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Frahier H, Klopfenstein T, Brunel AS, Chirouze C, Bouiller K. Characteristics of patients consulted for suspected Lyme neuroborreliosis in an endemic area. Ticks Tick Borne Dis 2024; 15:102353. [PMID: 38761786 DOI: 10.1016/j.ttbdis.2024.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Some patients with unexplained neurological symptoms sought care for presumed Lyme neuroborreliosis (LNB). We aimed to compare patients' characteristics with and without LNB. MATERIAL AND METHODS All patients consulting for LNB suspicion and having a lumbar puncture between 2014 and 2020 in a high endemic area of Lyme borreliosis were included in the study. RESULTS One hundred fifty-five patients were included. Forty-five patients (29 %) had LNB (mean age: 57.6 years, 28.9 % of women) including 17 with isolated intrathecal synthesis. One hundred and ten patients had no LNB (mainly neurological (29 %) and rheumatological diseases (19 %)). Non-neurological symptoms were similar in patients with LNB and patients with no LNB (asthenia, 31 % vs. 46 %, p = 0.14, arthralgia 20 % vs. 31 %, p = 0.14) with the exception of myalgia, which was less frequent in patients with LNB (4.4 % vs. 19.1 % p = 0.02). In multivariable analysis, factors associated with LNB were presence of facial nerve palsy (OR = 5.7), radiculopathy (OR = 11.3), positive Lyme serology (OR = 5.4) and duration of symptoms less than 3 months (OR = 4.48). Patients with isolated intrathecal synthesis had a longer duration of symptoms (3 vs 1 months) than patients with pleocytosis. Asthenia (5.9 % vs. 32.1 %), headaches (0 % vs. 39.3 %) neuropathic pain (17.6 % vs. 50 %) and facial palsy (11.8 % vs. 39.3 %) were less frequent in patients with isolated intrathecal synthesis than patients with pleocytosis. The presence of isolated subjective neurological symptoms (paresthesia, memory disorders, insomnia, irritability, asthenia, headaches) was reported in 7/17 (41 %) of patients with isolated intrathecal synthesis, 2/28 (7.1 %) in patients with pleocytosis and 75/110 (68 %) in patients without LNB (p < 0.001). CONCLUSION More than one quarter of patients consulted for suspected LNB had non-neurologic symptoms, whether or not they have a LNB. Concerning patients with isolated intrathecal synthesis, the question of presence of sequelae with a spontaneously cured disease or an active Lyme borreliosis requiring antibiotic remain.
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Affiliation(s)
- Hélène Frahier
- Besançon University Hospital, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Timothée Klopfenstein
- Nord Franche-Comté Hospital, Department of Infectious Diseases, 90400, Trevenans, France
| | - Anne-Sophie Brunel
- Besançon University Hospital, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Catherine Chirouze
- Franche-Comté university, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, F-25000 Besançon, France
| | - Kevin Bouiller
- Franche-Comté university, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, F-25000 Besançon, France.
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Pustijanac E, Buršić M, Millotti G, Paliaga P, Iveša N, Cvek M. Tick-Borne Bacterial Diseases in Europe: Threats to public health. Eur J Clin Microbiol Infect Dis 2024; 43:1261-1295. [PMID: 38676855 DOI: 10.1007/s10096-024-04836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Tick-borne diseases, caused by bacterial pathogens, pose a growing threat to public health in Europe. This paper provides an overview of the historical context of the discovery of the most impactful pathogens transmitted by ticks, including Borrelia burgdorferi sensu lato, Rickettsia spp., Anaplasma spp., Francisella spp., Ehrlichia spp., and Neoehrlichia mikurensis. Understanding the historical context of their discovery provides insight into the evolution of our understanding of these pathogens. METHODS AND RESULTS Systematic investigation of the prevalence and transmission dynamics of these bacterial pathogens is provided, highlighting the intricate relationships among ticks, host organisms, and the environment. Epidemiology is explored, providing an in-depth analysis of clinical features associated with infections. Diagnostic methodologies undergo critical examination, with a spotlight on technological advancements that enhance detection capabilities. Additionally, the paper discusses available treatment options, addressing existing therapeutic strategies and considering future aspects. CONCLUSIONS By integrating various pieces of information on these bacterial species, the paper aims to provide a comprehensive resource for researchers and healthcare professionals addressing the impact of bacterial tick-borne diseases in Europe. This review underscores the importance of understanding the complex details influencing bacterial prevalence and transmission dynamics to better combat these emerging public health threats.
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Affiliation(s)
- Emina Pustijanac
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, Zagrebačka 30, 52100, Pula, Croatia.
| | - Moira Buršić
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, Zagrebačka 30, 52100, Pula, Croatia
| | - Gioconda Millotti
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, Zagrebačka 30, 52100, Pula, Croatia
| | - Paolo Paliaga
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, Zagrebačka 30, 52100, Pula, Croatia
| | - Neven Iveša
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, Zagrebačka 30, 52100, Pula, Croatia
| | - Maja Cvek
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000, Rijeka, Croatia
- Teaching Institute of Public Health of the Region of Istria, Nazorova 23, 52100, Pula, Croatia
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Tetens MM, Omland LH, Dessau RB, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen ACY, Møller JK, Chen M, Svendsen JH, Obel N, Lebech AM. Risk of heart failure among individuals tested for Borrelia burgdorferi sensu lato antibodies, and serum Borrelia burgdorferi sensu lato seropositive individuals; a nationwide population-based, registry-based matched cohort study. Ticks Tick Borne Dis 2024; 15:102345. [PMID: 38636178 DOI: 10.1016/j.ttbdis.2024.102345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Lyme borreliosis is a tick-borne disease caused by the bacterium Borrelia burgdorferi (Bb) sensu lato complex. Previous studies have suggested an association between Lyme borreliosis and heart failure, which have been suggested to be a possible manifestation of Lyme carditis. We aimed to investigate the risk of heart failure among individuals tested for serum Bb antibodies, and serum Bb seropositive individuals. METHODS We performed a matched nationwide cohort study (Denmark, 1993-2020) and included 52,200 Bb seropositive individuals, and two age- and sex-matched comparison cohorts: 1) 104,400 Bb seronegative comparison cohort members, and 2) 261,000 population controls. We investigated the risk associated with 1) being tested for serum Bb antibodies, and 2) being Bb seropositive. Outcomes were: 1) a composite of heart failure, cardiomyopathy, and/or myocarditis diagnosis, and 2) redemption of cardiovascular medicine used for treatment of heart failure. We calculated short-term odds ratios (aOR) (within 1 month) and long-term hazard rates (aHR) (after 1 month) adjusted for age, sex, diabetes, pre-existing heart failure, and kidney disease. RESULTS Compared with the population controls, individuals tested for Bb antibodies, regardless of the test result, had increased short-term risk of heart failure, cardiomyopathy, and myocarditis (aOR 8.3, 95 %CI: 6.7-10.2), and both increased short- and long-term risk of redemption of cardiovascular medicine (aOR 4.3, 95 %CI: 3.8-4.8, aHR 1.13, 95 % CI: 1.11-1.15). The Bb seropositive individuals had no increased short- or long-term risk of any outcome compared with Bb seronegative comparison cohort members. CONCLUSIONS In conclusion, Bb antibody tests seemed to be performed in the diagnostic work-up of heart failure, but Bb seropositivity was not associated with heart failure.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirstine K Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Yde Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Sønderborg Hospital, Sønderborg, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yıldız AB, Çetin E, Pınarlık F, Keske Ş, Can F, Ergönül Ö. Discrepancy between IDSA and ESGBOR in Lyme disease: Individual participant meta-analysis in Türkiye. Zoonoses Public Health 2024; 71:337-348. [PMID: 38413371 DOI: 10.1111/zph.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 01/28/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The evidence on the prevalence of Lyme borreliosis (LB) is limited, but there is a suspicion of overdiagnosis of LB in recent years. We reviewed the LB diagnosis and treatment-related data in Türkiye, based on the Infectious Diseases Society of America (IDSA) 2020 and European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis (ESGBOR) 2018 guidelines. By detecting the disagreements between these two, we outlined the areas to be improved for future guidelines. METHODS We performed a literature search according to the PRISMA guidelines in PubMed, Ovid-Medline, Web of Science, Turkish Medline, Scopus, CINAHL, ULAKBIM TR Index, Google Scholar and Cochrane Library databases. We included the published cases in a database and evaluated according to IDSA and ESGBOR guidelines. We outlined the reasons for misdiagnoses and inappropriate uses of antibiotics. RESULTS We included 42 relevant studies with 84 LB cases reported from Türkiye between 1990 and December 2022. Among 84 cases, the most common clinical findings were nervous system findings (n = 37, 44.0%), erythema migrans (n = 29, 34.5%) and ophthalmologic findings (n = 15, 17.9%). The IDSA 2020 and ESGBOR 2018 guidelines agreed on the diagnosis of 71 (84.5%) cases; there was an agreement that 31 cases (36.9%) were misdiagnosed and 40 cases (47.6%) were correctly diagnosed, and there was disagreement for 13 cases (15.5%). Serum immunoglobulin M (IgM), IgG measurements by ELISA and western blot were widely performed, and they were effective in definitive diagnosis merely when used according to guidelines. Inappropriate use of antibiotics was detected in 42 (50.0%) of cases which were classified in the following categories: incorrect LB diagnosis, inappropriate choice of antibiotic, inappropriate route of drug administration and prolonged antibiotic treatment. CONCLUSION Overdiagnosis and non-adherence to guidelines is a common problem. The discordance between seroprevalence and clinical studies necessitates a consensus over the best clinical approach.
