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Angulo FJ, Olsen J, Purdel V, Lupșe M, Hristea A, Briciu V, Colby E, Pilz A, Halsby K, Kelly PH, Brestrich G, Moïsi JC, Stark JH. Incidence of symptomatic Borrelia burgdorferi sensu lato infection in Romania, 2018-2023. Parasit Vectors 2024; 17:378. [PMID: 39238048 PMCID: PMC11378645 DOI: 10.1186/s13071-024-06449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato (Bbsl), is the most common tick-borne disease in Europe. Although public health surveillance for LB has been conducted in Romania since 2007, the extent of under-detection of Bbsl infections by LB surveillance has not been estimated. We therefore estimated the under-detection of symptomatic Bbsl infections by LB surveillance to better understand the LB burden in Romania. METHODS The number of incident symptomatic Bbsl infections were estimated from a seroprevalence study conducted in six counties (population 2.3 M) and estimates of the symptomatic proportion and duration of persistence of anti-Bbsl immunoglobulin G (IgG) antibodies. The number of incident symptomatic Bbsl infections were compared with the number of surveillance-reported LB cases to derive an under-detection multiplier, and then the under-detection multiplier was applied to LB surveillance data to estimate the incidence of symptomatic Bbsl infection from 2018 to 2023. RESULTS We estimate that there were 1968 individuals with incident symptomatic Bbsl infection in the six counties where the seroprevalence study was conducted in 2020, compared with the 187 surveillance-reported LB cases, resulting in an under-detection multiplier of 10.5 (i.e., for every surveillance-reported LB case, there were 10.5 symptomatic incident Bbsl infections). The incidence of symptomatic Bbsl infection in the six counties was 86.9/100,000 population in 2023, similar to the incidence in 2018-2020 (86.0) and higher than in 2021-2022 (40.3). CONCLUSIONS There is a higher incidence of symptomatic Bbsl infection than is reported through public health surveillance for LB in Romania. Additional efforts are needed to strengthen disease prevention and address the important public health problem of LB.
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Affiliation(s)
- Frederick J Angulo
- Vaccines and Antivirals Medical Affairs, Pfizer US Commercial Division, 500 Arcola Road, Collegeville, PA, 19426, USA.
| | - Julia Olsen
- Vaccines and Antivirals Medical Affairs, Pfizer US Commercial Division, 500 Arcola Road, Collegeville, PA, 19426, USA
- Hologic, Inc, Marlborough, MA 01752, USA
| | - Veronica Purdel
- Pfizer Romania SRL, Vaccines, Willbrook Platinum Business & Convention Center Sos, București-Ploiești No. 172-176, Building B, Stage 5, Sector 1, Bucharest, 013686, Romania
| | - Mihaela Lupșe
- Department of Infectious Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adriana Hristea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Violeta Briciu
- Department of Infectious Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emily Colby
- Vaccines and Antivirals Medical Affairs, Pfizer US Commercial Division, 500 Arcola Road, Collegeville, PA, 19426, USA
| | - Andreas Pilz
- Pfizer Corporation Austria, Vaccines and Antivirals Medical Affairs, Floridsdorfer Hauptstraße 1, 1210, Vienna, Austria
| | - Kate Halsby
- Vaccines and Antivirals Medical Affairs, Dorking Road, Tadworth, Surrey, KT20 7NY, UK
| | - Patrick H Kelly
- Vaccines and Antivirals Medical Affairs, Pfizer US Commercial Division, 500 Arcola Road, Collegeville, PA, 19426, USA
| | - Gordon Brestrich
- Pfizer Pharma GmbH, Vaccines and Antivirals Medical Affairs, Friedrichstraße, 110-10117, Berlin, Germany
| | - Jennifer C Moïsi
- Vaccines and Antivirals Medical Affairs, 23 Avenue du Docteur Lannelongue, 75014, Paris, France
| | - James H Stark
- Vaccines and Antivirals Medical Affairs, Pfizer US Commercial Division, 1 Portland Street, Cambridge, MA, 02139, USA
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2
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Motamed M, Liblik K, Miranda-Arboleda AF, Wamboldt R, Wang CN, Cingolani O, Rebman AW, Novak CB, Aucott JN, Farina JM, Baranchuk A. Disseminated Lyme disease and dilated cardiomyopathy: A systematic review. Trends Cardiovasc Med 2023; 33:531-536. [PMID: 35667636 DOI: 10.1016/j.tcm.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Lyme carditis is a well-established manifestation of early disseminated Lyme infection, yet the relationship between late disseminated Lyme disease and the development of dilated cardiomyopathy (DCM) remains unclear. The present systematic review aims to summarize existing literature on the association between late disseminated Lyme disease and DCM. A systematic review was conducted in PubMed, Embase, CENTRAL, and MEDLINE databases, after which a total of 11 observational studies (n = 771) were ultimately included for final data extraction. Although most studies (7/11) identified evidence associating Borrelia-infection with DCM, further research is required to isolate late disseminated Borrelia infection as a causative agent of DCM.
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Affiliation(s)
- Mehras Motamed
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Andres F Miranda-Arboleda
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada; Cardiology Department, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - Rachel Wamboldt
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Chang Nancy Wang
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Oscar Cingolani
- Division of Cardiology, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cheryl B Novak
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan M Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada.
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3
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Colby E, Olsen J, Angulo FJ, Kelly P, Halsby K, Pilz A, Sot U, Chmielewski T, Pancer K, Moïsi JC, Jodar L, Stark JH. Estimated Incidence of Symptomatic Lyme Borreliosis Cases in Lublin, Poland in 2021. Microorganisms 2023; 11:2481. [PMID: 37894139 PMCID: PMC10608808 DOI: 10.3390/microorganisms11102481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Lyme borreliosis (LB), the most common tick-borne disease in Europe, is endemic to Poland. Despite public health surveillance with mandatory reporting of LB cases by physicians and laboratories, many symptomatic LB cases are not included in surveillance in Poland. We estimated the extent of the under-ascertainment of symptomatic LB cases via surveillance in the Polish province of Lublin to better understand Poland's LB burden. The number of incident symptomatic LB cases in Lublin in 2010 was estimated from two seroprevalence studies conducted among adults in Lublin, as well as estimates of the proportion of asymptomatic LB cases and the duration of LB antibody persistence. The estimated number of incident symptomatic LB cases was compared to the number of surveillance-reported cases in Lublin to derive an under-ascertainment multiplier. This multiplier was applied to the number of surveillance-reported cases in 2021 to estimate the number and population-based incidence of symptomatic LB cases in Lublin in 2021. We estimate that there are 5.9 symptomatic LB cases for every surveillance-reported LB case in Lublin. Adjusting for under-ascertainment, the estimated number of symptomatic LB cases in Lublin in 2021 was 6204 (population-based incidence: 467.6/100,000). After adjustment for under-ascertainment, the incidence of symptomatic LB in Lublin, Poland, is high.
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Affiliation(s)
- Emily Colby
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Julia Olsen
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Frederick J. Angulo
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Patrick Kelly
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Kate Halsby
- Pfizer Vaccines, Tadworth, Surrey KT20 7NS, UK
| | - Andreas Pilz
- Vaccines, Pfizer Corporation Austria, 1210 Vienna, Austria
| | - Urszula Sot
- Vaccine Medical Affairs, Pfizer Poland Inc., 02-092 Warsaw, Poland
| | | | | | | | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - James H. Stark
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Cambridge, MA 02139, USA
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4
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Stelma FF, Berende A, Ter Hofstede H, Vrijmoeth HD, Vos F, Kullberg BJ. Classical Borrelia Serology Does Not Aid in the Diagnosis of Persistent Symptoms Attributed to Lyme Borreliosis: A Retrospective Cohort Study. Life (Basel) 2023; 13:life13051134. [PMID: 37240779 DOI: 10.3390/life13051134] [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: 03/27/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The diagnosis of Lyme borreliosis is based on two-tier testing using an ELISA and Western blot. About 5-10% of patients report persistent symptoms of unknown etiology after treatment, resulting in substantial difficulties in further diagnostic workup. This paper presents a study aimed at determining whether serology can differentiate between patients with persistent symptoms attributed to Lyme and other patients with Lyme borreliosis. METHODS A retrospective cohort study included 162 samples from four subgroups: patients with persistent symptoms of Lyme (PSL), early Lyme borreliosis with erythema migrans (EM), patients tested in a general practitioner setting (GP), and healthy controls (HC). ELISA, Western blots, and multiplex assays from different manufacturers were used to determine inter-test variations in PSL and to compare reactivity against Borrelia-specific antigens among the groups. RESULTS In comparing the IgG and IgM reactivity by Western blot, IgG was more often positive in the PSL group than in the GP group. The individual antigen reactivity was similar between the PSL and EM or GP groups. Inter-test agreement among the manufacturers was variable, and agreement was higher for IgG testing compared to IgM. CONCLUSIONS Serological testing is unable to define the subgroup of patients with persistent symptoms attributed to Lyme borreliosis. Additionally, the current two-tier testing protocol shows a large variance among different manufacturers in these patients.
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Affiliation(s)
- Foekje F Stelma
- Department of Medical Microbiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
| | - Anneleen Berende
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hadewych Ter Hofstede
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hedwig D Vrijmoeth
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Fidel Vos
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases, 6525 GA Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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5
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Olsen J, Angulo FJ, Pilz A, Halsby K, Kelly P, Brestrich G, Stark JH, Jodar L. Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment. Public Health 2023; 219:1-9. [PMID: 37075486 DOI: 10.1016/j.puhe.2023.03.002] [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: 12/13/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment. METHODS Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany. RESULTS Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case. CONCLUSIONS We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.
