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Masséglia S, René-Martellet M, Rates M, Hizo-Teufel C, Fingerle V, Margos G, Bailly X. Development and validation of a multi-target TaqMan qPCR method for detection of Borrelia burgdorferi sensu lato. J Microbiol Methods 2024; 222:106941. [PMID: 38714225 DOI: 10.1016/j.mimet.2024.106941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 05/09/2024]
Abstract
Reliable detection of bacteria belonging to the Borrelia burgdorferi sensu lato species complex in vertebrate reservoirs, tick vectors, and patients is key to answer questions regarding Lyme borreliosis epidemiology. Nevertheless, the description of characteristics of qPCRs for the detection of B. burgdorferi s. l. are often limited. This study covers the development and validation of two duplex taqman qPCR assays used to target four markers on the chromosome of genospecies of B. burgdorferi s. l. Analytical specificity was determined with a panel of spirochete strains. qPCR characteristics were specified using water or tick DNA spiked with controlled quantities of the targeted DNA sequences of B. afzelii, B. burgdorferi sensu stricto or B. bavariensis. The effectiveness of detection results was finally evaluated using DNA extracted from ticks and biopsies from mammals whose infectious status had been determined by other detection assays. The developed qPCR assays allow exclusive detection of B. burgdorferi s. l. with the exception of the M16 marker which also detect relapsing fever Borreliae. The limit of detection is between 10 and 40 copies per qPCR reaction depending on the sample type, the B. burgdorferi genospecies and the targeted marker. Detection tests performed on various kind of samples illustrated the accuracy and robustness of our qPCR assays. Within the defined limits, this multi-target qPCR method allows a versatile detection of B. burgdorferi s. l., regardless of the genospecies and the sample material analyzed, with a sensitivity that would be compatible with most applications and a reproducibility of 100% under measurement conditions of limits of detection, thereby limiting result ambiguities.
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Affiliation(s)
- Sébastien Masséglia
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, F-63122 Saint-Genès-Champanelle, France.
| | - Magalie René-Martellet
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, F-63122 Saint-Genès-Champanelle, France; Université de Lyon, INRAE, VetAgro Sup, UMR EPIA, F-69280 Marcy l'Etoile, France
| | - Maxime Rates
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, F-63122 Saint-Genès-Champanelle, France; Université de Lyon, INRAE, VetAgro Sup, UMR EPIA, F-69280 Marcy l'Etoile, France
| | - Cecilia Hizo-Teufel
- Bavarian Health and Food Safety Authority, German National Reference Centre for Borrelia, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, German National Reference Centre for Borrelia, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - Gabriele Margos
- Bavarian Health and Food Safety Authority, German National Reference Centre for Borrelia, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - Xavier Bailly
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, F-63122 Saint-Genès-Champanelle, France
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2
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Rubino F, Foley J. Prevalence and Knowledge of Tick-Borne Disease Among Forest Management Workers in Santa Cruz, California. Vector Borne Zoonotic Dis 2024. [PMID: 38682292 DOI: 10.1089/vbz.2024.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Background: In Lyme-endemic areas, limited research has investigated the risk of tick-borne diseases among frontline workers in fire management. This study aimed to compare the exposure histories to ticks and tick-borne pathogens, knowledge, and prevention practices between individuals engaged in fire-related forest management and those participating in recreational activities within Santa Cruz County, CA, in an area of high risk of tick exposure. Methods: Blood samples from 55 forest workers and 58 members of the public were tested for bacterial DNA of and antibodies to Borrelia burgdorferi, Anaplasma phagocytophilum, and Rickettsia species. In addition, a questionnaire was administered to 54 workers and 84 members of the public to identify gaps in knowledge and prevention practices. Results: Although workers had a higher percentage of positive B. burgdorferi antibodies than the public (5.5% compared with 1.7%), the difference was not statistically significant. Conversely, rickettsial antibodies were more prevalent among the public (17.2% versus 3.6% for workers), but specificity to pathogenic bacteria could not be confirmed. No DNA for the three pathogens or antibodies against A. phagocytophilum were detected. Many workers and members of the public reported tick bites (67.4% of participants), with a notable 11% increase among workers in the odds of being bitten for each additional year spent working in forests. Although workers took greater precautions, significant knowledge and practice gaps were identified among both populations, such as an inability to distinguish tick species from common arthropods (mites, spiders, fleas), overestimating the size of ticks, and inappropriate tick-removal techniques. Conclusion: This study underscores the risk of tick-borne diseases faced by fire management workers in Lyme disease-endemic regions. The findings emphasize the necessity for future studies of Lyme disease within this population, and highlight the urgent need for enhanced training programs to minimize these risks.
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Affiliation(s)
- Francesca Rubino
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Janet Foley
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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3
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Sanchez-Vicente S, Tokarz R. Tick-Borne Co-Infections: Challenges in Molecular and Serologic Diagnoses. Pathogens 2023; 12:1371. [PMID: 38003835 PMCID: PMC10674443 DOI: 10.3390/pathogens12111371] [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: 11/01/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Co-infections are a poorly understood aspect of tick-borne diseases. In the United States alone, nineteen different tick-borne pathogens have been identified. The majority of these agents are transmitted by only two tick species, Ixodes scapularis and Amblyomma americanum. Surveillance studies have demonstrated the presence of multiple pathogens in individual ticks suggesting a risk of polymicrobial transmission to humans. However, relatively few studies have explored this relationship and its impact on human disease. One of the key factors for this deficiency are the intrinsic limitations associated with molecular and serologic assays employed for the diagnosis of tick-borne diseases. Limitations in the sensitivity, specificity and most importantly, the capacity for inclusion of multiple agents within a single assay represent the primary challenges for the accurate detection of polymicrobial tick-borne infections. This review will focus on outlining these limitations and discuss potential solutions for the enhanced diagnosis of tick-borne co-infections.
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Affiliation(s)
- Santiago Sanchez-Vicente
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Rafal Tokarz
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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4
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Thompson AD, Balamuth F, Neville DN, Chapman LL, Levas MN, Kharbanda AB, Branda JA, Ladell MM, Loiselle C, Nigrovic LE. Sensitivity of Two-Tiered Lyme Disease Serology in Children With an Erythema Migrans Lesion. J Pediatric Infect Dis Soc 2023; 12:553-555. [PMID: 37756491 DOI: 10.1093/jpids/piad073] [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: 05/26/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023]
Abstract
In our prospective cohort of 192 children with a physician-diagnosed erythema migrans (EM) lesion, two-tier Lyme disease serology had higher sensitivity in children with multiple EM lesions (76.8% multiple lesions vs. 38.1% single EM; difference 38.7%, 95% confidence interval 24.8%-50.4%). The diagnosis of cutaneous Lyme disease should be based on careful physical examination rather than laboratory testing.
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Affiliation(s)
- Amy D Thompson
- Division of Emergency Medicine, Nemours Children's Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA
| | - Fran Balamuth
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Desiree N Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura L Chapman
- Division of Pediatric Emergency Medicine, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Meagan M Ladell
- Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Claire Loiselle
- Department of Research, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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5
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Grąźlewska W, Holec-Gąsior L. Antibody Cross-Reactivity in Serodiagnosis of Lyme Disease. Antibodies (Basel) 2023; 12:63. [PMID: 37873860 PMCID: PMC10594444 DOI: 10.3390/antib12040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
Lyme disease is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex. The disease is characterized by a varied course; therefore, the basis for diagnosis is laboratory methods. Currently, a two-tiered serological test is recommended, using an ELISA as a screening test and a Western blot as a confirmatory test. This approach was introduced due to the relatively high number of false-positive results obtained when using an ELISA alone. However, even this approach has not entirely solved the problem of false-positive results caused by cross-reactive antibodies. Many highly immunogenic B. burgdorferi s.l. proteins are recognized nonspecifically by antibodies directed against other pathogens. This also applies to antigens, such as OspC, BmpA, VlsE, and FlaB, i.e., those commonly used in serodiagnostic assays. Cross-reactions can be caused by both bacterial (relapsing fever Borrelia, Treponema pallidum) and viral (Epstein-Baar virus, Cytomegalovirus) infections. Additionally, a rheumatoid factor has also been shown to nonspecifically recognize B. burgdorferi s.l. proteins, resulting in false-positive results. Therefore, it is necessary to carefully interpret the results of serodiagnostic tests so as to avoid overdiagnosis of Lyme disease, which causes unnecessary implementations of strong antibiotic therapies and delays in the correct diagnosis.
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Affiliation(s)
| | - Lucyna Holec-Gąsior
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdansk University of Technology, 80-233 Gdansk, Poland;
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Shah JS, Burrascano JJ, Ramasamy R. Recombinant protein immunoblots for differential diagnosis of tick-borne relapsing fever and Lyme disease. J Vector Borne Dis 2023; 60:353-364. [PMID: 38174512 DOI: 10.4103/0972-9062.383641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Lyme disease (LD) is caused by a group of tick-borne bacteria of the genus Borrelia termed Lyme disease Borreliae (LDB). The detection of serum antibodies to specific LDB antigens is widely used to support diagnosis of LD. Recent findings highlight a need for serological tests that can differentiate LD from tick-borne relapsing fever (TBRF) caused by a separate group of Borrelia species termed relapsing fever Borreliae. This is because LD and TBRF share some clinical symptoms and can occur in overlapping locations. The development of serological tests for TBRF is at an early stage compared with LD. This article reviews the application of line immunoblots (IBs), where recombinant proteins applied as lines on nitrocellulose membrane strips are used to detect antibodies in patient sera, for the diagnosis and differentiation of LD and TBRF.
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Affiliation(s)
- Jyotsna S Shah
- IGeneX Inc. Milpitas; ID-FISH Technology Inc., California, USA
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7
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Kim S, Samanta K, Nguyen BT, Mata-Robles S, Richer L, Yoon JY, Gomes-Solecki M. A portable immunosensor provides sensitive and rapid detection of Borrelia burgdorferi antigen in spiked blood. Sci Rep 2023; 13:7546. [PMID: 37161039 PMCID: PMC10170079 DOI: 10.1038/s41598-023-34108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
There are no assays for detecting B. burgdorferi antigen in blood of infected Lyme disease individuals. Here, we provide proof-of-principle evidence that we can quantify B. burgdorferi antigen in spiked blood using a portable smartphone-based fluorescence microscope that measures immunoagglutination on a paper microfluidic chip. We targeted B. burgdorferi OspA to develop a working prototype and added examples of two antigens (OspC and VlsE) that have diagnostic value for discrimination of Lyme disease stage. Using an extensively validated monoclonal antibody to OspA (LA-2), detection of OspA antigen had a broad linear range up to 100 pg/mL in 1% blood and the limit of detection (LOD) was 100 fg/mL (= 10 pg/mL in undiluted blood), which was 1000 times lower than our target of 10 ng/mL. Analysis of the two other targets was done using polyclonal and monoclonal antibodies. OspC antigen was detected at LOD 100 pg/mL (= 10 ng/mL of undiluted blood) and VlsE antigen was detected at LOD 1-10 pg/mL (= 0.1-1 ng/mL of undiluted blood). The method is accurate and was performed in 20 min from sample to answer. When optimized for detecting several B. burgdorferi antigens, this assay may differentiate active from past infections and facilitate diagnosis of Lyme disease in the initial weeks of infection, when antibody presence is typically below the threshold to be detected by serologic methods.