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Affiliation(s)
| | - Ecesu Çetin
- Koç University School of Medicine, Istanbul, Turkey
| | - Fatihan Pınarlık
- Graduate School of Health Sciences, Koc University, Istanbul, Turkey
- Koç University-Isbank Center for Infectious Diseases, Istanbul, Turkey
| | - Şiran Keske
- Koç University-Isbank Center for Infectious Diseases, Istanbul, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Füsun Can
- Koç University-Isbank Center for Infectious Diseases, Istanbul, Turkey
- Department of Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Önder Ergönül
- Koç University-Isbank Center for Infectious Diseases, Istanbul, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
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Tetens MM, Omland LH, Dessau RB, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen AC, Møller JK, Chen M, Svendsen JH, Obel N, Lebech AM. Risk of cardiac conduction disorders, and pacemaker implantations among individuals tested for serum Borrelia burgdorferi antibodies, a nationwide, matched, population-based cohort study. Clin Microbiol Infect 2024; 30:621-629. [PMID: 38316360 DOI: 10.1016/j.cmi.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To investigate the short- and long-term risks of atrioventricular block and other cardiac conduction disorders associated with being tested for Borrelia burgdorferi (Bb) antibodies or Bb seropositivity as measures of confounding by indication and Bb infection, respectively. METHODS We performed a nationwide population-based matched cohort study (Denmark, 1993-2021). We included 52 200 Bb-seropositive individuals (stratified as only Bb-IgM-seropositive [n = 26 103], only Bb-IgG-seropositive [n = 18 698], and Bb-IgM-and-IgG-seropositive [n = 7399]) and two age- and sex-matched comparison cohorts: 104 400 Bb-seronegative individuals and 261 000 population controls. We investigated the risk associated with being tested for serum Bb antibodies and being Bb seropositive. Outcomes were atrioventricular block and other conduction disorders. We calculated short-term odds ratios (aOR) (within 1 month), and long-term hazard ratios (aHR) (after 1 month) adjusted for age, sex, diabetes, chronic heart failure, and kidney disease with 95% CI. RESULTS Compared with population controls, individuals tested for Bb antibodies had increased short- and long-term risks of atrioventricular block (aOR 47.9, 95% CI: 30.0-76.7, aHR 1.3, 95% CI:1.2-1.3), and other conduction disorders (aOR 18.2, 95% CI: 10.1-32.8, aHR 1.2, 95% CI: 1.1-1.4). Compared with Bb-seronegative individuals, only Bb-IgM-and-IgG-seropositive individuals had increased short-term risk of atrioventricular block (aOR: 2.1, 95% CI: 1.5-3.1). DISCUSSION The results suggest that Bb antibody testing is included in the diagnostic work-up of conduction disorders. Finally, that Bb seropositivity is not associated with other conduction disorders than atrioventricular block or with increased long-term risk of conduction disorders.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirstine K Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Sønderborg Hospital, Sønderborg, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Raffetin A, Puppo C, Chahour A, Belkasmi A, Baux E, Patrat-Delon S, Caraux-Paz P, Rivière J, Gallien S. Lyme borreliosis and medical wandering: what do patients think about multidisciplinary management? A qualitative study in the context of scientific and social controversy. BMC Infect Dis 2024; 24:344. [PMID: 38519907 PMCID: PMC10958838 DOI: 10.1186/s12879-024-09194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/05/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION To answer to patients' medical wandering, often due to "unexplained symptoms" of "unexplained diseases" and to misinformation, multidisciplinary care centers for suspected Lyme borreliosis (LB), such as the 5 Tick-Borne Diseases (TBDs) Reference Centers (TBD-RC), were created a few years ago in France, the Netherlands and Denmark. Our study consisted of a comprehensive analysis of the satisfaction of the patients managed at a TBD-RC for suspected LB in the context of scientific and social controversy. METHODS We included all adults who were admitted to one of the TBD-RC from 2017 to 2020. A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains, including 2 free-text items: "What points did you enjoy?" and "What would you like us to change or to improve?". In the current study, the 2 free-items were analyzed with a qualitative method called reflexive thematic analysis within a semantic and latent approach. RESULTS The answer rate was 61.3% (349/569) and 97 distinctive codes from the 2-free-text items were identified and classified into five themes: (1) multidisciplinarity makes it possible to set up quality time dedicated to patients; (2) multidisciplinarity enables seamless carepaths despite the public hospital crisis compounded by the COVID-19 pandemic; (3) multidisciplinarity is defined as trust in the team's competences; (4) an ambivalent opinion and uncertainty are barriers to acceptance of the diagnosis, reflecting the strong influence of the controversy around LB; and (5) a lack of adapted communication about TBDs, their management, and ongoing research is present. CONCLUSION The multidisciplinary management for suspected LB seemed an answer to medical wandering for the majority of patients and helped avoid misinformation, enabling better patient-centered shared information and satisfaction, despite the context of controversy.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France.
- EpiMAI Research Unity, Laboratory of Animal Health, Anses-National Veterinary School of Alfort, 7 Av. du Général de Gaulle, 94700, Maisons-Alfort, France.
- DYNAMIC Research Unity, UPEC-Anses, 8 Rue du Général Sarrail, 94000, Créteil, France.
| | - Costanza Puppo
- Department of Psychology, University Lyon II, France, UMR 1296, 86 Rue Pasteur, 69007, Lyon, France
| | - Amal Chahour
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France
| | - Assia Belkasmi
- Department of Public Health, University of Versailles Saint-Quentin en Yvelines, 55 Avenue de Paris, 78000, Versailles, France
| | - Elisabeth Baux
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Eastern Region, Brabois Hospital, University Hospital of Nancy, Rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France
| | - Solène Patrat-Delon
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of the Western Region, University Hospital of Rennes, 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France
| | - Julie Rivière
- EpiMAI Research Unity, Laboratory of Animal Health, Anses-National Veterinary School of Alfort, 7 Av. du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Sébastien Gallien
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center of Paris and the Northern Region, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40 Allée de La Source, 94190, Villeneuve-Saint-Georges, France
- DYNAMIC Research Unity, UPEC-Anses, 8 Rue du Général Sarrail, 94000, Créteil, France
- Department of Infectious Diseases, Tropical Medicine and Immunology, University Hospital Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
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Tijani MK, Svensson J, Adlerborn P, Danielsson L, Teleka A, Lövmar ML, Lindgren PE, Forsberg P, Persson KEM. How to Detect Antibodies Against Babesia divergens in Human Blood Samples. Open Forum Infect Dis 2024; 11:ofae028. [PMID: 38328497 PMCID: PMC10849114 DOI: 10.1093/ofid/ofae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Background Today only indirect fluorescent antibody assays (IFAs) are commercially available to detect antibodies against Babesia divergens in humans. IFA is subjective and requires highly experienced staff. We have therefore developed an enzyme-linked immunosorbent assay (ELISA)-based method for measuring anti-B. divergens immunoglobulin G antibodies in human blood samples. Methods Crude merozoite extract from in vitro cultures of a new B. divergens isolate was used in ELISA to detect antibodies in different sets of samples: Borrelia burgdorferi-positive samples, healthy individuals, tick-bitten individuals including follow-up samples 3 months later, positive control samples from patients with an active Babesia infection, and samples from malaria-endemic regions. As a reference, IFA was used to detect antibodies in the tick-bitten samples. Western blot was used to evaluate reactions against specific bands in extracts with/without parasites. Results Using IFA as the reference method, the sensitivity and specificity of the ELISA were 86% (12/14) and 100% (52/52). There was a very high correlation (r = -0.84; P = .0004) between IFA dilution factors and ELISA absorbances among the samples classified as positive. Five percent of the B. burgdorferi-positive samples were judged as weakly positive and 5% as strongly positive in our ELISA. Western blot showed that the immunodominant antigens (∼120 kDa) were from merozoites and not from erythrocytes. Conclusions This ELISA can detect antibodies directed against B. divergens, and it can be a useful and easy assay to handle compared with IFA. The ELISA can also measure high and low levels of antibodies, which could give insight into the recency of a B. divergens infection.
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Affiliation(s)
| | - Joel Svensson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
- Laboratory Medicine, Unilabs, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Paula Adlerborn
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Lena Danielsson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Alexandra Teleka
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Matilda Ljungqvist Lövmar
- Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per-Eric Lindgren
- Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kristina E M Persson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
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Önal U, Saraç-Pektaş F, Sağlık İ. Is There a Role for Dark Field Microscopy in the Diagnosis of Lyme Disease?A Narrative Review. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:281-286. [PMID: 38633860 PMCID: PMC10986710 DOI: 10.36519/idcm.2023.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
The diagnosis of Lyme disease is becoming more common in Turkey. Nonetheless, some physicians are not aware of the diagnostic principles that should be followed when faced with a suspected patient and could use tests that are not recommended, such as darkfield microscopy. Dark field microscopy is a diagnostic technique to visualize the spirochetes that cause Lyme disease; however, it is not recommended for the diagnosis of Lyme disease. One of the main limitations of dark field microscopy is its low sensitivity. Another limitation is its high false-positivity rate, as other microorganisms and cellular debris can be mistaken for spirochetes, leading to a misdiagnosis thatmay result in unnecessary treatment. Therefore, this study aimed to review the literature on the role of dark field microscopy as a diagnostic method for Lyme disease and inform physicians about recommended approaches in line with the recommendations of national or international guidelines. An electronic search of Pubmed, Scopus, and Web of Science was performed using the following medical subject headings (MeSH) search terms: Lyme borreliosis, Lyme disease, Borrelia burgdorferi, diagnosis, and microscopy. With this narrative review, we aimed to inform physicians better and improve patient care for patients with suspected Lyme disease.
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Affiliation(s)
- Uğur Önal
- Department of Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Türkiye
| | - Fatma Saraç-Pektaş
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - İmran Sağlık
- Department of Microbiology, Uludağ University School of Medicine, Bursa, Türkiye
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Westerholt M, Krogfelt KA, Dessau RB, Ocias LF. Exploring the dynamics of Borrelia burgdorferi sensu lato antibodies-a registry-based study on laboratory data from Sweden and Denmark. Clin Microbiol Infect 2023; 29:1561-1566. [PMID: 37769899 DOI: 10.1016/j.cmi.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Lyme borreliosis (LB) is the most common tick-transmitted infection in the northern hemisphere and is caused by bacteria in the Borrelia burgdorferi sensu lato (Bbsl)-complex. The diagnosis is partially based on serology, and clinicians often take follow-up serum samples to look for seroconversion or an increase in IgG-antibody levels. In this registry-based study, we proposed a method for determining actual changes in IgG and examined antibody reactivity and decay. METHODS Serological data from the departments of clinical microbiology at Karlstad Hospital, Sweden, and Slagelse Hospital, Denmark, were used to calculate a seroreactivity cut-off (SCOFF), above which changes between two samples from the patient cannot be explained by random variation. Increases in IgG reactivity as well as IgG and IgM decay were illustrated using time-to-event analysis and the SCOFF. RESULTS A total of 44,861 serum samples from 34,157 patients were tested for Bbsl-antibodies. Of the 4301 patients with follow-up samples taken within 100 days, 201 (4.67%) were above the SCOFF of 1.42 with a median time to follow-up sample of 36 days (interquartile range: 21). IgG demonstrated longer median time for all antibody levels (indeterminate: 4.6 years, low: 7.0 years, moderate-high: 8.8 years) than IgM antibodies (indeterminate: 2.1 years, low: 3.9 years, moderate-high: 6.8 years) and higher initial antibody levels persisted significantly longer for both IgG and IgM antibodies (p < 0.001). Of the 7868 patients with follow-up samples, isolated IgM reactivity preceded an increase in IgG reactivity in 18 patients (0.23%). DISCUSSION The SCOFF indicated little biological and random variation for Bbsl-specific IgG antibodies on the platforms used during the study. In most follow-up samples, both IgG and IgM antibodies persisted for years, with longer seropositivity associated with high initial antibody levels and IgG-type antibodies. The diagnostic value of isolated IgM reactivity was limited.
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Affiliation(s)
- Marc Westerholt
- Department of Clinical Microbiology, Karlstad Hospital, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | | | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lukas Frans Ocias
- Department of Clinical Microbiology, Karlstad Hospital, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
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Radzišauskienė D, Urbonienė J, Jasionis A, Klimašauskienė A, Malickaitė R, Petrulionienė A, Vitkauskaitė M, Kaubrys G. Clinical and epidemiological features of Lyme neuroborreliosis in adults and factors associated with polyradiculitis, facial palsy and encephalitis or myelitis. Sci Rep 2023; 13:19881. [PMID: 37964035 PMCID: PMC10646085 DOI: 10.1038/s41598-023-47312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/12/2023] [Indexed: 11/16/2023] Open
Abstract
The clinical course of Lyme neuroborreliosis (LNB) is highly variable. Delayed diagnosis and treatment still remain actual challenges. Moreover, there is a lack of studies analyzing the factors associated with different LNB syndromes. We aimed to analyze clinical and epidemiological features of LNB in hospitalized adults in eastern Lithuania. A retrospective study was performed for patients presenting in the years 2010-2021. A total of 103 patients were included in the study, 100 with early, and three with late LNB. Patients with early LNB most often presented polyradiculitis [75/100, (75%)], which was also the most common initial neurological syndrome. Peripheral facial palsy was diagnosed in 53/100 (53%) patients, in 16/53 (30.2%) cases both facial nerves were affected. Encephalitis or myelitis was diagnosed in 14% of patients with LNB. A total of 76/103 (73.8%) patients were discharged with residual symptoms or signs. One patient presenting encephalomyelitis died because of bacterial complications. The absence of observed erythema migrans (EM) was the predictor of peripheral facial palsy, while female sex and EM untreated with antibiotics were predictors of isolated polyradiculitis. A fever of ≥ 38 ° °C and pleocytosis of ≥ 300 × 106/l were associated with the development of encephalitis or myelitis in patients with early LNB.
