1
|
Koutantou M, Drancourt M, Angelakis E. Prevalence of Lyme Disease and Relapsing Fever Borrelia spp. in Vectors, Animals, and Humans within a One Health Approach in Mediterranean Countries. Pathogens 2024; 13:512. [PMID: 38921809 PMCID: PMC11206712 DOI: 10.3390/pathogens13060512] [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: 05/02/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
The genus Borrelia has been divided into Borreliella spp., which can cause Lyme Disease (LD), and Borrelia spp., which can cause Relapsing Fever (RF). The distribution of genus Borrelia has broadened due to factors such as climate change, alterations in land use, and enhanced human and animal mobility. Consequently, there is an increasing necessity for a One Health strategy to identify the key components in the Borrelia transmission cycle by monitoring the human-animal-environment interactions. The aim of this study is to summarize all accessible data to increase our understanding and provide a comprehensive overview of Borrelia distribution in the Mediterranean region. Databases including PubMed, Google Scholar, and Google were searched to determine the presence of Borreliella and Borrelia spp. in vectors, animals, and humans in countries around the Mediterranean Sea. A total of 3026 were identified and screened and after exclusion of papers that did not fulfill the including criteria, 429 were used. After examination of the available literature, it was revealed that various species associated with LD and RF are prevalent in vectors, animals, and humans in Mediterranean countries and should be monitored in order to effectively manage and prevent potential infections.
Collapse
Affiliation(s)
- Myrto Koutantou
- Diagnostic Department and Public Health Laboratories, Hellenic Pasteur Institute, 11521 Athens, Greece
| | | | - Emmanouil Angelakis
- Diagnostic Department and Public Health Laboratories, Hellenic Pasteur Institute, 11521 Athens, Greece
| |
Collapse
|
2
|
Sloupenska K, Koubkova B, Horak P, Dolezilkova J, Hutyrova B, Racansky M, Miklusova M, Mares J, Raska M, Krupka M. Antigenicity and immunogenicity of different morphological forms of Borrelia burgdorferi sensu lato spirochetes. Sci Rep 2024; 14:4014. [PMID: 38369537 PMCID: PMC10874929 DOI: 10.1038/s41598-024-54505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
Borrelia burgdorferi sensu lato is a species complex of pleomorphic spirochetes, including species that cause Lyme disease (LD) in humans. In addition to classic spiral forms, these bacteria are capable of creating morphological forms referred to as round bodies and aggregates. The subject of discussion is their possible contribution to the persistence of infection or post-infection symptoms in LD. This study investigates the immunological properties of these forms by monitoring reactivity with early (n = 30) and late stage (n = 30) LD patient sera and evaluating the immune response induced by vaccination of mice. In patient sera, we found a quantitative difference in reactivity with individual morphotypes, when aggregates were recognized most intensively, but the difference was statistically significant in only half of the tested strains. In post-vaccination mouse sera, we observed a statistically significant higher reactivity with antigens p83 and p25 (OspC) in mice vaccinated with aggregates compared to mice vaccinated with spiral forms. The importance of the particulate nature of the antigen for the induction of a Th1-directed response has also been demonstrated. In any of morphological forms, the possibility of inducing antibodies cross-reacting with human nuclear and myositis specific/associated autoantigens was not confirmed by vaccination of mice.
Collapse
Affiliation(s)
- Kristyna Sloupenska
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic
| | - Barbora Koubkova
- Department of Allergology and Clinical Immunology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Pavel Horak
- Third Department of Internal Medicine-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
- Third Department of Internal Medicine-Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic
| | - Jana Dolezilkova
- Laboratory of Medical Parasitology and Zoology, Public Health Institute Ostrava, Partyzanske Namesti 2633/7, Moravska Ostrava, 702 00, Ostrava, Czech Republic
| | - Beata Hutyrova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic
- Department of Allergology and Clinical Immunology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Mojmir Racansky
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic
- Department of Allergology and Clinical Immunology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Martina Miklusova
- Department of Neurology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Jan Mares
- Department of Neurology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic
| | - Milan Raska
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic
- Department of Immunology, University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Michal Krupka
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00, Olomouc, Czech Republic.
| |
Collapse
|
3
|
Loridon L, Langlois V, Boulard C. [Erythema of the lower limb]. Rev Med Interne 2024; 45:50-51. [PMID: 37626002 DOI: 10.1016/j.revmed.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Affiliation(s)
- L Loridon
- Service de dermatologie, CHU de Rouen, 76000 Rouen, France.
| | - V Langlois
- Service de médecine interne, groupe hospitalier du Havre, 76600 Le Havre, France
| | - C Boulard
- Service de dermatologie, groupe hospitalier du Havre, 76600 Le Havre, France
| |
Collapse
|
4
|
Nyman D, Nordberg M, Nyberg C, Olausson S, Carlströmer Berthen N, Carlsson SA. Diagnostic probability classification in suspected borreliosis by a novel Borrelia C6-peptide IgG1- subclass antibody test. Front Cell Infect Microbiol 2023; 13:1108115. [PMID: 37753485 PMCID: PMC10518385 DOI: 10.3389/fcimb.2023.1108115] [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: 11/28/2022] [Accepted: 08/15/2023] [Indexed: 09/28/2023] Open
Abstract
The tick-borne multisystemic infection caused by Borrelia burgdorferi sensu lato, Lyme borreliosis, or Lyme disease, occurring in temperate regions of the northern hemisphere, continues to spread geographically with the expanding tick population. Despite the rising perceived risk of infection in the population, the clinical diagnosis of Borrelia infection is not always obvious and the most important laboratory test, antibody detection, has limited accuracy in diagnosing active disease. According to international guidelines, the primary serology test, which has a high sensitivity-low specificity, should, be verified using a high specificity confirmation test to improve the specificity. However, this enhancement in specificity comes at the cost of lower sensitivity. This two-step procedure is often omitted in everyday clinical practice. An optimal primary test would be one where no secondary tests for confirmation would be necessary. In the present study, the performance of a novel assay for quantitating IgG1-subclass antibodies to Borrelia C6-peptide was compared to a commercial reference assay of total IgG and IgM antibodies to Borrelia C6-peptide in the setting of a high endemic area for borreliosis. A derivation study on a retrospective clinical material was performed to compare the performance parameters and assess the discriminatory properties of the assays, followed by a prospective validation study. The IgG1-antibody assay achieved comparable summary performance parameters to those of the reference assay. The sensitivity was almost 100% while the specificity was about 50%. In a high-endemic setting, characterized by high background seropositivity of about 50% and disease prevalence of approximately 10%, antibody tests are unable to rule-in active Borrelia infection. The rule-out assessment of the methods revealed that of 1000 patients, 7 - 54 with negative results based on the reference method could have an active Borrelia infection. Such uncertainty was not found for the index test and may help improve the risk classification of patients.
Collapse
Affiliation(s)
- Dag Nyman
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Bimelix Laboratory, Mariehamn, Finland
| | - Marika Nordberg
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Department of Infection, Åland Public Health Care Services, Mariehamn, Finland
| | - Clara Nyberg
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Department of Infection, Åland Public Health Care Services, Mariehamn, Finland
| | - Susanne Olausson
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Bimelix Laboratory, Mariehamn, Finland
| | | | - Sten-Anders Carlsson
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Bimelix Laboratory, Mariehamn, Finland
| |
Collapse
|
5
|
Stevenson B. The Lyme disease spirochete, Borrelia burgdorferi, as a model vector-borne pathogen: insights on regulation of gene and protein expression. Curr Opin Microbiol 2023; 74:102332. [PMID: 37279610 PMCID: PMC10524203 DOI: 10.1016/j.mib.2023.102332] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023]
Abstract
The Lyme disease spirochete persists in nature through cycles between ticks and vertebrates. Although the spirochete interacts with numerous, distinct tissues and environmental conditions during its infectious cycle, Borrelia burgdorferi appears to possess a limited ability to sense its external environment. This apparent paradox is being resolved through detailed investigations of the molecular mechanisms through which B. burgdorferi controls production of virulence-associated factors such as the Erp outer surface proteins. The results have led to development of a model for how B. burgdorferi controls expression of its diverse proteins, wherein physiological and metabolic states that are unique to specific points in the infectious cycle trigger changes in gene and protein expression levels.
Collapse
Affiliation(s)
- Brian Stevenson
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, KY, USA; Department of Entomology, University of Kentucky, Lexington, KY, USA.
| |
Collapse
|
6
|
Susnjar J, Cerar Kisek T, Strasek Smrdel K, Ruzic-Sabljic E, Adam K, Ivovic V. Detection, identification and genotyping of Borrelia spp. in ticks of Coastal-Karst and Littoral-Inner Carniola regions in Slovenia. Folia Parasitol (Praha) 2023; 70. [PMID: 37042198 DOI: 10.14411/fp.2023.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/13/2023] [Indexed: 04/03/2023]
Abstract
The density and spread of tick vector species have increased throughout Europe in the last 30 years, leading to an increase of Lyme borreliosis cases, including in Slovenia. The aim of this study was to isolate Borrelia strains and determine the prevalence of B. burgdorferi sensu lato and B. miyamotoi in adults of Ixodes ricinus (Linnaeus) collected in 2019 in the two regions of the country (Coastal-Karst and Littoral-Inner Carniola) by cultivation and PCR. We isolated B. burgdorferi s.l. by culture method in 28/559 (5%) ticks from both regions. Culture-negative samples (531/559, i.e., 95%) were additionally tested by real-time PCR. In 155/531 (29.2%) PCR-positive samples, a fragment of flaB or glpQ was amplified and further sequenced to identify species of the Borrelia. Using both methods, cultivation and PCR, Borrelia spp. prevalence was 32.7% in the Coastal-Karst region and 33.0% in the Littoral-Inner Carniola region. Genotyping of the Borrelia spp. isolates revealed that 17/28 (60%) were B. garinii subtype Mlg2. Of all tick samples tested for B. miyamotoi 8/398 (2%) were PCR positive. Based on previous studies in these regions, we had expected more ticks to be infected with B. afzelii, but genotyping revealed that B. garinii was the most abundant.
