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Rowan S, Mohseni N, Chang M, Burger H, Peters M, Mir S. From Tick to Test: A Comprehensive Review of Tick-Borne Disease Diagnostics and Surveillance Methods in the United States. Life (Basel) 2023; 13:2048. [PMID: 37895430 PMCID: PMC10608558 DOI: 10.3390/life13102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Tick-borne diseases (TBDs) have become a significant public health concern in the United States over the past few decades. The increasing incidence and geographical spread of these diseases have prompted the implementation of robust surveillance systems to monitor their prevalence, distribution, and impact on human health. This comprehensive review describes key disease features with the geographical distribution of all known tick-borne pathogens in the United States, along with examining disease surveillance efforts, focusing on strategies, challenges, and advancements. Surveillance methods include passive and active surveillance, laboratory-based surveillance, sentinel surveillance, and a One Health approach. Key surveillance systems, such as the National Notifiable Diseases Surveillance System (NNDSS), TickNET, and the Tick-Borne Disease Laboratory Network (TBDLN), are discussed. Data collection and reporting challenges, such as underreporting and misdiagnosis, are highlighted. The review addresses challenges, including lack of standardization, surveillance in non-human hosts, and data integration. Innovations encompass molecular techniques, syndromic surveillance, and tick surveillance programs. Implications for public health cover prevention strategies, early detection, treatment, and public education. Future directions emphasize enhanced surveillance networks, integrated vector management, research priorities, and policy implications. This review enhances understanding of TBD surveillance, aiding in informed decision-making for effective disease prevention and control. By understanding the current surveillance landscape, public health officials, researchers, and policymakers can make informed decisions to mitigate the burden of (TBDs).
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Affiliation(s)
| | | | | | | | | | - Sheema Mir
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91766, USA; (S.R.)
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Guérin M, Shawky M, Zedan A, Octave S, Avalle B, Maffucci I, Padiolleau-Lefèvre S. Lyme borreliosis diagnosis: state of the art of improvements and innovations. BMC Microbiol 2023; 23:204. [PMID: 37528399 PMCID: PMC10392007 DOI: 10.1186/s12866-023-02935-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
With almost 700 000 estimated cases each year in the United States and Europe, Lyme borreliosis (LB), also called Lyme disease, is the most common tick-borne illness in the world. Transmitted by ticks of the genus Ixodes and caused by bacteria Borrelia burgdorferi sensu lato, LB occurs with various symptoms, such as erythema migrans, which is characteristic, whereas others involve blurred clinical features such as fatigue, headaches, arthralgia, and myalgia. The diagnosis of Lyme borreliosis, based on a standard two-tiered serology, is the subject of many debates and controversies, since it relies on an indirect approach which suffers from a low sensitivity depending on the stage of the disease. Above all, early detection of the disease raises some issues. Inappropriate diagnosis of Lyme borreliosis leads to therapeutic wandering, inducing potential chronic infection with a strong antibody response that fails to clear the infection. Early and proper detection of Lyme disease is essential to propose an adequate treatment to patients and avoid the persistence of the pathogen. This review presents the available tests, with an emphasis on the improvements of the current diagnosis, the innovative methods and ideas which, ultimately, will allow more precise detection of LB.
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Affiliation(s)
- Mickaël Guérin
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Marc Shawky
- Connaissance Organisation Et Systèmes TECHniques (COSTECH), EA 2223, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Ahed Zedan
- Polyclinique Saint Côme, 7 Rue Jean Jacques Bernard, 60204, Compiègne, France
| | - Stéphane Octave
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Bérangère Avalle
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Irene Maffucci
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Séverine Padiolleau-Lefèvre
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France.