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Affiliation(s)
- Daiva Radzišauskienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Jurgita Urbonienė
- Center of Infectious Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arminas Jasionis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aušra Klimašauskienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Radvilė Malickaitė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Monika Vitkauskaitė
- Center of Infectious Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Grąźlewska W, Holec-Gąsior L. Antibody Cross-Reactivity in Serodiagnosis of Lyme Disease. Antibodies (Basel) 2023; 12:63. [PMID: 37873860 PMCID: PMC10594444 DOI: 10.3390/antib12040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
Lyme disease is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex. The disease is characterized by a varied course; therefore, the basis for diagnosis is laboratory methods. Currently, a two-tiered serological test is recommended, using an ELISA as a screening test and a Western blot as a confirmatory test. This approach was introduced due to the relatively high number of false-positive results obtained when using an ELISA alone. However, even this approach has not entirely solved the problem of false-positive results caused by cross-reactive antibodies. Many highly immunogenic B. burgdorferi s.l. proteins are recognized nonspecifically by antibodies directed against other pathogens. This also applies to antigens, such as OspC, BmpA, VlsE, and FlaB, i.e., those commonly used in serodiagnostic assays. Cross-reactions can be caused by both bacterial (relapsing fever Borrelia, Treponema pallidum) and viral (Epstein-Baar virus, Cytomegalovirus) infections. Additionally, a rheumatoid factor has also been shown to nonspecifically recognize B. burgdorferi s.l. proteins, resulting in false-positive results. Therefore, it is necessary to carefully interpret the results of serodiagnostic tests so as to avoid overdiagnosis of Lyme disease, which causes unnecessary implementations of strong antibiotic therapies and delays in the correct diagnosis.
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Affiliation(s)
| | - Lucyna Holec-Gąsior
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdansk University of Technology, 80-233 Gdansk, Poland;
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Bonnet C, Figoni J, Souty C, Septfons A, de Martino S, de Valk H, Fournier L, Hanslik T, Jaulhac B, Blanchon T. Prevalence and factors associated with a prescription of a Lyme borreliosis serology for erythema migrans diagnosis in general practice: a study from the French sentinel network, 2009-2020. BMC PRIMARY CARE 2023; 24:163. [PMID: 37620763 PMCID: PMC10464237 DOI: 10.1186/s12875-023-02108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/18/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Serological testing of patients consulting for typical erythema migrans (EM) is not recommended in European recommendations for diagnosis of Lyme borreliosis (LB). Little is known on the level of adherence of French general practitioners to these recommendations. The objectives were to estimate the proportion of Lyme borreliosis serological test prescription in patients with erythema migrans seen in general practice consultations in France, and to study the factors associated with this prescription. METHODS LB cases with an EM reported by the French general practitioners (GPs) of the Sentinelles network between January 2009 and December 2020 were included. To assess the associations with a prescription of a serological test, multilevel logistic regression models were used. RESULTS Among the 1,831 EM cases included, a prescription for a LB serological test was requested in 24.0% of cases. This proportion decreased significantly over the study period, from 46.8% in 2009 to 15.8% in 2020. A LB serological prescription was associated with patients with no reported tick bite (Odds Ratio (OR): 1.95; 95% confidence interval [1.23-3.09]), multiple EM (OR: 3.82 [1.63-8.92]), EM of five centimeters or more (OR: 4.34 [2.33-8.08]), and GPs having diagnosed less than one EM case per year during the study period (OR: 5.28 [1.73-16.11]). CONCLUSIONS Serological testing of patients consulting for EM is not recommended in European recommendations for diagnosis of Lyme borreliosis. Therefore, the significant decrease in the rate of LB serological test for EM over the study period is encouraging. The factors identified in this study can be used to improve messaging to GPs and patients. Further efforts are needed to continue to disseminate diagnostic recommendations for LB to GPs, especially those who rarely see patients with EM.
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Affiliation(s)
- Camille Bonnet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France.
| | - Julie Figoni
- Santé publique France, Saint-Maurice, F94410, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | | | - Sylvie de Martino
- CNR des Borrelia et Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, CHRU Strasbourg, UR7290, ITI InnoVec, Strasbourg, 67000, France
| | | | - Lucie Fournier
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
- Service de Médecine Interne, APHP, Hôpital Ambroise Paré, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France
- Université Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine Simone Veil, Versailles, France
| | - Benoît Jaulhac
- CNR des Borrelia et Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, CHRU Strasbourg, UR7290, ITI InnoVec, Strasbourg, 67000, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
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Ganbold D, Uudus B, Nyamdavaa N, Chultemsuren Y, Zagd A, Tangad M, Bayarmaa A, Lkunrev R, Baasandagva U, Nyamdorj T, Narankhajid M. Seroprevalence and risk factors of Borrelia burgdorferi sensu lato and Rickettsia species infection in humans in Mongolia, 2016-2020. PLoS One 2023; 18:e0289274. [PMID: 37552652 PMCID: PMC10409273 DOI: 10.1371/journal.pone.0289274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/15/2023] [Indexed: 08/10/2023] Open
Abstract
Borrelia burgdorferi sensu lato and Rickettsia spp. are worldwide causes of tick-borne infections. We aimed to estimate the seroprevalence of immunoglobulin G (IgG) antibodies against different tick-borne diseases (TBDs) and determine risk factors among Mongolians from 2016 to 2020. Blood samples were obtained from voluntary participants with a history of suspected tick bite who visited our hospital, and IgG antibodies against Rickettsia and Borrelia were detected using enzyme-linked immunosorbent assay (ELISA). The IgG antibody seropositivity rate against Rickettsia was 21.8% (1032/4724), while 3.4% (162/4724) of participants tested positive for serum IgG antibodies against Borrelia by ELISA.Binary logistic regression analysis was performed to evaluate risk factors for tick-borne rickettsiosis (TBR) and tick-borne borreliosis (TBB) using IgG serum sample. Age, occupation, and residence were significantly associated with these diseases; however, sex did not show any significant association. Seroprevalence was significantly higher among herders (40.6%, 95% confidence interval [CI]: 35.5-45.8; odds ratio [OR] 0.61; P < 0.001) and students (32.8%, 95% CI: 30.2-35.4; OR 0.75; P < 0.001) than among individuals with other occupations. The 25-29 age group had a slightly higher seroprevalence (35.1%, 95% CI: 28.1-42.6; OR 0.61; P < 0.006) than those in other age groups. Province was a stronger predictor of TBR than occupation and age group. In univariate subgroup analysis by age group, occupation, and residence were significantly associated with TBR seroprevalence, whereas age and province were associated with TBB seroprevalence. Thus, risk factors for TBD include residence, occupation, and age group. This study was conducted using samples from all Mongolian provinces and the capital city, and the risk factors and prevalence of Rickettsia and Borreliaare highlighted.
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Affiliation(s)
- Dashdavaa Ganbold
- Department of Biology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Bayarsaikhan Uudus
- Department of Biology, School of Sciences and Art Science, National University of Mongolia, Ulaanbaatar, Mongolia
| | | | - Yeruult Chultemsuren
- Department of Biology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Amarbayasgalan Zagd
- Department of Biology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mungunzaya Tangad
- Department of Biology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Agarzandan Bayarmaa
- Department of Biology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | - Myadagsuren Narankhajid
- Department of Biology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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Mack I, Kohns Vasconcelos M, Ritz N, Zimmermann P. A diagnostic algorithm for children presenting with peripheral facial nerve palsy and inconclusive diagnosis of neuroborreliosis. Acta Paediatr 2023; 112:1644-1647. [PMID: 37424283 DOI: 10.1111/apa.16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Ines Mack
- Department of Paediatrics, University Children's Hospital, Regensburg, Germany
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Nicole Ritz
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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15
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Liu X, Tabibzada N, Lindgren H, Sjöstedt A. Utility of Borrelia-specific IgM and IgG antibody titer determinations during a 12-year period - results from a clinical laboratory in Northern Sweden. Front Cell Infect Microbiol 2023; 13:1192038. [PMID: 37465761 PMCID: PMC10350645 DOI: 10.3389/fcimb.2023.1192038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Interpretation of serological findings in suspected Lyme borreliosis (LB) is challenging and IgM reactivities may have low predictive value. Therefore, if used indiscriminately, there is a risk for incorrect diagnosis of LB. To evaluate the usefulness of IgM titer determination, we performed a study of the prevalence of Borrelia-specific antibodies in serological samples from patients with suspected LB analyzed during the period 2010 - 2021 at the University Hospital of Umeå in Sweden. In total, 19,335 samples had been analyzed for the presence of IgG and IgM antibodies. Overall, there were higher percentages of IgM positive or borderline titers, 1,847 (9.6%) and 905 (4.7%), respectively, than IgG positive or borderline titers, 959 (5.0%) and 406 (2.1%), respectively. Peak number of samples were recorded 2012 - 2013, exceeding 1,800, whereas there were around 1,200 during 2020 - 2021. The peak number of positive IgG and/or positive IgM samples were observed during the period 2015 - 2017 with close to, or above 400, and concomitantly, the proportion of IgG positive samples increased markedly. For IgG positive samples, the increase followed a positive linear time trend (P< 0.001). Peak monthly numbers were observed during August, September, and October. This seasonal increase was significant for the IgG positive group (P< 0.05), but not for the IgM positive/IgG negative group. Repeated samples were obtained from 3,188 individuals and of the initial samples 2,817 were (88%) IgG negative and 2,315 (72%) were IgM negative and of these, 130 (4%) showed IgG seroconversion and 300 (9%) IgM seroconversion. Collectively, the data demonstrate that IgG and/or IgM positive samples represented a minority of all samples, even when repeated sampling had occurred, and IgM positive samples were much more common than IgG positive samples. Thus, the accuracy of the clinical suspicion was low and this will lead to a low predictive value of the analysis, in particular of IgM. These findings question the use of IgM titer determination as a routine analysis.
