1
|
Mertens-Scholz K, Hoffmann B, Gethmann JM, Brangsch H, Pletz MW, Klaus C. Prevalence of tick-borne bacterial pathogens in Germany-has the situation changed after a decade? Front Cell Infect Microbiol 2024; 14:1429667. [PMID: 39091677 PMCID: PMC11291221 DOI: 10.3389/fcimb.2024.1429667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Tick-borne pathogens, such as Borreliella spp., Rickettsia spp., and Anaplasma spp., are frequently detected in Germany. They circulate between animals and tick vectors and can cause mild to severe diseases in humans. Knowledge about distribution and prevalence of these pathogens over time is important for risk assessment of human and animal health. Methods Ixodes ricinus nymphs were collected at different locations in 2009/2010 and 2019 in Germany and analyzed for tick-borne pathogens by real-time PCR and sequencing. Results Borreliella spp. were detected with a prevalence of 11.96% in 2009/2010 and 13.10% in 2019 with B. afzelii and B. garinii as dominant species. Borrelia miyamotoi was detected in seven ticks and in coinfection with B. afzelii or B. garinii. Rickettsia spp. showed a prevalence of 8.82% in 2009/2010 and 1.68% in 2019 with the exclusive detection of R. helvetica. The prevalence of Anaplasma spp. was 1.00% in 2009/2010 and 7.01% in 2019. A. phagocytophilum was detected in seven tick samples. None of the nymphs were positive for C. burnetii. Discussion Here, observed changes in prevalence were not significant after a decade but require longitudinal observations including parameters like host species and density, climatic factors to improve our understanding of tick-borne diseases.
Collapse
Affiliation(s)
- Katja Mertens-Scholz
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Jena, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Bernd Hoffmann
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Greifswald-Insel Riems, Germany
| | - Jörn M. Gethmann
- Institute of Epidemiology, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Greifswald-Insel Riems, Germany
| | - Hanka Brangsch
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Jena, Germany
| | - Mathias W. Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Christine Klaus
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Jena, Germany
| |
Collapse
|
2
|
Lee JT, Li Z, Nunez LD, Katzel D, Perrin Jr. BS, Raghuraman V, Rajyaguru U, Llamera KE, Andrew L, Anderson AS, Hovius JW, Liberator PA, Simon R, Hao L. Development of a sequence-based in silico OspA typing method for Borrelia burgdorferi sensu lato. Microb Genom 2024; 10:001252. [PMID: 38787376 PMCID: PMC11165634 DOI: 10.1099/mgen.0.001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Lyme disease (LD), caused by spirochete bacteria of the genus Borrelia burgdorferi sensu lato, remains the most common vector-borne disease in the northern hemisphere. Borrelia outer surface protein A (OspA) is an integral surface protein expressed during the tick cycle, and a validated vaccine target. There are at least 20 recognized Borrelia genospecies, that vary in OspA serotype. This study presents a new in silico sequence-based method for OspA typing using next-generation sequence data. Using a compiled database of over 400 Borrelia genomes encompassing the 4 most common disease-causing genospecies, we characterized OspA diversity in a manner that can accommodate existing and new OspA types and then defined boundaries for classification and assignment of OspA types based on the sequence similarity. To accommodate potential novel OspA types, we have developed a new nomenclature: OspA in silico type (IST). Beyond the ISTs that corresponded to existing OspA serotypes 1-8, we identified nine additional ISTs that cover new OspA variants in B. bavariensis (IST9-10), B. garinii (IST11-12), and other Borrelia genospecies (IST13-17). The IST typing scheme and associated OspA variants are available as part of the PubMLST Borrelia spp. database. Compared to traditional OspA serotyping methods, this new computational pipeline provides a more comprehensive and broadly applicable approach for characterization of OspA type and Borrelia genospecies to support vaccine development.
Collapse
Affiliation(s)
- Jonathan T. Lee
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Zhenghui Li
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Lorna D. Nunez
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Daniel Katzel
- Pfizer Digital, Pfizer, Inc., Pearl River, NY, 10965, USA
| | | | - Varun Raghuraman
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Urvi Rajyaguru
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Katrina E. Llamera
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Lubomira Andrew
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | | | - Joppe W. Hovius
- Amsterdam University Medical Centers (UMC), location Academic Medical Center (AMC), Department of Internal Medicine, Division of Infectious Diseases, Center for Experimental and Molecular Medicine, Amsterdam Institute for Immunology and Infectious Diseases, University of Amsterdam, Amsterdam, Netherlands
| | - Paul A. Liberator
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Raphael Simon
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| | - Li Hao
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY, 10965, USA
| |
Collapse
|
3
|
Dulipati V, Kotimaa J, Rezola M, Kontiainen M, Jarva H, Nyman D, Meri S. Antibody responses to immunoevasion proteins BBK32 and OspE constitute part of the serological footprint in neuroborreliosis but are insufficient to prevent the disease. Scand J Immunol 2024; 99:e13353. [PMID: 39007994 DOI: 10.1111/sji.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 07/16/2024]
Abstract
Lyme borreliosis, caused by Borrelia burgdorferi sensu lato, is the most common tickborne disease. Its neuronal form, neuroborreliosis, comprises 3 to 38% of borreliosis cases in Europe. Borrelia outer surface proteins and virulence factors, OspE and BBK32, have been previously reported to help cause infection by promoting attachment to human host epithelial cells and evading complement attack. We assessed the serological responses to BBK32 and OspE in 19 individuals diagnosed with neuroborreliosis to see whether antibodies that could both target the bacteria and neutralize the virulence mechanisms on the microbial surface emerge. Results evaluate levels of total protein, IgG and the chemokine CXCL13, a determinant for B-cell recruitment during neuroinflammation, in patients' cerebrospinal fluid samples. Antibody levels against BBK32 and OspE correlated with those against VlsE, a well-characterized diagnostic serological marker of the disease. A dual serological profile of the patients was observed. K-means clustering split the cohort into two discrete groups presenting distinct serological and CNS responses. One group contained young patients with low levels of anti-BBK32 and OspE antibodies. The other group showed stronger responses, possibly following prolonged infections or reinfections. Additionally, we assessed anti-ganglioside antibodies that could cause autoimmunity or complement dysregulation but observed that they did not correlate with neuroborreliosis in our patient cohort. The dual nature of antibody responses against the virulence factors BBK32 and OspE in neuroborreliosis patients may suggest the necessity of repeated exposures for efficient immune responses. Better protection could be achieved if the virulence factors were formulated into vaccines.
Collapse
Affiliation(s)
- Vinaya Dulipati
- Translational Immunology Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Kotimaa
- Translational Immunology Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- VTT Technical Research Center of Finland, Espoo, Finland
| | - Mikel Rezola
- Translational Immunology Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université Paris Cité, Inflammation, Complement and Cancer team, Paris, France
| | - Mikko Kontiainen
- Translational Immunology Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna Jarva
- Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Dag Nyman
- Åland Group for Borreliosis Research, Mariehamn, Finland
| | - Seppo Meri
- Translational Immunology Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
4
|
Sarani S, Enferadi A, Hasani SJ, Sarani MY, Rahnama M, Sarani F. Identification of zoonotic pathogenic bacteria from blood and ticks obtained from hares and long-eared hedgehogs (Hemiechinus megalofis) in eastern Iran. Comp Immunol Microbiol Infect Dis 2024; 104:102097. [PMID: 38029723 DOI: 10.1016/j.cimid.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
The role of wildlife in the complex balance of tick-borne diseases within ecosystems is crucial, as they serve as hosts for tick carriers and reservoirs for the pathogens carried by these ticks. This study aimed to investigate the presence of zoonotic pathogenic bacteria in wildlife, specifically in hares and long-eared hedgehogs (Hemiechinus megalofis), in the eastern region of Iran. The focus was on the detection of Borrelia spp., Coxiella burnetii, Anaplasma spp., Francisella spp., and Leptospira spp., using the Nested-PCR method. We analyzed a total of 124 blood samples, and 196 ticks collected from hares and long-eared hedgehogs were analyzed. The Nested-PCR method was employed to identify the presence of zoonotic pathogenic bacteria DNA. Our study revealed the presence of these zoonotic pathogenic bacteria in both wildlife species, indicating their potential role as hosts and reservoirs for the ticks carrying these pathogens. The specific presence and prevalence of Borrelia spp., Coxiella burnetii, Anaplasma spp., Francisella spp., and Leptospira spp. were determined through the Nested-PCR method. This study contributes to the limited knowledge about the involvement of wild animals in the transmission of tick-borne diseases. By using the Nested-PCR method, we successfully identified the presence of zoonotic pathogenic bacteria in hares and long-eared hedgehogs. This study emphasizes the need for further research to better understand the ecological process of tick-borne diseases, particularly the role of wildlife in their spread. Such knowledge is crucial for wildlife conservation efforts and the management of tick-borne diseases, ultimately benefiting both animal and human health.
Collapse
Affiliation(s)
- Saeedeh Sarani
- Department of Pathology, Faculty of Veterinary Medicine, Zabol University, Iran
| | - Ahmad Enferadi
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, Iran.
| | - Sayyed Jafar Hasani
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, Iran
| | | | - Mohammad Rahnama
- Department of Pathology, Faculty of Veterinary Medicine, Zabol University, Iran
| | - Faroogh Sarani
- Department of Pathology, Faculty of Veterinary Medicine, Zabol University, Iran
| |
Collapse
|
5
|
Begier E, Pilz A, Loew-Baselli A, Harper LR, Stark JH, Bowdery M, Halsby K, Dzingina M, Bézay N, Allen KE, Parslow B, Gessner BD. Prospective incidence epidemiology study protocol: conducting active surveillance to assess the burden of Lyme disease (BOLD) in primary care practices in endemic areas of six European countries. BMJ Open 2023; 13:e070903. [PMID: 38072499 PMCID: PMC10729257 DOI: 10.1136/bmjopen-2022-070903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Lyme disease (LD) is the most frequent tick-borne disease in the moderate climates of Europe. This study will inform the phase III efficacy study for Pfizer and Valneva's investigational Lyme disease vaccine, VLA15. VLA15 phase III will be conducted in the USA and Europe due to the vaccine's serotype coverage and public health burden of LD. In Europe, the existence and location of sites that have access to populations with high LD annual incidence is uncertain. This active, prospective surveillance study assesses annual LD incidence at general practice (GP)/primary care sites, allowing for phase III site vetting and better characterisation of LD burden in selected regions for study size calculations. METHODS AND ANALYSIS This burden of Lyme disease (BOLD) study will assess LD incidence overall and by site at 15 GP/primary care practices in endemic areas of 6 European countries from Spring 2021 to December 2022 and will be summarised with counts (n), percentages (%) and associated 95% CIs. Suspected LD cases identified from site's practice panels are documented on screening logs, where clinical LD manifestations, diagnoses and standard of care diagnostic results are recorded. In the initial 12-month enrolment phase, suspected LD cases are offered enrolment. Participants undergo interview and clinical assessments to establish medical history, final clinical diagnosis, clinical manifestations and quality of life impact. Study-specific procedures include LD serology, skin punch biopsies and Lyme manifestation photographs. For every enrolled participant diagnosed with LD, 6-10 age-matched controls are randomly selected and offered enrolment for an embedded LD risk factor analysis. Persistent symptoms or post-treatment LD will be assessed at follow-up visits up to 2 years after initial diagnosis, while patients remain symptomatic. ETHICS AND DISSEMINATION This study has been approved by all sites' local ethics committees. The results will be presented at conferences and published in peer-reviewed journals.