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Affiliation(s)
- Sangsik Kim
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA
| | - Kamalika Samanta
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Merck & Co., West Point, PA, 19486, USA
- Immuno Technologies, Inc, Memphis, TN, 38103, USA
| | - Brandon T Nguyen
- College of Medicine, The University of Arizona, Tucson, AZ, 85724, USA
| | - Samantha Mata-Robles
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA
| | - Luciana Richer
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Immuno Technologies, Inc, Memphis, TN, 38103, USA
- US Biologic, Inc, Memphis, TN, 38103, USA
| | - Jeong-Yeol Yoon
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA.
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
- Immuno Technologies, Inc, Memphis, TN, 38103, USA.
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8
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Govil S, Capitle E, Lacqua A, Khianey R, Coyle PK, Schutzer SE. Common Neurologic Features of Lyme Disease That May Present to a Rheumatologist. Pathogens 2023; 12:pathogens12040576. [PMID: 37111462 PMCID: PMC10146759 DOI: 10.3390/pathogens12040576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Lyme disease, caused by Borrelia burgdorferi (Bb) infection, has a broad spectrum of clinical manifestations and severity. Patients with possible Lyme disease may seek out or be referred to rheumatologists. Today, the most common reason to engage a rheumatologist is due to complaints of arthralgia. After skin, neurologic manifestations of Lyme disease are now among the most common. Therefore, it is important for rheumatologists to be aware of clues that suggest neurologic Lyme disease and prompt help from a neurologist experienced with Lyme disease.
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Affiliation(s)
- Swati Govil
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| | - Eugenio Capitle
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| | - Alexandra Lacqua
- Department of Medicine, Florida Atlantic University, Boca Raton, FL 33486, USA
| | - Reena Khianey
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
| | - P K Coyle
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Steven E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Allergy, Immunology, and Rheumatology, Newark, NJ 07103, USA
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9
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Servellita V, Bouquet J, Rebman A, Yang T, Samayoa E, Miller S, Stone M, Lanteri M, Busch M, Tang P, Morshed M, Soloski MJ, Aucott J, Chiu CY. A diagnostic classifier for gene expression-based identification of early Lyme disease. COMMUNICATIONS MEDICINE 2022; 2:92. [PMID: 35879995 PMCID: PMC9306241 DOI: 10.1038/s43856-022-00127-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Lyme disease is a tick-borne illness that causes an estimated 476,000 infections annually in the United States. New diagnostic tests are urgently needed, as existing antibody-based assays lack sufficient sensitivity and specificity. Methods Here we perform transcriptome profiling by RNA sequencing (RNA-Seq), targeted RNA-Seq, and/or machine learning-based classification of 263 peripheral blood mononuclear cell samples from 218 subjects, including 94 early Lyme disease patients, 48 uninfected control subjects, and 57 patients with other infections (influenza, bacteremia, or tuberculosis). Differentially expressed genes among the 25,278 in the reference database are selected based on ≥1.5-fold change, ≤0.05 p value, and ≤0.001 false-discovery rate cutoffs. After gene selection using a k-nearest neighbor algorithm, the comparative performance of ten different classifier models is evaluated using machine learning. Results We identify a 31-gene Lyme disease classifier (LDC) panel that can discriminate between early Lyme patients and controls, with 23 genes (74.2%) that have previously been described in association with clinical investigations of Lyme disease patients or in vitro cell culture and rodent studies of Borrelia burgdorferi infection. Evaluation of the LDC using an independent test set of samples from 63 subjects yields an overall sensitivity of 90.0%, specificity of 100%, and accuracy of 95.2%. The LDC test is positive in 85.7% of seronegative patients and found to persist for ≥3 weeks in 9 of 12 (75%) patients. Conclusions These results highlight the potential clinical utility of a gene expression classifier for diagnosis of early Lyme disease, including in patients negative by conventional serologic testing. Lyme disease is a bacterial infection spread by ticks and there are nearly half a million cases a year in the United States. However, the disease is difficult to diagnose and existing laboratory tests have limited accuracy. Here, we develop a new genetic test, described as a Lyme disease classifier (LDC), for diagnosing early Lyme disease from blood samples by assessing the patient’s response to the infection. We find that the LDC can identify early Lyme disease patients (those presenting with symptoms within weeks of a tick bite) accurately, even before standard laboratory tests turn positive. In the future, the LDC may be clinically useful as a test for Lyme disease to diagnose patients earlier in the course of their illness, thus guiding more timely and effective treatment for the infection. Servellita et al. develop a machine learning-based classifier to diagnose Lyme disease using gene expression data. The classifier achieves high sensitivity for early infections, even prior to positivity on antibody testing.
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10
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Kight E, Alfaro R, Gadila SKG, Chang S, Evans D, Embers M, Haselton F. Direct Capture and Early Detection of Lyme Disease Spirochete in Skin with a Microneedle Patch. BIOSENSORS 2022; 12:819. [PMID: 36290956 PMCID: PMC9599122 DOI: 10.3390/bios12100819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Borrelia burgdorferi sensu lato family of spirochetes causes Lyme disease (LD) in animals and humans. As geographic territory of ticks expands across the globe, surveillance measures are needed to measure transmission rates and provide early risk testing of suspected bites. The current standard testing of LD uses an indirect two-step serological assay that detects host immune reactivity. Early detection remains a challenge because the host antibody response develops several weeks after infection. A microneedle (MN) device was developed to sample interstitial fluid (ISF) and capture spirochetes directly from skin. After sampling, the MN patch is easily dissolved in water or TE buffer, and the presence of spirochete DNA is detected by PCR. Performance was tested by spiking porcine ear skin with inactivated Borrelia burgdorferi, which had an approximate recovery of 80% of spirochetes. With further development, this simple direct PCR method could be a transformative approach for early detection of the causative agent of Lyme disease and enable rapid treatment to patients when infection is early, and numbers of systemic spirochetes are low.
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Affiliation(s)
- Emily Kight
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37211, USA
| | - Rosana Alfaro
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37211, USA
| | - Shiva Kumar Goud Gadila
- Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA 70433, USA
| | - Shuang Chang
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37211, USA
| | - David Evans
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37211, USA
| | - Monica Embers
- Division of Immunology, Tulane National Primate Research Center, Tulane University Health Sciences, Covington, LA 70433, USA
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11
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Abstract
Most patients with Lyme disease will fully recover with recommended antibiotic therapy. However, some patients report persisting nonspecific symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), depending on the degree to which the individual's symptoms impact their quality of life. PTLDs occur in a portion of patients diagnosed with chronic Lyme disease (CLD), a controversial term describing different patient populations, diagnosed based on unvalidated tests and criteria. Practitioners should review the evidence for the Lyme disease diagnosis and not overlook unrelated conditions. Current evidence shows that prolonged antibiotic therapy provides little benefit and carries significant risk. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and to understand CLD is needed.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, BG 10 RM 12C118 MSC 1888 10 Center, Bethesda, MD 20892-1888, USA.
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12
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Haslund-Gourley BS, Grauzam S, Mehta AS, Wigdahl B, Comunale MA. Acute lyme disease IgG N-linked glycans contrast the canonical inflammatory signature. Front Immunol 2022; 13:949118. [PMID: 35990620 PMCID: PMC9389449 DOI: 10.3389/fimmu.2022.949118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022] Open
Abstract
Lyme disease (LD) infection is caused by Borrelia burgdorferi sensu lato (Bb). Due to the limited presence of this pathogen in the bloodstream in humans, diagnosis of LD relies on seroconversion. Immunoglobulins produced in response to infection are differentially glycosylated to promote or inhibit downstream inflammatory responses by the immune system. Immunoglobulin G (IgG) N-glycan responses to LD have not been characterized. In this study, we analyzed IgG N-glycans from cohorts of healthy controls, acute LD patient serum, and serum collected after acute LD patients completed a 2- to 3-week course of antibiotics and convalesced for 70-90 days. Results indicate that during the acute phase of Bb infection, IgG shifts its glycosylation profile to include structures that are not associated with the classic proinflammatory IgG N-glycan signature. This unexpected result is in direct contrast to what is reported for other inflammatory diseases. Furthermore, IgG N-glycans detected during acute LD infection discriminated between control, acute, and treated cohorts with a sensitivity of 75-100% and specificity of 94.7-100%.
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Affiliation(s)
- Benjamin Samuel Haslund-Gourley
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
- Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Stéphane Grauzam
- GlycoPath, LLC Charleston, SC, United States
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Anand S. Mehta
- GlycoPath, LLC Charleston, SC, United States
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina (MUSC), Charleston, SC, United States
| | - Brian Wigdahl
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
- Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Mary Ann Comunale
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
- Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, United States
- *Correspondence: Mary Ann Comunale,
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13
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Divers TJ, Mongodin EF, Miller CB, Belgrave RL, Gardner RB, Fraser CM, Schutzer SE. Genomic hybrid capture assay to detect Borrelia burgdorferi: an application to diagnose neuroborreliosis in horses. J Vet Diagn Invest 2022; 34:909-912. [PMID: 35864735 DOI: 10.1177/10406387221112617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Antemortem diagnosis of neuroborreliosis in horses has been hindered by both the low sensitivity of PCR testing for Borrelia burgdorferi in CSF and the low specificity of serum:CSF ELISA ratios used to determine intrathecal antibody production against the bacterium. PCR testing of the CSF of an adult horse with acute neurologic disease for the B. burgdorferi flagellin gene was negative. However, we enriched B. burgdorferi DNA through nucleic acid hybrid capture, followed by next-generation sequencing, and identified B. burgdorferi in the CSF of the horse, confirming a diagnosis of neuroborreliosis.
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Affiliation(s)
- Thomas J Divers
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Emmanuel F Mongodin
- Institute of Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Claire M Fraser
- Institute of Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven E Schutzer
- Institute of Genome Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA
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14
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Chen WH, Strych U, Bottazzi ME, Lin YP. Past, present, and future of Lyme disease vaccines: antigen engineering approaches and mechanistic insights. Expert Rev Vaccines 2022; 21:1405-1417. [PMID: 35836340 DOI: 10.1080/14760584.2022.2102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction: Transmitted by ticks, Lyme disease is the most common vector-borne disease in the Northern hemisphere. Despite the geographical expansion of human Lyme disease cases, no effective preventive strategies are currently available. Developing an efficacious and safe vaccine is therefore urgently needed. Efforts have previously been taken to identify vaccine targets in the causative pathogen (Borrelia burgdorferi sensu lato) and arthropod vector (Ixodes spp.). However, progress was impeded due to a lack of consumer confidence caused by the myth of undesired off-target responses, low immune responses, a limited breadth of immune reactivity, as well as by the complexities of the vaccine process development.Area covered: In this review, we summarize the antigen engineering approaches that have been applied to overcome those challenges and the underlying mechanisms that can be exploited to improve both safety and efficacy of future Lyme disease vaccines.Expert opinion: Over the past two decades, several new genetically redesigned Lyme disease vaccine candidates have shown success in both preclinical and clinical settings and built a solid foundation for further development. These studies have greatly informed the protective mechanisms of reducing Lyme disease burdens and ending the endemic of this disease.
