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Hunfeld KP, Kraiczy P, Norris DE, Lohr B. The In Vitro Antimicrobial Susceptibility of Borrelia burgdorferi sensu lato: Shedding Light on the Known Unknowns. Pathogens 2023; 12:1204. [PMID: 37887720 PMCID: PMC10609913 DOI: 10.3390/pathogens12101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/28/2023] Open
Abstract
Human Lyme borreliosis (LB) represents a multisystem disorder that can progress in stages. The causative agents are transmitted by hard ticks of the Ixodes ricinus complex that have been infected with the spirochete Borrelia burgdorferi sensu lato. Today, LB is considered the most important human tick-borne illness in the Northern Hemisphere. The causative agent was identified and successfully isolated in 1982 and, shortly thereafter, antibiotic treatment was found to be safe and efficacious. Since then, various in vitro studies have been conducted in order to improve our knowledge of the activity of antimicrobial agents against B. burgdorferi s. l. The full spectrum of in vitro antibiotic susceptibility has still not been defined for some of the more recently developed compounds. Moreover, our current understanding of the in vitro interactions between B. burgdorferi s. l. and antimicrobial agents, and their possible mechanisms of resistance remains very limited and is largely based on in vitro susceptibility experiments on only a few isolates of Borrelia. Even less is known about the possible mechanisms of the in vitro persistence of spirochetes exposed to antimicrobial agents in the presence of human and animal cell lines. Only a relatively small number of laboratory studies and cell culture experiments have been conducted. This review summarizes what is and what is not known about the in vitro susceptibility of B. burgdorferi s. l. It aims to shed light on the known unknowns that continue to fuel current debates on possible treatment resistance and mechanisms of persistence of Lyme disease spirochetes in the presence of antimicrobial agents.
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Affiliation(s)
- Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Academic Teaching Hospital, Medical Faculty, Goethe University Frankfurt, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Germany;
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Ubierstraße 20, D-40223 Düsseldorf, Germany
| | - Peter Kraiczy
- Institute for Medical Microbiology & Infection Control, University Hospital Frankfurt, Goethe University Frankfurt, Paul-Ehrlich Str. 40, D-60596 Frankfurt am Main, Germany;
| | - Douglas E. Norris
- W. Harry Feinstone Department of Molecular Microbiology & Immunology, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA;
| | - Benedikt Lohr
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Academic Teaching Hospital, Medical Faculty, Goethe University Frankfurt, Steinbacher Hohl 2-26, D-60488 Frankfurt am Main, Germany;
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Papp M, Tóth AG, Valcz G, Makrai L, Nagy SÁ, Farkas R, Solymosi N. Antimicrobial resistance gene lack in tick-borne pathogenic bacteria. Sci Rep 2023; 13:8167. [PMID: 37210378 DOI: 10.1038/s41598-023-35356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
Tick-borne infections, including those of bacterial origin, are significant public health issues. Antimicrobial resistance (AMR), which is one of the most pressing health challenges of our time, is driven by specific genetic determinants, primarily by the antimicrobial resistance genes (ARGs) of bacteria. In our work, we investigated the occurrence of ARGs in the genomes of tick-borne bacterial species that can cause human infections. For this purpose, we processed short/long reads of 1550 bacterial isolates of the genera Anaplasma (n = 20), Bartonella (n = 131), Borrelia (n = 311), Coxiella (n = 73), Ehrlichia (n = 13), Francisella (n = 959) and Rickettsia (n = 43) generated by second/third generation sequencing that have been freely accessible at the NCBI SRA repository. From Francisella tularensis, 98.9% of the samples contained the FTU-1 beta-lactamase gene. However, it is part of the F. tularensis representative genome as well. Furthermore, 16.3% of them contained additional ARGs. Only 2.2% of isolates from other genera (Bartonella: 2, Coxiella: 8, Ehrlichia: 1, Rickettsia: 2) contained any ARG. We found that the odds of ARG occurrence in Coxiella samples were significantly higher in isolates related to farm animals than from other sources. Our results describe a surprising lack of ARGs in these bacteria and suggest that Coxiella species in farm animal settings could play a role in the spread of AMR.