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Affiliation(s)
- J Olsen
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
| | - F J Angulo
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - A Pilz
- Vaccines, Pfizer Corporation Austria, Floridsdorfer Hauptstrasse 1, 1210 Wien, Vienna, Austria
| | - K Halsby
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - P Kelly
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - G Brestrich
- Vaccines, Pfizer Pharma GmbH, Linkstrasse 10, 10785 Berlin, Germany
| | - J H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - L Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
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6
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Baarsma ME, van de Schoor FR, Gauw SA, Vrijmoeth HD, Ursinus J, Goudriaan N, Popa CD, Ter Hofstede HJ, Leeflang MM, Kremer K, van den Wijngaard CC, Kullberg BJ, Joosten LA, Hovius JW. Diagnostic parameters of cellular tests for Lyme borreliosis in Europe (VICTORY study): a case-control study. THE LANCET. INFECTIOUS DISEASES 2022; 22:1388-1396. [PMID: 35714662 DOI: 10.1016/s1473-3099(22)00205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/21/2022] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cellular tests for Lyme borreliosis might be able to overcome major shortcomings of serological testing, such as its low sensitivity in early stages of infection. Therefore, we aimed to assess the sensitivity and specificity of three cellular tests. METHODS This was a nationwide, prospective, multiple-gate case-control study done in the Netherlands. Patients with physician-confirmed Lyme borreliosis, either early localised or disseminated, were consecutively included as cases at the start of antibiotic treatment. Controls were those without Lyme borreliosis from the general population (healthy controls) and those with potentially cross-reactive conditions (eg, autoimmune disease). We used three cellular tests for Lyme borreliosis (Spirofind Revised, iSpot Lyme, and LTT-MELISA) as index tests, and standard two-tier serological testing (STTT) as a comparator. Clinical data from Lyme borreliosis patients were collected at baseline and at 12 weeks after inclusion, and blood samples were obtained at baseline, 6 weeks, and 12 weeks. Control participants underwent clinical and laboratory assessments at baseline only. FINDINGS Cases comprised 271 patients with Lyme borreliosis (of whom 245 had early-localised Lyme borreliosis and 26 had disseminated disease) and controls comprised 228 participants without Lyme borreliosis from the general population and 41 participants with potentially cross-reactive conditions. Recruitment occurred between May 14, 2018, and March 16, 2020. The specificity of STTT in healthy controls (216 of 228 samples [94·7%, 95% CI 91·5-97·7]) was higher than that of the cellular tests: Spirofind (140 of 171 [81·9%, 76·1-87·2]), iSpot Lyme (32 of 103 [31·1%, 21·5-40·3]) and LTT-MELISA (100 of 190 [52·6%, 44·9-60·3]). Cellular tests had varying sensitivities: Spirofind (88 of 204 [43·1%, 36·4-50·4]), iSpot Lyme (51 of 94 [54·3%, 44·5-63·7]), and LTT-MELISA (66 of 218 [30·3%, 23·8-36·7]). The Spirofind and iSpot Lyme outperformed STTT for sensitivity, but were similar to the C6-ELISA (C6-ELISA: 135 of 270 [50·0%, 44·5-55·5]; STTT: 76 of 270 [28·1%, 23·0-33·6]). INTERPRETATION The cellular tests for Lyme borreliosis used in this study have a low specificity compared with serological tests, which leads to a high number of false-positive test results. We conclude that these cellular tests are unfit for clinical use at this stage. FUNDING Netherlands Organization for Health Research and Development, AMC Foundation (Amsterdam UMC), and Ministry of Health of the Netherlands.
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Affiliation(s)
- M E Baarsma
- Center for Experimental and Molecular Medicine, Amsterdam UMC location AMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Freek R van de Schoor
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Stefanie A Gauw
- Center for Experimental and Molecular Medicine, Amsterdam UMC location AMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Hedwig D Vrijmoeth
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Jeanine Ursinus
- Center for Experimental and Molecular Medicine, Amsterdam UMC location AMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Nienke Goudriaan
- Center for Experimental and Molecular Medicine, Amsterdam UMC location AMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Calin D Popa
- Department of Rheumatology, Radboudumc, Nijmegen, Netherlands; Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Hadewych Jm Ter Hofstede
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Mariska Mg Leeflang
- Department of Epidemiology and Data Science, Amsterdam UMC location AMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Kristin Kremer
- National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, Netherlands; KNCV Tuberculosis Foundation, The Hague, Netherlands
| | - Cees C van den Wijngaard
- National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, Netherlands
| | - Bart-Jan Kullberg
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Leo Ab Joosten
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam UMC location AMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands.
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Tetens MM, Dessau R, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Damgaard DF, Bangsborg J, Nielsen AC, Møller JK, Omland LH, Obel N, Lebech AM. The diagnostic value of serum Borrelia burgdorferi antibodies and seroconversion after Lyme neuroborreliosis, a nationwide observational study. Clin Microbiol Infect 2022; 28:1500.e1-1500.e6. [PMID: 35709901 DOI: 10.1016/j.cmi.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Clinical guidelines disagree on the diagnostic usefulness of Borrelia burgdorferi (Bb) serum antibodies (serum-Bb) in investigation of Lyme neuroborreliosis (LNB). We investigated the association between serum-Bb and Bb intrathecal antibody index (Bb-AI) and rates of seroconversion and seroreversion after LNB. METHODS Danish residents who had a Bb-AI and corresponding serum-Bb measured between 1994-2020 were identified at all Danish departments of clinical microbiology. We used descriptive statistics to examine the proportions of positive Bb-AI combined with positive or negative serum-Bb antibody tests. Next, the rate of seroconversion and seroreversion among those with positive Bb-AI and either an initial negative or positive serum-Bb was estimated. RESULTS We included 34 609 individuals with a Bb-AI and corresponding serum-Bb. The proportion of individuals with positive Bb-AI who had negative serum-Bb was 16.8% (95% confidence interval (CI), 15.1-18.6). The proportion of individuals with positive serum-Bb IgM, serum-Bb IgG or serum-Bb IgM and IgG antibodies who had positive Bb-AI was 10.6% (95% CI, 9.5-11.8), 24.7% (95% CI, 23.0-26.4) and 45.0% (95% CI, 42.4-48.0), respectively. The proportion of children (<18 years) with positive serum-Bb IgM and IgG antibodies who had a positive Bb-AI was 59.7% (95% CI, 53.4-65.8). The proportion of individuals with positive Bb-AI with initial negative or positive serum-Bb antibodies who seroconverted or seroreverted within 2 years was 17.3% (95% CI, 6.9-27.8) and 23.2% (95% CI, 19.1-27.7), respectively. CONCLUSIONS Serum-Bb antibodies could not predict results of Bb-AI. A fifth of both seronegative and seropositive individuals with positive Bb-AI seroconverted or seroreverted within 2 years.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Ram Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - David F Damgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev Hospital, Herlev, Copenhagen University Hospital, Denmark
| | - Alex Christian Nielsen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Chou E, Minor A, Cady NC. Quantitative multiplexed strategies for human Lyme disease serological testing. Exp Biol Med (Maywood) 2021; 246:1388-1399. [PMID: 33794698 PMCID: PMC8243215 DOI: 10.1177/15353702211003496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lyme disease, which is primarily caused by infection with the bacterium Borrelia burgdorferi in the United States or other Borrelia species internationally, presents an ongoing challenge for diagnostics. Serological testing is the primary means of diagnosis but testing approaches differ widely, with varying degrees of sensitivity and specificity. Moreover, there is currently no reliable test to determine disease resolution following treatment. A distinct challenge in Lyme disease diagnostics is the variable patterns of human immune response to a plurality of antigens presented by Borrelia spp. during the infection. Thus, multiplexed testing approaches that capture these patterns and detect serological response against multiple antigens may be the key to prompt, accurate Lyme disease diagnosis. In this review, current state-of-the-art multiplexed diagnostic approaches are presented and compared with respect to their diagnostic accuracy and their potential for monitoring response to treatment.
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Affiliation(s)
- Eunice Chou
- Nanobioscience Constellation, College of Nanoscale Science &
Engineering, State University of New York Polytechnic Institute, Albany, NY
12203, USA
- College of Medicine, State University of New York, Downstate
Medical Center, Brooklyn, NY 11203, USA
| | - Armond Minor
- Nanobioscience Constellation, College of Nanoscale Science &
Engineering, State University of New York Polytechnic Institute, Albany, NY
12203, USA
| | - Nathaniel C Cady
- Nanobioscience Constellation, College of Nanoscale Science &
Engineering, State University of New York Polytechnic Institute, Albany, NY
12203, USA
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9
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Bockenstedt LK, Wooten RM, Baumgarth N. Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes. Curr Issues Mol Biol 2020; 42:145-190. [PMID: 33289684 PMCID: PMC10842262 DOI: 10.21775/cimb.042.145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The mammalian host responds to infection with Borrelia spirochetes through a highly orchestrated immune defense involving innate and adaptive effector functions aimed toward limiting pathogen burdens, minimizing tissue injury, and preventing subsequent reinfection. The evolutionary adaptation of Borrelia spirochetes to their reservoir mammalian hosts may allow for its persistence despite this immune defense. This review summarizes our current understanding of the host immune response to B. burgdorferi sensu lato, the most widely studied Borrelia spp. and etiologic agent of Lyme borreliosis. Pertinent literature will be reviewed with emphasis on in vitro, ex vivo and animal studies that influenced our understanding of both the earliest responses to B. burgdorferi as it enters the mammalian host and those that evolve as spirochetes disseminate and establish infection in multiple tissues. Our focus is on the immune response of inbred mice, the most commonly studied animal model of B. burgdorferi infection and surrogate for one of this pathogen's principle natural reservoir hosts, the white-footed deer mouse. Comparison will be made to the immune responses of humans with Lyme borreliosis. Our goal is to provide an understanding of the dynamics of the mammalian immune response during infection with B. burgdorferi and its relation to the outcomes in reservoir (mouse) and non-reservoir (human) hosts.
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Affiliation(s)
- Linda K. Bockenstedt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8031, USA
| | - R. Mark Wooten
- Department of Medical Microbiology and Immunology, University of Toledo Health Science Campus, Toledo, OH 43614, USA
| | - Nicole Baumgarth
- Center for Immunology and Infectious Diseases and Dept. Pathology, Microbiology and Immunology, University of California, Davis, Davis CA 95616, USA
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10
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Abstract
Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
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Affiliation(s)
- Bart Jan Kullberg
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedwig D Vrijmoeth
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Freek van de Schoor
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joppe W Hovius
- Amsterdam University Medical Centers, location AMC, Department of Medicine, Division of Infectious Diseases, and Amsterdam Multidisciplinary Lyme borreliosis Center, Amsterdam, Netherlands
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11
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Brouwer MAE, van de Schoor FR, Vrijmoeth HD, Netea MG, Joosten LAB. A joint effort: The interplay between the innate and the adaptive immune system in Lyme arthritis. Immunol Rev 2020; 294:63-79. [PMID: 31930745 PMCID: PMC7065069 DOI: 10.1111/imr.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
Abstract
Articular joints are a major target of Borrelia burgdorferi, the causative agent of Lyme arthritis. Despite antibiotic treatment, recurrent or persistent Lyme arthritis is observed in a significant number of patients. The host immune response plays a crucial role in this chronic arthritic joint complication of Borrelia infections. During the early stages of B. burgdorferi infection, a major hinder in generating a proper host immune response is the lack of induction of a strong adaptive immune response. This may lead to a delayed hyperinflammatory reaction later in the disease. Several mechanisms have been suggested that might be pivotal for the development of Lyme arthritis and will be highlighted in this review, from molecular mimicry of matrix metallopeptidases and glycosaminoglycans, to autoimmune responses to live bacteria, or remnants of Borrelia spirochetes in joints. Murine studies have suggested that the inflammatory responses are initiated by innate immune cells, but this does not exclude the involvement of the adaptive immune system in this dysregulated immune profile. Genetic predisposition, via human leukocyte antigen-DR isotype and microRNA expression, has been associated with the development of antibiotic-refractory Lyme arthritis. Yet the ultimate cause for (antibiotic-refractory) Lyme arthritis remains unknown. Complex processes of different immune cells and signaling cascades are involved in the development of Lyme arthritis. When these various mechanisms are fully been unraveled, new treatment strategies can be developed to target (antibiotic-refractory) Lyme arthritis more effectively.