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Affiliation(s)
- Wen-Hsiang Chen
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA
| | - Ulrich Strych
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Center for Vaccine Development, Houston, TX, USA.,Department of Biology, Baylor University, Waco, TX, United States
| | - Yi-Pin Lin
- Division of Infectious Diseases, Wadsworth Center, NYSDOH, Albany, NY, USA.,Department of Biomedical Sciences, SUNY Albany, Albany, NY, USA
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15
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Garro AC, Thompson AD, Neville DN, Balamuth F, Levas MN, Kharbanda AB, Bennett JE, Grant DS, Aresco RK, Nigrovic LE. Empiric antibiotics for children with suspected Lyme disease. Ticks Tick Borne Dis 2022; 13:101989. [PMID: 35759989 DOI: 10.1016/j.ttbdis.2022.101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
In our prospective cohort of children undergoing evaluation for non-cutaneous Lyme disease, 02 (13.9% of those with Lyme disease) were not initially treated with an appropriate antibiotics and 356 (13.3% without Lyme disease) received potentially unnecessary antibiotics. Rapid and accurate diagnostics are needed to further improve initial antibiotic treatment decisions.
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Affiliation(s)
- Aris C Garro
- Department of Emergency Medicine, Rhode Island (Post-Mortem), Providence, USA
| | - Amy D Thompson
- Division of Emergency Medicine, Nemours Children's Health, USA
| | - Desiree N Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh, USA
| | - Fran Balamuth
- Division of Emergency Medicine, Children's Hospital of Philadelphia, USA
| | - Michael N Levas
- Pediatric Emergency Medicine, Children's Hospital of Wisconsin, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | | | - Rachael K Aresco
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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16
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Arora G, Hart T, Fikrig E. Use of host lipids by the Lyme disease spirochete may lead to biomarkers. J Clin Invest 2022; 132:e158254. [PMID: 35289311 PMCID: PMC8920323 DOI: 10.1172/jci158254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lyme disease is the most common tick-borne disease in North America and Europe, however, current biomarkers inconsistently detect the disease. In this issue of the JCI, Gwynne et al. revealed how the Lyme disease agent Borrelia burgdorferi relies on host lipids for growth. The authors used a murine model to show that B. burgdorferi infection led to the production of antibodies against phospholipids, possibly as a consequence of incorporation into the spirochete membrane. Antibodies were induced against phosphatidic acid, phosphatidylcholine, and phosphatidylserine. Notably, no antibodies against cardiolipin were found, distinguishing Lyme disease from syphilis and some other diseases. Sera samples from patients with Lyme disease suggested that these antibodies may help diagnose B. burgdorferi infection and that antibody titers may effectively indicate the response to treatment. These findings suggest that B. burgdorferi-induced anti-lipid antibodies, in conjunction with a careful clinical assessment, may aid in the diagnosis of Lyme disease.
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17
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Senger RS, Sayed Issa A, Agnor B, Talty J, Hollis A, Robertson JL. Disease-Associated Multimolecular Signature in the Urine of Patients with Lyme Disease Detected Using Raman Spectroscopy and Chemometrics. APPLIED SPECTROSCOPY 2022; 76:284-299. [PMID: 35102746 DOI: 10.1177/00037028211061769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A urine-based screening technique for Lyme disease (LD) was developed in this research. The screen is based on Raman spectroscopy, iterative smoothing-splines with root error adjustment (ISREA) spectral baselining, and chemometric analysis using Rametrix software. Raman spectra of urine from 30 patients with positive serologic tests (including the US Centers for Disease Control [CDC] two-tier standard) for LD were compared against subsets of our database of urine spectra from 235 healthy human volunteers, 362 end-stage kidney disease (ESKD) patients, and 17 patients with active or remissive bladder cancer (BCA). We found statistical differences (p < 0.001) between urine scans of healthy volunteers and LD-positive patients. We also found a unique LD molecular signature in urine involving 112 Raman shifts (31 major Raman shifts) with significant differences from urine of healthy individuals. We were able to distinguish the LD molecular signature as statistically different (p < 0.001) from the molecular signatures of ESKD and BCA. When comparing LD-positive patients against healthy volunteers, the Rametrix-based urine screen performed with 86.7% for overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively. When considering patients with ESKD and BCA in the LD-negative group, these values were 88.7% (accuracy), 83.3% (sensitivity), 91.0% (specificity), 80.7% (PPV), and 92.4% (NPV). Additional advantages to the Raman-based urine screen include that it is rapid (minutes per analysis), is minimally invasive, requires no chemical labeling, uses a low-profile, off-the-shelf spectrometer, and is inexpensive relative to other available LD tests.
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Affiliation(s)
- Ryan S Senger
- Department of Biological Systems Engineering, 1757Virginia Tech, Blacksburg, Virginia, USA
- DialySensors Inc., Blacksburg, Virginia, USA
| | | | - Ben Agnor
- Department of Biological Systems Engineering, 1757Virginia Tech, Blacksburg, Virginia, USA
| | - Janine Talty
- Neuromusculoskeletal Medicine & OMM, Roanoke, Virginia, USA
| | | | - John L Robertson
- DialySensors Inc., Blacksburg, Virginia, USA
- Department of Biomedical Engineering and Mechanics, 1757Virginia Tech, Blacksburg, Virginia, USA
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18
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Papadopoulou K, Falk TM, Metze D, Böer-Auer A. No evidence of Borrelia in Cutaneous Infiltrates of B-cell lymphomas with a highly sensitive, semi-nested real time Polymerase chain reaction (PCR) targeting the 5S-23S intergenic spacer region (IGS). J Eur Acad Dermatol Venereol 2022; 36:836-845. [PMID: 35171539 DOI: 10.1111/jdv.18003] [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: 10/25/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
BACKROUND The role of Borrelia in the development of skin lymphomas has been under discussion for decades. A similar association has been shown for Helicobacter pylori and gastric lymphomas (MALT type). Nevertheless, few molecular studies investigated Borrelia in skin lymphomas and the results are controversial. METHODS We analysed 46 formalin-fixed, paraffin-embedded skin specimens of clincopathologically confirmed B-cell lymphomas (15 marginal zone lymphomas; 20 follicular lymphomas; 3 diffuse large B-cell lymphomas; 8 secondary cutaneous infiltrates) taken from 36 patients from Northern Germany, an endemic area for Borrelia. Fifteen pseudolymphomatous lesions of cutaneous Borreliosis served as control. Both groups were examined with a real time (rt) PCR and a semi-nested PCR targeting the 5S-23S intergenic spacer region (IGS). A multiplex PCR was used to investigate B-cell clonality in all lymphomatous infiltrates (Biomed Primers). RESULTS With both assays no B. burgdorferi-specific DNA was identified in any of the B-cell lymphomas, while all 15 Borreliosis specimens gave a positive PCR result in the semi-nested PCR protocol, 12 were also positive in the rt PCR (p<.01). All B-cell lymphomas showed monoclonal IgH-Rearrangement. Analysis of cutaneous B-cell lymphomas from available studies including ours (n=334) reveals an Odds ratio < 1. CONCLUSION While some previous studies suggested an association between B. burgdorferi and the development of cutaneous B-cell lymphomas in endemic areas, we were unable to confirm this in our patients, despite a highly sensitive Borrelia PCR assay. Our results including meta-analysis of previous studies question the need for antibiotic therapy in patients with cutaneous B-cell lymphomas.
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Affiliation(s)
- K Papadopoulou
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Germany
| | - T M Falk
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Germany
| | - D Metze
- Münster University, Department of Dermatology, Von-Esmarch-Strasse 58, 48149, Münster, Germany
| | - A Böer-Auer
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Germany.,Münster University, Department of Dermatology, Von-Esmarch-Strasse 58, 48149, Münster, Germany
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19
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Olkhovskiy IA, Gorbenko AS, Komarovskiy YY, Stolyar MA, Vasil'eva DI, Epifanova OS, Khodov DA, Rudakova SA, Rudakov NV, Oskorbin IP, Filipenko ML. Modification of isothermal test for detecting DNA of pathogens of tick-borne borreliosis. Klin Lab Diagn 2022; 67:59-64. [PMID: 35077072 DOI: 10.51620/0869-2084-2022-67-1-59-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Early diagnosis of tick-borne borreliosis determines the indications for etiotropic therapy, and the detection of borrelia in a tick that has bitten you serves as the basis for antibiotic prophylaxis. To determine the causative agent of borreliosis, PCR methods are most widely used, which requires special conditions for organizing the work of laboratories and the use of expensive equipment. In addition, the procedure for isolating bacterial DNA and subsequent amplification takes several hours of working time. At the same time, methods for detecting borrelia in the isothermal LAMP-reaction are described, which makes it possible to significantly speed up the diagnosis, does not require complex equipment and highly qualified personnel. It is also known that LAMP in some cases allows analysis without prior extraction of nucleic acids. The purpose was a development of a modified test for isothermal detection of DNA of borreliosis pathogens for an accelerated result and the possibility of excluding the stage of nucleic acid extraction. We used 40 samples of Borrelia DNA and 11 Ixodes persulcatus ticks. To shorten the detection time for Borrelia, the previously described LAMP method was modified by the introduction of additional loop primers. The copy number of the positive DNA sample of the borrelia plasmid was estimated using digital PCR. The results of the LAMP reaction were compared with those of the commercial PRC-RT test. The additional use of loop primers approximately halved the detection time for Borrelia DNA without affecting the comparative diagnostic efficiency. The analytical sensitivity limit of the modified LAMP method was 4 copies/μl or 21 molecules of the plasmid standard added to the reaction. In comparative testing with RT-PCR, the sensitivity of the LAMP method is 90%, and the specificity is 100%. The possibility of detecting borrelia in ticks without the stage of DNA extraction has been demonstrated for the first time. A modified isothermal method for the detection of pathogens of tick-borne borreliosis has been developed, which allows analysis within 20-30 minutes, including in ticks without preliminary DNA extraction.