Collapse
Affiliation(s)
| | | | | | - Lisa R Harper
- Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | - James H Stark
- Pfizer Biopharma Group, Collegeville, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Margos G, Hofmann M, Casjens S, Dupraz M, Heinzinger S, Hartberger C, Hepner S, Schmeusser M, Sing A, Fingerle V, McCoy KD. Genome diversity of Borrelia garinii in marine transmission cycles does not match host associations but reflects the strains evolutionary history. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 115:105502. [PMID: 37716446 DOI: 10.1016/j.meegid.2023.105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023]
Abstract
Borrelia burgdorferi sensu lato is a species complex of spirochetal bacteria that occupy different ecological niches which is reflected in their reservoir host- and vector-associations. Borrelia genomes possess numerous linear and circular plasmids. Proteins encoded by plasmid genes play a major role in host- and vector-interaction and are important for Borrelia niche adaptation. However, the plasmid composition and therewith the gene repertoire may vary even in strains of a single species. Borrelia garinii, one of the six human pathogenic species, is common in Europe (vector Ixodes ricinus), Asia (vector Ixodes persulcatus) and in marine birds (vector Ixodes uriae). For the latter, only a single culture isolate (Far04) and its genome were previously available. The genome was rather small containing only one circular and six linear plasmids with a notable absence of cp32 plasmids. To further investigate B. garinii from marine transmission cycles and to explore i) whether the small number of plasmids found in isolate Far04 is a common feature in B. garinii from marine birds and presents an adaptation to this particular niche and ii) whether there may be a correlation between genome type and host species, we initiated in vitro cultures from live I. uriae collected in 2017 and 2018 from marine avian hosts and their nests. Hosts included common guillemots, Atlantic Puffin, razorbill, and kittiwake. We obtained 17 novel isolates of which 10 were sequenced using Illumina technology, one also with Pacific Bioscience technology. The 10 genomes segregated into five different genome types defined by plasmid types (based on PFam32 loci). We show that the genomes of seabird associated B. garinii contain fewer plasmids (6-9) than B. garinii from terrestrial avian species (generally ≥10), potentially suggesting niche adaptation. However, genome type did not match an association with the diverse avian seabird hosts investigated but matched the clonal complex they originated from, perhaps reflecting the isolates evolutionary history. Questions that should be addressed in future studies are (i) how is plasmid diversity related to host- and/or vector adaptation; (ii) do the different seabird species differ in reservoir host competence, and (iii) can the genome types found in seabirds use terrestrial birds as reservoir hosts.
Collapse
Affiliation(s)
- Gabriele Margos
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Markus Hofmann
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Sherwood Casjens
- Pathology Department, School of Medicine, University of Utah, 15 North Medical Drive East Ste. #1100, Salt Lake City, UT 84112, USA.
| | - Marlene Dupraz
- MIVEGEC, University of Montpellier - CNRS - IRD, Centre IRD, Domaine La Valette - 900, rue Jean François BRETON, 34090 Montpellier, France
| | - Susanne Heinzinger
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Christine Hartberger
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Sabrina Hepner
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Mercy Schmeusser
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Andreas Sing
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Volker Fingerle
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany.
| | - Karen D McCoy
- MIVEGEC, University of Montpellier - CNRS - IRD, Centre IRD, Domaine La Valette - 900, rue Jean François BRETON, 34090 Montpellier, France.
| |
Collapse
|
7
|
Del Giudice P, Freychet F, Kopec L, Fenollar F, Eldin C, Velin M, Hubiche T, Raoult D, Mediannikov O. Erythema Migrans Caused by Borrelia spielmanii, France. Emerg Infect Dis 2023; 29:2366-2369. [PMID: 37877610 PMCID: PMC10617338 DOI: 10.3201/eid2911.230149] [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: 10/26/2023] Open
Abstract
We describe a rare case of early Lyme borreliosis in France caused by Borrelia spielmanii, which manifested as a large erythema chronicum migrans rash. The patient completely recovered after a 15-day course of amoxicillin. Absence of pathognomonic signs prevented distinguishing B. spielmanii from other etiologies as cause in this case-patient.
Collapse
|
8
|
Grąźlewska W, Holec-Gąsior L. Antibody Cross-Reactivity in Serodiagnosis of Lyme Disease. Antibodies (Basel) 2023; 12:63. [PMID: 37873860 PMCID: PMC10594444 DOI: 10.3390/antib12040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
Lyme disease is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex. The disease is characterized by a varied course; therefore, the basis for diagnosis is laboratory methods. Currently, a two-tiered serological test is recommended, using an ELISA as a screening test and a Western blot as a confirmatory test. This approach was introduced due to the relatively high number of false-positive results obtained when using an ELISA alone. However, even this approach has not entirely solved the problem of false-positive results caused by cross-reactive antibodies. Many highly immunogenic B. burgdorferi s.l. proteins are recognized nonspecifically by antibodies directed against other pathogens. This also applies to antigens, such as OspC, BmpA, VlsE, and FlaB, i.e., those commonly used in serodiagnostic assays. Cross-reactions can be caused by both bacterial (relapsing fever Borrelia, Treponema pallidum) and viral (Epstein-Baar virus, Cytomegalovirus) infections. Additionally, a rheumatoid factor has also been shown to nonspecifically recognize B. burgdorferi s.l. proteins, resulting in false-positive results. Therefore, it is necessary to carefully interpret the results of serodiagnostic tests so as to avoid overdiagnosis of Lyme disease, which causes unnecessary implementations of strong antibiotic therapies and delays in the correct diagnosis.
Collapse
Affiliation(s)
| | - Lucyna Holec-Gąsior
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdansk University of Technology, 80-233 Gdansk, Poland;
| |
Collapse
|
9
|
Hunfeld KP, Kraiczy P, Norris DE, Lohr B. The In Vitro Antimicrobial Susceptibility of Borrelia burgdorferi sensu lato: Shedding Light on the Known Unknowns. Pathogens 2023; 12:1204. [PMID: 37887720 PMCID: PMC10609913 DOI: 10.3390/pathogens12101204] [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: 08/20/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/28/2023] Open
Abstract
Human Lyme borreliosis (LB) represents a multisystem disorder that can progress in stages. The causative agents are transmitted by hard ticks of the Ixodes ricinus complex that have been infected with the spirochete Borrelia burgdorferi sensu lato. Today, LB is considered the most important human tick-borne illness in the Northern Hemisphere. The causative agent was identified and successfully isolated in 1982 and, shortly thereafter, antibiotic treatment was found to be safe and efficacious. Since then, various in vitro studies have been conducted in order to improve our knowledge of the activity of antimicrobial agents against B. burgdorferi s. l. The full spectrum of in vitro antibiotic susceptibility has still not been defined for some of the more recently developed compounds. Moreover, our current understanding of the in vitro interactions between B. burgdorferi s. l. and antimicrobial agents, and their possible mechanisms of resistance remains very limited and is largely based on in vitro susceptibility experiments on only a few isolates of Borrelia. Even less is known about the possible mechanisms of the in vitro persistence of spirochetes exposed to antimicrobial agents in the presence of human and animal cell lines. Only a relatively small number of laboratory studies and cell culture experiments have been conducted. This review summarizes what is and what is not known about the in vitro susceptibility of B. burgdorferi s. l. It aims to shed light on the known unknowns that continue to fuel current debates on possible treatment resistance and mechanisms of persistence of Lyme disease spirochetes in the presence of antimicrobial agents.
Collapse
Affiliation(s)
- Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Academic Teaching Hospital, Medical Faculty, Goethe University Frankfurt, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Germany;
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Ubierstraße 20, D-40223 Düsseldorf, Germany
| | - Peter Kraiczy
- Institute for Medical Microbiology & Infection Control, University Hospital Frankfurt, Goethe University Frankfurt, Paul-Ehrlich Str. 40, D-60596 Frankfurt am Main, Germany;
| | - Douglas E. Norris
- W. Harry Feinstone Department of Molecular Microbiology & Immunology, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA;
| | - Benedikt Lohr
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Academic Teaching Hospital, Medical Faculty, Goethe University Frankfurt, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Germany;
| |
Collapse
|
10
|
Carrera M, Tolini C, Trogu T, Boscarino A, Tranquillo V, Munari M, Callegari E, Tartari D, Moreno A, Rubini S. Spatiotemporal Distribution of Salmonella enterica in European Hedgehogs in Northern Italy. Pathogens 2023; 12:946. [PMID: 37513793 PMCID: PMC10385418 DOI: 10.3390/pathogens12070946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Growing attention is being given to the European hedgehog (Erinaceus europaeus) because of its synanthropic behaviour and its potential role in harbouring parasites, viruses, fungi and bacteria and disseminating them to several animals and humans. Salmonella are the most frequently detected zoonotic bacteria that hedgehogs could transmit through contaminating water and food sources with faeces. This study aimed to determine the prevalence and distribution of Salmonella spp. in wild hedgehogs in the Emilia-Romagna region (northern Italy). From 2019 to 2022, 212 European hedgehogs that died naturally were tested for Salmonella spp. through culture isolation. Positive samples were subjected to serological typing. A total of 82 samples tested positive for Salmonella spp., with the overall Bayesian posterior estimated prevalence ranging from 35% (95% CI: 23-47%) to a maximum of 45% (95% CI: 31-59%) during the years considered and with an overall prevalence calculated at 39% (95% CI: 33-45%). Salmonella enterica Enteritidis and Veneziana were the most prevalent detected serovars in 65% and 17% of the positive samples, respectively. Since 2021, S. Typhimurium, S. Typhimurium Monofasica, S. Zaiman, S. Hessarek, S. Muenster, S. Isangi serovars, S. enterica subsp. Diarizonae and S. enterica subsp. Houtenae have been detected. These findings show a high prevalence of Salmonella spp. in tested hedgehogs, suggesting an important role of this animal species in the epidemiology of potentially zoonotic serovars circulating in the Emilia-Romagna region.
Collapse
Affiliation(s)
- Maya Carrera
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Clara Tolini
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Tiziana Trogu
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Andrea Boscarino
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Vito Tranquillo
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Martina Munari
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Emanuele Callegari
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Davide Tartari
- LIPU Lega Italiana per la Protezione degli Uccelli, "Il Giardino delle Capinere", Via Porta Catena 118, 44122 Ferrara, Italy
| | - Ana Moreno
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| | - Silva Rubini
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IZSLER), Via Antonio Bianchi 7/9, 25124 Brescia, Italy
| |
Collapse
|
11
|
Olsen J, Angulo FJ, Pilz A, Halsby K, Kelly P, Brestrich G, Stark JH, Jodar L. Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment. Public Health 2023; 219:1-9. [PMID: 37075486 DOI: 10.1016/j.puhe.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment. METHODS Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany. RESULTS Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case. CONCLUSIONS We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.
Collapse
Affiliation(s)
- J Olsen
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
| | - F J Angulo
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - A Pilz
- Vaccines, Pfizer Corporation Austria, Floridsdorfer Hauptstrasse 1, 1210 Wien, Vienna, Austria
| | - K Halsby
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - P Kelly
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - G Brestrich
- Vaccines, Pfizer Pharma GmbH, Linkstrasse 10, 10785 Berlin, Germany
| | - J H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - L Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| |
Collapse
|
12
|
Golidonova K, Korenberg E, Krupinskaya E, Matrosova V, Gintsburg A. Allelic Variants of P66 Gene in Borrelia bavariensis Isolates from Patients with Ixodid Tick-Borne Borreliosis. Microorganisms 2022; 10:microorganisms10122509. [PMID: 36557762 PMCID: PMC9782215 DOI: 10.3390/microorganisms10122509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Protein P66 is one of the crucial virulence factors of Borrelia, inducing the production of specific antibodies in patients with ixodid tick-borne borreliosis (ITBB). Various species of Borrelia are characterized by genetic variability of the surface-exposed loop of P66. However, little is known about this variability in Borrelia bavariensis. Here we describe the variability of the nucleotide sequences of P66 gene locus in isolates of B. bavariensis. Analysis of nucleotide sequences of P66 in 27 isolates of B. bavariensis from ITBB patients revealed three allelic variants of this gene. The alignment score of amino acid sequences in the isolates showed amino acid replacements in various positions confirming the presence of three allelic variants. Two of them are characteristic only for some isolates of B. bavariensis of the Eurasian gene pool from various parts of the geographic ranges of B. bavariensis from various samples. At least three allelic variants of P66 B. bavariensis have been identified, which have different amino acid expression, occur with different frequency in ITBB patients and, presumably, can have different effects on the course of the infection.
Collapse
Affiliation(s)
- Kristina Golidonova
- N. F. Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia
- Correspondence: ; Tel.: +7-985-337-01-85
| | - Eduard Korenberg
- N. F. Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Ekaterina Krupinskaya
- N. F. Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Vera Matrosova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Alexander Gintsburg
- N. F. Gamaleya National Research Centre for Epidemiology and Microbiology, 123098 Moscow, Russia
| |
Collapse
|
13
|
Terriere N, Glazemaekers E, Bregman S, Rasschaert G, Willems S, Boyen F, Lens L, Baeten L, Verheyen K, Pasmans F, Strubbe D, Martel A. Zoonotic pathogens linked with hedgehog diphtheric disease. Transbound Emerg Dis 2022; 69:3618-3623. [PMID: 36219469 DOI: 10.1111/tbed.14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 02/07/2023]
Abstract
Hedgehog diphtheric disease (HDD), an ulcerative skin disease with a high fatality rate, is an emerging threat to European hedgehogs (Erinaceus europaeus). We explored the potential role of a panel of zoonotic pathogens in the presumed multifactorial nature of HDD in 188 hedgehogs from 3 wildlife rescue centres in Belgium. As expected, and with a prevalence of 67% in 57 hedgehogs with skin lesions, characteristic of HDD, the occurrence of Corynebacterium ulcerans was strongly associated with the disease. Remarkably, with a prevalence of 42% in affected animals, infections with Borrelia burgdorferi sensu lato were 3.92 times more likely to be detected in HDD (95% confidence interval: 1.650-9.880; p = .0024). Overall, 40 hedgehogs tested positive for the B. burgdorferi sensu lato complex, including Borrelia afzelii (n = 30), Borrelia bavariensis (n = 7) and Borrelia spielmanii (n = 7). Other widely occurring pathogens included Salmonella (prevalence of 19%, with three pulsed-field gel electrophoresis profiles) and Leptospira sp. (prevalence of 11%, including Leptospira interrogans and Leptospira borgpetersenii), but these were not associated with the occurrence of HDD. These findings show that hedgehogs in Belgium represent a significant reservoir of multiple zoonotic bacteria, of which toxigenic C. ulcerans and B. burgdorferi sensu lato are associated with widespread hedgehog skin pathology and mortality.