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Affiliation(s)
- Xijia Liu
- Umeå School of Business, Economics and Statistics, Statistics, Västerbotten, Sweden
| | | | - Helena Lindgren
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Anders Sjöstedt
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
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Tjernberg I, Lager M, Furset Jensen G, Eikeland R, Nyman D, Brudin L, Henningsson AJ. Identification of potential biomarkers in active Lyme borreliosis. PLoS One 2023; 18:e0287586. [PMID: 37363901 DOI: 10.1371/journal.pone.0287586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES Lyme serology does not readily discriminate an active Lyme borreliosis (LB) from a previous Borrelia infection or exposure. Here, we aimed to investigate a large number of immunological protein biomarkers to search for an immunological pattern typical for active LB, in contrast to patterns found in healthy blood donors, a proportion of whom were previously exposed to Borrelia. METHODS Serum samples from well-characterised adult patients with ongoing LB and healthy blood donors were included and investigated using a proximity extension assay (provided by Olink®) by which 92 different immune response-related human protein biomarkers were analysed simultaneously. RESULTS In total, 52 LB patients and 75 healthy blood donors were included. The blood donors represented both previously Borrelia exposed (n = 34) and not exposed (n = 41) based on anti-Borrelia antibody status. Ten of the examined 92 proteins differed between patients and blood donors and were chosen for further logistic regression (p<0.1). Six proteins were statistically significantly different between LB patients and blood donors (p<0.05). These six proteins were then combined in an index and analysed using receiver-operating-characteristic curve analysis showing an area under the curve of 0.964 (p<0.001). CONCLUSIONS The results from this study suggest that there is an immunological protein pattern that can distinguish a present Borrelia infection from a previous exposure as well as anti-Borrelia antibody negative blood donors. Although this method is not adapted for routine clinical use at this point, the possibility is interesting and may open new diagnostic opportunities improving the laboratory diagnostics of LB.
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Affiliation(s)
- Ivar Tjernberg
- Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
| | - Malin Lager
- National Reference Laboratory for Borrelia, Department of Clinical Microbiology in Jönköping, Region Jönköping County, Linköping University, Linköping, Sweden
| | - Guro Furset Jensen
- National Reference Laboratory for Borrelia, Department of Clinical Microbiology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Microbiology, Sørlandet Hospital Health Enterprise, Kristiansand, Norway
| | - Randi Eikeland
- National Advisory Unit on Tick Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sports Science, University of Agder, Grimstad, Norway
- ESCMID Study Group for Lyme Borreliosis-ESGBOR, Part of the European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
| | - Dag Nyman
- ESCMID Study Group for Lyme Borreliosis-ESGBOR, Part of the European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
- The Åland Group for Borrelia Research, Mariehamn, Finland
| | - Lars Brudin
- Department of Clinical Physiology, Region Kalmar County, Kalmar, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna J Henningsson
- ESCMID Study Group for Lyme Borreliosis-ESGBOR, Part of the European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
- National Reference Laboratory for Borrelia and Other Tick-Borne Bacteria, Department of Clinical Microbiology in Jönköping, Region Jönköping County, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Leth TA, Nymark A, Knudtzen FC, Larsen SL, Skov MN, Jensen TG, Bek-Thomsen M, Jensen HB, Hovius JW, Skarphédinsson S, Møller JK, Andersen NS. Detection of Borrelia burgdorferi sensu lato DNA in cerebrospinal fluid samples following pre-enrichment culture. Ticks Tick Borne Dis 2023; 14:102138. [PMID: 36746091 DOI: 10.1016/j.ttbdis.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/06/2023]
Abstract
Molecular methods for diagnosing Lyme neuroborreliosis (LNB) have shown suboptimal diagnostic sensitivities. The objective of this study was to improve the clinical sensitivity of PCR detection of Borrelia burgdorferi sensu lato spirochetes by inoculating cerebrospinal fluid (CSF) from patients suspected of LNB directly into culture medium at the time of lumbar puncture, with this pursuing enrichment of Borrelia spirochetes before PCR analysis. Adult patients with symptoms suggestive of LNB were prospectively enrolled at two hospitals in the Region of Southern Denmark. The CSF-culture samples were incubated for at least eight weeks. During this period, culture sample aliquots were analysed for the presence of Borrelia DNA by separate PCR protocols in two independent clinical laboratories. The included patients were diagnosed with definite (n=12) or possible (n=2) LNB, and non-LNB (n=171) based on clinical and paraclinical findings. Patients in the LNB and the non-LNB group had a median duration from symptom onset to lumbar puncture of 40 days (IQR [23-90] days) and 120 days (IQR [32-365] days), respectively. Pre-enrichment growth of Borrelia spirochetes was accomplished from three patients (21 %) in the LNB group. The positive culture samples were confirmed by both the digital droplet PCR and the real-time PCR methods employed. All CSF samples were PCR negative in the non-LNB group. The results of this study do not support the use of Borrelia-specific PCR as a general routine diagnostic tool in adults. Still, they suggest it may prove of additional value in selected patients with a limited time from symptom onset to sample collection.
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Affiliation(s)
- Trine Andreasen Leth
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Anita Nymark
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Fredrikke Christie Knudtzen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sanne Løkkegaard Larsen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Marianne N Skov
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Thøger Gorm Jensen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Malene Bek-Thomsen
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark
| | - Henrik Boye Jensen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Neurology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark
| | - Joppe W Hovius
- Amsterdam UMC, location AMC, Center for Experimental and Molecular Medicine, Amsterdam Multidisciplinary Lyme Borreliosis Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sigurdur Skarphédinsson
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Nanna Skaarup Andersen
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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Hoeve-Bakker BJA, van den Berg OE, Doppenberg HS, van der Klis FRM, van den Wijngaard CC, Kluytmans JAJW, Thijsen SFT, Kerkhof K. Seroprevalence and Risk Factors of Lyme Borreliosis in The Netherlands: A Population-Based Cross-Sectional Study. Microorganisms 2023; 11:microorganisms11041081. [PMID: 37110504 PMCID: PMC10143428 DOI: 10.3390/microorganisms11041081] [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: 03/01/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Lyme borreliosis (LB) is not notifiable in many European countries, and accurate data on the incidence are often lacking. This study aimed to determine the seroprevalence of Borrelia burgdorferi sensu lato (s.l.)-specific antibodies in the general population of The Netherlands, and to determine risk factors associated with seropositivity. Sera and questionnaires were obtained from participants (n = 5592, aged 0-88 years) enrolled in a nationwide serosurveillance study. The sera were tested for B. burgdorferi s.l.-specific IgM and IgG antibodies using ELISA and immunoblot. Seroprevalence was estimated controlling for the survey design. Risk factors for seropositivity were analyzed using a generalized linear mixed-effect model. In 2016/2017, the seroprevalence in The Netherlands was 4.4% (95% CI 3.5-5.2). Estimates were higher in men (5.7% [95% CI 4.4-7.2]) than in women (3.1% [95% CI 2.0-4.0]), and increased with age from 2.6% (95% CI 1.4-4.4) in children to 7.7% (95% CI 5.9-7.9) in 60- to 88-year-olds. The seroprevalence for B. burgdorferi s.l. in the general population in The Netherlands was comparable to rates reported in European countries. The main risk factors for seropositivity were increasing age, being male and the tick bite frequency. The dynamics of LB infection are complex and involve variables from various disciplines. This could be further elucidated using infectious disease modelling.
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Affiliation(s)
- B J A Hoeve-Bakker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Oda E van den Berg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - H S Doppenberg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Cees C van den Wijngaard
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Jan A J W Kluytmans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Steven F T Thijsen
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Karen Kerkhof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
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19
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Olsen J, Angulo FJ, Pilz A, Halsby K, Kelly P, Brestrich G, Stark JH, Jodar L. Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment. Public Health 2023; 219:1-9. [PMID: 37075486 DOI: 10.1016/j.puhe.2023.03.002] [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: 12/13/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment. METHODS Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany. RESULTS Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case. CONCLUSIONS We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.
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Affiliation(s)
- J Olsen
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
| | - F J Angulo
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - A Pilz
- Vaccines, Pfizer Corporation Austria, Floridsdorfer Hauptstrasse 1, 1210 Wien, Vienna, Austria
| | - K Halsby
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - P Kelly
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - G Brestrich
- Vaccines, Pfizer Pharma GmbH, Linkstrasse 10, 10785 Berlin, Germany
| | - J H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - L Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
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20
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Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA, Guillén S, Mascaró JM, Portillo A. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:40-45. [PMID: 36621247 DOI: 10.1016/j.eimce.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 01/09/2023]
Abstract
The diagnosis of Lyme borreliosis (LB) is based on the epidemiological history, clinical manifestations and microbiological findings in the early disseminated and late phases of the disease. Related to this fact, microbiological diagnostic techniques have recently appeared. Far from facilitating the diagnosis and the clinical-therapeutic management of LB patients, they are generating confusion. Herein, experts and representatives of Spanish Scientific Societies [Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV)] exposed the executive summary after reviewing the epidemiology, clinical spectrum, available diagnostic techniques for the diagnosis of Borrelia burgdorferi infection, therapeutic and prevention options of LB. By consensus, recommendations for microbiological diagnosis are offered together with those supporting the therapeutic management and prophylaxis of infection.
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Affiliation(s)
- José A Oteo
- Centre of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Department of Infectious Diseases, San Pedro University Hospital - Centre for Biomedical Research from La Rioja (CIBIR), Logroño, Spain.
| | - Héctor Corominas
- Spanish Society of Rheumatology, Rheumatology and Systemic Autoimmune Diseases Department, Hospital de la Santa Creu i Sant Pau/Hospital Dos de Maig, Barcelona, Spain
| | - Raquel Escudero
- Special Pathogens Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Fernando Fariñas-Guerrero
- Spanish Society of Immunology. Institute of Clinical Immunology and Infectious Diseases, YNMUN Biomedicine Group, Málaga, Spain
| | - Juan Carlos García-Moncó
- Spanish Society of Neurology. Department of Neurology, Hospital Universitario Basurto, Bilbao, Spain
| | - Miguel A Goenaga
- Infectious Diseases Service, Hospital Donostia, OSI Donostialdea. Instituto BioDonostia, San Sebastián, Spain
| | - Sara Guillén
- Spanish Society of Pediatric Infectology (SEIP), Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - José M Mascaró
- Spanish Academy of Dermatology and Venereology, Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Aránzazu Portillo
- Centre of Rickettsiosis and Arthropod-Borne Diseases (CRETAV), Department of Infectious Diseases, San Pedro University Hospital - Centre for Biomedical Research from La Rioja (CIBIR), Logroño, Spain
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21
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Leth TA, Joensen SM, Bek-Thomsen M, Møller JK. Establishment of a digital PCR method for detection of Borrelia burgdorferi sensu lato complex DNA in cerebrospinal fluid. Sci Rep 2022; 12:19991. [PMID: 36411296 PMCID: PMC9678864 DOI: 10.1038/s41598-022-24041-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022] Open
Abstract
Direct detection of Borrelia burgdorferi sensu lato bacteria in patient samples for diagnosis of Lyme neuroborreliosis (LNB) is hampered by low diagnostic sensitivity, due to few bacteria in cerebrospinal fluids (CSF) samples. Evaluation of novel molecular methods, including digital PCR (dPCR), as future tools in diagnostics of LNB is desirable. This study aimed to establish a dPCR assay and validate pre-PCR procedures for detection of Borrelia in CSF. Synthetic DNA fragments and cultured Borrelia reference strains were used during optimisation experiments. In addition, 59 CSF specimens from patients examined for LNB were included for clinical validation. The results showed that the pre-PCR parameters with the highest impact on Borrelia-specific dPCR method performance were incubation of the PCR-plate at 4 °C for stabilization of droplets, centrifugation for target concentration, quick-spin for dPCR rain reduction, and PCR inhibition by matrix components. Borrelia DNA in CSF was detected in one out of nine patients with LNB. Diagnostic sensitivity was determined to be 11.1% and specificity 100%. In conclusion, this study reports an optimized Borrelia-specific dPCR method for direct detection of Borrelia in CSF samples. The present study does not support the use of Borrelia-specific dPCR as a routine method for diagnosing LNB.