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Affiliation(s)
- I A Olkhovskiy
- Krasnoyarsk branch of the «National Research Center for Hematology» Department of Health.,Federal Research Center Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences
| | - A S Gorbenko
- Krasnoyarsk branch of the «National Research Center for Hematology» Department of Health.,Federal Research Center Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences
| | - Yu Yu Komarovskiy
- Krasnoyarsk branch of the «National Research Center for Hematology» Department of Health.,Federal Research Center Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences
| | - M A Stolyar
- Krasnoyarsk branch of the «National Research Center for Hematology» Department of Health.,Federal Research Center Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences
| | - D I Vasil'eva
- Institute of Fundamental Biology and Biotechnology of Siberian Federal University
| | - O S Epifanova
- Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of Center for Hygiene and Epidemiology
| | - D A Khodov
- Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of Center for Hygiene and Epidemiology
| | - S A Rudakova
- Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of Omsk Research Institute of Natural Focal Infections
| | - N V Rudakov
- Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of Omsk Research Institute of Natural Focal Infections
| | - I P Oskorbin
- Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences
| | - M L Filipenko
- Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences
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20
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Marques A, Okpali G, Liepshutz K, Ortega‐Villa AM. Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States. Ann Clin Transl Neurol 2022; 9:41-49. [PMID: 35064770 PMCID: PMC8791801 DOI: 10.1002/acn3.51488] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Facial palsy is the most common manifestation of Lyme neuroborreliosis (LNB) in the United States. This study aimed to describe features of patients with early LNB presenting with facial palsy and to determine if corticosteroids in addition to antibiotic therapy was associated with unfavorable outcome. METHODS Retrospective analysis of participants enrolled in clinical studies investigating Lyme disease (N = 486) identified 44 patients who had facial palsy from LNB. The House-Brackmann scale was used to quantify the facial nerve dysfunction. RESULTS Most patients presented in the summer months. Erythema migrans, frequently associated with systemic symptoms, occurred in 29 patients. Thirteen patients presented with bilateral facial palsy, usually with sequential involvement. Fourteen patients had painful radiculopathy. Of the 38 patients treated with antibiotics before the resolution of the palsy who had complete follow-up, 24 received both antibiotics and corticosteroids. Of these 38 patients, 34 recovered completely, 3 had nearly complete recovery, and 1 had moderate dysfunction. There were no differences between the treatment groups in achieving complete resolution of the palsy at 12 months or in time to complete recovery. INTERPRETATION A history of rash compatible with erythema migrans or febrile illness in the weeks preceding the palsy are helpful clues pointing toward LNB and should be actively sought when evaluating patients with acute-onset peripheral facial palsy, particularly bilateral facial palsy. Treatment with antibiotic therapy is highly effective and most patients will fully recover facial nerve function. Adjunctive corticosteroid therapy appears to not affect the speed of recovery or overall outcome in this retrospective observational study.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Microbiology and ImmunologyNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | - Grace Okpali
- Laboratory of Clinical Microbiology and ImmunologyNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | - Kelly Liepshutz
- Clinical Monitoring Research Program DirectorateFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | - Ana Maria Ortega‐Villa
- Biostatistics Research Branch, Division of Clinical ResearchNational Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
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21
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Jernigan DA, Hart MC, Dodd KK, Jameson S, Farney T. Induced Native Phage Therapy for the Treatment of Lyme Disease and Relapsing Fever: A Retrospective Review of First 14 Months in One Clinic. Cureus 2021; 13:e20014. [PMID: 34873551 PMCID: PMC8636187 DOI: 10.7759/cureus.20014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
The overall failure rate of standard therapeutic options for late/chronic/persistent borreliosis emphasizes the need for novel therapeutic strategies. In this report, we are presenting a novel therapeutic option based on a new technology, Induced Native Phage Therapy (INPT; PhagenCorp, LLC, Sarasota, FL), and its ability to facilitate the elimination of infection more rapidly, efficiently, and with less harm to the patient than conventional treatments. Borrelia species in the environment are themselves always infected by their own type of Borrelia bacteriophages. Both the Borrelia spirochete and the Borrelia bacteriophages are transmitted into humans via the bite of a vector, such as ticks. The Borrelia bacteriophages (phages) are called native phages in that they coexist naturally within the human body, and only infect the specific bacteria host population. Native phages persist in humans only as long as there are host bacteria of the correct type to continue replicating more phages. The purposeful manipulation of native phages to kill their host bacteria is the basis of INPT. INPT is a patent-pending technology that uses a proprietary adjunctive assay called Biospectral Emission Sequencing to identify and isolate the specific complex electromagnetic signatures necessary to induce the native phages to epigenetically revert from their normal quiescent, lysogenic activity to virulent, lytic activity, thereby killing their host bacteria. The strategic subtle, low-frequency/low-energy signatures are imprinted into a proprietary oral formula, Inducen-LD, which serves as a carrier to introduce the signals therapeutically into the body. As a proof-of-concept method validation, a total of 26 patients with post-treatment (antibiotic) Lyme disease syndrome, who initially were found upon Phelix Borrelia-phage testing (R.E.D. Laboratories, Belgium) to have one or more Borrelia species, were submitted to INPT treatment. A total of 20 patients (77%) were found to be negative after two weeks of the total program of care. Six patients who remained positive after the initial therapy received an extended INPT treatment and were retested. Four were subsequently found to be negative for one or more of their previously diagnosed Borrelia strains. Thus a total of 24 out of 26 (92%) patients were successfully treated with INPT. Mild to substantial clinical improvements were reported by all participants without noticeable adverse reactions to the INPT treatments. We have demonstrated a possible mechanism in which native bacteriophages can be induced to epigenetically switch from lysogenic to lytic actions, thereby eliminating the targeted bacteria efficiently, with little to no harm to tissues or the microbiome.
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Affiliation(s)
- David A Jernigan
- Biological Medicine, Biologix Center for Optimum Health, Franklin, USA
| | - Martin C Hart
- Biological Medicine, Biologix Center for Optimum Health, Franklin, USA
| | - Keeley K Dodd
- Research and Development, PhagenCorp, LLC, Sarasota, USA
| | - Samuel Jameson
- Biological Medicine, Biologix Center for Optimum Health, Franklin, USA
| | - Todd Farney
- Biological Medicine, Biologix Center for Optimum Health, Franklin, USA
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22
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A Review of Post-treatment Lyme Disease Syndrome and Chronic Lyme Disease for the Practicing Immunologist. Clin Rev Allergy Immunol 2021; 62:264-271. [PMID: 34687445 DOI: 10.1007/s12016-021-08906-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/22/2022]
Abstract
Lyme disease is an infection caused by Borrelia burgdorferi sensu lato, which is transmitted to humans through the bite of an infected Ixodes tick. The majority of patients recover without complications with antibiotic therapy. However, for a minority of patients, accompanying non-specific symptoms can persist for months following completion of therapy. The constellation of symptoms such as fatigue, cognitive dysfunction, and musculoskeletal pain that persist beyond 6 months and are associated with disability have been termed post-treatment Lyme disease syndrome (PTLDS), a subset of a broader term "chronic Lyme disease." Chronic Lyme disease is a broad, vaguely defined term that is used to describe patients with non-specific symptoms that are attributed to a presumed persistent Borrelia burgdorferi infection in patients who may or may not have evidence of either previous or current Lyme disease. The diagnoses of chronic Lyme disease and of PTLDS have become increasingly relevant to the practice of immunologists due to referrals for consultation or for intravenous immunoglobulin (IVIG) treatment. This review aims to explore the relationship between chronic Lyme disease, post-treatment Lyme disease syndrome, and the immune system. Here, we review the current literature on (1) issues in conventional and alternative diagnostic testing for Lyme disease, (2) the hypothesis that B. burgdorferi infection can persist despite appropriate use of recommended antibiotics, (3) current theories regarding B. burgdorferi's role in causing both immune dysregulation and protracted symptoms, and (4) the use of IVIG for the treatment of Lyme disease.
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23
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Lantos PM, Balamuth F, Neville D, Garro AC, Levas MN, Bennett J, Thompson AD, Kharbanda AB, Branda JA, Nigrovic LE. Two-Tier Lyme Disease Serology in Children with Previous Lyme Disease. Vector Borne Zoonotic Dis 2021; 21:839-842. [PMID: 34610255 DOI: 10.1089/vbz.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: A history of Lyme disease can complicate the interpretation of Lyme disease serology in acutely symptomatic patients. Materials and Methods: We prospectively enrolled children undergoing evaluation for Lyme disease in the emergency department of one of eight participating Pedi Lyme Net centers. We selected symptomatic children with a Lyme disease history (definite, probable, or none) as well as an available research biosample. We defined a Lyme disease case with either an erythema migrans (EM) lesion or positive two-tier serology with compatible symptoms. Using a generalized estimating equation, we examined the relationship between time from previous Lyme disease diagnosis and current Lyme disease after adjustment for patient demographics and symptoms as well as clustering by center. Results: Of 2501 prospectively enrolled study patients, 126 (5.0%) reported a history of definite or probable Lyme disease. Of these children with previous Lyme disease, 47 met diagnostic criteria for Lyme disease at the time of enrollment (37.3%; 95% confidence interval [CI] 29.1-45.7%); 2 had an EM lesion, and 45 had positive two-tier Lyme disease serology. Over time from the previous Lyme disease diagnosis, the less likely the patient met diagnostic criteria for Lyme disease (adjusted odds ratio 0.62 per time period; 95% CI 0.46-0.84). Conclusions: For children with a history of Lyme disease before enrollment, one-third met the diagnostic criteria for acute Lyme disease with a declining rate over time from previous Lyme disease diagnosis. Novel Lyme disease diagnostics are needed to help distinguish acute from previous Lyme disease.
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Affiliation(s)
- Paul M Lantos
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Frances Balamuth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Desiree Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aris C Garro
- Department of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Michael N Levas
- Division of Emergency Medicine, Milwaukee Children's Hospital, Milwaukee, Wisconsin, USA
| | - Jonathan Bennett
- Division of Emergency Medicine, A.I. Dupont Children's Hospital, Wilmington, Delaware, USA
| | - Amy D Thompson
- Division of Emergency Medicine, A.I. Dupont Children's Hospital, Wilmington, Delaware, USA
| | - Anupam B Kharbanda
- Department of Pediatrics, Children's Minnesota, Minneapolis, Minnesota, USA
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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24
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Branda JA, Lemieux JE, Blair L, Ahmed AA, Hong DK, Bercovici S, Blauwkamp TA, Hollemon D, Ho C, Strle K, Damle NS, Lepore TJ, Pollock NR. Detection of Borrelia burgdorferi Cell-free DNA in Human Plasma Samples for Improved Diagnosis of Early Lyme Borreliosis. Clin Infect Dis 2021; 73:e2355-e2361. [PMID: 32584965 PMCID: PMC8492203 DOI: 10.1093/cid/ciaa858] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laboratory confirmation of early Lyme borreliosis (LB) is challenging. Serology is insensitive during the first days to weeks of infection, and blood polymerase chain reaction (PCR) offers similarly poor performance. Here, we demonstrate that detection of Borrelia burgdorferi (B.b.) cell-free DNA (cfDNA) in plasma can improve diagnosis of early LB. METHODS B.b. detection in plasma samples using unbiased metagenomic cfDNA sequencing performed by a commercial laboratory (Karius Inc) was compared with serology and blood PCR in 40 patients with physician-diagnosed erythema migrans (EM), 28 of whom were confirmed to have LB by skin biopsy culture (n = 18), seroconversion (n = 2), or both (n = 8). B.b. sequence analysis was performed using investigational detection thresholds, different from Karius' clinical test. RESULTS B.b. cfDNA was detected in 18 of 28 patients (64%) with laboratory-confirmed EM. In comparison, sensitivity of acute-phase serology using modified 2-tiered testing (MTTT) was 50% (P = .45); sensitivity of blood PCR was 7% (P = .0002). Combining B.b. cfDNA detection and MTTT increased diagnostic sensitivity to 86%, significantly higher than either approach alone (P ≤ .04). B.b. cfDNA sequences matched precisely with strain-specific sequence generated from the same individual's cultured B.b. isolate. B.b. cfDNA was not observed at any level in plasma from 684 asymptomatic ambulatory individuals. Among 3000 hospitalized patients tested as part of clinical care, B.b. cfDNA was detected in only 2 individuals, both of whom had clinical presentations consistent with LB. CONCLUSIONS This is the first report of B.b. cfDNA detection in early LB and a demonstration of potential diagnostic utility. The combination of B.b. cfDNA detection and acute-phase MTTT improves clinical sensitivity for diagnosis of early LB.
