenging for the infectious disease physician when the referral question centers on the use of prolonged or empirical antibiotic treatment of Lyme disease and associated tick-borne infections. Patients who have been infected with Borrelia burgdorferi, and many who have been misdiagnosed, are confronted with a seemingly endless array of misinformation that is not in keeping with the current understanding of the clinical spectrum of Lyme disease and its response to evidence-based treatment. Preparing for these conversations with a good grasp of the public beliefs regarding Lyme disease and its treatment can be beneficial.
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Abstract
Most patients with Lyme disease will fully recover with recommended antibiotic therapy. However, some patients report persisting nonspecific symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), depending on the degree to which the individual's symptoms impact their quality of life. PTLDs occur in a portion of patients diagnosed with chronic Lyme disease (CLD), a controversial term describing different patient populations, diagnosed based on unvalidated tests and criteria. Practitioners should review the evidence for the Lyme disease diagnosis and not overlook unrelated conditions. Current evidence shows that prolonged antibiotic therapy provides little benefit and carries significant risk. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and to understand CLD is needed.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, BG 10 RM 12C118 MSC 1888 10 Center, Bethesda, MD 20892-1888, USA.
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9
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Seroprevalence of Antibodies against Tick-Borne Pathogens in Czech Patients with Suspected Post-Treatment Lyme Disease Syndrome. Microorganisms 2021; 9:microorganisms9112217. [PMID: 34835343 PMCID: PMC8619037 DOI: 10.3390/microorganisms9112217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
The hypothesized importance of coinfections in the pathogenesis of post-treatment Lyme disease syndrome (PTLDS) leads to the use of combined, ongoing antimicrobial treatment in many cases despite the absence of symptoms typical of the presence of infection with specific pathogens. Serum samples from 103 patients with suspected post-treatment Lyme disease syndrome were tested for the presence of antibodies to the major tick-borne pathogens Anaplasma phagocytophilum, Bartonella henselae/Bartonella quinatana, and Babesia microti. Although the presence of anti-Anaplasma antibodies was detected in 12.6% of the samples and anti-Bartonella antibodies in 9.7% of the samples, the presence of antibodies against both pathogens in the same samples or anti-Babesia antibodies in the selected group of patients could not be confirmed. However, we were able to detect autoantibodies, mostly antinuclear, in 11.6% of the patients studied. Our results are in good agreement with previously published studies showing the presence of a wide spectrum of autoantibodies in some patients with complicated forms of Lyme disease and post-treatment Lyme disease syndrome, but they do not reveal a significant influence of co-infections on the development of PTLDS in the studied group of patients.
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10
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Guarino C, Pinn-Woodcock T, Levine DG, Miller J, Johnson AL. Case Report: Nuchal Bursitis Associated With Borrelia burgdorferi Infection in a Horse. Front Vet Sci 2021; 8:743067. [PMID: 34631864 PMCID: PMC8495068 DOI: 10.3389/fvets.2021.743067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Cases of cranial nuchal bursitis associated with Borrelia burgdorferi infection have not been thoroughly described. Here, we describe the case of a 17-year-old mare that was presented for low head carriage, dull demeanor, and resistance to haltering. Imaging supported a diagnosis of nuchal bursitis, and bursoscopy with surgical debridement of the nuchal bursa was performed. B. burgdorferi was identified by molecular diagnostics in serial samples of the bursal fluid, with no other organisms identified. Serology revealed significant elevation in antibodies directed against OspA of B. burgdorferi, but not the typical infection markers, OspC and OspF. Intravenous ceftiofur was administered for 80 days, and the nuchal bursa was directly injected with ceftiofur. The mare recovered and was able to return to work with no recrudescence of clinical signs over the following year to date. Infection with B. burgdorferi should be considered as a differential in cases of septic nuchal bursitis.
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Affiliation(s)
- Cassandra Guarino
- Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, United States
| | - Toby Pinn-Woodcock
- Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, United States
| | - David G Levine
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Julia Miller
- General Medicine, Alliance Equine Health Care, Glenmoore, PA, United States
| | - Amy L Johnson
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
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11
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Borreliosi di Lyme e neuroborreliosi. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45319-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Raffetin A, Barquin A, Nguala S, Paoletti G, Rabaud C, Chassany O, Caraux-Paz P, Covasso S, Partouche H. Perceptions, Representations, and Experiences of Patients Presenting Nonspecific Symptoms in the Context of Suspected Lyme Borreliosis. Microorganisms 2021; 9:microorganisms9071515. [PMID: 34361950 PMCID: PMC8304161 DOI: 10.3390/microorganisms9071515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Some subjective symptoms may be reported at all stages of Lyme borreliosis (LB) and may persist for several months after treatment. Nonspecific symptoms without any objective manifestation of LB are sometimes attributed by patients to a possible tick bite. The aim of our study was to explore the perceptions, representations, and experiences that these patients had of their disease and care paths. METHODS We performed a qualitative study through individual interviews (October 2017-May 2018), based on grounded theory, following the COREQ checklist. A balanced sample of patients with diverse profiles was recruited at consultations with general practitioners and infectious disease physicians. RESULTS Twelve patients were interviewed. Data saturation was reached at the twelfth interview. For codes, 293 were identified, and classified into 5 themes: (1) the experience of disabling nonspecific symptoms, especially pain, causing confusion and fear, (2) long and difficult care paths for the majority of the patients, experienced as an obstacle course, (3) a break with the previous state of health, causing a negative impact on every sphere of the patient's life, (4) empowerment of the patients and the self-management of their disease, and (5) the strong expression of a desire for change, with better listening, greater recognition of the symptoms, and simpler care paths. CONCLUSIONS This study allows for the understanding of a patient's behaviours and the obstacles encountered, the way they are perceived, and the necessary solutions. The patients' expectations identified here could help physicians better understand the doctor-patient relationship in these complex management situations, which would reduce the burden of the disease. The current development of specialised reference centres could help meet the patients' demands and those of family physicians.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
- European Study Group for Lyme Borreliosis ESGBOR, ESCMID, Gerbergasse 14 3rd Floor, 4001 Basel, Switzerland
- Correspondence: ; Tel.: +33-143862068
| | - Aude Barquin
- Département de Médecine Générale, Paris University, Site Cochin 27, Rue du Fbg Saint-Jacques, CEDEX 14, 75679 Paris, France; (A.B.); (H.P.)
