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Norman FF, Sánchez-Martín J, Rodríguez-Domínguez M, Escudero R, Martín O. Dermacentor-borne necrosis erythema lymphadenopathy (DEBONEL) due to Rickettsia raoultii in a patient with erythema migrans. J Travel Med 2023; 30:taad057. [PMID: 37074133 DOI: 10.1093/jtm/taad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023]
Abstract
Erythema migrans is usually associated with infections/co-infections with Borrelia spp. DEBONEL and other localized diseases caused by Rickettsia spp. following a tick bite usually respond to therapy with doxycycline but possible co-infections with Borrelia spp should be excluded. In this case, PCR in the tick was positive for Rickettsia raoultii.
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Affiliation(s)
- Francesca F Norman
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBERINFEC, Madrid, Spain
| | - Jesús Sánchez-Martín
- Plastic Surgery Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | | | - Raquel Escudero
- Reference and Research Laboratory on Special Pathogens, National Microbiology Center, Carlos III Health Institute, Madrid, Spain
| | - Oihane Martín
- Microbiology Department, Ramón y Cajal University Hospital, IRYCIS, CIBERINFEC, Madrid, Spain
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2
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Dermatological manifestations of tick-borne viral infections found in the United States. Virol J 2022; 19:199. [PMID: 36443864 PMCID: PMC9702624 DOI: 10.1186/s12985-022-01924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
Tick-borne diseases (TBDs) are bacterial, viral, and parasitic diseases transmitted by ticks. Viral TBDs have increased in prevalence over the last decade with many new pathogenic viruses being discovered. Doxycycline is often empirically prescribed by clinicians to treat symptomatic patients following tick bites due to suspicions of bacterial TBDs such as Rocky Mountain spotted fever, anaplasmosis, and ehrlichiosis. However, viral TBDs are included in the differential diagnosis if patients do not clinically improve following antibiotic therapy. Several viral TBDs present with dermatological manifestations. Recognizing the differences in clinical presentations of TBDs, particularly of newly emerging viral TBDs in the United States, can help physicians identify the viral TBD, and possibly rule out viral illnesses with different clinical presentations. Therefore, this review discusses clinical manifestations, with an emphasis on dermatologic manifestations of Heartland Virus, Bourbon Virus, Powassan Virus, Deer Tick Virus and Colorado Tick Fever Virus. KEY POINTS: Viral tick-borne diseases have increased in prevalence over the last decade and often have similar clinical manifestations to other tick-borne diseases, including bacterial infections. Here, we review the dermatologic manifestations of Heartland Virus (HRTV), Bourbon Virus (BRBV), Powassan Virus (POWV), Deer Tick Virus (DTV) and Colorado Tick Fever Virus (CTFV) that are important for clinicians.
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Maqbool M, Sajid MS, Saqib M, Anjum FR, Tayyab MH, Rizwan HM, Rashid MI, Rashid I, Iqbal A, Siddique RM, Shamim A, Hassan MA, Atif FA, Razzaq A, Zeeshan M, Hussain K, Nisar RHA, Tanveer A, Younas S, Kamran K, Rahman SU. Potential Mechanisms of Transmission of Tick-Borne Viruses at the Virus-Tick Interface. Front Microbiol 2022; 13:846884. [PMID: 35602013 PMCID: PMC9121816 DOI: 10.3389/fmicb.2022.846884] [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: 12/31/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Ticks (Acari; Ixodidae) are the second most important vector for transmission of pathogens to humans, livestock, and wildlife. Ticks as vectors for viruses have been reported many times over the last 100 years. Tick-borne viruses (TBVs) belong to two orders (Bunyavirales and Mononegavirales) containing nine families (Bunyaviridae, Rhabdoviridae, Asfarviridae, Orthomyxovirida, Reoviridae, Flaviviridae, Phenuviridae, Nyamiviridae, and Nairoviridae). Among these TBVs, some are very pathogenic, causing huge mortality, and hence, deserve to be covered under the umbrella of one health. About 38 viral species are being transmitted by <10% of the tick species of the families Ixodidae and Argasidae. All TBVs are RNA viruses except for the African swine fever virus from the family Asfarviridae. Tick-borne viral diseases have also been classified as an emerging threat to public health and animals, especially in resource-poor communities of the developing world. Tick-host interaction plays an important role in the successful transmission of pathogens. The ticks' salivary glands are the main cellular machinery involved in the uptake, settlement, and multiplication of viruses, which are required for successful transmission into the final host. Furthermore, tick saliva also participates as an augmenting tool during the physiological process of transmission. Tick saliva is an important key element in the successful transmission of pathogens and contains different antimicrobial proteins, e.g., defensin, serine, proteases, and