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Affiliation(s)
- Trine Andreasen Leth
- grid.459623.f0000 0004 0587 0347Department of Clinical Microbiology, Lillebaelt Hospital – University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark
| | - Sara Moeslund Joensen
- grid.459623.f0000 0004 0587 0347Department of Clinical Microbiology, Lillebaelt Hospital – University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Malene Bek-Thomsen
- grid.154185.c0000 0004 0512 597XDepartment of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kjølseth Møller
- grid.459623.f0000 0004 0587 0347Department of Clinical Microbiology, Lillebaelt Hospital – University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark
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22
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Häring J, Hassenstein MJ, Becker M, Ortmann J, Junker D, Karch A, Berger K, Tchitchagua T, Leschnik O, Harries M, Gornyk D, Hernández P, Lange B, Castell S, Krause G, Dulovic A, Strengert M, Schneiderhan-Marra N. Borrelia multiplex: a bead-based multiplex assay for the simultaneous detection of Borrelia specific IgG/IgM class antibodies. BMC Infect Dis 2022; 22:859. [PMID: 36396985 PMCID: PMC9670078 DOI: 10.1186/s12879-022-07863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Lyme borreliosis (LB) is the most common tick-borne infectious disease in the northern hemisphere. The diagnosis of LB is usually made by clinical symptoms and subsequently supported by serology. In Europe, a two-step testing consisting of an enzyme-linked immunosorbent assay (ELISA) and an immunoblot is recommended. However, due to the low sensitivity of the currently available tests, antibody detection is sometimes inaccurate, especially in the early phase of infection, leading to underdiagnoses. Methods To improve upon Borrelia diagnostics, we developed a multiplex Borrelia immunoassay (Borrelia multiplex), which utilizes the new INTELLIFLEX platform, enabling the simultaneous dual detection of IgG and IgM antibodies, saving further time and reducing the biosample material requirement. In order to enable correct classification, the Borrelia multiplex contains eight antigens from the five human pathogenic Borrelia species known in Europe. Six antigens are known to mainly induce an IgG response and two antigens are predominant for an IgM response. Results To validate the assay, we compared the Borrelia multiplex to a commercial bead-based immunoassay resulting in an overall assay sensitivity of 93.7% (95% CI 84.8–97.5%) and a specificity of 96.5% (95%CI 93.5–98.1%). To confirm the calculated sensitivity and specificity, a comparison with a conventional 2-step diagnostics was performed. With this comparison, we obtained a sensitivity of 95.2% (95% CI 84.2–99.2%) and a specificity of 93.0% (95% CI 90.6–94.7%). Conclusion Borrelia multiplex is a highly reproducible cost- and time-effective assay that enables the profiling of antibodies against several individual antigens simultaneously. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07863-9.
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Skufca J, De Smedt N, Pilz A, Vyse A, Begier E, Blum M, Riera-Montes M, Gessner B, Skovdal M, Stark JH. Incidence of Lyme neuroborreliosis in Denmark: Exploring observed trends using public surveillance data, 2015-2019. Ticks Tick Borne Dis 2022; 13:102039. [PMID: 36166915 DOI: 10.1016/j.ttbdis.2022.102039] [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: 12/29/2021] [Revised: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 11/24/2022]
Abstract
Lyme neuroborreliosis (LNB) can be a serious manifestation of Lyme borreliosis. We describe the incidence, time trends and geographic distribution of LNB in Denmark. We obtained LNB cases reported by laboratories and physicians (2015-2019) from the online platform maintained by the Statens Serum Institut (SSI) (2021b). The LNB incidence (per 100,000 persons) was calculated by dividing LNB cases by the population data (denominator) obtained from Statistics Denmark (2021). Between 2015 and 2019, laboratories reported annually 162 to 200 LNB cases, while physicians reported 48 to 68 cases. The annual LNB incidence notified by laboratories ranged from 2.8 (95% CI: 2.4‒3.3) to 3.4 (95% CI: 3.0‒4.0) per 100,000 persons for the 5 study years. The average annual LNB incidence per 100,000 persons for 5 Danish regions ranged from 2.3 to 3.3; for 11 provinces, from 1.9 to 7.6; and for 98 municipalities, from 0 to 22.1. Incidence peaks occurred in persons 5‒14 and 65‒74 years of age. Higher incidences were observed among males versus females in all age groups. LNB cases were reported throughout the year, with peaks in July to September. Notified LNB incidence in Denmark was moderate with no evidence of decline. Cases occurred across all regions but were focally concentrated among residents of some municipalities. Expanding the current surveillance system to include other manifestations of LB would be valuable to better understand geographic endemicity to inform targeted preventive measures.
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Affiliation(s)
- Jozica Skufca
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Nick De Smedt
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | - Andreas Pilz
- Pfizer Global Medical Affairs, Vaccines, Vienna, Austria
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK
| | - Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Maxim Blum
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
| | | | - Bradford Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA
| | - Mette Skovdal
- Pfizer Denmark, Pfizer Inc, Lautrupvang 8 2750 Ballerup, Denmark
| | - James H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA.
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The Impact of Telemedicine in the Diagnosis of Erythema Migrans during the COVID Pandemic: A Comparison with In-Person Diagnosis in the Pre-COVID Era. Pathogens 2022; 11:pathogens11101122. [PMID: 36297179 PMCID: PMC9607313 DOI: 10.3390/pathogens11101122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Erythema migrans (EM) is the hallmark manifestation of the Lyme borreliosis (LB), and therefore its presence and recognition are sufficient to make a diagnosis and to start proper antibiotic treatment to attempt to eradicate the infection. Methods: In this study we compared the clinical data of 439 patients who presented an EM either according to the diagnostic modality through physical assessment or through telemedicine. Conclusions: Our data clearly show that telemedicine for EM diagnosis is useful as it enables prompt administration of appropriate antibiotic therapy, which is critical to avoid complications, especially for neurologic and articular entities. Therefore, telemedicine is a tool that could be adopted for the diagnosis of Lyme disease both by specialized centers but also by general practitioners.
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25
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Krogen I, Skarphédinsson S, Jensen TG, Knudtzen FC. No correlation between symptom duration and intrathecal production of IgM and/or IgG antibodies in Lyme neuroborreliosis - a retrospective cohort study in Denmark. J Infect 2022; 85:507-512. [PMID: 36122734 DOI: 10.1016/j.jinf.2022.08.045] [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: 03/22/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES In Europe, a definite diagnosis of Lyme neuroborreliosis (LNB) requires intrathecally produced Borrelia-specific antibodies. We aimed to examine if the time from symptom debut to lumbar puncture (LP) correlated with findings of intrathecal production of Borrelia-specific IgM and/or IgG antibodies in LNB METHODS: A retrospective study of 544 patients with a positive Borrelia burgdorferi antibody index (Bb-AI) analysed at the Department of Clinical Microbiology, Odense University Hospital, Denmark, between 01.01.1995 and 31.12.2020 RESULTS: The delay from symptom onset to LP for patients with positive Bb-AI IgM was 30 days (IQR 14-95 days), IgG 24 days (IQR 11-62), IgM+IgG 24 days (IQR 14-48), P = 0.098. Ninety-three patients had a second LP after median 125 days (IQR 28-432) and 25 had a third LP after median 282 days (IQR 64-539). Most patients (66.7%) did not convert from their initial intrathecal antibody finding. The prevalence of different clinical manifestations differed significantly between the three Bb-AI groups. CONCLUSIONS Intrathecal Borrelia-specific antibody production did not follow the typical immune response of initial IgM production followed by IgG production. Diagnosis of LNB stage should not be based on the type of antibodies found in the cerebrospinal fluid.
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Affiliation(s)
- Ingrid Krogen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Sigurdur Skarphédinsson
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Thøger Gorm Jensen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Fredrikke Christie Knudtzen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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26
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Kalaszi M, Donlon E, Ahmad MW, Mohamed AS, Boers P. Case report: Dueling etiologies: Longitudinally extensive spinal cord lesion mimicking spinal cord infarct with simultaneous positive Lyme serology and amphiphysin antibody. Front Neurol 2022; 13:905283. [PMID: 36176565 PMCID: PMC9513320 DOI: 10.3389/fneur.2022.905283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Longitudinally extensive spinal cord lesions are challenging diagnostic entities as they are uncommon, but various etiologies can cause them. Case report We report a case of a 55-year-old man with a past medical history of hypertension. He is an ex-smoker. He presented with chest pain, followed by right lower limb weakness, preceded by 2 weeks of constipation and voiding dysfunction. The examination revealed right lower limb mild flaccid paresis, absent reflexes, reduced anal tone, and urinary retention. His symptoms deteriorated over 24 h, and he developed severe flaccid paraparesis with impaired pinprick sensation below the T4 level. MRI spine showed an abnormal, non-enhancing signal in the anterior aspect of the spinal cord extending from the T4 level to the conus without associated edema. He was commenced on intravenous steroids and had significant improvement after one dose. The imaging was felt to be consistent with spinal cord infarction, and aspirin was started. The cerebrospinal fluid analysis showed elevated protein (0.8 mg/ml). Investigations for stroke and autoimmune pathologies were negative. The Lyme immunoblot confirmed intrathecal production of IgG to Borrelia antigens. The patient was started on ceftriaxone. The paraneoplastic screen identified amphiphysin antibodies. CT-TAP and PET-CT did not identify occult malignancy. The patient had a significant improvement over 2 months, strength was almost fully recovered, and autonomic functions returned to normal. Conclusion We describe an unusual steroid-responsive, longitudinally extensive spinal cord lesion with radiological features of spinal cord infarct and a simultaneous finding of intrathecal Lyme antibodies and serum amphiphysin antibodies.
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Pedersen RR, Kragh KN, Fritz BG, Ørbæk M, Østrup Jensen P, Lebech AM, Bjarnsholt T. A novel Borrelia-specific real-time PCR assay is not suitable for diagnosing Lyme neuroborreliosis. Ticks Tick Borne Dis 2022; 13:101971. [DOI: 10.1016/j.ttbdis.2022.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
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Halperin JJ, Eikeland R, Branda JA, Dersch R. Lyme neuroborreliosis: known knowns, known unknowns. Brain 2022; 145:2635-2647. [PMID: 35848861 DOI: 10.1093/brain/awac206] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
Lyme borreliosis affects the nervous system in three principal ways-mononuclear cell meningitis, cranial neuropathies and radiculoneuropathies-the last a broad term encompassing painful radiculopathy, unifocal and multifocal peripheral nerve involvement. Diagnostic tools have been significantly refined-including improved peripheral blood and CSF serodiagnostics-and much has been learned about the interactions between the causative pathogen and the nervous system. Despite these advances in our understanding of this disease, a broad range of other disorders continue to be misattributed to nervous system Lyme borreliosis, supported by, at best, limited evidence. These misattributions often reflect limited understanding not only of Lyme neuroborreliosis but also of what constitutes nervous system disease generally. Fortunately, a large body of evidence now exists to clarify many of these issues, establishing a clear basis for diagnosing nervous system involvement in this infection and, based on well performed studies, clarifying which clinical disorders are associated with Lyme neuroborreliosis, which with non-neurologic Lyme borreliosis, and which with neither.
