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Lindland ES, Røvang MS, Solheim AM, Andreassen S, Skarstein I, Dareez N, MacIntosh BJ, Eikeland R, Ljøstad U, Mygland Å, Bos SD, Ulvestad E, Reiso H, Lorentzen ÅR, Harbo HF, Bjørnerud A, Beyer MK. Are white matter hyperintensities associated with neuroborreliosis? The answer is twofold. Neuroradiology 2024:10.1007/s00234-024-03482-0. [PMID: 39422730 DOI: 10.1007/s00234-024-03482-0] [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: 02/06/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024]
Abstract
PURPOSE Many consider white matter hyperintensities (WMHs) to be important imaging findings in neuroborreliosis. However, evidence regarding association with WMHs is of low quality. The objective was to investigate WMHs in neuroborreliosis visually and quantitatively. MATERIALS AND METHODS Patients underwent brain MRI within one month of diagnosis and six months after treatment. Healthy controls were recruited. WMHs were counted by visual rating and the volume was calculated from automatic segmentation. Biochemical markers and scores for clinical symptoms and findings were used to explore association with longitudinal volume change of WMHs. RESULTS The study included 74 patients (37 males) with early neuroborreliosis and 65 controls (30 males). Mean age (standard deviation) was 57.4 (13.5) and 57.7 (12.9) years, respectively. Baseline WMH lesion count was zero in 14 patients/16 controls, < 10 in 36/31, 10-20 in 9/7 and > 20 in 13/11, with no difference between groups (p = 0.90). However, from baseline to follow-up the patients had a small reduction in WMH volume and the controls a small increase, median difference 0.136 (95% confidence interval 0.051-0.251) ml. In patients, volume change was not associated with biochemical or clinical markers, but with degree of WMHs (p values 0.002-0.01). CONCLUSION WMH lesions were not more numerous in patients with neuroborreliosis compared to healthy controls. However, there was a small reduction of WMH volume from baseline to follow-up among patients, which was associated with higher baseline WMH severity, but not with disease burden or outcome. Overall, non-specific WMHs should not be considered suggestive of neuroborreliosis.
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Affiliation(s)
- Elisabeth S Lindland
- Department of Radiology, Sorlandet Hospital, Sykehusveien 1, 4838, Arendal, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Martin S Røvang
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Anne Marit Solheim
- Department of Neurology, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Silje Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics, Sorlandet Hospital, Arendal, Norway
| | - Ingerid Skarstein
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Nazeer Dareez
- Department of Radiology, Sorlandet Hospital, Sykehusveien 1, 4838, Arendal, Norway
| | - Bradley J MacIntosh
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Randi Eikeland
- The Norwegian National Advisory Unit on Tick-Borne Diseases, Sorlandet Hospital, Kristiansand, Norway
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Unn Ljøstad
- Department of Neurology, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Åse Mygland
- Department of Neurology, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Steffan D Bos
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Cancer Registry of Norway, The Norwegian Institute of Public Health, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Elling Ulvestad
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Harald Reiso
- The Norwegian National Advisory Unit on Tick-Borne Diseases, Sorlandet Hospital, Kristiansand, Norway
| | - Åslaug R Lorentzen
- Department of Neurology, Sorlandet Hospital, Kristiansand, Norway
- The Norwegian National Advisory Unit on Tick-Borne Diseases, Sorlandet Hospital, Kristiansand, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Mona K Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Skarstein I, Ulvestad E, Solheim AM, Vedeler C, Ljøstad U, Mygland Å, Eikeland R, Reiso H, Lorentzen ÅR, Bos SD. Serum neurofilament light chain associates with symptom burden in Lyme neuroborreliosis patients: a longitudinal cohort study from Norway. J Neurol 2024; 271:2768-2775. [PMID: 38407594 PMCID: PMC11055709 DOI: 10.1007/s00415-024-12237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Serum neurofilament light chain (sNfL), an indicator of neuronal damage, is increasingly recognized as a potential biomarker for disease activity in neurodegenerative disorders. In this study, we wanted to investigate sNfL as a prognostic marker in a large, well-defined population of 90 patients with Lyme neuroborreliosis (LNB). In addition, we sought to explore associations between symptoms and sNfL levels during the acute phase of LNB. MATERIALS AND METHODS Patients diagnosed with definite or possible LNB were recruited from a double-blinded, placebo-controlled, multi-center trial, in which the participants were randomly assigned to 2 or 6 weeks of oral doxycycline treatment. The sNfL levels were measured using a single molecule array assay at both diagnosis and 6-month follow-up, and analysed against clinical parameters, variations in symptom burden and long-term complaints as assessed by a composite clinical score. RESULTS At the time of diagnosis, approximately 60% of the patients had elevated sNfL levels adjusted for age. Notably, mean sNfL levels were significantly higher at diagnosis (52 pg/ml) compared to 6 months after treatment (12 pg/ml, p < 0.001), when sNfL levels had normalized in the majority of patients. Patients with objective signs of spinal radiculitis had significantly higher baseline sNfL levels compared to patients without spinal radiculitis (p = 0.033). CONCLUSION Our findings suggest that sNfL can serve as a biomarker for peripheral nerve tissue involvement in the acute phase of LNB. As found in an earlier study, we confirm normalization of sNfL levels in blood after treatment. We found no prognostic value of acute-phase sNfL levels on patient outcome.