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Affiliation(s)
- John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob E Lemieux
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lily Blair
- Karius Inc, Redwood City, California, USA
| | | | | | | | | | | | - Carine Ho
- Karius Inc, Redwood City, California, USA
| | - Klemen Strle
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nitin S Damle
- South County Internal Medicine Inc, Wakefield, Rhode Island, USA
| | | | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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25
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Dolange V, Simon S, Morel N. Detection of Borrelia burgdorferi antigens in tissues and plasma during early infection in a mouse model. Sci Rep 2021; 11:17368. [PMID: 34462491 PMCID: PMC8405660 DOI: 10.1038/s41598-021-96861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Borrelia burgdorferi is the causative agent of Lyme borreliosis, which is the most common tick-borne human disease in Europe and North America. Currently, the diagnosis of Lyme borreliosis is based on serological tests allowing indirect detection of anti-Borrelia antibodies produced by patients. Their main drawback is a lack of sensitivity in the early phase of disease and an incapacity to prove an active infection. Direct diagnostic tests are clearly needed. The objectives of this study were to produce tools allowing sensitive detection of potential circulating Borrelia antigens and to evaluate them in a mouse model. We focused on two potential early bacterial makers, the highly variable OspC protein and the conserved protein FlaB. High-affinity monoclonal antibodies were produced and used to establish various immunoassays and western blot detection. A very good limit of detection for OspC as low as 17 pg/mL of sample was achieved with SPIE-IA. In infected mice, we were able to measure OspC in plasma with a mean value of 10 ng/mL at 7 days post-inoculation. This result suggests that OspC could be a good blood marker for diagnosis of Lyme borreliosis and that the tools developed during this study could be very useful.
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Affiliation(s)
- Victoria Dolange
- Paris-Saclay University, CEA, INRAE, Medicines and Healthcare Technologies Department (DMTS), SPI, 91191, Gif-sur-Yvette, France
| | - Stéphanie Simon
- Paris-Saclay University, CEA, INRAE, Medicines and Healthcare Technologies Department (DMTS), SPI, 91191, Gif-sur-Yvette, France
| | - Nathalie Morel
- Paris-Saclay University, CEA, INRAE, Medicines and Healthcare Technologies Department (DMTS), SPI, 91191, Gif-sur-Yvette, France.
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Zeidler H, Hudson AP. Reactive Arthritis Update: Spotlight on New and Rare Infectious Agents Implicated as Pathogens. Curr Rheumatol Rep 2021; 23:53. [PMID: 34196842 PMCID: PMC8247622 DOI: 10.1007/s11926-021-01018-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/11/2022]
Abstract
Purpose of Review This article presents a comprehensive narrative review of reactive arthritis (ReA) with focus on articles published between 2018 and 2020. We discuss the entire spectrum of microbial agents known to be the main causative agents of ReA, those reported to be rare infective agents, and those reported to be new candidates causing the disease. The discussion is set within the context of changing disease terminology, definition, and classification over time. Further, we include reports that present at least a hint of effective antimicrobial therapy for ReA as documented in case reports or in double-blind controlled studies. Additional information is included on microbial products detected in the joint, as well as on the positivity of HLA-B27. Recent Findings Recent reports of ReA cover several rare causative microorganism such as Neisseria meningitides, Clostridium difficile, Escherichia coli, Hafnia alvei, Blastocytosis, Giardia lamblia, Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica/dispar, Strongyloides stercoralis, β-haemolytic Streptococci, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Mycobacterium bovis bacillus Calmette-Guerin, and Rickettsia rickettsii. The most prominent new infectious agents implicated as causative in ReA are Staphylococcus lugdunensis, placenta- and umbilical cord–derived Wharton’s jelly, Rothia mucilaginosa, and most importantly the SARS-CoV-2 virus. Summary In view of the increasingly large spectrum of causative agents, diagnostic consideration for the disease must include the entire panel of post-infectious arthritides termed ReA. Diagnostic procedures cannot be restricted to the well-known HLA-B27-associated group of ReA, but must also cover the large number of rare forms of arthritis following infections and vaccinations, as well as those elicited by the newly identified members of the ReA group summarized herein. Inclusion of these newly identified etiologic agents must necessitate increased research into the pathogenic mechanisms variously involved, which will engender important insights for treatment and management of ReA. Supplementary Information The online version contains supplementary material available at 10.1007/s11926-021-01018-6.
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Affiliation(s)
- Henning Zeidler
- Division of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Alan P Hudson
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
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Subbiah M, Thirumalapura N, Thompson D, Kuchipudi SV, Jayarao B, Tewari D. Detection of Anaplasma Phagocytophilum in Horses With Suspected Tick-Borne Disease in Northeastern United States by Metagenomic Sequencing. Front Vet Sci 2021; 8:673193. [PMID: 34179165 PMCID: PMC8219919 DOI: 10.3389/fvets.2021.673193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/17/2021] [Indexed: 12/27/2022] Open
Abstract
Metagenomic sequencing of clinical diagnostic specimens has a potential for unbiased detection of infectious agents, diagnosis of polymicrobial infections and discovery of emerging pathogens. Herein, next generation sequencing (NGS)-based metagenomic approach was used to investigate the cause of illness in a subset of horses recruited for a tick-borne disease surveillance study during 2017–2019. Blood samples collected from 10 horses with suspected tick-borne infection and five apparently healthy horses were subjected to metagenomic analysis. Total genomic DNA extracted from the blood samples were enriched for microbial DNA and subjected to shotgun next generation sequencing using Nextera DNA Flex library preparation kit and V2 chemistry sequencing kit on the Illumina MiSeq sequencing platform. Overall, 0.4–0.6 million reads per sample were analyzed using Kraken metagenomic sequence classification program. The taxonomic classification of the reads indicated that bacterial genomes were overrepresented (0.5 to 1%) among the total microbial reads. Most of the bacterial reads (~91%) belonged to phyla Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria, Cyanobacteria and Tenericutes in both groups. Importantly, 10–42.5% of Alphaproteobacterial reads in 5 of 10 animals with suspected tick-borne infection were identified as Anaplasma phagocytophilum. Of the 5 animals positive for A. phagocytophilum sequence reads, four animals tested A. phagocytophilum positive by PCR. Two animals with suspected tick-borne infection and A. phagocytophilum positive by PCR were found negative for any tick-borne microbial reads by metagenomic analysis. The present study demonstrates the usefulness of the NGS-based metagenomic analysis approach for the detection of blood-borne microbes.
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Affiliation(s)
- Murugan Subbiah
- Pennsylvania Veterinary Laboratory, Harrisburg, PA, United States
| | | | - David Thompson
- Pennsylvania Veterinary Laboratory, Harrisburg, PA, United States
| | - Suresh V Kuchipudi
- Animal Diagnostic Laboratory, Pennsylvania State University, University Park, PA, United States.,Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, United States
| | - Bhushan Jayarao
- Animal Diagnostic Laboratory, Pennsylvania State University, University Park, PA, United States.,Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, United States
| | - Deepanker Tewari
- Pennsylvania Veterinary Laboratory, Harrisburg, PA, United States
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Farber C, Morey R, Krimmer M, Kurouski D, Rogovskyy AS. Exploring a possibility of using Raman spectroscopy for detection of Lyme disease. JOURNAL OF BIOPHOTONICS 2021; 14:e202000477. [PMID: 33486893 DOI: 10.1002/jbio.202000477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Lyme disease (LD), one of the most prevalent tick-borne diseases in the United States (US), is caused by Borreliella burgdorferi sensu stricto (Bb). To date, in the US, LD diagnostics is primarily based on validated two-tiered serological testing, which overall exhibits low sensitivity among other drawbacks. In the present study, a potential of Raman spectroscopy (RS) to detect Bb infection in mice has been explored. For that, C3H mice were infected with wild-type Bb strains, 297, B31, or B31-derived mutant, ∆vlsE. Blood samples taken prior to and post Bb infection were subjected to RS. The data demonstrated that RS did not directly detect Bb spirochetes in blood, but rather sensed biochemical changes associated with Bb infection. Despite Bb infection-associated blood changes detectable by RS were very limited, the partial least square discriminant analysis showed that the average true positive rates were 86% for 297 and 89% for B31 and ∆vlsE.
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Affiliation(s)
- Charles Farber
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, Texas, USA
| | - Rohini Morey
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, Texas, USA
| | - Mark Krimmer
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, Texas, USA
| | - Dmitry Kurouski
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, Texas, USA
| | - Artem S Rogovskyy
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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29
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Convergence Research for Emerging Zoonoses. Trends Parasitol 2021; 37:465-467. [PMID: 33858779 DOI: 10.1016/j.pt.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/26/2022]
Abstract
Global emergence of vector-borne and zoonotic diseases presents a rapidly growing 'wicked' problem. We outline the need for a transdisciplinary research program that is grounded in ecological and evolutionary theory but integrates fundamentally with research perspectives spanning the health, social, and natural sciences.
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30
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Muldur S, Ellett F, Marand AL, Marvil C, Branda JA, LeMieux JE, Raff AB, Strle K, Irimia D. Microfluidic Assays for Probing Neutrophil-Borrelia Interactions in Blood During Lyme Disease. Cells Tissues Organs 2021; 211:313-323. [PMID: 33735890 PMCID: PMC8448788 DOI: 10.1159/000513118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023] Open
Abstract
Human neutrophils are highly sensitive to the presence of Borrelia burgdorferi (Bb), the agent of Lyme disease (LD), in tissues. Although Bb is also found in the blood of LD patients, far less is known about how neutrophils respond to Bb in the presence of blood. In this study, we employed microfluidic tools to probe the interaction between human neutrophils and Bb and measured the activation of human neutrophils in blood samples from patients. We found that neutrophils migrate vigorously toward Bb in the presence of serum, and this process was complement-dependent. Preventing complement factor 5 cleavage or blocking complement receptors decreased neutrophil's ability to interact with Bb. We also found that spiking Bb directly into the blood from healthy donors induced spontaneous neutrophil motility. This response to Bb was also complement-dependent. Preventing complement factor 5 cleavage decreased spontaneous neutrophil motility in Bb-spiked blood. Moreover, we found that neutrophils in blood samples from acute LD patients displayed spontaneous motility patterns similar to those observed in Bb-spiked samples. Neutrophil motility was more robust in blood samples from LD patients than that measured in healthy and ill controls, validating the utility of the microfluidic assay for the study of neutrophil-Bb interactions in the presence of blood.