Collapse
Affiliation(s)
- Naomi Terriere
- Wildlife Health Ghent, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Evelien Glazemaekers
- Wildlife Health Ghent, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Seline Bregman
- Wildlife Health Ghent, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Geertrui Rasschaert
- Institute for Agricultural and Fisheries Research, Technology and Food Science Unit, Melle, Belgium
| | - Sjarlotte Willems
- Institute for Agricultural and Fisheries Research, Technology and Food Science Unit, Melle, Belgium
| | - Filip Boyen
- Wildlife Health Ghent, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Lens
- Department of Biology, Terrestrial Ecology Unit, Ghent University, Campus Ledeganck, Ghent, Belgium
| | - Lander Baeten
- Department of Environment, Forest & Nature Lab, Melle-Gontrode, Belgium
| | - Kris Verheyen
- Department of Environment, Forest & Nature Lab, Melle-Gontrode, Belgium
| | - Frank Pasmans
- Wildlife Health Ghent, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Diederik Strubbe
- Department of Biology, Terrestrial Ecology Unit, Ghent University, Campus Ledeganck, Ghent, Belgium
| | - An Martel
- Wildlife Health Ghent, Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
14
|
Vaccines for Lyme Borreliosis: Facts and Challenges. FOLIA VETERINARIA 2022. [DOI: 10.2478/fv-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Lyme borreliosis (LB) is a multisystem infectious disease abundant in the northern countries of the world and is caused by Borrelia species. Vaccination against LB is an effective way to prevent and reduce the number of diseases in endemic areas. Several vaccines have been developed and tested in the past, but no human LB vaccine is currently available on the market. This review aims to uncover and delineate various strategies and diverse technological approaches related to vaccine production. Furthermore, we characterize already tested vaccines, possibilities for their future development, and reasons for their failure.
Collapse
|
15
|
Hromníková D, Furka D, Furka S, Santana JAD, Ravingerová T, Klöcklerová V, Žitňan D. Prevention of tick-borne diseases: challenge to recent medicine. Biologia (Bratisl) 2022; 77:1533-1554. [PMID: 35283489 PMCID: PMC8905283 DOI: 10.1007/s11756-021-00966-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
Abstract Ticks represent important vectors and reservoirs of pathogens, causing a number of diseases in humans and animals, and significant damage to livestock every year. Modern research into protection against ticks and tick-borne diseases focuses mainly on the feeding stage, i.e. the period when ticks take their blood meal from their hosts during which pathogens are transmitted. Physiological functions in ticks, such as food intake, saliva production, reproduction, development, and others are under control of neuropeptides and peptide hormones which may be involved in pathogen transmission that cause Lyme borreliosis or tick-borne encephalitis. According to current knowledge, ticks are not reservoirs or vectors for the spread of COVID-19 disease. The search for new vaccination methods to protect against ticks and their transmissible pathogens is a challenge for current science in view of global changes, including the increasing migration of the human population. Highlights • Tick-borne diseases have an increasing incidence due to climate change and increased human migration • To date, there is no evidence of transmission of coronavirus COVID-19 by tick as a vector • To date, there are only a few modern, effective, and actively- used vaccines against ticks or tick-borne diseases • Neuropeptides and their receptors expressed in ticks may be potentially used for vaccine design
Collapse
Affiliation(s)
- Dominika Hromníková
- Department of Molecular Physiology, Slovak Academy of Sciences, Institute of Zoology, Dúbravská cesta 9, 84506 Bratislava, Slovakia
| | - Daniel Furka
- Faculty of Natural Sciences, Department of Physical and Theoretical Chemistry, Comenius University, Mlynská dolina, Ilkovičova 6, 84104 Bratislava, SK Slovakia
- Department of Cardiovascular Physiology and Pathophysiology, Slovak Academy of Sciences, Institute of Heart Research, Dúbravská cesta 9, SK 84005 Bratislava, Slovakia
| | - Samuel Furka
- Faculty of Natural Sciences, Department of Physical and Theoretical Chemistry, Comenius University, Mlynská dolina, Ilkovičova 6, 84104 Bratislava, SK Slovakia
- Department of Cardiovascular Physiology and Pathophysiology, Slovak Academy of Sciences, Institute of Heart Research, Dúbravská cesta 9, SK 84005 Bratislava, Slovakia
| | - Julio Ariel Dueñas Santana
- Chemical Engineering Department, University of Matanzas, Km 3 Carretera a Varadero, 44740 Matanzas, CU Cuba
| | - Táňa Ravingerová
- Department of Cardiovascular Physiology and Pathophysiology, Slovak Academy of Sciences, Institute of Heart Research, Dúbravská cesta 9, SK 84005 Bratislava, Slovakia
| | - Vanda Klöcklerová
- Department of Molecular Physiology, Slovak Academy of Sciences, Institute of Zoology, Dúbravská cesta 9, 84506 Bratislava, Slovakia
| | - Dušan Žitňan
- Department of Molecular Physiology, Slovak Academy of Sciences, Institute of Zoology, Dúbravská cesta 9, 84506 Bratislava, Slovakia
| |
Collapse
|
16
|
Utilizing Two Borrelia bavariensis Isolates Naturally Lacking the PFam54 Gene Array To Elucidate the Roles of PFam54-Encoded Proteins. Appl Environ Microbiol 2022; 88:e0155521. [PMID: 34986011 DOI: 10.1128/aem.01555-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lyme borreliosis is the most common vector-borne disease in the Northern Hemisphere, caused by spirochetes belonging to the Borrelia burgdorferi sensu lato species complex, which are transmitted by ixodid ticks. B. burgdorferi sensu lato species produce a family of proteins on the linear plasmid 54 (PFam54), some of which confer the functions of cell adhesion and inactivation of complement, the first line of host defense. However, the impact of PFam54 in promoting B. burgdorferi sensu lato pathogenesis remains unclear because of the hurdles to simultaneously knock out all PFam54 proteins in a spirochete. Here, we describe two Borrelia bavariensis strains, PBN and PNi, isolated from patients naturally lacking PFam54 but maintaining the rest of the genome with greater than 95% identity to the reference B. bavariensis strain, PBi. We found that PBN and PNi less efficiently survive in human serum than PBi. Such defects were restored by introducing two B. bavariensis PFam54 recombinant proteins, BGA66 and BGA71, confirming the role of these proteins in providing complement evasion of B. bavariensis. Further, we found that all three strains remain detectable in various murine tissues 21 days post-subcutaneous infection, supporting the nonessential role of B. bavariensis PFam54 in promoting spirochete persistence. This study identified and utilized isolates deficient in PFam54 to associate the defects with the absence of these proteins, building the foundation to further study the role of each PFam54 protein in contributing to B. burgdorferi sensu lato pathogenesis. IMPORTANCE To establish infections, Lyme borreliae utilize various means to overcome the host's immune system. Proteins encoded by the PFam54 gene array play a role in spirochete survival in vitro and in vivo. Moreover, this gene array has been described in all currently available Lyme borreliae genomes. By investigating the first two Borrelia bavariensis isolates naturally lacking the entire PFam54 gene array, we showed that both patient isolates display an increased susceptibility to human serum, which can be rescued in the presence of two PFam54 recombinant proteins. However, both isolates remain infectious to mice after intradermal inoculation, suggesting the nonessential role of PFam54 during the long-term, but may differ slightly in the colonization of specific tissues. Furthermore, these isolates show high genomic similarity to type strain PBi (>95%) and could be used in future studies investigating the role of each PFam54 protein in Lyme borreliosis pathogenesis.
Collapse
|
17
|
Böhmer MM, Ens K, Böhm S, Heinzinger S, Fingerle V. Epidemiological Surveillance of Lyme Borreliosis in Bavaria, Germany, 2013-2020. Microorganisms 2021; 9:microorganisms9091872. [PMID: 34576768 PMCID: PMC8467410 DOI: 10.3390/microorganisms9091872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 01/12/2023] Open
Abstract
Lyme borreliosis (LB) is the most common tick-borne disease in Germany. Mandatory notification of acute LB manifestations (erythema migrans (EM), neuroborreliosis (NB), and Lyme arthritis (LA)) was implemented in Bavaria on 1 March 2013. We aimed to describe the epidemiological situation and to identify LB risk areas and populations. Therefore, we analyzed LB cases notified from March 2013 to December 2020 and calculated incidence (cases/100,000 inhabitants) by time, place, and person. Overall, 35,458 cases were reported during the study period (EM: 96.7%; NB: 1.7%; LA: 1.8%). The average incidence was 34.3/100,000, but annual incidence varied substantially (2015: 23.2; 2020: 47.4). Marked regional differences at the district level were observed (annual average incidence range: 4–154/100,000). The Bavarian Forest and parts of Franconia were identified as high-risk regions. Additionally, high risk for LB was found in 5–9-year-old males and in 60–69-year-old females. The first group also had the highest risk of a severe disease course. We were able to identify areas and populations in Bavaria with an increased LB risk, thereby providing a basis for targeted measures to prevent LB. Since LB vaccination is currently not available, such measures should comprise (i) avoiding tick bites, (ii) removing ticks rapidly after a bite, and (iii) treating LB early/adequately.
Collapse
Affiliation(s)
- Merle Margarete Böhmer
- Department for Infectious Disease Epidemiology, Taskforce Infectiology, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-9131-6808-5634
| | - Katharina Ens
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich (LMU), 81377 Munich, Germany;
| | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, 80636 Munich, Germany;
| | - Susanne Heinzinger
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (S.H.); (V.F.)
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (S.H.); (V.F.)
- National Reference Centre for Borrelia, 85764 Oberschleissheim, Germany
| |
Collapse
|
18
|
Bobe JR, Jutras BL, Horn EJ, Embers ME, Bailey A, Moritz RL, Zhang Y, Soloski MJ, Ostfeld RS, Marconi RT, Aucott J, Ma'ayan A, Keesing F, Lewis K, Ben Mamoun C, Rebman AW, McClune ME, Breitschwerdt EB, Reddy PJ, Maggi R, Yang F, Nemser B, Ozcan A, Garner O, Di Carlo D, Ballard Z, Joung HA, Garcia-Romeu A, Griffiths RR, Baumgarth N, Fallon BA. Recent Progress in Lyme Disease and Remaining Challenges. Front Med (Lausanne) 2021; 8:666554. [PMID: 34485323 PMCID: PMC8416313 DOI: 10.3389/fmed.2021.666554] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Lyme disease (also known as Lyme borreliosis) is the most common vector-borne disease in the United States with an estimated 476,000 cases per year. While historically, the long-term impact of Lyme disease on patients has been controversial, mounting evidence supports the idea that a substantial number of patients experience persistent symptoms following treatment. The research community has largely lacked the necessary funding to properly advance the scientific and clinical understanding of the disease, or to develop and evaluate innovative approaches for prevention, diagnosis, and treatment. Given the many outstanding questions raised into the diagnosis, clinical presentation and treatment of Lyme disease, and the underlying molecular mechanisms that trigger persistent disease, there is an urgent need for more support. This review article summarizes progress over the past 5 years in our understanding of Lyme and tick-borne diseases in the United States and highlights remaining challenges.