cement protein, which are key players in tick-virus interaction. While tick-virus interaction is a crucial factor in the propagation of tick-borne viral diseases, other factors (physiological, immunological, and gut flora) are also involved. Some immunological factors, e.g., toll-like receptors, scavenger receptors, Janus-kinase (JAK-STAT) pathway, and immunodeficiency (IMD) pathway are involved in tick-virus interaction by helping in virus assembly and acting to increase transmission. Ticks also harbor some endogenous viruses as internal microbial faunas, which also play a significant role in tick-virus interaction. Studies focusing on tick saliva and its role in pathogen transmission, tick feeding, and control of ticks using functional genomics all point toward solutions to this emerging threat. Information regarding tick-virus interaction is somewhat lacking; however, this information is necessary for a complete understanding of transmission TBVs and their persistence in nature. This review encompasses insight into the ecology and vectorial capacity of tick vectors, as well as our current understanding of the predisposing, enabling, precipitating, and reinforcing factors that influence TBV epidemics. The review explores the cellular, biochemical, and immunological tools which ensure and augment successful evading of the ticks' defense systems and transmission of the viruses to the final hosts at the virus-vector interface. The role of functional genomics, proteomics, and metabolomics in profiling tick-virus interaction is also discussed. This review is an initial attempt to comprehensively elaborate on the epidemiological determinants of TBVs with a focus on intra-vector physiological processes involved in the successful execution of the docking, uptake, settlement, replication, and transmission processes of arboviruses. This adds valuable data to the existing bank of knowledge for global stakeholders, policymakers, and the scientific community working to devise appropriate strategies to control ticks and TBVs.
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Affiliation(s)
- Mahvish Maqbool
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Sohail Sajid
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
- Department of Epidemiology and Public Health, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Faisal Rasheed Anjum
- Department of Epidemiology and Public Health, University of Agriculture, Faisalabad, Pakistan
- Institute of Microbiology, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Haleem Tayyab
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Hafiz Muhammad Rizwan
- Section of Parasitology, Department of Pathobiology, KBCMA College of Veterinary and Animal Sciences Narowal, Lahore, Pakistan
| | - Muhammad Imran Rashid
- Department of Parasitology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Imaad Rashid
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Asif Iqbal
- Section of Parasitology, Department of Pathobiology, Riphah College of Veterinary Sciences, Riphah International University, Lahore, Pakistan
| | - Rao Muhammad Siddique
- Section of Parasitology, Department of Pathobiology, Riphah College of Veterinary Sciences, Riphah International University, Lahore, Pakistan
| | - Asim Shamim
- Department of Pathobiology, University of the Poonch Rawalakot, Rawalakot, Pakistan
| | - Muhammad Adeel Hassan
- Department of Parasitology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Farhan Ahmad Atif
- Medicine Section, Department of Clinical Sciences, Collège of Veterinary and Animal Sciences, Jhang, Pakistan
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Abdul Razzaq
- Agricultural Linkages Program, Pakistan Agriculture Research Council, Islamabad, Pakistan
| | - Muhammad Zeeshan
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Kashif Hussain
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | | | - Akasha Tanveer
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Sahar Younas
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Kashif Kamran
- Department of Zoology, University of Balochistan, Quetta, Pakistan
| | - Sajjad ur Rahman
- Institute of Microbiology, University of Agriculture, Faisalabad, Pakistan
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Abdelmaseih R, Ashraf B, Abdelmasih R, Dunn S, Nasser H. Southern Tick-Associated Rash Illness: Florida's Lyme Disease Variant. Cureus 2021; 13:e15306. [PMID: 34221760 PMCID: PMC8237921 DOI: 10.7759/cureus.15306] [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] [Indexed: 11/05/2022] Open
Abstract
Southern tick-associated rash illness (STARI) is an emerging zoonotic disease causing an annular rash with central clearing that is almost identical to erythema migrans seen in Lyme disease. It is spread by Amblyomma americanum tick bite. Although it is still debatable, this zoonotic disease is thought to be caused by Borrelia lonestari spirochete. At this time, there is no approved diagnostic modality nor approved treatment for such an illness. Here we describe a rare case of STARI in a 63-year-old female and shed light on the differences between STARI and Lyme disease.