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Clinical Evaluation of a Borrelia Modified Two-Tiered Testing (MTTT) Shows Increased Early Sensitivity for Borrelia burgdorferi But Not Other Endemic Borrelia Species in A High Incidence Region for Lyme Disease in Wisconsin. Diagn Microbiol Infect Dis 2022; 105:115837. [DOI: 10.1016/j.diagmicrobio.2022.115837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022]
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Kugeler KJ, Cervantes K, Brown CM, Horiuchi K, Schiffman E, Lind L, Barkley J, Broyhill J, Murphy J, Crum D, Robinson S, Kwit NA, Mullins J, Sun J, Hinckley AF. Potential quantitative effect of a laboratory-based approach to Lyme disease surveillance in high-incidence states. Zoonoses Public Health 2022; 69:451-457. [PMID: 35253377 PMCID: PMC10949917 DOI: 10.1111/zph.12933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
Historically, public health surveillance for Lyme disease has required clinical follow-up on positive laboratory reports for the purpose of case classification. In areas with sustained high incidence of the disease, this resource-intensive activity yields a limited benefit to public health practice. A range of burden-reducing strategies have been implemented in many states, creating inconsistencies that limit the ability to decipher trends. Laboratory-based surveillance, or surveillance based solely on positive laboratory reports without follow-up for clinical information on positive laboratory reports, emerged as a feasible alternative to improve standardization in already high-incidence areas. To inform expectations of a laboratory-based surveillance model, we conducted a retrospective analysis of Lyme disease data collected during 2012-2018 from 10 high-incidence states. The number of individuals with laboratory evidence of infection ranged from 1302 to 20,994 per state and year. On average, 55% of those were ultimately classified as confirmed or probable cases (range: 29%-86%). Among all individuals with positive laboratory evidence, 18% (range: 2%-37%) were determined to be 'not a case' upon investigation and 23% (range: 2%-52%) were classified as suspect cases due to lack of associated clinical information and thus were not reported to the Centers for Disease Control and Prevention (CDC). The number of reported cases under a laboratory-based approach to surveillance in high-incidence states using recommended two-tier testing algorithms is likely to be, on average, 1.2 times higher (range: 0.6-1.8 times) than what was reported to CDC during 2012-2018. A laboratory-based surveillance approach for high-incidence states will improve standardization and reduce burden on public health systems, allowing public health resources to focus on prevention messaging, exploration of novel prevention strategies and alternative data sources to yield information on the epidemiology of Lyme disease.
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Affiliation(s)
- Kiersten J. Kugeler
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Kim Cervantes
- New Jersey Department of Health, Trenton, New Jersey, USA
| | | | - Kalanthe Horiuchi
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | | | - Leah Lind
- Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
| | - Jonathan Barkley
- Rhode Island Department of Health, Providence, Rhode Island, USA
| | | | - Julia Murphy
- Virginia Department of Health, Richmond, Virginia, USA
| | - David Crum
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Augusta, Maine, USA
| | | | - Jocelyn Mullins
- Connecticut Department of Health, Hartford, Connecticut, USA
| | - Jianxin Sun
- Connecticut Department of Health, Hartford, Connecticut, USA
| | - Alison F. Hinckley
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Gwynne PJ, Clendenen LH, Turk SP, Marques AR, Hu LT. Antiphospholipid autoantibodies in Lyme disease arise after scavenging of host phospholipids by Borrelia burgdorferi. J Clin Invest 2022; 132:152506. [PMID: 35289310 PMCID: PMC8920326 DOI: 10.1172/jci152506] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Abstract
A close association with its vertebrate and tick hosts allows Borrelia burgdorferi, the bacterium responsible for Lyme disease, to eliminate many metabolic pathways and instead scavenge key nutrients from the host. A lipid-defined culture medium was developed to demonstrate that exogenous lipids are an essential nutrient of B. burgdorferi, which can accumulate intact phospholipids from its environment to support growth. Antibody responses to host phospholipids were studied in mice and humans using an antiphospholipid ELISA. Several of these environmentally acquired phospholipids including phosphatidylserine and phosphatidic acid, as well as borrelial phosphatidylcholine, are the targets of antibodies that arose early in infection in the mouse model. Patients with acute infections demonstrated antibody responses to the same lipids. The elevation of antiphospholipid antibodies predicted early infection with better sensitivity than did the standardized 2-tier tests currently used in diagnosis. Sera obtained from patients with Lyme disease before and after antibiotic therapy showed declining antiphospholipid titers after treatment. Further study will be required to determine whether these antibodies have utility in early diagnosis of Lyme disease, tracking of the response to therapy, and diagnosis of reinfection, areas in which current standardized tests are inadequate.