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Affiliation(s)
- Márton Papp
- Centre for Bioinformatics, University of Veterinary Medicine, Budapest, 1078, Hungary
| | - Adrienn Gréta Tóth
- Centre for Bioinformatics, University of Veterinary Medicine, Budapest, 1078, Hungary
| | - Gábor Valcz
- Translational Extracellular Vesicle Research Group, Eötvös Loránd Research Network-Semmelweis University, Budapest, 1089, Hungary
- Department of Image Analysis, 3DHISTECH Ltd., Budapest, 1141, Hungary
| | - László Makrai
- Department of Microbiology and Infectious Diseases, University of Veterinary Medicine, Budapest, 1143, Hungary
| | - Sára Ágnes Nagy
- Centre for Bioinformatics, University of Veterinary Medicine, Budapest, 1078, Hungary
| | - Róbert Farkas
- Department of Parasitology and Zoology, University of Veterinary Medicine, Budapest, 1078, Hungary
| | - Norbert Solymosi
- Centre for Bioinformatics, University of Veterinary Medicine, Budapest, 1078, Hungary.
- Department of Physics of Complex Systems, Eötvös Loránd University, Budapest, 1117, Hungary.
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Cleveland DW, Anderson CC, Brissette CA. Borrelia miyamotoi: A Comprehensive Review. Pathogens 2023; 12:267. [PMID: 36839539 PMCID: PMC9967256 DOI: 10.3390/pathogens12020267] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Borrelia miyamotoi is an emerging tick-borne pathogen in the Northern Hemisphere and is the causative agent of Borrelia miyamotoi disease (BMD). Borrelia miyamotoi is vectored by the same hard-bodied ticks as Lyme disease Borrelia, yet phylogenetically groups with relapsing fever Borrelia, and thus, has been uniquely labeled a hard tick-borne relapsing fever Borrelia. Burgeoning research has uncovered new aspects of B. miyamotoi in human patients, nature, and the lab. Of particular interest are novel findings on disease pathology, prevalence, diagnostic methods, ecological maintenance, transmission, and genetic characteristics. Herein, we review recent literature on B. miyamotoi, discuss how findings adapt to current Borrelia doctrines, and briefly consider what remains unknown about B. miyamotoi.
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Affiliation(s)
| | | | - Catherine A. Brissette
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND 58202, USA
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Hoornstra D, Azagi T, van Eck JA, Wagemakers A, Koetsveld J, Spijker R, Platonov AE, Sprong H, Hovius JW. Prevalence and clinical manifestation of Borrelia miyamotoi in Ixodes ticks and humans in the northern hemisphere: a systematic review and meta-analysis. THE LANCET. MICROBE 2022; 3:e772-e786. [PMID: 36113496 DOI: 10.1016/s2666-5247(22)00157-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Various studies have evaluated the infection of Ixodes ticks and humans with the relapsing fever spirochaete Borrelia miyamotoi. However, to our knowledge, the prevalence of infection and disease has not been assessed systematically. We aimed to examine the prevalence of B miyamotoi in Ixodes ticks and humans, and the disease it can cause, in the northern hemisphere. METHODS For this systematic review and meta-analysis, we searched PubMed and Web of Science up to March 1, 2021. Studies assessing Ixodes tick infection published since Jan 1, 2011 were eligible, whereas no time limitation was placed on reports of human infection and disease. We extracted B miyamotoi test positivity ratios and used a random-effects model to calculate estimated proportions of infected ticks, infected humans, and human disease with 95% CI. This study was registered with PROSPERO, CRD42021268996. FINDINGS We identified 730 studies through database searches and 316 additional studies that referenced two seminal articles on B miyamotoi. Of these 1046 studies, 157 were included in the review, reporting on 165 637 questing ticks, 45 608 unique individuals, and 504 well described cases of B miyamotoi disease in humans. In ticks, the highest prevalence of B miyamotoi was observed in Ixodes persulcatus (2·8%, 95% CI 2·4-3·1) and the lowest in Ixodes pacificus (0·7%, 0·6-0·8). The overall seroprevalence in humans was 4·4% (2·8-6·3), with significantly (p<0·0001) higher seroprevalences in the high-risk group (4·6%, 2·6-7·1), participants with confirmed or suspected Lyme borreliosis (4·8%, 1·8-8·8), and individuals suspected of having a different tick-borne disease (11·9%, 5·6-19·9) than in healthy controls (1·3%, 0·4-2·8). Participants suspected of having a different tick-borne disease tested positive for B miyamotoi by PCR significantly more often than did the high-risk group (p=0·025), with individuals in Asia more likely to test positive than those in the USA (odds ratio 14·63 [95% CI 2·80-76·41]). INTERPRETATION B miyamotoi disease should be considered an emerging infectious disease, especially in North America and Asia. Prospective studies and increased awareness are required to obtain further insights into the burden of disease. FUNDING ZonMW and the European Regional Development Fund (Interreg).