| | - Steve Nguala
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
| | - Giulia Paoletti
- Department of Psychiatry, Tick-Borne Diseases Reference Centre, Île-de-France/Hauts-de-France, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France;
| | - Christian Rabaud
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, East Region, CHRU Nancy, Bâtiment Philippe Canton, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre les Nancy, France;
| | - Olivier Chassany
- Health Economics Clinical Trial Unit (URC-ECO), Hôpital Hotel-Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004 Paris, France;
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
| | - Sarah Covasso
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
- Department of Anthropology, University Lyon II, UFR Anthropologie, Sociologie et Science Politique, Université Lumière Lyon 2, 5 Avenue Pierre Mendès France, 69676 Bron, France
| | - Henri Partouche
- Département de Médecine Générale, Paris University, Site Cochin 27, Rue du Fbg Saint-Jacques, CEDEX 14, 75679 Paris, France; (A.B.); (H.P.)
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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: 142] [Impact Index Per Article: 47.3] [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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Mangat R, Winbush A, Louie T. Recurrent Fevers in a Triathlete. Cureus 2021; 13:e12564. [PMID: 33575137 PMCID: PMC7869908 DOI: 10.7759/cureus.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Human granulocytic anaplasmosis (HGA) is a tick-borne illness that typically causes a self-limited febrile illness. We describe herein a healthy triathlete who had recurrent fevers for six weeks as a result of HGA and discuss the impact of this patient’s HGA on his metabolic fitness during training over a three month time period. We also review the literature for other cases of Ehrlichia and Anaplasma with prolonged courses.
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Affiliation(s)
- Rupinder Mangat
- Division of Infectious Diseases, University of Rochester Medical Center, Rochester, USA
| | - Angelina Winbush
- Division of Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Ted Louie
- Division of Infectious Diseases, University of Rochester Medical Center, Rochester, USA
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15
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Cotes-Perdomo AP, Oviedo Á, Castro LR. Molecular detection of pathogens in ticks associated with domestic animals from the Colombian Caribbean region. EXPERIMENTAL & APPLIED ACAROLOGY 2020; 82:137-150. [PMID: 32809186 DOI: 10.1007/s10493-020-00531-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
Tick-borne diseases constitute a problem for livestock and public health. Given the socio-economic and environmental conditions of the Colombian Caribbean, ticks are particularly abundant, in turn exposing domestic animals and people in contact with them to such diseases. This study evaluates the presence of Babesia spp., Anaplasma spp., Coxiella spp. and Borrelia spp. in domestic animal ticks (Amblyomma mixtum, A. dissimile, Dermacentor nitens, Rhipicephalus sanguineus and R. microplus) by conventional PCR. Findings show a prevalence of 12.5% of Babesia, 0% of Borrelia, 39.4% of Anaplasma and 52.9% of Coxiella, whereas 6.2% of a total sample of 104 tick pools presented coinfections between Babesia and Anaplasma. Among the molecularly identified species are Ba. vogeli, Ba. bigemina and A. marginale, in addition to two Coxiella species-one being C. mudrowiae and the other similar to an undescribed endosymbiont of Rhipicephalus sp. It is necessary to evaluate the vector capacity of ticks such as A. mixtum, D. nitens and R. sanguineus in the transmission of A. marginale. Moreover, it is necessary to explore the role that bacteria of the genus Coxiella might have both in the health of humans and animals, and in the metabolism and reproduction of ticks. This is the first report on Babesia vogeli and B. bigemina in ticks from the Colombian Caribbean, representing a risk to animal and human health.
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Affiliation(s)
- Andrea P Cotes-Perdomo
- Grupo de Investigación Evolución, Sistemática Y Ecología Molecular (GIESEMOL), Universidad del Magdalena, Santa Marta, Colombia.
| | - Ángel Oviedo
- Grupo de Investigación Evolución, Sistemática Y Ecología Molecular (GIESEMOL), Universidad del Magdalena, Santa Marta, Colombia
| | - Lyda R Castro
- Grupo de Investigación Evolución, Sistemática Y Ecología Molecular (GIESEMOL), Universidad del Magdalena, Santa Marta, Colombia
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16
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Haddad E, Chabane K, Jaureguiberry S, Monsel G, Pourcher V, Caumes E. Holistic Approach in Patients With Presumed Lyme Borreliosis Leads to Less Than 10% of Confirmation and More Than 80% of Antibiotic Failures. Clin Infect Dis 2020; 68:2060-2066. [PMID: 30239603 DOI: 10.1093/cid/ciy799] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is no precise idea whether patients with chronic symptoms attributed to Lyme borreliosis (LB) have LB or another disease. METHODS We evaluated patients consulting for a presumed LB with a holistic approach including presumptive treatment. We included symptomatic patients consulting for presumed LB. They were classified as confirmed LB when they met four criteria, and possible LB if three with a positive clinical response to presumptive treatment. RESULTS Amongst the 301 patients, 275 (91%) were exposed to tick bites, and 165 (54%) were bitten by a tick. At presentation, 151 patients (50.1%) had already been treated with a median of one (1-22) course of antimicrobials, during 34 (28-730) days. Median number of symptoms was three (1-12) with a median duration of 16 (1-68) months. Median number of signs was zero (0-2). ELISA was positive in 84/295 (28.4%) for IgM and 86/295 (29.1%) for IgG, and immunoblot was positive in 21/191 (10.9%) for IgM and 50/191 (26.1 %) for IgG. Presumptive treatment after presentation failed in 46/88 patients (52%). Diagnosis of LB was confirmed in 29 patients (9.6%), and possible in 9 (2.9%). Of the 243 patients with non-LB diagnosis, diseases were psychological, musculoskeletal, neurological or other origin in 76 (31.2%), 48 (19.7%), 37 (15.2%) and 82 (33.7%) patients respectively. Patients with other diseases were significantly younger, having more symptoms, longest duration of symptoms, less clinical signs and less frequent LB positive serologies. CONCLUSIONS Overdiagnosis and overtreatment of LB is worsening. Health authorities should investigate this phenomenon.
