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Ogrinc K, Bogovič P, Maraspin V, Lotrič Furlan S, Rojko T, Ružić-Sabljić E, Kastrin A, Strle K, Wormser GP, Strle F. Assessment of three criteria to establish borrelial infection in suspected lyme neuroborreliosis. Infection 2024:10.1007/s15010-024-02338-2. [PMID: 38980540 DOI: 10.1007/s15010-024-02338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Diagnosis of (European) Lyme neuroborreliosis has been based on clinical presentation, cerebrospinal fluid (CSF) pleocytosis and demonstration of intrathecal borrelial antibody synthesis (ITBAS) to document Borrelia burgdorferi s. l. INFECTION It is not known if other criteria to document Borrelia infection may contribute to the diagnosis. METHODS We compared the sensitivity of three individual criteria (ITBAS, CSF Borrelia culture, and the presence of erythema migrans [EM]) to confirm the diagnosis of early Lyme neuroborreliosis in 280 patients ≥ 15 years of age evaluated at a Lyme borreliosis outpatient clinic in Slovenia. The patients had either radicular pain of new onset or involvement of a cranial nerve but without radicular pain, each in conjunction with CSF pleocytosis. Evaluation was of patients who had each of the three confirmatory criteria assessed, and for whom at least one criterion was positive. RESULTS Analysis of 280 patients, 120 women and 160 men, median age 57 (range 15-84) years, revealed that ITBAS was the most frequently observed positive criterion (85.4%), followed by EM (52.9%), and by a positive CSF Borrelia culture (9.6%). Of the 280 patients, 154 (55%) met only one criterion (43.2% ITBAS only, 10.7% EM only, and 1.1% positive CSF culture only), whereas 42.1% met two criteria. Only 2.9% of patients were positive by all three criteria. CONCLUSION Although ITBAS was the most frequent criterion for confirmation for Borrelia infection, the presence of EM alone confirmed an additional 10.7% of patients and a positive CSF Borrelia culture alone added another 1.1%.
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Affiliation(s)
- Katarina Ogrinc
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Vera Maraspin
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Stanka Lotrič Furlan
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tereza Rojko
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Kastrin
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Strle
- Tufts University School of Medicine, Boston, Mass, USA
| | | | - Franc Strle
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
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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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Carlströmer Berthén N, Tompa E, Olausson S, Nyberg C, Nyman D, Ringbom M, Perander L, Svärd J, Lindgren PE, Forsberg P, Wilhelmsson P, Sjöwall J, Nordberg M. The AxBioTick Study: Borrelia Species and Tick-Borne Encephalitis Virus in Ticks, and Clinical Responses in Tick-Bitten Individuals on the Aland Islands, Finland. Microorganisms 2023; 11:1100. [PMID: 37317075 DOI: 10.3390/microorganisms11051100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/16/2023] Open
Abstract
The AxBioTick study was initiated to investigate the prevalence of ticks and tick-borne pathogens and their impact on antibody and clinical responses in tick-bitten individuals on the Aland Islands. This geographical area is hyperendemic for both Lyme borreliosis (LB) and Tick-borne encephalitis (TBE). Blood samples and ticks were collected from 100 tick-bitten volunteers. A total of 425 ticks was collected, all determined to Ixodes ricinus using molecular tools. Of them 20% contained Borrelia species, of which B. garinii and B. afzelii were most common. None contained the TBE virus (TBEV). Blood samples were drawn in conjunction with the tick bite, and eight weeks later. Sera were analyzed for Borrelia- and TBEV-specific antibodies using an ELISA and a semiquantitative antibody assay. In total 14% seroconverted in Borrelia C6IgG1, 3% in TBEV IgG, and 2% in TBEV IgM. Five participants developed clinical manifestations of LB. The high seroprevalence of both Borrelia (57%) and TBEV (52%) antibodies are likely attributed to the endemic status of the corresponding infections as well as the TBE vaccination program. Despite the similar prevalence of Borrelia spp. detected in ticks in other parts of Europe, the infection rate in this population is high. The AxBioTick study is continuing to investigate more participants and ticks for co-infections, and to characterize the dermal immune response following a tick bite.
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Affiliation(s)
- Nellie Carlströmer Berthén
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Eszter Tompa
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Susanne Olausson
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Clara Nyberg
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
| | - Dag Nyman
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Malin Ringbom
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
| | - Linda Perander
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
| | - Joel Svärd
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Per-Eric Lindgren
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Clinical Microbiology, Laboratory Medicine, County Hospital Ryhov, 551 85 Jonkoping, Sweden
| | - Pia Forsberg
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Peter Wilhelmsson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Clinical Microbiology, Laboratory Medicine, County Hospital Ryhov, 551 85 Jonkoping, Sweden
| | - Johanna Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Department of Infectious Diseases, Vrinnevi Hospital, 603 79 Norrkoping, Sweden
| | - Marika Nordberg
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
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Dong Y, Zhou G, Cao W, Xu X, Zhang Y, Ji Z, Yang J, Chen J, Liu M, Fan Y, Kong J, Wen S, Li B, Yue P, Liu A, Bao F. Global seroprevalence and sociodemographic characteristics of Borrelia burgdorferi sensu lato in human populations: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2021-007744. [PMID: 35697507 PMCID: PMC9185477 DOI: 10.1136/bmjgh-2021-007744] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Borrelia burgdorferi sensu lato (Bb) infection, the most frequent tick-transmitted disease, is distributed worldwide. This study aimed to describe the global seroprevalence and sociodemographic characteristics of Bb in human populations. Methods We searched PubMed, Embase, Web of Science and other sources for relevant studies of all study designs through 30 December 2021 with the following keywords: ‘Borrelia burgdorferi sensu lato’ AND ‘infection rate’; and observational studies were included if the results of human Bb antibody seroprevalence surveys were reported, the laboratory serological detection method reported and be published in a peer-reviewed journal. We screened titles/abstracts and full texts of papers and appraised the risk of bias using the Cochrane Collaboration-endorsed Newcastle-Ottawa Quality Assessment Scale. Data were synthesised narratively, stratified by different types of outcomes. We also conducted random effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO (CRD42021261362). Results Of 4196 studies, 137 were eligible for full-text screening, and 89 (158 287 individuals) were included in meta-analyses. The reported estimated global Bb seroprevalence was 14.5% (95% CI 12.8% to 16.3%), and the top three regions of Bb seroprevalence were Central Europe (20.7%, 95% CI 13.8% to 28.6%), Eastern Asia (15.9%, 95% CI 6.6% to 28.3%) and Western Europe (13.5%, 95% CI 9.5% to 18.0%). Meta-regression analysis showed that after eliminating confounding risk factors, the methods lacked western blotting (WB) confirmation and increased the risk of false-positive Bb antibody detection compared with the methods using WB confirmation (OR 1.9, 95% CI 1.6 to 2.2). Other factors associated with Bb seropositivity include age ≥50 years (12.6%, 95% CI 8.0% to 18.1%), men (7.8%, 95% CI 4.6% to 11.9%), residence of rural area (8.4%, 95% CI 5.0% to 12.6%) and suffering tick bites (18.8%, 95% CI 10.1% to 29.4%). Conclusion The reported estimated global Bb seropositivity is relatively high, with the top three regions as Central Europe, Western Europe and Eastern Asia. Using the WB to confirm Bb serological results could significantly improve the accuracy. More studies are needed to improve the accuracy of global Lyme borreliosis burden estimates. PROSPERO registration number CRD42021261362.
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Affiliation(s)
- Yan Dong
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Guozhong Zhou
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Wenjing Cao
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Xin Xu
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Yu Zhang
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Zhenhua Ji
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Jiaru Yang
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Jingjing Chen
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Meixiao Liu
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Yuxin Fan
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Jing Kong
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Shiyuan Wen
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Bingxue Li
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China.,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Peng Yue
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China
| | - Aihua Liu
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China .,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
| | - Fukai Bao
- The Institute for Tropical Medicine, Kunming Medical University, Kunming, China .,Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, China
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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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Mukhametov A, Osadchuk M, Berechikidze I, Pronkin N. Epizootiological aspects of natural nidality of Ixodes tick-borne borreliosis in the Moscow region (Russian Federation). Vet World 2022; 15:213-219. [PMID: 35369590 PMCID: PMC8924394 DOI: 10.14202/vetworld.2022.213-219] [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: 06/25/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background and Aim: At present, tick-borne borreliosis is the most common infectious disease transmitted by ticks in Europe, Asia, and North America. This study aimed to examine the epizootiological aspects of the natural nidality of tick-borne borreliosis in Moscow region (the Russian Federation). Materials and Methods: A total of 2,537 ticks representing two species were collected, namely, Ixodes ricinus and Dermacentor reticulatus. The activity, number of ticks, and Borrelia infestation rates were investigated during a high season, that is, from early spring to mid-autumn. Results: In May, amount of I. ricinus spp. was found 2.5 times more than those representing D. reticulatus spp. (p≤0.01). In June, August, and September, the amount of I. ricinus was 9.0 (p≤0.0001), 2.0 (p≤0.05), and 5.0 times higher, respectively, compared to D. reticulatus. In the first 10 days of April, the amount of D. reticulatus was 3 times higher than that of I. ricinus (p≤0.02); in the next 10 days, their amounts were equal (p≥0.05) and in the last 10 days the amount of I. ricinus exceeded that of D. reticulatus (p≤0.05) by 1.5 times. In general, Borrelia afzelii, and Borrelia garinii, were detected. In addition, the naturally occurring tick-borne borreliosis pesthole was revealed in the Moscow region. Conclusion: Borrelia infection rates for ticks comprise 30%. An increase in Borrelia tick infestation was detected within the vicinity of populated areas. The amount of ticks directly depends on the temperature (20°C-25°C) and moisture (from 50%) values.
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Affiliation(s)
- Almas Mukhametov
- Department of Technology and Safety of Food Products, Kazakh National Agrarian Research University, Almaty, Kazakhstan
| | - Mikhail Osadchuk
- Department of Polyclinic Therapy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Iza Berechikidze
- Department of Biology and General Genetics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Nikolay Pronkin
- Department of Medical Computer Science and Statistics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Lager M, Wilhelmsson P, Matussek A, Lindgren PE, Henningsson AJ. Molecular Detection of Borrelia Bacteria in Cerebrospinal Fluid-Optimisation of Pre-Analytical Sample Handling for Increased Analytical Sensitivity. Diagnostics (Basel) 2021; 11:diagnostics11112088. [PMID: 34829435 PMCID: PMC8623531 DOI: 10.3390/diagnostics11112088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
The main tools for clinical diagnostics of Lyme neuroborreliosis (LNB) are based on serology, i.e., detection of antibodies in cerebrospinal fluid (CSF). In some cases, PCR may be used as a supplement, e.g., on CSF from patients with early LNB. Standardisation of the molecular methods and systematic evaluation of the pre-analytical handling is lacking. To increase the analytical sensitivity for detection of Borrelia bacteria in CSF by PCR targeting the 16S rRNA gene, parameters were systematically evaluated on CSF samples spiked with a known amount of cultured Borrelia bacteria. The results showed that the parameters such as centrifugation time and speed, the use of complementary DNA as a template (in combination with primers and a probe aiming at target gene 16S rRNA), and the absence of inhibitors (e.g., erythrocytes) had the highest impact on the analytical sensitivity. Based on these results, a protocol for optimised handling of CSF samples before molecular analysis was proposed. However, no clinical evaluation of the proposed protocol has been done so far, and further investigations of the diagnostic sensitivity need to be performed on well-characterised clinical samples from patients with LNB.
