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del Giudice P, Reverte M, Giraudon E, Durant J, Ahmed Abdoulah S, Jaulhac B, Poirier JP. First case of documented Lyme borreliosis in the Alpes-Maritimes department of South-Eastern France: Erythema chronicum migrans associated with Borrelia afzelii. Ann Dermatol Venereol 2022; 149:146-147. [DOI: 10.1016/j.annder.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
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2
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Norte AC, Boyer PH, Castillo-Ramirez S, Chvostáč M, Brahami MO, Rollins RE, Woudenberg T, Didyk YM, Derdakova M, Núncio MS, de Carvalho IL, Margos G, Fingerle V. The Population Structure of Borrelia lusitaniae Is Reflected by a Population Division of Its Ixodes Vector. Microorganisms 2021; 9:microorganisms9050933. [PMID: 33925391 PMCID: PMC8145215 DOI: 10.3390/microorganisms9050933] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/29/2023] Open
Abstract
Populations of vector-borne pathogens are shaped by the distribution and movement of vector and reservoir hosts. To study what impact host and vector association have on tick-borne pathogens, we investigated the population structure of Borrelia lusitaniae using multilocus sequence typing (MLST). Novel sequences were acquired from questing ticks collected in multiple North African and European locations and were supplemented by publicly available sequences at the Borrelia Pubmlst database (accessed on 11 February 2020). Population structure of B. lusitaniae was inferred using clustering and network analyses. Maximum likelihood phylogenies for two molecular tick markers (the mitochondrial 16S rRNA locus and a nuclear locus, Tick-receptor of outer surface protein A, trospA) were used to confirm the morphological species identification of collected ticks. Our results confirmed that B. lusitaniae does indeed form two distinguishable populations: one containing mostly European samples and the other mostly Portuguese and North African samples. Of interest, Portuguese samples clustered largely based on being from north (European) or south (North African) of the river Targus. As two different Ixodes species (i.e., I. ricinus and I. inopinatus) may vector Borrelia in these regions, reference samples were included for I. inopinatus but did not form monophyletic clades in either tree, suggesting some misidentification. Even so, the trospA phylogeny showed a monophyletic clade containing tick samples from Northern Africa and Portugal south of the river Tagus suggesting a population division in Ixodes on this locus. The pattern mirrored the clustering of B. lusitaniae samples, suggesting a potential co-evolution between tick and Borrelia populations that deserve further investigation.
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Affiliation(s)
- Ana Cláudia Norte
- MARE-Marine and Environmental Sciences Centre, Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal;
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, 2965-575 Setúbal, Portugal; (M.S.N.); (I.L.d.C.)
| | - Pierre H. Boyer
- CHRU Strasbourg, UR7290 Lyme Borreliosis Group, ITI InnoVec, Fédération de Médecine Translationnelle de Strasbourg, Institut de Bactériologie, University of Strasbourg, 3 rue Koeberlé, 67000 Strasbourg, France;
| | - Santiago Castillo-Ramirez
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Apartado Postal 565-A, Cuernavaca, CP 62210, Mexico;
| | - Michal Chvostáč
- Institute of Zoology, Slovak Academy of Sciences, 84506 Bratislava, Slovakia; (M.C.); (Y.M.D.); (M.D.)
| | - Mohand O. Brahami
- Laboratory of Ecology and Biology of Terrestrial Ecosystems, Faculty Biological and Agronomic Sciences, University Mouloud Mammeri, 15000 Tizi-Ouzou, Algeria;
| | - Robert E. Rollins
- Division of Evolutionary Biology, LMU Munich, Faculty of Biology, Grosshaderner Strasse 2, 82152 Planegg-Martinsried, Germany;
| | - Tom Woudenberg
- National Reference Center for Borrelia, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (T.W.); (V.F.)
| | - Yuliya M. Didyk
- Institute of Zoology, Slovak Academy of Sciences, 84506 Bratislava, Slovakia; (M.C.); (Y.M.D.); (M.D.)
- Department of Acarology, I. I. Schmalhausen Institute of Zoology, National Academy of Sciences of Ukraine, B. Khmelnytskogo 15, 01030 Kyiv, Ukraine
| | - Marketa Derdakova
- Institute of Zoology, Slovak Academy of Sciences, 84506 Bratislava, Slovakia; (M.C.); (Y.M.D.); (M.D.)
| | - Maria Sofia Núncio
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, 2965-575 Setúbal, Portugal; (M.S.N.); (I.L.d.C.)
- Environmental Health Institute, Medicine Faculty, University of Lisbon, 1649-026 Lisbon, Portugal
| | - Isabel Lopes de Carvalho
- Centre for Vector and Infectious Diseases Research, National Institute of Health Doutor Ricardo Jorge, Águas de Moura, 2965-575 Setúbal, Portugal; (M.S.N.); (I.L.d.C.)