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Affiliation(s)
- Michelle A. E. Brouwer
- Department of Internal MedicineRadboud Center for Infectious Diseases (RCI)Radboud Institute of Molecular Life Sciences (RIMLS)Radboud Institute of Health Sciences (RIHS)Radboud University Medical CenterNijmegenThe Netherlands
| | - Freek R. van de Schoor
- Department of Internal MedicineRadboud Center for Infectious Diseases (RCI)Radboud Institute of Molecular Life Sciences (RIMLS)Radboud Institute of Health Sciences (RIHS)Radboud University Medical CenterNijmegenThe Netherlands
| | - Hedwig D. Vrijmoeth
- Department of Internal MedicineRadboud Center for Infectious Diseases (RCI)Radboud Institute of Molecular Life Sciences (RIMLS)Radboud Institute of Health Sciences (RIHS)Radboud University Medical CenterNijmegenThe Netherlands
| | - Mihai G. Netea
- Department of Internal MedicineRadboud Center for Infectious Diseases (RCI)Radboud Institute of Molecular Life Sciences (RIMLS)Radboud Institute of Health Sciences (RIHS)Radboud University Medical CenterNijmegenThe Netherlands
- Department for Genomics & ImmunoregulationLife and Medical Sciences Institute (LIMES)University of BonnBonnGermany
| | - Leo A. B. Joosten
- Department of Internal MedicineRadboud Center for Infectious Diseases (RCI)Radboud Institute of Molecular Life Sciences (RIMLS)Radboud Institute of Health Sciences (RIHS)Radboud University Medical CenterNijmegenThe Netherlands
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12
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Rauer S, Kastenbauer S, Hofmann H, Fingerle V, Huppertz HI, Hunfeld KP, Krause A, Ruf B, Dersch R. Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2020; 18:Doc03. [PMID: 32341686 PMCID: PMC7174852 DOI: 10.3205/000279] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Lyme borreliosis is the most common tick-borne infectious disease in Europe. A neurological manifestation occurs in 3–15% of infections and can manifest as polyradiculitis, meningitis and (rarely) encephalomyelitis. This S3 guideline is directed at physicians in private practices and clinics who treat Lyme neuroborreliosis in children and adults. Twenty AWMF member societies, the Robert Koch Institute, the German Borreliosis Society and three patient organisations participated in its development. A systematic review and assessment of the literature was conducted by the German Cochrane Centre, Freiburg (Cochrane Germany). The main objectives of this guideline are to define the disease and to give recommendations for the confirmation of a clinically suspected diagnosis by laboratory testing, antibiotic therapy, differential diagnostic testing and prevention.
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Affiliation(s)
| | | | | | - Volker Fingerle
- German Society for Hygiene and Microbiology (DGHM), Münster, Germany
| | - Hans-Iko Huppertz
- German Society of Paediatrics and Adolescent Medicine (DGKJ), Berlin, Germany.,German Society of Paediatric Infectology (DGPI), Berlin, Germany
| | - Klaus-Peter Hunfeld
- The German United Society of Clinical Chemistry and Laboratory Medicine (DGKL), Bonn, Germany.,INSTAND e.V., Düsseldorf, Germany
| | | | - Bernhard Ruf
- German Society of Infectious Diseases (DGI), Berlin, Germany
| | - Rick Dersch
- German Society of Neurology (DGN), Berlin, Germany.,Cochrane Germany, Faculty of Medicine, University of Freiburg, Germany
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Chou E, Lasek-Nesselquist E, Taubner B, Pilar A, Guignon E, Page W, Lin YP, Cady NC. A fluorescent plasmonic biochip assay for multiplex screening of diagnostic serum antibody targets in human Lyme disease. PLoS One 2020; 15:e0228772. [PMID: 32040491 PMCID: PMC7010292 DOI: 10.1371/journal.pone.0228772] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Lyme disease (LD) diagnosis using the current two-tier algorithm is constrained by low sensitivity for early-stage infection and ambiguity in determining treatment response. We recently developed a protein microarray biochip that measures diagnostic serum antibody targets using grating-coupled fluorescent plasmonics (GC-FP) technology. This strategy requires microliters of blood serum to enable multiplexed biomarker screening on a compact surface and generates quantitative results that can be further processed for diagnostic scoring. The GC-FP biochip was used to detect serum antibodies in patients with active and convalescent LD, as well as various negative controls. We hypothesized that the quantitative, high-sensitivity attributes of the GC-FP approach permit: 1) screening of antibody targets predictive for LD status, and 2) development a diagnostic algorithm that is more sensitive, specific, and informative than the standard ELISA and Western blot assays. Notably, our findings led to a diagnostic algorithm that may be more sensitive than the current standard for detecting early LD, while maintaining 100% specificity. We further show that analysis of relative antibody levels to predict disease status, such as in acute and convalescent stages of infection, is possible with a highly sensitive and quantitative platform like GC-FP. The results from this study add to the urgent conversation regarding better diagnostic strategies and more effective treatment for patients affected by tick-borne disease.
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Affiliation(s)
- Eunice Chou
- College of Nanoscale Science & Engineering, State University of New York Polytechnic Institute, Albany, New York, United States of America
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America
| | - Erica Lasek-Nesselquist
- Bioinformatics Core, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Benjamin Taubner
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Biomedical Engineering, Mercer University, Macon, Georgia, United States of American
| | - Arturo Pilar
- Ciencia, Inc., East Hartford, Connecticut, United States of America
| | - Ernest Guignon
- Ciencia, Inc., East Hartford, Connecticut, United States of America
| | - William Page
- Ciencia, Inc., East Hartford, Connecticut, United States of America
| | - Yi-Pin Lin
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Biomedical Science, State University of New York at Albany, Albany, New York, United States of America
| | - Nathaniel C. Cady
- College of Nanoscale Science & Engineering, State University of New York Polytechnic Institute, Albany, New York, United States of America
- * E-mail:
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14
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Ocias LF, Wilhelmsson P, Sjöwall J, Henningsson AJ, Nordberg M, Jørgensen CS, Krogfelt KA, Forsberg P, Lindgren PE. Emerging tick-borne pathogens in the Nordic countries: A clinical and laboratory follow-up study of high-risk tick-bitten individuals. Ticks Tick Borne Dis 2019; 11:101303. [PMID: 31631052 DOI: 10.1016/j.ttbdis.2019.101303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Despite the presence of several microorganisms, other than Borrelia burgdorferi sensu lato (Bbsl) and TBE virus, in Ixodes ricinus ticks from the Nordic countries, data is lacking on their pathogenic potential in humans. In this study, we wanted to investigate the aetiology and clinical manifestations of tick-transmitted infections in individuals seeking medical care following a tick-bite. The sampling frame was participants of a large-scale, prospective, multi-centre, follow-up study of tick-bitten volunteers recruited in Sweden, Finland and Norway in the years 2007-2015. Participants who sought medical care during the three-month follow-up period and from whom blood samples were collected during this healthcare visit (n = 92) were tested, using PCR, for exposure to spotted fever group (SFG) Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Moreover, 86 of these individuals had two serum samples, collected three months apart, tested serologically for six tick-borne microorganisms. The selected organisms - Bbsl, SFG rickettsiae, Anaplasma phagocytophilum, TBE virus, Babesia microti and Bartonella henselae - have all been detected in field-collected ticks from the Nordic countries. Medical records were reviewed and questionnaires were completed to determine clinical manifestations. We found Lyme borreliosis to be the most common tick-transmitted infection as seen in 46 (54%) of the 86 participants with available medical records. Among the 86 participants with paired sera, serological or molecular evidence of recent exposure to other microorganisms than Bbsl could be demonstrated in eight (9%). Five participants (6%) exhibited serological evidence of recent concomitant exposure to more than one tick-borne microorganism. Clinical presentations were mild with one exception (TBE). In conclusion, our data suggest a low risk of infection with tick-borne microorganisms, other than Bbsl, in immunocompetent tick-bitten persons from the examined regions, a low occurrence of co-infection and mostly mild or no overt clinical signs of infection in immunocompetent persons exposed to the studied agents.