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Affiliation(s)
- John J Halperin
- Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Ave., Summit, NJ 07901, USA.,Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.,Department of Neurology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Randi Eikeland
- National Advisory on Tick-borne Diseases, Sørlandet Hospital Trust, Egvsveien 100, 4615 Kristiansand, Norway.,Faculty of Health and Sport Sciences, University of Agder, 4879 Grimstad, Norway
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Pathology, Harvard Medical School, Boston, MA 02114, USA
| | - Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Leth TA, Dessau RB, Møller JK. Discriminating between Lyme neuroborreliosis and other central nervous system infections by use of biomarkers CXCL13 and IL-6. Ticks Tick Borne Dis 2022; 13:101984. [DOI: 10.1016/j.ttbdis.2022.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/03/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
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Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA, Guillén S, Mascaró JM, Portillo A. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hoeve-Bakker BJA, Jonker M, Brandenburg AH, den Reijer PM, Stelma FF, van Dam AP, van Gorkom T, Kerkhof K, Thijsen SF, Kremer K. The Performance of Nine Commercial Serological Screening Assays for the Diagnosis of Lyme Borreliosis: a Multicenter Modified Two-Gate Design Study. Microbiol Spectr 2022; 10:e0051022. [PMID: 35297658 PMCID: PMC9045392 DOI: 10.1128/spectrum.00510-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
In this retrospective study, the performance of nine serological screening assays for Lyme borreliosis (LB) diagnostics was evaluated using a study population of LB cases and controls. Sera derived from 74 well-defined LB cases and 122 controls were included. The LB cases were diagnosed with erythema migrans (EM; n = 11), Lyme neuroborreliosis (LNB; n = 35), Lyme arthritis (LA; n = 20), or acrodermatitis chronica atrophicans (ACA; n = 8). Controls comprised 74 age- and gender-matched healthy individuals and 48 patients with other diseases with anticipated high rates of cross-reactivity. The assays under evaluation were selected based on a literature review and expected continued availability with CE marking under the new in vitro diagnostic regulation (European Union) 2017/746. The overall sensitivity (IgG and IgM results combined) among LB cases ranged between 54.5% (6 of 11) and 90.9% (10 of 11) for EM patients and between 97.1% (34 of 35) and 100% for patients with LNB, LA, and ACA. The positivity rate ranged between 8.1% (6 of 74) and 29.7% (22 of 74) among the healthy controls and between 22.9% (11 of 48) and 64.6% (31 of 48) among the cross-reactivity controls. The IgM results were more heterogeneous than the IgG and IgM/IgG results and did not contribute to the overall sensitivity but substantially increased the positivity rates among the controls. In conclusion, all evaluated Borrelia serological screening assays performed comparably with respect to early- and late-disseminated LB. The addition of an IgM assay to the screening of Borrelia-specific IgG antibodies had no added value for the diagnosis of Lyme borreliosis. IMPORTANCE Serology plays an important role in the diagnosis of Lyme borreliosis. Guidelines prescribe a two-tier testing algorithm in which a highly sensitive screening assay is used for screening and reactive sera are retested with an immunoblot to reduce false positivity rates. Recently, two commonly used screening assays were discontinued, including the very well-performing C6 Lyme enzyme-linked immunosorbent assay (ELISA) (Immunetics). This study provides an evaluation of the performance of nine different Borrelia serology screening assays, eight with expected future availably and the C6 Lyme ELISA, using a well-defined study panel of Lyme borreliosis patients, healthy population controls, and cross-reactivity controls. Evaluation data on multiple assays aid diagnostic laboratories in their choice for a reliable Borrelia serology screening assay to improve their diagnostic algorithm for Lyme borreliosis.
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Affiliation(s)
- B. J. A. Hoeve-Bakker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Mark Jonker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - P. Martijn den Reijer
- Department of Medical Microbiology and Infection Prevention, Gelre Hospitals Apeldoorn, Apeldoorn, the Netherlands
| | - Foekje F. Stelma
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Alje P. van Dam
- Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Tamara van Gorkom
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Karen Kerkhof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Steven F.T. Thijsen
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Kristin Kremer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Sevestre J, Benichou A, Rio V, Delaunay P, Gonfrier G, Martaresche C, Carlo V, Nakam S, Mondain V, Carles M, Jeandel PY, Durant J. Emergence of Lyme Disease on the French Riviera, a Retrospective Survey. Front Med (Lausanne) 2022; 9:737854. [PMID: 35391881 PMCID: PMC8981725 DOI: 10.3389/fmed.2022.737854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe French Riviera has been declared free of Lyme Borreliosis (LB) for years. Many patients are referred for presumed LB, sometimes with atypical clinical signs and/or doubtful serology, calling the diagnosis into question.MethodsPatients were assessed for LB diagnosis, depending on clinical presentation, laboratory findings, and further examination by other medical professionals.ResultsAmong 255 patients, 45 (18%) were classified as confirmed LB cases [including 28 ongoing LB (10%) and 17 past LB (8%)], and for 210 (82%) a Lyme borreliosis diagnosis was ruled out. Among ongoing LB, 56% had been exposed to or bitten by ticks, exclusively in rural locations of the Alpes-Maritimes. As a result of the diagnostic procedure, 132 (52%) patients had been treated. An alternative diagnosis was established for 134 (52%) patients, covering a wide range of conditions, including mainly psychological (28%) and neurological conditions (25%) or inflammatory and systemic diseases (22%).ConclusionsOur results strongly suggest the endemicity of LB in the Alpes-Maritimes region. Confirmed LB accounted for 18% of patients while 52% were diagnosed with other conditions.
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Affiliation(s)
- Jacques Sevestre
- Laboratory of Parasitology, Nice University Hospital, Nice, France
- IHU Méditerranée Infection, Marseille, France
| | - Antoine Benichou
- Department of Internal Medicine, Nice University Hospital, Nice, France
| | - Vanessa Rio
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Pascal Delaunay
- Laboratory of Parasitology, Nice University Hospital, Nice, France
| | | | | | - Virginie Carlo
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Sarah Nakam
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Véronique Mondain
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | - Michel Carles
- Department of Infectious Diseases, Nice University Hospital, Nice, France
| | | | - Jacques Durant
- Department of Infectious Diseases, Nice University Hospital, Nice, France
- *Correspondence: Jacques Durant
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Knudtzen FC, Jensen TG, Andersen NS, Johansen IS, Hovius JW, Skarphédinsson S. An intervention in general practice to improve the management of Lyme borreliosis in Denmark. Eur J Public Health 2022; 32:436-442. [PMID: 35323885 PMCID: PMC9159330 DOI: 10.1093/eurpub/ckac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Our objectives were to improve the following outcomes in patients with Lyme borreliosis (LB) through an educational intervention in general practice: (i) increase the number of hospital referrals on suspicion of LB, (ii) increase the number of cerebrospinal fluid (CSF) tests examined for Borrelia burgdorferi antibody index, (iii) decrease the number of serum-B. burgdorferi antibody tests ordered, (iv) shorten delay from symptom onset to hospital in Lyme neuroborreliosis (LNB) patients, (v) increase LB knowledge among general practitioners. Methods A prospective non-blinded non-randomized intervention trial on the island of Funen, Denmark. The intervention included oral and written education about LB and was carried out in areas with an LNB incidence ≥4.7/100.000 between 22 January 2019 and 7 May 2019. Results were compared between the intervention group (49 general practices) and the remaining general practices in Funen (71 practices) 2 years before and after the intervention. Results In the study period, 196 patients were referred on suspicion of LB, a 28.9% increase in the intervention group post-intervention, 59.5% increase in the control group (P = 0.47). The number of CSF-Borrelia-antibody index tests increased 20.8% in the intervention group, 18.0% in the control group (P = 0.68), while ordered serum-B. burgdorferi antibody tests declined 43.1% in the intervention group, 34.5% in the control group (P = 0.30). 25.1% had the presence of serum-B. burgdorferi antibodies. We found no difference in LNB pre-hospital delay before and after intervention or between groups (P = 0.21). The intervention group performed significantly better on a follow-up questionnaire (P = 0.02). Conclusion We found an overall improvement in LB awareness and referrals among general practitioners but could not show any effect of the intervention on clinical outcomes of LNB.
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Affiliation(s)
- Fredrikke Christie Knudtzen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Thøger Gorm Jensen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Clinical Microbiology, Odense University Hospital and Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Nanna Skaarup Andersen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Joppe W Hovius
- Amsterdam UMC, Location AMC, Center for Experimental and Molecular Medicine, Amsterdam Multidisciplinary Lyme Borreliosis Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sigurdur Skarphédinsson
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Boyer PH, Lenormand C, Jaulhac B, Talagrand-Reboul E. Human Co-Infections between Borrelia burgdorferi s.l. and Other Ixodes-Borne Microorganisms: A Systematic Review. Pathogens 2022; 11:pathogens11030282. [PMID: 35335606 PMCID: PMC8948674 DOI: 10.3390/pathogens11030282] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 01/03/2023] Open
Abstract
When it comes to tick-borne diseases, co-infections are often mentioned. This concept includes several entities. On the one hand, tick vectors or vertebrate reservoir host can harbor several microorganisms that can be pathogenic for humans. On the other hand, human co-infections can also be understood in different ways, ranging from seropositivity without clinical symptoms to co-disease, i.e., the simultaneous clinical expression of infections by two tick-borne microorganisms. The latter, although regularly speculated, is not often reported. Hence, we conducted a systematic review on co-infections between B. burgdorferi s.l., the etiological agent of Lyme borreliosis, and other microorganisms potentially transmitted to humans by Ixodes spp. ticks. A total of 68 relevant articles were included, presenting 655 cases of possible co-infections. Most cases of co-infections corresponded to patients with one tick-borne disease and presenting antibody against another tick-borne microorganism. Co-disease was particularly frequent in two situations: patients with clinical symptoms of high fever and erythema migrans (EM), and patients with neurological symptoms linked to the TBEv or a neuroborreliosis. No impact on severity was evidenced. Further studies are needed to better appreciate the frequency and the impact of co-infections between several tick-borne microorganisms.
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Affiliation(s)
- Pierre H. Boyer
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, UR7290, ITI InnoVec, 3 Rue Koeberlé, F-67000 Strasbourg, France; (C.L.); (B.J.); (E.T.-R.)
- Correspondence:
| | - Cédric Lenormand
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, UR7290, ITI InnoVec, 3 Rue Koeberlé, F-67000 Strasbourg, France; (C.L.); (B.J.); (E.T.-R.)
- Service de Dermatologie, Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Benoît Jaulhac
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, UR7290, ITI InnoVec, 3 Rue Koeberlé, F-67000 Strasbourg, France; (C.L.); (B.J.); (E.T.-R.)
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Emilie Talagrand-Reboul
- Institut de Bactériologie, Fédération de Médecine Translationnelle de Strasbourg, University of Strasbourg, UR7290, ITI InnoVec, 3 Rue Koeberlé, F-67000 Strasbourg, France; (C.L.); (B.J.); (E.T.-R.)
