Lyme disease (Lyme borreliosis)

Distribution of tick-borne diseases in Japan: Past patterns and implications for the future

The rapid geographical spread of tick-borne diseases (TBDs) worldwide has recently provoked significant concerns amongst public health authorities. Tick-borne pathogens are maintained in enzootic cycles involving ticks and wild animal hosts, with epizootic spread to other mammals, including livestock and humans. Despite the increasing public health concern, current TBD diagnostic tests and treatments are inadequate, and predictive models of future risks posed by TBDs are limited by the heterogeneity of environmental, vector, and host factors, even in neighboring regions. In recent years, infections resulting in severe fever with thrombocytopenia syndrome (SFTS), Japanese spotted fever, and the scrub typhus pathogens have been reported frequently in addition to traditional TBDs in Japan. The Japanese archipelago is extremely elongated from north to south and its climate varies considerably, creating remarkable regional differences in tick species. The importance of continuous surveillance of TBDs has been growing in terms of geopathology - studies dealing with the relationships between geographic factors and the causes of specific diseases - in Japan and neighboring areas among eastern Asian countries, including China and Korea. In this review, we summarize detailed information regarding the history and epidemic status of human TBDs in Japan.

[Ocular Lyme disease occurring during childhood: five case reports]

INTRODUCTION

Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood are discussed in this paper.

PATIENTS AND METHODS

Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia, as well as exclusion of other causes were the diagnosis criteria.

RESULTS

Two cases of uveitis, two cases of abducens palsies, one case of optical neuropathy, and one case of orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained of severe knee arthritis. Determination of antibodies was positive in all patients. They were all treated with antibiotics adjusted to individual circumstances and some of them (two cases of uveitis and one of optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, with no relapse, was observed in all patients within two to 12 weeks.

CONCLUSION

For any unexplained ocular symptom, even in children, LB should be taken into account, especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during the childhood period, even following long-term manifestation at an early age.

Multilocus sequence typing implicates rodents as the main reservoir host of human-pathogenic Borrelia garinii in Japan

Multilocus sequence typing of Borrelia garinii isolates from humans and comparison with rodent and tick isolates were performed. Fifty-nine isolates were divided into two phylogenetic groups, and an association was detected between clinical and rodent isolates, suggesting that, in Japan, human-pathogenic B. garinii comes from rodents via ticks.

Prevalence of Borrelia burgdorferi in Ixodes ricinus ticks in Belgrade area

OBJECTIVE

Lyme borreliosis is vector-borne zoonosis. The causative agent of Lyme borreliosis is a spirochete of Borrelia burgdorferi (Bb) sensu lato complex, which is transmitted by ticks of the Ixodes ricinus complex. The aim of our paper is to estimate the prevalence of I. ricinus ticks, the level of their infectivity by Bb, and the prevalence of certain genospecies of Bb sensu lato in ixodide ticks inhabiting Belgrade.

MATERIALS AND METHODS

An estimate of the tick population density was expressed by the value of flag/hour. For isolation and cultivation of Borrelia, selective Barbour-Stonner-Kelly II media was used. Typization of Borrelia was made by applying the species-specific polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism analysis. In statistical analysis, Chi(2) test was used.

RESULTS

Values of flag/hour have varied in relation to year observed and type of habitat: The lowest values were recorded in the city parks (17.9). The values were higher in parks-woods (19.7 and 33.4, respectively). The highest values were detected in localities similar to wooded areas (48.0). The estimated average infestation of ticks with Bb was 21.9%, excluding statistically significant differences by years of investigation. We found the dominance of Borrelia afzelii (75%). Bb sensu stricto (22.2%) as well as Borrelia garinii (2.8%) was much less present. Statistically significant difference was established in the prevalence of the above-mentioned genospecies in relation to the examined localities.

CONCLUSIONS

We have established the prevalence of all three genospecies in the city of Belgrade. Bb sensu lato was found, with the dominance of B. afzelii.

Allozyme polymorphism of Mdh and alpha-Gpdh in Ixodes ricinus populations: comparison of borreliae-infected and uninfected ticks

Ixodes ricinus Linnaeus (Acari: Ixodidae) ticks are vectors of numerous infectious diseases in humans and animals. The allozyme variability of MDH and alpha-Gpdh was detected by native polyacrylamide gel electrophoresis in I. ricinus natural populations in three localities in Serbia. Four alleles of Mdh locus (MDH 1, MDH 2, MDH 3 and MDH X) and four alleles of alpha-Gpdh locus (VS, S, F and VF) were detected. Interpopulation differences in Mdh and alpha-Gpdh allele frequencies were statistically insignificant. Significant difference in alpha-Gpdh allele frequencies between males and females was recorded in the largest sample only. Differences in allele frequencies, detected between borreliae-infected and uninfected I. ricinus ticks, were close to the level of statistical significance, especially for alpha-Gpdh locus. Clear significant difference appeared in females when sexes were tested separatelly (P = 0.037). It is interesting that genotypes containing rarer alleles (MDH 1 and S) were infected in higher proportion in comparison to other genotypes. Our results point towards a possible role of Mdh and alpha-Gpdh loci in I. ricinus ticks in the determination of energy requirements for host seeking. Sex differences in alpha-Gpdh allele frequencies suggest that selective pressure, concerning efficiency of reserve materials utilisation, points to alpha-Gpdh rather than to Mdh locus.