- Environmental Health Institute, Medicine Faculty, University of Lisbon, 1649-026 Lisbon, Portugal
| | - Gabriele Margos
- National Reference Center for Borrelia, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (T.W.); (V.F.)
- Correspondence: or ; Tel.: +49-9131-6808-5883
| | - Volker Fingerle
- National Reference Center for Borrelia, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (T.W.); (V.F.)
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Barriales D, Martín-Ruiz I, Carreras-González A, Montesinos-Robledo M, Azkargorta M, Iloro I, Escobés I, Martín-Mateos T, Atondo E, Palacios A, Gonzalez-Lopez M, Bárcena L, Cortázar AR, Cabrera D, Peña-Cearra A, van Liempd SM, Falcón-Pérez JM, Pascual-Itoiz MA, Flores JM, Abecia L, Pellon A, Martínez-Chantar ML, Aransay AM, Pascual A, Elortza F, Berra E, Lavín JL, Rodríguez H, Anguita J. Borrelia burgdorferi infection induces long-term memory-like responses in macrophages with tissue-wide consequences in the heart. PLoS Biol 2021; 19:e3001062. [PMID: 33395408 PMCID: PMC7808612 DOI: 10.1371/journal.pbio.3001062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/14/2021] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
Lyme carditis is an extracutaneous manifestation of Lyme disease characterized by episodes of atrioventricular block of varying degrees and additional, less reported cardiomyopathies. The molecular changes associated with the response to Borrelia burgdorferi over the course of infection are poorly understood. Here, we identify broad transcriptomic and proteomic changes in the heart during infection that reveal a profound down-regulation of mitochondrial components. We also describe the long-term functional modulation of macrophages exposed to live bacteria, characterized by an augmented glycolytic output, increased spirochetal binding and internalization, and reduced inflammatory responses. In vitro, glycolysis inhibition reduces the production of tumor necrosis factor (TNF) by memory macrophages, whereas in vivo, it produces the reversion of the memory phenotype, the recovery of tissue mitochondrial components, and decreased inflammation and spirochetal burdens. These results show that B. burgdorferi induces long-term, memory-like responses in macrophages with tissue-wide consequences that are amenable to be manipulated in vivo. Lyme carditis is a manifestation of Lyme disease characterized by episodes of atrioventricular block and additional cardiomyopathies. This study describes the proteomic and transcriptomic changes in the heart upon infection with Borrelia burgdorferi, and identifies innate immune memory hallmarks specific to the response to the spirochete that are amenable to therapeutic manipulation.
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Affiliation(s)
- Diego Barriales
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Itziar Martín-Ruiz
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Ana Carreras-González
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Marta Montesinos-Robledo
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Mikel Azkargorta
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Ibon Iloro
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Iraide Escobés
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Teresa Martín-Mateos
- Physiopathology of the Hypoxia-Signaling Pathway Laboratory, CIC bioGUNE-BRTA, Derio, Spain
| | - Estibaliz Atondo
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Ainhoa Palacios
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | | | - Laura Bárcena
- Genomic Analysis Platform, CIC bioGUNE-BRTA, Derio, Spain
| | | | - Diana Cabrera
- Metabolomics Platform, CIC bioGUNE-BRTA, Derio, Spain
| | - Ainize Peña-Cearra
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | | | - Juan M. Falcón-Pérez
- Metabolomics Platform, CIC bioGUNE-BRTA, Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Miguel A. Pascual-Itoiz
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Juana María Flores
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - Leticia Abecia
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Aize Pellon
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | | | - Ana M. Aransay
- Genomic Analysis Platform, CIC bioGUNE-BRTA, Derio, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Pascual
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Felix Elortza
- Proteomics Platform, ProteoRed-ISCIII, CIC bioGUNE-BRTA, Derio, Spain
| | - Edurne Berra
- Physiopathology of the Hypoxia-Signaling Pathway Laboratory, CIC bioGUNE-BRTA, Derio, Spain
| | | | - Héctor Rodríguez
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
| | - Juan Anguita
- Inflammation and Macrophage Plasticity Laboratory, CIC bioGUNE-BRTA (Basque Research and Technology Alliance), Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
- * E-mail:
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Lefeuvre B, Cantero P, Ehret-Sabatier L, Lenormand C, Barthel C, Po C, Parveen N, Grillon A, Jaulhac B, Boulanger N. Effects of topical corticosteroids and lidocaine on Borrelia burgdorferi sensu lato in mouse skin: potential impact to human clinical trials. Sci Rep 2020; 10:10552. [PMID: 32601348 PMCID: PMC7324597 DOI: 10.1038/s41598-020-67440-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022] Open
Abstract
Lyme borreliosis is the most prevalent vector-borne disease in northern hemisphere. Borrelia burgdorferi sensu lato spirochetes are transmitted by Ixodes species ticks. During a blood meal, these spirochetes are inoculated into the skin where they multiply and often spread to various target organs: disseminated skin sites, the central nervous system, the heart and large joints. The usual diagnosis of this disease relies on serological tests. However, in patients presenting persistent clinical manifestations, this indirect diagnosis is not capable of detecting an active infection. If the serological tests are positive, it only proves that exposure of an individual to Lyme spirochetes had occurred. Although culture and quantitative PCR detect active infection, currently used tests are not sensitive enough for wide-ranging applications. Animal models have shown that B. burgdorferi persists in the skin. We present here our targeted proteomics results using infected mouse skin biopsies that facilitate detection of this pathogen. We have employed several novel approaches in this study. First, the effect of lidocaine, a local anesthetic used for human skin biopsy, on B. burgdorferi presence was measured. We further determined the impact of topical corticosteroids to reactivate Borrelia locally in the skin. This local immunosuppressive compound helps follow-up detection of spirochetes by proteomic analysis of Borrelia present in the skin. This approach could be developed as a novel diagnostic test for active Lyme borreliosis in patients presenting disseminated persistent infection. Although our results using topical corticosteroids in mice are highly promising for recovery of spirochetes, further optimization will be needed to translate this strategy for diagnosis of Lyme disease in patients.
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Affiliation(s)
- Bastien Lefeuvre
- Fédération de Médecine Translationnelle - UR7290, Virulence bactérienne précoce-groupe Borrelia, Université de Strasbourg, 67000, Strasbourg, France
| | - Paola Cantero
- Laboratoire de Spectrométrie de Masse BioOrganique, CNRS, IPHC UMR 7178, Université de Strasbourg, 67000, Strasbourg, France
| | - Laurence Ehret-Sabatier
- Laboratoire de Spectrométrie de Masse BioOrganique, CNRS, IPHC UMR 7178, Université de Strasbourg, 67000, Strasbourg, France
| | - Cedric Lenormand
- Fédération de Médecine Translationnelle - UR7290, Virulence bactérienne précoce-groupe Borrelia, Université de Strasbourg, 67000, Strasbourg, France
- Clinique dermatologique, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Cathy Barthel
- Fédération de Médecine Translationnelle - UR7290, Virulence bactérienne précoce-groupe Borrelia, Université de Strasbourg, 67000, Strasbourg, France
| | - Chrystelle Po
- ICube UMR 7357, Université de Strasbourg/CNRS, Fédération de Médecine Translationnelle de Strasbourg, 67000, Strasbourg, France
| | - Nikhat Parveen
- Microbiology, Biochemistry and Molecular Genetics, Rutgers-New Jersey Medical School, ICPH Building, 225 Warren Street, Newark, NJ, 07103, USA
| | - Antoine Grillon
- Fédération de Médecine Translationnelle - UR7290, Virulence bactérienne précoce-groupe Borrelia, Université de Strasbourg, 67000, Strasbourg, France
| | - Benoit Jaulhac
- Fédération de Médecine Translationnelle - UR7290, Virulence bactérienne précoce-groupe Borrelia, Université de Strasbourg, 67000, Strasbourg, France
- French National Reference Center on Lyme borreliosis, Centre Hospitalier Régional Uinversitaire de Strasbourg, 67000, Strasbourg, France
| | - Nathalie Boulanger
- Fédération de Médecine Translationnelle - UR7290, Virulence bactérienne précoce-groupe Borrelia, Université de Strasbourg, 67000, Strasbourg, France.
- French National Reference Center on Lyme borreliosis, Centre Hospitalier Régional Uinversitaire de Strasbourg, 67000, Strasbourg, France.
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5
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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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Kannangara DW, Sidra S, Pritiben P. First case report of inducible heart block in Lyme disease and an update of Lyme carditis. BMC Infect Dis 2019; 19:428. [PMID: 31096922 PMCID: PMC6524294 DOI: 10.1186/s12879-019-4025-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. Case presentation A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120–200 ms). Physical exam was unremarkable. The cardiologist’s initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. Conclusions Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.