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Affiliation(s)
- Sinan Muldur
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Massachusetts, USA
| | - Felix Ellett
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Massachusetts, USA
| | - Anika L Marand
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Massachusetts, USA
| | - Charles Marvil
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Emory Medical School, Atlanta, Georgia, USA
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob E LeMieux
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam B Raff
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Beth Israel Lahey Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Klemen Strle
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Irimia
- BioMEMS Resource Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Hospital, Boston, Massachusetts, USA,
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Shan J, Jia Y, Teulières L, Patel F, Clokie MRJ. Targeting Multicopy Prophage Genes for the Increased Detection of Borrelia burgdorferi Sensu Lato (s.l.), the Causative Agents of Lyme Disease, in Blood. Front Microbiol 2021; 12:651217. [PMID: 33790883 PMCID: PMC8005754 DOI: 10.3389/fmicb.2021.651217] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
The successful treatment of Lyme disease (LD) is contingent on accurate diagnosis. However, current laboratory detection assays lack sensitivity in the early stages of the disease. Because delayed diagnosis of LD incurs high healthcare costs and great suffering, new highly sensitive tests are in need. To overcome these challenges, we developed an internally controlled quantitative PCR (Ter-qPCR) that targets the multicopy terminase large subunit (terL) gene encoded by prophages that are only found in LD-causing bacteria. The terL protein helps phages pack their DNA. Strikingly, the detection limit of the Ter-qPCR was analytically estimated to be 22 copies and one bacterial cell in bacteria spiked blood. Furthermore, significant quantitative differences was observed in terms of the amount of terL detected in healthy individuals and patients with either early or late disease. Together, the data suggests that the prophage-targeting PCR has significant power to improve success detection for LD. After rigorous clinical validation, this new test could deliver a step-change in the detection of LD. Prophage encoded markers are prevalent in many other pathogenic bacteria rendering this approach highly applicable to bacterial identification in general.
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Affiliation(s)
- Jinyu Shan
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Ying Jia
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Louis Teulières
- PhelixRD Charity 230 Rue du Faubourg St Honoré, Paris, France
| | - Faizal Patel
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Martha R. J. Clokie
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
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32
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Arthritis and Diagnostics in Lyme Disease. Trop Med Infect Dis 2021; 6:tropicalmed6010018. [PMID: 33572912 PMCID: PMC7931108 DOI: 10.3390/tropicalmed6010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
The diagnosis of Lyme disease, caused by Borrelia burgdorferi, is clinical but frequently supported by laboratory tests. Lyme arthritis is now less frequently seen than at the time of its discovery. However, it still occurs, and it is important to recognize this, the differential diagnoses, and how laboratory tests can be useful and their limitations. The most frequently used diagnostic tests are antibody based. However, antibody testing still suffers from many drawbacks and is only an indirect measure of exposure. In contrast, evolving direct diagnostic methods can indicate active infection.
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Abstract
Lyme borreliosis is caused by a growing list of related, yet distinct, spirochetes with complex biology and sophisticated immune evasion mechanisms. It may result in a range of clinical manifestations involving different organ systems, and can lead to persistent sequelae in a subset of cases. The pathogenesis of Lyme borreliosis is incompletely understood, and laboratory diagnosis, the focus of this review, requires considerable understanding to interpret the results correctly. Direct detection of the infectious agent is usually not possible or practical, necessitating a continued reliance on serologic testing. Still, some important advances have been made in the area of diagnostics, and there are many promising ideas for future assay development. This review summarizes the state of the art in laboratory diagnostics for Lyme borreliosis, provides guidance in test selection and interpretation, and highlights future directions.
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34
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Abstract
PURPOSE OF REVIEW Lyme disease is an important, vector-borne infection found throughout the temperate Northern hemisphere. The disease causes rash, acute systemic illness, and in some untreated patients, inflammatory arthritis. This review examines the emergence, clinical features and management of early Lyme disease and Lyme arthritis. RECENT FINDINGS There has been continuing progress in characterizing the clinical manifestations, diagnostic testing and treatment of Lyme disease. Almost all patients with early Lyme disease can be cured with antibiotic treatment. In most cases, Lyme arthritis also responds to antibiotics, but some patients require additional treatment approaches. SUMMARY The diagnosis of Lyme disease is based on clinical manifestations and adjunctive laboratory testing. For the rheumatologist, Lyme arthritis should be recognized by a pattern of attacks of asymmetric, oligo-arthritis, recognizable by clinical manifestations in the same way that other rheumatic diseases, such as gout or rheumatoid arthritis, are diagnosed.
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35
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Springer A, Glass A, Probst J, Strube C. Tick-borne zoonoses and commonly used diagnostic methods in human and veterinary medicine. Parasitol Res 2021; 120:4075-4090. [PMID: 33459849 PMCID: PMC8599405 DOI: 10.1007/s00436-020-07033-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
Around the world, human health and animal health are closely linked in terms of the One Health concept by ticks acting as vectors for zoonotic pathogens. Animals do not only maintain tick cycles but can either be clinically affected by the same tick-borne pathogens as humans and/or play a role as reservoirs or sentinel pathogen hosts. However, the relevance of different tick-borne diseases (TBDs) may vary in human vs. veterinary medicine, which is consequently reflected by the availability of human vs. veterinary diagnostic tests. Yet, as TBDs gain importance in both fields and rare zoonotic pathogens, such as Babesia spp., are increasingly identified as causes of human disease, a One Health approach regarding development of new diagnostic tools may lead to synergistic benefits. This review gives an overview on zoonotic protozoan, bacterial and viral tick-borne pathogens worldwide, discusses commonly used diagnostic techniques for TBDs, and compares commercial availability of diagnostic tests for humans vs. domestic animals, using Germany as an example, with the aim of highlighting existing gaps and opportunities for collaboration in a One Health framework.
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Affiliation(s)
- Andrea Springer
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany
| | - Antje Glass
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany
| | - Julia Probst
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany
| | - Christina Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Buenteweg 17, 30559, Hanover, Germany.
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Molecular Microbiological and Immune Characterization of a Cohort of Patients Diagnosed with Early Lyme Disease. J Clin Microbiol 2020; 59:JCM.00615-20. [PMID: 33087434 DOI: 10.1128/jcm.00615-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022] Open
Abstract
Lyme disease is a tick-borne infection caused by the bacteria Borrelia burgdorferi Current diagnosis of early Lyme disease relies heavily on clinical criteria, including the presence of an erythema migrans rash. The sensitivity of current gold-standard diagnostic tests relies upon antibody formation, which is typically delayed and thus of limited utility in early infection. We conducted a study of blood and skin biopsy specimens from 57 patients with a clinical diagnosis of erythema migrans. Samples collected at the time of diagnosis were analyzed using an ultrasensitive, PCR-based assay employing an isothermal amplification step and multiple primers. In 75.4% of patients, we directly detected one or more B. burgdorferi genotypes in the skin. Two-tier testing showed that 20 (46.5%) of those found to be PCR positive remained serologically negative at both acute and convalescent time points. Multiple genotypes were found in three (8%) of those where a specific genotype could be identified. The 13 participants who lacked PCR and serologic evidence for exposure to B. burgdorferi could be differentiated as a group from PCR-positive participants by their levels of several immune markers as well as by clinical descriptors such as the number of acute symptoms and the pattern of their erythema migrans rash. These results suggest that within a Mid-Atlantic cohort, patient subgroups can be identified using PCR-based direct detection approaches. This may be particularly useful in future research such as vaccine trials and public health surveillance of tick-borne disease patterns.
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37
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Magni R, Almofee R, Yusuf S, Mueller C, Vuong N, Almosuli M, Hoang MT, Meade K, Sethi I, Mohammed N, Araujo R, McDonald TK, Marcelli P, Espina V, Kim B, Garritsen A, Green C, Russo P, Zhou W, Vaisman I, Petricoin EF, Hoadley D, Molestina RE, McIntyre H, Liotta LA, Luchini A. Evaluation of pathogen specific urinary peptides in tick-borne illnesses. Sci Rep 2020; 10:19340. [PMID: 33168903 PMCID: PMC7653918 DOI: 10.1038/s41598-020-75051-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Mass spectrometry enhanced by nanotechnology can achieve previously unattainable sensitivity for characterizing urinary pathogen-derived peptides. We utilized mass spectrometry enhanced by affinity hydrogel particles (analytical sensitivity = 2.5 pg/mL) to study tick pathogen-specific proteins shed in the urine of patients with (1) erythema migrans rash and acute symptoms, (2) post treatment Lyme disease syndrome (PTLDS), and (3) clinical suspicion of tick-borne illnesses (TBI). Targeted pathogens were Borrelia, Babesia, Anaplasma, Rickettsia, Ehrlichia, Bartonella, Francisella, Powassan virus, tick-borne encephalitis virus, and Colorado tick fever virus. Specificity was defined by 100% amino acid sequence identity with tick-borne pathogen proteins, evolutionary taxonomic verification for related pathogens, and no identity with human or other organisms. Using a cut off of two pathogen peptides, 9/10 acute Lyme Borreliosis patients resulted positive, while we identified zero false positive in 250 controls. Two or more pathogen peptides were identified in 40% of samples from PTLDS and TBI patients (categories 2 and 3 above, n = 59/148). Collectively, 279 distinct unique tick-borne pathogen derived peptides were identified. The number of pathogen specific peptides was directly correlated with presence or absence of symptoms reported by patients (ordinal regression pseudo-R2 = 0.392, p = 0.010). Enhanced mass spectrometry is a new tool for studying tick-borne pathogen infections.
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Affiliation(s)
- Ruben Magni
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Raghad Almofee
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Sameen Yusuf
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Claudius Mueller
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Ngoc Vuong
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Mahmood Almosuli
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Minh Thu Hoang
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Katherine Meade
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Ish Sethi
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Nuha Mohammed
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Robyn Araujo
- Queensland University of Technology, Brisbane, Australia
| | - Teresa Kaza McDonald
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Paul Marcelli
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Virginia Espina
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | | | | | | | - Paul Russo
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Weidong Zhou
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Iosif Vaisman
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Emanuel F Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Deborah Hoadley
- New England Institute for Lyme Disease and Tick-Borne Illness, Longmeadow, USA
| | | | | | - Lance A Liotta
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA
| | - Alessandra Luchini
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, 20110, USA.
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Galluzzo P, Grippi F, Di Bella S, Santangelo F, Sciortino S, Castiglia A, Sciacca C, Arnone M, Alduina R, Chiarenza G. Seroprevalence of Borrelia burgdorferi in Stray Dogs from Southern Italy. Microorganisms 2020; 8:microorganisms8111688. [PMID: 33142966 PMCID: PMC7692072 DOI: 10.3390/microorganisms8111688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
Abstract
Borrelia burgdorferi is a bacterial pathogen transmitted by Ixodes ticks and is responsible for Lyme disease in both humans and dogs. The aim of this work was to evaluate B. burgdorferi diffusion among stray dogs in Palermo (Sicily, Italy) by serological methods in order to study the risk factors associated with the infection. Serum and blood samples of 316 dogs were collected from a shelter in Palermo, and were analyzed for the presence of antibodies against B. burgdorferi by indirect immunofluorescence assay (IFA), and of the ospA gene by real-time PCR, respectively. Seventeen sera (5.4%) were positive for the antibodies via IFA and one blood (0.3%) for ospA via real time PCR. On the basis of serological results, the evaluation of the potential risk factors (sex, age, breed and coat color) was carried out. The multivariate analysis indicated that male sex is a factor significantly associated with B. burgdorferi seropositivity. This study confirms that male dogs have a higher risk of developing the disease than females, and represents the first investigation on the spread of B. burgdorferi among stray dogs in Sicily.