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Affiliation(s)
- Elie Haddad
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France
| | - Kahina Chabane
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Stéphane Jaureguiberry
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Gentiane Monsel
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France
| | - Valérie Pourcher
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France.,INSERM U1135 HIV Pathogenesis and Immune Aging, Immunity and Infectious Diseases Research Center, Paris, France
| | - Eric Caumes
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
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17
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Kolb B, Riesterer L, Widenhorn AM, Bier L. Monitoring of Hydrogen Emission from Bacteria in Food, Animals and in the Blood of Humans Suffering from Lyme Disease by A Specific Hydrogen Sensor. Antibiotics (Basel) 2020; 9:antibiotics9070427. [PMID: 32708106 PMCID: PMC7400184 DOI: 10.3390/antibiotics9070427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
A novel straightforward analytical technique was developed to monitor the emission of hydrogen from anaerobic bacteria cultured in sealed headspace vials using a specific hydrogen sensor. The results were compared with headspace gas chromatography carried out in parallel. This technique was also applied to investigate the efficacy of chemical antibiotics and of natural compounds with antimicrobial properties. Antibiotics added to the sample cultures are apparently effective if the emission of hydrogen is suppressed, or if not, are either ineffective or the related bacteria are even resistant. The sensor approach was applied to prove bacterial contamination in food, animals, medical specimens and in ticks infected by Borrelia bacteria and their transfer to humans, thus causing Lyme disease. It is a unique advantage that the progress of an antibiotic therapy can be examined until the emission of hydrogen is finished. The described technique cannot identify the related bacteria but enables bacterial contamination by hydrogen emitting anaerobes to be recognized. The samples are incubated with the proper culture broth in closed septum vials which remain closed during the whole process. The personnel in the lab never come into contact with pathogens and thus safety regulations are guaranteed.
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18
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GP coding behaviour for non-specific clinical presentations: a pilot study. BJGP Open 2020; 4:bjgpopen20X101050. [PMID: 32636202 PMCID: PMC7465576 DOI: 10.3399/bjgpopen20x101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022] Open
Abstract
Background Clinical coding is an integral part of primary care. Disease incidence studies based on primary care electronic health records (EHRs) rely on the accuracy of these codes. Current code validation methods are not appropriate for non-specific conditions and provide limited information about GPs' decision-making behaviour around coding. Qualitative methods could offer insight into decision-making behaviour around coding of patients with non-specific conditions. Aim To investigate the decision-making behaviour of GPs when applying Read codes to non-specific clinical presentations, using Lyme disease as a case example. Design & setting A pilot study was undertaken, involving masked semi-structured interviews of eight GPs in the North West of England. Method Semi-structured interviews were carried out based on 11 clinical cases representative of Lyme disease presentations. Discrete answers were described descriptively. Interview transcripts were analysed using a thematic approach. Results Themes underpinning GPs’ coding behaviour included: GP personal and professional experience; clinical evidence; diagnostic uncertainty; professional integrity and defensive practice; and patient-sourced health information and beliefs. GPs placed Lyme disease on their differential diagnosis list for five cases; in only two cases would GPs select a Lyme disease related Read code. Conclusion GPs were reluctant to code with specific diagnostic Read codes when they were presented with patients with vague or unfamiliar symptomology. This masked questionnaire methodology offers a new approach to validate incidence figures, based on Read codes of non-specific conditions. The reluctance to code poses many problems for primary care EHRs research. Further research is needed to understand what drives GPs’ coding behaviour.
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19
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Abstract
Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
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Affiliation(s)
- Bart Jan Kullberg
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedwig D Vrijmoeth
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Freek van de Schoor
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joppe W Hovius
- Amsterdam University Medical Centers, location AMC, Department of Medicine, Division of Infectious Diseases, and Amsterdam Multidisciplinary Lyme borreliosis Center, Amsterdam, Netherlands
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20
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Rauer S, Kastenbauer S, Hofmann H, Fingerle V, Huppertz HI, Hunfeld KP, Krause A, Ruf B, Dersch R. Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2020; 18:Doc03. [PMID: 32341686 PMCID: PMC7174852 DOI: 10.3205/000279] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Lyme borreliosis is the most common tick-borne infectious disease in Europe. A neurological manifestation occurs in 3–15% of infections and can manifest as polyradiculitis, meningitis and (rarely) encephalomyelitis. This S3 guideline is directed at physicians in private practices and clinics who treat Lyme neuroborreliosis in children and adults. Twenty AWMF member societies, the Robert Koch Institute, the German Borreliosis Society and three patient organisations participated in its development. A systematic review and assessment of the literature was conducted by the German Cochrane Centre, Freiburg (Cochrane Germany). The main objectives of this guideline are to define the disease and to give recommendations for the confirmation of a clinically suspected diagnosis by laboratory testing, antibiotic therapy, differential diagnostic testing and prevention.