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Affiliation(s)
- Don Walter Kannangara
- St Luke's University Health Network, Warren Campus, 185 Roseberry Street, Phillipsburg, NJ, 08865, USA.
| | - Sindhu Sidra
- St Luke's University Health Network, Warren Campus, 185 Roseberry Street, Phillipsburg, NJ, 08865, USA
| | - Patel Pritiben
- St Luke's University Health Network, Warren Campus, 185 Roseberry Street, Phillipsburg, NJ, 08865, USA
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Haddad O, Gillinov M, Fraser T, Shrestha N, Pettersson GB. Mitral Valve Endocarditis: A Rare Manifestation of Lyme Disease. Ann Thorac Surg 2019; 108:e85-e86. [PMID: 30690018 DOI: 10.1016/j.athoracsur.2018.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
Valvular involvement in Lyme disease is rare. Confirmation of Borrelia species as the causative agent with polymerase chain reaction was done in a few cases in Europe and the United States. We describe a case of mitral regurgitation with a preoperative diagnosis of myxomatous mitral valve degeneration. During surgery, the surgeon suspected infective rather than degenerative etiology; the results of tissue cultures were negative. However, universal bacterial polymerase chain reaction on explanted valve tissue detected Borrelia burgdorferi DNA. If a surgeon suspects infective endocarditis at the time surgery, appropriate specimens should be sent for histopathologic analysis, culture, and polymerase chain reaction assay.
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Affiliation(s)
- Osama Haddad
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Thomas Fraser
- Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nabin Shrestha
- Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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8
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Fatima B, Sohail MR, Schaff HV. Lyme Disease-An Unusual Cause of a Mitral Valve Endocarditis. Mayo Clin Proc Innov Qual Outcomes 2018; 2:398-401. [PMID: 30560244 PMCID: PMC6260468 DOI: 10.1016/j.mayocpiqo.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 11/02/2022] Open
Abstract
Lyme disease is a tick-borne infection caused by Borrelia burgdorferi. Cardiac manifestations are rare, occurring in 0.5% to 10% of patients. Lyme carditis and atrioventricular block are established manifestations of Lyme disease. Endocarditis caused by Borrelia has been reported only twice previously, and in both cases, these were species (Borrelia afzelii and Borrelia bissettii) not present in North America. We report a unique case of mitral valve endocarditis caused by B burgdorferi.
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Affiliation(s)
- Benish Fatima
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
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9
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Grillon A, Scherlinger M, Boyer PH, De Martino S, Perdriger A, Blasquez A, Wipff J, Korganow AS, Bonnard C, Cantagrel A, Eyer D, Guérin F, Monteiro I, Woehl JM, Moreau P, Pennaforte JL, Lechevallier J, Bastides F, Colombey A, Imbert I, Maugars Y, Gicquel P, Cuchet F, Brax M, Sibilia J, Zilliox L, Barthel C, Arnaud L, Jaulhac B. Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis. Semin Arthritis Rheum 2018; 48:1105-1112. [PMID: 30344080 DOI: 10.1016/j.semarthrit.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/18/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe the clinical and microbiological characteristics and outcomes after antibiotic treatment of a national cohort of patients with Lyme arthritis confirmed by PCR testing on synovial fluid and by serology, when available. METHODS Using the French National Reference Center for Borrelia database, patients with a positive PCR on synovial fluid for Borrelia were identified. Patient clinical and biological characteristics were reviewed from patient records. Long-term outcomes after treatment were studied through a questionnaire and with follow-up data. RESULTS Among 357 synovial fluid testing by PCR between 2010 and 2016, 37 (10.4%) were positive for Borrelia. Patients' median age was 36 years (range 6-78) with 61% of men and 28% patients under 18. The presentation was monoarticular in 92% and the knee was involved in 97%. Contrary to the Borrelia species repartition in European ticks, B. burgdorferi sensu stricto was the most prevalent species found in synovial fluid (54%) followed by B. azfelii (29%) and B. garinii (17%). Antibiotic treatments were mainly composed of doxycycline (n = 24), ceftriaxone (n = 10) and amoxicillin (n = 6), for a median duration of 4 weeks (range 3-12). Despite a properly conducted treatment, 34% of patients (n = 12) developed persistent synovitis for at least 2 months (median duration 3 months, range 2-16). Among those, 3 developed systemic inflammatory oligo- or polyarthritis in previously unaffected joints with no signs of persistent infection (repeated PCR testing negative), which mandated Disease-Modifying Antirheumatic Drugs (DMARD) introduction, leading to remission. CONCLUSION In France and contrary to ticks ecology, Lyme arthritis is mainly caused by B. burgdorferi sensu stricto. Despite proper antibiotic therapy, roughly one third of patients may present persistent inflammatory synovitis and a small proportion may develop systemic arthritis. In such cases, complete remission can be reached using DMARD.