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Affiliation(s)
- Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Tal Azagi
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jacqueline A van Eck
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Alex Wagemakers
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Joris Koetsveld
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - René Spijker
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Hein Sprong
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands.
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Insights from experience in the treatment of tick-borne bacterial coinfections with tick-borne encephalitis. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 2022. [DOI: 10.1016/bs.armc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wormser GP. Doxycycline for Prevention of Spirochetal Infections: Status Report. Clin Infect Dis 2021; 71:2014-2017. [PMID: 32157268 DOI: 10.1093/cid/ciaa240] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/05/2020] [Indexed: 11/14/2022] Open
Abstract
Important human infections caused by spirochetal microorganisms include Lyme disease, syphilis, leptospirosis, and tick-borne relapsing fever. Doxycycline prophylactic regimens have been shown to significantly reduce the risk for developing all of these infections in potentially exposed individuals, which is highly clinically relevant as no vaccines to prevent these infections in humans are currently available. Additional data, however, are needed to define more precisely the level of efficacy of the doxycycline prophylactic regimens, especially for Lyme disease and syphilis, infections that can be potentially prevented by a single 200-mg dose of doxycycline given within 72 hours postexposure.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, New York, USA
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Della-Giustina D, Duke C, Goldflam K. Underrecognized Tickborne Illnesses: Borrelia Miyamotoi and Powassan Virus. Wilderness Environ Med 2021; 32:240-246. [PMID: 33839017 DOI: 10.1016/j.wem.2021.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
Over the past 2 decades, tickborne disease has been increasingly recognized as a threat to humans as a result of the growing geographic range of ticks. This review describes 2 tickborne diseases, Borrelia miyamotoi and Powassan virus, that likely have a significant impact on humans, yet are underdiagnosed compared to most other tickborne diseases. We performed a literature search from 2015 to 2020. Borrelia miyamotoi is a tickborne pathogen that infects and co-infects ticks along with other pathogens, including Borrelia burgdorferi. Because B miyamotoi infects the same Ixodes ticks as B burgdorferi, B miyamotoi may cover a similar geographic range. B miyamotoi infection may be underdiagnosed for 2 reasons. First, a presumptive treatment approach to Lyme disease may result in B miyamotoi infection treatment without identification of the actual cause. Second, the absence of readily available testing and diagnostic criteria makes it difficult to diagnose B miyamotoi infection. Powassan virus is a tickborne flavivirus similar to the dengue virus. Powassan virus disease appears to have an asymptomatic or minimally symptomatic presentation in most people but can cause devastating and fatal encephalitis. The Powassan virus may be transmitted in less than 15 min of tick feeding. Powassan virus disease is a difficult diagnosis because testing capabilities are limited and because there may be co-infection with other tickborne pathogens.
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Affiliation(s)
| | - Charles Duke
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
| | - Katja Goldflam
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT
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Gao PF, Lei G, Huang CZ. Dark-Field Microscopy: Recent Advances in Accurate Analysis and Emerging Applications. Anal Chem 2021; 93:4707-4726. [DOI: 10.1021/acs.analchem.0c04390] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Peng Fei Gao
- Key Laboratory of Luminescence Analysis and Molecular Sensing (Southwest University), Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Gang Lei
- Key Laboratory of Luminescence Analysis and Molecular Sensing (Southwest University), Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Cheng Zhi Huang
- Key Laboratory of Luminescence Analysis and Molecular Sensing (Southwest University), Ministry of Education, College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
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Abstract
Relapsing fever (RF) is caused by several species of Borrelia; all, except two species, are transmitted to humans by soft (argasid) ticks. The species B. recurrentis is transmitted from one human to another by the body louse, while B. miyamotoi is vectored by hard-bodied ixodid tick species. RF Borrelia have several pathogenic features that facilitate invasion and dissemination in the infected host. In this article we discuss the dynamics of vector acquisition and subsequent transmission of RF Borrelia to their vertebrate hosts. We also review taxonomic challenges for RF Borrelia as new species have been isolated throughout the globe. Moreover, aspects of pathogenesis including symptomology, neurotropism, erythrocyte and platelet adhesion are discussed. We expound on RF Borrelia evasion strategies for innate and adaptive immunity, focusing on the most fundamental pathogenetic attributes, multiphasic antigenic variation. Lastly, we review new and emerging species of RF Borrelia and discuss future directions for this global disease.
