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Breitbart P, Meister S, Meyer T, Gärtner BC. Incidence and Prevalence of Borrelia burgdorferi Antibodies in Male Professional Football Players. Clin J Sport Med 2021; 31:e200-e206. [PMID: 31241490 DOI: 10.1097/jsm.0000000000000758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Infections with Borrelia burgdorferi can cause Lyme disease with multiorganic involvement such as (myo)carditis or joint manifestations. Musculoskeletal complaints possibly mimicking some of these symptoms are common among elite athletes. This study aimed to determine seroprevalence and incidence of B. burgdorferi antibodies in professional football players. DESIGN Prospective observational study. SETTING Healthy professional football players. PARTICIPANTS Five hundred thirty-five men in the first and second German league. INTERVENTIONS Two screening assays were used to examine immunoglobulin M (IgM) and immunoglobulin G (IgG) against B. burgdorferi: an enzyme immunoassay (EIA) and a chemiluminescence assay (CLIA). In case of a positive or equivocal result, an immunoblot including in vivo antigens was performed. MAIN OUTCOME MEASURES Course of IgM and IgG against B. burgdorferi in overall 1529 blood samples. RESULTS A total of 96.4% of all results were concordant between EIA and CLIA. Considering only samples with identical results in both assays, prevalence was 1.6%. A positive IgM was detected in 2.3%. No player showed any symptoms of Lyme disease. A seroconversion to IgG was not found. Three players developed a positive IgM corresponding to an incidence of 1032/100 000 person-years. Depending on the assay, 49% to 75% of positive or equivocal screening results could not be confirmed by immunoblot. CONCLUSIONS Seroprevalence and incidence of B. burgdorferi among healthy male professional football players are low. Therefore, infections with B. burgdorferi have to be regarded a rare differential diagnosis in professional football in Central Europe. The low confirmation rate of positive screening assays points to an unspecific immune activation.
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Affiliation(s)
- Philipp Breitbart
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Steffen Meister
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Sportmedizin München, Munich, Germany; and
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Barbara C Gärtner
- Department of Medical Microbiology and Hygiene, Saarland University, Faculty of Medicine and Medical Center, Homburg/Saar, Germany
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Garro A, Avery RA, Cohn KA, Neville DN, Balamuth F, Levas MN, Bennett JE, Kharbanda AB, Monuteaux MC, Nigrovic LE. Validation of the Rule of 7's for Identifying Children at Low-risk for Lyme Meningitis. Pediatr Infect Dis J 2021; 40:306-309. [PMID: 33710975 DOI: 10.1097/inf.0000000000003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Rule of 7's classifies children as low-risk for Lyme meningitis with the absence of the following: ≥7 days of headache, any cranial neuritis or ≥70% cerebrospinal fluid mononuclear cells. We sought to broadly validate this clinical prediction rule in children with meningitis undergoing evaluation for Lyme disease. METHODS We performed a patient-level data meta-analysis of 2 prospective and 2 retrospective cohorts of children ≤21 years of age with cerebrospinal fluid pleocytosis who underwent evaluation for Lyme disease. We defined a case of Lyme meningitis with a positive 2-tier serology result (positive or equivocal first-tier enzyme immunoassay followed by a positive supplemental immunoblot). We applied the Rule of 7's and report the accuracy for the identification of Lyme meningitis. RESULTS Of 721 included children with meningitis, 178 had Lyme meningitis (24.7%) and 543 had aseptic meningitis (75.3%). The pooled data from the 4 studies showed the Rule of 7's has a sensitivity of 98% [95% confidence interval (CI): 89%-100%, I2 = 71%], specificity 40% (95% CI: 30%-50%, I2 = 75%), and a negative predictive value of 100% (95% CI: 95%-100%, I2 = 55%). CONCLUSIONS The Rule of 7's accurately identified children with meningitis at low-risk for Lyme meningitis for whom clinicians should consider outpatient management while awaiting Lyme disease test results.