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Borrelia burgdorferi is a poor inducer of interferon-gamma: amplification induced by interleukin-12. Infect Immun 2022; 90:e0055821. [PMID: 35130450 DOI: 10.1128/iai.00558-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Laboratory diagnosis of Lyme borreliosis (LB) is mainly based on serology, which has limitations, particularly in the early stages of the disease. In recent years there have been conflicting reports concerning a new diagnostic tool using the cytokine interferon-gamma (IFN-γ). Previous studies have generally found low concentrations of IFN-γ in early LB infection. The goal of this study is to investigate IFN-γ regulation during early LB and provide insights into the host response to B. burgdorferi. Methods We performed in vitro experiments with whole blood assays and peripheral blood mononuclear cells (PBMCs) of LB patients and healthy volunteers exposed to B. burgdorferi and evaluated the IFN-γ response using ELISA and related interindividual variation in IFN-γ production to the presence of single nucleotide polymorphisms. Results IFN-γ production of B. burgdorferi-exposed PBMCs and whole blood was amplified by the addition of IL-12 to the stimulation system. This effect was observed after 24 hours of B. burgdorferi stimulation in both healthy individuals and LB patients. The effect was highly variable between individuals, but was significantly higher in LB patients six weeks since the start of antibiotic treatment compared to healthy individuals. IL-12 p40 and IL-18 mRNA was upregulated upon exposure to B. burgdorferi, whereas IL-12 p35 and IFN-γ mRNA expression remained relatively unchanged. SNP Rs280520 in the downstream IL-12 pathway, Tyrosine Kinase 2, was associated with increased IFN-γ production. Conclusions This study shows that IL-12 evokes an IFN-γ response in B. burgdorferi exposed cells, and LB patients and healthy controls respond differently to this stimulation.
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The evolving story of Borrelia burgdorferi sensu lato transmission in Europe. Parasitol Res 2022; 121:781-803. [PMID: 35122516 PMCID: PMC8816687 DOI: 10.1007/s00436-022-07445-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022]
Abstract
Beside mosquitoes, ticks are well-known vectors of different human pathogens. In the Northern Hemisphere, Lyme borreliosis (Eurasia, LB) or Lyme disease (North America, LD) is the most commonly occurring vector-borne infectious disease caused by bacteria of the genus Borrelia which are transmitted by hard ticks of the genus Ixodes. The reported incidence of LB in Europe is about 22.6 cases per 100,000 inhabitants annually with a broad range depending on the geographical area analyzed. However, the epidemiological data are largely incomplete, because LB is not notifiable in all European countries. Furthermore, not only differ reporting procedures between countries, there is also variation in case definitions and diagnostic procedures. Lyme borreliosis is caused by several species of the Borrelia (B.) burgdorferi sensu lato (s.l.) complex which are maintained in complex networks including ixodid ticks and different reservoir hosts. Vector and host influence each other and are affected by multiple factors including climate that have a major impact on their habitats and ecology. To classify factors that influence the risk of transmission of B. burgdorferi s.l. to their different vertebrate hosts as well as to humans, we briefly summarize the current knowledge about the pathogens including their astonishing ability to overcome various host immune responses, regarding the main vector in Europe Ixodes ricinus, and the disease caused by borreliae. The research shows, that a higher standardization of case definition, diagnostic procedures, and standardized, long-term surveillance systems across Europe is necessary to improve clinical and epidemiological data.
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Pietikäinen A, Backman I, Henningsson AJ, Hytönen J. Clinical performance and analytical accuracy of a C6 peptide-based point-of-care lateral flow immunoassay in Lyme borreliosis serology. Diagn Microbiol Infect Dis 2022; 103:115657. [DOI: 10.1016/j.diagmicrobio.2022.115657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 01/02/2023]
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Joyner G, Mavin S, Milner R, Lim C. Introduction of IgM testing for the diagnosis of acute Lyme borreliosis: a study of the benefits, limitations and costs. Eur J Clin Microbiol Infect Dis 2022; 41:671-675. [PMID: 35089441 PMCID: PMC8934319 DOI: 10.1007/s10096-021-04366-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
Testing for IgM antibodies to Borrelia burgdorferi in Scottish patients with suspected Lyme borreliosis was introduced in 2018 to supplement the IgG testing already in situ. Results from 2018 to 2020 were assessed alongside available clinical data to evaluate the utility of IgM testing in serum. An estimated false positive rate of 25.5% was observed with IgM immunoblot vs 80.1% for IgM chemiluminescent immunoassay (CLIA). IgM testing can aid earlier diagnoses if used within a selective two-tier testing protocol: only patients with acute onset of symptoms should be tested for IgM CLIA but confirmation by immunoblot and consideration of clinical picture is necessary.
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Affiliation(s)
- Greg Joyner
- Scottish Lyme Disease and Tick-Borne Infections Reference Laboratory (SLDTRL), Raigmore Hospital, Inverness, IV2 3UJ, UK
| | - Sally Mavin
- Scottish Lyme Disease and Tick-Borne Infections Reference Laboratory (SLDTRL), Raigmore Hospital, Inverness, IV2 3UJ, UK.
| | - Rachel Milner
- Scottish Lyme Disease and Tick-Borne Infections Reference Laboratory (SLDTRL), Raigmore Hospital, Inverness, IV2 3UJ, UK
| | - Chin Lim
- Scottish Lyme Disease and Tick-Borne Infections Reference Laboratory (SLDTRL), Raigmore Hospital, Inverness, IV2 3UJ, UK
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van de Schoor FR, Baarsma ME, Leeflang MMG, Fingerle V, Margos G, Hovius JW, van Dam AP. Opinion: Methodological Shortcomings in the Study on a Prophage-based PCR Test for Lyme Borreliosis. Front Microbiol 2021; 12:802131. [PMID: 34966377 PMCID: PMC8710760 DOI: 10.3389/fmicb.2021.802131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Freek R van de Schoor
- Radboudumc, Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Nijmegen, Netherlands
| | - M E Baarsma
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mariska M G Leeflang
- Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Volker Fingerle
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
| | - Gabriele Margos
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
| | - Alje P van Dam
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
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Kalmár Z, Briciu V, Coroian M, Flonta M, Rădulescu AL, Topan A, Mihalca AD, Lupșe M. Seroprevalence of antibodies against Borrelia burgdorferi sensu lato in healthy blood donors in Romania: an update. Parasit Vectors 2021; 14:596. [PMID: 34863277 PMCID: PMC8645117 DOI: 10.1186/s13071-021-05099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Borrelia burgdorferi sensu lato (s.l.) genogroup is the causative agent responsible for Lyme borreliosis, a common tick-borne infectious disease in some temperate regions of the Northern Hemisphere. In humans, the clinical manifestations of Lyme borreliosis vary from dermatological infection to severe systemic manifestations. In Romania, data on the seroprevalence of Lyme borreliosis and associated risk factors are scarce and outdated, as the only seroprevalence study with a large dataset was published more than 20 years ago. Therefore, the aim of the present study was to evaluate the seroprevalence for Borrelia burgdorferi s.l. in healthy blood donors from six Romanian counties and identify the associated risk factors. METHODS The study was conducted among 1200 healthy blood donors aged between 18 and 65 years during November 2019 and September 2020 from six counties in the northwestern and central parts of Romania. A two-tiered testing strategy was applied. Positive and equivocal immunoenzymatic test results for IgG and IgM antibodies were further confirmed by Western blot. RESULTS Serum samples from 20% of the blood donors had positive or equivocal IgG and IgM ELISA index values. In total, 2.3% of the serum samples for IgG and 1.8% for IgM were positive by Western blot. The seroprevalence for both antibodies varied between 1.5% (Satu-Mare) and 6.5% (Bistrița-Năsăud) in the six counties investigated. The highest seroprevalence was observed in men (4.7%), in blood donors performing their professional activities outdoors (4.2%), and in those aged ≥ 56 years (8%). CONCLUSIONS These findings confirm the presence of specific IgG and IgM antibodies to B. burgdorferi s.l. among healthy blood donors from Romania. Furthermore, potential risk factors, such as gender, age, and behavior, associated with the presence of positive B. burgdorferi s.l. antibodies among healthy blood donors were identified.
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Affiliation(s)
- Zsuzsa Kalmár
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Violeta Briciu
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania. .,Hospital for Infectious Diseases, Cluj-Napoca, Romania.
| | - Mircea Coroian
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.,University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Cluj-Napoca, Romania
| | - Mirela Flonta
- Hospital for Infectious Diseases, Cluj-Napoca, Romania
| | | | - Adriana Topan
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Andrei Daniel Mihalca
- University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Cluj-Napoca, Romania
| | - Mihaela Lupșe
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.,Hospital for Infectious Diseases, Cluj-Napoca, Romania
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41
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Lyme Disease and Associated NMDAR Encephalitis: A Case Report and Literature Review. Neurol Int 2021; 13:487-496. [PMID: 34698265 PMCID: PMC8544377 DOI: 10.3390/neurolint13040048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
We present a case of a patient with positive N-methyl-D-aspartate receptor (NMDAR) IgG antibodies in their serum and cerebrospinal fluid (CSF) associated with neuroborreliosis. Clinically, the patient presented with symptoms of confusion, as well as behavioral and speech impairments. Regardless of antibacterial treatment, no significant improvement was achieved. Methylprednisolone provided a marked improvement in the patient’s clinical signs and CSF findings. The screening did not reveal any underlying neoplasm. Taking into account the marked clinical improvement after treatment with glucocorticosteroids, we suggest that NMDAR encephalitis is a possible autoimmune complication in neuroborreliosis patients requiring additional immunotherapy.
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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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Abstract
The histology of erythema (chronicum) migrans (ECM) is classically described as a nonspecific perivascular infiltrate with a variable number of plasma cells and eosinophils. However, deviations from this pattern were described, such as focal interface changes or spongiosis, potentially posing a clinicopathological challenge. In this study, cases submitted with a serologically confirmed, clinically unequivocal, or highly suspicious diagnosis of ECM/Lyme disease between January 01, 2016, and September 01, 2018, were retrieved from the electronic database system and reviewed to delineate the histopathologic features of ECM. The series consisted of 14 cases. A superficial perivascular lymphocytic infiltrate was noted in all biopsies, accompanied by a deep and/or interstitial inflammatory infiltrate in 9 cases (64%). The inflammation ranged from relatively sparse to dense and prominent. At least focal interface changes were noted in 12 biopsies (86%). Eosinophils and plasma cells were noted in 7 (50%) and 10 (71%) cases, respectively. From a histologic standpoint, ECM is a protean entity and may manifest with a variable density of perivascular and/or interstitial lymphocytic infiltrate admixed with eosinophils and/or plasma cells and accompanied by focal interface dermatitis. Within the appropriate clinical context, ECM should be considered in the differential diagnosis of focal interface and/or sparse perivascular dermatitis.