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Affiliation(s)
- Peter J Gwynne
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Luke H Clendenen
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Siu-Ping Turk
- Laboratory of Clinical Microbiology and Immunology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Adriana R Marques
- Laboratory of Clinical Microbiology and Immunology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Linden T Hu
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
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Senger RS, Sayed Issa A, Agnor B, Talty J, Hollis A, Robertson JL. Disease-Associated Multimolecular Signature in the Urine of Patients with Lyme Disease Detected Using Raman Spectroscopy and Chemometrics. APPLIED SPECTROSCOPY 2022; 76:284-299. [PMID: 35102746 DOI: 10.1177/00037028211061769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A urine-based screening technique for Lyme disease (LD) was developed in this research. The screen is based on Raman spectroscopy, iterative smoothing-splines with root error adjustment (ISREA) spectral baselining, and chemometric analysis using Rametrix software. Raman spectra of urine from 30 patients with positive serologic tests (including the US Centers for Disease Control [CDC] two-tier standard) for LD were compared against subsets of our database of urine spectra from 235 healthy human volunteers, 362 end-stage kidney disease (ESKD) patients, and 17 patients with active or remissive bladder cancer (BCA). We found statistical differences (p < 0.001) between urine scans of healthy volunteers and LD-positive patients. We also found a unique LD molecular signature in urine involving 112 Raman shifts (31 major Raman shifts) with significant differences from urine of healthy individuals. We were able to distinguish the LD molecular signature as statistically different (p < 0.001) from the molecular signatures of ESKD and BCA. When comparing LD-positive patients against healthy volunteers, the Rametrix-based urine screen performed with 86.7% for overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively. When considering patients with ESKD and BCA in the LD-negative group, these values were 88.7% (accuracy), 83.3% (sensitivity), 91.0% (specificity), 80.7% (PPV), and 92.4% (NPV). Additional advantages to the Raman-based urine screen include that it is rapid (minutes per analysis), is minimally invasive, requires no chemical labeling, uses a low-profile, off-the-shelf spectrometer, and is inexpensive relative to other available LD tests.
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Affiliation(s)
- Ryan S Senger
- Department of Biological Systems Engineering, 1757Virginia Tech, Blacksburg, Virginia, USA
- DialySensors Inc., Blacksburg, Virginia, USA
| | | | - Ben Agnor
- Department of Biological Systems Engineering, 1757Virginia Tech, Blacksburg, Virginia, USA
| | - Janine Talty
- Neuromusculoskeletal Medicine & OMM, Roanoke, Virginia, USA
| | | | - John L Robertson
- DialySensors Inc., Blacksburg, Virginia, USA
- Department of Biomedical Engineering and Mechanics, 1757Virginia Tech, Blacksburg, Virginia, USA
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Marques A, Okpali G, Liepshutz K, Ortega‐Villa AM. Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States. Ann Clin Transl Neurol 2022; 9:41-49. [PMID: 35064770 PMCID: PMC8791801 DOI: 10.1002/acn3.51488] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Facial palsy is the most common manifestation of Lyme neuroborreliosis (LNB) in the United States. This study aimed to describe features of patients with early LNB presenting with facial palsy and to determine if corticosteroids in addition to antibiotic therapy was associated with unfavorable outcome. METHODS Retrospective analysis of participants enrolled in clinical studies investigating Lyme disease (N = 486) identified 44 patients who had facial palsy from LNB. The House-Brackmann scale was used to quantify the facial nerve dysfunction. RESULTS Most patients presented in the summer months. Erythema migrans, frequently associated with systemic symptoms, occurred in 29 patients. Thirteen patients presented with bilateral facial palsy, usually with sequential involvement. Fourteen patients had painful radiculopathy. Of the 38 patients treated with antibiotics before the resolution of the palsy who had complete follow-up, 24 received both antibiotics and corticosteroids. Of these 38 patients, 34 recovered completely, 3 had nearly complete recovery, and 1 had moderate dysfunction. There were no differences between the treatment groups in achieving complete resolution of the palsy at 12 months or in time to complete recovery. INTERPRETATION A history of rash compatible with erythema migrans or febrile illness in the weeks preceding the palsy are helpful clues pointing toward LNB and should be actively sought when evaluating patients with acute-onset peripheral facial palsy, particularly bilateral facial palsy. Treatment with antibiotic therapy is highly effective and most patients will fully recover facial nerve function. Adjunctive corticosteroid therapy appears to not affect the speed of recovery or overall outcome in this retrospective observational study.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Microbiology and ImmunologyNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | - Grace Okpali
- Laboratory of Clinical Microbiology and ImmunologyNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | - Kelly Liepshutz
- Clinical Monitoring Research Program DirectorateFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | - Ana Maria Ortega‐Villa
- Biostatistics Research Branch, Division of Clinical ResearchNational Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
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Porwancher R, Landsberg L. Optimizing use of multi-antibody assays for Lyme disease diagnosis: A bioinformatic approach. PLoS One 2021; 16:e0253514. [PMID: 34499659 PMCID: PMC8428682 DOI: 10.1371/journal.pone.0253514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