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Affiliation(s)
- Lukas Frans Ocias
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark; Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden; Department of Clinical Microbiology, County Hospital Ryhov, Sjukhusgatan, 55305 Jönköping, Sweden
| | - Johanna Sjöwall
- Clinic of Infectious Diseases, Linköping University Hospital, 58185 Linköping, Sweden
| | - Anna Jonsson Henningsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden; Department of Clinical Microbiology, County Hospital Ryhov, Sjukhusgatan, 55305 Jönköping, Sweden; Department of Clinical Microbiology, Linköping University Hospital, 58185 Linköping, Sweden
| | - Marika Nordberg
- The Åland Group for Borrelia Research, Åland Central Hospital, Doktorsvägen 2, 22110 Mariehamn, Åland, Finland
| | - Charlotte Sværke Jørgensen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Karen Angeliki Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark; Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark; Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
| | - Pia Forsberg
- Division of Infectious Medicine, Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - Per-Eric Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden; Department of Clinical Microbiology, County Hospital Ryhov, Sjukhusgatan, 55305 Jönköping, Sweden
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15
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van de Schoor FR, Baarsma ME, Gauw SA, Joosten LAB, Kullberg BJ, van den Wijngaard CC, Hovius JW. Validation of cellular tests for Lyme borreliosis (VICTORY) study. BMC Infect Dis 2019; 19:732. [PMID: 31429716 PMCID: PMC6700813 DOI: 10.1186/s12879-019-4323-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/26/2019] [Indexed: 11/21/2022] Open
Abstract
Background Lyme borreliosis (LB) is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato species. Due to a variety of clinical manifestations, diagnosing LB can be challenging, and laboratory work-up is usually required in case of disseminated LB. However, the current standard of diagnostics is serology, which comes with several shortcomings. Antibody formation may be absent in the early phase of the disease, and once IgG-seroconversion has occurred, it can be difficult to distinguish between a past (cured or self-cleared) LB and an active infection. It has been postulated that novel cellular tests for LB may have both higher sensitivity earlier in the course of the disease, and may be able to discriminate between a past and active infection. Methods VICTORY is a prospective two-gate case-control study. We strive to include 150 patients who meet the European case definitions for either localized or disseminated LB. In addition, we aim to include 225 healthy controls without current LB and 60 controls with potentially cross-reactive conditions. We will perform four different cellular tests in all of these participants, which will allow us to determine sensitivity and specificity. In LB patients, we will repeat cellular tests at 6 weeks and 12 weeks after start of antibiotic treatment to assess the usefulness as ‘test-of-cure’. Furthermore, we will investigate the performance of the different cellular tests in a cohort of patients with persistent symptoms attributed to LB. Discussion This article describes the background and design of the VICTORY study protocol. The findings of our study will help to better appreciate the utility of cellular tests in the diagnosis of Lyme borreliosis. Trial registration NL7732 (Netherlands Trial Register, trialregister.nl). Electronic supplementary material The online version of this article (10.1186/s12879-019-4323-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F R van de Schoor
- Radboudumc, Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI) and Radboud Institute of Health Sciences (RIHS), P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - M E Baarsma
- Amsterdam UMC, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands
| | - S A Gauw
- Amsterdam UMC, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands
| | - L A B Joosten
- Radboudumc, Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI) and Radboud Institute of Health Sciences (RIHS), P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - B J Kullberg
- Radboudumc, Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI) and Radboud Institute of Health Sciences (RIHS), P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - C C van den Wijngaard
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
| | - J W Hovius
- Amsterdam UMC, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands.
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16
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The value of seroprevalence data as surveillance tool for Lyme borreliosis in the general population: the experience of Belgium. BMC Public Health 2019; 19:597. [PMID: 31101034 PMCID: PMC6525443 DOI: 10.1186/s12889-019-6914-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Serological surveillance, based on the measurement of the presence of specific antibodies in a given population, can be used in addition to traditional and routine disease surveillance methods. The added value of this has been largely documented for vaccine-preventable diseases, but to a lesser extent for vector-borne diseases. This study aimed to evaluate the utility of seroprevalence data as additional source of information on the epidemiology of Lyme borreliosis in Belgium. METHODS In total, 3215 residual blood samples collected in 2013-2015 were analysed with Liaison® Borrelia IgG kit (DiaSorin S.p.A, Saluggia, Italy). Positive and equivocal results were further examined with immunoblotting (recomLine Borrelia IgG kit, Mikrogen, Neuried, Germany). Crude prevalence estimates of equivocal and seropositive results were calculated and further adjusted accounting for clustered sampling and standardized for age, sex and population per province, according to the Belgian population structure in 2014. The effect of age, sex and region on seropositivity was assessed using log-binomial regression. RESULTS The overall weighted national seroprevalence for Borrelia burgdorferi sensu lato, adjusted for clustered sampling, age, sex and province was 1.06% (95%CI 0.67-1.67). Although not statistically significant, the highest prevalences were observed in men and in those younger than 15 years or older than 59 years of age. At provincial level, the seroprevalence estimates do not follow the geographical distribution of tick bites and diagnoses of Lyme borreliosis as detected through other surveillance systems. CONCLUSIONS Although the use of residual samples for seroprevalence estimates has several advantages, it seems to be a limited tool for serological surveillance of Lyme borreliosis in Belgium, other than follow-up of trends if repeated over time. A population-based sampling strategy might provide a more representative nationwide sample, but would be very time intensive and expensive. Seroprevalence studies within risk groups or risk areas in Belgium could provide a useful alternative approach to complement routine surveillance data of Lyme borreliosis.
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Kirpach J, Colone A, Bürckert JP, Faison WJ, Dubois ARSX, Sinner R, Reye AL, Muller CP. Detection of a Low Level and Heterogeneous B Cell Immune Response in Peripheral Blood of Acute Borreliosis Patients With High Throughput Sequencing. Front Immunol 2019; 10:1105. [PMID: 31156648 PMCID: PMC6532064 DOI: 10.3389/fimmu.2019.01105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/30/2019] [Indexed: 01/08/2023] Open
Abstract
The molecular diagnosis of acute Borreliosis is complicated and better strategies to improve the diagnostic processes are warranted. High Throughput Sequencing (HTS) of human B cell repertoires after e.g., Dengue virus infection or influenza vaccination revealed antigen-associated “CDR3 signatures” which may have the potential to support diagnosis in infectious diseases. The human B cell immune response to Borrelia burgdorferi sensu lato—the causative agent of Borreliosis—has mainly been studied at the antibody level, while less attention has been given to the cellular part of the humoral immune response. There are indications that Borrelia actively influence the B cell immune response and that it is therefore not directly comparable to responses induced by other infections. The main goal of this study was to identify B cell features that could be used to support diagnosis of Borreliosis. Therefore, we characterized the B cell immune response in these patients by combining multicolor flow cytometry, single Borrelia-reactive B cell receptor (BCR) sequencing, and B cell repertoire deep sequencing. Our phenotyping experiments showed, that there is no significant difference between B cell subpopulations of acute Borreliosis patients and controls. BCR sequences from individual epitope-reactive B cells had little in common between each other. HTS showed, however, a higher complementarity determining region 3 (CDR3) amino acid (aa) sequence overlap between samples from different timepoints in patients as compared to controls. This indicates, that HTS is sensitive enough to detect ongoing B cell immune responses in these patients. Although each individual's repertoire was dominated by rather unique clones, clustering of bulk BCR repertoire sequences revealed a higher overlap of IgG BCR repertoire sequences between acute patients than controls. Even if we have identified a few Borrelia-associated CDR3aa sequences, they seem to be rather unique for each patient and therefore not suitable as biomarkers.
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Affiliation(s)
- Josiane Kirpach
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Alessia Colone
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Jean-Philippe Bürckert
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - William J Faison
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Axel R S X Dubois
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Regina Sinner
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Anna L Reye
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Claude P Muller
- Vaccinology and B Cell Immunology, Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
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Garg K, Meriläinen L, Franz O, Pirttinen H, Quevedo-Diaz M, Croucher S, Gilbert L. Evaluating polymicrobial immune responses in patients suffering from tick-borne diseases. Sci Rep 2018; 8:15932. [PMID: 30374055 PMCID: PMC6206025 DOI: 10.1038/s41598-018-34393-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023] Open
Abstract
There is insufficient evidence to support screening of various tick-borne diseases (TBD) related microbes alongside Borrelia in patients suffering from TBD. To evaluate the involvement of multiple microbial immune responses in patients experiencing TBD we utilized enzyme-linked immunosorbent assay. Four hundred and thirty-two human serum samples organized into seven categories followed Centers for Disease Control and Prevention two-tier Lyme disease (LD) diagnosis guidelines and Infectious Disease Society of America guidelines for post-treatment Lyme disease syndrome. All patient categories were tested for their immunoglobulin M (IgM) and G (IgG) responses against 20 microbes associated with TBD. Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes. We have established a causal association between TBD patients and TBD associated co-infections and essential opportunistic microbes following Bradford Hill's criteria. This study indicated an 85% probability that a randomly selected TBD patient will respond to Borrelia and other related TBD microbes rather than to Borrelia alone. A paradigm shift is required in current healthcare policies to diagnose TBD so that patients can get tested and treated even for opportunistic infections.
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Affiliation(s)
- Kunal Garg
- Department of Biological and Environmental Sciences, NanoScience Center, University of Jyväskylä, Jyväskylä, Finland
- Te?ted Ltd, Mattilaniemi 6-8, Jyväskylä, Finland
| | - Leena Meriläinen
- Department of Biological and Environmental Sciences, NanoScience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Ole Franz
- Department of Biological and Environmental Sciences, NanoScience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Heidi Pirttinen
- Department of Biological and Environmental Sciences, NanoScience Center, University of Jyväskylä, Jyväskylä, Finland
| | - Marco Quevedo-Diaz
- Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Stephen Croucher
- School of Communication, Journalism, and Marketing, Massey University, Wellington, New Zealand
| | - Leona Gilbert
- Department of Biological and Environmental Sciences, NanoScience Center, University of Jyväskylä, Jyväskylä, Finland.
- Te?ted Ltd, Mattilaniemi 6-8, Jyväskylä, Finland.
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Dersch R, Sarnes A, Maul M, Minakowski O, Hottenrott T, Stich O, Rauer S. Immunoblot reactivity at follow-up in treated patients with Lyme neuroborreliosis and healthy controls. Ticks Tick Borne Dis 2018; 10:166-169. [PMID: 30352738 DOI: 10.1016/j.ttbdis.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
About 5-20% of the general population in endemic areas have seroprevalence for anti-borrelial antibodies. Previous studies have shown a high rate of 25-97% of persisting anti-borrelial antibodies in patients with treated Lyme neuroborreliosis (LNB) at follow-up. These studies used immunoblots with antigens from whole-cell sonicates, which could be less specific than modern recombinant antigens. We assessed the seroprevalence of anti-borrelial antibodies in serum from patients with definite LNB and healthy controls with a line immunoblot using highly specific recombinant antigens. We retrospectively identified patients with treated definite LNB who were treated at the Medical Center-University of Freiburg. Serum from LNB patients at a mean follow-up period of 4.9 years (SD: 3.3) and serum from healthy controls were assessed for anti-borrelial antibodies with a line immunoblot with recombinant antigens. A total of 45 patients with definite LNB and 40 healthy controls were included. Ten LNB patients (22.7%) had persisting antibodies (IgG and/or IgM) in serum at follow-up. Serum samples from six healthy controls (15%) were positive for anti-borrelial antibodies (IgG and or IgM). Prevalence of positive IgM or IgG antibodies showed no statistically significant difference between LNB patients at follow-up and healthy controls (IgM p = 0.32, IgG p = 0.54). Immunoblot reactivity patterns at follow-up in LNB patients did not have statistically significant differences from healthy controls. The discrepancy regarding earlier studies reporting higher amounts of LNB patients with persisting antibodies could be due to a higher specificity of the antigens used in recombinant immunoblots compared to other immunoblots (e.g., whole-cell sonicates). The results of our study should be replicated in a larger prospective multi-center study.