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Affiliation(s)
- Ramy Abdelmaseih
- Internal Medicine, University of Central Florida College of Medicine, Ocala, USA
| | - Bilal Ashraf
- Internal Medicine, University of Central Florida College of Medicine, Ocala, USA
| | - Randa Abdelmasih
- Internal Medicine, University of Central Florida College of Medicine, Ocala, USA
| | - Sandi Dunn
- Internal Medicine, University of Central Florida College of Medicine, Ocala, USA
| | - Hesham Nasser
- Internal Medicine, University of Central Florida College of Medicine, Ocala, USA
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Rebman AW, Yang T, Mihm EA, Novak CB, Yoon I, Powell D, Geller SA, Aucott JN. The presenting characteristics of erythema migrans vary by age, sex, duration, and body location. Infection 2021; 49:685-692. [PMID: 33682067 DOI: 10.1007/s15010-021-01590-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The erythema migrans (EM) skin lesion is often the first clinical sign of Lyme disease. Significant variability in EM presenting characteristics such as shape, color, pattern, and homogeneity, has been reported. We studied associations between these presenting characteristics, as well as whether they were associated with age, sex, EM duration, body location, and initiation of antibiotics. METHODS Two hundred and seventy one adult participants with early Lyme disease who had a physician-diagnosed EM skin lesion of ≥ 5 cm in diameter and ≤ 72 h of antibiotic treatment were enrolled. Participant demographics, clinical characteristics, and characteristics of their primary EM lesion were recorded. RESULTS After adjusting for potential confounders, EM size increased along with increasing EM duration to a peak of 14 days. Male EM were found to be on average 2.18 cm larger than female EM. The odds of a red (vs blue/red) EM were 65% lower in males compared to females, and were over 3 times as high for EM found on the pelvis, torso, or arm compared to the leg. Age remained a significant predictor of central clearing in adjusted models; for every 10-year increase in age, the odds of central clearing decreased 25%. CONCLUSIONS Given that EM remains a clinical diagnosis, it is essential that both physicians and the general public are aware of its varied manifestations. Our findings suggest possible patterns within this variability, with implications for prompt diagnosis and treatment initiation, as well as an understanding of the clinical spectrum of EM.