Collapse
Affiliation(s)
- Jana Susnjar
- Department of Biodiversity, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska,Koper, Slovenia
| | - Tjasa Cerar Kisek
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Strasek Smrdel
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Ruzic-Sabljic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Adam
- Department of Biodiversity, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska,Koper, Slovenia
| | - Vladimir Ivovic
- Department of Biodiversity, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska,Koper, Slovenia
| |
Collapse
|
7
|
Bruinsma RA, Zomer TP, Skogman BH, van Hensbroek MB, Hovius JW. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr 2023; 182:1965-1976. [PMID: 36856886 DOI: 10.1007/s00431-023-04811-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
Lyme neuroborreliosis (LNB) is a manifestation of Lyme disease involving the central and peripheral nervous system. It is caused by the spirochete Borrelia burgdorferi, transmitted by tick bites to a human host. Clinical signs of LNB develop after the dissemination of the pathogen to the nervous system. The infection occurs in children and adults, but the clinical manifestations differ. In adults, painful meningoradicultis is the most common manifestation of LNB, while children often present with facial nerve palsy and/or subacute meningitis. Subacute headache can be the only manifestation of LNB in children, especially during the summer months in Lyme disease-endemic regions. Non-specific symptoms, such as loss of appetite, fatigue or mood changes, may also occur, especially in young children. A high level of suspicion and early recognition of the various clinical manifestations presented by children with LNB is essential to minimize delay in diagnosis and optimize management. This review provides an overview of the spectrum of clinical manifestations, and discusses diagnosis, antibiotic treatment, and clinical outcome of LNB in children.
Collapse
Affiliation(s)
- R A Bruinsma
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.,Department of Pediatrics, Gelre Hospital, Apeldoorn, the Netherlands
| | - T P Zomer
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.
| | - B H Skogman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - M Boele van Hensbroek
- Department of Pediatrics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J W Hovius
- Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam UMC Medical Centers, location AMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
8
|
Müller M. Gerold Stanek (1946-2022). Wien Klin Wochenschr 2022; 134:811-812. [PMID: 36480059 DOI: 10.1007/s00508-022-02140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Markus Müller
- Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| |
Collapse
|
9
|
Strle F, Wormser GP. Early Lyme Disease (Erythema Migrans) and Its Mimics (Southern Tick-Associated Rash Illness and Tick-Associated Rash Illness). Infect Dis Clin North Am 2022; 36:523-539. [PMID: 36116832 DOI: 10.1016/j.idc.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Erythema migrans, an expanding erythematous skin lesion that develops days to weeks following an Ixodes species tick bite, is the most common clinical manifestation of Lyme disease. Presentations in the United States differ somewhat from that in Europe, presumably because of the different etiologic agents. Diagnosis is based on the appearance of the skin lesion, rather than on laboratory testing. After treatment with an appropriate oral antibiotic for 10 to 14 days, the prognosis is excellent. Two conditions that cause a similar skin lesion following a tick bite, but are of unknown cause, are Southern tick-associated rash illness in the United States and tick-associated rash illness in Japan.
Collapse
Affiliation(s)
- Franc Strle
- University Medical Center Ljubljana, Japljeva 2, Ljubljana 1525, Slovenia.
| | - Gary P Wormser
- New York Medical College, 40 Sunshine Cottage Road, Skyline Office, Valhalla, NY 10595, USA
| |
Collapse
|
10
|
Abstract
Lyme disease is the most common vector-borne illness in North America and Europe. The etiologic agent, Borrelia burgdorferi sensu lato, is transmitted to humans by certain species of Ixodes ticks, which are found widely in temperate regions of the Northern hemisphere. Clinical features are diverse but death is rare. The risk of human infection is determined by the distribution and abundance of vector ticks, ecologic factors influencing tick infection rates, and human behaviors that promote tick bite. Rates of infection are highest among children aged 5 to 15 years and adults aged more than 50 years. In the northeastern United States where disease is most common, exposure occurs primarily in areas immediately around the home. Knowledge of disease epidemiology is important for patient management and proper diagnosis.
Collapse
Affiliation(s)
- Paul Mead
- Bacterial Diseases Branch, Division of Vector-borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 3156 Rampart Road, Ft Collins, CO 80521, USA.
| |
Collapse
|
11
|
Arnason S, Molewijk K, Henningsson AJ, Tjernberg I, Skogman BH. Brain damage markers neuron-specific enolase (NSE) and S100B in serum in children with Lyme neuroborreliosis-detection and evaluation as prognostic biomarkers for clinical outcome. Eur J Clin Microbiol Infect Dis 2022; 41:1051-1057. [PMID: 35665437 PMCID: PMC9250468 DOI: 10.1007/s10096-022-04460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022]
Abstract
Lyme borreliosis (LB) is the most common tick-borne infection in Europe, with Lyme neuroborreliosis (LNB) its second most frequent clinical manifestation. Prognostic factors for clinical outcomes in LNB have not been identified. Elevated serum levels of the brain damage markers neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) have been associated with poor clinical outcomes in other disorders of the central nervous system. The aim of this study is to assess NSE and S100B in serum as prognostic biomarkers for clinical outcomes in paediatric LNB patients. Children evaluated for LNB (n = 121) in Sweden were prospectively included during 2010–2014, serum samples were collected on admission, and all children underwent a 2-month follow-up. Patients with pleocytosis and anti-Borrelia antibodies in cerebrospinal fluid (CSF) were classified as having LNB (n = 61). Controls were age- and gender-matched non-LNB patients (n = 60). NSE was elevated in 38/61 (62%) LNB patients and in 31/60 (52%) controls. S100B was elevated in 3/60 (5%) LNB patients and 0/59 (0%) controls. NSE and S100B concentrations did not differ significantly when comparing LNB patients with controls. No differences were found in the concentrations when comparing the clinical recovery of LNB patients at the 2-month follow-up. NSE was detectable in the majority of LNB patients and controls, whereas S100B was detectable in only a few LNB patients and no controls. NSE and S100B in serum cannot be recommended as prognostic biomarkers for clinical outcomes in children with LNB.
Collapse
Affiliation(s)
- Sigurdur Arnason
- Department of Clinical Science, Intervention and Technology - CLINTEC, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden. .,Department of Pediatric Infectious Diseases, Astrid Lindgren's Children's Hospital, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden.
| | - Kesia Molewijk
- Faculty of Health and Medical Sciences, Örebro University, Södra Grev Rosengatan 42 B, S-703 62, Örebro, Sweden
| | - Anna J Henningsson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden.,National Reference Laboratory for Borrelia and Other Tick-Borne Bacteria, Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Linköping University, Linköping, Sweden.,Department of Clinical Microbiology in Linköping, Linköping University, Linköping, Sweden
| | - Ivar Tjernberg
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
| | - Barbro H Skogman
- Faculty of Health and Medical Sciences, Örebro University, Södra Grev Rosengatan 42 B, S-703 62, Örebro, Sweden.,Center for Clinical Research Dalarna - Uppsala University, Nissers väg 3, S-791 82, Falun, Sweden.,Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Alfred Nobels Allé 8, S-141 52, Huddinge, Stockholm, Sweden
| |
Collapse
|
12
|
Liebmann N, Sterker I, Sorge I, Opitz S, Merkenschlager A, Gburek-Augustat J. [Unusual Localisation of a Borrelia Lymphocytoma]. Klin Monbl Augenheilkd 2021. [PMID: 34911119 DOI: 10.1055/a-1686-9274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nora Liebmann
- Neuropädiatrie, Klinik und Poliklinik für Kinder und Jugendmedizin, Universitätsklinikum Leipzig, Deutschland
| | - Ina Sterker
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Deutschland
| | - Ina Sorge
- Abteilung für Kinderradiologie, Universitätsklinikum Leipzig, Deutschland
| | - Sabine Opitz
- Institut für Pathologie, Universitätsklinikum Leipzig, Deutschland
| | - Andreas Merkenschlager
- Neuropädiatrie, Klinik und Poliklinik für Kinder und Jugendmedizin, Universitätsklinikum Leipzig, Deutschland
| | - Janina Gburek-Augustat
- Neuropädiatrie, Klinik und Poliklinik für Kinder und Jugendmedizin, Universitätsklinikum Leipzig, Deutschland
| |
Collapse
|
13
|
Kortela E, Kanerva MJ, Kurkela S, Oksi J, Koivisto M, Järvinen A. Consumption of healthcare services and antibiotics in patients with presumed disseminated Lyme borreliosis before and after evaluation of an infectious disease specialist. Ticks Tick Borne Dis 2021; 13:101854. [PMID: 34695770 DOI: 10.1016/j.ttbdis.2021.101854] [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: 11/04/2020] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Our objective was to study the consumption of healthcare services and antibiotics in patients with suspicion of disseminated Lyme borreliosis (LB) before and after consultation of an infectious disease specialist. We evaluated retrospectively all presumed disseminated LB patients (n = 256) with a referral to the Department of Infectious Diseases (DID) in Helsinki University Hospital in 2013. Medical records from all healthcare providers in the area were reviewed and the number of physician contacts because of symptoms leading to LB suspicion and antimicrobial purchases were calculated 1 year before and after consultation or treatment at the DID. Patients were divided into three groups according to certainty of LB: unlikely, possible or probable/definite LB. The number of healthcare contacts 1 year before referral was higher among 121 patients with unlikely LB (6; interquartile range [IQR] 3-10), than 65 possible (4; IQR 2.5-7; p = 0.018) or 66 probable/definite LB patients (4; IQR 2.8-7; p = 0.010). The median number of contacts to healthcare during one year after consultation or treatment was 3 (IQR 0.5-7), 1 (IQR 0-3) and 0.5 (IQR 0-2.3), respectively, with a statistically significant difference between the groups (p<0.001). Antibiotics were purchased by 151 (60%) patients one year before referral and by 127 (50%) patients year after consultation or treatment at DID without statistically significant difference between groups with different LB certainty. These antibiotic purchases do not include the treatments prescribed by infectious disease specialists. In the case of 27 patients, an antimicrobial treatment was recommended in the consultation reply. In conclusion, patients with unlikely LB used more healthcare services than patients with possible or probable/definite LB. Antimicrobial consumption was similar between groups of different LB certainty.