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Affiliation(s)
- Antoine Grillon
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | | | - Pierre-Hugues Boyer
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sylvie De Martino
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France; Centre National de Référence des Borrelia, CHRU Strasbourg, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Isabelle Imbert
- Service de Rhumatologie, Hôpital d'instruction des armées, Saint-Mandé, France
| | | | | | | | | | - Jean Sibilia
- Service de Rhumatologie, CHRU Strasbourg, France
| | - Laurence Zilliox
- Centre National de Référence des Borrelia, CHRU Strasbourg, France
| | - Cathy Barthel
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Benoit Jaulhac
- EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France; Centre National de Référence des Borrelia, CHRU Strasbourg, France
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10
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Paim AC, Baddour LM, Pritt BS, Schuetz AN, Wilson JW. Lyme Endocarditis. Am J Med 2018; 131:1126-1129. [PMID: 29605416 DOI: 10.1016/j.amjmed.2018.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Valvular involvement as a manifestation of Lyme carditis is rare. The first case describing a possible association between Lyme disease and cardiac valvular disease in the United States was published in 1993. Since that time there have been 2 cases of Lyme endocarditis confirmed by Borrelia-positive 16S ribosomal RNA polymerase chain reaction and sequencing from valvular tissue and reported from Europe. Here we describe a case of Lyme endocarditis that, to our knowledge, is the first reported case confirmed by molecular diagnostics in the United States. METHODS We present the case of a 68-year-old man with progressive dyspnea who had mitral valve perforation with severe mitral valve insufficiency seen on transesophageal echocardiogram. RESULTS Subsequently resected valve tissue had signs of acute inflammation without organisms seen. Although blood and valve tissue cultures were negative, 16S ribosomal RNA polymerase chain reaction and sequencing demonstrated Borrelia burgdorferi. CONCLUSION Lyme endocarditis can be a challenging diagnosis to confirm, given the rarity of cases and the need for molecular tools of resected valve tissue. It should be included among diagnostic possibilities in patients with culture-negative endocarditis who have exposure to ticks in endemic and emerging areas of Lyme disease.
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Affiliation(s)
- Ana C Paim
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn.
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn
| | - Bobbi S Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minn
| | | | - John W Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minn
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11
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Gallais F, De Martino SJ, Sauleau EA, Hansmann Y, Lipsker D, Lenormand C, Talagrand-Reboul E, Boyer PH, Boulanger N, Jaulhac B, Schramm F. Multilocus sequence typing of clinical Borreliella afzelii strains: population structure and differential ability to disseminate in humans. Parasit Vectors 2018; 11:374. [PMID: 29954419 PMCID: PMC6027761 DOI: 10.1186/s13071-018-2938-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lyme borreliosis in humans results in a range of clinical manifestations, thought to be partly due to differences in the pathogenicity of the infecting strain. This study compared European human clinical strains of Borreliella afzelii (previously named Borrelia afzelii) using multilocus sequence typing (MLST) to determine their spatial distribution across Europe and to establish whether there are associations between B. afzelii genotypes and specific clinical manifestations of Lyme borreliosis. For this purpose, typing was performed on 63 strains, and data on a further 245 strains were accessed from the literature. RESULTS All 308 strains were categorized into 149 sequence types (STs), 27 of which are described here for the first time. Phylogenetic and goeBURST analyses showed short evolutionary distances between strains. Although the main STs differed among the countries with the largest number of strains of interest (Germany, the Netherlands, France and Slovenia), the B. afzelii clinical strains were less genetically structured than those previously observed in the European tick population. Two STs were found significantly more frequently in strains associated with clinical manifestations involving erythema migrans, whereas another ST was found significantly more frequently in strains associated with disseminated manifestations, especially neuroborreliosis. CONCLUSIONS The MLST profiles showed low genetic differentiation between B. afzelii strains isolated from patients with Lyme borreliosis in Europe. Also, clinical data analysis suggests the existence of lineages with differential dissemination properties in humans.
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Affiliation(s)
- Floriane Gallais
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France
| | - Sylvie J De Martino
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,French National Reference Center for Borrelia, University Hospital Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
| | - Erik A Sauleau
- Public Health, Methods in Clinical Research Team, University Hospital Strasbourg, Strasbourg, France
| | - Yves Hansmann
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France.,Infectious Disease Department, University Hospital Strasbourg, Strasbourg, France
| | - Dan Lipsker
- Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France.,Dermatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Cédric Lenormand
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France.,Dermatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Emilie Talagrand-Reboul
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France
| | - Pierre H Boyer
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France
| | - Nathalie Boulanger
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,French National Reference Center for Borrelia, University Hospital Strasbourg, Strasbourg, France
| | - Benoît Jaulhac
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.,French National Reference Center for Borrelia, University Hospital Strasbourg, Strasbourg, France.,Groupe d'Étude de la Borréliose de Lyme (GEBLY), Strasbourg, France
| | - Frédéric Schramm
- EA7290 Early Bacterial Virulence: Lyme borreliosis Group, FMTS, University of Strasbourg, Strasbourg, France.