Characterization of Borrelia burgdorferi sensu lato isolated in Moscow province – a sympatric region for Ixodes ricinus and Ixodes persulcatus

The relationships between Borrelia species and the vector ticks, Ixodes persulcatus and Ixodes ricinus were examined in a molecular epidemiological study. We conducted a survey in the Moscow region which is a sympatric region for both species of tick. We examined 630 unfed I. ricinus and I. persulcatus, ticks collected from four different regions around Moscow within an area of 250 km2. Eighty-four ticks were culture positive (13.3%) and the prevalence rate varied in each region from 5.7% to 42.3%. No difference was found between the total prevalence rate for both species. Eight Borrelia afzelii-like variant isolates from I. ricinus and Clethrionomys glareolus were identified as B. afzelii by flagellin gene and 16S rDNA sequence analyses. Most isolates from I. ricinus were identified as Borrelia garinii type 20047 and B. afzelii. Two isolates were identified as Borrelia burgdorferi sensu stricto (s.s.) and Borrelia valaisiana, respectively, but no B. garinii type NT29 was found. In contrast, isolates from I. persulcatus were identified as both types 20047 and NT29 of B. garinii, and B. afzelii. No B. burgdorferi s.s. isolate was found among isolates from I. persulcatus.

New genomospecies related to Borrelia valaisiana, isolated from mammals in Okinawa archipelago, Japan

In 2000 and 2001, a survey was conducted of Borrelia isolated from various mammals in the southernmost islands of Japan, including Okinawa (main island), Izena, Iriomote and Ishigaki. Isolates obtained from the ear tissues of Suncus murinus (10 isolates), Mus calori (four isolates), Rattus norvegicus (one isolate) and Crocidura watasei (one isolate), were characterized by RFLP of the 5S–23S rDNA intergenic spacer and sequence analysis of the intergenic spacer, 16S rDNA and flagellin gene. While these isolates showed identical RFLPs to Borrelia valaisiana found in Korea, Taiwan and the southern and central parts of China, their RFLP patterns differed from those of B. valaisiana found in European countries, and strain Am501 isolated from Ixodes columnae in Japan. It was found that these isolates clustered with each other on a phylogenetic tree based on flagellin gene and 16S rDNA sequences, but were relatively divergent from the European B. valaisiana and strain Am501. These findings suggest that these isolates found in East Asia should be classified as a new genomospecies of Borrelia burgdorferi sensu lato.

First isolation and characterization of Borrelia burgdorferi sensu lato strains from Ixodes ricinus ticks in Turkey

In order to investigate the presence and prevalence of Lyme borreliosis (Lyme disease) Borrelia species, 312 unfed ticks were collected by flagging at a woodland area in Trakya, in the European side of Turkey, in May 2002. Twelve of 299 Ixodes ricinus ticks were infected with Borrelia spp., as determined by cultivation in BSK medium (prevalence rate 4.0 %). Ten pure cultures were subjected to further characterization by sequencing analysis of the 5S-23S rDNA intergenic spacer, 16S rDNA and flagellin gene. One isolate of Borrelia burgdorferi sensu stricto, two of Borrelia garinii (Eurasian type), two of Borrelia afzelii, four of Borrelia lusitaniae and one of Borrelia valaisiana were identified. However, no Asian-type B. garinii was found. Interestingly, all Borrelia species that are known to be carried by I. ricinus were discovered among the 10 isolates. These results provide the first evidence for the existence of the Lyme borreliosis agent in Turkey.

Ultrastructural features of Borrelia garinii in naturally infected voles, Clethrionomys rufocanus, with special reference to the relationship with peripheral nerves

The ultrastructural features of Borrelia garinii found in the ear tissues of the vole, Clethrionomys rufocanus, are described. The spirochetes were observed in the interstitium of connective tissue or in contact with fibroblasts and were occasionally situated in the endoneurium of the peripheral nerves. The spirochetes did not injure or enter into the fibroblasts or Schwann cells. The cytotoxicity and migration of the spirochetes are also discussed.

Lyme disease Borrelia spp. in ticks and rodents from northwestern China

In May 1999, field surveys of Lyme disease spirochetes were conducted around the Tianshan Mountains in Xinjiang Uygur Autonomous Region in northwestern People's Republic of China. Ixodes persulcatus ticks were obtained in a Tianchi Lake valley with primary forest, while the tick fauna was poor in the semidesert or at higher altitudes in this region. Species identities were confirmed by molecular analysis in which an internal transcribed spacer sequence was used. Of 55 adult ticks, 22 (40%) were positive for spirochetes as determined by Barbour-Stoenner-Kelly culture passages. In addition, some rodents, including Apodemus uralensis (5 of 14 animals) and Cricetulus longicaudatus (the only animal examined), and some immature stages of I. persulcatus (4 of 11 ticks) that had fed on A. uralensis were positive for spirochetes. Based on 5S-23S rRNA intergenic spacer restriction fragment length polymorphism analysis and reactivity with monoclonal antibodies, 35 cultures (including double isolation cultures) were identified as Borrelia garinii (20 isolates, including 9 Eurasian pattern B isolates and 11 Asian pattern C isolates), Borrelia afzelii (10 pattern D isolates), and mixed cultures (5 cultures, including isolates that produced B. garinii patterns B and C plus B. afzelii pattern D). These findings revealed that Lyme disease pathogens are distributed in the mountainous areas in northwestern China even though it is an arid region, and they also confirmed the specific relationship between I. persulcatus and genetic patterns of Borrelia spp. on the Asian continent.