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Affiliation(s)
- Job Lopez
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston TX, USA
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam Medical centers, location Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Sven Bergström
- Department of Molecular Biology, Umeå Center for Microbial Research, Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
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Koetsveld J, Platonov AE, Kuleshov K, Wagemakers A, Hoornstra D, Ang W, Szekeres S, van Duijvendijk GLA, Fikrig E, Embers ME, Sprong H, Hovius JW. Borrelia miyamotoi infection leads to cross-reactive antibodies to the C6 peptide in mice and men. Clin Microbiol Infect 2019; 26:513.e1-513.e6. [PMID: 31404672 DOI: 10.1016/j.cmi.2019.07.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/11/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Borrelia miyamotoi is a relapsing fever Borrelia, transmitted by hard (Ixodes) ticks, which are also the main vector for Borrelia burgdorferi. A widely used test for serodiagnosis of Lyme borreliosis is an enzyme immunoassay (EIA) based on the C6 peptide of the B. burgdorferi sl VlsE protein. We set out to study C6 reactivity upon infection with B. miyamotoi in a large well-characterized set of B. miyamotoi disease (BMD) patient sera and in experimental murine infection. METHODS We performed in silico analyses, comparing the C6-peptide to immunodominant B. miyamotoi variable large proteins (Vlps). Next, we determined C6 reactivity in sera from mice infected with B. miyamotoi and in a unique longitudinal set of 191 sera from 46 BMD patients. RESULTS In silico analyses revealed similarity of the C6 peptide to domains within B. miyamotoi Vlps. Cross-reactivity against the C6 peptide was confirmed in 21 out of 24 mice experimentally infected with B. miyamotoi. Moreover, 35 out of 46 BMD patients had a C6 EIA Lyme index higher than 1.1 (positive). Interestingly, 27 out of 37 patients with a C6 EIA Lyme index higher than 0.9 (equivocal) were negative when tested for specific B. burgdorferi sl antibodies using a commercially available immunoblot. CONCLUSIONS We show that infection with B. miyamotoi leads to cross-reactive antibodies to the C6 peptide. Since BMD and Lyme borreliosis are found in the same geographical locations, caution should be used when relying solely on C6 reactivity testing. We propose that a positive C6 EIA with negative immunoblot, especially in patients with fever several weeks after a tick bite, warrants further testing for B. miyamotoi.
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Affiliation(s)
- J Koetsveld
- AMC Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, the Netherlands.
| | - A E Platonov
- Central Research Scientific Institute of Epidemiology, Laboratory for Zoonoses, Moscow, Russia
| | - K Kuleshov
- Central Research Scientific Institute of Epidemiology, Laboratory for Zoonoses, Moscow, Russia
| | - A Wagemakers
- AMC Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, the Netherlands
| | - D Hoornstra
- AMC Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, the Netherlands
| | - W Ang
- VU University Medical Centre, Medical Microbiology and Infection Control, Amsterdam, the Netherlands
| | - S Szekeres
- National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, the Netherlands
| | - G L A van Duijvendijk
- National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, the Netherlands
| | - E Fikrig
- Yale University, Internal Medicine, New Haven, USA
| | - M E Embers
- Tulane University, Division of Bacteriology and Parasitology, Covington, USA
| | - H Sprong
- National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, the Netherlands
| | - J W Hovius
- AMC Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, the Netherlands
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Paris DH, Neumayr A. Ticks and tick-borne infections in Asia: Implications for travellers. Travel Med Infect Dis 2018; 26:3-4. [DOI: 10.1016/j.tmaid.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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