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12
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Identification of Borrelia protein candidates in mouse skin for potential diagnosis of disseminated Lyme borreliosis. Sci Rep 2017; 7:16719. [PMID: 29196626 PMCID: PMC5711925 DOI: 10.1038/s41598-017-16749-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/16/2017] [Indexed: 11/09/2022] Open
Abstract
In vector-borne diseases, the skin plays an essential role in the transmission of vector-borne pathogens between the vertebrate host and blood-feeding arthropods and in pathogen persistence. Borrelia burgdorferi sensu lato is a tick-borne bacterium that causes Lyme borreliosis (LB) in humans. This pathogen may establish a long-lasting infection in its natural vertebrate host where it can persist in the skin and some other organs. Using a mouse model, we demonstrate that Borrelia targets the skin regardless of the route of inoculation, and can persist there at low densities that are difficult to detect via qPCR, but that were infective for blood-feeding ticks. Application of immunosuppressive dermocorticoids at 40 days post-infection (PI) significantly enhanced the Borrelia population size in the mouse skin. We used non-targeted (Ge-LC-MS/MS) and targeted (SRM-MS) proteomics to detect several Borrelia-specific proteins in the mouse skin at 40 days PI. Detected Borrelia proteins included flagellin, VlsE and GAPDH. An important problem in LB is the lack of diagnosis methods capable of detecting active infection in humans suffering from disseminated LB. The identification of Borrelia proteins in skin biopsies may provide new approaches for assessing active infection in disseminated manifestations.
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13
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Maheshwari A, Bache RJ. Hints of Lyme: Disseminated Borreliosis Involving the Mitral and Tricuspid Valves. Am J Med 2017; 130:e441-e442. [PMID: 28532987 DOI: 10.1016/j.amjmed.2017.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Ankit Maheshwari
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis.
| | - Robert J Bache
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis
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14
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Boyer PH, Boulanger N, Nebbak A, Collin E, Jaulhac B, Almeras L. Assessment of MALDI-TOF MS biotyping for Borrelia burgdorferi sl detection in Ixodes ricinus. PLoS One 2017; 12:e0185430. [PMID: 28950023 PMCID: PMC5614582 DOI: 10.1371/journal.pone.0185430] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/12/2017] [Indexed: 12/27/2022] Open
Abstract
Matrix Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has been demonstrated to be useful for tick identification at the species level. More recently, this tool has been successfully applied for the detection of bacterial pathogens directly in tick vectors. The present work has assessed the detection of Borrelia burgdorferi sensu lato in Ixodes ricinus tick vector by MALDI-TOF MS. To this aim, experimental infection model of I. ricinus ticks by B. afzelii was carried out and specimens collected in the field were also included in the study. Borrelia infectious status of I. ricinus ticks was molecularly controlled using half-idiosome to classify specimens. Among the 39 ticks engorged on infected mice, 14 were confirmed to be infected by B. afzelii. For field collection, 14.8% (n = 12/81) I. ricinus ticks were validated molecularly as infected by B. burgdorferi sl. To determine the body part allowing the detection of MS protein profile changes between non-infected and B. afzelii infected specimens, ticks were dissected in three compartments (i.e. 4 legs, capitulum and half-idiosome) prior to MS analysis. Highly reproducible MS spectra were obtained for I. ricinus ticks according to the compartment tested and their infectious status. However, no MS profile change was found when paired body part comparison between non-infected and B. afzelii infected specimens was made. Statistical analyses did not succeed to discover, per body part, specific MS peaks distinguishing Borrelia-infected from non-infected ticks whatever their origins, laboratory reared or field collected. Despite the unsuccessful of MALDI-TOF MS to classify tick specimens according to their B. afzelii infectious status, this proteomic tool remains a promising method for rapid, economic and accurate identification of tick species. Moreover, the singularity of MS spectra between legs and half-idiosome of I. ricinus could be used to reinforce this proteomic identification by submission of both these compartments to MS.