Western blot analysis for diagnosis of Lyme disease in acute facial palsy

BACKGROUND

Lyme borreliosis has been implicated in the pathogenesis of acute peripheral facial palsy (APFP). Few studies, however, have used Western blot analyses to confirm the serological diagnosis.

PURPOSE

To analyze the prevalence of anti-Borrelia antibodies in patients with APFP compared with healthy control subjects living in Hokkaido Island, Japan.

PATIENTS AND METHODS

In total, 113 patients with APFP were analyzed. They included 32 patients with varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome and zoster sine herpete) and 81 patients with Bell's palsy. Fifty-eight healthy control subjects were also included. IgM and IgG antibodies to Borrelia garinii and afzelii were tested by Western blot, and diagnoses were made according to the Centers for Disease Control and Prevention criteria.

RESULTS

Five of 81 (6.2%) patients with Bell's palsy, 1 of 32 (3.1%) patients with VZV reactivation, and 1 of 58 control subjects (1.7%) were judged to have both IgM and IgG antibodies to Borrelia. This difference was not significant (P >.05, chi2 test). Patients with Bell's palsy who had herpes simplex virus type 1 (HSV-1) reactivation at the onset of palsy had a higher IgM-immunoreactivity to Borrelia afzelii.

CONCLUSIONS

Although it is one of the endemic areas of Lyme disease in Japan, the prevalence of APFP caused by Lyme borreliosis is low in Hokkaido Island. In addition, cross-reactivity to B. afzelii in IgM blots is often observed in patients with HSV-1 reactivation, suggesting that careful interpretation of Borrelia IgM immunoblot data are needed for accurate serological diagnosis.

High prevalence of varicella-zoster virus reactivation in herpes simplex virus-seronegative patients with acute peripheral facial palsy

Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are considered to be the major causes of acute peripheral facial palsy (APFP). One hundred and forty-two patients with APFP were analyzed by serological assays and polymerase chain reaction analysis. Ramsay Hunt syndrome was diagnosed in 21 patients. Of the remaining 121 patients clinically diagnosed with Bell's palsy, VZV reactivation without zoster (zoster sine herpete) was detected in 35 patients (29%). The prevalence of antibodies to HSV among patients with Bell's palsy was significantly higher than the prevalence among those with VZV reactivation (Ramsay Hunt syndrome or zoster sine herpete). In contrast, a high incidence (88%) of VZV reactivation among HSV-seronegative patients with APFP was observed. Our data indicate that VZV is one of the major etiologic agents of clinically diagnosed Bell's palsy and that VZV reactivation causes APFP in most patients who lack antibodies to HSV.

Molecular typing of Borrelia burgdorferi sensu lato: taxonomic, epidemiological, and clinical implications

Borrelia burgdorferi sensu lato, the spirochete that causes human Lyme borreliosis (LB), is a genetically and phenotypically divergent species. In the past several years, various molecular approaches have been developed and used to determine the phenotypic and genetic heterogeneity within the LB-related spirochetes and their potential association with distinct clinical syndromes. These methods include serotyping, multilocus enzyme electrophoresis, DNA-DNA reassociation analysis, rRNA gene restriction analysis (ribotyping), pulsed-field gel electrophoresis, plasmid fingerprinting, randomly amplified polymorphic DNA fingerprinting analysis, species-specific PCR and PCR-based restriction fragment length polymorphism (RFLP) analysis, and sequence analysis of 16S rRNA and other conserved genes. On the basis of DNA-DNA reassociation analysis, 10 different Borrelia species have been described within the B. burgdorferi sensu lato complex: B. burgdorferi sensu stricto, Borrelia garinii, Borrelia afzelii, Borrelia japonica, Borrelia andersonii, Borrelia valaisiana, Borrelia lusitaniae, Borrelia tanukii, Borrelia turdi, and Borrelia bissettii sp. nov. To date, only B. burgdorferi sensu stricto, B. garinii, and B. afzelii are well known to be responsible for causing human disease. Different Borrelia species have been associated with distinct clinical manifestations of LB. In addition, Borrelia species are differentially distributed worldwide and may be maintained through different transmission cycles in nature. In this paper, the molecular methods used for typing of B. burgdorferi sensu lato are reviewed. The current taxonomic status of B. burgdorferi sensu lato and its epidemiological and clinical implications, especiallly correlation between the variable clinical presentations and the infecting Borrelia species, are discussed in detail.