Multiple different recombinant and peptide antigens are now available for serodiagnosis of Lyme disease (LD), but optimizing test utilization remains challenging. Since 1995 the Centers for Disease Control and Prevention (CDC) has recommended a 2-tiered serologic approach consisting of a first-tier whole-cell enzyme immunoassay (EIA) for polyvalent antibodies to Borrelia burgdorferi followed by confirmation of positive or equivocal results by IgG and IgM immunoblots [standard 2-tiered (STT) approach]. Newer modified 2-tiered (MTT) approaches employ a second-tier EIA to detect antibodies to B. burgdorferi rather than immunoblotting. We applied modern bioinformatic techniques to a large public database of recombinant and peptide antigen-based immunoassays to improve testing strategy. A retrospective CDC collection of 280 LD samples and 559 controls had been tested using the STT approach as well as kinetic-EIAs for VlsE1-IgG, C6-IgG, VlsE1-IgM, and pepC10-IgM antibodies. When used individually, the cutoff for each kinetic-EIA was set to generate 99% specificity. Utilizing logistic-likelihood regression analysis and receiver operating characteristic (ROC) techniques we determined that VlsE1-IgG, C6-IgG, and pepC10-IgM antibodies each contributed significant diagnostic information; a single-tier diagnostic score (DS) was generated for each sample using a weighted linear combination of antibody levels to these 3 antigens. DS performance was then compared to the STT and to MTT models employing different combinations of kinetic-EIAs. After setting the DS cutoff to match STT specificity (99%), the DS was 22.5% more sensitive than the STT for early-acute-phase disease (95% CI: 11.8% to 32.2%), 16.0% more sensitive for early-convalescent-phase disease (95% CI: 7.2% to 24.7%), and equivalent for detection of disseminated infection. The DS was also significantly more sensitive for early-acute-phase LD than MTT models whose specificity met or exceeded 99%. Prospective validation of this single-tier diagnostic score for Lyme disease will require larger studies using a broader range of potential cross-reacting conditions.
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Affiliation(s)
- Richard Porwancher
- Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
- Infectious Disease Consultants, PC, Mercerville, New Jersey, United States of America
| | - Lisa Landsberg
- Clinical Research Operations & Regulatory Affairs, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States of America
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Abstract
Lyme disease, or Lyme borreliosis, is the most common tickborne disease in the United States and Europe. In both locations, Ixodes species ticks transmit the Borrelia burgdorferi sensu lato bacteria species responsible for causing the infection. The diversity of Borrelia species that cause human infection is greater in Europe; the 2 B. burgdorferi s.l. species collectively responsible for most infections in Europe, B. afzelii and B. garinii, are not found in the United States, where most infections are caused by B. burgdorferi sensu stricto. Strain differences seem to explain some of the variation in the clinical manifestations of Lyme disease, which are both minor and substantive, between the United States and Europe. Future studies should attempt to delineate the specific virulence factors of the different species of B. burgdorferi s.l. responsible for these variations in clinical features.
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Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1-e48. [PMID: 33417672 DOI: 10.1093/cid/ciaa1215] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
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Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Yngve T Falck-Ytter
- Case Western Reserve University, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | | | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Baldwin
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Kiran K Belani
- Childrens Hospital and Clinical of Minnesota, Minneapolis, Minnesota, USA
| | - William R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David B Clifford
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Peter J Krause
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | | | | | - Amy A Pruitt
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Rips
- Consumer Representative, Omaha, Nebraska, USA
| | | | | | | | - Allen C Steere
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franc Strle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Sundel
- Boston Children's Hospital Boston, Massachusetts, USA
| | - Jean Tsao
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Lawrence S Zemel
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Lopez-Nunez O, Srivastava P, Wheeler BJ, Oakes N, Thomas H, Nowalk A, Wheeler S. Pediatric decision limits for serologic screening of Lyme disease. Clin Biochem 2021; 91:59-62. [PMID: 33617846 DOI: 10.1016/j.clinbiochem.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laboratory diagnosis of Lyme disease (LD) relies on a two-tier protocol. We have observed disproportionate equivocal serologies in children requiring reflex western blot (WB) using manufacturer-provided ranges based on adult studies. We aimed to determine appropriate ranges for our pediatric population. METHODS We performed a one-year retrospective institutional review of all 2755 children with LD testing with the Vidas® Lyme IgM II/IgG II immunoassays with reflex to WB for equivocal/positive serologies. Results were assessed by frequency distributions, optimization via percent agreement analysis, and clinical adjudication. RESULTS The proposed ranges for IgM (negative ≤0.20, equivocal ≥0.21 to <0.32, positive ≥0.32) and IgG (negative ≤0.50, positive >0.50) allowed for a decrease in the IgM equivocal rate (7% to 2%) and IgG positive rate (15% to 13%). There was a decrease in the positive percent agreement between tiers (95% to 83% and 98% to 95%) with increase in the negative (32% to 63% and 70% to 81%) and overall (65% to 73% and 85% to 88%) percent agreements for IgM and IgG, respectively. Of 15 IgM serologies reclassified as negative with a positive WB and not positive for IgG, 8 were clinically negative, 5 were clinically positive, and two had insufficient history. Of the 10 IgG serologies reclassified as negative with a positive WB 3 were clinically positive, 6 were clinically negative and one had insufficient history. CONCLUSIONS Our modified ranges are more suitable for our pediatric population while reducing overdiagnosis, unnecessary treatment, diagnostic uncertainty, and turnaround time.