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Affiliation(s)
- Malin Lager
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Correspondence: ; Tel.: +46-(0)10-2425238
| | - Peter Wilhelmsson
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Andreas Matussek
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Laboratory Medicine, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Per-Eric Lindgren
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Anna J. Henningsson
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Division of Clinical Microbiology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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Pawełczyk A, Bednarska M, Hamera A, Religa E, Poryszewska M, Mierzejewska EJ, Welc-Falęciak R. Long-term study of Borrelia and Babesia prevalence and co-infection in Ixodes ricinus and Dermacentor recticulatus ticks removed from humans in Poland, 2016-2019. Parasit Vectors 2021; 14:348. [PMID: 34210355 PMCID: PMC8252237 DOI: 10.1186/s13071-021-04849-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/12/2021] [Indexed: 02/01/2023] Open
Abstract
Background Lyme borreliosis (LB) is the most common vector-borne disease in Europe. Monitoring changes in the prevalence of different Borrelia species in ticks may be an important indicator of risk assessment and of differences in pathogenicity in humans. The objective of our study was to assess the prevalence, co-infection and distribution of Borrelia and Babesia species in ticks removed from humans in a large sample collected during a study period of 4 years. Methods The ticks were collected throughout Poland from March to November over 4-year period from 2016 to 2019. All ticks (n = 1953) were morphologically identified in terms of species and developmental stage. Molecular screening for Borrelia and Babesia by amplification of the flagellin gene (flaB) or 18S rRNA marker was performed. Pathogen identity was confirmed by Sanger sequencing or PCR–restriction fragment length polymorphism analysis. Results The ticks removed from humans in Poland during this study belonged to two species: Ixodes ricinus (97%) and Dermacentor reticulatus (3%). High Borrelia prevalence (25.3%), including B. miyamotoi (8.4%), was confirmed in Ixodes ricinus ticks removed from humans, as was the change in frequency of occurrence of Borrelia species during the 4-year study. Despite Babesia prevalence being relatively low (1.3%), the majority of tested isolates are considered to be pathogenic to humans. Babesia infection was observed more frequently among Borrelia-positive ticks (2.7%) than among ticks uninfected with Borrelia (0.8%). The most frequent dual co-infections were between Borrelia afzelii and Babesia microti. The presence of Borrelia was also confirmed in D. reticulatus (12.7%); however the role of these ticks in spirochete transmission to susceptible hosts is still unclear. Conclusions Although the overall risk of developing LB after a tick bite is low in Europe, knowledge of the prevalence and distribution of Borrelia and Babesia species in ticks might be an important indicator of the risk of both these tick-borne diseases. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04849-5.
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Affiliation(s)
- Agnieszka Pawełczyk
- Department of Immunopathology of Infectious and Parasitic Diseases, Medical University of Warsaw, 3C Pawińskiego Street, 02-106, Warsaw, Poland
| | - Małgorzata Bednarska
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland
| | - Adrianna Hamera
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland
| | - Emilia Religa
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland
| | - Milena Poryszewska
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland
| | - Ewa J Mierzejewska
- Wild Urban Evolution and Ecology Lab, Centre of New Technologies, Banacha 2c Street, 02-097, Warsaw, Poland
| | - Renata Welc-Falęciak
- Department of Parasitology, Faculty of Biology, University of Warsaw, 1 Miecznikowa Street, 02-096, Warsaw, Poland.
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Jensen BB, Bruun MT, Jensen PM, Pedersen AK, Fournier PE, Skarphedinsson S, Chen M. Evaluation of factors influencing tick bites and tick-borne infections: a longitudinal study. Parasit Vectors 2021; 14:289. [PMID: 34051820 PMCID: PMC8164064 DOI: 10.1186/s13071-021-04751-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various tick-borne infections like borreliosis and rickettsiosis pose a health risk to humans in many parts of the world. We investigated seroprevalence of and seroconversion to Borrelia burgdorferi and Rickettsia spp. and relation to tick-bites, weather and clinical manifestations in Denmark. METHODS Blood donors were enrolled at the Hospital of Southern Jutland in June-July with follow-up November-February of 2018 and 2019. Blood samples were collected, and a questionnaire regarding tick bites, potential exposures and symptoms was completed at each visit. Samples were tested for presence of IgM and IgG antibodies directed against B. burgdorferi and Rickettsia spp. using R. helvetica and R. felis as antigens. Data were examined for correlation between tick bites, serological results, potential exposures and symptoms. RESULTS Two-hundred and fourteen (93 follow-ups) and 130 (38 follow-ups) blood donors were included in 2018 and 2019, respectively. The total borrelia seroconversion rate was 6.3% (CI 2.1-10.5), while the prevalence of IgM and IgG antibodies was 7.8% (CI 4.9-10.6) and 6.7% (CI 4-9.3), respectively. Seroconversion to Rickettsia spp. was detected in one participant. Tick bites and seroconversion were not significantly associated with the reported unspecific symptoms, but unspecific symptoms were common in the study population. There was no significant difference in number of tick bites or seroconversion/prevalence between seasons with highly alternating weather. CONCLUSIONS Results suggest that weather conditions in an individual year have a limited impact. Anti-Borrelia-antibodies do not seem to persist in serum for several years. Rickettsiosis is of limited concern in Denmark.
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Affiliation(s)
- Bo Bødker Jensen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark. .,Clinical Centre for Emerging and Vector-Borne Infections, Odense University Hospital, Odense, Denmark. .,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | | | - Pierre-Edouard Fournier
- Aix-Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Mediterranée Infection, Marseille, France
| | - Sigurdur Skarphedinsson
- Clinical Centre 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
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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10
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Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1-e48. [PMID: 33417672 DOI: 10.1093/cid/ciaa1215] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
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Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Yngve T Falck-Ytter
- Case Western Reserve University, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | | | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Baldwin
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Kiran K Belani
- Childrens Hospital and Clinical of Minnesota, Minneapolis, Minnesota, USA
| | - William R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David B Clifford
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Peter J Krause
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | | | | | - Amy A Pruitt
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Rips
- Consumer Representative, Omaha, Nebraska, USA
| | | | | | | | - Allen C Steere
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franc Strle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Sundel
- Boston Children's Hospital Boston, Massachusetts, USA
| | - Jean Tsao
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Lawrence S Zemel
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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11
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Ponosheci-Biçaku A, Ahmeti S, Trkulja V, Biçaku A, Tešović G. First Data on Human Lyme Borreliosis in Kosovo: Prospective Evaluation of the Disease from a Tick Bite Perspective. Vector Borne Zoonotic Dis 2021; 21:247-255. [PMID: 33534638 DOI: 10.1089/vbz.2020.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Lyme borreliosis (LB) occurs throughout Europe. No clinical and seroprevalence studies for LB in Kosovo have been publicly available thus far. Therefore, this study aimed to investigate LB from a tick bite perspective in the Pristina region, Kosovo. Methods: This single-center prospective observational study enrolled consecutive adult participants (≥18 years of age) with tick bite (embedded tick in the skin), who were examined at the Clinic of Infectious Diseases, Pristina, between January 2015 and August 2018. At the first visit related to the index tick bite, ticks (the complete ticks or parts of the ticks) were removed from the skin, blood samples were taken for serological tests, and antibiotic treatment was started when deemed necessary. The complete, undamaged ticks removed were proceeded for entomological identification. Participants were followed up at 2 months (serological tests were repeated) and 6 months after the index event for the development of clinical manifestations of LB and/or seroconversion against Borrelia burgdorferi. Results: A total of 380 subjects were included in the study. Most cases were seen in May and June in all study years. All 117 preserved ticks were identified as Ixodes ricinus. Immunoglobulin G seroprevalence among subjects during the first visit in the study was 28/380 (7.4%). Erythema migrans (EM) was clinically diagnosed in 74/380 patients (19.5%, 95% confidence interval 15.6-23.8). Only 15 clinically diagnosed EM (in seronegative patients) were serologically confirmed with seroconversion (2 months later), 3.9% of all subjects included in the study. There were three cases with clinical manifestation between the second and third visit: EM recidivans, multiple erythema, or several nonspecific systemic symptoms. Doxycycline and amoxicillin were mainly used for the treatment of borrelial skin lesions. Conclusion: This assessment can help indicate the need for disease awareness and reinforce the importance of primary prevention measures, early diagnosis, and appropriate treatment.
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Affiliation(s)
- Albina Ponosheci-Biçaku
- Faculty of Medicine, Clinic of Infectious Diseases, University Clinical Center of Kosovo, University of Pristina "Hasan Pristina," Pristina, Kosovo
| | - Salih Ahmeti
- Faculty of Medicine, Clinic of Infectious Diseases, University Clinical Center of Kosovo, University of Pristina "Hasan Pristina," Pristina, Kosovo
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ardian Biçaku
- Department of Radiology, Faculty of Medicine, University Clinical Center of Kosovo, University of Pristina "Hasan Pristina," Pristina, Kosovo
| | - Goran Tešović
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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12
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Skogman BH, Wilhelmsson P, Atallah S, Petersson AC, Ornstein K, Lindgren PE. Lyme neuroborreliosis in Swedish children-PCR as a complementary diagnostic method for detection of Borrelia burgdorferi sensu lato in cerebrospinal fluid. Eur J Clin Microbiol Infect Dis 2021; 40:1003-1012. [PMID: 33387122 PMCID: PMC8084766 DOI: 10.1007/s10096-020-04129-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/13/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate polymerase chain reaction (PCR) as a diagnostic method for the detection of Borrelia burgdorferi s.l. in CSF of Swedish children with LNB. This study was performed retrospectively on CSF and serum samples collected from children evaluated for LNB (n = 233) and controls with other specific neurological disorders (n = 59) in a Swedish Lyme endemic area. For anti-Borrelia antibody index, the IDEIA Lyme Neuroborreliosis kit (Oxoid) was used. Two in-house real-time PCR assays targeting the 16S rRNA gene were evaluated (TaqMan® and LUX™). Among patients classified as LNB cases (n = 102), five children (5%) were Borrelia PCR-positive in CSF with the TaqMan® assay. In the Non-LNB group (n = 131), one patient was Borrelia PCR positive with the TaqMan® assay. Among controls (n = 59), all CSF samples were PCR negative. When amplifying and sequencing ospA, we found B. garinii (n = 2), B. afzelii (n = 2), B. bavariensis (n = 1), and one untypable (n = 1). With the LUX™ technology, all CSF samples were PCR negative. The TaqMan® assay could detect only few cases (n = 6) of B. burgdorferi s.l. in CSF among children with LNB and the sensitivity was very low (5%). However, using larger CSF volumes and centrifugation of samples, the PCR technique could still be useful as a complementary diagnostic method when evaluating LNB. Furthermore, detection of spirochete DNA in clinical matrices, including CSF, is the method of choice for studying epidemiological aspects of LNB, a tick-borne emerging disease.