Collapse
Affiliation(s)
- Jason R. Bobe
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brandon L. Jutras
- Department of Biochemistry, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA, United States
| | | | - Monica E. Embers
- Tulane University Health Sciences, New Orleans, LA, United States
| | - Allison Bailey
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Ying Zhang
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mark J. Soloski
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Richard T. Marconi
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - John Aucott
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Avi Ma'ayan
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Kim Lewis
- Department of Biology, Northeastern University, Boston, MA, United States
| | | | - Alison W. Rebman
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mecaila E. McClune
- Department of Biochemistry, Fralin Life Sciences Institute, Virginia Tech, Blacksburg, VA, United States
| | - Edward B. Breitschwerdt
- Department of Clinical Sciences, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | | | - Ricardo Maggi
- Department of Clinical Sciences, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Frank Yang
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bennett Nemser
- Steven & Alexandra Cohen Foundation, Stamford, CT, United States
| | - Aydogan Ozcan
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Omai Garner
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Dino Di Carlo
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Zachary Ballard
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Hyou-Arm Joung
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roland R. Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicole Baumgarth
- Center for Immunology and Infectious Diseases and the Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Brian A. Fallon
- Columbia University Irving Medical Center, New York, NY, United States
| |
Collapse
|
19
|
Hedgehogs as a Potential Source of Zoonotic Pathogens-A Review and an Update of Knowledge. Animals (Basel) 2021; 11:ani11061754. [PMID: 34208276 PMCID: PMC8230866 DOI: 10.3390/ani11061754] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Up to date studies indicate that wild hedgehogs may act as carriers and/or hosts for bacterial, viral, and fungal pathogens with zoonotic potential, posing a significant threat to humans. The same applies to domestic hedgehogs, which are increasingly kept as pets. Considering the potential risk of infection to humans through close contact with hedgehogs or the contaminated environment they inhabit, current data on the prevalence of various zoonotic pathogens in these animals is desirable. Abstract Hedgehogs are small insectivorous mammals common across Europe, Asia, and Africa. The increased encroachment of humans into hedgehog habitats has disrupted the human-animal-environment interface. With growing interest in the zoonotic diseases of wildlife species, more studies have been devoted to this subject in the last few years. These papers provide information about known and new emerging diseases. Here we review the current knowledge regarding bacterial, viral, protozoic, and mycotic pathogens with zoonotic potential and assess the importance of hedgehogs as their carriers. Both wild and pet hedgehogs were included in the review. Data from several countries and various hedgehog species were included. The study shows the importance of hedgehogs as carriers of zoonotic diseases and reservoirs of zoonotic pathogens in varied habitats.
Collapse
|
20
|
Răileanu C, Silaghi C, Fingerle V, Margos G, Thiel C, Pfister K, Overzier E. Borrelia burgdorferi Sensu Lato in Questing and Engorged Ticks from Different Habitat Types in Southern Germany. Microorganisms 2021; 9:microorganisms9061266. [PMID: 34200876 PMCID: PMC8230558 DOI: 10.3390/microorganisms9061266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/31/2022] Open
Abstract
Borrelia burgdorferi sensu lato (s.l.) causes the most common tick-borne infection in Europe, with Germany being amongst the countries with the highest incidences in humans. This study aimed at (1) comparing infection rates of B. burgdorferi s.l. in questing Ixodes ricinus ticks from different habitat types in Southern Germany, (2) analysing genospecies distribution by habitat type, and (3) testing tissue and ticks from hosts for B. burgdorferi s.l. Questing ticks from urban, pasture, and natural habitats together with feeding ticks from cattle (pasture) and ticks and tissue samples from wild boars and roe deer (natural site) were tested by PCR and RFLP for species differentiation. B. burgdorferi s.l. was found in 29.8% questing adults and 15% nymphs. Prevalence was lower at the urban sites with occurrence of roe deer than where these were absent. Borrelia burgdorferi s.l. DNA was found in 4.8% ticks from roe deer, 6.3% from wild boar, and 7.8% from cattle. Six genospecies were identified in unfed ticks: Borrelia afzelii (48.6%), Borrelia burgdorferi sensu stricto (16%), Borrelia garinii (13.2%), Borrelia valaisiana (7.5%), Borrelia spielmanii (6.2%), and Borrelia bavariensis (0.9%). This study shows high infection levels and a great diversity of Borrelia in questing ticks. The presence of roe deer seems to reduce B. burgdorferi s.l. infection rates in tick populations.
Collapse
Affiliation(s)
- Cristian Răileanu
- Institute of Infectology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany;
| | - Cornelia Silaghi
- Institute of Infectology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany;
- Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, 80805 Munich, Germany; (C.T.); (K.P.); (E.O.)
- Correspondence:
| | - Volker Fingerle
- National Reference Center for Borrelia, Bavarian Health and Food Safety Authority (LGL), 85764 Oberschleißheim, Germany; (V.F.); (G.M.)
| | - Gabriele Margos
- National Reference Center for Borrelia, Bavarian Health and Food Safety Authority (LGL), 85764 Oberschleißheim, Germany; (V.F.); (G.M.)
| | - Claudia Thiel
- Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, 80805 Munich, Germany; (C.T.); (K.P.); (E.O.)
| | - Kurt Pfister
- Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, 80805 Munich, Germany; (C.T.); (K.P.); (E.O.)
| | - Evelyn Overzier
- Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, 80805 Munich, Germany; (C.T.); (K.P.); (E.O.)
| |
Collapse
|
21
|
Spatial variability in prevalence and genospecies distributions of Borrelia burgdorferi sensu lato from ixodid ticks collected in southern Germany. Ticks Tick Borne Dis 2020; 12:101589. [PMID: 33096511 DOI: 10.1016/j.ttbdis.2020.101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022]
Abstract
Lyme borreliosis (LB) is the most common arthropod-borne disease in Europe and North America and is caused by members of the Borrelia burgdorferi sensu lato (Bbsl) species complex. These bacteria are transmitted by ixodid tick vectors and therefore human LB risk is influenced by the prevalence and distribution of Bbsl genospecies within tick vectors throughout the wild. These distributions can easily change over spatiotemporal scales and, to understand LB risk fully, up to date information on prevalence and distribution of Bbsl is required. The last survey of Bbsl in southern Germany, including parts of the Munich metropolitan area, was completed in 2006 and new data is needed. Ixodid ticks were collected in seven plots located in and around Munich, Germany, from March to July 2019 and were screened for Bbsl. Borrelia burgdorferi s. l. positive ticks (52 adults, 158 nymphs) were found in all plots and adults (0-61.5 % Bbsl positive/plot) and nymphs (17.4-59.5 % Bbsl positive/plot) did not differ significantly in their overall Bbsl prevalence. The number of Bbsl positive nymphs did vary significantly between plots but the number of positive adults did not. In total, six Bbsl genospecies were located with B. afzelii and B. garinii dominating. Additionally, the relapsing-fever species B. miyamotoi was found in two sampling plots. Our results highlight the variability in Bbsl prevalence and genospecies distribution over short geographic distances and aid in understanding LB risk in and around the Munich metropolitan area.
Collapse
|
22
|
Dulipati V, Meri S, Panelius J. Complement evasion strategies of Borrelia burgdorferi sensu lato. FEBS Lett 2020; 594:2645-2656. [PMID: 32748966 DOI: 10.1002/1873-3468.13894] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023]
Abstract
Borreliosis (Lyme disease) is a spirochetal disease caused by the species complex of Borrelia burgdorferi transmitted by Ixodes spp. ticks. Recorded to be the most common tick-borne disease in the world, the last two decades have seen an increase in disease incidence and distribution, exceeding 360 000 cases in Europe alone. If untreated, infection may cause skin symptoms, arthritis, and neurological or cardiac complications. Borrelia spirochetes have developed strategies to evade the mammalian host immune system. These include the complement system, which is an important first-line defense mechanism against invading microbes. To evade the complement, spirochetes bind soluble complement regulators factor H (FH), factor H-like protein, and C4bp to their outer surfaces. B. burgdorferi spirochetes can inhibit the classical pathway of complement by the outer surface protein (Osp) BBK32, which blocks the activation of the C1 complex, composed of C1q, C1r, and C1s. The FH-binding proteins of borreliae include Osps OspE, CspA, and CspZ. Following repeated infections, antibodies against these proteins develop and may provide functional immunity against borreliosis. This review discusses critical immune evasion strategies, focusing on complement evasion by borreliae.
Collapse
Affiliation(s)
- Vinaya Dulipati
- Department of Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Seppo Meri
- Department of Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Jaana Panelius
- Department of Dermatology and Allergology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
23
|
Naddaf SR, Mahmoudi A, Ghasemi A, Rohani M, Mohammadi A, Ziapour SP, Nemati AH, Mostafavi E. Infection of hard ticks in the Caspian Sea littoral of Iran with Lyme borreliosis and relapsing fever borreliae. Ticks Tick Borne Dis 2020; 11:101500. [PMID: 32993956 DOI: 10.1016/j.ttbdis.2020.101500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
The Caspian Sea littoral of Iran is home to various hard tick species, including Ixodes ricinus, the notorious vector of Lyme borreliosis (LB) in Eurasia. Here, in this area, we examined I. ricinus and other hard ticks, along with common rodents and small mammals for LB and relapsing fever (RF) borreliae infection. Ticks were collected from various mammalian hosts, including sheep, goats, cattle, camels, horses, dogs, donkeys, rodents, and hedgehogs. Rodents and small mammals were live-captured from different habitats. A real-time PCR for 16S rRNA sequence revealed borrelial DNA in 71 out of 501 (≈14 %) specimens belonging to I. ricinus and Rhipicephalus ticks. None of the rodents and small mammals showed borrelial infection in the viscera. PCR amplification and sequencing of a 600-bp sequence of the flaB identified Borrelia bavariensis, Borrelia garinii, Borrelia afzelii, and Borrelia valaisiana, and the RF Borrelia, B. miyamotoi in I. ricinus ticks. The RF-like Borrelia in Rhipicephalus ticks shared the highest identity (98.97 %) with an isolate infecting Haemaphysalis megaspinosa ticks in Japan. Our phylogeny and BLAST analysis suggest the range extension of the European I. ricinus-associated borreliae into the north of Iran.
Collapse
Affiliation(s)
- Saied Reza Naddaf
- Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran.
| | - Ahmad Mahmoudi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| | - Ahmad Ghasemi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| | - Mahdi Rohani
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran; Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Ali Mohammadi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| | - Seyyed Payman Ziapour
- Department of Parasitology, Zoonosis Research Center, Pasteur Institute of Iran, Amol, Mazandaran, Iran
| | - Amir Hesam Nemati
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| | - Ehsan Mostafavi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| |
Collapse
|
24
|
Broadly Protective Multivalent OspA Vaccine against Lyme Borreliosis, Developed Based on Surface Shaping of the C-Terminal Fragment. Infect Immun 2020; 88:IAI.00917-19. [PMID: 31932330 DOI: 10.1128/iai.00917-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/22/2019] [Indexed: 12/14/2022] Open
Abstract
The development of vaccines for prevention of diseases caused by pathogenic species can encounter major obstacles if high sequence diversity is observed between individual strains. Therefore, development might be restricted either to conserved antigens, which are often rare, or to multivalent vaccines, which renders the production more costly and cumbersome. In light of this complexity, we applied a structure-based surface shaping approach for the development of a Lyme borreliosis (LB) vaccine suitable for the United States and Europe. The surface of the C-terminal fragment of outer surface protein A (OspA) was divided into distinct regions, based primarily on binding sites of monoclonal antibodies (MAbs). In order to target the six clinically most relevant OspA serotypes (ST) in a single protein, exposed amino acids of the individual regions were exchanged to corresponding amino acids of a chosen OspA serotype. Six chimeric proteins were constructed, and, based on their immunogenicity, four of these chimeras were tested in mouse challenge models. Significant protection could be demonstrated for all four proteins following challenge with infected ticks (OspA ST1, OspA ST2, and OspA ST4) or with in vitro-grown spirochetes (OspA ST1 and OspA ST5). Two of the chimeric proteins were linked to form a fusion protein, which provided significant protection against in vitro-grown spirochetes (OspA ST1) and infected ticks (OspA ST2). This article presents the proof-of-concept study for a multivalent OspA vaccine targeting a wide range of pathogenic LB Borrelia species with a single recombinant antigen for prevention of Lyme borreliosis.
Collapse
|
25
|
Rauer S, Kastenbauer S, Hofmann H, Fingerle V, Huppertz HI, Hunfeld KP, Krause A, Ruf B, Dersch R. Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2020; 18:Doc03. [PMID: 32341686 PMCID: PMC7174852 DOI: 10.3205/000279] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Lyme borreliosis is the most common tick-borne infectious disease in Europe. A neurological manifestation occurs in 3–15% of infections and can manifest as polyradiculitis, meningitis and (rarely) encephalomyelitis. This S3 guideline is directed at physicians in private practices and clinics who treat Lyme neuroborreliosis in children and adults. Twenty AWMF member societies, the Robert Koch Institute, the German Borreliosis Society and three patient organisations participated in its development. A systematic review and assessment of the literature was conducted by the German Cochrane Centre, Freiburg (Cochrane Germany). The main objectives of this guideline are to define the disease and to give recommendations for the confirmation of a clinically suspected diagnosis by laboratory testing, antibiotic therapy, differential diagnostic testing and prevention.