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Affiliation(s)
- Pierre H. Boyer
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France
| | - Nathalie Boulanger
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- * E-mail:
| | - Amira Nebbak
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Institut Hospitalo-Universitaire Méditerranée Infection 19–21 Boulevard Jean Moulin, Marseille, France
- Laboratoire de Biodiversité et Environnement: Interactions génomes, Faculté des Sciences Biologiques, Université des Sciences et de la Technologie Houari Boumediene (USTHB), Bab Ezzouar, Algiers, Algeria
| | - Elodie Collin
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France
| | - Benoit Jaulhac
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France
- French National Reference Center for Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lionel Almeras
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, Institut Hospitalo-Universitaire Méditerranée Infection 19–21 Boulevard Jean Moulin, Marseille, France
- Unité de Parasitologie et Entomologie, Département des Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
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15
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No evidence of Borrelia mayonii in an endemic area for Lyme borreliosis in France. Parasit Vectors 2017; 10:282. [PMID: 28583197 PMCID: PMC5460422 DOI: 10.1186/s13071-017-2212-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/22/2017] [Indexed: 12/30/2022] Open
Abstract
Background Borrelia mayonii is currently the latest species belonging to the Borrelia burgdorferi (sensu lato) complex to be discovered. Interestingly it is involved in human pathology causing a high fever. We looked for its presence in post- tick bite febrile patients as well as in Ixodes ricinus ticks in an endemic area of France. Results After ensuring that our molecular technics correctly detected B. mayonii, 575 patients and 3,122 Ixodes ricinus nymphs were tested. Neither B. mayonii nor another species of the B. burgdorferi (s.l.) complex previously not reported in Europe has been identified. Conclusions For now, B. mayonii seems to be an epiphenomenon. However, its discovery broadens the etiology of post-Ixodes bite febrile syndromes.
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16
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Kostić T, Momčilović S, Perišić ZD, Apostolović SR, Cvetković J, Jovanović A, Barać A, Šalinger-Martinović S, Tasić-Otašević S. Manifestations of Lyme carditis. Int J Cardiol 2016; 232:24-32. [PMID: 28082088 DOI: 10.1016/j.ijcard.2016.12.169] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/18/2016] [Accepted: 12/25/2016] [Indexed: 02/02/2023]
Abstract
The first data of Lyme carditis, a relatively rare manifestation of Lyme disease, were published in eighties of the last century. Clinical manifestations include syncope, light-headedness, fainting, shortness of breath, palpitations, and/or chest pain. Atrioventricular (AV) electrical block of varying severity presents the most common conduction disorder in Lyme carditis. Although is usually mild, AV block can fluctuates rapidly and progress from a prolonged P-R interval to a His-Purkinje block within minutes to hours and days. Rarely, Lyme disease may be the cause of endocarditis, while some studies and reports, based on serological and/or molecular investigations, have suggested possible influence of Borrelia burgdorferi on degenerative cardiac valvular disease. Myocarditis, pericarditis, pancarditis, dilated cardiomyopathy, and heart failure have also been described as possible manifestations of Lyme carditis. The clinical course of Lyme carditis is generally mild, short term, and in most cases, completely reversible after adequate antibiotic treatment.
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Affiliation(s)
- Tomislav Kostić
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Blvd Zorana Djindjica 48, 18000 Niš, Serbia; Department of Cardiology, Faculty of Medicine, University of Niš, Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia
| | - Stefan Momčilović
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Blvd Zorana Djindjica 48, 18000 Niš, Serbia.
| | - Zoran D Perišić
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Blvd Zorana Djindjica 48, 18000 Niš, Serbia; Department of Cardiology, Faculty of Medicine, University of Niš, Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia
| | - Svetlana R Apostolović
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Blvd Zorana Djindjica 48, 18000 Niš, Serbia; Department of Cardiology, Faculty of Medicine, University of Niš, Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia
| | - Jovana Cvetković
- Institute for Treatment and Rehabilitation "Niška Banja", Srpskih junaka 2, 18205 Niška Banja, Niš, Serbia
| | - Andriana Jovanović
- Faculty of Medicine, University of Niš Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, Clinical Center Serbia, Blvd Oslobodjenja 16, 11000, Belgrade
| | - Sonja Šalinger-Martinović
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Blvd Zorana Djindjica 48, 18000 Niš, Serbia; Department of Cardiology, Faculty of Medicine, University of Niš, Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia
| | - Suzana Tasić-Otašević
- Center of Microbiology and Parasitology, Public Health Institute Niš, Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia; Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia, Blvd Zorana Djindjica 81, 18000 Niš, Serbia
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17
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Expanding the clinicopathological spectrum of late cutaneous Lyme borreliosis (acrodermatitis chronica atrophicans [ACA]): A prospective study of 20 culture- and/or polymerase chain reaction (PCR)-documented cases. J Am Acad Dermatol 2016; 74:685-92. [PMID: 26781226 DOI: 10.1016/j.jaad.2015.10.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The diagnosis of acrodermatitis chronica atrophicans (ACA), the late cutaneous manifestation of Lyme borreliosis, can be challenging. Histologic changes in ACA have been described in a few studies from endemic countries, relying on cases documented by serology only. OBJECTIVES We sought to reassess the clinicopathological spectrum of ACA in a series of thoroughly documented cases. METHODS Patients prospectively included in a national prospective study were selected on the basis of positive culture and/or polymerase chain reaction of a skin biopsy sample. The diagnosis of ACA was confirmed by reviewing the clinical and serologic data. Histopathological samples were carefully reviewed. RESULTS Twenty patients were included. Unusual clinical features (ie, numerous small violaceous patches and equidistant small spinous papules with background faint erythema) were observed in 2 patients. Histopathological examination revealed a classic plasma cell-rich perivascular and interstitial pattern with telangiectases in 16 of 25 samples, whereas strikingly prominent granuloma annulare-like or lichenoid features were observed in 4 and 2 of 25 cases, respectively, and discrete nonspecific minor changes in 3 of 25 cases. LIMITATIONS The small number of patients was a limitation. CONCLUSIONS Genuine culture- and/or polymerase chain reaction-proven ACA can rarely present as numerous violaceous patches or cluster of spinous papules clinically, and as a granuloma annulare-like or lichenoid dermatosis histologically.