Collapse
Affiliation(s)
- Elisa Kortela
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
| | - Mari J Kanerva
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Satu Kurkela
- Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Asko Järvinen
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
14
|
Hove PR, Magunda F, de Mello Marques MA, Islam MN, Harton MR, Jackson M, Belisle JT. Identification and functional analysis of a galactosyltransferase capable of cholesterol glycolipid formation in the Lyme disease spirochete Borrelia burgdorferi. PLoS One 2021; 16:e0252214. [PMID: 34061884 PMCID: PMC8168883 DOI: 10.1371/journal.pone.0252214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/11/2021] [Indexed: 01/22/2023] Open
Abstract
Borrelia burgdorferi (Bb), the etiological agent of Lyme disease, produces a series of simple glycolipids where diacylglycerol and cholesterol serve as the precursor. The cholesterol-based glycolipids, cholesteryl 6-O-acyl-β-D-galactopyranoside (ACGal) and cholesteryl-β-D-galactopyranoside (CGal) are immunogenic and proposed to contribute to the pathogenesis of Lyme disease. Detailed studies of CGal and ACGal in Bb have been hampered by a lack of knowledge of their underlying biosynthetic processes. The genome of Bb encodes four putative glycosyltransferases, and only one of these, BB0572, was predicted to be an inverting family 2 glycosyltransferase (GT2 enzyme) capable of using UDP-galactose as a substrate and forming a β-glycosidic bond. Comparison of the 42 kDa BB0572 amino acid sequence from Bb with other Borrelia spp demonstrates that this protein is highly conserved. To establish BB0572 as the galactosyltransferase capable of cholesterol glycolipid formation in Bb, the protein was produced as a recombinant product in Escherichia coli and tested in a cell-free assay with 14C-cholesterol and UDP-galactose as the substrates. This experiment resulted in a radiolabeled lipid that migrated with the cholesterol glycolipid standard of CGal when evaluated by thin layer chromatography. Additionally, mutation in the predicted active site of BB0572 resulted in a recombinant protein that was unable to catalyze the formation of the cholesterol glycolipid. These data characterize BB0572 as a putative cholesterol galactosyltransferase. This provides the first step in understanding how Bb cholesterol glycolipids are formed and will allow investigations into their involvement in pathogen transmission and disease development.
Collapse
Affiliation(s)
- Petronella R. Hove
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| | - Forgivemore Magunda
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| | - Maria Angela de Mello Marques
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| | - M. Nurul Islam
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| | - Marisa R. Harton
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| | - Mary Jackson
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| | - John T. Belisle
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, United States of America
| |
Collapse
|
15
|
Travaglino A, Varricchio S, Pace M, Russo D, Picardi M, Baldo A, Staibano S, Mascolo M. Borrelia burgdorferi
in primär kutanen Lymphomen: eine systematische Übersicht und Metaanalyse. J Dtsch Dermatol Ges 2020; 18:1379-1386. [PMID: 33373156 DOI: 10.1111/ddg.14289_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Travaglino
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Silvia Varricchio
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mirella Pace
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Russo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Marco Picardi
- Hematology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonello Baldo
- Dermatology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mascolo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
16
|
Travaglino A, Varricchio S, Pace M, Russo D, Picardi M, Baldo A, Staibano S, Mascolo M. Borrelia burgdorferi in primary cutaneous lymphomas: a systematic review and meta-analysis. J Dtsch Dermatol Ges 2020; 18:1379-1384. [PMID: 33029842 DOI: 10.1111/ddg.14289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The association between Borrelia burgdorferi and primary cutaneous lymphoma is still unclear. This systematic review and meta-analysis aims to define the association of Borrelia burgdorferi with primary cutaneous lymphoma and its different entities. METHODS Electronic databases were searched for all studies that assessed the presence of Borrelia burgdorferi DNA in specimens of primary cutaneous lymphoma. The association between Borrelia and primary cutaneous lymphomas was assessed with an odds ratio (significant p < 0.05); cutaneous specimens with no lymphoproliferative disorders were used as controls. A secondary analysis was performed to assess the prevalence of Borrelia infection in different lymphoma entities. RESULTS Ten studies with 506 primary cutaneous lymphomas and 201 controls were included. The prevalence of Borrelia DNA positivity was highly heterogeneous among studies from different regions. Borrelia DNA positivity was significantly associated with primary cutaneous lymphomas (odds ratio = 10.88; p < 0.00001). The prevalence of Borrelia DNA positivity was similar among different entities (marginal zone: 7.3 %; follicular: 8.1 %; diffuse large B-cell: 7.5 %; mycosis fungoides: 8 %). CONCLUSIONS Borrelia burgdorferi is significantly associated with primary cutaneous lymphomas, with no differences among the several lymphoma entities (both B-cell and T-cell), but with strong geographical differences. Molecular testing for Borrelia would be justified in patients with primary cutaneous lymphoma from endemic areas.
Collapse
Affiliation(s)
- Antonio Travaglino
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Silvia Varricchio
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mirella Pace
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Russo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Marco Picardi
- Hematology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonello Baldo
- Dermatology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mascolo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
17
|
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
|
18
|
Margos G, Castillo-Ramirez S, Cutler S, Dessau RB, Eikeland R, Estrada-Peña A, Gofton A, Graña-Miraglia L, Hunfeld KP, Krause A, Lienhard R, Lindgren PE, Oskam C, Rudolf I, Schwartz I, Sing A, Stevenson B, Wormser GP, Fingerle V. Rejection of the name Borreliella and all proposed species comb. nov. placed therein. Int J Syst Evol Microbiol 2020; 70:3577-3581. [PMID: 32320380 DOI: 10.1099/ijsem.0.004149] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rejection (nomen rejiciendum) of the name Borreliella and all new combinations therein is being requested on grounds of risk to human health and patient safety (Principle 1, subprinciple 2 and Rule 56a) and violation to aim for stability of names, to avoid useless creation of names (Principle 1, subprinciple 1 and 3) and that names should not be changed without sufficient reason (Principle 9 of the International Code of Nomenclature of Prokaryotes).
