Development and Validation of a Protein Array for Detection of Antibodies against the Tick-Borne Pathogen Borrelia miyamotoi

Exposure, infection and disease with the tick-borne pathogen Borrelia miyamotoi in the Netherlands and Sweden, 2007-2019

The impact of the emerging tick-borne pathogen Borrelia miyamotoi is not fully understood. We utilised a protein array to investigate B. miyamotoi seroreactivity in various human populations in the Netherlands and Sweden. The IgM/IgG seroprevalence in Dutch healthy (2·5%, 95%CI 1·5-4·1) and population controls (2·0%, 95%CI 0·9-4·4) was lower (p = 0·01 and p = 0·01) compared to the tick-bite cohort (6·1%, 95%CI 3·9-9·5). In accordance, the Swedish healthy controls (1·0%, 95%CI 0·1-6·9) revealed a lower (p = 0·005 and p < 0·001) IgM/IgG seroprevalence compared to the tick-bite (8·9%, 95%CI 5·7-13·7) and fever after tick-bite cohort (16·5%, 95%CI 10·6-24·8). Altogether, 15 of 2175 individuals had serologic evidence of early B. miyamotoi infection. The risk of infection with B. miyamotoi was 0·7% (95%CI 0·3-1·4) in tick-bitten individuals, and of disease 7·3% (95%CI 2·6-12·8) in those with a febrile illness after tick-bite. Our findings provide insights into the risk of infection and disease with this pathogen in Europe.

The occurrence of Borrelia miyamotoi in Dermacentor reticulatus and Ixodes ricinus ticks in the Chornobyl Exclusion Zone, Ukraine

Borrelia miyamotoi spirochete is carried by Ixodidae ticks and causing Borrelia miyamotoi disease (BMD), a relapsing fever illness reported worldwide, often in the same geographic areas where Lyme disease is endemic. The purpose of this study was to examine the presence of B. miyamotoi infection in Dermacentor reticulatus and Ixodes ricinus ticks collected within the boundaries of the Chornobyl Exclusion Zone, Ukraine. A total of 1176 adult D. reticulatus ticks and 113 adult I. ricinus ticks sampled from five different habitats in the Chornobyl Exclusion Zone, Ukraine, were tested for Borrelia miyamotoi using a two-step nested PCR procedure. Borrelia miyamotoi was found in two (0.17%) out of the 1176 D. reticulatus ticks tested. The obtained sequences were submitted to GenBank (MZ365312-MZ365313). Phylogenetic analysis showed that the B. miyamotoi sequences detected cluster together with a strain originating from I. scapularis in the USA. The strain identified in the Chornobyl Exclusion Zone belongs to the group of strains found in Eastern Europe and Asia, north of the Himalayas. No I. ricinus ticks were found to be infected. This study presents the first detection of B. miyamotoi in D. reticulatus ticks in the Chornobyl Exclusion Zone, Ukraine.

Survey of tick-borne relapsing fever borreliae in southern and southeastern Kazakhstan

Tick-borne relapsing fever group borreliae (TBRFGB) are spirochetes that cause disease in humans and animals. Little is known about the prevalence of TBRFGB infections in ticks and humans in Kazakhstan. A total of 846 ticks belonging to ten species of the family Ixodidae and three species of the family Argasidae were collected from the vegetation, poultry shelters, domestic ruminants, bitten humans, pigeons, dogs and house walls in four oblasts of the southern and southeastern regions of Kazakhstan. The ticks were subjected to DNA extraction and identification of TBRFGB by conventional PCR using primers targeting flagella subunit B (flaB), glycerophosphodiester phosphodiesterase (glpQ) and P66 porin (P66) genes. The overall infection rate of TBRFGB in the ticks was 6.2 % (46/846). TBRFGB DNA was identified in Ixodes persulcatus (5.5 %; 26/477), Ornithodoros tartakovskyi (6 %; 2/36) and Argas persicus (13.4 %; 18/134) ticks. Partial sequencing of flaB, glpQ and P66 genes identified Borrelia miyamotoi in I. persulcatus and Borrelia anserina in A. persicus. To detect the presence of B. miyamotoi infection in people in the study region, we performed serological analysis of samples collected from 42 patients admitted to hospital with fever of unknown etiology or with a history of a tick bite. The analysis revealed IgM and IgG antibodies against one or several B. miyamotoi antigens in 10 % and 5 % of patients, respectively. The data obtained provide strong evidence of the presence of B. miyamotoi and B. anserina in the southern and southeastern regions of Kazakhstan, underscoring the need for increased awareness of potential infections caused by these borreliae in these regions.