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Affiliation(s)
- Barbro H Skogman
- Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden. .,Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
| | - Stephanie Atallah
- Department of infectious diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Katarina Ornstein
- Ystad Hospital, Skåne University Health Care, Region Skåne, Ystad, Sweden
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Division of Clinical Microbiology, Laboratory Medicine, Ryhov County Hospital, Jönköping, Sweden
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13
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Wilhelmsson P, Lövmar M, Krogfelt KA, Nielsen HV, Forsberg P, Lindgren PE. Clinical/serological outcome in humans bitten by Babesia species positive Ixodes ricinus ticks in Sweden and on the Åland Islands. Ticks Tick Borne Dis 2020; 11:101455. [PMID: 32386909 DOI: 10.1016/j.ttbdis.2020.101455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
The risk of contracting babesiosis after a tick bite in Sweden and on the Åland Islands, Finland, is unknown. We investigated clinical and serological outcomes in people bitten by Ixodes ricinus ticks positive for Babesia species. Ticks, blood and questionnaires were obtained from study participants in Sweden and on the Åland Islands. Sixty-five of 2098 (3.1 %) ticks were positive by real-time PCR. Three Babesia species were detected, Babesia microti (n = 33), B. venatorum (n = 27) and B. capreoli (n = 5), the latter species not known to cause human infection. Half (46 %) of the Babesia PCR-positive ticks also contained Borrelia spp. Fifty-three participants bitten by a Babesia PCR-positive tick and a control group bitten by a Babesia PCR-negative tick were tested for B. microti IgG antibodies by IFA. The overall seroprevalence was 4.4 %, but there was no significant difference between the groups. None of the participants seroconverted and no participant with a Babesia PCR-positive tick sought medical care or reported symptoms suggestive of babesiosis. Given the prevalence of Babesia in I. ricinus ticks in southern Sweden and on the Åland Islands, babesiosis should be considered a possible diagnosis in symptomatic residents who seek medical care following tick exposure.
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Affiliation(s)
- P Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.
| | - M Lövmar
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - K A Krogfelt
- Department of Bacteria Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark; Department of Science and Environmental, Roskilde University, Denmark.
| | - H V Nielsen
- Department of Bacteria Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark.
| | - P Forsberg
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - P E Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.
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14
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Carlsson H, Sandholm K, Haddish HW, Brudin L, Ekdahl KN, Tjernberg I. Complement activation in individuals with previous subclinical Lyme borreliosis and patients with previous Lyme neuroborreliosis. Eur J Clin Microbiol Infect Dis 2019; 39:855-862. [PMID: 31893341 PMCID: PMC7182544 DOI: 10.1007/s10096-019-03807-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 01/25/2023]
Abstract
Lyme borreliosis (LB) is caused by Borrelia burgdorferi and infection may lead to not only a large variety of clinical manifestations but also a subclinical outcome. The aim of the present study was to investigate if there is a constitutional difference in complement activation between individuals with previous subclinical Lyme borreliosis (SB) and patients previously diagnosed with Lyme neuroborreliosis (LNB). Lepirudin plasma for activation studies was collected from 60 SB individuals and from 22 patients pre-diagnosed with LNB. The plasma was incubated with live Borrelia spirochetes of two strains (complement sensitive B. garinii Lu59 and complement resistant B. afzelii ACA1). Complement factor C3 was measured in non-activated lepirudin plasma with immune-nephelometry and C3a and sC5b-9 generated during complement activation were measured by enzyme-linked immunosorbent assay. We found that the complement sensitive Lu59 induced higher complement activation than the complement resistant ACA1 when measuring activation products C3a and sC5b-9 in SB and LNB patients, p < 0.0001. No significant difference was found between SB and LNB patients in systemic levels of C3. Furthermore, SB individuals generated a higher activation of C3 cleavage to C3a (C3a/C3 ratio) than LNB patients after activation with ACA1, p < 0.001, but no significant differences were found in response to Lu59. In conclusion, Lu59 induced higher complement activation than ACA1 and individuals with previous SB showed increased generation of C3a compared with patients with previous LNB. In our study population, this mechanism could lead to less elimination of spirochetes in LNB patients and thereby be a factor contributing to the clinical outcome.
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Affiliation(s)
- Hanna Carlsson
- Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Kerstin Sandholm
- Centre of Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
| | - Haben Woldu Haddish
- Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Region Kalmar County, Kalmar, Department of Clinical and Experimental Medicine and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristina Nilsson Ekdahl
- Centre of Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden.,Department of Immunology, Genetics and Pathology, Rudbeck Laboratory C5:3, Uppsala University, Uppsala, Sweden
| | - Ivar Tjernberg
- Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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15
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Cull B, Pietzsch ME, Gillingham EL, McGinley L, Medlock JM, Hansford KM. Seasonality and anatomical location of human tick bites in the United Kingdom. Zoonoses Public Health 2019; 67:112-121. [PMID: 31705595 DOI: 10.1111/zph.12659] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/17/2019] [Accepted: 10/11/2019] [Indexed: 12/15/2022]
Abstract
Tick bites on humans can occur in a variety of habitats and may result in the transmission of tick-borne pathogens, such as the causative agent of Lyme borreliosis (LB), Borrelia burgdorferi sensu lato. As the risk of transmission of this pathogen to the host increases with the duration of tick feeding, the recognition and removal of ticks as soon as possible following attachment is important for reducing the risk of infection. Performing a thorough body examination for ticks following potential exposure is recommended by tick awareness campaigns. Knowledge of where on the body feeding ticks are frequently found, and at which times of year peak tick exposure occurs, provides important information for public health messaging and may aid those bitten by ticks to engage more effectively with tick-checking behaviour. This paper summarizes human tick bites in the United Kingdom (UK) during 2013-2018 reported to Public Health England's passive Tick Surveillance Scheme and further examines the anatomical location and seasonality of bites from the most commonly encountered tick and LB vector Ixodes ricinus. A total of 1,328 tick records from humans were received of which 93% were I. ricinus. Humans were most commonly bitten by I. ricinus nymphs (70% bites). Tick bites were recorded on all parts of the body, but there were significant differences in their anatomical location on adults and children. Most tick bites on adults occurred on the legs (50%), whereas on children tick bites were mostly on the head and neck (43%). Bites from I. ricinus were recorded throughout the year but were most numerous during May to August. This study adds to the body of research on the seasonality and anatomical location of human tick bites in temperate Europe and highlights the importance of data collected through passive surveillance in addition to research and epidemiological studies.
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Affiliation(s)
- Benjamin Cull
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK
| | - Maaike E Pietzsch
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK
| | - Emma L Gillingham
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK.,NIHR Health Protection Research Unit in Environmental Change and Health, London, UK
| | - Liz McGinley
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK
| | - Jolyon M Medlock
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK.,NIHR Health Protection Research Unit in Environmental Change and Health, London, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | - Kayleigh M Hansford
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK.,NIHR Health Protection Research Unit in Environmental Change and Health, London, UK
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16
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Velušček M, Blagus R, Cerar Kišek T, Ružić-Sabljić E, Avšič-Županc T, F Bajrović F, Stupica D. Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study. J Clin Med 2019; 8:jcm8101740. [PMID: 31635153 PMCID: PMC6832614 DOI: 10.3390/jcm8101740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 12/30/2022] Open
Abstract
In this retrospective cohort study of patients with tick-borne encephalitis (TBE), the clinical outcome in relation to co-infection with B. burgdorferi sensu lato (s.l.) and, specifically, the effect of antibiotic treatment on clinical outcome in patients with TBE who were seropositive for borreliae but who did not fulfil clinical or microbiologic criteria for proven co-infection, were assessed at a single university medical center in Slovenia, a country where TBE and Lyme borreliosis are endemic with high incidence. Among 684 patients enrolled during a seven-year period from 2007 through 2013, 382 (55.8%) had TBE alone, 62 (9.1%) had proven co-infection with borreliae and 240 (35.1%) had possible co-infection. The severity of acute illness was similar in all the groups. The odds for incomplete recovery decreased during a 12-month follow-up but were higher in women, older patients, and in those with more severe acute illness. Incomplete recovery was not associated with either proven (odds ratio (OR) 1.21, 95% confidence interval (CI) 0.49-2.95; p = 0.670) or possible co-infection (OR 0.95, 95% CI 0.55-1.65; p = 0.853). Among patients with possible co-infection, older patients were more likely to be prescribed antibiotics, but the odds for incomplete recovery were similar in those who received antibiotics and those who did not (OR 0.82, 95% CI 0.36-1.87; p = 0.630), suggesting that routine antibiotic treatment in patients with TBE and possible co-infection may not be warranted.
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Affiliation(s)
- Maša Velušček
- Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, Ljubljana 1525, Slovenia.
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine Ljubljana, Vrazov trg 2, Ljubljana 1104, Slovenia.
| | - Tjaša Cerar Kišek
- Institute for Microbiology and Immunology Ljubljana, Faculty of Medicine Ljubljana, Zaloška 4, Ljubljana 1000, Slovenia.
| | - Eva Ružić-Sabljić
- Institute for Microbiology and Immunology Ljubljana, Faculty of Medicine Ljubljana, Zaloška 4, Ljubljana 1000, Slovenia.
| | - Tatjana Avšič-Županc
- Institute for Microbiology and Immunology Ljubljana, Faculty of Medicine Ljubljana, Zaloška 4, Ljubljana 1000, Slovenia.
| | - Fajko F Bajrović
- Department of Neurology, University Medical Center Ljubljana, Zaloška 2, Ljubljana 1000, Slovenia.
- Faculty of Medicine Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia.
| | - Daša Stupica
- Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, Ljubljana 1525, Slovenia.
- Faculty of Medicine Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia.