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Affiliation(s)
- R Dersch
- Department of Neurology, Medical Center - University of Freiburg, Germany.
| | - A Sarnes
- Department of Neurology, Medical Center - University of Freiburg, Germany
| | - M Maul
- Department of Neurology, Medical Center - University of Freiburg, Germany
| | - O Minakowski
- Department of Neurology, Medical Center - University of Freiburg, Germany
| | - T Hottenrott
- Department of Neurology, Medical Center - University of Freiburg, Germany
| | - O Stich
- MVZ Neurology, Constance, Germany
| | - S Rauer
- Department of Neurology, Medical Center - University of Freiburg, Germany
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Blum LK, Adamska JZ, Martin DS, Rebman AW, Elliott SE, Cao RRL, Embers ME, Aucott JN, Soloski MJ, Robinson WH. Robust B Cell Responses Predict Rapid Resolution of Lyme Disease. Front Immunol 2018; 9:1634. [PMID: 30072990 PMCID: PMC6060717 DOI: 10.3389/fimmu.2018.01634] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022] Open
Abstract
Lyme disease (Borrelia burgdorferi infection) is increasingly recognized as a significant source of morbidity worldwide. Here, we show that blood plasmablasts and CD27− memory B cells are elevated in untreated Lyme disease, with higher plasmablast levels associated with more rapid resolution of clinical symptoms. Stronger serum reactivity to surface proteins and peptides from B. burgdorferi was also associated with faster resolution of clinical symptoms. Through molecular identifier-enabled antibody heavy-chain sequencing of bulk B cells and single-cell paired-chain antibody sequencing of blood plasmablasts, we characterized immunoglobulin gene usage patterns specific to B. burgdorferi infection. Recombinantly expressed antibodies from expanded lineages bound B. burgdorferi antigens, confirming that these clones are driven by the infection. Furthermore, recombinant sequence-derived antibodies were functional, inhibiting growth of B. burgdorferi in vitro. Elevations and clonal expansion of blood plasmablasts were associated with rapid return to health, while poor plasmablast responses were associated with a longer duration of symptoms following treatment. Plasmablasts induced by B. burgdorferi infection showed preferential antibody gene segment usage, while bulk sequencing of total B cells revealed convergent CDR3 motifs specific to B. burgdorferi-infected patients. Our results show that robust plasmablast responses encoding Bb-static antibodies are associated with more rapid resolution of Lyme disease, and these antibodies could provide the basis for next-generation therapeutics for Lyme disease.
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Affiliation(s)
- Lisa K Blum
- Stanford University School of Medicine, Stanford, CA, United States.,VA Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Julia Z Adamska
- Stanford University School of Medicine, Stanford, CA, United States.,VA Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Dale S Martin
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Serra E Elliott
- Stanford University School of Medicine, Stanford, CA, United States.,VA Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Richard R L Cao
- Stanford University School of Medicine, Stanford, CA, United States
| | - Monica E Embers
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark J Soloski
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - William H Robinson
- Stanford University School of Medicine, Stanford, CA, United States.,VA Palo Alto Healthcare System, Palo Alto, CA, United States
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21
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Kříž B, Malý M, Balátová P, Kodym P, Kurzová Z, Daniel M, Kybicová K. A serological study of antibodies to Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato in the sera of healthy individuals collected two decades apart. Acta Parasitol 2018; 63:33-39. [PMID: 29351070 DOI: 10.1515/ap-2018-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/21/2017] [Indexed: 11/15/2022]
Abstract
Sera collected from healthy individuals from the general population in the Czech Republic during repeated cross-sectional surveys were analyzed. Samples collected in the same six districts in two time periods, 1978-1989 and 2001, were compared. The study subjects were divided into six age categories between 10 and 59 years. Overall, 434 samples from 1978-1989 and 270 samples from 2001 were screened for Anaplasma phagocytophilum (AP) and Borrelia burgdorferi sensu lato (BB). The anti-AP positivity rates were 13.1% and 11.5% in the first and second period, respectively, and did not differ significantly between the periods (P = 0.559). The anti-BB antibodies were detected in 33.9% and 14.8% of study subjects, respectively. The positivity rates were significantly lower in the second period (P<0.001). No considerable changes were observed in the sex distribution of positive findings between the two periods. The highest positivity rates of anti-AP antibodies were found in the 10-14 year age group: 16.0% in 1978-1989 and 16.7% in 2001. The age distribution of the anti-AP antibody positivity rates did not change substantially (P = 0.872). In 1978-1989, the lowest anti-BB antibody positivity rate (26.7%) was found in the 10-14 year age group, with a gradual increase with age to 41.1% in 50-59 year-olds. In 2001, the positivity rate in the 10-14 year age group was 26.2% and was not significantly different from that in the first period (P = 0.955). However, the positivity rates in the older age groups 15-59 years decreased significantly (P<0.001) and varied between 8.3% and 15.1%.
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Affiliation(s)
- Bohumír Kříž
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
| | - Marek Malý
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
| | - Pavla Balátová
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
| | - Petr Kodym
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
| | - Zuzana Kurzová
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
| | - Milan Daniel
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
| | - Kateřina Kybicová
- National Institute of Public Health, Šrobárova 48, 100 42 Praha 10, Czech Republic
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22
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Sprong H, Azagi T, Hoornstra D, Nijhof AM, Knorr S, Baarsma ME, Hovius JW. Control of Lyme borreliosis and other Ixodes ricinus-borne diseases. Parasit Vectors 2018; 11:145. [PMID: 29510749 PMCID: PMC5840726 DOI: 10.1186/s13071-018-2744-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/23/2018] [Indexed: 12/25/2022] Open
Abstract
Lyme borreliosis (LB) and other Ixodes ricinus-borne diseases (TBDs) are diseases that emerge from interactions of humans and domestic animals with infected ticks in nature. Nature, environmental and health policies at (inter)national and local levels affect the risk, disease burden and costs of TBDs. Knowledge on ticks, their pathogens and the diseases they cause have been increasing, and resulted in the discovery of a diversity of control options, which often are not highly effective on their own. Control strategies involving concerted actions from human and animal health sectors as well as from nature managers have not been formulated, let alone implemented. Control of TBDs asks for a “health in all policies” approach, both at the (inter)national level, but also at local levels. For example, wildlife protection and creating urban green spaces are important for animal and human well-being, but may increase the risk of TBDs. In contrast, culling or fencing out deer decreases the risk for TBDs under specific conditions, but may have adverse effects on biodiversity or may be societally unacceptable. Therefore, in the end, nature and health workers together must carry out tailor-made control options for the control of TBDs for humans and animals, with minimal effects on the environment. In that regard, multidisciplinary approaches in environmental, but also medical settings are needed. To facilitate this, communication and collaboration between experts from different fields, which may include patient representatives, should be promoted.
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Affiliation(s)
- Hein Sprong
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. .,Laboratory of Entomology, Wageningen University and Research Centre, Wageningen, the Netherlands.
| | - Tal Azagi
- Centre for Zoonoses & Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Ard M Nijhof
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Sarah Knorr
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - M Ewoud Baarsma
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands
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Divers TJ, Gardner RB, Madigan JE, Witonsky SG, Bertone JJ, Swinebroad EL, Schutzer SE, Johnson AL. Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement. J Vet Intern Med 2018; 32:617-632. [PMID: 29469222 PMCID: PMC5866975 DOI: 10.1111/jvim.15042] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.
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Affiliation(s)
- T J Divers
- Department of Clinical Sciences, Cornell University, Ithaca, NY
| | | | - J E Madigan
- Department of Medicine and Epidemiology, University of California - Davis, CA
| | - S G Witonsky
- Department of Large Animal Clinical Sciences, Virginia-Maryland Region CVM, Blacksburg, VA
| | - J J Bertone
- CVMm Western University of Health Sciences, Pomona, CA
| | | | - S E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - A L Johnson
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, PA
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van Beek J, Sajanti E, Helve O, Ollgren J, Virtanen MJ, Rissanen H, Lyytikäinen O, Hytönen J, Sane J. Population-based Borrelia burgdorferi sensu lato seroprevalence and associated risk factors in Finland. Ticks Tick Borne Dis 2018; 9:275-280. [DOI: 10.1016/j.ttbdis.2017.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 12/29/2022]
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Cutler SJ, Rudenko N, Golovchenko M, Cramaro WJ, Kirpach J, Savic S, Christova I, Amaro A. Diagnosing Borreliosis. Vector Borne Zoonotic Dis 2017; 17:2-11. [PMID: 28055580 DOI: 10.1089/vbz.2016.1962] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Borrelia species fall into two groups, the Borrelia burgdorferi sensu lato (Bbsl) complex, the cause of Lyme borreliosis (also known as Lyme disease), and the relapsing fever group. Both groups exhibit inter- and intraspecies diversity and thus have variations in both clinical presentation and diagnostic approaches. A further layer of complexity is derived from the fact that ticks may carry multiple infectious agents and are able to transmit them to the host during blood feeding, with potential overlapping clinical manifestations. Besides this, pathogens like Borrelia have developed strategies to evade the host immune system, which allows them to persist within the host, including humans. Diagnostics can be applied at different times during the clinical course and utilize sample types, each with their own advantages and limitations. These differing methods should always be considered in conjunction with potential exposure and compatible clinical features. Throughout this review, we aim to explore different approaches providing the reader with an overview of methods appropriate for various situations. This review will cover human pathogenic members of Bbsl and relapsing fever borreliae, including newly recognized Borrelia miyamotoi spirochetes.