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Affiliation(s)
- Oscar Lopez-Nunez
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Pooja Srivastava
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bradley J Wheeler
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicole Oakes
- Department of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Holly Thomas
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh PA, USA
| | - Andrew Nowalk
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh PA, USA; University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Sarah Wheeler
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh PA, USA.
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Abstract
Lyme borreliosis is caused by a growing list of related, yet distinct, spirochetes with complex biology and sophisticated immune evasion mechanisms. It may result in a range of clinical manifestations involving different organ systems, and can lead to persistent sequelae in a subset of cases. The pathogenesis of Lyme borreliosis is incompletely understood, and laboratory diagnosis, the focus of this review, requires considerable understanding to interpret the results correctly. Direct detection of the infectious agent is usually not possible or practical, necessitating a continued reliance on serologic testing. Still, some important advances have been made in the area of diagnostics, and there are many promising ideas for future assay development. This review summarizes the state of the art in laboratory diagnostics for Lyme borreliosis, provides guidance in test selection and interpretation, and highlights future directions.
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13
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Erdman MD, Kossari N, Ye J, Reynolds KH, Blodget E, Mozayeni BR, Rahbar FS. Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness - Experience in an Urban Gastroenterology Practice. J Patient Cent Res Rev 2021; 8:39-47. [PMID: 33511252 DOI: 10.17294/2330-0698.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose In the clinical setting, it is not common practice to consider a vector bite, such as from a tick or flea, to be a contributing factor to chronic digestive symptoms. This article investigates associations we have observed among symptomatic patients and positive blood tests for vector-borne illness (VBI). Methods Patients who visited an urban gastroenterology clinic over a 3-year period were retrospectively reviewed. A total of 270 patients presenting with a constellation of digestive symptoms - and who had no apparent digestive pathology and reported no prior diagnosis or treatments for VBI - were analyzed. Before the initial visit, all patients completed a review of systems medical history form, which comprised 19 gastrointestinal (GI) symptoms and 73 non-GI-related symptoms and conditions. Patients were tested for small intestinal bacterial overgrowth (SIBO) by lactulose breath test. VBI (babesiosis, ehrlichiosis, anaplasmosis, bartonellosis, borreliosis) was established using 1 or more of several blood tests. Odds ratio (OR) analysis determined associations between exposure to VBI, SIBO, and presenting symptoms/conditions. Two age groups (≤35 years and ≥36 years) were studied using Cochran-Mantel-Haenszel stratum-based test. Results A higher OR (2.03, 95% CI: 1.5-3.6) was found between patients with ≥3 digestive symptoms and positive blood tests for ≥1 VBI. Five of the 19 GI symptoms were independently associated with VBI-positive samples: food intolerance, indigestion, nausea/vomiting, constipation, and heartburn. A similar association in patients with ≥3 non-GI symptoms (OR: 2.83, 95% CI: 1.3-6.4) was observed. Five of the 73 non-GI symptoms/conditions were independently associated with VBI-positive samples: chest pain, shortness of breath, extremity or joint pain, anxiety, and night sweats. Having ≥3 of any digestive or nondigestive symptoms generated significant relative risk of being VBI-positive. Presence of SIBO alone did not identify significant relative risk for a VBI, and age was not a confounder. Conclusions Findings revealed an association between positive blood tests for vector-borne illness and chronically symptomatic patients regardless of whether symptoms were digestive or nondigestive. The manifestation of 3 or more gastrointestinal and/or extraintestinal symptoms should raise suspicion for a VBI.