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17
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Lager M, Dessau RB, Wilhelmsson P, Nyman D, Jensen GF, Matussek A, Lindgren PE, Henningsson AJ, Baqir H, Serrander L, Johansson M, Tjernberg I, Skarstein I, Ulvestad E, Grude N, Pedersen AB, Bredberg A, Veflingstad R, Wass L, Aleke J, Nordberg M, Nyberg C, Perander L, Bojesson C, Sjöberg E, Lorentzen ÅR, Eikeland R, Noraas S, Henriksson GA, Petrányi G. Serological diagnostics of Lyme borreliosis: comparison of assays in twelve clinical laboratories in Northern Europe. Eur J Clin Microbiol Infect Dis 2019; 38:1933-1945. [PMID: 31399914 PMCID: PMC6778534 DOI: 10.1007/s10096-019-03631-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
Lyme borreliosis (LB), caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, is the most common tick-borne infection in Europe. Laboratory diagnosis of LB is mainly based on the patients’ medical history, clinical signs and symptoms in combination with detection of Borrelia-specific antibodies where indirect enzyme-linked-immunosorbent assay (ELISA) is the most widely used technique. The objective of the study was to evaluate and compare the diagnostic accuracy (sensitivities and specificities) of serological tests that are currently in use for diagnosis of LB in clinical laboratories in Northern Europe, by use of a large serum panel. The panel consisted of 195 serum samples from well-characterized and classified patients under investigation for clinically suspected LB (n = 59) including patients with Lyme neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans, erythema migrans or other diseases (n = 112). A total of 201 serum samples from healthy blood donors were also included. The panel (396 serum samples altogether) was sent to 12 clinical laboratories (using five different ELISA methods) as blinded for group affiliation and the laboratories were asked to perform serological analysis according to their routine procedure. The results from the study demonstrated high diagnostic concordance between the laboratories using the same diagnostic assay and lower diagnostic concordance between laboratories using different diagnostic assays. For IgG, the results were in general rather homogenous and showed an average sensitivity of 88% (range 85–91%) compared to IgM which showed lower average sensitivity of 59% (range 50–67%) and more heterogeneous results between assays and laboratories.
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Affiliation(s)
- Malin Lager
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden. .,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Peter Wilhelmsson
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Åland, Mariehamn, Finland
| | - Guro F Jensen
- Department of Medical Microbiology, Sørlandet Hospital, Kristiansand, Norway
| | - Andreas Matussek
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Karolinska University Laboratory, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Per-Eric Lindgren
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna J Henningsson
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Division of Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden
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Abstract
Diseases spread by ticks are complex and typically come under the One Health approach because the implications for human, animal and environmental health are so intricately interconnected. In Europe and North America, these diseases, particularly the emblematic case of Lyme disease, are constantly on the rise. They are associated with a very strong emotional element in Western societies, where citizens are preoccupied by this upsurge and call on governments and health services to act. There is no vaccine against Lyme disease. This is the backdrop against which scientists are looking for alternative solutions based on the identification of ecological factors that are liable to better control tick populations and the movements of pathogens within ecosystems. This article describes the main knowledge already acquired about the ecology of Lyme disease and then provides a list of a number of instruments that can be leveraged to limit the risks and improve control.
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Comment on: Improving access to appropriate post-exposure doxycycline for Lyme disease prophylaxis: role for community pharmacies. J Antimicrob Chemother 2019; 74:1464-1465. [DOI: 10.1093/jac/dky570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Carlsson H, Ekerfelt C, Henningsson AJ, Brudin L, Tjernberg I. Subclinical Lyme borreliosis is common in south-eastern Sweden and may be distinguished from Lyme neuroborreliosis by sex, age and specific immune marker patterns. Ticks Tick Borne Dis 2018; 9:742-748. [PMID: 29502989 DOI: 10.1016/j.ttbdis.2018.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Determinants of a subclinical course of Lyme borreliosis (LB) remain largely unknown. The aim of this study was to assess the extent, sex and age profiles of subclinical Borrelia seroconversion in a LB endemic area in Sweden and to map blood cellular Borrelia-specific immune marker patterns in individuals with a previous subclinical LB course compared with patients previously diagnosed with Lyme neuroborreliosis (LNB). METHODS A large group of 1113 healthy blood donors was screened for multiple IgG anti-Borrelia antibodies and asked to complete a health inquiry regarding previous LB. A group of subjects with anti-Borrelia-specific IgG antibodies but no previous history of LB (subclinical LB, n = 60) was identified together with 22 cases of previous LNB. Whole Borrelia spirochetes, strains B. afzelii ACA1 and B. garinii Ip90, were used for ex vivo whole blood stimulations, whereas outer surface protein enriched fractions of the same strains were used for stimulation of peripheral blood mononuclear cells (PBMCs). An extensive panel of immune markers was analysed in the supernatants after stimulation using multiplex bead arrays, and Borrelia-specific secretion was determined by subtracting the spontaneous secretion. RESULTS A total of 125/1113 blood donors reported previous clinical LB. In contrast, 66 donors denied previous LB but showed multiple IgG anti-Borrelia antibodies; these were defined as subclinical subjects, of whom 60 were available for further studies. The subclinical subjects consisted of significantly more men and had a younger age compared with the LNB patients (p ≤ 0.01). Discriminant analysis revealed a distinct pattern of sex, age and PBMC B. garinii-specific levels of IL-10, IL-17A and CCL20 discriminating subclinical subjects from LNB patients. CONCLUSIONS This study confirms that subclinical Borrelia seroconversion is common in south-eastern Sweden. The findings further suggest that male sex, younger age together with B. gariniii induced levels of IL-10, IL-17A and CCL20 may be associated with a subclinical course.
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Affiliation(s)
- Hanna Carlsson
- Clinical Chemistry and Transfusion Medicine, Kalmar County Hospital, 385 91 Kalmar, Sweden; Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden.
| | - Christina Ekerfelt
- Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden.
| | - Anna J Henningsson
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, 553 05 Jönköping, Sweden.
| | - Lars Brudin
- Clinical Chemistry and Transfusion Medicine, Kalmar County Hospital, 385 91 Kalmar, Sweden; Department of Clinical Physiology, Kalmar County Hospital, 385 91 Kalmar, Sweden; Department of Medicine and Health Sciences, Linkoping University, 581 83 Linköping, Sweden.
| | - Ivar Tjernberg
- Clinical Chemistry and Transfusion Medicine, Kalmar County Hospital, 385 91 Kalmar, Sweden; Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden.
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21
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Lager M, Faller M, Wilhelmsson P, Kjelland V, Andreassen Å, Dargis R, Quarsten H, Dessau R, Fingerle V, Margos G, Noraas S, Ornstein K, Petersson AC, Matussek A, Lindgren PE, Henningsson AJ. Molecular detection of Borrelia burgdorferi sensu lato - An analytical comparison of real-time PCR protocols from five different Scandinavian laboratories. PLoS One 2017; 12:e0185434. [PMID: 28937997 PMCID: PMC5609768 DOI: 10.1371/journal.pone.0185434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Lyme borreliosis (LB) is the most common tick transmitted disease in Europe. The diagnosis of LB today is based on the patient´s medical history, clinical presentation and laboratory findings. The laboratory diagnostics are mainly based on antibody detection, but in certain conditions molecular detection by polymerase chain reaction (PCR) may serve as a complement. Aim The purpose of this study was to evaluate the analytical sensitivity, analytical specificity and concordance of eight different real-time PCR methods at five laboratories in Sweden, Norway and Denmark. Method Each participating laboratory was asked to analyse three different sets of samples (reference panels; all blinded) i) cDNA extracted and transcribed from water spiked with cultured Borrelia strains, ii) cerebrospinal fluid spiked with cultured Borrelia strains, and iii) DNA dilution series extracted from cultured Borrelia and relapsing fever strains. The results and the method descriptions of each laboratory were systematically evaluated. Results and conclusions The analytical sensitivities and the concordance between the eight protocols were in general high. The concordance was especially high between the protocols using 16S rRNA as the target gene, however, this concordance was mainly related to cDNA as the type of template. When comparing cDNA and DNA as the type of template the analytical sensitivity was in general higher for the protocols using DNA as template regardless of the use of target gene. The analytical specificity for all eight protocols was high. However, some protocols were not able to detect Borrelia spielmanii, Borrelia lusitaniae or Borrelia japonica.
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Affiliation(s)
- Malin Lager
- Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- * E-mail:
| | - Maximilian Faller
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
| | - Vivian Kjelland
- Faculty of Engineering and Science, Department of Natural Sciences, University of Agder, Kristiansand, Norway
- Research Unit, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Åshild Andreassen
- Division of Infectious Disease Control, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Rimtas Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Hanne Quarsten
- Department of Medical Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Ram Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Volker Fingerle
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Gabriele Margos
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Sølvi Noraas
- Department of Medical Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | | | | | - Andreas Matussek
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
- Karolinska University Laboratory, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Per-Eric Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
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22
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Hofhuis A, van de Kassteele J, Sprong H, van den Wijngaard CC, Harms MG, Fonville M, Docters van Leeuwen A, Simões M, van Pelt W. Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model. PLoS One 2017; 12:e0181807. [PMID: 28742149 PMCID: PMC5524385 DOI: 10.1371/journal.pone.0181807] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and quantification of the risk of Lyme borreliosis after a tick bite can aid development of prevention strategies against Lyme borreliosis. METHODS We used 3,525 single tick bite reports from three large prospective studies on the transmission risk of tick-borne pathogens to humans, with 50 reports of Lyme borreliosis during the follow-up period, among 1,973 reports with known outcome. A structural equation model was applied to estimate the risk of Lyme borreliosis after a tick bite, and quantify the influence of: developmental stage of the tick, detection of Borrelia burgdorferi s.l. DNA in the tick by PCR, tick engorgement, patient-estimated duration of tick attachment, and patient age. RESULTS The overall risk of developing Lyme borreliosis after a tick bite was 2.6% (95%CI 1.4-5.1). The risk increased with: - Tick engorgement: 1.4% (95%CI 0.7%-2.3%) for low engorgement to 5.5% (95%CI 2.8%-9.2%) for substantially engorged ticks;- Rising patient-estimated tick attachment duration: 2.0% (95%CI 1.3%-2.8%) after <12 hours, to 5.2% (95%CI 3.0%-8.9%) after ≥4 days;- Detection of Borrelia burgdorferi s.l. DNA in ticks: 6.7% (95%CI 3.6%-13.5%), versus 1.4% (95%CI 0.7%-2.9%) when ticks tested negative.The highest observed risk of Lyme borreliosis was 14.4% (95%CI 6.8%-24.6%) after one tick bite of a substantially engorged tick that tested positive for Borrelia burgdorferi s.l. DNA, which corresponds to one new case of Lyme borreliosis per 7 (95%CI 4-15) of such tick bites. CONCLUSIONS An individual's risk of Lyme borreliosis after a tick bite can be predicted with tick engorgement, patient-estimated duration of tick attachment, and detection of Borrelia burgdorferi s.l. DNA in the tick.