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Affiliation(s)
- Aris Garro
- From the Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Robert A Avery
- Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Keri A Cohn
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Desiree N Neville
- Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fran Balamuth
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael N Levas
- Pediatric Emergency Medicine, Wisconsin Children's Hospital, Milwaukee, Wisconsin
| | - Jonathan E Bennett
- Pediatric Emergency Medicine, Nemours/A.I. DuPont Hospital for Children, Wilmington, Delaware
| | - Anupam B Kharbanda
- Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota
| | - Michael C Monuteaux
- Pediatric Emergency Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lise E Nigrovic
- Pediatric Emergency Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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Jore S, Vanwambeke SO, Slunge D, Boman A, Krogfelt KA, Jepsen MT, Vold L. Spatial tick bite exposure and associated risk factors in Scandinavia. Infect Ecol Epidemiol 2020; 10:1764693. [PMID: 32922687 PMCID: PMC7448850 DOI: 10.1080/20008686.2020.1764693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tick-borne diseases are emerging and re-emerging threats causing public health concerns in Europe and North America. Prevention and control requires understanding of human exposure and behaviour. The aim was to measure exposure to tick bites across Scandinavia, its spatial distribution and the associated risk factors. Methods We sent a web-based survey to a randomly chosen population and analysed answers by Principal Component Analysis and Chi-Square. Individual responses were aggregated at the municipality level to assess the spatial distribution of bites. Results Nearly 60% of adults reported bites at low levels (1-5 bites); however, the majority were not in their resident municipality. We found two spatial profiles: In their home municipalities, people were most often bitten in less, but not the least, urbanized areas. When visiting other municipalities, people were most frequently bitten in peri-urban areas. Running/walking in the forest, gardening, and paddling/rowing were activities most strongly associated with bites. Conclusion Tick bites affect the entire Scandinavian population, with a higher risk in Sweden compared to Denmark and Norway. The frequency of observation of ticks in the environment or on pets might be used as a proxy for the actual risk of exposure to tick bites. Our results indicates that urban-dwelling outdoor enthusiasts and inhabitants of rural areas must be equally targeted for prevention campaigns.
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Affiliation(s)
- Solveig Jore
- Department of Infection Prevention & Preparedness, Norwegian Public Health Institute, Oslo, Norway
| | - Sophie O Vanwambeke
- Georges Lemaître Centre for Earth and Climate Research, Earth & Life Institute, Louvain-la-Neuve, Belgium
| | - Daniel Slunge
- Center for Sustainable Development, GMV, University of Gothenburg, Gothenburg, Sweden
| | - Anders Boman
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
| | - Karen A Krogfelt
- Department of Virus and Microbiological Diagnostics, Statens Serum Institut, Copenhagen, Denmark.,Dept of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Martin Tugwell Jepsen
- Department of Virus and Microbiological Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Line Vold
- Department of Infection Prevention & Preparedness, Norwegian Public Health Institute, Oslo, Norway
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Barreiro-Hurlé L, Melón-García S, Seco-Bernal C, Muñoz-Turrillas C, Rodríguez-Pérez M. Seroprevalencia de enfermedad de Lyme en el suroccidente de Asturias. Enferm Infecc Microbiol Clin 2020; 38:155-158. [DOI: 10.1016/j.eimc.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/10/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022]
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Thortveit ET, Aase A, Petersen LB, Lorentzen ÅR, Mygland Å, Ljøstad U. Human seroprevalence of antibodies to tick-borne microbes in southern Norway. Ticks Tick Borne Dis 2020; 11:101410. [PMID: 32156478 DOI: 10.1016/j.ttbdis.2020.101410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/30/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022]
Abstract
The tick Ixodes ricinus is widespread along the coastline of southern Norway, but data on human exposure to tick-borne microbes are scarce. We aimed to assess the seroprevalence of IgG antibodies to various tick-borne microbes in the general adult population living in a Norwegian municipality where ticks are abundant. Søgne is a coastline municipality in the southernmost part of Norway, and has a high density of ticks. All individuals aged 18-69 years with residential address in Søgne municipality (n = 7424) were invited to give a blood sample and answer a questionnaire. Blood samples from 3568 individuals were available for analysis. All samples were analyzed for IgG antibodies to Borrelia burgdorferi sensu lato (Bbsl), and around 1500 samples for IgG antibodies to other tick-borne microbes. Serum IgG antibodies to Bbsl were present in 22.0% (785/3568) of the tested samples, tick-borne encephalitis virus (TBEV) in 3.1% (45/1453), Anaplasma phagocytophilum in 11.0% (159/1452), Babesia microti in 2.1% (33/1537), Bartonella henselae/B. quintana in 0.1% (2/1451) and Rickettsia helvetica/R. conorii in 4.2% (60/1445). Serum IgG antibodies to A. phagocytophilum and R. helvetica/R. conorii were significantly more prevalent (p = 0.010 and p = 0.016, respectively) among individuals with serum IgG antibodies to Bbsl than among individuals without. In conclusion, our study showed a high exposure to Bbsl in the general adult population living in a coastline municipality in the southernmost part of Norway. The population is also exposed to A. phagocytophilum, R. helvetica/R. conorii, B. microti and TBEV, but very rarely B. henselae/B. quintana.