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Affiliation(s)
- Paola Galluzzo
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
- Dipartimento Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche, Viale delle Scienze, University of Palermo, 90133 Palermo, Italy;
| | - Francesca Grippi
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
- Correspondence: (F.G.); (S.D.B.)
| | - Santina Di Bella
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
- Correspondence: (F.G.); (S.D.B.)
| | - Francesco Santangelo
- U.O. Igiene Urbana ASP Palermo presso Canile Municipale, Piazza Tiro a Segno 5, 90141 Palermo, Italy;
| | - Sonia Sciortino
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
| | - Alessandra Castiglia
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
| | - Carmela Sciacca
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
| | - Maria Arnone
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
| | - Rosa Alduina
- Dipartimento Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche, Viale delle Scienze, University of Palermo, 90133 Palermo, Italy;
| | - Giuseppina Chiarenza
- Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, via G. Marinuzzi 3, 90129 Palermo, Italy; (P.G.); (S.S.); (A.C.); (C.S.); (M.A.); (G.C.)
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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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Flynn C, Ignaszak A. Lyme Disease Biosensors: A Potential Solution to a Diagnostic Dilemma. BIOSENSORS 2020; 10:E137. [PMID: 32998254 PMCID: PMC7601730 DOI: 10.3390/bios10100137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Over the past four decades, Lyme disease has remained a virulent and pervasive illness, persisting throughout North America and many other regions of the world. Recent increases in illness in many countries has sparked a renewed interest in improved Lyme diagnostics. While current standards of diagnosis are acceptable for the late stages of the disease, it remains difficult to accurately diagnose early forms of the illness. In addition, current diagnostic methods tend to be relatively expensive and require a large degree of laboratory-based analysis. Biosensors represent the fusion of biological materials with chemical techniques to provide simple, inexpensive alternatives to traditional diagnostic methods. Lyme disease biosensors have the potential to better diagnose early stages of the illness and provide possible patients with an inexpensive, commercially available test. This review examines the current state of Lyme disease biosensing, with a focus on previous biosensor development and essential future considerations.
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Affiliation(s)
- Connor Flynn
- Department of Chemistry, University of New Brunswick, Fredericton, NB E3B 5A3, Canada;
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41
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Abstract
The laboratory diagnosis of Lyme disease relies upon serologic testing. A standard or modified two-tiered testing algorithm is used to enhance the accuracy of antibody detection. However, this approach suffers from a lack of sensitivity in early Lyme disease. Ongoing efforts to develop more sensitive antibody detection technologies and other diagnostic approaches are dependent upon the availability of quality-assured biospecimens linked to reliable clinical data. In this issue of the Journal of Clinical Microbiology, Horn et al. (E. J. Horn, G. Dempsey, A. M. Schotthoefer, U. L. Prisco, et al., J Clin Microbiol 58:e00032-20, 2020, https://doi.org/10.1128/JCM.00032-20) described the development of the Lyme Disease Biobank. Clinically categorized case patients with early Lyme disease and healthy controls were identified (without laboratory diagnostic testing) from three sites where Lyme disease is endemic. Subjects provided whole blood and urine, which were processed and stored at a central biorepository. Whole blood, serum, and urine aliquots were prepared and are available to investigators developing laboratory diagnostics for Lyme disease. After obtaining samples, extensive laboratory testing was performed, including serologic and nucleic acid amplification testing for B. burgdorferi and other tick-borne pathogens. Direct detection methods yielded few positive results. Relative to the findings for another commonly used biorepository cohort, the results of this testing demonstrated a low seropositive rate, as determined by standard two-tiered testing. Additionally, relatively few subjects demonstrated seroconversion with testing of convalescent-phase samples. This clinical and serologically defined cohort of samples from Lyme disease and control cases from areas of Lyme disease endemicity offers an additional valuable resource for novel test development that includes alternate specimen types.
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Horn EJ, Dempsey G, Schotthoefer AM, Prisco UL, McArdle M, Gervasi SS, Golightly M, De Luca C, Evans M, Pritt BS, Theel ES, Iyer R, Liveris D, Wang G, Goldstein D, Schwartz I. The Lyme Disease Biobank: Characterization of 550 Patient and Control Samples from the East Coast and Upper Midwest of the United States. J Clin Microbiol 2020; 58:e00032-20. [PMID: 32102853 PMCID: PMC7269379 DOI: 10.1128/jcm.00032-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022] Open
Abstract
Lyme disease (LD) is an increasing public health problem. Current laboratory testing is insensitive in early infection, the stage at which appropriate treatment is most effective in preventing disease sequelae. The Lyme Disease Biobank (LDB) collects samples from individuals with symptoms consistent with early LD presenting with or without erythema migrans (EM) or an annular, expanding skin lesion and uninfected individuals from areas of endemicity. Samples were collected from 550 participants (298 cases and 252 controls) according to institutional review board-approved protocols and shipped to a centralized biorepository. Testing was performed to confirm the presence of tick-borne pathogens by real-time PCR, and a subset of samples was tested for Borrelia burgdorferi by culture. Serology was performed on all samples using the CDC's standard two-tiered testing algorithm (STTTA) for LD. LD diagnosis was supported by laboratory testing in 82 cases, including positive results by use of the STTTA, PCR, or culture or positive results by two enzyme-linked immunosorbent assays for cases presenting with EM lesion sizes of >5 cm. The remaining 216 cases had negative laboratory testing results. For the controls, 43 were positive by at least one of the tiers and 6 were positive by use of the STTTA. The results obtained with this collection highlight and reinforce the known limitations of serologic testing in early LD, with only 29% of individuals presenting with EM lesion sizes of >5 cm yielding a positive result using the STTTA. Aliquots of whole blood, serum, and urine from clinically characterized patients with and without LD are available to investigators in academia and industry for evaluation or development of novel diagnostic assays for LD, to continue to improve upon currently available methods.
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Affiliation(s)
| | - George Dempsey
- East Hampton Family Medicine, East Hampton, New York, USA
| | | | - U Lena Prisco
- Vineyard Center for Clinical Research, Martha's Vineyard, Massachusetts, USA
| | | | | | - Marc Golightly
- Department of Pathology, Stony Brook University, Stony Brook, New York, USA
| | - Cathy De Luca
- Department of Pathology, Stony Brook University, Stony Brook, New York, USA
| | - Mel Evans
- Department of Pathology, Stony Brook University, Stony Brook, New York, USA
| | - Bobbi S Pritt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elitza S Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Radha Iyer
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, USA
| | - Dionysios Liveris
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, USA
| | - Guiqing Wang
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, USA
| | - Don Goldstein
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, USA
| | - Ira Schwartz
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, USA
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Petzke MM, Volyanskyy K, Mao Y, Arevalo B, Zohn R, Quituisaca J, Wormser GP, Dimitrova N, Schwartz I. Global Transcriptome Analysis Identifies a Diagnostic Signature for Early Disseminated Lyme Disease and Its Resolution. mBio 2020; 11:e00047-20. [PMID: 32184234 PMCID: PMC7078463 DOI: 10.1128/mbio.00047-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Abstract
A bioinformatics approach was employed to identify transcriptome alterations in the peripheral blood mononuclear cells of well-characterized human subjects who were diagnosed with early disseminated Lyme disease (LD) based on stringent microbiological and clinical criteria. Transcriptomes were assessed at the time of presentation and also at approximately 1 month (early convalescence) and 6 months (late convalescence) after initiation of an appropriate antibiotic regimen. Comparative transcriptomics identified 335 transcripts, representing 233 unique genes, with significant alterations of at least 2-fold expression in acute- or convalescent-phase blood samples from LD subjects relative to healthy donors. Acute-phase blood samples from LD subjects had the largest number of differentially expressed transcripts (187 induced, 54 repressed). This transcriptional profile, which was dominated by interferon-regulated genes, was sustained during early convalescence. 6 months after antibiotic treatment the transcriptome of LD subjects was indistinguishable from that of healthy controls based on two separate methods of analysis. Return of the LD expression profile to levels found in control subjects was concordant with disease outcome; 82% of subjects with LD experienced at least one symptom at the baseline visit compared to 43% at the early convalescence time point and only a single patient (9%) at the 6-month convalescence time point. Using the random forest machine learning algorithm, we developed an efficient computational framework to identify sets of 20 classifier genes that discriminated LD from other bacterial and viral infections. These novel LD biomarkers not only differentiated subjects with acute disseminated LD from healthy controls with 96% accuracy but also distinguished between subjects with acute and resolved (late convalescent) disease with 97% accuracy.IMPORTANCE Lyme disease (LD), caused by Borrelia burgdorferi, is the most common tick-borne infectious disease in the United States. We examined gene expression patterns in the blood of individuals with early disseminated LD at the time of diagnosis (acute) and also at approximately 1 month and 6 months following antibiotic treatment. A distinct acute LD profile was observed that was sustained during early convalescence (1 month) but returned to control levels 6 months after treatment. Using a computer learning algorithm, we identified sets of 20 classifier genes that discriminate LD from other bacterial and viral infections. In addition, these novel LD biomarkers are highly accurate in distinguishing patients with acute LD from healthy subjects and in discriminating between individuals with active and resolved infection. This computational approach offers the potential for more accurate diagnosis of early disseminated Lyme disease. It may also allow improved monitoring of treatment efficacy and disease resolution.
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Affiliation(s)
- Mary M Petzke
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Valhalla, New York, USA
| | | | - Yong Mao
- Phillips Research North America, Valhalla, New York, USA
| | - Byron Arevalo
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Raphael Zohn
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Johanna Quituisaca
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Gary P Wormser
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York, USA
| | | | - Ira Schwartz
- Department of Microbiology and Immunology, School of Medicine, New York Medical College, Valhalla, New York, USA
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44
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Nikolić A, Boljević D, Bojić M, Veljković S, Vuković D, Paglietti B, Micić J, Rubino S. Lyme Endocarditis as an Emerging Infectious Disease: A Review of the Literature. Front Microbiol 2020; 11:278. [PMID: 32161576 PMCID: PMC7054245 DOI: 10.3389/fmicb.2020.00278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/06/2020] [Indexed: 11/29/2022] Open
Abstract
Lyme endocarditis is extremely rare manifestation of Lyme disease. The clinical manifestations of Lyme endocarditis are non-specific and can be very challenging diagnosis to make when it is the only manifestation of the disease. Until now, only a few cases where reported. Physicians should keep in mind the possibility of borrelial etiology of endocarditis in endemic areas. Appropriate valve tissue sample should be sent for histopathology, culture, and PCR especially in case of endocarditis of unknown origin PCR on heart valve samples is recommended. With more frequent PCR, Borrelia spp. may be increasingly found as a cause of infective endocarditis. Prompt diagnosis and treatment of Lyme carditis may prevent surgical treatment and pacemaker implantations. Due to climate change and global warming Lyme disease is a growing problem. Rising number of Lyme disease cases we can expect and rising number of Lyme endocarditis.