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Affiliation(s)
- Agnetha Hofhuis
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jan van de Kassteele
- Department of Statistics, Informatics and Mathematical Modeling, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hein Sprong
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Cees C van den Wijngaard
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Margriet G Harms
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Manoj Fonville
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Arieke Docters van Leeuwen
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mariana Simões
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Wilfrid van Pelt
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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23
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Johansson M, Manfredsson L, Wistedt A, Serrander L, Tjernberg I. Significant variations in the seroprevalence of C6 ELISA antibodies in a highly endemic area for Lyme borreliosis: evaluation of age, sex and seasonal differences. APMIS 2017; 125:476-481. [PMID: 28225145 DOI: 10.1111/apm.12664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to assess the seroprevalence of C6 ELISA antibodies in healthy blood donors in Kalmar County, Sweden, in relation to age, sex and time of year (peak season vs off season). In addition, we wanted to assess serological status over time in a group of C6 ELISA seropositive blood donors. Sera were collected from 273 (131 women, 142 men) blood donors in autumn 2011 and 300 (144 women, 156 men) in winter 2014. All sera were analysed in the C6 ELISA and the results were interpreted according to the manufacturer's instructions. The seroprevalence was 22% (females 16%, males 28%) in 2011 and 24% (females 15%, males 33%) in 2014. The seroprevalence was significantly higher in males and increased with age. The highest seroprevalence was observed among elderly men, 60-70 years old (46% in 2011 and 52% in 2014). No significant difference was detected in seropositivity between the samples collected in winter and autumn. All (34/34) seropositive blood donors followed over time remained seropositive at follow-up after 22-29 months. C6 ELISA seroprevalence in healthy blood donors is high in Kalmar County, thereby reducing the specificity of a positive test result regarding the clinical diagnosis of Lyme borreliosis (LB). Although C6 seroprevalence appears not to be affected by seasonal sample time, it varies greatly with age and sex. A careful evaluation of pre-test probability is therefore of the utmost importance in the clinical diagnosis of LB, especially in elderly men. We suggest that colleagues in other endemic regions also consider initiating similar evaluations to optimize the laboratory and clinical diagnosis of LB in relation to age and sex.
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Affiliation(s)
- Marcus Johansson
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Lena Manfredsson
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Annika Wistedt
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Lena Serrander
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ivar Tjernberg
- Department of Clinical Chemistry and Transfusion Medicine, Kalmar County Council, Kalmar, Sweden.,Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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24
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Eisen L, Gray JS. 29. Lyme borreliosis prevention strategies: United States versus Europe. ECOLOGY AND CONTROL OF VECTOR-BORNE DISEASES 2016. [DOI: 10.3920/978-90-8686-838-4_29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Lars Eisen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Jeremy S. Gray
- UCD School of Biology and Environmental Science, University College Dublin, Belfield, Dublin 4, Republic of Ireland
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25
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Briciu VT, Flonta M, Ţăţulescu DF, Meyer F, Sebah D, Cârstina D, Mihalca AD, Gherman CM, Hizo-Teufel C, Huber I, Fingerle V, Lupșe M. Clinical and serological one-year follow-up of patients after the bite of Ixodes ricinus ticks infected with Borrelia burgdorferi sensu lato. Infect Dis (Lond) 2016; 49:277-285. [PMID: 27866446 DOI: 10.1080/23744235.2016.1258488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The risk of developing Lyme borreliosis (LB) after the bite of a Borrelia (B.) burgdorferi sensu lato (s.l.) infected tick in Romania is unknown. METHODS The present prospective study, performed in 2010-2011 in a hospital in Romania, has followed-up clinical and serological outcome of patients that presented with B. burgdorferi positive Ixodes (I.) ricinus bite. A second group of patients, including age, sex and residence-matched individuals bitten by B. burgdorferi negative ticks, was followed-up as a control group. The subjects' outcome was evaluated one year after the tick bite. RESULTS Forty-three out of 389 ticks detached from patients were positive by hbb Real-Time PCR (RT-PCR) for B. burgdorferi s.l. (mainly B. afzelii, but also B. garinii, B. burgdorferi sensu stricto, B. spielmanii/B. valaisiana and B. lusitaniae). Twenty patients bitten by B. burgdorferi positive ticks and twenty matched control patients returned for the one year follow-up. Two patients from the B. burgdorferi positive group developed clinical manifestations of acute LB (erythema migrans) and 5 patients seroconverted (two from the B. burgdorferi positive group and three from the B. burgdorferi negative group). Borrelia afzelii was identified in ticks collected from persons that developed erythema migrans (EM). Comparing the two groups of patients, no statistical significant differences were found regarding presence of clinical symptoms or seroconversion. CONCLUSIONS No outcome differences were found between the group of patients bitten by B. burgdorferi positive ticks and the group of patients bitten by B. burgdorferi negative ticks.
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Affiliation(s)
- Violeta T Briciu
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania.,c Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine , University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania.,d National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Mirela Flonta
- b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania
| | - Doina F Ţăţulescu
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania
| | - Fabian Meyer
- e Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Daniela Sebah
- e Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Dumitru Cârstina
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Andrei D Mihalca
- c Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine , University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania
| | - Călin M Gherman
- c Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine , University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania
| | - Cecilia Hizo-Teufel
- d National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Ingrid Huber
- e Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Volker Fingerle
- d National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Mihaela Lupșe
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania
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26
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Prevalence of Rickettsia spp. in Ticks and Serological and Clinical Outcomes in Tick-Bitten Individuals in Sweden and on the Åland Islands. PLoS One 2016; 11:e0166653. [PMID: 27846275 PMCID: PMC5113005 DOI: 10.1371/journal.pone.0166653] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/01/2016] [Indexed: 11/23/2022] Open
Abstract
Tick-transmitted diseases are an emerging health problem, and the hard tick Ixodes ricinus is the main vector for Borrelia spp., tick-borne encephalitis virus and most of the spotted fever Rickettsiae in Europe. The aim of the present study was to examine the incidence of rickettsial infection in the southernmost and south central parts of Sweden and the Åland Islands in Finland, the risk of infection in humans and its correlation with a bite of a Rickettsia-infected tick, the self-reported symptoms of rickettsial disease, and the prevalence of co-infection between Rickettsia spp. and Borrelia spp. Persons with a recent tick bite were enrolled through public media and asked to answer a questionnaire, provide a blood sample and bring detached ticks at enlistment and at follow-up three months later. Blood samples were previously analysed for Borrelia spp. antibodies and, for this report, analysed for antibodies to Rickettsia spp. by immunofluorescence and in 16 cases also using Western Blot. Ninety-six (44.0%) of the 218 participants were seropositive for IgG antibodies to Rickettsia spp. Forty (18.3%) of the seropositive participants had increased titres at the follow-up, indicating recent/current infection, while four (1.8%) had titres indicating probable recent/current infection (≥1:256). Of 472 ticks, 39 (8.3%) were Rickettsia sp. positive. Five (31.3%) of 16 participants bitten by a Rickettsia-infected tick seroconverted. Experience of the self-reported symptoms nausea (p = 0.006) and radiating pain (p = 0.041) was more common among those with recent, current or probable infection compared to those who did not seroconvert. Participants who showed seroreactivity or seroconversion to Rickettsia spp. had more symptoms than those who were seronegative. Seven (3.2%) participants showed seroconversion to Borrelia spp., and three (1.4%) of these showed seroconversion to both Rickettsia spp. and Borrelia spp., in accordance with previous studies in Sweden. Symptoms of rickettsial disease were in most of the cases vague and general that were difficult to differentiate from other tick-borne diseases.
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27
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Hofhuis A, Bennema S, Harms M, van Vliet AJH, Takken W, van den Wijngaard CC, van Pelt W. Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase. BMC Public Health 2016; 16:425. [PMID: 27216719 PMCID: PMC4877959 DOI: 10.1186/s12889-016-3105-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nationwide surveys have shown a threefold increase in general practitioner (GP) consultations for tick bites and early Lyme borreliosis from 1994 to 2009 in the Netherlands. We now report an update on 2014, with identical methods as for the preceding GP surveys. METHODS To all GPs in the Netherlands, a postal questionnaire was sent inquiring about the number of consultations for tick bites and erythema migrans diagnoses (most common manifestation of early Lyme borreliosis) in 2014, and the size of their practice populations. RESULTS Contrasting to the previously rising incidence of consultations for tick bites between 1994 and 2009, the incidence decreased in 2014 to 488 consultations for tick bites per 100,000 inhabitants, i.e., 82,000 patients nationwide. This survey revealed a first sign of stabilization of the previously rising trend in GP diagnosed erythema migrans, with 140 diagnoses per 100,000 inhabitants of the Netherlands. This equals about 23,500 annual diagnoses of erythema migrans nationwide in 2014. CONCLUSIONS In contrast to the constantly rising incidence of GP consultations for tick bites and erythema migrans diagnoses in the Netherlands between 1994 and 2009, the current survey of 2014 showed a first sign of stabilization of erythema migrans diagnoses and a decreased incidence for tick bite consultations.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Sita Bennema
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Margriet Harms
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands
| | - Cees C van den Wijngaard
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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28
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Aubry C, Socolovschi C, Raoult D, Parola P. Bacterial agents in 248 ticks removed from people from 2002 to 2013. Ticks Tick Borne Dis 2016; 7:475-81. [DOI: 10.1016/j.ttbdis.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 01/18/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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29
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A prospective study on the incidence of Borrelia burgdorferi sensu lato infection after a tick bite in Sweden and on the Åland Islands, Finland (2008-2009). Ticks Tick Borne Dis 2015; 7:71-79. [PMID: 26341726 DOI: 10.1016/j.ttbdis.2015.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 07/20/2015] [Accepted: 08/20/2015] [Indexed: 01/28/2023]
Abstract
Lyme borreliosis (LB) is a common and increasing tick-borne disease in Europe. The risk of acquiring a Borrelia infection after a tick bite is not fully known. Therefore, we investigated the incidence of Borrelia infection after a bite by a Borrelia-infected tick and if the Borrelia load and/or the duration of tick-feeding influenced the risk of infection. During 2008-2009, ticks and blood samples were collected from 1546 tick-bitten persons from Sweden and the Åland Islands, Finland. Follow-up blood samples were taken 3 months after the tick bite. The duration of tick feeding was microscopically estimated and Borrelia was detected and quantified in ticks by real-time PCR. Anti-Borrelia antibodies were detected in sera using ELISA tests and immunoblot. Five percent (78/1546) of the study participants developed Borrelia infection (LB diagnosis and/or seroconversion) after a tick bite (45% bitten by Borrelia-infected ticks and 55% bitten by uninfected ticks). Of these, 33 developed LB (whereof 9 also seroconverted) while 45 participants seroconverted only. Experience of non-specific symptoms was more frequently reported by Borrelia-infected participants compared to uninfected participants. All who seroconverted removed "their" ticks significantly later than those who did not. The Borrelia load in the ticks did not explain the risk of seroconversion. Regional and sex differences in the Borrelia seroprevalence were found. The risk of developing a Borrelia infection after a bite by a Borrelia-infected tick is small but increases with the duration of tick feeding.