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Affiliation(s)
| | | | | | - Volker Fingerle
- German Society for Hygiene and Microbiology (DGHM), Münster, Germany
| | - Hans-Iko Huppertz
- German Society of Paediatrics and Adolescent Medicine (DGKJ), Berlin, Germany.,German Society of Paediatric Infectology (DGPI), Berlin, Germany
| | - Klaus-Peter Hunfeld
- The German United Society of Clinical Chemistry and Laboratory Medicine (DGKL), Bonn, Germany.,INSTAND e.V., Düsseldorf, Germany
| | | | - Bernhard Ruf
- German Society of Infectious Diseases (DGI), Berlin, Germany
| | - Rick Dersch
- German Society of Neurology (DGN), Berlin, Germany.,Cochrane Germany, Faculty of Medicine, University of Freiburg, Germany
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21
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Rebman AW, Aucott JN. Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease. Front Med (Lausanne) 2020; 7:57. [PMID: 32161761 PMCID: PMC7052487 DOI: 10.3389/fmed.2020.00057] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
It has long been observed in clinical practice that a subset of patients with Lyme disease report a constellation of symptoms such as fatigue, cognitive difficulties, and musculoskeletal pain, which may last for a significant period of time. These symptoms, which can range from mild to severe, have been reported throughout the literature in both prospective and population-based studies in Lyme disease endemic regions. The etiology of these symptoms is unknown, however several illness-causing mechanisms have been hypothesized, including microbial persistence, host immune dysregulation through inflammatory or secondary autoimmune pathways, or altered neural networks, as in central sensitization. Evaluation and characterization of persistent symptoms in Lyme disease is complicated by potential independent, repeat exposures to B. burgdorferi, as well as the potential for co-morbid diseases with overlapping symptom profiles. Antibody testing for B. burgdorferi is an insensitive measure after treatment, and no other FDA-approved tests currently exist. As such, diagnosis presents a complex challenge for physicians, while the lived experience for patients is one marked by uncertainty and often illness invalidation. Currently, there are no FDA-approved pharmaceutical therapies, and the safety and efficacy of off-label and/or complementary therapies have not been well studied and are not agreed-upon within the medical community. Post-treatment Lyme disease represents a narrow, defined, mechanistically-neutral subset of this larger, more heterogeneous group of patients, and is a useful definition in research settings as an initial subgroup of study. The aim of this paper is to review the current literature on the diagnosis, etiology, risk factors, and treatment of patients with persistent symptoms in the context of Lyme disease. The meaning and relevance of existing patient subgroups will be discussed, as will future research priorities, including the need to develop illness biomarkers, elucidate the biologic mechanisms of disease, and drive improvements in therapeutic options.
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Affiliation(s)
- Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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22
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Kobayashi T, Higgins Y, Samuels R, Moaven A, Sanyal A, Yenokyan G, Lantos PM, Melia MT, Auwaerter PG. Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic. Open Forum Infect Dis 2019; 6:5527068. [PMID: 31363774 PMCID: PMC6663506 DOI: 10.1093/ofid/ofz299] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Although Lyme disease is the most common vector-borne infection in the United States, diagnostic accuracy within community settings is not well characterized. Methods A retrospective observational cohort study of patients referred to an academic center with a presumed diagnosis or concern for Lyme disease between 2000 and 2013 was performed to analyze diagnoses and treatments. Characteristics of those with Lyme disease and those misdiagnosed as having Lyme disease were compared. Results Of 1261 patients, 911 (72.2%) did not have Lyme disease, 184 (14.6%) had active or recent Lyme disease, 150 (11.9%) had a remote history of Lyme disease, and 16 (1.3%) were identified as having possible Lyme disease. Patients without current Lyme disease were more likely to be female (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.08–2.45), to have had symptoms for >3 months (OR, 8.78; 95% CI, 5.87–13.1), to have higher symptom counts (OR per additional symptom, 1.08; 95% CI, 1.02–1.13), to have had more Lyme-related laboratory testing (OR per additional laboratory test, 1.17; 95% CI, 1.03–1.32), and to have been diagnosed with what were regarded as coinfections (OR, 3.13; 95% CI, 1.14–8.57). Of the 911 patients without Lyme disease, 764 (83.9%) had received antimicrobials to treat Lyme disease or their coinfections. The percentage of patients established to have Lyme disease was lower than in earlier studies of referred populations. Conclusions Among patients referred to an academic Infectious Diseases practice for Lyme disease, incorrect diagnoses and unnecessary antibiotic treatment were common, both for Lyme disease and for coinfections.
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Affiliation(s)
- Takaaki Kobayashi
- Infectious Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yvonne Higgins
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger Samuels
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aurasch Moaven
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Abanti Sanyal
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul M Lantos
- Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Michael T Melia
- Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Vrijmoeth HD, Ursinus J, Harms MG, Zomer TP, Gauw SA, Tulen AD, Kremer K, Sprong H, Knoop H, Vermeeren YM, van Kooten B, Joosten LAB, Kullberg BJ, Hovius JWR, van den Wijngaard CC. Prevalence and determinants of persistent symptoms after treatment for Lyme borreliosis: study protocol for an observational, prospective cohort study (LymeProspect). BMC Infect Dis 2019; 19:324. [PMID: 30987580 PMCID: PMC6466793 DOI: 10.1186/s12879-019-3949-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/03/2019] [Indexed: 01/23/2023] Open
Abstract
Background After antibiotic treatment of Lyme borreliosis, a subset of patients report persistent symptoms, also referred to as post-treatment Lyme disease syndrome. The reported prevalence of persistent symptoms varies considerably, and its pathophysiology is under debate. The LymeProspect study has been designed to investigate the prevalence, severity, and a wide range of hypotheses on the etiology of persistent symptoms among patients treated for Lyme borreliosis in the Netherlands. Methods LymeProspect is a prospective, observational cohort study among adults with proven or probable Lyme borreliosis, either erythema migrans or disseminated manifestations, included at the start of antibiotic treatment. During one year of follow-up, participants are subjected to questionnaires every three months and blood is collected repeatedly during the first three months. The primary outcome is the prevalence of persistent symptoms after treatment, assessed by questionnaires online focusing on fatigue (CIS, subscale fatigue severity), pain (SF-36, subscale pain) and neurocognitive dysfunction (CFQ). Potential microbiological, immunological, genetic, epidemiological and cognitive-behavioral determinants for persistent symptoms are secondary outcome measures. Control cohorts include patients with long-lasting symptoms and unconfirmed Lyme disease, population controls, and subjects having reported a tick bite not followed by Lyme borreliosis. Discussion This article describes the background and design of the LymeProspect study protocol. This study is characterized by a prospective, explorative and multifaceted design. The results of this study will provide insights into the prevalence and determinants of persistent symptoms after treatment for Lyme borreliosis, and may provide a rationale for preventive and treatment recommendations. Trial registration NTR4998 (Netherlands Trial Register). Date of registration: 13 February 2015. Electronic supplementary material The online version of this article (10.1186/s12879-019-3949-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hedwig D Vrijmoeth
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - Jeanine Ursinus
- Department of Internal Medicine, Division of Infectious Diseases & Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands. .,National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands.