Collapse
Affiliation(s)
- Gabriele Margos
- Bavarian Health and Food Safety Authority, National Reference Center for Borrelia, Oberschleissheim, Germany.,Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor)
| | - Santiago Castillo-Ramirez
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónomade México, CP 62210, Cuernavaca, Morelos, México
| | - Sally Cutler
- School of Health, Sport and Bioscience, University of East London, London E15 4LZ, UK.,Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor)
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Denmark.,Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor)
| | - Randi Eikeland
- Norwegian Advisory Unit for Tick Borne Diseases, Sørlandet Hospital, Norway.,Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor)
| | - Agustin Estrada-Peña
- Department of Animal Pathology, Faculty of Veterinary Medicine, 50013 Zaragoza, Spain
| | - Alexander Gofton
- Australian National Insect Collection CSIRO, Black Mountain, Acton, ACT, 2901, Australia
| | - Lucía Graña-Miraglia
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónomade México, CP 62210, Cuernavaca, Morelos, México
| | - Klaus-Peter Hunfeld
- Zentralinstitut für Labormedizin, Mikrobiologie & Krankenhaushygiene, Krankenhaus Nordwest, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany.,Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor)
| | - Andreas Krause
- Abteilung Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Reto Lienhard
- Microbiologiste FAMH, Laboratoire Borrelia (CNRT/ NRZK Spiez), La Chaux-de-Fonds, Switzerland
| | - Per-Eric Lindgren
- Department of Biomedical and Clinical Sciences (BKV), Division of Inflammation and Infection (II), Linköping University, Sweden.,Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor)
| | - Charlotte Oskam
- Vector & Waterborne Pathogens Research Group, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, 6150, Australia
| | - Ivo Rudolf
- Institute of Vertebrate Biology, v.v.i., Academy of Sciences of the Czech Republic, CZ-691 42 Valtice, Czech Republic
| | - Ira Schwartz
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA
| | - Andreas Sing
- Bavarian Health and Food Safety Authority, National Reference Center for Borrelia, Oberschleissheim, Germany
| | - Brian Stevenson
- Department of Microbiology, Immunology and Molecular Genetics and Department of Entomology, University of Kentucky, Lexington, Kentucky, 40502, USA
| | - Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA
| | - Volker Fingerle
- Members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR, www.escmid.org/esgbor).,Bavarian Health and Food Safety Authority, National Reference Center for Borrelia, Oberschleissheim, Germany
| |
Collapse
|
19
|
Maraspin V, Bogovič P, Rojko T, Ogrinc K, Ružić-Sabljić E, Strle F. Early Lyme Borreliosis in Patients Treated with Tumour Necrosis Factor-Alfa Inhibitors. J Clin Med 2019; 8:jcm8111857. [PMID: 31684103 PMCID: PMC6912410 DOI: 10.3390/jcm8111857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/19/2019] [Accepted: 10/30/2019] [Indexed: 12/30/2022] Open
Abstract
The study evaluated the course and outcome of erythema migrans in patients receiving tumour necrosis factor-alpha (TNF-α) inhibitors. Among 4157 adults diagnosed with erythema migrans in the period 2009–2018, 16 (2.6%) patients were receiving TNF-α inhibitors (adalimumab, infliximab, etarnecept, golimumab), often in combination with other immunosuppressants, for rheumatic (13 patients) or inflammatory bowel (three patients) disease. Findings in this group were compared with those in 32 sex- and age-matched immunocompetent patients diagnosed with erythema migrans in the same years. In comparison with the control group, the immunocompromised patients had a shorter incubation period (7 vs. 14 days; p = 0.0153), smaller diameter of erythema migrans (10.5 vs. 15.5 cm; p = 0.0014), and more frequent comorbidities other than immune-mediated diseases (62.5% vs. 25%, p = 0.0269), symptoms/signs of disseminated Lyme borreliosis (18.8% vs. 0%, p = 0.0324), and treatment failure (25% vs. 0%, p = 0.0094). After retreatment with an antibiotic, the clinical course of Lyme borreliosis resolved. Continuing TNF inhibitor treatment during concomitant borrelial infection while using identical approaches for antibiotic treatment as in immunocompetent patients resulted in more frequent failure of erythema migrans treatment in patients receiving TNF inhibitors. However, the majority of treatment failures were mild, and the course and outcome of Lyme borreliosis after retreatment with antibiotics was favourable.
Collapse
Affiliation(s)
- Vera Maraspin
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
| | - Tereza Rojko
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
| | - Katarina Ogrinc
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
| | - Eva Ružić-Sabljić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
| |
Collapse
|
20
|
Barstad B, Tveitnes D, Dalen I, Noraas S, Ask IS, Bosse FJ, Øymar K. The B-lymphocyte chemokine CXCL13 in the cerebrospinal fluid of children with Lyme neuroborreliosis: associations with clinical and laboratory variables. Infect Dis (Lond) 2019; 51:856-863. [PMID: 31573360 DOI: 10.1080/23744235.2019.1671988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: The B-lymphocyte chemokine CXCL13 is increasingly considered as a useful early phase diagnostic marker of Lyme neuroborreliosis (LNB). However, the large variation in level of CXCL13 in the cerebrospinal fluid (CSF) observed in LNB patients is still unexplained. We aimed to identify factors associated with the level of CXCL13 in children with LNB, possibly improving the interpretation of CXCL13 as a diagnostic marker of LNB. Methods: Children with confirmed and probable LNB were included in a prospective study on CXCL13 in CSF as a diagnostic marker of LNB. The variables age, sex, facial nerve palsy, generalized inflammation symptoms (fever, headache, neck-stiffness and/or fatigue), duration of symptoms, Borrelia antibodies in CSF, Borrelia antibody index (AI), CSF white blood cells (WBC), CSF protein and detection of the genospecies Borrelia garinii by PCR were included in simple and multivariable regression analyses to study the associations with the CXCL13 level. Results: We included 53 children with confirmed and 17 children with probable LNB. CXCL13 levels in CSF were positively associated with WBC, protein and Borrelia antibodies in CSF in both simple and multivariable analyses. We did not find any associations between CXCL13 and age, sex, clinical symptoms, duration of symptoms, AI or the detection of Borrelia garinii. Conclusions: High levels of CSF CXCL13 are present in the early phase of LNB and correlate with the level of CSF WBC and protein. Our results indicate that CSF CXCL13 in children evaluated for LNB can be interpreted independently of clinical features or duration of symptoms.
Collapse
Affiliation(s)
- Bjørn Barstad
- Department of Pediatric and Adolescent Medicine, Stavanger University Hospital , Stavanger , Norway.,Department of Clinical Science, University of Bergen , Bergen , Norway
| | - Dag Tveitnes
- Department of Pediatric and Adolescent Medicine, Stavanger University Hospital , Stavanger , Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital , Stavanger , Norway
| | - Sølvi Noraas
- Department of Medical Microbiology, Hospital of Southern Norway Trust , Kristiansand , Norway
| | - Ingvild S Ask
- Department of Pediatric and Adolescent Medicine, Hospital of Southern Norway Trust , Kristiansand , Norway
| | - Franziskus J Bosse
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital , Bergen , Norway
| | - Knut Øymar
- Department of Pediatric and Adolescent Medicine, Stavanger University Hospital , Stavanger , Norway.,Department of Clinical Science, University of Bergen , Bergen , Norway
| |
Collapse
|
21
|
Lager M, Dessau RB, Wilhelmsson P, Nyman D, Jensen GF, Matussek A, Lindgren PE, Henningsson AJ, Baqir H, Serrander L, Johansson M, Tjernberg I, Skarstein I, Ulvestad E, Grude N, Pedersen AB, Bredberg A, Veflingstad R, Wass L, Aleke J, Nordberg M, Nyberg C, Perander L, Bojesson C, Sjöberg E, Lorentzen ÅR, Eikeland R, Noraas S, Henriksson GA, Petrányi G. Serological diagnostics of Lyme borreliosis: comparison of assays in twelve clinical laboratories in Northern Europe. Eur J Clin Microbiol Infect Dis 2019; 38:1933-1945. [PMID: 31399914 PMCID: PMC6778534 DOI: 10.1007/s10096-019-03631-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
Lyme borreliosis (LB), caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, is the most common tick-borne infection in Europe. Laboratory diagnosis of LB is mainly based on the patients’ medical history, clinical signs and symptoms in combination with detection of Borrelia-specific antibodies where indirect enzyme-linked-immunosorbent assay (ELISA) is the most widely used technique. The objective of the study was to evaluate and compare the diagnostic accuracy (sensitivities and specificities) of serological tests that are currently in use for diagnosis of LB in clinical laboratories in Northern Europe, by use of a large serum panel. The panel consisted of 195 serum samples from well-characterized and classified patients under investigation for clinically suspected LB (n = 59) including patients with Lyme neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans, erythema migrans or other diseases (n = 112). A total of 201 serum samples from healthy blood donors were also included. The panel (396 serum samples altogether) was sent to 12 clinical laboratories (using five different ELISA methods) as blinded for group affiliation and the laboratories were asked to perform serological analysis according to their routine procedure. The results from the study demonstrated high diagnostic concordance between the laboratories using the same diagnostic assay and lower diagnostic concordance between laboratories using different diagnostic assays. For IgG, the results were in general rather homogenous and showed an average sensitivity of 88% (range 85–91%) compared to IgM which showed lower average sensitivity of 59% (range 50–67%) and more heterogeneous results between assays and laboratories.