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Affiliation(s)
- Ingerid Skarstein
- Department of Microbiology, Haukeland University Hospital, Post Box 1400, 5021, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Elling Ulvestad
- Department of Microbiology, Haukeland University Hospital, Post Box 1400, 5021, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Marit Solheim
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Unn Ljøstad
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Åse Mygland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Section of Habilitation, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Randi Eikeland
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Harald Reiso
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Steffan Daniel Bos
- Department of Microbiology, Haukeland University Hospital, Post Box 1400, 5021, Bergen, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Cancer Registry of Norway, The Norwegian Institute of Public Health, Oslo, Norway
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3
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Eikeland R, Henningsson AJ, Lebech AM, Kerlefsen Y, Mavin S, Vrijlandt A, Hovius JW, Lernout T, Lim C, Dobler G, Fingerle V, Gynthersen RM, Lindgren PE, Reiso H. Tick-borne diseases in the North Sea region-A comprehensive overview and recommendations for diagnostics and treatment. Ticks Tick Borne Dis 2024; 15:102306. [PMID: 38183851 DOI: 10.1016/j.ttbdis.2023.102306] [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: 08/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
As part of the NorthTick project, co-funded by the European Union through the European Regional Development Fund and the North Sea Region Programme, specialists in the field of tick-borne diseases from seven North Sea countries co-operated with patient organisations and governmental health care institutions to provide this comprehensive overview of diagnostics and treatment recommendations in the region for Lyme borreliosis, Borrelia miyamotoi infection, tick-borne encephalitis, human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis and babesiosis. The main conclusion is that the recommendations in these northern countries are essentially the same, with very few differences. This overview presents the current diagnostics and provides useful clinical guidance.
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Affiliation(s)
- Randi Eikeland
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway; Faculty of Health and Sport science, University of Agder, Grimstad, Norway.
| | - Anna J Henningsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; National Reference Laboratory for Borreliosis and Other Tick-Borne Bacteria, Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Yvonne Kerlefsen
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway
| | - Sally Mavin
- Scottish Lyme Disease and Tick-borne Infections Reference Laboratory, Raigmore Hospital, Inverness, UK
| | - Amber Vrijlandt
- Amsterdam UMC, location AMC, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam, The Netherlands
| | - Joppe W Hovius
- Amsterdam UMC, location AMC, Department of Internal Medicine, Section of Infectious Diseases, Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam, The Netherlands
| | - Tinne Lernout
- Sciensano Epidemiology of infectious diseases, Brussels, Belgium
| | - Chin Lim
- Scottish Lyme Disease and Tick-borne Infections Reference Laboratory, Raigmore Hospital, Inverness, UK
| | - Gerhard Dobler
- Nationales Konsiliarlabor FSME, Institut für Mikrobiologie der Bundeswehr, Munich, Germany
| | - Volker Fingerle
- German National Reference Center for Borreliae, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Rosa M Gynthersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Harald Reiso
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Kristiansand, Norway
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Stupica D, Collinet-Adler S, Kejžar N, Velušček M, Boršič K. Which trial do we need? Treatment of multiple erythema migrans with doxycycline for 7 days versus 14 days. Clin Microbiol Infect 2024; 30:159-161. [PMID: 37353079 DOI: 10.1016/j.cmi.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Daša Stupica
- Department of Infectious Diseases, Clinical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Stefan Collinet-Adler
- Department of Infectious Diseases, Park Nicollet/Health Partners, Methodist Hospital, Saint Louis Park, MN, USA
| | - Nataša Kejžar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maša Velušček
- Department of Infectious Diseases, Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Boršič
- Department of Infectious Diseases, Clinical Centre Ljubljana, Ljubljana, Slovenia