| | - Margriet G Harms
- National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - Tizza P Zomer
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300, DS, Apeldoorn, the Netherlands
| | - Stefanie A Gauw
- Department of Internal Medicine, Division of Infectious Diseases & Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Anna D Tulen
- National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - Kristin Kremer
- National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - Hein Sprong
- National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Yolande M Vermeeren
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300, DS, Apeldoorn, the Netherlands
| | - Barend van Kooten
- Lyme Center Apeldoorn, Gelre Hospital, P.O. Box 9014, 7300, DS, Apeldoorn, the Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Bart-Jan Kullberg
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Joppe W R Hovius
- Department of Internal Medicine, Division of Infectious Diseases & Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Cees C van den Wijngaard
- National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, the Netherlands
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24
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Wormser GP. Should Patients Infected with Borrelia burgdorferi No Longer Be Referred to as Having Lyme Disease? Am J Med 2019; 132:11-12. [PMID: 30012359 DOI: 10.1016/j.amjmed.2018.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla.
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25
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Sprong H, Azagi T, Hoornstra D, Nijhof AM, Knorr S, Baarsma ME, Hovius JW. Control of Lyme borreliosis and other Ixodes ricinus-borne diseases. Parasit Vectors 2018; 11:145. [PMID: 29510749 PMCID: PMC5840726 DOI: 10.1186/s13071-018-2744-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/23/2018] [Indexed: 12/25/2022] Open
Abstract
Lyme borreliosis (LB) and other Ixodes ricinus-borne diseases (TBDs) are diseases that emerge from interactions of humans and domestic animals with infected ticks in nature. Nature, environmental and health policies at (inter)national and local levels affect the risk, disease burden and costs of TBDs. Knowledge on ticks, their pathogens and the diseases they cause have been increasing, and resulted in the discovery of a diversity of control options, which often are not highly effective on their own. Control strategies involving concerted actions from human and animal health sectors as well as from nature managers have not been formulated, let alone implemented. Control of TBDs asks for a “health in all policies” approach, both at the (inter)national level, but also at local levels. For example, wildlife protection and creating urban green spaces are important for animal and human well-being, but may increase the risk of TBDs. In contrast, culling or fencing out deer decreases the risk for TBDs under specific conditions, but may have adverse effects on biodiversity or may be societally unacceptable. Therefore, in the end, nature and health workers together must carry out tailor-made control options for the control of TBDs for humans and animals, with minimal effects on the environment. In that regard, multidisciplinary approaches in environmental, but also medical settings are needed. To facilitate this, communication and collaboration between experts from different fields, which may include patient representatives, should be promoted.
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Affiliation(s)
- Hein Sprong
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. .,Laboratory of Entomology, Wageningen University and Research Centre, Wageningen, the Netherlands.
| | - Tal Azagi
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Ard M Nijhof
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Sarah Knorr
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - M Ewoud Baarsma
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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26
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Divers TJ, Gardner RB, Madigan JE, Witonsky SG, Bertone JJ, Swinebroad EL, Schutzer SE, Johnson AL. Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement. J Vet Intern Med 2018; 32:617-632. [PMID: 29469222 PMCID: PMC5866975 DOI: 10.1111/jvim.15042] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.
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Affiliation(s)
- T J Divers
- Department of Clinical Sciences, Cornell University, Ithaca, NY
| | | | - J E Madigan
- Department of Medicine and Epidemiology, University of California - Davis, CA
| | - S G Witonsky
- Department of Large Animal Clinical Sciences, Virginia-Maryland Region CVM, Blacksburg, VA
| | - J J Bertone
- CVMm Western University of Health Sciences, Pomona, CA
| | | | - S E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - A L Johnson
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, PA
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Ali A. Lyme Disease. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Geebelen L, Lernout T, Kabamba-Mukadi B, Saegeman V, Sprong H, Van Gucht S, Beutels P, Speybroeck N, Tersago K. The HUMTICK study: protocol for a prospective cohort study on post-treatment Lyme disease syndrome and the disease and cost burden of Lyme borreliosis in Belgium. ACTA ACUST UNITED AC 2017; 75:42. [PMID: 28794875 PMCID: PMC5545865 DOI: 10.1186/s13690-017-0202-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Belgium, different routine surveillance systems are in place to follow-up Lyme borreliosis trends. However, accurate data on the disease and monetary burden for the different clinical manifestations are lacking. Despite recommended antibiotic treatment, a proportion of Lyme patients report persisting aspecific symptoms for six months or more (e.g. fatigue, widespread musculoskeletal pain, cognitive difficulties), a syndrome now named "post-treatment Lyme disease syndrome" (PTLDS). Controversy exists on the cause, incidence and severity of PTLDS. This study aims to estimate the incidence of PTLDS in patients with Lyme borreliosis and to quantify the disease burden and economic costs associated with the different clinical manifestations of Lyme borreliosis in Belgium. METHODS The project is a prospective cohort study in which about 600 patients with an erythema migrans and 100 patients with disseminated Lyme borreliosis will be followed up. Questionnaires, including the SF-36 vitality and pain subscale, the Cognitive Failure Questionnaire and the EQ-5D-5L, will be used to collect information on acute and persisting symptoms and the impact on quality of life. Symptom frequency and severity will be compared with self-reported pre-Lyme health status, a control group and existing Belgian population norms. Additionally, information on the associated costs and possible risk factors for the development of PTLDS will be collected. DISCUSSION A study of the health burden will allow evaluation of the relative importance of Lyme borreliosis in Belgium and information on the economic cost will help to formulate cost-effective measures. There are only few prospective studies conducted estimating the incidence of PTLDS and even though discussion exists about the prevalence of subjective symptoms in the general population, a control group of non-Lyme borreliosis participants has often not been included.