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Affiliation(s)
- Alison W Rebman
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ting Yang
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica A Mihm
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cheryl B Novak
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Debra Powell
- Reading Hospital Tower Health, West Reading, PA, USA
| | | | - John N Aucott
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Sanderson VP, Mainprize IL, Verzijlenberg L, Khursigara CM, Wills MKB. The Platelet Fraction Is a Novel Reservoir to Detect Lyme Borrelia in Blood. BIOLOGY 2020; 9:biology9110366. [PMID: 33137967 PMCID: PMC7694117 DOI: 10.3390/biology9110366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
Simple Summary To diagnose Lyme disease, a patient’s blood is tested for antibodies that develop as part of the immune response. This can lead to cases being missed or inadequately treated. An ideal test would directly detect the Lyme disease bacteria, Borrelia, to provide better clinical guidance. In this study, we aimed to improve the methods currently used to find Borrelia in human blood, and identified two opportunities for optimization. We demonstrate that the container most commonly used to collect blood (EDTA) decreases Borrelia’s ability to grow, and we identify a superior alternative (citrate). Additionally, using experimentally infected blood, we show that Borrelia is highly concentrated in the platelet fraction, making it an ideal candidate for direct detection. These results lay the foundation for diagnostic test development, which could improve patient outcomes in Lyme disease. Abstract Serological diagnosis of Lyme disease suffers from considerable limitations. Yet, the technique cannot currently be replaced by direct detection methods, such as bacterial culture or molecular analysis, due to their inadequate sensitivity. The low bacterial burden in vasculature and lack of consensus around blood-based isolation of the causative pathogen, Borrelia burgdorferi, are central to this challenge. We therefore addressed methodological optimization of Borrelia recovery from blood, first by analyzing existing protocols, and then by using experimentally infected human blood to identify the processing conditions and fractions that increase Borrelia yield. In this proof-of-concept study, we now report two opportunities to improve recovery and detection of Borrelia from clinical samples. To enhance pathogen viability and cultivability during whole blood collection, citrate anticoagulant is superior to more commonly used EDTA. Despite the widespread reliance on serum and plasma as analytes, we found that the platelet fraction of blood concentrates Borrelia, providing an enriched resource for direct pathogen detection by microscopy, laboratory culture, Western blot, and PCR. The potential for platelets to serve as a reservoir for Borrelia and its diagnostic targets may transform direct clinical detection of this pathogen.
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Affiliation(s)
- Victoria P. Sanderson
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (V.P.S.); (I.L.M.); (L.V.)
| | - Iain L. Mainprize
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (V.P.S.); (I.L.M.); (L.V.)
| | - Lisette Verzijlenberg
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (V.P.S.); (I.L.M.); (L.V.)
| | - Cezar M. Khursigara
- Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Melanie K. B. Wills
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; (V.P.S.); (I.L.M.); (L.V.)
- Correspondence: ; Tel.: +1-519-824-4120 (ext. 54062); Fax: +1-519-837-1802
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Buczek W, Buczek AM, Bartosik K, Buczek A. Comparison of Skin Lesions Caused by Ixodes ricinus Ticks and Lipoptena cervi Deer Keds Infesting Humans in the Natural Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093316. [PMID: 32397578 PMCID: PMC7246670 DOI: 10.3390/ijerph17093316] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
Background: The territorial expansion and increased population size of haematophagous arthropods (i.e., the castor bean tick Ixodes ricinus (Ixodida: Ixodidae) and the deer ked Lipoptena cervi (Diptera: Hippoboscidae)) has enhanced the risk of human infestations in Europe. The aim of our study was to present skin lesions induced by tick and deer ked bites in patients from recreational forest regions in southeastern Poland and pay attention to features of skin changes that may be useful in differential diagnosis. Methods: We compare the skin lesions after I. ricinus and L. cervi bite and draw attention to the biological and ecological traits of both ectoparasites, which may be diagnostically relevant for determination of the cause of skin symptoms reported by patients. Results: I. ricinus bites lead to development of erythematous-infiltrative poorly demarcated lesions with a centrally located bite mark, which usually disappears within one to several days. In turn, L. cervi bites leave irregularly shaped scattered erythematous papules. The papules may persist for up to one year and are accompanied by itching. Conclusions: Correct assessment of the clinical picture and its association with an arthropod bite (e.g., tick or deer ked) is highly important for further diagnostic procedures (i.e., differentiation of skin lesions developing in tick-borne diseases and, consequently, correct choice of pharmacological therapy). I. ricinus and L. cervi differ in their developmental cycles and rhythms of activity, which indicates that both species should be considered potential causative agents in the differential diagnosis of skin lesions when the patient has been bitten by an arthropod in autumn and winter months.