Collapse
Affiliation(s)
- Malin Lager
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden. .,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Peter Wilhelmsson
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Åland, Mariehamn, Finland
| | - Guro F Jensen
- Department of Medical Microbiology, Sørlandet Hospital, Kristiansand, Norway
| | - Andreas Matussek
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Karolinska University Laboratory, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Per-Eric Lindgren
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna J Henningsson
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Division of Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Rauwald HW, Liebold T, Grötzinger K, Lehmann J, Kuchta K. Labdanum and Labdanes of Cistus creticus and C. ladanifer: Anti-Borrelia activity and its phytochemical profiling ✰. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 60:152977. [PMID: 31474477 DOI: 10.1016/j.phymed.2019.152977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Intrigued by testimonies of Saxon borreliosis self-help groups concerning considerabl improvements of their symptoms by ingestion of Cistus creticus L. (Cistaceae) leaf preparations, we recently reported on the growth inhibiting activity of extracts with different polarities and its volatile oil against Borrelia burgdorferi sensu stricto (Bbss) in vitro, determined by a bioassay guided procedure. The most active volatile oil (only about 0.10% in leaves) was found to be dominated by labdane-type manoyloxides as well as carvacrol, determined via GC-MS. HYPOTHESIS These terpenes are major active constituents of the old pharmaceutical oleoresin labdanum, which is secreted from the leaf surface of C. creticus and traditionally harvested, e.g., on Crete by brushing the shrubs. METHODS In order to elucidate the definite anti-Borrelia active principles of C. creticus, preparative scale separation of the diethyl‑ether soluble fraction of Cretan labdanum was achieved by combined silica gel 60-and RP-18 CC and analysed by novel TLC-Extractor/ES-MS as well as by 1d/2d-1H/13C-NMR data. For the antispirochaetal activity tests against Bbss in vitro, all samples were solubilised in water with addition of polysorbate 80, the effect of which on bacterial growth was examined and found to be negligible. RESULTS This led to isolation and identification of the monoterpene carvacrol as well as of the four major manoyloxides manoyloxide (A), 3-acetoxy-manoyloxide (B), 3‑hydroxy-manoyloxide (C), and epi‑manoyloxide (D). Additionally, 2-keto-manoyloxide (E) and sclareol (F) were identified via GC/EI-MS. In subsequent microbiological tests of the isolated compounds, epi‑manoyloxide (D) exhibited by far the strongest individual antispirochaetal effect, equal to the positive control amoxicilline. Furthermore, manoyloxide (A), carvacrol, and the diethyl‑ether soluble fraction of labdanum as a whole contribute to the strong antispirochaetal activity, while the other labdanes were less active. Isolated manoyloxides were further used as external standards for a GC-MS screening of labdanum samples from different origins, revealing exceptionally high contents of all analysed manoyloxides in the samples of Cretan labdanum from C. creticus, while their contents in other commercial available labdanum samples were lower by several orders of magnitude. Especially in Spanish labdanum samples, declared as Cistus ladanifer L., mainly simple alkanes and at most traces of epi‑manoyloxide (D) and of manoyloxide (A) could be detected. CONCLUSION The application of C. creticus preparations by Lyme disease self-help groups may be considered as a reasonable therapy approach. For the first time, isolated epi‑manoyloxide and carvacrol could be evaluated as most promising candidates for drug development and labdanum based phytomedicine development, respectively. They should serve as vital active markers for quality assessments of C. creticus preparations.
Collapse
Affiliation(s)
- Hans Wilhelm Rauwald
- Department of Pharmaceutical Biology, Institute of Pharmacy, Leipzig University, Johannisallee 21-23, Leipzig 04103, Germany.
| | - Tobias Liebold
- Department of Pharmaceutical Biology, Institute of Pharmacy, Leipzig University, Johannisallee 21-23, Leipzig 04103, Germany
| | - Kristina Grötzinger
- Department of Pharmaceutical Biology, Institute of Pharmacy, Leipzig University, Johannisallee 21-23, Leipzig 04103, Germany
| | - Jörg Lehmann
- Department of Therapy Validation, Fraunhofer Institute for Cell Therapy and Immunology, Perlickstr. 1, Leipzig 04103, Germany
| | - Kenny Kuchta
- Department of Pharmaceutical Biology, Institute of Pharmacy, Leipzig University, Johannisallee 21-23, Leipzig 04103, Germany
| |
Collapse
|
23
|
Munro HJ, Ogden NH, Mechai S, Lindsay LR, Robertson GJ, Whitney H, Lang AS. Genetic diversity of Borrelia garinii from Ixodes uriae collected in seabird colonies of the northwestern Atlantic Ocean. Ticks Tick Borne Dis 2019; 10:101255. [PMID: 31280947 DOI: 10.1016/j.ttbdis.2019.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
The occurrence of Borrelia garinii in seabird ticks, Ixodes uriae, associated with different species of colonial seabirds has been studied since the early 1990s. Research on the population structure of this bacterium in ticks from seabird colonies in the northeastern Atlantic Ocean has revealed admixture between marine and terrestrial tick populations. We studied B. garinii genetic diversity and population structure in I. uriae collected from seabird colonies in the northwestern Atlantic Ocean, in Newfoundland and Labrador, Canada. We applied a multi-locus sequence typing (MLST) scheme to B. garinii found in ticks from four species of seabirds. The B. garinii strains found in this seabird colony ecosystem were diverse. Some were very similar to strains from Asia and Europe, including some obtained from human clinical samples, while others formed a divergent group specific to this region of the Atlantic Ocean. Our findings highlight the genetic complexity of B. garinii circulating in seabird ticks and their avian hosts but also demonstrate surprisingly close connections between B. garinii in this ecosystem and terrestrial sources in Eurasia. Genetic similarities among B. garinii from seabird ticks and humans indicate the possibility that B. garinii circulating within seabird tick-avian host transmission cycles could directly, or indirectly via connectivity with terrestrial transmission cycles, have consequences for human health.
Collapse
Affiliation(s)
- Hannah J Munro
- Department of Biology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3X9, Canada.
| | - Nicholas H Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, J2S 2M2, Canada; Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, J2S 2M2, Canada.
| | - Samir Mechai
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, J2S 2M2, Canada; Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, J2S 2M2, Canada.
| | - L Robbin Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada.
| | - Gregory J Robertson
- Wildlife Research Division, Environment and Climate Change Canada, Mount Pearl, Newfoundland and Labrador, A1N 4T3, Canada.
| | - Hugh Whitney
- Department of Biology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3X9, Canada.
| | - Andrew S Lang
- Department of Biology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3X9, Canada.
| |
Collapse
|
24
|
Conforti C, Vezzoni R, Retrosi C, Longone M, Corneli P, Magaton Rizzi G, Nan K, Di Meo N, Zalaudek I. Overview on the treatment of Lyme disease in pregnancy. GIORN ITAL DERMAT V 2019; 155:220-222. [PMID: 31210468 DOI: 10.23736/s0392-0488.19.06396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lyme disease is a tick-borne illness, which is typically caused by Borrelia Burgdoferi. Over time, a typical Borreliosis skin reaction takes shape, i.e. the formation of an annular erythema that tends to expand centrifugally with erythematous edges whose diameter can reach up to 20 cm. The symptoms of Lyme disease are not only cutaneous but there may be a systemic involvement. Obviously, this disease can also affect pregnant women and for this reason this review aims to summarize the main ways of treatment to avoid worsening of the clinical condition in the mother and an eventual, albeit rare, involvement of the fetus.
Collapse
Affiliation(s)
- Claudio Conforti
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Vezzoni
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Chiara Retrosi
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy -
| | - Michela Longone
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paola Corneli
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Katiuscia Nan
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Nicola Di Meo
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| |
Collapse
|
25
|
Pilypas AA, Raišelienė G, Valaikienė J. Lyme disease and heart transplantation: presentation of a clinical case and a literature review. Acta Med Litu 2019; 26:173-180. [PMID: 32015672 PMCID: PMC6992363 DOI: 10.6001/actamedica.v26i3.4147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Lyme disease, the most common anthropozoonosis, is a transmissible natural focal infection affecting various organs and systems. Also known as Lyme borreliosis, it is caused by Borrelia spirochetes, which are distributed by ticks of the genus Ixodes. Early diagnosis is difficult due to frequent occurrence of atypical symptoms, unnoticed tick bites, the absence of migratory erythematous lesions, and symptoms occurring during the non-tick season. If not diagnosed and treated in time, dissemination of the infection occurs and various complications develop since borrelias damage not only the skin but also the nervous system, joints, and, in rare cases, the heart and eyes. MATERIALS AND METHODS This article presents a clinical case of Lyme borreliosis-induced myocarditis, which led to the development of dilated cardiomyopathy and, consequently, urgent cardiac transplantation. According to our data, this is one of the first described cases of this complication in the world. RESULTS AND CONCLUSIONS When diagnosed in time and treated properly, the prognosis of Lyme myocarditis is usually good. In most cases, the atrioventricular block disappears within 1-2 weeks of antibiotic treatment and the implantation of a temporary pacemaker is rarely needed. In those rare cases of a chronic Borrelia burgdorferi infection, dilated cardiomyopathy may develop; thus if a sudden atrioventricular block occurs, the physician should be vigilant and perform the necessary tests to exclude the diagnosis of Lyme disease. RESULTS AND CONCLUSIONS When diagnosed in time and treated properly, the prognosis of Lyme myocarditis is usually good. In most cases, the atrioventricular block disappears within 1-2 weeks of antibiotic treatment and the implantation of a temporary pacemaker is rarely needed. In those rare cases of a chronic Borrelia burgdorferi infection, dilated cardiomyopathy may develop; thus if a sudden atrioventricular block occurs, the physician should be vigilant and perform the necessary tests to exclude the diagnosis of Lyme disease.
Collapse
Affiliation(s)
| | - Giedrutė Raišelienė
- Clinic of Cardiac and Vascular Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jurgita Valaikienė
- Centre of Neurology, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
26
|
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
|
27
|
Acrodermatitis chronica atrophicans in children: Report on two cases and review of the literature. Ticks Tick Borne Dis 2018; 10:180-185. [PMID: 30389325 DOI: 10.1016/j.ttbdis.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/02/2018] [Accepted: 10/24/2018] [Indexed: 12/15/2022]
Abstract
Acrodermatitis chronica atrophicans is a late manifestation of European Lyme borreliosis and is characterized by high levels of borrelial IgG antibodies, slowly expanding skin redness usually beginning on distal parts of extremities, and corresponding histologic findings. It very rarely develops in children. The main prerequisite for the diagnosis is clinical suspicion. In the present article we report on two children with acrodermatitis chronica atrophicans and on the findings of a PubMed literature search on acrodermatitis chronica atrophicans in childhood, published in the past three decades.