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Affiliation(s)
- Laurence Geebelen
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Tinne Lernout
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Benoît Kabamba-Mukadi
- Laboratory of Medical Microbiology, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Veroniek Saegeman
- Department of Microbiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Steven Van Gucht
- Viral Diseases, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Katrien Tersago
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
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Regier Y, O Rourke F, Kempf VAJ. Bartonella spp. - a chance to establish One Health concepts in veterinary and human medicine. Parasit Vectors 2016; 9:261. [PMID: 27161111 PMCID: PMC4862191 DOI: 10.1186/s13071-016-1546-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 12/02/2022] Open
Abstract
Infectious diseases remain a remarkable health threat for humans and animals. In the past, the epidemiology, etiology and pathology of infectious agents affecting humans and animals have mostly been investigated in separate studies. However, it is evident, that combined approaches are needed to understand geographical distribution, transmission and infection biology of “zoonotic agents”. The genus Bartonella represents a congenial example of the synergistic benefits that can arise from such combined approaches: Bartonella spp. infect a broad variety of animals, are linked with a constantly increasing number of human diseases and are transmitted via arthropod vectors. As a result, the genus Bartonella is predestined to play a pivotal role in establishing a One Health concept combining veterinary and human medicine.
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Affiliation(s)
- Yvonne Regier
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Fiona O Rourke
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe-University, Frankfurt am Main, Germany.
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Silaghi C, Beck R, Oteo JA, Pfeffer M, Sprong H. Neoehrlichiosis: an emerging tick-borne zoonosis caused by Candidatus Neoehrlichia mikurensis. EXPERIMENTAL & APPLIED ACAROLOGY 2016; 68:279-97. [PMID: 26081117 DOI: 10.1007/s10493-015-9935-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/27/2015] [Indexed: 05/17/2023]
Abstract
Candidatus Neoehrlichia mikurensis is an emerging tick-borne pathogen causing a systemic inflammatory syndrome mostly in persons with underlying hematologic or autoimmune diseases. As it is neither well-known nor well-recognized, it might be misdiagnosed as recurrence of the underlying disease or as an unrelated arteriosclerotic vascular event. The pathogen is transmitted by hard ticks of the genus Ixodes and is closely associated with rodents in which transplacental transmission occurs. Transovarial transmission in ticks has not yet been shown. Infection rates vary greatly in ticks and rodents, but the causes for its spatiotemporal variations are largely unknown. This review summarizes the current state of knowledge on the geographical distribution and clinical importance of Ca. N. mikurensis. By elucidating the life history traits of this pathogen and determining more accurately its incidence in the human population, a better assessment of its public health relevance can be made. Most urgent research needs are the in vitro-cultivation of the pathogen, the development of specific serological tests, the determination of the full genomic sequence, the routine implementation of molecular diagnosis in diseased patients with a particular panel of underlying diseases, and promoting the knowledge about neoehrlichiosis among general practitioners, hospital physicians and the risk groups such as forest workers or immune-compromised people to raise awareness about this disease that can easily be treated when correctly diagnosed.
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Affiliation(s)
- Cornelia Silaghi
- National Center for Vector Entomology, Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057, Zurich, Switzerland.
| | - Relja Beck
- Department for Bacteriology and Parasitology, Croatian Veterinary Institute, Zagreb, Croatia
| | - José A Oteo
- Center of Rickettsiosis and Arthropod-borne Diseases, Hospital San Pedro-Center of Biomedical Research of La Rioja, Logroño, Spain
| | - Martin Pfeffer
- Institute for Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute of Public Health and Environment (RIVM), Bilthoven, The Netherlands
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Abstract
Chronic Lyme disease is a poorly defined diagnosis that is usually given to patients with prolonged, unexplained symptoms or with alternative medical diagnoses. Data do not support the proposition that chronic, treatment-refractory infection with Borrelia burgdorferi is responsible for the many conditions that get labeled as chronic Lyme disease. Prolonged symptoms after successful treatment of Lyme disease are uncommon, but in rare cases may be severe. Prolonged courses of antibiotics neither prevent nor ameliorate these symptoms and are associated with considerable harm.
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Affiliation(s)
- Paul M Lantos
- Divisions of Pediatric Infectious Diseases and General Internal Medicine, Duke University School of Medicine, DUMC 100800, Durham, NC 27710, USA.
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32
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Auwaerter PG. Lyme disease: knowing good evidence to help inform practice. Infect Dis Clin North Am 2016; 29:xi-xvi. [PMID: 25999231 DOI: 10.1016/j.idc.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Paul G Auwaerter
- Johns Hopkins University School of Medicine, Sherrilyn and Ken Fisher Professor of Medicine, Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, 725 North Wolfe Street, Room # 231, Baltimore, MD 21205, USA.
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Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences. Trends Parasitol 2015; 32:30-42. [PMID: 26613664 DOI: 10.1016/j.pt.2015.09.008] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 12/13/2022]
Abstract
Ixodes ticks maintain a large and diverse array of human pathogens in the enzootic cycle, including Borrelia burgdorferi and Babesia microti. Despite the poor ecological fitness of B. microti, babesiosis has recently emerged in areas endemic for Lyme disease. Studies in ticks, reservoir hosts, and humans indicate that coinfection with B. burgdorferi and B. microti is common, promotes transmission and emergence of B. microti in the enzootic cycle, and causes greater disease severity and duration in humans. These interdisciplinary studies may serve as a paradigm for the study of other vector-borne coinfections. Identifying ecological drivers of pathogen emergence and host factors that fuel disease severity in coinfected individuals will help guide the design of effective preventative and therapeutic strategies.