Limited evidence of infection with other tick-borne pathogens in patients tested for Lyme neuroborreliosis in the Netherlands

Ixodes ricinus is the main vector of the causative agents of Lyme neuroborreliosis. This tick species can also transmit tick-borne encephalitis virus (TBEV), spotted fever group (SFG) Rickettsia and Borrelia miyamotoi to humans. These tick-borne pathogens are present in Dutch ticks and have also been associated with human neurological infections, but well characterized disease cases are seldom reported. We therefore assessed the evidence for TBEV, SFG Rickettsia or B. miyamotoi infection in clinically well-described patients suspected of Lyme neuroborreliosis. We retrospectively included patients with specific predefined clinical criteria from patients that were tested for Lyme neuroborreliosis between 2010 and 2014 at an academic Lyme borreliosis Center. Serology was performed on available serum samples, and cerebrospinal fluid (CSF) was tested by molecular methods. Out of 514 potentially eligible patients, 176 individual patients were included. None of CSF samples was positive for the tested tick-borne pathogens, except for one previously described patient with Borrelia miyamotoi disease (BMD). Serology revealed 27, 14 and three patients with antibodies against SFG Rickettsia, B. miyamotoi and TBEV, respectively. No distinctive clinical symptoms or signs could be associated with seropositivity against any of these tick-borne pathogens. Apart from the previously published BMD case, we were unable to find convincing evidence of new cases of tick-borne encephalitis, spotted fever rickettsiosis or BMD in a cohort of patients suspected of Lyme neuroborreliosis. While antibodies against these tick-borne pathogens were detected, we could not associate these findings to clinical symptoms or signs. Therefore, prospective studies on humans with tick exposure are necessary to describe the prevalence, etiology and clinical symptoms of these tick-borne diseases other than Lyme borreliosis and tick-borne encephalitis.

Borrelia miyamotoi BipA-like protein, BipM, is a candidate serodiagnostic antigen distinguishing between Lyme disease and relapsing fever Borrelia infections

A Borrelia miyamotoi gene with partial homology to bipA of relapsing fever spirochetes Borrelia hermsii and Borrelia turicatae was identified by a GenBank basic alignment search analysis. We hypothesized that this gene product may be an immunogenic antigen as described for other relapsing fever Borrelia (RFB) and could serve as a serological marker for B. miyamotoi infections. The B. miyamotoi gene was a truncated version about half the size of the B. hermsii and B. turicatae bipA with a coding sequence of 894 base pairs. The gene product had a calculated molecular size of 32.7 kDa (including the signal peptide). Amino acid alignments with B. hermsii and B. turicatae BipA proteins and with other B. miyamotoi isolates showed conservation at the carboxyl end. We cloned the B. miyamotoi bipA-like gene (herein named bipM) and generated recombinant protein for serological characterization and for antiserum production. Protease protection analysis demonstrated that BipM was surface exposed. Serologic analyses using anti-B. miyamotoi serum samples from tick bite-infected and needle inoculated mice showed 94 % positivity against BipM. The 4 BipM negative serum samples were blotted against another B. miyamotoi antigen, BmaA, and two of them were seropositive resulting in 97 % positivity with both antigens. Serum samples from B. burgdorferi sensu stricto (s.s.)-infected mice were non-reactive against rBipM by immunoblot. Serum samples from Lyme disease patients were also serologically negative against BipM except for 1 sample which may have indicated a possible co-infection. A recently published study demonstrated that B. miyamotoi BipM was non-reactive against serum samples from B. hermsii, Borrelia parkeri, and B. turicatae infected animals. These results show that BipM has potential for a B. miyamotoi-infection specific and sensitive serodiagnostic to differentiate between Lyme disease and various RFB infections.