Collapse
|
28
|
Correlation of Reflectance Confocal Microscopy and Dermatopathology Findings in a Case of Acrodermatitis Chronica Atrophicans. Am J Dermatopathol 2018; 40:367-370. [PMID: 29251638 DOI: 10.1097/dad.0000000000001069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Acrodermatitis chronica atrophicans (ACA) that is characterized by thin, papery dry, translucent, and alopecic patches with visible superficial veins is a late cutaneous manifestation of Lyme borreliosis. Clinical findings, a history of exposure to tick bite, and serology are helpful for the diagnosis of ACA and sometimes a biopsy is performed to rule out other infectious or inflammatory processes. In this study, we report reflectance confocal microscopy (RCM) findings in a case of ACA. RCM examination revealed a flattened surface with broadened skin folds, a flattened dermoepidermal junction with few papillae and less bright basal cells and multiple small bright reflecting spots in the dermis. To the best of our knowledge, this is the first description of the RCM findings in this disorder.
Collapse
|
29
|
Stevenson B, Fingerle V, Wormser GP, Margos G. Public health and patient safety concerns merit retention of Lyme borreliosis-associated spirochetes within the genus Borrelia, and rejection of the genus novum Borreliella. Ticks Tick Borne Dis 2018; 10:1-4. [PMID: 30154058 DOI: 10.1016/j.ttbdis.2018.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/10/2018] [Accepted: 08/14/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Brian Stevenson
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky, 40536-0298, USA; Department of Entomology, University of Kentucky, Lexington, Kentucky, 40546-0091, USA.
| | - Volker Fingerle
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.
| | - Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA.
| | - Gabriele Margos
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.
| |
Collapse
|
30
|
McGhee S, Visovksy C, Zambroski C, Finnegan A. Lyme disease: recognition and management for emergency nurses. Emerg Nurse 2018; 26:17-34. [PMID: 30091549 DOI: 10.7748/en.2018.e1850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/09/2022]
Abstract
Over the past ten years there has been a significant rise in the number of people who present to emergency departments with Lyme disease. Although some patients remain asymptomatic many present with a rash around a previous tick bite and others may present with a range of debilitating symptoms that can be problematic if left untreated. Due to the growing prevalence of Lyme disease in the UK and the US this article gives an overview of the vector-borne condition and provides emergency nurses with information about the pathophysiology, prevention, presenting signs and symptoms and management.
Collapse
Affiliation(s)
- Stephen McGhee
- College of Nursing, University of South Florida, Tampa FL, United States
| | - Connie Visovksy
- College of Nursing, University of South Florida, Tampa FL, United States
| | - Cheryl Zambroski
- College of Nursing, University of South Florida, Tampa FL, United States
| | | |
Collapse
|
31
|
A Community Study of Borrelia burgdorferi Antibodies among Individuals with Prior Lyme Disease in Endemic Areas. Healthcare (Basel) 2018; 6:healthcare6020069. [PMID: 29921784 PMCID: PMC6023339 DOI: 10.3390/healthcare6020069] [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: 05/03/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 01/18/2023] Open
Abstract
The objective was to examine the prevalence of Borrelia antibodies among symptomatic individuals with recent and past Lyme disease in endemic communities using standard assays and novel assays employing next-generation antigenic substrates. Single- and two-tiered algorithms included different anti-Borrelia ELISAs and immunoblots. Antibody prevalence was examined in sera from 32 individuals with recent erythema migrans (EM), 335 individuals with persistent symptoms following treatment for Lyme disease (PTLS), and 41 community controls without a history of Lyme disease. Among convalescent EM cases, sensitivity was highest using the C6 ELISA (93.8%) compared to other single assays; specificity was 92.7% for the C6 ELISA vs. 85.4–97.6% for other assays. The two-tiered ELISA-EUROLINE IgG immunoblot combinations enhanced case detection substantially compared to the respective ELISA-IgG Western blot combinations (75.0% vs. 34.4%) despite similar specificity (95.1% vs. 97.6%, respectively). For PTLS cohorts, two-tier ELISA-IgG-blot positivity ranged from 10.1% to 47.4%, depending upon assay combination, time from initial infection, and clinical history. For controls, the two-tier positivity rate was 0–14.6% across assays. A two-tier algorithm of two-ELISA assays yielded a high positivity rate of 87.5% among convalescent EM cases with specificity of 92.7%. For convalescent EM, combinations of the C6 ELISA with a second-tier ELISA or line blot may provide useful alternatives to WB-based testing algorithms.
Collapse
|
32
|
Rimoldi SG, Merli S, Bestetti G, Giacomet V, Cislaghi G, Grande R, Zanzani S, Pagani C, Trevisan G, De Faveri E, Gismondo MR, Ruzić-Sabljić E. Occurrence of Lyme disease infection in a non-endemic area in Northern Italy. GIORN ITAL DERMAT V 2018; 155:320-324. [PMID: 29600690 DOI: 10.23736/s0392-0488.18.05941-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Italy, the incidence of human tick-borne disease has increased over the last decades. Since 2015 a multidisciplinary group has been established in Sacco Hospital for the management of the patients affected by Lyme disease (LD). A retrospective evaluation (2015-2017) was performed for LD in non-endemic areas. METHODS Retrospective analysis of all 1000 samples for 800 patients screened for LD antibodies at the Sacco Hospital in 3 years (2015-2017). Clinical and epidemiological data were collected and compared with the serological results. RESULTS Among the 800 patients screened, 134 of them were diagnosed with borreliosis during 2015 (37 cases), 2016 (31 cases) and 2017 (66 cases). Localized LD was diagnosed 100 out of 134 cases (69%): in most of them (N.=63) erythema migrans has been documented; in 37 out of 100 it was not possible to detect it. In only three cases, patients complained of different clinical symptoms such as headache, arm and facial pain respectively. 23 out of 134 cases (16%) showed a persistence of serological positivity and symptoms with osteomuscular involvement and fatigue, despite the therapy (late LD). In that same study 11 out of 134 patients (7%) received a diagnosis of neuroborreliosis. CONCLUSIONS Our data reported a high percentage of LD infection (19%) in a non-endemic area. The definition of a Multidisciplinary Working Group and a clinical care pathway allowed a better clinical management of LD cases treated in Sacco Hospital, Milan.
Collapse
Affiliation(s)
- Sara G Rimoldi
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy -
| | - Stefania Merli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanna Bestetti
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vania Giacomet
- Unit of Pediatrics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Romualdo Grande
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sergio Zanzani
- Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - Cristina Pagani
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | | | - Maria R Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Eva Ruzić-Sabljić
- Laboratory for Boreliosis and Leptospirosis, University of Ljubljana, Ljubljana, Slovenia
| | | |
Collapse
|
33
|
Nunes M, Parreira R, Carreira T, Inácio J, Vieira ML. Development and evaluation of a two-step multiplex TaqMan real-time PCR assay for detection/quantification of different genospecies of Borrelia burgdorferi sensu lato. Ticks Tick Borne Dis 2018; 9:176-182. [DOI: 10.1016/j.ttbdis.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/21/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
|
34
|
Shah JS, D' Cruz I, Ward S, Harris NS, Ramasamy R. Development of a sensitive PCR-dot blot assay to supplement serological tests for diagnosing Lyme disease. Eur J Clin Microbiol Infect Dis 2017; 37:701-709. [PMID: 29282568 PMCID: PMC5978905 DOI: 10.1007/s10096-017-3162-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
Laboratory diagnosis of Lyme disease is difficult and presently dependent on detecting Borrelia burgdorferi-specific antibodies in patient serum with the disadvantage that the immune response to B. burgdorferi can be weak or variable, or alternatively, the slow and inefficient culture confirmation of B. burgdorferi. PCR tests have previously shown poor sensitivity and are not routinely used for diagnosis. We developed a sensitive and specific Lyme Multiplex PCR-dot blot assay (LM-PCR assay) applicable to blood and urine samples to supplement western blot (WB) serological tests for detecting B. burgdorferi infection. The LM-PCR assay utilizes specific DNA hybridization to purify B. burgdorferi DNA followed by PCR amplification of flagellin and OspA gene fragments and their detection by southern dot blots. Results of the assay on 107 and 402 clinical samples from patients with suspected Lyme disease from Houston, Texas or received at the IGeneX laboratory in Palo Alto, California, respectively, were analyzed together with WB findings. The LM-PCR assay was highly specific for B. burgdorferi. In the Texas samples, 23 (21.5%) patients antibody-negative in WB assays by current US Centers for Disease Control (CDC) recommended criteria were positive by LM-PCR performed on urine, serum or whole blood samples. With IGeneX samples, of the 402 LM-PCR positive blood samples, only 70 met the CDC criteria for positive WBs, while 236 met IGeneX criteria for positive WB. Use of the LM-PCR assay and optimization of current CDC serological criteria can improve the diagnosis of Lyme disease.