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Affiliation(s)
| | - Edouard Vannier
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Krause
- Yale School of Public Health and Yale School of Medicine, New Haven, CT, USA.
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Cordeiro FA, Amorim FG, Anjolette FAP, Arantes EC. Arachnids of medical importance in Brazil: main active compounds present in scorpion and spider venoms and tick saliva. J Venom Anim Toxins Incl Trop Dis 2015; 21:24. [PMID: 26273285 PMCID: PMC4535291 DOI: 10.1186/s40409-015-0028-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/21/2015] [Indexed: 11/30/2022] Open
Abstract
Arachnida is the largest class among the arthropods, constituting over 60,000 described species (spiders, mites, ticks, scorpions, palpigrades, pseudoscorpions, solpugids and harvestmen). Many accidents are caused by arachnids, especially spiders and scorpions, while some diseases can be transmitted by mites and ticks. These animals are widely dispersed in urban centers due to the large availability of shelter and food, increasing the incidence of accidents. Several protein and non-protein compounds present in the venom and saliva of these animals are responsible for symptoms observed in envenoming, exhibiting neurotoxic, dermonecrotic and hemorrhagic activities. The phylogenomic analysis from the complementary DNA of single-copy nuclear protein-coding genes shows that these animals share some common protein families known as neurotoxins, defensins, hyaluronidase, antimicrobial peptides, phospholipases and proteinases. This indicates that the venoms from these animals may present components with functional and structural similarities. Therefore, we described in this review the main components present in spider and scorpion venom as well as in tick saliva, since they have similar components. These three arachnids are responsible for many accidents of medical relevance in Brazil. Additionally, this study shows potential biotechnological applications of some components with important biological activities, which may motivate the conducting of further research studies on their action mechanisms.
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Affiliation(s)
- Francielle A Cordeiro
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Avenida do Café, s/n, Ribeirão Preto, SP 14.040-903 Brazil
| | - Fernanda G Amorim
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Avenida do Café, s/n, Ribeirão Preto, SP 14.040-903 Brazil
| | - Fernando A P Anjolette
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Avenida do Café, s/n, Ribeirão Preto, SP 14.040-903 Brazil
| | - Eliane C Arantes
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Avenida do Café, s/n, Ribeirão Preto, SP 14.040-903 Brazil
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Abstract
Lyme disease, caused by the Borrelia burgdorferi bacterium, is the most common vector-borne disease in the northern hemisphere. The clinical presentation varies with disease stage, and neurological manifestations (often referred to as Lyme neuroborreliosis) are reported in up to 12% of patients with Lyme disease. Most aspects of the epidemiology, clinical manifestation and treatment of Lyme neuroborreliosis are well known and accepted; only the management of so-called chronic Lyme disease is surrounded by considerable controversy. This term is used for disparate patient groups, including those who have untreated late-stage infection (for example, late neuroborreliosis), those with subjective symptoms that persist after treatment (termed 'post-treatment Lyme disease syndrome' [PTLDS]), and those with unexplained subjective complaints that may or may not be accompanied by positive test results for B. burgdorferi infection in serum (here called 'chronic Lyme disease'). The incidence of PTLDS is still a matter of debate, and its pathogenesis is unclear, but there is evidence that these patients do not have ongoing B. burgdorferi infection and, thus, do not benefit from additional antibiotic therapy. Chronic Lyme disease lacks an accepted clinical definition, and most patients who receive this diagnosis have other illnesses. Thus, a careful diagnostic work-up is needed to ensure proper treatment.
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Affiliation(s)
- Uwe Koedel
- Clinic Grosshadern of the Ludwig-Maximilians University of Munich, Department of Neurology, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority &German National Reference Centre for Borrelia, Veterinärstrasse 2, 85764 Oberschleissheim, Germany
| | - Hans-Walter Pfister
- Clinic Grosshadern of the Ludwig-Maximilians University of Munich, Department of Neurology, Marchioninistrasse 15, D-81377 Munich, Germany
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36
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Hansmann Y, Cazenave-Roblot F, Weinbreck P, Michelet C, Caumes E. Maladie de Lyme : où est la controverse ? Presse Med 2015. [DOI: 10.1016/j.lpm.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lantos PM, Shapiro ED, Auwaerter PG, Baker PJ, Halperin JJ, McSweegan E, Wormser GP. Unorthodox alternative therapies marketed to treat Lyme disease. Clin Infect Dis 2015; 60:1776-82. [PMID: 25852124 PMCID: PMC4490322 DOI: 10.1093/cid/civ186] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/01/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some patients with medically unexplained symptoms or alternative medical diagnoses suspect that they chronically suffer from the tick-borne infection Lyme disease. These patients are commonly targeted by providers of alternative therapies. This study was designed to identify and characterize the range of unorthodox alternative therapies advertised to patients with a diagnosis of Lyme disease. METHODS Internet searches using the Google search engine were performed to identify the websites of clinics and services that marketed nonantimicrobial therapies for Lyme disease. We subsequently used the PubMed search engine to identify any scientific studies evaluating such treatments for Lyme disease. Websites were included in our review so long as they advertised a commercial, nonantimicrobial product or service that specifically mentioned utility for Lyme disease. Websites with patient testimonials (such as discussion groups) were excluded unless the testimonial appeared as marketing on a commercial site. RESULTS More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments. CONCLUSIONS Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful.