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Middelveen MJ, Martinez RM, Fesler MC, Sapi E, Burke J, Shah JS, Nicolaus C, Stricker RB. Classification and Staging of Morgellons Disease: Lessons from Syphilis. Clin Cosmet Investig Dermatol 2020; 13:145-164. [PMID: 32104041 PMCID: PMC7012249 DOI: 10.2147/ccid.s239840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Morgellons disease (MD) is a contested dermopathy that is associated with Borrelia spirochetal infection. A simple classification system was previously established to help validate the disease based on clinical features (classes I-IV). METHODS Drawing on historical and pathological parallels with syphilis, we formulated a more detailed staging system based on clinical features as well as severity of skin lesions and corresponding histopathological infection patterns, as determined by anti-Borrelia immunohistochemical staining. RESULTS Clinical classes I-IV of MD are further categorized as mild, moderate and severe, or stages A, B and C, respectively, based on histopathological findings. Stage A lesions demonstrated little or no immune infiltrates and little or no disorganization of cells; macrophages were not present, and hemorrhage was negligible. Extracellular isolated spirochetes and intracellular staining of keratinocytes in the lower epidermis was occasionally seen. Stage C lesions demonstrated positive staining of keratinocytes in the stratum basale and stratum spinosum and positive intracellular staining of macrophages for Borrelia. Aggregate Borrelia colonies were frequently encountered, hemorrhage was frequent, and intracellularly stained fibroblasts were occasionally seen. Stage B lesions demonstrated a pattern intermediate between Stages A and C. CONCLUSION The enhanced staging system provides objective criteria to assess the severity of dermopathy in MD. Further studies are needed to determine the optimal treatment for MD based on this staging system related to Borrelia infection.
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Affiliation(s)
| | | | | | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA
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Lee SH, Healy JE, Lambert JS. Single Core Genome Sequencing for Detection of both Borrelia burgdorferi Sensu Lato and Relapsing Fever Borrelia Species. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101779. [PMID: 31137527 PMCID: PMC6571920 DOI: 10.3390/ijerph16101779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/20/2019] [Accepted: 05/16/2019] [Indexed: 01/05/2023]
Abstract
Lyme disease, initially described as Lyme arthritis, was reported before nucleic-acid based detection technologies were available. The most widely used diagnostic tests for Lyme disease are based on the serologic detection of antibodies produced against antigens derived from a single strain of Borrelia burgdorferi. The poor diagnostic accuracy of serological tests early in the infection process has been noted most recently in the 2018 Report to Congress issued by the U.S. Department of Health and Human Services Tick-Borne Disease Working Group. Clinical Lyme disease may be caused by a diversity of borreliae, including those classified as relapsing fever species, in the United States and in Europe. It is widely accepted that antibiotic treatment of Lyme disease is most successful during this critical early stage of infection. While genomic sequencing is recognized as an irrefutable direct detection method for laboratory diagnosis of Lyme borreliosis, development of a molecular diagnostic tool for all clinical forms of borreliosis is challenging because a “core genome” shared by all pathogenic borreliae has not yet been identified. After a diligent search of the GenBank database, we identified two highly conserved segments of DNA sequence among the borrelial 16S rRNA genes. We further developed a pair of Borrelia genus-specific PCR primers for amplification of a segment of borrelial 16S rRNA gene as a “core genome” to be used as the template for routine Sanger sequencing-based metagenomic direct detection test. This study presented examples of base-calling DNA sequencing electropherograms routinely generated in a clinical diagnostic laboratory on DNA extracts of human blood specimens and ticks collected from human skin bites and from the environment. Since some of the tick samples tested were collected in Ireland, borrelial species or strains not known to exist in the United States were also detected by analysis of this 16S rRNA “core genome”. We recommend that hospital laboratories located in Lyme disease endemic areas begin to use a “core genome” sequencing test to routinely diagnose spirochetemia caused by various species of borreliae for timely management of patients at the early stage of infection.