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Affiliation(s)
- Michael D Erdman
- Los Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CA
| | - Niloofar Kossari
- Los Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CA
| | - Jessica Ye
- Los Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CA
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14
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Coburn J, Garcia B, Hu LT, Jewett MW, Kraiczy P, Norris SJ, Skare J. Lyme Disease Pathogenesis. Curr Issues Mol Biol 2020; 42:473-518. [PMID: 33353871 DOI: 10.21775/cimb.042.473] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lyme disease Borrelia are obligately parasitic, tick- transmitted, invasive, persistent bacterial pathogens that cause disease in humans and non-reservoir vertebrates primarily through the induction of inflammation. During transmission from the infected tick, the bacteria undergo significant changes in gene expression, resulting in adaptation to the mammalian environment. The organisms multiply and spread locally and induce inflammatory responses that, in humans, result in clinical signs and symptoms. Borrelia virulence involves a multiplicity of mechanisms for dissemination and colonization of multiple tissues and evasion of host immune responses. Most of the tissue damage, which is seen in non-reservoir hosts, appears to result from host inflammatory reactions, despite the low numbers of bacteria in affected sites. This host response to the Lyme disease Borrelia can cause neurologic, cardiovascular, arthritic, and dermatologic manifestations during the disseminated and persistent stages of infection. The mechanisms by which a paucity of organisms (in comparison to many other infectious diseases) can cause varied and in some cases profound inflammation and symptoms remains mysterious but are the subjects of diverse ongoing investigations. In this review, we provide an overview of virulence mechanisms and determinants for which roles have been demonstrated in vivo, primarily in mouse models of infection.
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Affiliation(s)
- Jenifer Coburn
- Center For Infectious Disease Research, Medical College of Wisconsin, 8701 Watertown Plank Rd., TBRC C3980, Milwaukee, WI 53226, USA
| | - Brandon Garcia
- Department of Microbiology and Immunology, East Carolina University, Brody School of Medicine, Greenville, NC 27858, USA
| | - Linden T Hu
- Department of Molecular Biology and Microbiology, Vice Dean of Research, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, USA
| | - Mollie W Jewett
- Immunity and Pathogenesis Division Head, Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, 6900 Lake Nona Blvd. Orlando, FL 32827, USA
| | - Peter Kraiczy
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt, Germany
| | - Steven J Norris
- Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston, P.O. Box 20708, Houston, TX 77225, USA
| | - Jon Skare
- Professor and Associate Head, Texas A and M University, 8447 Riverside Pkwy, Bryan, TX 77807, USA
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15
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Flynn C, Ignaszak A. Lyme Disease Biosensors: A Potential Solution to a Diagnostic Dilemma. BIOSENSORS 2020; 10:E137. [PMID: 32998254 PMCID: PMC7601730 DOI: 10.3390/bios10100137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Over the past four decades, Lyme disease has remained a virulent and pervasive illness, persisting throughout North America and many other regions of the world. Recent increases in illness in many countries has sparked a renewed interest in improved Lyme diagnostics. While current standards of diagnosis are acceptable for the late stages of the disease, it remains difficult to accurately diagnose early forms of the illness. In addition, current diagnostic methods tend to be relatively expensive and require a large degree of laboratory-based analysis. Biosensors represent the fusion of biological materials with chemical techniques to provide simple, inexpensive alternatives to traditional diagnostic methods. Lyme disease biosensors have the potential to better diagnose early stages of the illness and provide possible patients with an inexpensive, commercially available test. This review examines the current state of Lyme disease biosensing, with a focus on previous biosensor development and essential future considerations.