Collapse
Affiliation(s)
| | | | | | - Volker Fingerle
- German Society for Hygiene and Microbiology (DGHM), Münster, Germany
| | - Hans-Iko Huppertz
- German Society of Paediatrics and Adolescent Medicine (DGKJ), Berlin, Germany.,German Society of Paediatric Infectology (DGPI), Berlin, Germany
| | - Klaus-Peter Hunfeld
- The German United Society of Clinical Chemistry and Laboratory Medicine (DGKL), Bonn, Germany.,INSTAND e.V., Düsseldorf, Germany
| | | | - Bernhard Ruf
- German Society of Infectious Diseases (DGI), Berlin, Germany
| | - Rick Dersch
- German Society of Neurology (DGN), Berlin, Germany.,Cochrane Germany, Faculty of Medicine, University of Freiburg, Germany
| | | |
Collapse
|
26
|
Borrelia prevalence and species distribution in ticks removed from humans in Germany, 2013-2017. Ticks Tick Borne Dis 2019; 11:101363. [PMID: 31987819 DOI: 10.1016/j.ttbdis.2019.101363] [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: 07/02/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 12/15/2022]
Abstract
Lyme borreliosis caused by spirochaetes of the Borrelia burgdorferi sensu lato (s.l.) complex is the most common tick-borne disease in Europe. In addition, the relapsing-fever spirochaete Borrelia miyamotoi, which has been associated with febrile illness and meningoencephalitis in immunocompromised persons, is present in Europe. This study investigated Borrelia prevalence and species distribution in ticks removed from humans and sent as diagnostic material to the Institute for Parasitology, University of Veterinary Medicine Hannover, in 2013-2017. A probe-based real-time PCR was carried out and Borrelia-positive samples were subjected to species determination by reverse line blot (RLB), including a B. miyamotoi-specific probe. The overall Borrelia-infection rate as determined by real-time PCR was 20.02 % (510/2547, 95 % CI: 18.48-21.63 %), with annual prevalences ranging from 17.17 % (90/524, 95 % CI: 14.04-20.68 %) in 2014 to 24.12 % (96/398, 95 % CI: 19.99-28.63 %) in 2015. In total, 271/475 (57.1 %) positive samples available for RLB were successfully differentiated. Borrelia afzelii was detected in 30.53 % of cases (145/475, 95 % CI: 26.41-34.89), followed by B. garinii/B. bavariensis (13.26 % [63/475], 95 % CI: 10.34-16.65). Borrelia valaisiana occurred in 5.89 % (28/475, 95 % CI: 3.95-8.41), B. spielmanii in 4.63 % (22/475, 95 % CI: 2.93-6.93), B. burgdorferi sensu stricto (s.s.)/B. carolinensis in 2.32 % (11/475, 95 % CI: 1.16-4.11), B. lusitaniae in 0.63 % (3/475, 95 % CI: 0.13-1.83) and B. bisettiae in 0.42 % (2/475, 95 % CI: 0.05-1.51) of positive ticks. Borrelia kurtenbachii was not detected, while B. miyamotoi was identified in 7.37 % (35/475, 95 % CI: 5.19-10.10) of real-time PCR-positive samples. Sanger sequencing of B. garinii/B. bavariensis-positive ticks revealed that the majority were B. garinii-infections (50/52 successfully amplified samples), while only 2 ticks were infected with B. bavariensis. Furthermore, 6/12 B. burgdorferi s.s./B. carolinensis-positive samples could be differentiated; all of them were identified as B. burgdorferi sensu stricto. Thirty-nine ticks (8.21 %, 95 % CI: 5.90-11.05) were coinfected with two different species. Comparison of the species distribution between ticks removed from humans in 2015 and questing ticks collected in the same year and the same area revealed a significantly higher B. afzelii-prevalence in diagnostic tick samples than in questing ticks, confirming previous observations. The obtained data indicate that Borrelia prevalence fluctuated in the same range as observed in a previous study, analysing the period from 2006 to 2012. Detection of B. miyamotoi in 7.37 % of Borrelia-positive samples points to the fact that clinicians should be aware of this pathogen as a differential diagnosis in cases of febrile illness.
Collapse
|
27
|
Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel) 2019; 8:antibiotics8040269. [PMID: 31888310 PMCID: PMC6963229 DOI: 10.3390/antibiotics8040269] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease. Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories, CLD, untreated (CLD-U) and CLD, previously treated (CLD-PT). The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more. Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT. Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term's meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease. Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection.
Collapse
|
28
|
Prevention of transmission of Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum by Ixodes spp. ticks to dogs treated with the Seresto® collar (imidacloprid 10% + flumethrin 4.5%). Parasitol Res 2019; 119:299-315. [PMID: 31734862 PMCID: PMC6942034 DOI: 10.1007/s00436-019-06394-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/05/2019] [Indexed: 11/02/2022]
Abstract
The capability of imidacloprid 10% + flumethrin 4.5% (Seresto®) collars to prevent transmission of Borrelia burgdorferi sensu lato (Bbsl) and Anaplasma phagocytophilum (Ap) by naturally infected ticks was evaluated in two studies with 44 dogs. In each study, one group served as non-treated control, whereas the other groups were treated with the Seresto® collar. All dogs were exposed to naturally Bbsl- and Ap-infected hard ticks (Ixodes ricinus, Ixodes scapularis). In study 1, tick infestation was performed on study day (SD) 63 (2 months post-treatment [p.t.]); in study 2, it was performed on SD 32 (one month p.t.) respectively SD 219 (seven months p.t.). In situ tick counts were performed 2 days after infestation. Tick counts and removals followed 6 (study 1) or 5 days (study 2) later. Blood sampling was performed for the detection of specific Bbsl and Ap antibodies and, in study 1, for the documentation of Ap DNA by PCR. Skin biopsies were examined for Bbsl by PCR and culture (only study 1). The efficacy against Ixodes spp. was 100% at all time points. In study 1, two of six non-treated dogs became infected with Bbsl, and four of six tested positive for Ap; none of the treated dogs tested positive for Bbsl or Ap. In study 2, ten of ten non-treated dogs became infected with Bbsl and Ap; none of the treated dogs tested positive for Bbsl or Ap; 100% acaricidal efficacy was shown in both studies. Transmission of Bbsl and Ap was successfully blocked for up to 7 months.
Collapse
|
29
|
Margos G, Fingerle V, Reynolds S. Borrelia bavariensis: Vector Switch, Niche Invasion, and Geographical Spread of a Tick-Borne Bacterial Parasite. Front Ecol Evol 2019. [DOI: 10.3389/fevo.2019.00401] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
30
|
Wang Y, Li S, Wang Z, Zhang L, Cai Y, Liu Q. Prevalence and Identification of Borrelia burgdorferi Sensu Lato Genospecies in Ticks from Northeastern China. Vector Borne Zoonotic Dis 2019; 19:309-315. [PMID: 30907702 DOI: 10.1089/vbz.2018.2316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lyme disease is considered as one of important tick-transmitted zoonosis in northeastern China, where the causative agents, the Borrelia burgdorferi sensu lato (s.l.) complex, remain poorly characterized. The purpose of the present study was to determine the prevalence and genospecies of B. burgdorferi s.l. in ticks in northeastern China. In May, 2015, a total of 2785 unfed adult ticks were collected in the Jilin and Heilongjiang provinces of northeastern China, with the predominant tick species of Ixodes persulcatus (59.9%), followed by Haemaphysalis concinna (14.8%), Haemaphysalis longicornis (8.9%), Dermacentor nuttalli (9.4%), and Dermacentor silvarum (7.0%). Only I. persulcatus was tested positive for Borrelia spirochetes DNA by PCR, targeting the 5S-23S rRNA intergenic spacer and 16S rRNA genes, with a prevalence of 1.9%. Phylogenetic analysis based on the partial 5S-23S rRNA intergenic spacer and 16S rRNA genes showed that these positive samples were grouped into four pathogenic genospecies for humans, including Borrelia garinii (2.8%), Borrelia afzelii (0.2%), Borrelia bavariensis (0.1%), and Borrelia bissettii (0.1%). These results showed that B. garinii is the predominant genospecies and I. persulcatus is the main tick host and carrier in northeastern China. To our knowledge, B. bissettii were detected for the first time in China.
Collapse
Affiliation(s)
- Yanchun Wang
- 1 Department of Clinical Veterinary, College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, China
| | - Shuang Li
- 1 Department of Clinical Veterinary, College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, China
| | - Zedong Wang
- 2 Department of Animal Medicine, College of Life Sciences and Engineering, Foshan University, Foshan, Guangdong Province, China
| | - Li Zhang
- 1 Department of Clinical Veterinary, College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, China
| | - Yanan Cai
- 1 Department of Clinical Veterinary, College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, China
| | - Quan Liu
- 2 Department of Animal Medicine, College of Life Sciences and Engineering, Foshan University, Foshan, Guangdong Province, China
| |
Collapse
|
31
|
Stanek G, Strle F. Lyme borreliosis-from tick bite to diagnosis and treatment. FEMS Microbiol Rev 2018; 42:233-258. [PMID: 29893904 DOI: 10.1093/femsre/fux047] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/16/2017] [Indexed: 12/23/2022] Open
Abstract
Lyme borreliosis is caused by certain genospecies of the Borrelia burgdorferi sensu lato complex, which are transmitted by hard ticks of the genus Ixodes. The most common clinical manifestation is erythema migrans, an expanding skin redness that usually develops at the site of a tick bite and eventually resolves even without antibiotic treatment. The infecting pathogens can spread to other tissues and organs, resulting in manifestations that can involve the nervous system, joints, heart and skin. Fatal outcome is extremely rare and is due to severe heart involvement; fetal involvement is not reliably ascertained. Laboratory support-mainly by serology-is essential for diagnosis, except in the case of typical erythema migrans. Treatment is usually with antibiotics for 2 to 4 weeks; most patients recover uneventfully. There is no convincing evidence for antibiotic treatment longer than 4 weeks and there is no reliable evidence for survival of borreliae in adequately treated patients. European Lyme borreliosis is a frequent disease with increasing incidence. However, numerous scientifically questionable ideas on its clinical presentation, diagnosis and treatment may confuse physicians and lay people. Since diagnosis of Lyme borreliosis should be based on appropriate clinical signs, solid knowledge of clinical manifestations is essential.
Collapse
Affiliation(s)
- Gerold Stanek
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia
| |
Collapse
|
32
|
Estrada-Peña A, Cutler S, Potkonjak A, Vassier-Tussaut M, Van Bortel W, Zeller H, Fernández-Ruiz N, Mihalca AD. An updated meta-analysis of the distribution and prevalence of Borrelia burgdorferi s.l. in ticks in Europe. Int J Health Geogr 2018; 17:41. [PMID: 30514310 PMCID: PMC6319795 DOI: 10.1186/s12942-018-0163-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
Background The bacteria of the group Borrelia burgdorferi s.l. are the etiological agents of Lyme borreliosis in humans, transmitted by bites of ticks. Improvement of control measures requires a solid framework of the environmental traits driving its prevalence in ticks. Methods We updated a previous meta-analysis of the reported prevalence of Borrelia burgdorferi s.l. in questing nymphs of Ixodes ricinus with a literature search from January 2010–June 2017. This resulted in 195 new papers providing the prevalence of Bb for 926 geo-referenced records. Previously obtained data (878 records, years 2000–2010) were appended for modelling. The complete dataset contains data from 82,004 questing nymphs, resulting in 558 records of B. afzelii, 404 of B. burgdorferi s.s. (only 80 after the year 2010), 552 of B. garinii, 78 of B. lusitaniae, 61 of B. spielmanii, and 373 of B. valaisiana. We associated the records with explicit coordinates to environmental conditions and to a categorical definition of European landscapes (LANMAP2) looking for a precise definition of the environmental niche of the most reported species of the pathogen, using models based on different classification methods. Results The most commonly reported species are B. afzelii, B. garinii and B. valaisiana largely overlapping across Europe. Prevalence in ticks is associated with portions of the environmental niche. Highest prevalence occurs in areas of 280°–290° (Kelvin) of mean annual temperature experiencing a small amplitude, steady spring slope, together with high mean values and a moderate spring rise of vegetation vigor. Low prevalence occurs in sites with low and a noteworthy annual amplitude of temperature and the Normalized Difference Vegetation Index (colder areas with abrupt annual changes of vegetation). Models based on support vector machines provided a correct classification rate of the habitat and prevalence of 89.5%. These results confirm the association of prevalence of the three most commonly reported species of B. burgdorferi s.l. in Europe to parts of the environmental niche and provide a statistically tractable framework for analyzing trends under scenarios of climate change. Electronic supplementary material The online version of this article (10.1186/s12942-018-0163-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Agustín Estrada-Peña
- Department of Animal Health, Faculty of Veterinary Medicine, Miguel Servet 177, 50013, Zaragoza, Spain.