Collapse
Affiliation(s)
- J S Shah
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA.
| | - I D' Cruz
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| | - S Ward
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| | - N S Harris
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| | - R Ramasamy
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| |
Collapse
|
35
|
Marciano-Fellous L. [Cutaneous infections: Pathologist's role in unusual or atypical situations]. Ann Pathol 2017; 38:20-30. [PMID: 29287934 DOI: 10.1016/j.annpat.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
In infectious pathology, the gold standard consists of the detection of the pathogen within the sample. Identification of the pathogen is often difficult despite the presence of few and inexpensive tools, such, as special stain, immunohistochemistry, or in situ hybridization specific of the pathogen. In infectious pathology, there are morphological signs, which can guide us towards an etiology. We present some clinicopathological examples illustrating rare or unusual situations in cutaneous infectious pathology.
Collapse
Affiliation(s)
- Léa Marciano-Fellous
- Département de pathologie, groupe hospitalier Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| |
Collapse
|
36
|
Cerebrospinal Fluid B-lymphocyte Chemoattractant CXCL13 in the Diagnosis of Acute Lyme Neuroborreliosis in Children. Pediatr Infect Dis J 2017; 36:e286-e292. [PMID: 28661964 DOI: 10.1097/inf.0000000000001669] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current markers of Lyme neuroborreliosis (LNB) in children have insufficient sensitivity in the early stage of disease. The B-lymphocyte chemoattractant CXCL13 in the cerebrospinal fluid (CSF) may be useful in diagnosing LNB, but its specificity has not been evaluated in studies including children with clinically relevant differential diagnoses. The aim of this study was to elucidate the diagnostic value of CSF CXCL13 in children with symptoms suggestive of LNB. METHODS Children with symptoms suggestive of LNB were included prospectively into predefined groups with a high or low likelihood of LNB based on CSF pleocytosis and the detection of Borrelia antibodies or other causative agents. CSF CXCL13 levels were compared between the groups, and receiver-operating characteristic analyses were performed to indicate optimal cutoff levels to discriminate LNB from non-LNB conditions. RESULTS Two hundred and ten children were included. Children with confirmed LNB (n=59) and probable LNB (n=18) had higher CSF CXCL13 levels than children with possible LNB (n=7), possible peripheral LNB (n=7), non-Lyme aseptic meningitis (n=12), non-meningitis (n=91) and negative controls (n=16). Using 18 pg/mL as a cutoff level, both the sensitivity and specificity of CSF CXCL13 for LNB (confirmed and probable) were 97%. Comparing only children with LNB and non-Lyme aseptic meningitis, the sensitivity and specificity with the same cutoff level were 97% and 83%, respectively. CONCLUSION CSF CXCL13 is a sensitive marker of LNB in children. The specificity to discriminate LNB from non-Lyme aseptic meningitis may be more moderate, suggesting that CSF CXCL13 should be used together with other variables in diagnosing LNB in children.
Collapse
|
37
|
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
|
38
|
Huang NL, Ye L, Lv H, Du YX, Schneider M, Fan LB, Du WD. A biochip-based combined immunoassay for detection of serological status of Borrelia burgdorferi in Lyme borreliosis. Clin Chim Acta 2017; 472:13-19. [DOI: 10.1016/j.cca.2017.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 12/18/2022]
|
39
|
Cutler SJ, Rudenko N, Golovchenko M, Cramaro WJ, Kirpach J, Savic S, Christova I, Amaro A. Diagnosing Borreliosis. Vector Borne Zoonotic Dis 2017; 17:2-11. [PMID: 28055580 DOI: 10.1089/vbz.2016.1962] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Borrelia species fall into two groups, the Borrelia burgdorferi sensu lato (Bbsl) complex, the cause of Lyme borreliosis (also known as Lyme disease), and the relapsing fever group. Both groups exhibit inter- and intraspecies diversity and thus have variations in both clinical presentation and diagnostic approaches. A further layer of complexity is derived from the fact that ticks may carry multiple infectious agents and are able to transmit them to the host during blood feeding, with potential overlapping clinical manifestations. Besides this, pathogens like Borrelia have developed strategies to evade the host immune system, which allows them to persist within the host, including humans. Diagnostics can be applied at different times during the clinical course and utilize sample types, each with their own advantages and limitations. These differing methods should always be considered in conjunction with potential exposure and compatible clinical features. Throughout this review, we aim to explore different approaches providing the reader with an overview of methods appropriate for various situations. This review will cover human pathogenic members of Bbsl and relapsing fever borreliae, including newly recognized Borrelia miyamotoi spirochetes.
Collapse
Affiliation(s)
- Sally J Cutler
- 1 School of Health, Sport & Bioscience, University of East London , London, United Kingdom
| | - Nataliia Rudenko
- 2 Biology Centre CAS, Institute of Parasitology , Ceske Budejovice, Czech Republic
| | - Maryna Golovchenko
- 2 Biology Centre CAS, Institute of Parasitology , Ceske Budejovice, Czech Republic
| | - Wibke J Cramaro
- 3 Department of Infection and Immunity, Luxembourg Institute of Health , Esch-sur-Alzette, Luxembourg
| | - Josiane Kirpach
- 3 Department of Infection and Immunity, Luxembourg Institute of Health , Esch-sur-Alzette, Luxembourg
| | - Sara Savic
- 4 Scientific Veterinary Institute "Novi Sad ," Rumenacki put 20, Novi Sad, Serbia
| | - Iva Christova
- 5 Department of Microbiology, National Center of Infectious and Parasitic Diseases , Sofia, Bulgaria
| | - Ana Amaro
- 6 National Institute for Agrarian and Veterinarian Research (INIAV) , Lisboa, Portugal
| |
Collapse
|
40
|
Johansson M, Manfredsson L, Wistedt A, Serrander L, Tjernberg I. Significant variations in the seroprevalence of C6 ELISA antibodies in a highly endemic area for Lyme borreliosis: evaluation of age, sex and seasonal differences. APMIS 2017; 125:476-481. [PMID: 28225145 DOI: 10.1111/apm.12664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to assess the seroprevalence of C6 ELISA antibodies in healthy blood donors in Kalmar County, Sweden, in relation to age, sex and time of year (peak season vs off season). In addition, we wanted to assess serological status over time in a group of C6 ELISA seropositive blood donors. Sera were collected from 273 (131 women, 142 men) blood donors in autumn 2011 and 300 (144 women, 156 men) in winter 2014. All sera were analysed in the C6 ELISA and the results were interpreted according to the manufacturer's instructions. The seroprevalence was 22% (females 16%, males 28%) in 2011 and 24% (females 15%, males 33%) in 2014. The seroprevalence was significantly higher in males and increased with age. The highest seroprevalence was observed among elderly men, 60-70 years old (46% in 2011 and 52% in 2014). No significant difference was detected in seropositivity between the samples collected in winter and autumn. All (34/34) seropositive blood donors followed over time remained seropositive at follow-up after 22-29 months. C6 ELISA seroprevalence in healthy blood donors is high in Kalmar County, thereby reducing the specificity of a positive test result regarding the clinical diagnosis of Lyme borreliosis (LB). Although C6 seroprevalence appears not to be affected by seasonal sample time, it varies greatly with age and sex. A careful evaluation of pre-test probability is therefore of the utmost importance in the clinical diagnosis of LB, especially in elderly men. We suggest that colleagues in other endemic regions also consider initiating similar evaluations to optimize the laboratory and clinical diagnosis of LB in relation to age and sex.
Collapse
Affiliation(s)
- Marcus Johansson
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Lena Manfredsson
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Annika Wistedt
- Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
| | - Lena Serrander
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ivar Tjernberg
- Department of Clinical Chemistry and Transfusion Medicine, Kalmar County Council, Kalmar, Sweden.,Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
41
|
Tracy KE, Baumgarth N. Borrelia burgdorferi Manipulates Innate and Adaptive Immunity to Establish Persistence in Rodent Reservoir Hosts. Front Immunol 2017; 8:116. [PMID: 28265270 PMCID: PMC5316537 DOI: 10.3389/fimmu.2017.00116] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/25/2017] [Indexed: 01/17/2023] Open
Abstract
Borrelia burgdorferi sensu lato species complex is capable of establishing persistent infections in a wide variety of species, particularly rodents. Infection is asymptomatic or mild in most reservoir host species, indicating successful co-evolution of the pathogen with its natural hosts. However, infected humans and other incidental hosts can develop Lyme disease, a serious inflammatory syndrome characterized by tissue inflammation of joints, heart, muscles, skin, and CNS. Although B. burgdorferi infection induces both innate and adaptive immune responses, they are ultimately ineffective in clearing the infection from reservoir hosts, leading to bacterial persistence. Here, we review some mechanisms by which B. burgdorferi evades the immune system of the rodent host, focusing in particular on the effects of innate immune mechanisms and recent findings suggesting that T-dependent B cell responses are subverted during infection. A better understanding of the mechanisms causing persistence in rodents may help to increase our understanding of the pathogenesis of Lyme disease and ultimately aid in the development of therapies that support effective clearance of the bacterial infection by the host’s immune system.