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Affiliation(s)
- Paul M. Lantos
- Divisions of Pediatric Infectious Diseases and General Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Eugene D. Shapiro
- Departments of Pediatrics, Epidemiology of Microbial Diseases and Investigative Medicine, Yale University Schools of Medicine and of Public Health and Graduate School of Arts and Sciences, New Haven, Connecticut
| | - Paul G. Auwaerter
- Division of Infectious Diseases, Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - John J. Halperin
- Department of Neurosciences, Overlook Medical Center, Atlantic Health System, Summit, New Jersey
- Departments of Neurology and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Gary P. Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, New York
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Zając V, Wójcik-Fatla A, Dutkiewicz J, Szymańska J. Bartonella henselae in eastern Poland: the relationship between tick infection rates and the serological response of individuals occupationally exposed to tick bites. JOURNAL OF VECTOR ECOLOGY : JOURNAL OF THE SOCIETY FOR VECTOR ECOLOGY 2015; 40:75-82. [PMID: 26047187 DOI: 10.1111/jvec.12135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 06/04/2023]
Abstract
To explore the potential role of Ixodes ricinus as the presumed vector of Bartonella henselae in eastern Poland, ticks collected in various geographic locations were examined for the presence of B. henselae, and the results were matched against the prevalence of anti-B. henselae antibodies in individuals occupationally exposed to tick bites. The presence of Bartonella DNA was investigated by PCR in a total of 1,603 unfed Ixodes ricinus ticks. The presence of IgG antibodies against B. henselae was investigated in serum samples from 332 people occupationally exposed to tick bites (94 farmers and 238 forestry workers). The total prevalence of B. henselae in ticks was 1.7%; the infection rates in males (3.1%) and females (2.7%) were nearly ten times greater than in nymphs (0.3%). The prevalence of seropositive results in the risk group (30.4%), farmers (27.7%) and forestry workers (31.5%), was significantly greater compared to the control group (8.9%). The results showed a weak positive correlation between the degree of infection of ticks and humans living in the same geographic region. The lack of a direct relationship indicates that exposure to tick bites is only one of the factors contributing to the significant preponderance of a seropositive response to B. henselae in the forestry workers and farmers over the control group. Other factors must be considered, such as contact with cats, which are popular domestic animals in Polish villages, and exposure to cat fleas.
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Affiliation(s)
- Violetta Zając
- Department of Zoonoses, Institute of Rural Health, Lublin, Poland.
| | | | - Jacek Dutkiewicz
- Department of Zoonoses, Institute of Rural Health, Lublin, Poland
| | - Jolanta Szymańska
- Department of Paedodontics, Medical University of Lublin, Lublin, Poland
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Divan A, Budd RC, Tobin RP, Newell-Rogers MK. γδ T Cells and dendritic cells in refractory Lyme arthritis. J Leukoc Biol 2015; 97:653-63. [PMID: 25605869 DOI: 10.1189/jlb.2ru0714-343rr] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Lyme disease is a multisystem infection transmitted by tick vectors with an incidence of up to 300,000 individuals/yr in the United States. The primary treatments are oral or i.v. antibiotics. Despite treatment, some individuals do not recover and have prolonged symptoms affecting multiple organs, including the nervous system and connective tissues. Inflammatory arthritis is a common symptom associated with Lyme pathology. In the past decades, γδ T cells have emerged as candidates that contribute to the transition from innate to adaptive responses. These cells are also differentially regulated within the synovia of patients affected by RLA. Here, we review and discuss potential cellular mechanisms involving γδ T cells and DCs in RLA. TLR signaling and antigen processing and presentation will be the key concepts that we review in aid of understanding the impact of γδ T cells in RLA.
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Affiliation(s)
- Ali Divan
- *Texas A&M Health Science, Temple, Texas, USA; and University of Vermont, Burlington, Vermont, USA
| | - Ralph C Budd
- *Texas A&M Health Science, Temple, Texas, USA; and University of Vermont, Burlington, Vermont, USA
| | - Richard P Tobin
- *Texas A&M Health Science, Temple, Texas, USA; and University of Vermont, Burlington, Vermont, USA
| | - M Karen Newell-Rogers
- *Texas A&M Health Science, Temple, Texas, USA; and University of Vermont, Burlington, Vermont, USA
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40
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Faure E. Malarial pathocoenosis: beneficial and deleterious interactions between malaria and other human diseases. Front Physiol 2014; 5:441. [PMID: 25484866 PMCID: PMC4240042 DOI: 10.3389/fphys.2014.00441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022] Open
Abstract
In nature, organisms are commonly infected by an assemblage of different parasite species or by genetically distinct parasite strains that interact in complex ways. Linked to co-infections, pathocoenosis, a term proposed by M. Grmek in 1969, refers to a pathological state arising from the interactions of diseases within a population and to the temporal and spatial dynamics of all of the diseases. In the long run, malaria was certainly one of the most important component of past pathocoenoses. Today this disease, which affects hundreds of millions of individuals and results in approximately one million deaths each year, is always highly endemic in over 20% of the world and is thus co-endemic with many other diseases. Therefore, the incidences of co-infections and possible direct and indirect interactions with Plasmodium parasites are very high. Both positive and negative interactions between malaria and other diseases caused by parasites belonging to numerous taxa have been described and in some cases, malaria may modify the process of another disease without being affected itself. Interactions include those observed during voluntary malarial infections intended to cure neuro-syphilis or during the enhanced activations of bacterial gastro-intestinal diseases and HIV infections. Complex relationships with multiple effects should also be considered, such as those observed during helminth infections. Moreover, reports dating back over 2000 years suggested that co- and multiple infections have generally deleterious consequences and analyses of historical texts indicated that malaria might exacerbate both plague and cholera, among other diseases. Possible biases affecting the research of etiological agents caused by the protean manifestations of malaria are discussed. A better understanding of the manner by which pathogens, particularly Plasmodium, modulate immune responses is particularly important for the diagnosis, cure, and control of diseases in human populations.
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Affiliation(s)
- Eric Faure
- Aix-Marseille Université, Centre National de la Recherche Scientifique, Centrale Marseille, I2M, UMR 7373Marseille, France
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