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Hjetland R, Reiso H, Ihlebæk C, Nilsen RM, Grude N, Ulvestad E. Subjective health complaints are not associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors in western Norway: a cross-sectional study. BMC Public Health 2015; 15:657. [PMID: 26169496 PMCID: PMC4499943 DOI: 10.1186/s12889-015-2026-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background There is controversy about chronic health consequences of tick-borne infections, especially Lyme borreliosis. This study aims to assess whether general function, physical fitness and subjective health complaints are associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors. Methods Sera from 1,213 blood donors at four different blood banks in Sogn and Fjordane county in western Norway were obtained during January to June 2010, and analysed for specific IgG and IgM antibodies. A questionnaire including questions on tick bites, subjective health complaints, general function and physical fitness was completed. Results Tick bites had been experienced by 65.7 % of the study population. 78 (6.4 %) were positive for IgG (9.7 % in men, 2.4 % in women), and 69 (5.7 %) for IgM (6.1 % in men, 5.1 % in women), verified by immunoblot. No association between number of experienced tick bites or seropositivity for Borrelia antibodies and subjective health complaints, reduced general function or reduced physical fitness was found. Conclusion The results do not support any association between tick bites or Borrelia antibodies and subjective health complaints in blood donors in an endemic area for Lyme borreliosis. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2026-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Reidar Hjetland
- Department of Microbiology, Førde General Hospital, Helse Førde Hospital Trust, PO Box 1000, NO-6807, Førde, Norway.
| | - Harald Reiso
- Institute of Health and Society, Department of General Practice, University of Oslo, Oslo, Norway.
| | - Camilla Ihlebæk
- Section of public health, ILP, Norwegian University of Life Sciences, Aas, Norway.
| | - Roy M Nilsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
| | - Nils Grude
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Elling Ulvestad
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
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Henningsson AJ, Wilhelmsson P, Gyllemark P, Kozak M, Matussek A, Nyman D, Ekerfelt C, Lindgren PE, Forsberg P. Low risk of seroconversion or clinical disease in humans after a bite by an Anaplasma phagocytophilum-infected tick. Ticks Tick Borne Dis 2015; 6:787-92. [PMID: 26187418 DOI: 10.1016/j.ttbdis.2015.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 01/24/2023]
Abstract
The risk of contracting human granulocytic anaplasmosis (HGA) after a tick bite is mainly unknown. In this study we investigated the clinical and serological response in 30 humans bitten by ticks positive for Anaplasma phagocytophilum (Group A), 30 humans bitten by Borrelia burgdorferi sensu lato (s.l.)-positive ticks (Group B), and 30 humans bitten by ticks negative for both A. phagocytophilum and B. burgdorferi s.l. (Group C). Ticks, blood samples and questionnaires were collected from tick-bitten humans at 34 primary healthcare centres in Sweden and in the Åland Islands, Finland, at the time of the tick bite and after three months. A total of 2553 ticks detached from humans in 2007-2009 were analyzed by polymerase chain reaction, and 31 (1.2%) were positive for A. phagocytophilum, 556 (21.8%) were positive for B. burgdorferi s.l., and eight (0.3%) were co-infected by A. phagocytophilum and B. burgdorferi s.l. The overall prevalence of Anaplasma IgG antibodies in the included participants (n=90) was 17%, and there was no significant difference between the groups A-C. Only one of the participants (in Group C) showed a four-fold increase of IgG antibodies against A. phagocytophilum at the three-month follow-up, but reported no symptoms. The frequency of reported symptoms did not differ between groups A-C, and was unrelated to the findings of A. phagocytophilum and B. burgdorferi s.l. in the detached ticks. We conclude that the risk for HGA or asymptomatic seroconversion after a tick bite in Sweden or in the Åland Islands is low, even if the tick is infected by A. phagocytophilum.
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Affiliation(s)
- Anna J Henningsson
- Department of Clinical Microbiology, Ryhov County Hospital, S-551 85 Jönköping, Sweden.
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
| | - Paula Gyllemark
- Department of Infectious Diseases, Ryhov County Hospital, S-551 85 Jönköping, Sweden
| | - Monika Kozak
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
| | - Andreas Matussek
- Department of Clinical Microbiology, Ryhov County Hospital, S-551 85 Jönköping, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Bimelix Biomedical Laboratory, Torggatan 10, AX-22100 Mariehamn, Åland, Finland
| | - Christina Ekerfelt
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Linköping University, S-551 85 Jönköping, Sweden
| | - Per-Eric Lindgren
- Department of Clinical Microbiology, Ryhov County Hospital, S-551 85 Jönköping, Sweden; Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
| | - Pia Forsberg
- Clinic of Infectious Diseases, Linköping University Hospital, and Department of Clinical and Experimental Medicine, Linköping University, S-551 85 Jönköping, Sweden
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Study of a Cohort of 1,886 Persons To Determine Changes in Antibody Reactivity to Borrelia burgdorferi 3 Months after a Tick Bite. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:823-7. [PMID: 25994550 DOI: 10.1128/cvi.00026-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022]
Abstract
Lyme borreliosis is a tick-borne disease caused by the bacterium Borrelia burgdorferi. The most frequent clinical manifestation is a rash called erythema migrans. Changes in antibody reactivity to B. burgdorferi 3 months after a tick bite are measured using enzyme-linked immunosorbent assays (ELISAs). One assay is based on native purified flagellum antigen (IgG), and the other assay is based on a recombinant antigen called C6 (IgG or IgM). Paired samples were taken at the time of a tick bite and 3 months later from 1,886 persons in Sweden and the Åland Islands, Finland. The seroconversion or relative change is defined by dividing the measurement units from the second sample by those from the first sample. The threshold for the minimum level of significant change was defined at the 2.5% level to represent the random error level. The thresholds were a 2.7-fold rise for the flagellar IgG assay and a 1.8-fold rise for the C6 assay. Of 1,886 persons, 102/101 (5.4%) had a significant rise in antibody reactivity in the flagellar assay or the C6 assay. Among 40 cases with a diagnosis of Lyme borreliosis, the sensitivities corresponding to a rise in antibodies were 33% and 50% for the flagellar antigen and the C6 antigen, respectively. Graphical methods to display the antibody response and to choose thresholds for a rise in relative antibody reactivity are shown and discussed. In conclusion, 5.4% of people with tick bites showed a rise in Borrelia-specific antibodies above the 2.5% threshold in either ELISA but only 40 (2.1%) developed clinical Lyme borreliosis.
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Quarsten H, Skarpaas T, Fajs L, Noraas S, Kjelland V. Tick-borne bacteria in Ixodes ricinus collected in southern Norway evaluated by a commercial kit and established real-time PCR protocols. Ticks Tick Borne Dis 2015; 6:538-44. [PMID: 25985721 DOI: 10.1016/j.ttbdis.2015.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 11/19/2022]
Abstract
Ticks are important vectors of human pathogens. The knowledge of disease causing agents harboured by ticks in Norway is limited. The focus of this study was (a) to detect the bacteria of medical importance in ticks collected from the vegetation at locations in the southern part of the country and (b) to evaluate a novel commercially available multiplex PCR based method by comparing results with conventional established real-time PCR protocols. Borrelia burgdorferi sensu lato was confirmed to be the most prevalent pathogen detected (31%) among one hundred individually analysed adult ticks. Borrelia miyamotoi, a spirochete associated with relapsing fever, was detected in one sample. Anaplasma phagocytophilum was found in 4% of the ticks, followed by Rickettsia helvetica which was detected in one sample. Similar pathogen prevalence was also detected in 500 ticks analysed in pools. This is the first report of the spotted fever group Rickettsia in Norway. Francisella tularensis, Bartonella species or Coxiella burnetti was not detected. However, due to the low number of ticks analysed, the possible presence of these pathogens in the region cannot be ruled out. All isolates were screened by at least two different molecular methods for each bacterial target; one commercially available multiplex PCR based tick-borne bacteria flow chip system (Master Diagnostica) and corresponding real-time PCR protocols. The comparison of methods verified that most findings were detected by both methods (71 Borrelia, 15 Anaplasma and 2 Rickettsia), whereas two additional Borrelia and Anaplasma infected samples were detected by the real-time protocols.
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Affiliation(s)
- H Quarsten
- Sørlandet Hospital Health Enterprise, Department of Medical Microbiology, PO Box 416, NO-4604 Kristiansand, Norway.
| | - T Skarpaas
- Sørlandet Hospital Health Enterprise, Department of Medical Microbiology, PO Box 416, NO-4604 Kristiansand, Norway
| | - L Fajs
- University of Ljubljana, Institute of Microbiology and Immunology, Faculty of Medicine, Zaloška 4, SI-1000 Ljubljana, Slovenia
| | - S Noraas
- Sørlandet Hospital Health Enterprise, Department of Medical Microbiology, PO Box 416, NO-4604 Kristiansand, Norway
| | - V Kjelland
- Sørlandet Hospital Health Enterprise, Research Unit, PO Box 416, NO-4604 Kristiansand, Norway; University of Agder, Department of Engineering and Science, Institute of Natural Sciences, Gimlemoen 25, NO-4630 Kristiansand, Norway
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Wagemakers A, Staarink PJ, Sprong H, Hovius JWR. Borrelia miyamotoi: a widespread tick-borne relapsing fever spirochete. Trends Parasitol 2015; 31:260-9. [PMID: 25892254 DOI: 10.1016/j.pt.2015.03.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Borrelia miyamotoi is a relapsing fever spirochete that has only recently been identified as a human pathogen. Borrelia miyamotoi is genetically and ecologically distinct from Borrelia burgdorferi sensu lato, while both are present in Ixodes ticks. Over 50 patients with an acute febrile illness have been described with a B. miyamotoi infection, and two infected immunocompromised patients developed a meningoencephalitis. Seroprevalence studies indicate exposure in the general population and in specific risk groups, such as patients initially suspected of having human granulocytic anaplasmosis. Here, we review the available literature on B. miyamotoi, describing its presence in ticks, reservoir hosts, and humans, and discussing its potential impact on public health.