Collapse
Affiliation(s)
- Karen E Tracy
- Graduate Group in Immunology, University of California Davis, Davis, CA, USA; Center for Comparative Medicine, University of California Davis, Davis, CA, USA
| | - Nicole Baumgarth
- Graduate Group in Immunology, University of California Davis, Davis, CA, USA; Center for Comparative Medicine, University of California Davis, Davis, CA, USA; Department of Pathology, Microbiology and Immunology, University of California Davis, Davis, CA, USA
| |
Collapse
|
42
|
A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations. Case Rep Infect Dis 2017; 2017:6598043. [PMID: 28512589 PMCID: PMC5420423 DOI: 10.1155/2017/6598043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/26/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022] Open
Abstract
Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient's symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.
Collapse
|
43
|
Sul H, Kim DM. Present state and future of tick-borne infectious diseases in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.6.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyoung Sul
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| |
Collapse
|
44
|
Kingry LC, Batra D, Replogle A, Rowe LA, Pritt BS, Petersen JM. Whole Genome Sequence and Comparative Genomics of the Novel Lyme Borreliosis Causing Pathogen, Borrelia mayonii. PLoS One 2016; 11:e0168994. [PMID: 28030649 PMCID: PMC5193363 DOI: 10.1371/journal.pone.0168994] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/09/2016] [Indexed: 12/11/2022] Open
Abstract
Borrelia mayonii, a Borrelia burgdorferi sensu lato (Bbsl) genospecies, was recently identified as a cause of Lyme borreliosis (LB) among patients from the upper midwestern United States. By microscopy and PCR, spirochete/genome loads in infected patients were estimated at 105 to 106 per milliliter of blood. Here, we present the full chromosome and plasmid sequences of two B. mayonii isolates, MN14-1420 and MN14-1539, cultured from blood of two of these patients. Whole genome sequencing and assembly was conducted using PacBio long read sequencing (Pacific Biosciences RSII instrument) followed by hierarchical genome-assembly process (HGAP). The B. mayonii genome is ~1.31 Mbp in size (26.9% average GC content) and is comprised of a linear chromosome, 8 linear and 7 circular plasmids. Consistent with its taxonomic designation as a new Bbsl genospecies, the B. mayonii linear chromosome shares only 93.83% average nucleotide identity with other genospecies. Both B. mayonii genomes contain plasmids similar to B. burgdorferi sensu stricto lp54, lp36, lp28-3, lp28-4, lp25, lp17, lp5, 5 cp32s, cp26, and cp9. The vls locus present on lp28-10 of B. mayonii MN14-1420 is remarkably long, being comprised of 24 silent vls cassettes. Genetic differences between the two B. mayonii genomes are limited and include 15 single nucleotide variations as well as 7 fewer silent vls cassettes and a lack of the lp5 plasmid in MN14-1539. Notably, 68 homologs to proteins present in B. burgdorferi sensu stricto appear to be lacking from the B. mayonii genomes. These include the complement inhibitor, CspZ (BB_H06), the fibronectin binding protein, BB_K32, as well as multiple lipoproteins and proteins of unknown function. This study shows the utility of long read sequencing for full genome assembly of Bbsl genomes, identifies putative genome regions of B. mayonii that may be linked to clinical manifestation or tissue tropism, and provides a valuable resource for pathogenicity, diagnostic and vaccine studies.
Collapse
Affiliation(s)
- Luke C. Kingry
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Dhwani Batra
- Division of Scientific Resources, Biotechnology Core Facility Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam Replogle
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Lori A. Rowe
- Division of Scientific Resources, Biotechnology Core Facility Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bobbi S. Pritt
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jeannine M. Petersen
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
- * E-mail:
| |
Collapse
|
45
|
Smaranda M, Nicoleta S, Zoltan B, Anca M, Brânduşa Ţ, Adrian A, Rodica B. Lyme Meningoradiculitis: Case Reports and Literature Review. ACTA MEDICA MARISIENSIS 2016. [DOI: 10.1515/amma-2016-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The clinical manifestations of Lyme disease are protean. The meningoradiculitis is a common and well-recognized complication of neuroborreliosis but can be easily misdiagnosed without a high degree of clinical suspicion, mainly if the tick bite is not present in the medical history. We report two cases of Lyme meningoradiculitis with excellent outcome after appropriate antibiotic therapy. In an endemic area in case of neurological manifestations suggestive for neuroborreliosis the serological testing for B. burgdorferi in serum and cerebrospinal fluid is imperative for the correct diagnosis.
Collapse
Affiliation(s)
- Maier Smaranda
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Stirbu Nicoleta
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Bajko Zoltan
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Moţăţăianu Anca
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Ţilea Brânduşa
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Alexandrescu Adrian
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| | - Bălaşa Rodica
- University of Medicine and Pharmacy Tirgu Mures, Romania
- Mures County Clinical Emergency Hospital, Romania
| |
Collapse
|
46
|
Acute Borrelia infection inducing an APMPPE-like picture. J Ophthalmic Inflamm Infect 2016; 6:22. [PMID: 27294731 PMCID: PMC4905935 DOI: 10.1186/s12348-016-0088-x] [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: 04/24/2016] [Accepted: 06/02/2016] [Indexed: 11/19/2022] Open
Abstract
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an uncommon disorder of unknown etiology affecting the retina, the retinal pigment epithelium, and the choroid. Although several etiological factors have been suggested, none has been confirmed. We report a case of APMPPE associated with acute infection of Borreliosis. A 30-year-old man presented with a decrease in vision in the right eye of about 1-week duration. His visual acuity in the right eye was 6/36. Fundus exam revealed the presence of multiple placoid creamy retinal/subretinal lesions in the right eye. Fundus fluorescein angiography supported the diagnosis of APMPPE. Blood tests revealed the presence of concomitant acute Borreliosis infection, as confirmed by IgM. The patient received oral prednisone therapy and amoxicillin. Six weeks later, the visual acuity returned to 6/6, and the patient was symptom free. Borreliosis can have several manifestations in the eye. One of the less common presentations is an APMPPE-like picture. The clinician should suspect acute Borreliosis infection in patients presenting with APMPPE, especially when there is a history of a tick bite, when the patient has systemic symptoms, or when living in/visiting endemic areas. This may help in the prompt management of APMPPE, avoiding complications due to the condition itself, or systemic involvement secondary to the Borreliosis infection.
Collapse
|
47
|
Tomasini C. Cordoniform morphea: a clinicopathologic study of two cases presenting with the rope sign. J Cutan Pathol 2016; 43:613-622. [PMID: 26990496 DOI: 10.1111/cup.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/23/2016] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Morphea clinically presenting as cordoniform lesions has not been described previously in the literature. OBJECTIVE Our goal was to describe the clinicopathologic features of morphea presenting with cord-like cutaneous lesions. METHODS The clinical notes of 420 patients with a diagnosis of morphea seen during the previous 10 years were reviewed to identify any cases that had cordoniform lesions at presentation. RESULTS Two adult patients (one male and one female) were identified. Both patients presented with chronic, slightly burning, bilateral, erythematous, linear or curvilinear elevated cutaneous indurations on the lateral chest wall strikingly reminiscent interstitial granulomatous dermatitis with arthritis. Histopathologically, typical changes of deep morphea with a band-like involvement only of the lower part of the reticular dermis and the superficial hypodermis and a remarkable perineural arrangement of the lymphoplasmocytic infiltrate were observed. The presence of Borrelia in skin biopsy samples of both patients was shown by immunohistochemistry and focus floating microscopy. In one patient, the presence of Borrelia afzelii DNA in the cutaneous biopsy was shown by polymerase chain reaction. CONCLUSIONS Cordoniform morphea is an exceedingly unusual and previously undescribed clinicopathologic presentation of morphea where Borrelia infection may play a causal role.
Collapse
Affiliation(s)
- Carlo Tomasini
- Dermatopathology Section, Azienda Ospedaliera Città della Salute d della Scienza, Turin, Italy
| |
Collapse
|
48
|
Abstract
Lyme disease is the most common vector-borne illness in North America and Europe. The etiologic agent, Borrelia burgdorferi sensu lato, is transmitted to humans by certain species of Ixodes ticks, which are found widely in temperate regions of the Northern hemisphere. Clinical features are diverse, but death is rare. The risk of human infection is determined by the geographic distribution of vector tick species, ecologic factors that influence tick infection rates, and human behaviors that promote tick bite. Rates of infection are highest among children 5 to 15 years old and adults older than 50 years.
Collapse
Affiliation(s)
- Paul S Mead
- Epidemiology and Surveillance Activity, Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 3156 Rampart Road, Fort Collins, CO 80521, USA.
| |
Collapse
|
49
|
Šmit R, Postma MJ. Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics. Expert Rev Vaccines 2015; 14:1549-61. [DOI: 10.1586/14760584.2015.1091313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
50
|
Abstract
Lyme disease is the most common tick-borne illness in the United States and is also seen in areas of Europe and Asia. The growing deer and Ixodes species tick populations in many areas underscore the importance of clinicians to properly recognize and treat the different stages of Lyme disease. Controversy regarding the cause and management of persistent symptoms following treatment of Lyme disease persists and is highlighted in this review.
Collapse
Affiliation(s)
- Joyce L Sanchez
- Division of General Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|