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Kalogeropoulos D, Asproudis I, Stefaniotou M, Moschos M, Gartzonika C, Bassukas I, Konitsiotis S, Milionis H, Gaitanis G, Malamos K, Kalogeropoulos C. Spirochetal uveitis: Spectrum of clinical manifestations, diagnostic and therapeutic approach, final outcome and epidemiological data. Int Ophthalmol 2021; 41:4111-4126. [PMID: 34297303 DOI: 10.1007/s10792-021-01984-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Analysis of cases with spirochetal uveitis related to spirochetes in a tertiary referral academic center. METHODS Retrospective study of patients diagnosed with uveitis attributed to Treponema pallidum, Leptospira spp. and Borrelia burgdorferi from June 1991 until December 2019. RESULTS A total of 57 cases of spirochetal uveitis (22 patients with T. pallidum, 26 with Leptospira spp., and 9 with B. burgdorferi) that consisted 1% of the overall number of uveitics were recorded. All these cases presented with a wide spectrum of clinical presentations (anterior uveitis, posterior uveitis, panuveitis, vasculitis, papillitis, and in some rare cases concomitant posterior scleritis). The treatment included mainly penicillin or doxycycline, while corticosteroids were administered systematically in some cases with Borrelia or Leptospira infection. The final visual outcome was favorable (> 6/10 in Snellen visual acuity) in approximately 76% of our patients. CONCLUSION Despite being rare, spirochetal uveitis can be detrimental for the vision and must always be included in the differential diagnosis.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece.
| | - Ioannis Asproudis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | - Marilita Moschos
- 1St Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Gartzonika
- Laboratory of Microbiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Bassukas
- Department of Skin & Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Spiros Konitsiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- 1St Division of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin & Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
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45
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Breitbart P, Meister S, Meyer T, Gärtner BC. Incidence and Prevalence of Borrelia burgdorferi Antibodies in Male Professional Football Players. Clin J Sport Med 2021; 31:e200-e206. [PMID: 31241490 DOI: 10.1097/jsm.0000000000000758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Infections with Borrelia burgdorferi can cause Lyme disease with multiorganic involvement such as (myo)carditis or joint manifestations. Musculoskeletal complaints possibly mimicking some of these symptoms are common among elite athletes. This study aimed to determine seroprevalence and incidence of B. burgdorferi antibodies in professional football players. DESIGN Prospective observational study. SETTING Healthy professional football players. PARTICIPANTS Five hundred thirty-five men in the first and second German league. INTERVENTIONS Two screening assays were used to examine immunoglobulin M (IgM) and immunoglobulin G (IgG) against B. burgdorferi: an enzyme immunoassay (EIA) and a chemiluminescence assay (CLIA). In case of a positive or equivocal result, an immunoblot including in vivo antigens was performed. MAIN OUTCOME MEASURES Course of IgM and IgG against B. burgdorferi in overall 1529 blood samples. RESULTS A total of 96.4% of all results were concordant between EIA and CLIA. Considering only samples with identical results in both assays, prevalence was 1.6%. A positive IgM was detected in 2.3%. No player showed any symptoms of Lyme disease. A seroconversion to IgG was not found. Three players developed a positive IgM corresponding to an incidence of 1032/100 000 person-years. Depending on the assay, 49% to 75% of positive or equivocal screening results could not be confirmed by immunoblot. CONCLUSIONS Seroprevalence and incidence of B. burgdorferi among healthy male professional football players are low. Therefore, infections with B. burgdorferi have to be regarded a rare differential diagnosis in professional football in Central Europe. The low confirmation rate of positive screening assays points to an unspecific immune activation.
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Affiliation(s)
- Philipp Breitbart
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Steffen Meister
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Sportmedizin München, Munich, Germany; and
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Barbara C Gärtner
- Department of Medical Microbiology and Hygiene, Saarland University, Faculty of Medicine and Medical Center, Homburg/Saar, Germany
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46
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Diagnostic Performance of the Novel BioPlex Lyme Serological Assays in European Patients with Lyme Disease. J Clin Microbiol 2021; 59:e0320520. [PMID: 33883179 DOI: 10.1128/jcm.03205-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Serodiagnosis of Lyme borreliosis (LB) comes with several drawbacks, among which is limited sensitivity in early disease. This study assesses the sensitivity and specificity of the novel BioPlex 2200 Lyme IgG and Lyme IgM assays. It also assesses potential improvements to the assays through receiver-operating characteristic (ROC) analysis. The BioPlex assays were performed on sera of 158 Dutch patients with physician-confirmed LB (both early localized and disseminated), 800 healthy blood donors from the Netherlands, and 90 cross-reactive controls. The BioPlex (Biopl) assays were compared with two commercial enzyme immunoassays (Euroimmun [Eur]/C6-ELISA) and one immunoblot (recomLine). The highest sensitivity in early LB was achieved with the BioPlex assays, which outperformed the Euroimmun and C6-ELISA (Biopl: 81/88, 92.1%; Eur: 64/88, 72.7%; C6: 72/88, 81.8%). Sensitivity of all assays was comparable in patients with disseminated LB. The BioPlex assays were outperformed in terms of specificity (all healthy blood donors, Biopl: 571/800, 71.4%; Eur: 711/800, 88.9%; C6: 727/800, 90.9%), but further analyses showed promising avenues following cutoff optimization. ROC analysis showed that 2/6 antigens of the combined BioPlex IgG and IgM assays had significantly higher areas under the curve (AUCs) than those of the other analyses. Potential modified versions of the assays based on these antigens largely outperformed the Euroimmun and C6-ELISA in EM patients (Biopl: 81/80, 92.1%) while maintaining a comparable or even higher specificity (Biopl: 714/800, 89.3%). The BioPlex 2200 Lyme IgG and Lyme IgM assays are promising tools for the serodiagnosis of early LB, with the potential to be used as a standalone test. Further research is necessary to validate the findings of this discovery cohort.
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47
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Lyme Neuroborreliosis in Children. Brain Sci 2021; 11:brainsci11060758. [PMID: 34200467 PMCID: PMC8226969 DOI: 10.3390/brainsci11060758] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 12/22/2022] Open
Abstract
Lyme neuroborreliosis (LNB) is an infectious disease, developing after a tick bite and the dissemination of Borrelia burgdorferi sensu lato spirochetes reach the nervous system. The infection occurs in children and adults but with different clinical courses. Adults complain of radicular pain and paresis, while among the pediatric population, the most common manifestations of LNB are facial nerve palsy and/or subacute meningitis. Moreover, atypical symptoms, such as fatigue, loss of appetite, or mood changes, may also occur. The awareness of the various clinical features existence presented by children with LNB suspicion remains to be of the greatest importance to diagnose and manage the disease.
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48
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Abstract
Lyme disease is a multisystem disease caused by Borrelia burgdorferi infection and accounts for well-defined manifestations, appearing either at an early or late stage. Appropriate antibiotic therapy generally leads to a favorable outcome. Still, unspecific persisting symptoms such as fatigue, myalgia, arthralgia or cognitive dysfunction are reported by several patients months to years after adequate treatment. Their underlying pathophysiologic mechanism is unclear. However, there is no evidence for microbiological persistence in these cases and attempts to resolve the symptoms by repeated or prolonged antibiotic treatment have not been convincingly successful, but they may rather be harmful. To narrow down the controversially handled entity of posttreatment Lyme disease syndrome (PTLDS) and to avoid overdiagnosis and overtreatment, case definitions have been proposed, acknowledging PTLDS as a complex of nonspecific, subjective symptoms, which are neither caused by ongoing infection nor by any other identifiable disease. PTLDS is mainly a diagnosis of exclusion and requires careful evaluation of differential diagnosis followed by counseling about optimal management in light of missing specific therapeutic options.
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Affiliation(s)
- Hanna Schmid
- From the University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland
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49
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Petrulionienė A, Radzišauskienė D, Paulauskas A, Venalis A. Lyme Disease among Patients at an Ambulatory Unit in a Highly Endemic Country: Lithuania. ACTA ACUST UNITED AC 2021; 57:medicina57020184. [PMID: 33669940 PMCID: PMC7924869 DOI: 10.3390/medicina57020184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background and objectives: Lyme disease is the most common tick-borne infectious disease in Europe, caused by the spirocheta bacteria of Borrelia burgdorferi. Several genospecies of B. burgdorferi are pathogenic to humans. B. burgdorferi sensu stricto, which is prevalent in North America, causes reactive arthritis, whereas B. garinii and B. afzelii, common in Europe, can affect the skin, heart, or nervous system; it has been shown that the clinical symptoms of the disease may be very different. The objective of this study was to identify the baseline characteristics of Lyme disease and to elucidate the frequency of different Lyme disease syndromes in Lithuania. Materials and Methods: Patients who were diagnosed with Lyme disease during an ambulatory visit to the Center of Infectious Diseases, Vilnius University Santaros clinics, from 2014 to 2016, were enrolled in this study. A retrospective material analysis was conducted. Results: In total, 1005 patients were enrolled with the following prevalence of clinical syndromes: erythema migrans (EM), 945 (94.02%); Lyme arthritis, 32 (3.18%); neuroborreliosis, 23 (2.28%); Lyme carditis, 4 (0.39%); and acrodermatitis, 1 (0.09%). Erythema migrans was dominant among middle-aged women, with a rash appearing mainly on the lower extremities. Lyme arthritis mainly manifested among middle-aged women as an oligoarthritis, mostly affecting the knee joint. Neuroborreliosis was seen more often in middle-aged women than men and the main symptom was nervus facialis neuropathy. Lyme carditis, manifested as an atrioventricular block, with a male/female ratio of 3:1, and the median age was 51. Acrodermatitis was diagnosed in a 61-year-old woman, as a painful, red rash on the hand. Conclusions: According to the prevalence of B. garinii and B. afzelii in Europe, previously it was thought that Lyme disease presented as erythema migrans, and less frequently as neuroborreliosis; however, this study revealed that other syndromes may also be seen. In addition, we revealed that the longer it takes for erythema migrans to appear, the greater the likelihood of Lyme arthritis developing.
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Affiliation(s)
- Agnė Petrulionienė
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-6401-9811
| | - Daiva Radzišauskienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | | | - Algirdas Venalis
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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50
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Hillerdal H, Henningsson AJ. Serodiagnosis of Lyme borreliosis-is IgM in serum more harmful than helpful? Eur J Clin Microbiol Infect Dis 2021; 40:1161-1168. [PMID: 33409833 PMCID: PMC8139919 DOI: 10.1007/s10096-020-04093-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 10/29/2022]
Abstract
Interpretation of serological findings in suspected Lyme borreliosis (LB) may be challenging and IgM reactivities in serum are often unspecific (false positive). There is a risk for overdiagnosis of LB, inadequate use of antibiotics, and potential delay of proper diagnosis. In this study, we evaluated the diagnostic value of IgM analysis in serum and IgM antibody index (AI) in LB diagnosis. This was a retrospective observational study regarding Borrelia-specific antibodies in serum and Borrelia-specific AI in LB investigations being made during 2017 in Jönköping County, Sweden. Medical records of 610 patients with detectable anti-Borrelia antibodies in serum (IgM and/or IgG) and 15 patients with elevated Borrelia-specific AI were retrospectively scrutinized, and the compliance to current European recommendations was assessed. Among the 610 patients, only 30% were tested according to the European recommendations. Within this group of tests taken correctly, 50% of the LB diagnoses in patients with isolated IgM reactivity in serum were retrospectively assessed as incorrect (LB unlikely). Three pediatric patients with clinical and laboratory findings suggestive of Lyme neuroborreliosis (LNB) had elevated IgM AI alone. Serological testing without distinct clinical signs/symptoms consistent with LB contributes to most misdiagnoses. Isolated IgM positivity in serum shows limited clinical value and needs further assessment before being reported by the laboratory. Detection of IgM in combination with IgG antibodies in serum shows no clinical enhancement for correct LB diagnosis compared to isolated IgG positivity. However, Borrelia-specific IgM AI may be important for sensitivity in early LNB.
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Affiliation(s)
- Henrik Hillerdal
- Department of Paediatrics, Region Jönköping County, Jönköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Anna J Henningsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
- Division of Clinical Microbiology, Linköping University Hospital, Linköping, Sweden
- ESCMID Study Group for Lyme Borreliosis - ESGBOR, European Society for Clinical Microbiology and Infectious Diseases, Jönköping, Sweden
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