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Affiliation(s)
- Sally J Cutler
- 1 School of Health, Sport & Bioscience, University of East London , London, United Kingdom
| | - Nataliia Rudenko
- 2 Biology Centre CAS, Institute of Parasitology , Ceske Budejovice, Czech Republic
| | - Maryna Golovchenko
- 2 Biology Centre CAS, Institute of Parasitology , Ceske Budejovice, Czech Republic
| | - Wibke J Cramaro
- 3 Department of Infection and Immunity, Luxembourg Institute of Health , Esch-sur-Alzette, Luxembourg
| | - Josiane Kirpach
- 3 Department of Infection and Immunity, Luxembourg Institute of Health , Esch-sur-Alzette, Luxembourg
| | - Sara Savic
- 4 Scientific Veterinary Institute "Novi Sad ," Rumenacki put 20, Novi Sad, Serbia
| | - Iva Christova
- 5 Department of Microbiology, National Center of Infectious and Parasitic Diseases , Sofia, Bulgaria
| | - Ana Amaro
- 6 National Institute for Agrarian and Veterinarian Research (INIAV) , Lisboa, Portugal
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26
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Prevalence of Rickettsia spp. in Ticks and Serological and Clinical Outcomes in Tick-Bitten Individuals in Sweden and on the Åland Islands. PLoS One 2016; 11:e0166653. [PMID: 27846275 PMCID: PMC5113005 DOI: 10.1371/journal.pone.0166653] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/01/2016] [Indexed: 11/23/2022] Open
Abstract
Tick-transmitted diseases are an emerging health problem, and the hard tick Ixodes ricinus is the main vector for Borrelia spp., tick-borne encephalitis virus and most of the spotted fever Rickettsiae in Europe. The aim of the present study was to examine the incidence of rickettsial infection in the southernmost and south central parts of Sweden and the Åland Islands in Finland, the risk of infection in humans and its correlation with a bite of a Rickettsia-infected tick, the self-reported symptoms of rickettsial disease, and the prevalence of co-infection between Rickettsia spp. and Borrelia spp. Persons with a recent tick bite were enrolled through public media and asked to answer a questionnaire, provide a blood sample and bring detached ticks at enlistment and at follow-up three months later. Blood samples were previously analysed for Borrelia spp. antibodies and, for this report, analysed for antibodies to Rickettsia spp. by immunofluorescence and in 16 cases also using Western Blot. Ninety-six (44.0%) of the 218 participants were seropositive for IgG antibodies to Rickettsia spp. Forty (18.3%) of the seropositive participants had increased titres at the follow-up, indicating recent/current infection, while four (1.8%) had titres indicating probable recent/current infection (≥1:256). Of 472 ticks, 39 (8.3%) were Rickettsia sp. positive. Five (31.3%) of 16 participants bitten by a Rickettsia-infected tick seroconverted. Experience of the self-reported symptoms nausea (p = 0.006) and radiating pain (p = 0.041) was more common among those with recent, current or probable infection compared to those who did not seroconvert. Participants who showed seroreactivity or seroconversion to Rickettsia spp. had more symptoms than those who were seronegative. Seven (3.2%) participants showed seroconversion to Borrelia spp., and three (1.4%) of these showed seroconversion to both Rickettsia spp. and Borrelia spp., in accordance with previous studies in Sweden. Symptoms of rickettsial disease were in most of the cases vague and general that were difficult to differentiate from other tick-borne diseases.
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Markowicz M, Kivaranovic D, Stanek G. Testing patients with non-specific symptoms for antibodies against Borrelia burgdorferi sensu lato does not provide useful clinical information about their aetiology. Clin Microbiol Infect 2015; 21:1098-103. [DOI: 10.1016/j.cmi.2015.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/05/2015] [Accepted: 08/15/2015] [Indexed: 11/16/2022]
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Grankvist A, Sandelin LL, Andersson J, Fryland L, Wilhelmsson P, Lindgren PE, Forsberg P, Wennerås C. Infections with Candidatus Neoehrlichia mikurensis and Cytokine Responses in 2 Persons Bitten by Ticks, Sweden. Emerg Infect Dis 2015; 21:1462-5. [PMID: 26197035 PMCID: PMC4517700 DOI: 10.3201/eid2108.150060] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of Candidatus Neoehrlichia mikurensis infection was determined in 102 persons bitten by ticks in Sweden. Two infected women had erythematous rashes; 1 was co-infected with a Borrelia sp., and the other showed seroconversion for Anaplasma phagocytophilum. Both patients had increased levels of Neoehrlichia DNA and serum cytokines for several months.
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30
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Abstract
Lyme disease, caused by the Borrelia burgdorferi bacterium, is the most common vector-borne disease in the northern hemisphere. The clinical presentation varies with disease stage, and neurological manifestations (often referred to as Lyme neuroborreliosis) are reported in up to 12% of patients with Lyme disease. Most aspects of the epidemiology, clinical manifestation and treatment of Lyme neuroborreliosis are well known and accepted; only the management of so-called chronic Lyme disease is surrounded by considerable controversy. This term is used for disparate patient groups, including those who have untreated late-stage infection (for example, late neuroborreliosis), those with subjective symptoms that persist after treatment (termed 'post-treatment Lyme disease syndrome' [PTLDS]), and those with unexplained subjective complaints that may or may not be accompanied by positive test results for B. burgdorferi infection in serum (here called 'chronic Lyme disease'). The incidence of PTLDS is still a matter of debate, and its pathogenesis is unclear, but there is evidence that these patients do not have ongoing B. burgdorferi infection and, thus, do not benefit from additional antibiotic therapy. Chronic Lyme disease lacks an accepted clinical definition, and most patients who receive this diagnosis have other illnesses. Thus, a careful diagnostic work-up is needed to ensure proper treatment.
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Affiliation(s)
- Uwe Koedel
- Clinic Grosshadern of the Ludwig-Maximilians University of Munich, Department of Neurology, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority &German National Reference Centre for Borrelia, Veterinärstrasse 2, 85764 Oberschleissheim, Germany
| | - Hans-Walter Pfister
- Clinic Grosshadern of the Ludwig-Maximilians University of Munich, Department of Neurology, Marchioninistrasse 15, D-81377 Munich, Germany
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Elsner RA, Hastey CJ, Olsen KJ, Baumgarth N. Suppression of Long-Lived Humoral Immunity Following Borrelia burgdorferi Infection. PLoS Pathog 2015; 11:e1004976. [PMID: 26136236 PMCID: PMC4489802 DOI: 10.1371/journal.ppat.1004976] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 05/26/2015] [Indexed: 01/17/2023] Open
Abstract
Lyme Disease caused by infection with Borrelia burgdorferi is an emerging infectious disease and already by far the most common vector-borne disease in the U.S. Similar to many other infections, infection with B. burgdorferi results in strong antibody response induction, which can be used clinically as a diagnostic measure of prior exposure. However, clinical studies have shown a sometimes-precipitous decline of such antibodies shortly following antibiotic treatment, revealing a potential deficit in the host’s ability to induce and/or maintain long-term protective antibodies. This is further supported by reports of frequent repeat infections with B. burgdorferi in endemic areas. The mechanisms underlying such a lack of long-term humoral immunity, however, remain unknown. We show here that B. burgdorferi infected mice show a similar rapid disappearance of Borrelia-specific antibodies after infection and subsequent antibiotic treatment. This failure was associated with development of only short-lived germinal centers, micro-anatomical locations from which long-lived immunity originates. These showed structural abnormalities and failed to induce memory B cells and long-lived plasma cells for months after the infection, rendering the mice susceptible to reinfection with the same strain of B. burgdorferi. The inability to induce long-lived immune responses was not due to the particular nature of the immunogenic antigens of B. burgdorferi, as antibodies to both T-dependent and T-independent Borrelia antigens lacked longevity and B cell memory induction. Furthermore, influenza immunization administered at the time of Borrelia infection also failed to induce robust antibody responses, dramatically reducing the protective antiviral capacity of the humoral response. Collectively, these studies show that B. burgdorferi-infection results in targeted and temporary immunosuppression of the host and bring new insight into the mechanisms underlying the failure to develop long-term immunity to this emerging disease threat. Infections with the Lyme Disease agent, Borrelia burgdorferi, often fail to generate long-term protective immunity. We show here that this is because the immune system of the Borrelia-infected host generates only short-lived, structurally abnormal and non-functional germinal centers. These germinal centers fail to induce memory B cells and long-lived antibody-producing plasma cells, leaving the host susceptible to reinfection with Bb. This inability to induce long-term immunity was not due to the nature of Borrelia antigens, as even T-dependent antigens of Borrelia were unable to induce such responses. Moreover, influenza vaccine antigens, when applied during Borrelia-infection, failed to induce strong antibody responses and immune-protection from influenza challenge. This data illustrate the potent, if temporal, immune suppression induced by Borrelia-infection. Collectively, the data reveal a new mechanism by which B. burgdorferi subverts the adaptive immune response.
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Affiliation(s)
- Rebecca A. Elsner
- Center for Comparative Medicine, University of California, Davis, Davis, California, United States of America
- Microbiology Graduate Group, University of California, Davis, Davis, California, United States of America
| | - Christine J. Hastey
- Center for Comparative Medicine, University of California, Davis, Davis, California, United States of America
- Microbiology Graduate Group, University of California, Davis, Davis, California, United States of America
| | - Kimberly J. Olsen
- Center for Comparative Medicine, University of California, Davis, Davis, California, United States of America
| | - Nicole Baumgarth
- Center for Comparative Medicine, University of California, Davis, Davis, California, United States of America
- Microbiology Graduate Group, University of California, Davis, Davis, California, United States of America
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
- * E-mail:
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Wagemakers A, Staarink PJ, Sprong H, Hovius JWR. Borrelia miyamotoi: a widespread tick-borne relapsing fever spirochete. Trends Parasitol 2015; 31:260-9. [PMID: 25892254 DOI: 10.1016/j.pt.2015.03.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Borrelia miyamotoi is a relapsing fever spirochete that has only recently been identified as a human pathogen. Borrelia miyamotoi is genetically and ecologically distinct from Borrelia burgdorferi sensu lato, while both are present in Ixodes ticks. Over 50 patients with an acute febrile illness have been described with a B. miyamotoi infection, and two infected immunocompromised patients developed a meningoencephalitis. Seroprevalence studies indicate exposure in the general population and in specific risk groups, such as patients initially suspected of having human granulocytic anaplasmosis. Here, we review the available literature on B. miyamotoi, describing its presence in ticks, reservoir hosts, and humans, and discussing its potential impact on public health.
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Affiliation(s)
- Alex Wagemakers
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Pieter J Staarink
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Antonie van Leeuwenhoeklaan 9, PO Box 1, Bilthoven, The Netherlands
| | - Joppe W R Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Amsterdam Multidisciplinary Lyme Center, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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Correll MH, Datta N, Arvidsson HSS, Melsom HA, Thielberg AK, Bjerager M, Brodsky MC, Saunte JP. Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children. Br J Ophthalmol 2015; 99:1401-4. [PMID: 25868792 DOI: 10.1136/bjophthalmol-2015-306855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB. METHODS Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients. RESULTS Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children. CONCLUSIONS LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition.