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Affiliation(s)
- Sin Hang Lee
- Milford Molecular Diagnostics, Milford, CT 06460, USA.
| | - John Eoin Healy
- School of Biological, Earth and Environmental Sciences, University College Cork, T23 N73K Cork, Ireland.
| | - John S Lambert
- Department of medicine, University College Dublin, D04 V1W8 Dublin, Ireland.
- Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland.
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Kannangara DW, Sidra S, Pritiben P. First case report of inducible heart block in Lyme disease and an update of Lyme carditis. BMC Infect Dis 2019; 19:428. [PMID: 31096922 PMCID: PMC6524294 DOI: 10.1186/s12879-019-4025-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. Case presentation A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120–200 ms). Physical exam was unremarkable. The cardiologist’s initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. Conclusions Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.
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Affiliation(s)
- Don Walter Kannangara
- St Luke's University Health Network, Warren Campus, 185 Roseberry Street, Phillipsburg, NJ, 08865, USA.
| | - Sindhu Sidra
- St Luke's University Health Network, Warren Campus, 185 Roseberry Street, Phillipsburg, NJ, 08865, USA
| | - Patel Pritiben
- St Luke's University Health Network, Warren Campus, 185 Roseberry Street, Phillipsburg, NJ, 08865, USA
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11
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Value of Patient Population Selection and Lyme Borreliosis Tests. J Clin Microbiol 2019; 57:57/3/e01517-18. [DOI: 10.1128/jcm.01517-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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12
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Jordan RA, Egizi A. The growing importance of lone star ticks in a Lyme disease endemic county: Passive tick surveillance in Monmouth County, NJ, 2006 - 2016. PLoS One 2019; 14:e0211778. [PMID: 30753233 PMCID: PMC6372165 DOI: 10.1371/journal.pone.0211778] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/22/2019] [Indexed: 11/18/2022] Open
Abstract
As human cases of tick-borne disease continue to increase, there is a heightened imperative to collect data on human-tick encounters to inform disease prevention. Passive tick surveillance programs that encourage members of the public to submit ticks they have encountered can provide a relatively low-cost means of collecting such data. We report the results of 11 years of tick submissions (2006–2016) collected in Monmouth County, New Jersey, an Atlantic coastal county long endemic for Lyme disease. A total of 8,608 ticks acquired in 22 U.S. states were submitted, 89.7% of which were acquired in Monmouth County, from 52 of the County’s 53 municipalities. Seasonal submission rates reflected known phenology of common human-biting ticks, but annual submissions of both Amblyomma americanum and Dermacentor variabilis increased significantly over time while numbers of Ixodes scapularis remained static. By 2016, A. americanum had expanded northward in the county and now accounted for nearly half (48.1%) of submissions, far outpacing encounters with I. scapularis (28.2% of submissions). Across all tick species and stages the greatest number of ticks were removed from children (ages 0–9, 40.8%) and older adults (ages 50+, 23.8%) and these age groups were also more likely to submit partially or fully engorged ticks, suggesting increased risk of tick-borne disease transmission to these vulnerable age groups. Significantly more people (43.2%) reported acquiring ticks at their place of residence than in a park or natural area (17.9%). This pattern was more pronounced for residents over 60 years of age (72.7% acquired at home). Education that stresses frequent tick checks should target older age groups engaged in activity around the home. Our results strongly suggest that encounter rates with ticks other than I. scapularis are substantial and increasing and that their role in causing human illness should be carefully investigated.
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Affiliation(s)
- Robert A. Jordan
- Tick-Borne Disease Program, Monmouth County Mosquito Control Division, Tinton Falls, New Jersey, United States of America
- Center for Vector Biology, Department of Entomology, Rutgers University, New Brunswick, New Jersey, United States of America
- * E-mail:
| | - Andrea Egizi
- Tick-Borne Disease Program, Monmouth County Mosquito Control Division, Tinton Falls, New Jersey, United States of America
- Center for Vector Biology, Department of Entomology, Rutgers University, New Brunswick, New Jersey, United States of America
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