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Dersch R, Rauer S. Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis: An updated systematic review. Eur J Neurol 2023; 30:3780-3788. [PMID: 37565386 DOI: 10.1111/ene.16034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Evidence-based recommendations for treatment of Lyme neuroborreliosis (LNB) should rely on the available literature. As new data emerges, close review and evaluation of the recent literature is needed to build evidence-based recommendations to inform clinical practice and management of LNB. We performed an update of a previous systematic review on treatment of LNB. METHODS A systematic literature search of Medline and CENTRAL was performed for published studies from 2015 to 2023 to update a previous systematic review. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs; NRS were assessed using the ROBINS-I-tool. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data were integrated into an existing meta-analysis of the available literature. RESULTS After screening 1530 records, two RCTs and five NRS with new and relevant data were additionally identified. Meta-analysis showed no statistically significant difference between doxycycline and beta-lactam antibiotics regarding residual neurological symptoms after 12 months. Meta-analysis showed no benefit of extended antibiotic treatment of LNB. Three NRS show no benefit for additional steroid use in LNB with facial palsy. DISCUSSION Additional incorporated recent research corroborates existing guideline recommendations for treatment of LNB. New RCTs add to the certainty of previous analysis showing similar efficacy for doxycycline and beta-lactam antibiotics in LNB. Available evidence shows no benefit for extended antibiotic treatment in LNB. NRS do not suggest a role for steroids in facial palsy due to LNB.
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Affiliation(s)
- Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Rauer
- Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lindland ES, Solheim AM, Andreassen S, Bugge R, Eikeland R, Reiso H, Lorentzen ÅR, Harbo HF, Beyer MK, Bjørnerud A. Dynamic contrast-enhanced MRI shows altered blood-brain barrier function of deep gray matter structures in neuroborreliosis: a case-control study. Eur Radiol Exp 2023; 7:52. [PMID: 37710058 PMCID: PMC10501980 DOI: 10.1186/s41747-023-00365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/22/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Main aim was assessment of regional blood-brain barrier (BBB) function by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with neuroborreliosis. Secondary aim was to study the correlation of BBB function with biochemical, clinical, and cognitive parameters. METHODS Regional ethical committee approved this prospective single-center case-control study. Within 1 month after diagnosis of neuroborreliosis, 55 patients underwent DCE-MRI. The patient group consisted of 25 males and 30 females with mean age 58 years, and the controls were 8 males and 7 females with mean age 57 years. Pharmacokinetic compartment modelling with Patlak fit was applied, providing estimates for capillary leakage rate and blood volume fraction. Nine anatomical brain regions were sampled with auto-generated binary masks. Fatigue, severity of clinical symptoms and findings, and cognitive function were assessed in the acute phase and 6 months after treatment. RESULTS Leakage rates and blood volume fractions were lower in patients compared to controls in the thalamus (p = 0.027 and p = 0.018, respectively), caudate nucleus (p = 0.009 for both), and hippocampus (p = 0.054 and p = 0.009). No correlation of leakage rates with fatigue, clinical disease severity or cognitive function was found. CONCLUSIONS In neuroborreliosis, leakage rate and blood volume fraction in the thalamus, caudate nucleus, and hippocampus were lower in patients compared to controls. DCE-MRI provided new insight to pathophysiology of neuroborreliosis, and can serve as biomarker of BBB function and regulatory mechanisms of the neurovascular unit in infection and inflammation. RELEVANCE STATEMENT DCE-MRI provided new insight to pathophysiology of neuroborreliosis, and can serve as biomarker of blood-brain barrier function and regulatory mechanisms of the neurovascular unit in infection and inflammation. KEY POINTS • Neuroborreliosis is an infection with disturbed BBB function. • Microvessel leakage can be studied with DCE-MRI. • Prospective case-control study showed altered microvessel properties in thalamus, caudate, and hippocampus.
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Affiliation(s)
- Elisabeth S Lindland
- Department of Radiology, Sorlandet Hospital, Sykehusveien 1, N-4809, Arendal, Norway.