| | - Sally Cutler
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Aleksandar Potkonjak
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | | | - Wim Van Bortel
- Surveillance and Response Support Unit, Solna, Sweden.,Institute of Tropical Medicine, Unite of Medical Entomology, Antwerp, Belgium
| | - Hervé Zeller
- Office of the Chief Scientist Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Natalia Fernández-Ruiz
- Department of Animal Health, Faculty of Veterinary Medicine, Miguel Servet 177, 50013, Zaragoza, Spain
| | - Andrei Daniel Mihalca
- Department of Parasitology and Parasitic Diseases, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Cluj-Napoca, Romania
| |
Collapse
|
33
|
Di Domenico EG, Cavallo I, Bordignon V, D'Agosto G, Pontone M, Trento E, Gallo MT, Prignano G, Pimpinelli F, Toma L, Ensoli F. The Emerging Role of Microbial Biofilm in Lyme Neuroborreliosis. Front Neurol 2018; 9:1048. [PMID: 30559713 PMCID: PMC6287027 DOI: 10.3389/fneur.2018.01048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 11/19/2018] [Indexed: 01/04/2023] Open
Abstract
Lyme borreliosis (LB) is the most common tick-borne disease caused by the spirochete Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia, respectively. The infection affects multiple organ systems, including the skin, joints, and the nervous system. Lyme neuroborreliosis (LNB) is the most dangerous manifestation of Lyme disease, occurring in 10-15% of infected individuals. During the course of the infection, bacteria migrate through the host tissues altering the coagulation and fibrinolysis pathways and the immune response, reaching the central nervous system (CNS) within 2 weeks after the bite of an infected tick. The early treatment with oral antimicrobials is effective in the majority of patients with LNB. Nevertheless, persistent forms of LNB are relatively common, despite targeted antibiotic therapy. It has been observed that the antibiotic resistance and the reoccurrence of Lyme disease are associated with biofilm-like aggregates in B. burgdorferi, B. afzelii, and B. garinii, both in vitro and in vivo, allowing Borrelia spp. to resist to adverse environmental conditions. Indeed, the increased tolerance to antibiotics described in the persisting forms of Borrelia spp., is strongly reminiscent of biofilm growing bacteria, suggesting a possible role of biofilm aggregates in the development of the different manifestations of Lyme disease including LNB.
Collapse
Affiliation(s)
- Enea Gino Di Domenico
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Ilaria Cavallo
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Valentina Bordignon
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Giovanna D'Agosto
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Martina Pontone
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Elisabetta Trento
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maria Teresa Gallo
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Grazia Prignano
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Fulvia Pimpinelli
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Fabrizio Ensoli
- Clinical Pathology and Microbiology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| |
Collapse
|
34
|
Gallais F, De Martino SJ, Sauleau EA, Hansmann Y, Lipsker D, Lenormand C, Talagrand-Reboul E, Boyer PH, Boulanger N, Jaulhac B, Schramm F. Multilocus sequence typing of clinical Borreliella afzelii strains: population structure and differential ability to disseminate in humans. Parasit Vectors 2018; 11:374. [PMID: 29954419 PMCID: PMC6027761 DOI: 10.1186/s13071-018-2938-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lyme borreliosis in humans results in a range of clinical manifestations, thought to be partly due to differences in the pathogenicity of the infecting strain. This study compared European human clinical strains of Borreliella afzelii (previously named Borrelia afzelii) using multilocus sequence typing (MLST) to determine their spatial distribution across Europe and to establish whether there are associations between B. afzelii genotypes and specific clinical manifestations of Lyme borreliosis. For this purpose, typing was performed on 63 strains, and data on a further 245 strains were accessed from the literature. RESULTS All 308 strains were categorized into 149 sequence types (STs), 27 of which are described here for the first time. Phylogenetic and goeBURST analyses showed short evolutionary distances between strains. Although the main STs differed among the countries with the largest number of strains of interest (Germany, the Netherlands, France and Slovenia), the B. afzelii clinical strains were less genetically structured than those previously observed in the European tick population. Two STs were found significantly more frequently in strains associated with clinical manifestations involving erythema migrans, whereas another ST was found significantly more frequently in strains associated with disseminated manifestations, especially neuroborreliosis. CONCLUSIONS The MLST profiles showed low genetic differentiation between B. afzelii strains isolated from patients with Lyme borreliosis in Europe. Also, clinical data analysis suggests the existence of lineages with differential dissemination properties in humans.
Collapse
Affiliation(s)
- Floriane Gallais
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France
| | - Sylvie J De Martino
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,French National Reference Center for Borrelia, University Hospital Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
| | - Erik A Sauleau
- Public Health, Methods in Clinical Research Team, University Hospital Strasbourg, Strasbourg, France
| | - Yves Hansmann
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France.,Infectious Disease Department, University Hospital Strasbourg, Strasbourg, France
| | - Dan Lipsker
- Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France.,Dermatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Cédric Lenormand
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France.,Dermatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Emilie Talagrand-Reboul
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France
| | - Pierre H Boyer
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France
| | - Nathalie Boulanger
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,French National Reference Center for Borrelia, University Hospital Strasbourg, Strasbourg, France
| | - Benoît Jaulhac
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,French National Reference Center for Borrelia, University Hospital Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
| | - Frédéric Schramm
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.
| |
Collapse
|
35
|
Lohr B, Fingerle V, Norris DE, Hunfeld KP. Laboratory diagnosis of Lyme borreliosis: Current state of the art and future perspectives. Crit Rev Clin Lab Sci 2018; 55:219-245. [PMID: 29606016 DOI: 10.1080/10408363.2018.1450353] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review is directed at physicians and laboratory personnel in private practice and clinics who treat and diagnose Lyme borreliosis (LB) in patients as part of their daily work. A major objective of this paper is to bring together background information on Borrelia (B.) burgdorferi sensu lato (s.l.) and basic clinical knowledge of LB, which is one of the most frequently reported vector-borne diseases in the Northern Hemisphere. The goal is to provide practical guidance for clinicians and for laboratory physicians, and scientists for a better understanding of current achievements and ongoing obstacles in the laboratory diagnosis of LB, an infectious disease that still remains one of the diagnostic chameleons of modern clinical medicine. Moreover, in bringing together current scientific information from guidelines, reviews, and original papers, this review provides recommendations for selecting the appropriate tests in relation to the patient's stage of disease to achieve effective, stage-related application of current direct and indirect laboratory methods for the detection of B. burgdorferi s.l. Additionally, the review aims to discuss the current state of the art concerning the diagnostic potential and limitations of the assays and test methods currently in use to optimize LB patient management and provide insight into the possible future prospects of this rapidly changing area of laboratory medicine.
Collapse
Affiliation(s)
- Benedikt Lohr
- a Institute for Laboratory Medicine, Microbiology & Infection Control , Northwest Medical Centre, Medical Faculty, Goethe University , Frankfurt/Main , Germany
| | - Volker Fingerle
- b Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) , Oberschleissheim , Germany
| | - Douglas E Norris
- c W. Harry Feinstone Department of Molecular Microbiology & Immunology , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Klaus-Peter Hunfeld
- a Institute for Laboratory Medicine, Microbiology & Infection Control , Northwest Medical Centre, Medical Faculty, Goethe University , Frankfurt/Main , Germany
| |
Collapse
|
36
|
Casjens SR, Di L, Akther S, Mongodin EF, Luft BJ, Schutzer SE, Fraser CM, Qiu WG. Primordial origin and diversification of plasmids in Lyme disease agent bacteria. BMC Genomics 2018; 19:218. [PMID: 29580205 PMCID: PMC5870499 DOI: 10.1186/s12864-018-4597-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With approximately one-third of their genomes consisting of linear and circular plasmids, the Lyme disease agent cluster of species has the most complex genomes among known bacteria. We report here a comparative analysis of plasmids in eleven Borreliella (also known as Borrelia burgdorferi sensu lato) species. RESULTS We sequenced the complete genomes of two B. afzelii, two B. garinii, and individual B. spielmanii, B. bissettiae, B. valaisiana and B. finlandensis isolates. These individual isolates carry between seven and sixteen plasmids, and together harbor 99 plasmids. We report here a comparative analysis of these plasmids, along with 70 additional Borreliella plasmids available in the public sequence databases. We identify only one new putative plasmid compatibility type (the 30th) among these 169 plasmid sequences, suggesting that all or nearly all such types have now been discovered. We find that the linear plasmids in the non-B. burgdorferi species have undergone the same kinds of apparently random, chaotic rearrangements mediated by non-homologous recombination that we previously discovered in B. burgdorferi. These rearrangements occurred independently in the different species lineages, and they, along with an expanded chromosomal phylogeny reported here, allow the identification of several whole plasmid transfer events among these species. Phylogenetic analyses of the plasmid partition genes show that a majority of the plasmid compatibility types arose early, most likely before separation of the Lyme agent Borreliella and relapsing fever Borrelia clades, and this, with occasional cross species plasmid transfers, has resulted in few if any species-specific or geographic region-specific Borreliella plasmid types. CONCLUSIONS The primordial origin and persistent maintenance of the Borreliella plasmid types support their functional indispensability as well as evolutionary roles in facilitating genome diversity. The improved resolution of Borreliella plasmid phylogeny based on conserved partition-gene clusters will lead to better determination of gene orthology which is essential for prediction of biological function, and it will provide a basis for inferring detailed evolutionary mechanisms of Borreliella genomic variability including homologous gene and plasmid exchanges as well as non-homologous rearrangements.
Collapse
Affiliation(s)
- Sherwood R. Casjens
- Division of Microbiology and Immunology, Pathology Department and Biology Department, University of Utah School of Medicine, Salt Lake City, UT USA
- Biology Department, University of Utah, Salt Lake City, UT USA
- Pathology Department, University of Utah School of Medicine, Room 2200K Emma Eccles Jones Medical Research Building, 15 North Medical Drive East, Salt Lake City, UT 84112 USA
| | - Lia Di
- Department of Biological Sciences and Center for Translational and Basic Research, Hunter College of the City University of New York, New York, NY USA
| | - Saymon Akther
- Department of Biology, The Graduate Center, City University of New York, New York, NY USA
| | - Emmanuel F. Mongodin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD USA
| | - Benjamin J. Luft
- Department of Medicine, Health Science Center, Stony Brook University, Stony Brook, NY USA
| | - Steven E. Schutzer
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ USA
| | - Claire M. Fraser
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD USA
| | - Wei-Gang Qiu
- Department of Biology, The Graduate Center, City University of New York, New York, NY USA
- Department of Biological Sciences and Center for Translational and Basic Research, Hunter College of the City University of New York, New York, NY USA
- Department of Physiology and Biophysics & Institute for Computational Biomedicine, Weil Cornell Medical College, New York, USA
| |
Collapse
|
37
|
Margos G, Notter I, Fingerle V. Species Identification and Phylogenetic Analysis of Borrelia burgdorferi Sensu Lato Using Molecular Biological Methods. Methods Mol Biol 2018; 1690:13-33. [PMID: 29032533 DOI: 10.1007/978-1-4939-7383-5_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bacterial species identification is required in different disciplines and-depending on the purpose-levels of specificity or resolution of typing may vary. Nowadays, molecular methods are the mainstay for bacterial identification and sequence-based analyses are of ever-growing importance. For diagnostics, immediate results are needed and often real-time PCR of one or two loci is the method of choice while for epidemiological or evolutionary studies sequence data of several loci improve phylogenetic resolution to required levels. Multilocus sequence typing (MLST) and multilocus sequence analyses (MLSA) utilize sequences information of several housekeeping loci (eight for Borrelia) to distinguish between species. This method has been widely used for bacterial species and strain identification and will be described in this chapter.As more and more diversity is being detected in the Borrelia burgdorferi sensu lato species complex, the importance of accurate species and strain typing has come to the fore. This is particularly significant with a view of differentiating human pathogenic and non-pathogenic strains or species and understanding the epidemiology, ecology, population structure, and evolution of species.