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Affiliation(s)
- Connor Flynn
- Department of Chemistry, University of New Brunswick, Fredericton, NB E3B 5A3, Canada;
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16
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Modified two-tiered testing algorithm for Lyme disease serology: the Canadian context. Can Commun Dis Rep 2020; 46:125-131. [PMID: 32558809 DOI: 10.14745/ccdr.v46i05a05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lyme disease (LD) is emerging in many parts of central and eastern Canada. Serological testing is most commonly used to support laboratory diagnosis of LD. Standard two-tiered testing (STTT) for LD involves detection of Borrelia burgdorferi antibodies using an enzyme immunoassay (EIA) followed by IgM and/or IgG immunoblots. However, improved sensitivity has been demonstrated using a modified two-tiered testing (MTTT) approach, in which a second EIA instead of the traditional immunoblot is used. This article summarises the evidence supporting the MTTT versus STTT for laboratory diagnosis of LD in Canada. METHODS Peer reviewed literature on the sensitivity and specificity of different EIAs were compared by Canadian experts in LD diagnostic for MTTT vs STTT in patients with clinical history of LD residing in LD endemic areas or in samples from the LD serum repository. RESULTS The MTTT approach consistently demonstrated improved sensitivity to detect early infections with B. burgdorferi and also maintained high specificity vs STTT. CONCLUSION Diagnostic improvements in sensitivity of LD testing without significant loss of specificity have been consistently reported when MTTT is compared with STTT in studies conducted in highly LD endemic regions. Our working group agrees with the recommendation by the United States Centers for Disease Control that serological testing for LD using MTTT is an acceptable alternative to STTT. This recommendation is contingent on development and implementation of comprehensive validation studies on the performance of MTTT vs STTT within the Canadian context, including evaluation of the test performance in areas of low endemicity for LD.
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17
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A Fully Automated Multiplex Assay for Diagnosis of Lyme Disease with High Specificity and Improved Early Sensitivity. J Clin Microbiol 2020; 58:JCM.01785-19. [PMID: 32132190 DOI: 10.1128/jcm.01785-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022] Open
Abstract
Lyme borreliosis is a tick-borne disease caused by the Borrelia burgdorferi sensu lato complex. Bio-Rad Laboratories has developed a fully automated multiplex bead-based assay for the detection of IgM and IgG antibodies to B. burgdorferi The BioPlex 2200 Lyme Total assay exhibits an improved rate of seropositivity in patients with early Lyme infection. Asymptomatic subjects from endemic and nonendemic origins demonstrated a seroreactivity rate of approximately 4% that was similar to other commercial assays evaluated in this study. Coupled to this result was the observation that the Lyme Total assay retained a high first-tier specificity of 96% while demonstrating a relatively high sensitivity of 91% among a well-characterized CDC Premarketing Lyme serum panel. The Lyme Total assay also performs well under a modified two-tier algorithm (sensitivity, 84.4 to 88.9%; specificity, 98.4 to 99.5%). Furthermore, the new assay is able to readily detect early Lyme infection in patient samples from outside North America.
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18
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Zannoli S, Fantini M, Semprini S, Marchini B, Ceccarelli B, Sparacino M, Schiavone P, Belgrano A, Ruscio M, Gobbetti M, Nicoletti M, Robatscher E, Pagani E, Sambri V. Multicenter Evaluation of the C6 Lyme ELISA Kit for the Diagnosis of Lyme Disease. Microorganisms 2020; 8:E457. [PMID: 32213811 PMCID: PMC7143974 DOI: 10.3390/microorganisms8030457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/23/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022] Open
Abstract
Lyme disease (LD), caused by infection with Borrelia burgdorferi, is the most common tick-borne infection in many regions of Eurasia. Antibody detection is the most frequently used laboratory test, favoring a two-step serodiagnostic algorithm; immunoenzymatic detection of antibodies to C6 has been shown to perform similarly to a standard two-step workflow. The aim of this study was the performance evaluation of the C6 Lyme ELISA kit compared to a standard two-step algorithm in three laboratories located in the northeastern region of Italy which cater to areas with different LD epidemiology. A total of 804 samples were tested, of which 695 gave concordant results between C6 testing and routine workflow (564 negative, 131 positive). Wherever available, clinical presentation and additional laboratory tests were analyzed to solve discrepancies. The C6 based method showed a good concordance with the standard two-step algorithm (Cohen's κ = 0.619), however, the distribution of discrepancies seems to point towards a slightly lower specificity of C6 testing, which is supported by literature and could impact on patient management. The C6 ELISA, therefore, is not an ideal stand-alone test; however, if integrated into a two-step algorithm, it might play a part in achieving a sensitive, specific laboratory diagnosis of LD.