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Anne Marit Solheim
- Department of Neurology, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Silje Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics, Sorlandet Hospital, Arendal, Norway
| | - Robin Bugge
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Randi Eikeland
- The Norwegian National Advisory Unit On Tick-Borne Diseases, Sorlandet Hospital, Kristiansand, Norway
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Harald Reiso
- The Norwegian National Advisory Unit On Tick-Borne Diseases, Sorlandet Hospital, Kristiansand, Norway
| | - Åslaug R Lorentzen
- Department of Neurology, Sorlandet Hospital, Kristiansand, Norway
- The Norwegian National Advisory Unit On Tick-Borne Diseases, Sorlandet Hospital, Kristiansand, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Atle Bjørnerud
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
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Naudion P, Raffetin A, Zayet S, Klopfenstein T, Baux E, Martinot M, Piroth L, Caumes E, Chirouze C, Bouiller K. Positive intrathecal anti-Borrelia antibody synthesis: what are the implications for clinical practice? Clinical features and outcomes of 138 patients in a French multicenter cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:441-452. [PMID: 36806057 DOI: 10.1007/s10096-023-04574-0] [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: 10/18/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
We aimed to describe the clinical characteristics, management, and residual symptoms (RS) in patients with definite and possible Lyme neuroborreliosis (LNB). We conducted a retrospective French multicenter cohort study (2010-2020). Cases of LNB were defined as clinical manifestations attributed to LNB and a positive Borrelia-specific intrathecal antibody index (AI) ("possible" LNB) and with pleocytosis ("definite" LNB). Risk factors of RS were determined using a logistic regression model. We included 138 adult patients with a positive AI. Mean age was 59.5 years (± 14.7). The median duration of symptoms before diagnosis was 1.0 [0.5-4.0] months. The most frequent manifestation was radicular pain (n = 79, 57%). Complete cerebrospinal fluid (CSF) leukocyte analysis was available in 131 patients, of whom 72 (55%) had pleocytosis. Patients with definite LNB had a shorter duration of symptoms (median 1.0 [0.5-2.6] vs. 3.0 [0.6-7.0] months, p < 0.01) and more radicular pain (74% vs 44%, p < 0.01) than patients with possible LNB. At the last visit (median duration of follow-up: 70 [30-175] days), 74/124 patients (59.7%) reported RS, mostly radicular pain (n = 31, 25%). In multivariate analysis, definite LNB (OR = 0.21 [0.05-0.931], p = 0.039) and duration of symptoms less than 3 months (OR = 0.04 [0.01-0.37], p = 0.005) were protective factors against RS at last follow-up. Our study highlights the challenges of LNB management, especially for patients with a positive AI without pleocytosis, questioning whether LB is still ongoing or not. Early diagnosis and treatment are important to improve outcomes and to lower potential RS.
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Affiliation(s)
- Pauline Naudion
- Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France
| | - Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Center, Paris and Northern Region, General Hospital of Villeneuve-Saint-Georges, 40 Allée de La Source, 94 190, Villeneuve-Saint-Georges, France. .,Research Unity of EpiMAI (USC Anses), Ecole Nationale Vétérinaire de Maisons-Alfort, Maisons-Alfort, France. .,European Study Group for Lyme Borreliosis (ESGBOR), Basel, Switzerland. .,EA 7380 Dynamyc, Université Paris-Est Créteil, Ecole Nationale Vétérinaire d'Alfort, USC Anses, Créteil, France.
| | - Souheil Zayet
- Department of Infectious Diseases, General Hospital of Nord Franche-Comté, Belfort, France
| | - Timothée Klopfenstein
- Department of Infectious Diseases, General Hospital of Nord Franche-Comté, Belfort, France
| | - Elisabeth Baux
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | - Martin Martinot
- Department of Infectious Diseases, General Hospital of Colmar, Colmar, France
| | - Lionel Piroth
- Department of Infectious Diseases, University Hospital of Dijon, Dijon, France
| | - Eric Caumes
- Department of Infectious Diseases, University Hospital of Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie Et de Santé Publique, Paris, France
| | - Catherine Chirouze
- Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France.,UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000, Besançon, France
| | - Kevin Bouiller
- Department of Infectious Diseases, CHU Besançon, 3 Bd Alexandre Fleming, 25030, Besançon, France. .,European Study Group for Lyme Borreliosis (ESGBOR), Basel, Switzerland. .,UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000, Besançon, France.
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