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Affiliation(s)
- Alex Wagemakers
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Pieter J Staarink
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Antonie van Leeuwenhoeklaan 9, PO Box 1, Bilthoven, The Netherlands
| | - Joppe W R Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Amsterdam Multidisciplinary Lyme Center, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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Hofhuis A, Harms M, van den Wijngaard C, Sprong H, van Pelt W. Continuing increase of tick bites and Lyme disease between 1994 and 2009. Ticks Tick Borne Dis 2014; 6:69-74. [PMID: 25448421 DOI: 10.1016/j.ttbdis.2014.09.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nationwide cross-sectional retrospective studies have shown a continuous increase in general practitioner (GP) consultations for tick bites and diagnoses of erythema migrans between 1994 and 2005 in the Netherlands. In this paper, we report incidence estimates for GP consultations for tick bites and erythema migrans diagnoses in 2009, and we compare the observed increase in GP consultations to reports of tick bites in two retrospective cross-sectional surveys of the general population. METHODS All GPs in the Netherlands were asked to complete a postal questionnaire on the number of consultations for tick bites and erythema migrans diagnoses in 2009, and the size of their practice populations. To investigate how the incidence of GP consultation rates for tick bites and erythema migrans relate to the incidence of tick bites in the general population, questionnaire data on tick bites were analyzed from two large population surveys conducted to evaluate the national immunization program in 1995/1996 and 2006/2007. RESULTS The 2009 GP survey revealed a further increase, to 564 tick bite consultations per 100,000 inhabitants, and 134 erythema migrans diagnoses per 100,000 inhabitants of the Netherlands. The two population surveys from 1995/1996 and 2006/2007 exhibited an almost twofold increase of the incidence of tick bites in the general population from 4099 per 100,000 population in 1996, to 7198 per 100,000 population in 2007. People nationwide noticed approximately 1.1 million tick bites in 2007. CONCLUSIONS Our observation of increases in GP consultations for tick bites and erythema migrans diagnoses between 1994 and 2009 are confirmed by the parallel increase of tick bites reported by the general population, although consultation rates slightly increased. For every sixty tick bites in the general population in 2007, we observed one GP consult for erythema migrans. The increase in tick bites poses a progressive threat to public health.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Margriet Harms
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cees van den Wijngaard
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Hai VV, Almeras L, Socolovschi C, Raoult D, Parola P, Pagès F. Monitoring human tick-borne disease risk and tick bite exposure in Europe: available tools and promising future methods. Ticks Tick Borne Dis 2014; 5:607-19. [PMID: 25178542 DOI: 10.1016/j.ttbdis.2014.07.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 12/30/2022]
Abstract
Ticks are the main vector for infectious disease pathogens in both humans and animals, and tick-borne diseases are currently spreading throughout Europe. Various surveillance methods have been developed to estimate the burden and risk of tick-borne diseases and host exposure to tick bites. The ultimate aims of these approaches are to determine the risk level of a tick-borne disease in a given area, determine its health priority, identify the at-risk population and propose specific countermeasures or complementary studies as needed. The purpose of this review is to present the current methods for monitoring the circulation of tick-borne diseases and to highlight the use of salivary antigens as original and recently developed serological tools that could be useful for tick bite risk assessment and could improve the current surveillance methods.
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Affiliation(s)
- Vinh Vu Hai
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France; Institut de Recherche Biomédicale des Armées (IRBA), Antenne Marseille, Unité de Parasitologie, URMITE UMR 6236, GSBdD de Marseille Aubagne, 111 Avenue de la Corse BP 40026, 13568 Marseille Cedex 02, France
| | - Lionel Almeras
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France; Institut de Recherche Biomédicale des Armées (IRBA), Antenne Marseille, Unité de Parasitologie, URMITE UMR 6236, GSBdD de Marseille Aubagne, 111 Avenue de la Corse BP 40026, 13568 Marseille Cedex 02, France
| | - Cristina Socolovschi
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Didier Raoult
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Philippe Parola
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France.
| | - Frédéric Pagès
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM 63, CNRS 7278, IRD 198, Inserm 1095, WHO Collaborative Center for Rickettsioses and Other Arthropod-Borne Bacterial Diseases, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France; CIRE/ARS Océan Indien, 2 bis Avenue Georges Brassens CS 60050, 97408 Saint Denis Cedex 9, Reunion.
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Tijsse-Klasen E, Koopmans MPG, Sprong H. Tick-borne pathogen - reversed and conventional discovery of disease. Front Public Health 2014; 2:73. [PMID: 25072045 PMCID: PMC4083466 DOI: 10.3389/fpubh.2014.00073] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/24/2014] [Indexed: 12/31/2022] Open
Abstract
Molecular methods have increased the number of known microorganisms associated with ticks significantly. Some of these newly identified microorganisms are readily linked to human disease while others are yet unknown to cause human disease. The face of tick-borne disease discovery has changed with more diseases now being discovered in a “reversed way,” detecting disease cases only years after the tick-borne microorganism was first discovered. Compared to the conventional discovery of infectious diseases, reverse order discovery presents researchers with new challenges. Estimating public health risks of such agents is especially challenging, as case definitions and diagnostic procedures may initially be missing. We discuss the advantages and shortcomings of molecular methods, serology, and epidemiological studies that might be used to study some fundamental questions regarding newly identified tick-borne diseases. With increased tick-exposure and improved detection methods, more tick-borne microorganisms will be added to the list of pathogens causing disease in humans in the future.
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Affiliation(s)
- Ellen Tijsse-Klasen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - Marion P G Koopmans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands ; Erasmus Medical Center , Rotterdam , Netherlands
| | - Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
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Lindblom P, Wilhelmsson P, Fryland L, Matussek A, Haglund M, Sjöwall J, Vene S, Nyman D, Forsberg P, Lindgren PE. Factors determining immunological response to vaccination against tick-borne encephalitis virus in older individuals. PLoS One 2014; 9:e100860. [PMID: 24967619 PMCID: PMC4072701 DOI: 10.1371/journal.pone.0100860] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 05/30/2014] [Indexed: 12/30/2022] Open
Abstract
We performed a cross-sectional study including 533 individuals (median age 61) from the highly TBE endemic Åland Islands in the archipelago between Sweden and Finland. Blood samples, questionnaires and vaccination records were obtained from all study participants. The aim was to investigate if there was any association between TBEV antibody titer and 12 health-related factors. Measurement of TBEV IgG antibodies was performed using two commercial ELISA assays (Enzygnost and Immunozym), and a third in-house rapid fluorescent focus inhibition test was used to measure TBEV neutralizing antibodies. The age of the individual and the number of vaccine doses were the two most important factors determining the immunological response to vaccination. The response to each vaccine dose declined linearly with increased age. A 35 year age difference corresponds to a vaccine dose increment from 3 to 4 to achieve the same immunological response. Participants previously vaccinated against other flaviviruses had lower odds of being seropositive for neutralizing TBEV antibodies on average, while participants with self-reported asthma had higher odds of being seropositive. By comparing the 3 serological assays we show that the Enzygnost and Immunozym assay differ due to choice of cutoffs, but not in overall accuracy.
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Affiliation(s)
- Pontus Lindblom
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- * E-mail:
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Linda Fryland
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Matussek
- Division of Medical Services, Department of Microbiology, County Hospital Ryhov, Jönköping, Sweden
| | - Mats Haglund
- Department of Infectious Diseases, County Hospital Kalmar, Kalmar, Sweden
| | - Johanna Sjöwall
- Clinic of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Sirkka Vene
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Dag Nyman
- Åland Central Hospital, Mariehamn, Åland, Finland
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Clinic of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Per-Eric Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Division of Medical Services, Department of Microbiology, County Hospital Ryhov, Jönköping, Sweden
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Wilhelmsson P, Lindblom P, Fryland L, Nyman D, Jaenson TGT, Forsberg P, Lindgren PE. Ixodes ricinus ticks removed from humans in Northern Europe: seasonal pattern of infestation, attachment sites and duration of feeding. Parasit Vectors 2013; 6:362. [PMID: 24360096 PMCID: PMC3880168 DOI: 10.1186/1756-3305-6-362] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022] Open
Abstract
Background The common tick Ixodes ricinus is the main vector in Europe of the tick-borne encephalitis virus and of several species of the Borrelia burgdorferi sensu lato complex, which are the etiological agents of Lyme borreliosis. The risk to contract bites of I. ricinus is dependent on many factors including the behaviour of both ticks and people. The tick’s site of attachment on the human body and the duration of tick attachment may be of clinical importance. Data on I. ricinus ticks, which were found attached to the skin of people, were analysed regarding potentially stage-specific differences in location of attachment sites, duration of tick attachment (= feeding duration), seasonal and geographical distribution of tick infestation in relation to age and gender of the tick-infested hosts. Methods During 2008–2009, 1770 tick-bitten persons from Sweden and the Åland Islands removed 2110 I. ricinus ticks. Participants provided information about the date of tick detection and location on their body of each attached tick. Ticks were identified to species and developmental stage. The feeding duration of each nymph and adult female tick was microscopically estimated based on the scutal and the coxal index. Results In 2008, participants were tick-bitten from mid-May to mid-October and in 2009 from early April to early November. The infestation pattern of the nymphs was bimodal whereas that of the adult female ticks was unimodal with a peak in late summer. Tick attachment site on the human body was associated with stage of the tick and gender of the human host. Site of attachment seemed to influence the duration of tick feeding. Overall, 63% of nymphs and adult female ticks were detected and removed more than 24 hours after attachment. Older persons, compared to younger ones, and men, compared to women, removed “their” ticks after a longer period of tick attachment. Conclusions The infestation behaviour of the different tick stages concerning where on the host’s body the ticks generally will attach and when such ticks generally will be detected and removed in relation to host age and gender, should be of value for the development of prophylactic methods against tick infestation and to provide relevant advice to people on how to avoid or reduce the risk of tick infestation.
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Affiliation(s)
- Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Wilhelmsson P, Lindblom P, Fryland L, Ernerudh J, Forsberg P, Lindgren PE. Prevalence, diversity, and load of Borrelia species in ticks that have fed on humans in regions of Sweden and Åland Islands, Finland with different Lyme borreliosis incidences. PLoS One 2013; 8:e81433. [PMID: 24278437 PMCID: PMC3836827 DOI: 10.1371/journal.pone.0081433] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/12/2013] [Indexed: 11/19/2022] Open
Abstract
The incidence of Lyme borreliosis (LB) in a region may reflect the prevalence of Borrelia in the tick population. Our aim was to investigate if regions with different LB incidences can be distinguished by studying the prevalence and diversity of Borrelia species in their respective tick populations. The Borrelia load in a feeding tick increases with the duration of feeding, which may facilitate a transmission of Borrelia Spirochetes from tick to host. Therefore, we also wanted to investigate how the Borrelia load in ticks that have fed on humans varies with the duration of tick feeding. During 2008 and 2009, ticks that had bitten humans were collected from four regions of Sweden and Finland, regions with expected differences in LB incidence. The duration of tick feeding was estimated and Borrelia were detected and quantified by a quantitative PCR assay followed by species determination. Out of the 2,154 Ixodes ricinus ticks analyzed, 26% were infected with Borrelia and seven species were identified. B. spielmanii was detected for the first time in the regions. The tick populations collected from the four regions exhibited only minor differences in both prevalence and diversity of Borrelia species, indicating that these variables alone cannot explain the regions’ different LB incidences. The number of Borrelia cells in the infected ticks ranged from fewer than ten to more than a million. We also found a lower number of Borrelia cells in adult female ticks that had fed for more than 36 hours, compared to the number of Borrelia cells found in adult female ticks that had fed for less than 36 hours.