Tick-borne infections in children in North America

PURPOSE OF REVIEW

Because both incidence and awareness of tick-borne infections is increasing, review of major infections and recent advances related to their diagnosis and management is important.

RECENT FINDINGS

A new algorithm, termed modified two-tier testing, for testing for antibodies to Borrelia burgdorferi , the cause of Lyme disease, has been approved and may replace traditional two-tier testing. In addition, doxycycline is now acceptable to use for treatment of and/or prophylaxis for Lyme disease for up to 21 days in children of any age. Borrelia miyamotoi , a bacterium in the relapsing fever type of Borrelia, is the first of this type of Borrelia that is transmitted by hard-bodied ticks such as Ixodes scapularis.

SUMMARY

Awareness of these infections and advances in their diagnosis and treatment is important to assure the best outcomes for affected patients. Table 1 contains a summary of infections discussed.

Determinants of persistent symptoms after treatment for Lyme borreliosis: a prospective observational cohort study

BACKGROUND

Patients treated for Lyme borreliosis (LB) frequently report persistent symptoms. Little is known about risk factors and etiology.

METHODS

In a prospective observational cohort study with a follow-up of one year, we assessed a range of microbiological, immunological, genetic, clinical, functional, epidemiological, psychosocial and cognitive-behavioral variables as determinants of persistent symptoms after treatment for LB. Between 2015 and 2018 we included 1135 physician-confirmed LB patients at initiation of antibiotic therapy, through clinical LB centers and online self-registration. Two reference cohorts of individuals without LB (n = 4000 and n = 2405) served as a control. Prediction analyses and association studies were used to identify determinants, as collected from online questionnaires (three-monthly) and laboratory tests (twice).

FINDINGS

Main predictors of persistent symptoms were baseline poorer physical and social functioning, higher depression and anxiety scores, more negative illness perceptions, comorbidity, as well as fatigue, cognitive impairment, and pain in 295 patients with persistent symptoms. The primary prediction model correctly indicated persistent symptoms in 71.0% of predictions (AUC 0.79). In patients with symptoms at baseline, cognitive-behavioral responses to symptoms predicted symptom persistence. Of various microbiological, immunological and genetic factors, only lower IL-10 concentrations in ex vivo stimulation experiments were associated with persistent symptoms. Clinical LB characteristics did not contribute to the prediction of persistent symptoms.

INTERPRETATION

Determinants of persistent symptoms after LB were mainly generic, including baseline functioning, symptoms and cognitive-behavioral responses. A potential role of host immune responses remains to be investigated.

FUNDING

Netherlands Organisation for Health Research and Development (ZonMw); the Dutch Ministry of Health, Welfare and Sport (VWS).

Case report: First case of Borrelia miyamotoi meningitis in an immunocompromised patient in Norway

Background

Tick-borne disease caused by B. miyamotoi (BMD) usually manifest as a febrile illness in humans. Complications include relapsing fever and in rare occasions involvement of the central nervous system. Only a few cases of meningoencephalitis have been described, mostly in immunosuppressed patients.

Case presentation

A 70-year-old female receiving immunosuppressive rituximab therapy presented with frontal headache, dizziness, nausea, vomiting and chills. Clinical laboratory blood analyses were normal. Cerebrospinal fluid (CSF) was translucent and analysis showed increased leucocyte count (187 106/L) and elevated level of protein (1056 mg/L). Empiric antibiotic treatment was initiated. The patient showed an early symptomatic relief and 24 h after admission she was discharged from the hospital and antibiotic treatment was discontinued. Two weeks after hospitalisation the B. miyamotoi specific PCR turned out positive in both CSF and serum. At the time, the patient was recovered with mild residual headache. She was treated with high dose doxycycline and her subtle symptoms disappeared.