Collapse
Affiliation(s)
- Gabriele Margos
- Bavarian Health and Food Safety Authority, National Reference Center for Borrelia, Veterinärstr. 2, 85764, Oberschleissheim, Germany.
| | - Isabell Notter
- Bavarian Health and Food Safety Authority, National Reference Center for Borrelia, Veterinärstr. 2, 85764, Oberschleissheim, Germany
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, National Reference Center for Borrelia, Veterinärstr. 2, 85764, Oberschleissheim, Germany
| |
Collapse
|
38
|
Glatz M, Müllegger RR. [Cutaneous manifestations of Lyme disease : Pitfalls in the serological diagnostic workup]. Hautarzt 2017; 68:329-339. [PMID: 28236088 DOI: 10.1007/s00105-017-3952-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Serology, the detection of B. burgdorferi-specific IgM and IgG serum antibodies, is the most common laboratory test to diagnose cutaneous manifestations of Lyme disease. In a two-tiered approach, an ELISA is used as a screening test. A positive or equivocal ELISA result needs confirmation by a specific immunoblot. The sensitivity of this approach reaches 80-95%. The diagnosis of erythema migrans is based on its typical clinical appearance. Serology is only indicated in atypical cases. In contrast, serology is mandatory in the diagnostic workup of borrelial lymphocytoma and acrodermatitis chronica atrophicans. A positive serology can persist for many years, even after adequate antibiotic treatment. A positive serology is no indication for antibiotic treatment if typical symptoms of Lyme disease are absent.
Collapse
Affiliation(s)
- M Glatz
- Allergiestation, Dermatologische Klinik, Universität und Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz.
| | - R R Müllegger
- Abteilung für Dermatologie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Österreich
| |
Collapse
|
39
|
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.
Collapse
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
| | | |
Collapse
|
40
|
Hofmann H, Fingerle V, Hunfeld KP, Huppertz HI, Krause A, Rauer S, Ruf B. Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc14. [PMID: 28943834 PMCID: PMC5588623 DOI: 10.3205/000255] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 02/07/2023]
Abstract
This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis. It has received consensus from 22 German medical societies and 2 German patient organisations. It is the first part of an AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) interdisciplinary guideline: “Lyme Borreliosis – Diagnosis and Treatment, development stage S3”. The guideline is directed at physicians in private practices and clinics who treat Lyme borreliosis. Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis (serological detection of IgM and IgG Borrelia antibodies using the 2-tiered ELISA/immunoblot process, sensible use of molecular diagnostic and culture procedures) and recommendations for the treatment of the localised, early-stage infection (erythema migrans, erythema chronicum migrans, and borrelial lymphocytoma), the disseminated early-stage infection (multiple erythemata migrantia, flu-like symptoms) and treatment of the late-stage infection (acrodermatitis chronica atrophicans with and without neurological manifestations). In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.
Collapse
Affiliation(s)
- Heidelore Hofmann
- Klinik für Dermatologie und Allergologie der TU München, München, Germany
| | - Volker Fingerle
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) Oberschleißheim, Germany
| | - Klaus-Peter Hunfeld
- Zentralinstitut für Labormedizin, Mikrobiologie & Krankenhaushygiene, Krankenhaus Nordwest, Frankfurt, Germany
| | | | | | | | - Bernhard Ruf
- Klinik für Infektiologie Klinik St Georg, Leipzig, Germany
| | | |
Collapse
|
41
|
The novel Lyme borreliosis vaccine VLA15 shows broad protection against Borrelia species expressing six different OspA serotypes. PLoS One 2017; 12:e0184357. [PMID: 28863166 PMCID: PMC5581183 DOI: 10.1371/journal.pone.0184357] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022] Open
Abstract
We have previously shown that the Outer surface protein A (OspA) based Lyme borreliosis vaccine VLA15 induces protective immunity in mice. Herein, we report the induction of protective immunity by VLA15 with mouse models using ticks infected with B. burgdorferi (OspA serotype 1), B. afzelii (OspA serotype 2) and B. bavariensis (OspA serotype 4) or with in vitro grown B. garinii (OspA serotype 5 and 6) for challenge. For B. garinii (OspA serotype 3), we have developed a growth inhibition assay using chicken complement and functional antibodies targeting B. garinii (OspA serotype 3) could be demonstrated after immunization with VLA15. Furthermore, following three priming immunizations, a booster dose was administered five months later and the induction of immunological memory could be confirmed. Thus, the antibody titers after the booster dose were increased considerably compared to those after primary immunization. In addition, the half-lives of anti-OspA serotype specific antibodies after administration of the booster immunization were longer than after primary immunization. Taken together, we could show that VLA15 induced protection in mice against challenge with four different clinically relevant Borrelia species (B. burgdorferi, B. afzelii, B. garinii and B. bavariensis) expressing five of the six OspA serotypes included in the vaccine. The protection data is supported by functional assays showing efficacy against spirochetes expressing any of the six OspA serotypes (1 to 6). To our knowledge, this is the first time a Lyme borreliosis vaccine has been able to demonstrate such broad protection in preclinical studies. These new data provide further promise for the clinical development of VLA15 and supports our efforts to provide a new Lyme borreliosis vaccine available for global use.
Collapse
|
42
|
|
43
|
Marchant A, Le Coupanec A, Joly C, Perthame E, Sertour N, Garnier M, Godard V, Ferquel E, Choumet V. Infection of Ixodes ricinus by Borrelia burgdorferi sensu lato in peri-urban forests of France. PLoS One 2017; 12:e0183543. [PMID: 28846709 PMCID: PMC5573218 DOI: 10.1371/journal.pone.0183543] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022] Open
Abstract
Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. In Europe, it is transmitted by Ixodes ticks that carry bacteria belonging to the Borrelia burgdorferi sensu lato complex. The objective of this work was to explore eco-epidemiological factors of Lyme borreliosis in peri-urban forests of France (Sénart, Notre-Dame and Rambouillet). We investigated whether the introduction of Tamias sibiricus in Sénart could alter the density of infected ticks. Moreover, the density and tick infection were investigated according to the tree species found in various patches of Sénart forest. For this purpose, ticks were sampled during 3 years. In the Sénart forest, the density of nymph and adult ticks showed no significant difference between 2008, 2009 and 2011. The nymph density varied significantly as a function of the month of collection. Regarding the nymphs, a higher rate of infection and infected density were found in 2009. Plots with chipmunks (C) presented a lower density of both nymphs and adult ticks than plots without chipmunks (NC) did. A higher rate of infection of nymphs with Borrelia was seen in C plots. The prevalence of the various species of Borrelia was also found to vary between C and NC plots with the year of the collect. The presence of chestnut trees positively influenced the density of both nymphs and adults. The infected nymph density showed a significant difference depending on the peri-urban forest studied, Sénart being higher than Rambouillet. The prevalence of Borrelia species also differed between the various forests studied. Concerning the putative role that Tamias sibiricus may play in the transmission of Borrelia, our results suggest that its presence is correlated with a higher rate of infection of questing ticks by Borrelia genospecies and if its population increases, it could play a significant role in the risk of transmission of Lyme borreliosis.
Collapse
Affiliation(s)
- Axelle Marchant
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Alain Le Coupanec
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Claire Joly
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Emeline Perthame
- Institut Pasteur – Bioinformatics and Biostatistics Hub – C3BI, USR 3756 IP CNRS –Bioinformatique et Biostatistique, Paris, France
| | - Natacha Sertour
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Martine Garnier
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Vincent Godard
- CNRS-UMR7533/LADYSS, Université de Paris 8 - Saint-Denis, France
| | - Elisabeth Ferquel
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
| | - Valerie Choumet
- Centre National de Référence des Borrelia, Institut Pasteur, Paris, France
- Unité Environnement et Risques Infectieux, Institut Pasteur, Paris, France
| |
Collapse
|
44
|
Szekeres S, Lügner J, Fingerle V, Margos G, Földvári G. Prevalence of Borrelia miyamotoi and Borrelia burgdorferi sensu lato in questing ticks from a recreational coniferous forest of East Saxony, Germany. Ticks Tick Borne Dis 2017; 8:922-927. [PMID: 28843481 DOI: 10.1016/j.ttbdis.2017.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
The hard tick Ixodes ricinus is the most important vector of tick-transmitted pathogens in Europe, frequently occurring in urban parks and greenbelts utilized for recreational activities. This species is the most common vector of the causative agents of Lyme borreliosis in Europe. Similarly, the species spreads Borrelia miyamotoi, causing a relapsing-fever like illness. A total of 1774 Ixodes ricinus (50 females, 68 males, 840 nymphs and 818 larvae) were collected with flagging between March and September 2014 in a coniferous forest patch in Niederkaina near the town of Bautzen in Saxony, Germany. To measure questing tick density a time-based density estimating method was utilized. From each month, a total of 100 adults and nymphal ticks and all larvae (pools of 10 individuals per tube/month) were selected for the molecular analyses. For simultaneous detection of B. burgdorferi s.l. and B. miyamotoi a duplex real-time PCR targeting the flaB locus was performed. Prevalence of B. burgdorferi s.l. was 9.4% (female: 6%, male: 2.9%, nymph: 12.2%, larva: 0%) and minimum prevalence of B. miyamotoi was 1.2% (female: 0%, male: 4.3%, nymph: 2.8%, larva: 0.1%) in the 714 samples with real-time polymerase chain reaction. A real-time PCR reaction was utilized first to target the histone-like protein gene (hbb) of B. burgdorferi s.l., a hemi-nested outer surface protein (ospA) gene conventional PCR was then performed followed by a restriction enzyme analysis to distinguish B. burgdorferi s.l. genospecies. Seven B. afzelii, one B. burgdorferi s.s., one B. bavariensis and four B. miyamotoi infections were confirmed. Prevalence of Lyme borreliosis spirochetes was significantly higher in nymphs than in adults (p<0.01, Fisher exact test) probably due to the diluting effect of the local roe deer population. Our data highlight the potential risk of human infection with the emerging pathogen B. miyamotoi within the study area.
Collapse
Affiliation(s)
- Sándor Szekeres
- Department of Parasitology and Zoology, University of Veterinary Medicine Budapest,2 Istvan street H-1078 Budapest, Hungary
| | - Jenny Lügner
- Department of Parasitology and Zoology, University of Veterinary Medicine Budapest,2 Istvan street H-1078 Budapest, Hungary
| | - Volker Fingerle
- German National Reference Centre for Borrelia; Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - Gabriele Margos
- German National Reference Centre for Borrelia; Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - Gábor Földvári
- Department of Parasitology and Zoology, University of Veterinary Medicine Budapest,2 Istvan street H-1078 Budapest, Hungary.
| |
Collapse
|
45
|
Europe-Wide Meta-Analysis of Borrelia burgdorferi Sensu Lato Prevalence in Questing Ixodes ricinus Ticks. Appl Environ Microbiol 2017; 83:AEM.00609-17. [PMID: 28550059 DOI: 10.1128/aem.00609-17] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023] Open
Abstract
Lyme borreliosis is the most common zoonotic disease transmitted by ticks in Europe and North America. Despite having multiple tick vectors, the causative agent, Borrelia burgdorferisensu lato, is vectored mainly by Ixodes ricinus in Europe. In the present study, we aimed to review and summarize the existing data published from 2010 to 2016 concerning the prevalence of B. burgdorferi sensu lato spirochetes in questing I. ricinus ticks. The primary focus was to evaluate the infection rate of these bacteria in ticks, accounting for tick stage, adult tick gender, region, and detection method, as well as to investigate any changes in prevalence over time. The data obtained were compared to the findings of a previous metastudy. The literature search identified data from 23 countries, with 115,028 ticks, in total, inspected for infection with B. burgdorferi sensu lato We showed that the infection rate was significantly higher in adults than in nymphs and in females than in males. We found significant differences between European regions, with the highest infection rates in Central Europe. The most common genospecies were B. afzelii and B. garinii, despite a negative correlation of their prevalence rates. No statistically significant differences were found among the prevalence rates determined by conventional PCR, nested PCR, and real-time PCR.IMPORTANCEBorrelia burgdorferisensu lato is a pathogenic bacterium whose clinical manifestations are associated with Lyme borreliosis. This vector-borne disease is a major public health concern in Europe and North America and may lead to severe arthritic, cardiovascular, and neurological complications if left untreated. Although pathogen prevalence is considered an important predictor of infection risk, solitary isolated data have only limited value. Here we provide summarized information about the prevalence of B. burgdorferi sensu lato spirochetes among host-seeking Ixodes ricinus ticks, the principal tick vector of borreliae in Europe. We compare the new results with previously published data in order to evaluate any changing trends in tick infection.