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Affiliation(s)
- M H Correll
- Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - N Datta
- Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - H S S Arvidsson
- Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - H A Melsom
- Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - A K Thielberg
- Department of Pediatrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - M Bjerager
- Department of Pediatrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - M C Brodsky
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J P Saunte
- Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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Verma V, Roman M, Shah D, Zaretskaya M, Yassin MH. A case of chronic progressive lyme encephalitis as a manifestation of late lyme neuroborreliosis. Infect Dis Rep 2014; 6:5496. [PMID: 25568755 PMCID: PMC4274401 DOI: 10.4081/idr.2014.5496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 01/07/2023] Open
Abstract
A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.
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Affiliation(s)
- Vivek Verma
- Department of Medicine, University of Pittsburgh Medical Center , PA, USA
| | - Matthew Roman
- Department of Medicine, University of Pittsburgh Medical Center , PA, USA
| | - Disha Shah
- Division of Neurology, University of Pittsburgh Medical Center , PA, USA
| | - Marina Zaretskaya
- Division of Neurology, University of Pittsburgh Medical Center , PA, USA
| | - Mohamed H Yassin
- Department of Medicine, University of Pittsburgh Medical Center , PA, USA ; Division of Infectious Diseases, University of Pittsburgh Medical Center , PA, USA
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Lumbosacral multiradiculopathy responsive to antibiotic therapy: description of four patients with lumbar spondylosis and a superimposed Lyme disease. Acta Neurol Belg 2014; 114:297-301. [PMID: 24515913 DOI: 10.1007/s13760-014-0280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
Lyme disease is a diffuse zoonosis caused by spirochaetes of the Borrelia burgdorferi species complex. Neurological manifestations of the disease, involving central or peripheral nervous system, are common. This study describes four consecutive patients with an MRI-proven lumbosacral spondylosis, who complained of progressive worsening of symptoms in the last months in which serological evaluation suggested a superimposed B. Burgdorferi infection. Four patients, all from the Lazio region, were admitted to the Department of Neurology. Extensive laboratory studies and clinical, anamnestic and neurophysiological evaluation were performed in all cases. In all cases, anamnesis revealed a previous diagnosis of lumbosacral foraminal stenosis. Clinical and neurophysiological findings were consistent with a lumbosacral multiradiculopathy. Considering serological evaluation suggestive of a superimposed B. burgdorferi infection a proper antibiotic therapy was started. All cases showed a marked improvement of symptoms. Clinicians should be aware that in all cases of lumbosacral multiradiculopathy, even if a mechanical cause is documented, B. burgdorferi may be a simply treatable condition.
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Blanc F, Jaulhac B, Hansmann Y, Dietemann JL, Tranchant C. Borreliosi di Lyme e neuroborreliosi. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)68869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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CD4+ T cells promote antibody production but not sustained affinity maturation during Borrelia burgdorferi infection. Infect Immun 2014; 83:48-56. [PMID: 25312948 DOI: 10.1128/iai.02471-14] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CD4 T cells are crucial for enhancing B cell-mediated immunity, supporting the induction of high-affinity, class-switched antibody responses, long-lived plasma cells, and memory B cells. Previous studies showed that the immune response to Borrelia burgdorferi appears to lack robust T-dependent B cell responses, as neither long-lived plasma cells nor memory B cells form for months after infection, and nonswitched IgM antibodies are produced continuously during this chronic disease. These data prompted us to evaluate the induction and functionality of B. burgdorferi infection-induced CD4 T(FH) cells. We report that CD4 T cells were effectively primed and T(FH) cells induced after B. burgdorferi infection. These CD4 T cells contributed to the control of B. burgdorferi burden and supported the induction of B. burgdorferi-specific IgG responses. However, while affinity maturation of antibodies against a prototypic T-dependent B. burgdorferi protein, Arthritis-related protein (Arp), were initiated, these increases were reversed later, coinciding with the previously observed involution of germinal centers. The cessation of affinity maturation was not due to the appearance of inhibitory or exhausted CD4 T cells or a strong induction of regulatory T cells. In vitro T-B cocultures demonstrated that T cells isolated from B. burgdorferi-infected but not B. burgdorferi-immunized mice supported the rapid differentiation of B cells into antibody-secreting plasma cells rather than continued proliferation, mirroring the induction of rapid short-lived instead of long-lived T-dependent antibody responses in vivo. The data further suggest that B. burgdorferi infection drives the humoral response away from protective, high-affinity, and long-lived antibody responses and toward the rapid induction of strongly induced, short-lived antibodies of limited efficacy.
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Hinckley AF, Connally NP, Meek JI, Johnson BJ, Kemperman MM, Feldman KA, White JL, Mead PS. Lyme disease testing by large commercial laboratories in the United States. Clin Infect Dis 2014; 59:676-81. [PMID: 24879782 PMCID: PMC4646413 DOI: 10.1093/cid/ciu397] [Citation(s) in RCA: 284] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laboratory testing is helpful when evaluating patients with suspected Lyme disease (LD). A 2-tiered antibody testing approach is recommended, but single-tier and nonvalidated tests are also used. We conducted a survey of large commercial laboratories in the United States to assess laboratory practices. We used these data to estimate the cost of testing and number of infections among patients from whom specimens were submitted. METHODS Large commercial laboratories were asked to report the type and volume of testing conducted nationwide in 2008, as well as the percentage of positive tests for 4 LD-endemic states. The total direct cost of testing was calculated for each test type. These data and test-specific performance parameters available in published literature were used to estimate the number of infections among source patients. RESULTS Seven participating laboratories performed approximately 3.4 million LD tests on approximately 2.4 million specimens nationwide at an estimated cost of $492 million. Two-tiered testing accounted for at least 62% of assays performed; alternative testing accounted for <3% of assays. The estimated frequency of infection among patients from whom specimens were submitted ranged from 10% to 18.5%. Applied to the total numbers of specimens, this yielded an estimated 240 000 to 444 000 infected source patients in 2008. DISCUSSION LD testing is common and costly, with most testing in accordance with diagnostic recommendations. These results highlight the importance of considering clinical and exposure history when interpreting laboratory results for diagnostic and surveillance purposes.
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Affiliation(s)
- Alison F Hinckley
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Neeta P Connally
- Connecticut Emerging Infections Program, Department of Biological and Environmental Sciences, Western Connecticut State University, Danbury
| | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven
| | - Barbara J Johnson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | | | | | - Paul S Mead
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
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Finch C, Al-Damluji MS, Krause PJ, Niccolai L, Steeves T, O'Keefe CF, Diuk-Wasser MA. Integrated assessment of behavioral and environmental risk factors for Lyme disease infection on Block Island, Rhode Island. PLoS One 2014; 9:e84758. [PMID: 24416278 PMCID: PMC3885597 DOI: 10.1371/journal.pone.0084758] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
Peridomestic exposure to Borrelia burgdorferi-infected Ixodes scapularis nymphs is considered the dominant means of infection with black-legged tick-borne pathogens in the eastern United States. Population level studies have detected a positive association between the density of infected nymphs and Lyme disease incidence. At a finer spatial scale within endemic communities, studies have focused on individual level risk behaviors, without accounting for differences in peridomestic nymphal density. This study simultaneously assessed the influence of peridomestic tick exposure risk and human behavior risk factors for Lyme disease infection on Block Island, Rhode Island. Tick exposure risk on Block Island properties was estimated using remotely sensed landscape metrics that strongly correlated with tick density at the individual property level. Behavioral risk factors and Lyme disease serology were assessed using a longitudinal serosurvey study. Significant factors associated with Lyme disease positive serology included one or more self-reported previous Lyme disease episodes, wearing protective clothing during outdoor activities, the average number of hours spent daily in tick habitat, the subject’s age and the density of shrub edges on the subject’s property. The best fit multivariate model included previous Lyme diagnoses and age. The strength of this association with previous Lyme disease suggests that the same sector of the population tends to be repeatedly infected. The second best multivariate model included a combination of environmental and behavioral factors, namely hours spent in vegetation, subject’s age, shrub edge density (increase risk) and wearing protective clothing (decrease risk). Our findings highlight the importance of concurrent evaluation of both environmental and behavioral factors to design interventions to reduce the risk of tick-borne infections.
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Affiliation(s)
- Casey Finch
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Mohammed Salim Al-Damluji
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America ; Department of Internal Medicine at Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Peter J Krause
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Linda Niccolai
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Tanner Steeves
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Corrine Folsom O'Keefe
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America ; Audubon Connecticut, Southbury, Connecticut, United States of America
| | - Maria A Diuk-Wasser
- Department of Epidemiology of Microbial Diseases at Yale School of Public Health, New Haven, Connecticut, United States of America
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Abstract
Lyme neuroborreliosis (LNB) designates the nervous system disorders caused by the tick-borne spirochete Borrelia burgdorferi (Bb). The clinical syndromes are usually distinct and are classified as early and the rare late or chronic LNB. Early LNB occurs 3-6 weeks after infection most frequently as a lymphocytic meningoradiculoneuritis (LMR). Symptoms are mainly due to a painful sensory radiculitis and a multifocal motor radiculo-neuritis. Fifty percent have cranial nerve involvement predominantly uni- or bilateral facial nerve palsies. Meningitic symptoms occur primarily in children. Nerve biopsies, autopsies, animal models, and nerve conduction studies showed that the pathology is a lymphocytic perineuritis leading to multisegmental axonal injury of nerve roots, spinal ganglia, and distal nerve segments. Due to meningeal and root inflammation cerebrospinal fluid (CSF) shows lymphocytic inflammation. The only evidence that Bb causes peripheral neuropathy without CSF inflammation is seen in patients with acrodermatitis chronica atrophicans (ACA), a chronic dermatoborreliosis. In the rare chronic or late LNB the pathology and thus the clinical presentation is primarily due to chronic meningitis and meningovascular CNS involvement, whereas the peripheral nervous system is not primarily affected. In early and late LNB the diagnosis is based on a characteristic clinical appearance and CSF inflammation with Bb-specific intrathecal antibody production. Both conditions, but not the ACA-associated neuropathy, respond to antibiotic therapy.
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Affiliation(s)
- Klaus Hansen
- Department of Neurology, Rigshospitalet, University Clinic Copenhagen, Denmark.