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Affiliation(s)
- Silvia Zannoli
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Michela Fantini
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Simona Semprini
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Barbara Marchini
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Barbara Ceccarelli
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Monica Sparacino
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Pasqua Schiavone
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
| | - Anna Belgrano
- Azienda Sanitaria Universitaria Integrata - Trieste (ASUIT) Laboratory, 34149 Trieste, Italy; (A.B.); (M.R.)
| | - Maurizio Ruscio
- Azienda Sanitaria Universitaria Integrata - Trieste (ASUIT) Laboratory, 34149 Trieste, Italy; (A.B.); (M.R.)
| | - Martina Gobbetti
- Azienda Sanitaria Alto Adige-Bolzano Microbiology Laboratory, 39100 Bolzano, Italy; (M.G.); (M.N.); (E.R.); (E.P.)
| | - Maira Nicoletti
- Azienda Sanitaria Alto Adige-Bolzano Microbiology Laboratory, 39100 Bolzano, Italy; (M.G.); (M.N.); (E.R.); (E.P.)
| | - Eva Robatscher
- Azienda Sanitaria Alto Adige-Bolzano Microbiology Laboratory, 39100 Bolzano, Italy; (M.G.); (M.N.); (E.R.); (E.P.)
| | - Elisabetta Pagani
- Azienda Sanitaria Alto Adige-Bolzano Microbiology Laboratory, 39100 Bolzano, Italy; (M.G.); (M.N.); (E.R.); (E.P.)
| | - Vittorio Sambri
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, 47522 Pievesestina di Cesena (FC), Italy; (M.F.); (S.S.); (B.M.); (B.C.); (M.S.); (P.S.); (V.S.)
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy
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19
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Joung HA, Ballard ZS, Wu J, Tseng DK, Teshome H, Zhang L, Horn EJ, Arnaboldi PM, Dattwyler RJ, Garner OB, Di Carlo D, Ozcan A. Point-of-Care Serodiagnostic Test for Early-Stage Lyme Disease Using a Multiplexed Paper-Based Immunoassay and Machine Learning. ACS NANO 2020; 14:229-240. [PMID: 31849225 DOI: 10.1021/acsnano.9b08151] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Caused by the tick-borne spirochete Borrelia burgdorferi, Lyme disease (LD) is the most common vector-borne infectious disease in North America and Europe. Though timely diagnosis and treatment are effective in preventing disease progression, current tests are insensitive in early stage LD, with a sensitivity of <50%. Additionally, the serological testing currently recommended by the U.S. Center for Disease Control has high costs (>$400/test) and extended sample-to-answer timelines (>24 h). To address these challenges, we created a cost-effective and rapid point-of-care (POC) test for early-stage LD that assays for antibodies specific to seven Borrelia antigens and a synthetic peptide in a paper-based multiplexed vertical flow assay (xVFA). We trained a deep-learning-based diagnostic algorithm to select an optimal subset of antigen/peptide targets and then blindly tested our xVFA using human samples (N(+) = 42, N(-) = 54), achieving an area-under-the-curve (AUC), sensitivity, and specificity of 0.950, 90.5%, and 87.0%, respectively, outperforming previous LD POC tests. With batch-specific standardization and threshold tuning, the specificity of our blind-testing performance improved to 96.3%, with an AUC and sensitivity of 0.963 and 85.7%, respectively.
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Affiliation(s)
- Hyou-Arm Joung
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
| | - Zachary S Ballard
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
| | - Jing Wu
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- Department of Chemistry , Lanzhou University , Lanzhou , Gansu 730000 , China
| | - Derek K Tseng
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
| | - Hailemariam Teshome
- Department of Neuroscience , University of California , Los Angeles , California 90025 , United States
| | - Linghao Zhang
- Department of Mechanical Engineering , University of California , Los Angeles , California 90025 , United States
| | | | - Paul M Arnaboldi
- Department of Microbiology/Immunology , New York Medical College , Valhalla , New York 10595 , United States
| | - Raymond J Dattwyler
- Department of Microbiology/Immunology , New York Medical College , Valhalla , New York 10595 , United States
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine , University of California , Los Angeles , California 90025 , United States
| | - Dino Di Carlo
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
- Department of Mechanical Engineering , University of California , Los Angeles , California 90025 , United States
| | - Aydogan Ozcan
- Department of Electrical & Computer Engineering , University of California , Los Angeles , California 90025 , United States
- California NanoSystems Institute (CNSI) , University of California , Los Angeles , California 90025 , United States
- Department of Bioengineering , University of California , Los Angeles , California 90025 , United States
- Department of Surgery , University of California , Los Angeles , California 90025 , United States
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