Collapse
|
46
|
Maes L, Carolus T, De Preter V, Ignoul S, Cartuyvels R, Braeken L, D'Huys PJ, Saegeman V, Kabamba B, Raymaekers M. Technical and clinical validation of three commercial real-time PCR kits for the diagnosis of neuroborreliosis in cerebrospinal fluid on three different real-time PCR platforms. Eur J Clin Microbiol Infect Dis 2016; 36:273-279. [PMID: 27714590 DOI: 10.1007/s10096-016-2797-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
This study reports the evaluation of the technical and clinical validation of the O-DiaBorburg kit (DIA), Borrelia burgdorferi PCR kit, ISEX (GENE), and Borrelia burgdorferi sensu lato Real-TM (SAC) for the diagnosis of neuroborreliosis in cerebrospinal fluid based on both Borrelia DNA and CSF samples from patients with clinical suspicion of neuroborreliosis. This validation study was done by analysing the kits on the Rotorgene Q (RGQ), CFX96, and LightCycler480 (LC480). For all kits, the linear range was larger on RGQ than on CFX96 and LC480. A good reproducibility was obtained for all assays on all instruments. Storage at -20 °C resulted in a decreased reproducibility for SAC. Results of the limit of detection (LOD95) experiments indicated a better sensitivity than described in the kit insert for all kits on all PCR platforms. No cross-reactivity was found for genetically related organisms nor for other pathogens which may be present in CSF. All species of the Borrelia burgdorferi sensu lato complex were detected with the GENE and SAC kits. The DIA kit failed to detect B. lusitaniae. The results seemed to indicate a better overall performance for the GENE kit on RGQ. However, its diagnostic value could not be confirmed in the clinical validation study, wherein none of the 103 CSF samples from clinical neuroborreliosis cases showed a positive real-time PCR result with the GENE kit analysed on RGQ.
Collapse
Affiliation(s)
- L Maes
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium.
| | - T Carolus
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium
| | - V De Preter
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium.,Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Gasthuisberg, KULeuven, Leuven, Belgium
| | - S Ignoul
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium
| | - R Cartuyvels
- Clinical Biology, Laboratory for Molecular Diagnostics, Campus Salvator, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - L Braeken
- Research group Lab4U, Faculty of Industrial Engineering, KU Leuven - Campus Diepenbeek, Agoralaan gebouw B, 3590, Diepenbeek, Belgium
| | - P-J D'Huys
- Research group Lab4U, Group of Management and Technology, UC Leuven-Limburg, Agoralaan gebouw B bus 3, 3590, Diepenbeek, Belgium
| | - V Saegeman
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - B Kabamba
- Clinical Microbiology, Laboratory of Microbiology, University Clinic St-Luc UCL, Avenue Mounier 10 F, 1200, Brussels, Belgium
| | - M Raymaekers
- Clinical Biology, Laboratory for Molecular Diagnostics, Campus Salvator, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| |
Collapse
|
47
|
Parallelisms and Contrasts in the Diverse Ecologies of the Anaplasma phagocytophilum and Borrelia burgdorferi Complexes of Bacteria in the Far Western United States. Vet Sci 2016; 3:vetsci3040026. [PMID: 29056734 PMCID: PMC5606591 DOI: 10.3390/vetsci3040026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/03/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Anaplasma phagocytophilum and Borrelia burgdorferi are two tick-borne bacteria that cause disease in people and animals. For each of these bacteria, there is a complex of closely related genospecies and/or strains that are genetically distinct and have been shown through both observational and experimental studies to have different host tropisms. In this review we compare the known ecologies of these two bacterial complexes in the far western USA and find remarkable similarities, which will help us understand evolutionary histories and coadaptation among vertebrate host, tick vector, and bacteria. For both complexes, sensu stricto genospecies (those that infect humans) share a similar geographic range, are vectored mainly by ticks in the Ixodes ricinus-complex, utilize mainly white-footed mice (Peromyscus leucopus) as a reservoir in the eastern USA and tree squirrels in the far west, and tend to be generalists, infecting a wider variety of vertebrate host species. Other sensu lato genospecies within each complex are generally more specialized, occurring often in local enzootic cycles within a narrow range of vertebrate hosts and specialized vector species. We suggest that these similar ecologies may have arisen through utilization of a generalist tick species as a vector, resulting in a potentially more virulent generalist pathogen that spills over into humans, vs. utilization of a specialized tick vector on a particular vertebrate host species, promoting microbe specialization. Such tight host-vector-pathogen coupling could also facilitate high enzootic prevalence and the evolution of host immune-tolerance and bacterial avirulence.
Collapse
|
48
|
Becker NS, Margos G, Blum H, Krebs S, Graf A, Lane RS, Castillo-Ramírez S, Sing A, Fingerle V. Recurrent evolution of host and vector association in bacteria of the Borrelia burgdorferi sensu lato species complex. BMC Genomics 2016; 17:734. [PMID: 27632983 PMCID: PMC5025617 DOI: 10.1186/s12864-016-3016-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/13/2016] [Indexed: 11/12/2022] Open
Abstract
Background The Borrelia burgdorferi sensu lato (s.l.) species complex consists of tick-transmitted bacteria and currently comprises approximately 20 named and proposed genospecies some of which are known to cause Lyme Borreliosis. Species have been defined via genetic distances and ecological niches they occupy. Understanding the evolutionary relationship of species of the complex is fundamental to explaining patterns of speciation. This in turn forms a crucial basis to frame testable hypotheses concerning the underlying processes including host and vector adaptations. Results Illumina Technology was used to obtain genome-wide sequence data for 93 strains of 14 named genospecies of the B. burgdorferi species complex and genomic data already published for 18 additional strain (including one new species) was added. Phylogenetic reconstruction based on 114 orthologous single copy genes shows that the genospecies represent clearly distinguishable taxa with recent and still ongoing speciation events apparent in Europe and Asia. The position of Borrelia species in the phylogeny is consistent with host associations constituting a major driver for speciation. Interestingly, the data also demonstrate that vector associations are an additional driver for diversification in this tick-borne species complex. This is particularly obvious in B. bavariensis, a rodent adapted species that has diverged from the bird-associated B. garinii most likely in Asia. It now consists of two populations one of which most probably invaded Europe following adaptation to a new vector (Ixodes ricinus) and currently expands its distribution range. Conclusions The results imply that genotypes/species with novel properties regarding host or vector associations have evolved recurrently during the history of the species complex and may emerge at any time. We suggest that the finding of vector associations as a driver for diversification may be a general pattern for tick-borne pathogens. The core genome analysis presented here provides an important source for investigations of the underlying mechanisms of speciation in tick-borne pathogens. Electronic supplementary material The online version of this article (doi:10.1186/s12864-016-3016-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Noémie S Becker
- Faculty of Biology, Division of Evolutionary Biology, Ludwig Maximilians University of Munich, Grosshaderner Strasse 2, 82152, Planegg-Martinsried, Germany.
| | - Gabriele Margos
- National Reference Centre for Borrelia at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764, Oberschleissheim, Germany
| | - Helmut Blum
- Gene Center, Laboratory for Functional Genome Analysis, Ludwig Maximilians University of Munich, Feodor-Lynen-Strasse 25, 81377, Munich, Germany
| | - Stefan Krebs
- Gene Center, Laboratory for Functional Genome Analysis, Ludwig Maximilians University of Munich, Feodor-Lynen-Strasse 25, 81377, Munich, Germany
| | - Alexander Graf
- Gene Center, Laboratory for Functional Genome Analysis, Ludwig Maximilians University of Munich, Feodor-Lynen-Strasse 25, 81377, Munich, Germany
| | - Robert S Lane
- Department of Environmental Science, Policy and Management, University of California, Berkeley, CA, USA
| | - Santiago Castillo-Ramírez
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Apartado Postal 565-A, CP 62210, Cuernavaca, Morelos, Mexico
| | - Andreas Sing
- National Reference Centre for Borrelia at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764, Oberschleissheim, Germany
| | - Volker Fingerle
- National Reference Centre for Borrelia at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764, Oberschleissheim, Germany
| |
Collapse
|
49
|
Kenedy MR, Scott EJ, Shrestha B, Anand A, Iqbal H, Radolf JD, Dyer DW, Akins DR. Consensus computational network analysis for identifying candidate outer membrane proteins from Borrelia spirochetes. BMC Microbiol 2016; 16:141. [PMID: 27400788 PMCID: PMC4939628 DOI: 10.1186/s12866-016-0762-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/02/2016] [Indexed: 01/15/2023] Open
Abstract
Background Similar to Gram-negative organisms, Borrelia spirochetes are dual-membrane organisms with both an inner and outer membrane. Although the outer membrane contains integral membrane proteins, few of the borrelial outer membrane proteins (OMPs) have been identified and characterized to date. Therefore, we utilized a consensus computational network analysis to identify novel borrelial OMPs. Results Using a series of computer-based algorithms, we selected all protein-encoding sequences predicted to be OM-localized and/or to form β-barrels in the borrelial OM. Using this system, we identified 41 potential OMPs from B. burgdorferi and characterized three (BB0838, BB0405, and BB0406) to confirm that our computer-based methodology did, in fact, identify borrelial OMPs. Triton X-114 phase partitioning revealed that BB0838 is found in the detergent phase, which would be expected of a membrane protein. Proteolysis assays indicate that BB0838 is partially sensitive to both proteinase K and trypsin, further indicating that BB0838 is surface-exposed. Consistent with a prior study, we also confirmed that BB0405 is surface-exposed and associates with the borrelial OM. Furthermore, we have shown that BB0406, the product of a co-transcribed downstream gene, also encodes a novel, previously uncharacterized borrelial OMP. Interestingly, while BB0406 has several physicochemical properties consistent with it being an OMP, it was found to be resistant to surface proteolysis. Consistent with BB0405 and BB0406 being OMPs, both were found to be capable of incorporating into liposomes and exhibit pore-forming activity, suggesting that both proteins are porins. Lastly, we expanded our computational analysis to identify OMPs from other borrelial organisms, including both Lyme disease and relapsing fever spirochetes. Conclusions Using a consensus computer algorithm, we generated a list of candidate OMPs for both Lyme disease and relapsing fever spirochetes and determined that three of the predicted B. burgdorferi proteins identified were indeed novel borrelial OMPs. The combined studies have identified putative spirochetal OMPs that can now be examined for their roles in virulence, physiology, and disease pathogenesis. Importantly, the studies described in this report provide a framework by which OMPs from any human pathogen with a diderm ultrastructure could be cataloged to identify novel virulence factors and vaccine candidates. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0762-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Melisha R Kenedy
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Edgar J Scott
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Binu Shrestha
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Arvind Anand
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, 06030, USA
| | - Henna Iqbal
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Justin D Radolf
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, 06030, USA.,Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, 06030, USA.,Department of Genetics and Genomic Science, University of Connecticut Health Center, Farmington, Connecticut, 06030, USA.,Department of Immunology, University of Connecticut Health Center, Farmington, Connecticut, 06030, USA.,Department of Molecular Biology and Biophysics, University of Connecticut Health Center, Farmington, Connecticut, 06030, USA
| | - David W Dyer
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Darrin R Akins
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA.
| |
Collapse
|
50
|
Veinović G, Ružić-Sabljić E, Strle F, Cerar T. Comparison of Growth of Borrelia afzelii, Borrelia garinii, and Borrelia burgdorferi Sensu Stricto at Five Different Temperatures. PLoS One 2016; 11:e0157706. [PMID: 27310556 PMCID: PMC4911167 DOI: 10.1371/journal.pone.0157706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Lyme borreliosis is caused by the spirochete Borrelia burgdorferi sensu lato, a fastidious bacterium that replicates slowly and requires special conditions to grow in the laboratory. Borrelia isolation from clinical material is a golden standard for microbiological diagnosis of borrelial infection. Important factors that affect in vitro borrelia growth are temperature of incubation and number of borrelia cells in the sample. The aim of the study was to assess the influence of temperature on borrelia growth and survival by evaluation and comparison of growth of 31 different borrelia strains at five different temperatures and to determine the influence of different inoculums on borrelia growth at different temperatures. Borreliae were cultured in the MKP medium; the initial and final number of spirochetes was determined by dark field microscopy using Neubauer counting chamber. The growth of borrelia was defined as final number of cells/mL after three days of incubation. For all three Borrelia species, the best growth was found at 33°C, followed by 37, 28, and 23°C, while no growth was detected at 4°C (P<0.05). The growth of B. afzelii species was weaker in comparison to the other two species at 23, 28, 33 and 37°C (P<0.05), respectively. There was no statistically significant difference between the growth of B. garinii and B. burgdorferi sensu stricto at 28, 33, and 37°C (P>0.05), respectively. Inoculum had statistically significant influence on growth of all three Borrelia species at all tested temperatures except at 4°C.
Collapse
Affiliation(s)
- Gorana Veinović
- Department of Microbiology and Immunology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tjaša Cerar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- * E-mail:
| |
Collapse
|