Conclusions

To our knowledge, we present the first patient with BMD-associated meningitis in Norway, one of eight cases reported worldwide. The patient had mild symptoms and received an early diagnosis. A more severe progression or relapse of disease may have been prevented by antibiotic treatment. BMD should be considered as causes of aseptic meningitis, especially in immunosuppressed patients living in endemic areas.

Human Borrelia miyamotoi Infection in North America

Borrelia miyamotoi is an emerging pathogen that causes a febrile illness and is transmitted by the same hard-bodied (ixodid) ticks that transmit several other pathogens, including Borrelia species that cause Lyme disease. B. miyamotoi was discovered in 1994 in Ixodes persulcatus ticks in Japan. It was first reported in humans in 2011 in Russia. It has subsequently been reported in North America, Europe, and Asia. B. miyamotoi infection is widespread in Ixodes ticks in the northeastern, northern Midwestern, and far western United States and in Canada. In endemic areas, human B. miyamotoi seroprevalence averages from 1 to 3% of the population, compared with 15 to 20% for B. burgdorferi. The most common clinical manifestations of B. miyamotoi infection are fever, fatigue, headache, chills, myalgia, arthralgia, and nausea. Complications include relapsing fever and rarely, meningoencephalitis. Because clinical manifestations are nonspecific, diagnosis requires laboratory confirmation by PCR or blood smear examination. Antibiotics are effective in clearing infection and are the same as those used for Lyme disease, including doxycycline, tetracycline, erythromycin, penicillin, and ceftriaxone. Preventive measures include avoiding areas where B. miyamotoi-infected ticks are found, landscape management, and personal protective strategies such as protective clothing, use of acaricides, and tick checks with rapid removal of embedded ticks.

Borrelia miyamotoi a neglected tick-borne relapsing fever spirochete in Thailand

Borrelia miyamotoi is a relapsing fever spirochete that shares the same vector as Lyme disease causing Borrelia. This epidemiological study of B. miyamotoi was conducted in rodent reservoirs, tick vectors and human populations simultaneously. A total of 640 rodents and 43 ticks were collected from Phop Phra district, Tak province, Thailand. The prevalence rate for all Borrelia species was 2.3% and for B. miyamotoi was 1.1% in the rodent population, while the prevalence rate was quite high in ticks collected from rodents with an infection rate of 14.5% (95% CI: 6.3-27.6%). Borrelia miyamotoi was detected in Ixodes granulatus collected from Mus caroli and Berylmys bowersi, and was also detected in several rodent species (Bandicota indica, Mus spp., and Leopoldamys sabanus) that live in a cultivated land, increasing the risk of human exposure. Phylogenetic analysis revealed that the B. miyamotoi isolates detected in rodents and I. granulatus ticks in this study were similar to isolates detected in European countries. Further investigation was conducted to determine the serological reactivity to B. miyamotoi in human samples received from Phop Phra hospital, Tak province and in rodents captured from Phop Phra district using an in-house, direct enzyme-linked immunosorbent assay (ELISA) assay with B. miyamotoi recombinant glycerophosphodiester-phosphodiesterase (rGlpQ) protein as coated antigen. The results showed that 17.9% (15/84) of human patients and 9.0% (41/456) of captured rodents had serological reactivity to B. miyamotoi rGlpQ protein in the study area. While a low level of IgG antibody titers (100-200) was observed in the majority of seroreactive samples, higher titers (400-1,600) were also detected in both humans and rodents. This study provides the first evidence of B. miyamotoi exposure in human and rodent populations in Thailand and the possible roles of local rodent species and Ixodes granulatus tick in its enzootic transmission cycle in nature.