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Affiliation(s)
- Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Pontus Lindblom
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Linda Fryland
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Ernerudh
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Clinic of Infectious Diseases, County Council of Östergötland, Linköping, Sweden
| | - Per-Eric Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Medical Services, Department of Microbiology, Ryhov County Hospital, Jönköping, Sweden
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Hofhuis A, Herremans T, Notermans DW, Sprong H, Fonville M, van der Giessen JWB, van Pelt W. A prospective study among patients presenting at the general practitioner with a tick bite or erythema migrans in The Netherlands. PLoS One 2013; 8:e64361. [PMID: 23696884 PMCID: PMC3655959 DOI: 10.1371/journal.pone.0064361] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background We performed a nationwide prospective study on the transmission risk for Borrelia to humans, investigating symptoms and serology at enrolment and three months after tick bites, and after standard treatment for erythema migrans (EM). Aiming to quantify the infection risk at point of care by physicians, we explored risk factors such as tick testing for Borrelia and assessment of the duration of the tick's blood meal. Methods and Findings Questionnaires, blood samples and ticks from patients who consulted one of 307 general practitioners for tick bites (n = 327) or EM (n = 283) in 2007 and 2008, were collected at enrolment and three months later at follow-up. Borrelia burgdorferi sensu lato DNA was detected in 29.3% of 314 ticks, using PCR/reverse line blot and real-time PCR on the OspA gene. Seroconversion in C6 ELISA, IgM or IgG immunoblots for Borrelia-specific antibodies was observed in 3.2% of tick bite cases. Fourteen tick bite cases had evidence of early Borrelia infection, of which EM developed among seven cases. The risk of developing EM after tick bites was 2.6% (95%CI: 1.1%–5.0%), and the risk of either EM or seroconversion was 5.1% (95%CI: 2.9%–8.2%). Participants with Borrelia-positive ticks had a significantly higher risk of either EM or seroconversion (odds ratio 4.8, 95%CI: 1.1–20.4), and of seroconversion alone (odds ratio 11.1, 95%CI: 1.1–108.9). A third (34%) of the cases enrolled with EM did not recall preceding tick bites. Three EM cases (1%) reported persisting symptoms, three months after standard antibiotic treatment for EM. Conclusions One out of forty participants developed EM within three months after tick bites. The infection risk can be assessed by tick testing for Borrelia at point of care by physicians. However, further refining is needed considering sensitivity and specificity of tick tests, accuracy of tick attachment time and engorgement.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Hjetland R, Eliassen KE, Lindbæk M, Nilsen RM, Grude N, Ulvestad E. Tick bites in healthy adults from western Norway: occurrence, risk factors, and outcomes. Ticks Tick Borne Dis 2013; 4:304-10. [PMID: 23608547 DOI: 10.1016/j.ttbdis.2013.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
The frequency of tick bites, risk factors, as well as simple outcome measures after tick bites in a healthy adult population (blood donors) from Sogn and Fjordane county situated at the western coast of Norway, was assessed. The study was based on cross-sectional data from blood donors at 4 different blood banks in the county during the period January to June 2010. Data on tick bites and potential risk factors were collected from 1213 blood donors using a questionnaire. Among participants, 65.7% had experienced tick bites during their life time, whereas 30% reported recent tick bites (during the latest 12 months). There were fewer tick bites in the eastern, inland part of the county, where the tick Ixodes ricinus is less prevalent compared to the western, coastal regions. The number of total and recent tick bites increased with the respondent's age, hours spent outdoors during summertime, educational level, ownership of domestic animals, and hunting. Women older than 50 years reported more bites than similarly aged men and younger females. Among bitten subjects, 22.7% reported ever having had a rash around a tick bite, whereas 12.7% had seen a medical doctor and 7.7% had received antibiotics owing to tick bite. Avoiding certain locations owing to a fear of tick bites was reported by 15.7% of all respondents, more women than men. In conclusion, tick bites are common in the western part of Norway. The risk of being bitten varies with age and outdoor activities, animal contact, and geography. The consequences in terms of disease seem modest.
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Affiliation(s)
- Reidar Hjetland
- Department of Microbiology, Division of Medicine, District General Hospital of Førde, Førde, Norway.
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Esposito S, Bosis S, Sabatini C, Tagliaferri L, Principi N. Borrelia burgdorferi infection and Lyme disease in children. Int J Infect Dis 2013; 17:e153-8. [DOI: 10.1016/j.ijid.2012.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/26/2012] [Indexed: 12/01/2022] Open
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Lindblom A, Wallménius K, Nordberg M, Forsberg P, Eliasson I, Påhlson C, Nilsson K. Seroreactivity for spotted fever rickettsiae and co-infections with other tick-borne agents among habitants in central and southern Sweden. Eur J Clin Microbiol Infect Dis 2012; 32:317-23. [PMID: 22961007 PMCID: PMC3569577 DOI: 10.1007/s10096-012-1742-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/22/2012] [Indexed: 11/08/2022]
Abstract
Patients seeking medical care with erythema migrans or flu-like symptoms after suspected or observed tick bite in the southeast of Sweden and previously investigated for Borrelia spp. and/or Anaplasma sp. were retrospectively examined for serological evidence of rickettsial infection (Study 1). Twenty of 206 patients had IgG and/or IgM antibodies to Rickettsia spp. equal to or higher than the cut-off titre of 1:64. Seven of these 20 patients showed seroconversion indicative of recent or current infection and 13 patients had titres compatible with past infection, of which five patients were judged as probable infection. Of 19 patients with medical records, 11 were positive for Borrelia spp. as well, and for Anaplasma sp., one was judged as positive. Five of the 19 patients had antibodies against all three pathogens. Erythema migrans or rash was observed at all combinations of seroreactivity, with symptoms including fever, muscle pain, headache and respiratory problems. The results were compared by screening an additional 159 patients (Study 2) primarily sampled for the analysis of Borrelia spp. or Mycoplasma pneumoniae. Sixteen of these patients were seroreactive for Rickettsia spp., of which five were judged as recent or current infection. Symptoms of arthritis, fever, cough and rash were predominant. In 80 blood donors without clinical symptoms, approximately 1 % were seroreactive for Rickettsia spp., interpreted as past infection. The study shows that both single and co-infections do occur, which illustrate the complexity in the clinical picture and a need for further studies to fully understand how these patients should best be treated.
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Affiliation(s)
- A Lindblom
- Unit of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Huppertz HI, Bartmann P, Heininger U, Fingerle V, Kinet M, Klein R, Korenke GC, Nentwich HJ. Rational diagnostic strategies for Lyme borreliosis in children and adolescents: recommendations by the Committee for Infectious Diseases and Vaccinations of the German Academy for Pediatrics and Adolescent Health. Eur J Pediatr 2012; 171:1619-24. [PMID: 22782450 PMCID: PMC3491193 DOI: 10.1007/s00431-012-1779-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/11/2012] [Indexed: 12/27/2022]
Abstract
The varying clinical manifestations of Lyme borreliosis, transmitted by Ixodes ricinus and caused by Borrelia burgdorferi, frequently pose diagnostic problems. Diagnostic strategies vary between early and late disease manifestations and usually include serological methods. Erythema migrans is pathognomonic and does not require any further laboratory investigations. In contrast, the diagnosis of neuroborreliosis requires the assessment of serum and cerebrospinal fluid. Lyme arthritis is diagnosed in the presence of newly recognized arthritis and high-titer serum IgG antibodies against B. burgdorferi. The committee concludes the following recommendations: Borrelial serology should only be ordered in case of well-founded clinical suspicion for Lyme borreliosis, i.e., manifestations compatible with the diagnosis. Tests for borrelial genomic sequences in ticks or lymphocyte proliferation assays should not be ordered. When results of such tests or of serological investigations that were not indicated are available, they should not influence therapeutic decisions. Laboratories should be cautious when interpreting results of serological tests and abstain from giving therapeutic recommendations and from proposing retesting after some time without intimate knowledge of patient's history and disease manifestations.
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Affiliation(s)
| | - P. Bartmann
- Department of Neonatology, University Bonn, 53113 Bonn, Germany
| | - U. Heininger
- University Children’s Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland
| | - V. Fingerle
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstr. 2, 85764 Oberschleißheim, Germany
| | - M. Kinet
- Graf-Luckner-Str. 4f, 24159 Kiel, Germany
| | - R. Klein
- Ministerium für Gesundheit und Verbraucherschutz, Referat B1, Ursulinenstraße 8-16, 66111 Saarbrücken, Germany
| | - G. C. Korenke
- Neuropädiatrie, Elisabeth-Kinderkrankenhaus, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - H. J. Nentwich
- Deutsche Akademie für Kinder- und Jugendmedizin e.V., Chausseestr. 128/129, 10115 Berlin, Germany
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Huegli D, Moret J, Rais O, Moosmann Y, Erard P, Malinverni R, Gern L. Prospective study on the incidence of infection by Borrelia burgdorferi sensu lato after a tick bite in a highly endemic area of Switzerland. Ticks Tick Borne Dis 2011; 2:129-36. [PMID: 21890065 DOI: 10.1016/j.ttbdis.2011.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 05/13/2011] [Accepted: 05/13/2011] [Indexed: 10/17/2022]
Abstract
The periurban forest of Neuchâtel (Switzerland) is a high-risk area for Lyme Borreliosis, due to a high density of infected Ixodes ricinus ticks. In this study, we evaluated the risk of subclinical (seroconversion) and clinical infection after a tick bite in Neuchâtel inhabitants from 2003 to 2005. Inhabitants have been invited, through media, to visit a physician after a tick bite. A questionnaire was filled out and two blood samples were taken at 8-week interval. EIA screening tests for IgM and IgG (IMX system, Abbott) were applied for paired sera. In case of a change in antibody titres between both samples, a homemade Western-blot using Borrelia afzelii, B. burgdorferi sensu stricto and B. garinii as antigens was performed. Participants were included into two groups. Group one included asymptomatic participants (n=255). Among them, nine (3.5%) seroconverted with seroconversion rates varying between 6.8% in 2003, 2.1% in 2004 and 2.3% in 2005. Participants who developed clinical symptoms of LB were included into group two (n=14). Erythema migrans (EM) was reported in 5.2% of participants (5.2%), varying between 7.5% in 2003, 5% in 2004 and 3.4% in 2005. Ticks obtained from 186 participants were examined for B. burgdorferi infection by PCR/Reverse Line Blotting, and by Real Time PCR and tick attachment duration was estimated. Among I. ricinus ticks collected from participants, 32.8% were infected by B. burgdorferi sensu lato. B. afzelii predominated among these ticks. Globally, 65.9% of nymphs remained attached for more than 24h whereas only 38.3% of female ticks remained attached for more than 24h. We observed that 6.6% and 2.4% of participants bitten by infected and uninfected ticks, respectively, developed EM.
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Affiliation(s)
- Delphine Huegli
- Institut de Biologie, Laboratoire d'Eco-Epidémiologie, Université de Neuchâtel, 2000 Neuchâtel, Switzerland
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