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Divers T, Grice A, Mohammed H, Glaser A, Wagner B. Changes in Borrelia burgdorferi ELISA antibody over time in both antibiotic treated and untreated horses. Acta Vet Hung 2012; 60:421-9. [PMID: 23160024 DOI: 10.1556/avet.2012.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Changes in ELISA serology are frequently used to determine antibiotic treatment success for Lyme disease in horses. This concept was based upon a previous report showing a marked decline in ELISA values in experimentally infected and antibiotic-treated ponies. Changes in Lyme serology following antibiotic treatment in naturally infected horses have not been reported. The objective of this study was to compare Borrelia ELISA antibody concentrations in naturally exposed horses both before and following antibiotic treatment for Lyme disease. A retrospective study was performed comparing oxytetracycline- or doxycyclinetreated (n = 68) and untreated (n = 183) horses from a single equine practice and their change in Borrelia ELISA values over a similar time period. Antibiotictreated horses had a decline in ELISA values in comparison to control horses (P ≤ 0.05) and untreated horses were twice as likely to have their ELISA values increase (OR = 0.5; 95% C.I. = 0.3-0.9) compared to treated horses. The magnitude of the decline in ELISA units following treatments was small compared to that previously reported in experimentally infected and treated ponies. Field-exposed horses with high Borrelia burgdorferi ELISA values who are treated with either oxytetracycline or doxycycline can be expected to have only a small decline in ELISA values following treatment. Persistently high ELISA titres following appropriate treatments for Lyme disease may not, without appropriate clinical signs, be a reason for more prolonged treatment.
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Affiliation(s)
- Thomas Divers
- 1 Cornell University Department of Clinical Sciences Ithaca NY 14853 USA
| | - Amy Grice
- 3 Rhinebeck Equine 26 Losee Lane Rhinebeck NY USA
| | - Hussni Mohammed
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
| | - Amy Glaser
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
| | - Bettina Wagner
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
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Early diagnosis and treatment of patients with symptomatic acute Q fever do not prohibit IgG antibody responses to Coxiella burnetii. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1661-6. [PMID: 22914364 DOI: 10.1128/cvi.00322-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Little is known about the effect of timing of antibiotic treatment on development of IgG antibodies following acute Q fever. We studied IgG antibody responses in symptomatic patients diagnosed either before or during development of the serologic response to Coxiella burnetii. Between 15 and 31 May 2009, 186 patients presented with acute Q fever, of which 181 were included in this retrospective study: 91 early-diagnosed (ED) acute Q fever patients, defined as negative IgM phase II enzyme-linked immunosorbent assay (ELISA) and positive PCR, and 90 late-diagnosed (LD) acute Q fever patients, defined as positive/dubious IgM phase II ELISA and positive immunofluorescence assay (IFA). Follow-up serology at 3, 6, and 12 months was performed using IFA (IgG phase I and II). High IgG antibody titers were defined as IgG phase II titers of ≥1:1,024 together with IgG phase I titers of ≥1:256. At 12 months, 28.6% of ED patients and 19.5% of LD patients had high IgG antibody titers (P = 0.17). No statistically significant differences were found in frequencies of IgG phase I and IgG phase II antibody titers at all follow-up appointments for adequately and inadequately treated patients overall, as well as for ED and LD patients analyzed separately. Additionally, no significant difference was found in frequencies of high antibody titers and between early (treatment started within 7 days after seeking medical attention) and late timing of treatment. This study indicates that early diagnosis and antibiotic treatment of acute Q fever do not prohibit development of the IgG antibody response.
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Abstract
PURPOSES To chart clinical, laboratory, and psychometric profiles in patients who attribute their complaints to chronic Lyme disease. METHODS We assessed the patients by clinical examination, laboratory tests, and questionnaires measuring fatigue, depression, anxiety, health-related quality of life, hypochondriasis, and illness perceptions. RESULTS We found no evidence of ongoing Borrelia burgdorferi (Bb) infection in any of the 29 included patients using current diagnostic guidelines and an extended array of tests. Eight (28%) had other well-defined illnesses. Twenty-one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post-Lyme disease syndrome. Fourteen (48%) had presence of anti-Bb antibodies. The patients had more fatigue and poorer health-related quality of life as compared to normative data, but were not more depressed, anxious, or hypochondriacal. Their beliefs about the illness were characterized by negative expectations. CONCLUSION Our patients, who all attributed their symptoms to chronic Lyme disease, were heterogeneous. None had evidences of persistent Bb infection, but whether current diagnostic criteria are functional in patients with longstanding complaints is controversial. Other well-defined illnesses or sequelae from earlier Lyme disease were probable as main explanatory factor in some cases. The patients were not more depressed, anxious, or hypochondriacal than the normal population, but they had poorer health-related quality of life, more fatigue, and negative expectations about their illness.
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Affiliation(s)
- U Ljøstad
- Department of Neurology, Sørlandet Hospital, Kristiansand, Norway.
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Adaptive and innate immune responsiveness to Borrelia burgdorferi sensu lato in exposed asymptomatic children and children with previous clinical Lyme borreliosis. Clin Dev Immunol 2011; 2012:294587. [PMID: 22190976 PMCID: PMC3235451 DOI: 10.1155/2012/294587] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 12/21/2022]
Abstract
Why some individuals develop clinical manifestations in Lyme borreliosis (LB) while others remain asymptomatic is largely unknown. Therefore, we wanted to investigate adaptive and innate immune responsiveness to Borrelia burgdorferi sensu lato in exposed Borrelia-antibody-positive asymptomatic children (n = 20), children with previous clinical LB (n = 24), and controls (n = 20). Blood samples were analyzed for Borrelia-specific interferon (IFN)-γ, interleukin (IL)-4, and IL-17 secretion by ELISPOT and Borrelia-induced IL-1β, IL-6, IL-10, IL-12(p70), and tumor necrosis factor (TNF) secretion by Luminex. We found no significant differences in cytokine secretion between groups, but a tendency towards an increased spontaneous secretion of IL-6 was found among children with previous clinical LB. In conclusion, the adaptive or innate immune responsiveness to Borrelia burgdorferi sensu lato was similar in Borrelia-exposed asymptomatic children and children with previous clinical LB. Thus, the immunological mechanisms of importance for eradicating the spirochete effectively without developing clinical manifestations of LB remain unknown.
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Abstract
Lyme borreliosis is a multisystem infectious disease caused by tick-transmitted spirochetes of the Borrelia burgdorferi sensu lato complex. The three characteristic cutaneous manifestations are erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. Erythema migrans occurs in acute Lyme borreliosis, lymphocytoma is a subacute lesion, and acrodermatitis is the typical manifestation of late Lyme borreliosis. Clinical appearances of erythema migrans and lymphocytoma (when located on the ear or breast) are characteristic, whereas acrodermatitis is often confused with vascular conditions. The diagnosis of erythema migrans is made clinically. Serologic analyses often yield false-negative results and are not required for the diagnosis. However, serologic proof of the diagnosis in lymphocytoma (approximately 90% positive) and acrodermatitis (100% positive) is mandatory. Histopathologic examination often adds substantial information in patients with skin manifestations of Lyme borreliosis and is recommended in clinically (and serologically) undecided cases of erythema migrans or lymphocytoma and is obligatory in acrodermatitis. Polymerase chain reaction for Borrelia-specific DNA (rather than culture of the spirochete) and immunohistochemical investigations (lymphocytoma) are sometimes necessary adjuncts for the diagnosis. Antibacterial treatment is necessary in all patients to eliminate the spirochete, cure current disease, and prevent late sequelae. Oral doxycycline, also effective against coinfection with Anaplasma phagocytophilum, is the mainstay of therapy of cutaneous manifestations of Lyme borreliosis. Other first-line antibacterials are amoxicillin and cefuroxime axetil. Erythema migrans is treated for 2 weeks, lymphocytoma for 3-4 weeks, and acrodermatitis for at least 4 weeks.
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Affiliation(s)
- Robert R Müllegger
- Department of Dermatology, Central Hospital Wiener Neustadt, Wiener Neustadt, Austria.
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Kristiansen BE, Grude N, Tveten Y, Emmert A. Laboratoriediagnostikk av Lyme-borreliose. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:2132-4. [DOI: 10.4045/tidsskr.09.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
Reports of the presence of Borrelia burgdorferi DNA in malignant lymphomas have raised the hypothesis that infection with B. burgdorferi may be causally related to non-Hodgkin lymphoma (NHL) development. We conducted a Danish-Swedish case-control study including 3055 NHL patients and 3187 population controls. History of tick bite or Borrelia infection was ascertained through structured telephone interviews and through enzyme-linked immunosorbent assay serum analyses for antibodies against B. burgdorferi in a subset of 1579 patients and 1358 controls. Statistical associations with risk of NHL, including histologic subtypes, were assessed by logistic regression. Overall risk of NHL was not associated with self-reported history of tick bite (odds ratio [OR] = 1.0; 95% confidence interval: 0.9-1.1), Borrelia infection (OR = 1.3 [0.96-1.8]) or the presence of anti-Borrelia antibodies (OR = 1.3 [0.9-2.0]). However, in analyses of NHL subtypes, self-reported history of B. burgdorferi infection (OR = 2.5 [1.2-5.1]) and seropositivity for anti-Borrelia antibodies (OR = 3.6 [1.8-7.4]) were both associated with risk of mantle cell lymphoma. Notably, this specific association was also observed in persons who did not recall Borrelia infection yet tested positive for anti-Borrelia antibodies (OR = 4.2 [2.0-8.9]). Our observations suggest a previously unreported association between B. burgdorferi infection and risk of mantle cell lymphoma.
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Bednárova J. Cerebrospinal-fluid profile in neuroborreliosis and its diagnostic significance. Folia Microbiol (Praha) 2007; 51:599-603. [PMID: 17455797 DOI: 10.1007/bf02931625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Selected cerebrospinal-fluid (CSF) parameters (intrathecal synthesis of Borrelia-specific antibodies, oligoclonal IgG bands, CSF-to-serum quotient of albumin as a marker of blood-CSF barrier function and cytology) and typical CSF profile in neuroborreliosis were evaluated with the aim of elucidating possible clinical and laboratory similarities of neuroborreliosis (NB) and other neurological diseases (OND). From the cohort of 58 patients (38 diagnosed for NB, 20 with OND) NB patients had positive Borrelia-specific IgG antibodies in 97 % and positive Borrelia-specific IgM antibodies in 55 %; oligoclonal IgG bands were detected in 55%. The blood-CSF barrier was impaired in 89%, positive cytology was detected in 97% of the NB patients. Evaluation of specific intrathecal synthesis improves CSF diagnosis of NB, therefore, a combined CSF analysis has to be considered along with the clinical picture and medical history when formulating the diagnosis of NB.
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Affiliation(s)
- J Bednárova
- Department of Clinical Microbiology, Faculty Hospital Brno, Czechia.
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