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Affiliation(s)
| | - Audun Aase
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Lizette Balle Petersen
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; The Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Arendal, Norway.
| | - Åse Mygland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Habilitation, Sørlandet Hospital Trust, Kristiansand, Norway.
| | - Unn Ljøstad
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Hvidsten D, Frafjord K, Gray JS, Henningsson AJ, Jenkins A, Kristiansen BE, Lager M, Rognerud B, Slåtsve AM, Stordal F, Stuen S, Wilhelmsson P. The distribution limit of the common tick, Ixodes ricinus, and some associated pathogens in north-western Europe. Ticks Tick Borne Dis 2020; 11:101388. [PMID: 32122808 DOI: 10.1016/j.ttbdis.2020.101388] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
In north-western Europe, the common tick, Ixodes ricinus, is widely established, its distribution appears to be increasing and the spread of tick-borne diseases is of increasing concern. The project 'Flått i Nord' (Ticks in northern Norway) commenced in spring 2009 with the intention of studying the tick's distribution and that of its pathogens in northern Norway. Several methods were used: cloth-dragging, collecting from trapped small mammals, and collecting from pets. Since 2010, the occurrence of ticks in the region of northern Norway was determined directly by cloth-dragging 167 times in 109 separate locations between the latitudes of 64 °N and 70 °N (included seven locations in the northern part of Trøndelag County). The northernmost location of a permanent I. ricinus population was found to be Nordøyvågen (66.2204 °N, 12.59 °E) on the Island of Dønna. In a sample of 518 nymphal and adult ticks, the Borrelia prevalence collected close to this distribution limit varied but was low (1-15 %) compared with the locations in Trøndelag, south of the study area (15-27 %). Five specimens (1 %) were positive for Rickettsia helvetica. The length of the vegetation growing season (GSL) can be used as an approximate index for the presence of established populations of I. ricinus. The present study suggests that the threshold GSL for tick establishment is about 170 days, because the median GSL from 1991 to 2015 was 174-184 days at sites with permanent tick populations, showing a clear increase compared with the period 1961-1990. This apparent manifestation of climate change could explain the northward extension of the range of I. ricinus.
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Affiliation(s)
- D Hvidsten
- University Hospital of North Norway, Department of Microbiology and Infection Control, Tromsø, Norway; Nordland Hospital, Division of Diagnostic Services, Department of Microbiology, Bodø, Norway.
| | - K Frafjord
- UiT The Arctic University of Norway, Tromsø University Museum, Tromsø, Norway
| | - J S Gray
- University College Dublin, Dublin, Ireland
| | - A J Henningsson
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - A Jenkins
- University of South-Eastern Norway, Department of Natural Science and Environmental Health, Bø, Norway
| | | | - M Lager
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Rognerud
- University of Oslo, Department of Geosciences, Oslo, Norway
| | - A M Slåtsve
- Nordland Hospital, Division of Diagnostic Services, Department of Microbiology, Bodø, Norway
| | - F Stordal
- University of Oslo, Department of Geosciences, Oslo, Norway
| | - S Stuen
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Section for Small Ruminants Research, Sandnes, Norway
| | - P Wilhelmsson
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Positive 2-Tiered Lyme Disease Serology is Uncommon in Asymptomatic Children Living in Endemic Areas of the United States. Pediatr Infect Dis J 2019; 38:e105-e107. [PMID: 30067595 PMCID: PMC6355375 DOI: 10.1097/inf.0000000000002157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Knowing the frequency of positive Lyme disease serology in children without signs of infection facilitates test interpretation. Of 315 asymptomatic children from Lyme disease endemic regions, 32 had positive or equivocal C6 enzyme-linked immunoassays, but only 5 had positive IgG or IgM supplemental immunoblots (1.6%; 95% confidence interval: 0.7%-3.7%).
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