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18
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Schnell G, Boeuf A, Westermann B, Jaulhac B, Lipsker D, Carapito C, Boulanger N, Ehret-Sabatier L. Discovery and targeted proteomics on cutaneous biopsies infected by borrelia to investigate lyme disease. Mol Cell Proteomics 2015; 14:1254-64. [PMID: 25713121 DOI: 10.1074/mcp.m114.046540] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Indexed: 12/11/2022] Open
Abstract
Lyme disease is the most important vector-borne disease in the Northern hemisphere and represents a major public health challenge with insufficient means of reliable diagnosis. Skin is rarely investigated in proteomics but constitutes in the case of Lyme disease the key interface where the pathogens can enter, persist, and multiply. Therefore, we investigated proteomics on skin samples to detect Borrelia proteins directly in cutaneous biopsies in a robust and specific way. We first set up a discovery gel prefractionation-LC-MS/MS approach on a murine model infected by Borrelia burgdorferi sensu stricto that allowed the identification of 25 Borrelia proteins among more than 1300 mouse proteins. Then we developed a targeted gel prefractionation-LC-selected reaction monitoring (SRM) assay to detect 9/33 Borrelia proteins/peptides in mouse skin tissue samples using heavy labeled synthetic peptides. We successfully transferred this assay from the mouse model to human skin biopsies (naturally infected by Borrelia), and we were able to detect two Borrelia proteins: OspC and flagellin. Considering the extreme variability of OspC, we developed an extended SRM assay to target a large set of variants. This assay afforded the detection of nine peptides belonging to either OspC or flagellin in human skin biopsies. We further shortened the sample preparation and showed that Borrelia is detectable in mouse and human skin biopsies by directly using a liquid digestion followed by LC-SRM analysis without any prefractionation. This study thus shows that a targeted SRM approach is a promising tool for the early direct diagnosis of Lyme disease with high sensitivity (<10 fmol of OspC/mg of human skin biopsy).
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Affiliation(s)
- Gilles Schnell
- From the ‡Laboratoire de Spectrométrie de Masse BioOrganique, Institut Pluridisciplinaire Hubert Curien, UMR 7178 CNRS-Université de Strasbourg, 67087 Strasbourg, France
| | - Amandine Boeuf
- From the ‡Laboratoire de Spectrométrie de Masse BioOrganique, Institut Pluridisciplinaire Hubert Curien, UMR 7178 CNRS-Université de Strasbourg, 67087 Strasbourg, France
| | - Benoît Westermann
- From the ‡Laboratoire de Spectrométrie de Masse BioOrganique, Institut Pluridisciplinaire Hubert Curien, UMR 7178 CNRS-Université de Strasbourg, 67087 Strasbourg, France
| | - Benoît Jaulhac
- ‖EA7290, Virulence bactérienne précoce, groupe Borréliose de Lyme, Facultés de Médecine et de Pharmacie, Université de Strasbourg, 67091 Strasbourg, France, and
| | - Dan Lipsker
- **Faculté de Médecine, Université de Strasbourg et Clinique Dermatologique, Hôpitaux Universitaires, 67091 Strasbourg, France
| | - Christine Carapito
- From the ‡Laboratoire de Spectrométrie de Masse BioOrganique, Institut Pluridisciplinaire Hubert Curien, UMR 7178 CNRS-Université de Strasbourg, 67087 Strasbourg, France
| | - Nathalie Boulanger
- ‖EA7290, Virulence bactérienne précoce, groupe Borréliose de Lyme, Facultés de Médecine et de Pharmacie, Université de Strasbourg, 67091 Strasbourg, France, and
| | - Laurence Ehret-Sabatier
- From the ‡Laboratoire de Spectrométrie de Masse BioOrganique, Institut Pluridisciplinaire Hubert Curien, UMR 7178 CNRS-Université de Strasbourg, 67087 Strasbourg, France,
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19
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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