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Affiliation(s)
- Aleksandra Nikolić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,"Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | | | - Milovan Bojić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,"Dedinje" Cardiovascular Institute, Belgrade, Serbia
| | | | - Dragana Vuković
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bianca Paglietti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Jelena Micić
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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45
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Rebman AW, Aucott JN. Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease. Front Med (Lausanne) 2020; 7:57. [PMID: 32161761 PMCID: PMC7052487 DOI: 10.3389/fmed.2020.00057] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
It has long been observed in clinical practice that a subset of patients with Lyme disease report a constellation of symptoms such as fatigue, cognitive difficulties, and musculoskeletal pain, which may last for a significant period of time. These symptoms, which can range from mild to severe, have been reported throughout the literature in both prospective and population-based studies in Lyme disease endemic regions. The etiology of these symptoms is unknown, however several illness-causing mechanisms have been hypothesized, including microbial persistence, host immune dysregulation through inflammatory or secondary autoimmune pathways, or altered neural networks, as in central sensitization. Evaluation and characterization of persistent symptoms in Lyme disease is complicated by potential independent, repeat exposures to B. burgdorferi, as well as the potential for co-morbid diseases with overlapping symptom profiles. Antibody testing for B. burgdorferi is an insensitive measure after treatment, and no other FDA-approved tests currently exist. As such, diagnosis presents a complex challenge for physicians, while the lived experience for patients is one marked by uncertainty and often illness invalidation. Currently, there are no FDA-approved pharmaceutical therapies, and the safety and efficacy of off-label and/or complementary therapies have not been well studied and are not agreed-upon within the medical community. Post-treatment Lyme disease represents a narrow, defined, mechanistically-neutral subset of this larger, more heterogeneous group of patients, and is a useful definition in research settings as an initial subgroup of study. The aim of this paper is to review the current literature on the diagnosis, etiology, risk factors, and treatment of patients with persistent symptoms in the context of Lyme disease. The meaning and relevance of existing patient subgroups will be discussed, as will future research priorities, including the need to develop illness biomarkers, elucidate the biologic mechanisms of disease, and drive improvements in therapeutic options.
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Affiliation(s)
- Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Chou E, Lasek-Nesselquist E, Taubner B, Pilar A, Guignon E, Page W, Lin YP, Cady NC. A fluorescent plasmonic biochip assay for multiplex screening of diagnostic serum antibody targets in human Lyme disease. PLoS One 2020; 15:e0228772. [PMID: 32040491 PMCID: PMC7010292 DOI: 10.1371/journal.pone.0228772] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Lyme disease (LD) diagnosis using the current two-tier algorithm is constrained by low sensitivity for early-stage infection and ambiguity in determining treatment response. We recently developed a protein microarray biochip that measures diagnostic serum antibody targets using grating-coupled fluorescent plasmonics (GC-FP) technology. This strategy requires microliters of blood serum to enable multiplexed biomarker screening on a compact surface and generates quantitative results that can be further processed for diagnostic scoring. The GC-FP biochip was used to detect serum antibodies in patients with active and convalescent LD, as well as various negative controls. We hypothesized that the quantitative, high-sensitivity attributes of the GC-FP approach permit: 1) screening of antibody targets predictive for LD status, and 2) development a diagnostic algorithm that is more sensitive, specific, and informative than the standard ELISA and Western blot assays. Notably, our findings led to a diagnostic algorithm that may be more sensitive than the current standard for detecting early LD, while maintaining 100% specificity. We further show that analysis of relative antibody levels to predict disease status, such as in acute and convalescent stages of infection, is possible with a highly sensitive and quantitative platform like GC-FP. The results from this study add to the urgent conversation regarding better diagnostic strategies and more effective treatment for patients affected by tick-borne disease.
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Affiliation(s)
- Eunice Chou
- College of Nanoscale Science & Engineering, State University of New York Polytechnic Institute, Albany, New York, United States of America
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America
| | - Erica Lasek-Nesselquist
- Bioinformatics Core, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Benjamin Taubner
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Biomedical Engineering, Mercer University, Macon, Georgia, United States of American
| | - Arturo Pilar
- Ciencia, Inc., East Hartford, Connecticut, United States of America
| | - Ernest Guignon
- Ciencia, Inc., East Hartford, Connecticut, United States of America
| | - William Page
- Ciencia, Inc., East Hartford, Connecticut, United States of America
| | - Yi-Pin Lin
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Biomedical Science, State University of New York at Albany, Albany, New York, United States of America
| | - Nathaniel C. Cady
- College of Nanoscale Science & Engineering, State University of New York Polytechnic Institute, Albany, New York, United States of America
- * E-mail:
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Joung HA, Ballard ZS, Wu J, Tseng DK, Teshome H, Zhang L, Horn EJ, Arnaboldi PM, Dattwyler RJ, Garner OB, Di Carlo D, Ozcan A. Point-of-Care Serodiagnostic Test for Early-Stage Lyme Disease Using a Multiplexed Paper-Based Immunoassay and Machine Learning. ACS NANO 2020; 14:229-240. [PMID: 31849225 DOI: 10.1021/acsnano.9b08151] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Caused by the tick-borne spirochete Borrelia burgdorferi, Lyme disease (LD) is the most common vector-borne infectious disease in North America and Europe. Though timely diagnosis and treatment are effective in preventing disease progression, current tests are insensitive in early stage LD, with a sensitivity of <50%. Additionally, the serological testing currently recommended by the U.S. Center for Disease Control has high costs (>$400/test) and extended sample-to-answer timelines (>24 h). To address these challenges, we created a cost-effective and rapid point-of-care (POC) test for early-stage LD that assays for antibodies specific to seven Borrelia antigens and a synthetic peptide in a paper-based multiplexed vertical flow assay (xVFA). We trained a deep-learning-based diagnostic algorithm to select an optimal subset of antigen/peptide targets and then blindly tested our xVFA using human samples (N(+) = 42, N(-) = 54), achieving an area-under-the-curve (AUC), sensitivity, and specificity of 0.950, 90.5%, and 87.0%, respectively, outperforming previous LD POC tests. With batch-specific standardization and threshold tuning, the specificity of our blind-testing performance improved to 96.3%, with an AUC and sensitivity of 0.963 and 85.7%, respectively.
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Affiliation(s)
- Hyou-Arm Joung
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
| | - Zachary S Ballard
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
| | - Jing Wu
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- Department of Chemistry , Lanzhou University , Lanzhou , Gansu 730000 , China
| | - Derek K Tseng
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
| | - Hailemariam Teshome
- Department of Neuroscience , University of California , Los Angeles , California 90025 , United States
| | - Linghao Zhang
- Department of Mechanical Engineering , University of California , Los Angeles , California 90025 , United States
| | | | - Paul M Arnaboldi
- Department of Microbiology/Immunology , New York Medical College , Valhalla , New York 10595 , United States
| | - Raymond J Dattwyler
- Department of Microbiology/Immunology , New York Medical College , Valhalla , New York 10595 , United States
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine , University of California , Los Angeles , California 90025 , United States
| | - Dino Di Carlo
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
- Department of Mechanical Engineering , University of California , Los Angeles , California 90025 , United States
| | - Aydogan Ozcan
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
- Department of Surgery , University of California , Los Angeles , California 90025 , United States
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Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel) 2019; 8:antibiotics8040269. [PMID: 31888310 PMCID: PMC6963229 DOI: 10.3390/antibiotics8040269] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease. Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories, CLD, untreated (CLD-U) and CLD, previously treated (CLD-PT). The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more. Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT. Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term's meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease. Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection.
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Bamm VV, Ko JT, Mainprize IL, Sanderson VP, Wills MKB. Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums. Pathogens 2019; 8:E299. [PMID: 31888245 PMCID: PMC6963551 DOI: 10.3390/pathogens8040299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022] Open
Abstract
Lyme disease is a complex tick-borne zoonosis that poses an escalating public health threat in several parts of the world, despite sophisticated healthcare infrastructure and decades of effort to address the problem. Concepts like the true burden of the illness, from incidence rates to longstanding consequences of infection, and optimal case management, also remain shrouded in controversy. At the heart of this multidisciplinary issue are the causative spirochetal pathogens belonging to the Borrelia Lyme complex. Their unusual physiology and versatile lifestyle have challenged microbiologists, and may also hold the key to unlocking mysteries of the disease. The goal of this review is therefore to integrate established and emerging concepts of Borrelia biology and pathogenesis, and position them in the broader context of biomedical research and clinical practice. We begin by considering the conventions around diagnosing and characterizing Lyme disease that have served as a conceptual framework for the discipline. We then explore virulence from the perspective of both host (genetic and environmental predispositions) and pathogen (serotypes, dissemination, and immune modulation), as well as considering antimicrobial strategies (lab methodology, resistance, persistence, and clinical application), and borrelial adaptations of hypothesized medical significance (phenotypic plasticity or pleomorphy).
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Affiliation(s)
| | | | | | | | - Melanie K. B. Wills
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada; (V.V.B.); (J.T.K.); (I.L.M.); (V.P.S.)
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Nigrovic LE, Lewander DP, Balamuth F, Neville DN, Levas MN, Bennett JE, Garro A. The Lyme Disease Polymerase Chain Reaction Test Has Low Sensitivity. Vector Borne Zoonotic Dis 2019; 20:310-313. [PMID: 31821110 DOI: 10.1089/vbz.2019.2547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: The Lyme PCR is a direct detection test, but has not been rigorously evaluated in children undergoing evaluation for acute Lyme disease. Methods: We performed a six-center prospective cohort study of children aged 1 to 21 years undergoing acute evaluation for Lyme disease. For this planned secondary analysis, we limited our cohort to children undergoing evaluation for Lyme disease who had any Lyme PCR test obtained by a treating clinician (blood, synovial fluid, or cerebrospinal fluid). We defined a case of Lyme disease with a positive two-tier Lyme disease serology: a positive or equivocal enzyme immunoassay followed by a positive supplemental immunoblot interpreted using standard criteria. We report the test characteristics of Lyme PCR for the diagnosis of Lyme disease. Results: We identified 124 children of whom 54 (43.5%) had Lyme disease. Overall, 23 had a positive PCR test (sensitivity 41.8%; 95% confidence interval [CI] 29.7-55.0; specificity 100%, 95% CI: 94.2-100). All children with a positive Lyme PCR also had a positive two-tiered Lyme disease serology. Conclusions: The Lyme disease PCR test did not improve the diagnosis of children undergoing evaluation for acute Lyme disease. Given the additional costs of this low utility test, clinicians should not order Lyme PCR testing in the acute care setting.
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Affiliation(s)
- Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - David P Lewander
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Fran Balamuth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Desiree N Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael N Levas
- Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jonathan E Bennett
- Division of Emergency Medicine, A.I. Dupont Hospital for Children, Wilmington, Delaware
| | - Aris Garro
- Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
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