1
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Akther S, Mongodin EF, Morgan RD, Di L, Yang X, Golovchenko M, Rudenko N, Margos G, Hepner S, Fingerle V, Kawabata H, Norte AC, de Carvalho IL, Núncio MS, Marques A, Schutzer SE, Fraser CM, Luft BJ, Casjens SR, Qiu W. Natural selection and recombination at host-interacting lipoprotein loci drive genome diversification of Lyme disease and related bacteria. mBio 2024:e0174924. [PMID: 39145656 DOI: 10.1128/mbio.01749-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/28/2024] [Indexed: 08/16/2024] Open
Abstract
Lyme disease, caused by spirochetes in the Borrelia burgdorferi sensu lato clade within the Borrelia genus, is transmitted by Ixodes ticks and is currently the most prevalent and rapidly expanding tick-borne disease in Europe and North America. We report complete genome sequences of 47 isolates that encompass all established species in this clade while highlighting the diversity of the widespread human pathogenic species B. burgdorferi. A similar set of plasmids has been maintained throughout Borrelia divergence, indicating that they are a key adaptive feature of this genus. Phylogenetic reconstruction of all sequenced Borrelia genomes revealed the original divergence of Eurasian and North American lineages and subsequent dispersals that introduced B. garinii, B. bavariensis, B. lusitaniae, B. valaisiana, and B. afzelii from East Asia to Europe and B. burgdorferi and B. finlandensis from North America to Europe. Molecular phylogenies of the universally present core replicons (chromosome and cp26 and lp54 plasmids) are highly consistent, revealing a strong clonal structure. Nonetheless, numerous inconsistencies between the genome and gene phylogenies indicate species dispersal, genetic exchanges, and rapid sequence evolution at plasmid-borne loci, including key host-interacting lipoprotein genes. While localized recombination occurs uniformly on the main chromosome at a rate comparable to mutation, lipoprotein-encoding loci are recombination hotspots on the plasmids, suggesting adaptive maintenance of recombinant alleles at loci directly interacting with the host. We conclude that within- and between-species recombination facilitates adaptive sequence evolution of host-interacting lipoprotein loci and contributes to human virulence despite a genome-wide clonal structure of its natural populations. IMPORTANCE Lyme disease (also called Lyme borreliosis in Europe), a condition caused by spirochete bacteria of the genus Borrelia, transmitted by hard-bodied Ixodes ticks, is currently the most prevalent and rapidly expanding tick-borne disease in the United States and Europe. Borrelia interspecies and intraspecies genome comparisons of Lyme disease-related bacteria are essential to reconstruct their evolutionary origins, track epidemiological spread, identify molecular mechanisms of human pathogenicity, and design molecular and ecological approaches to disease prevention, diagnosis, and treatment. These Lyme disease-associated bacteria harbor complex genomes that encode many genes that do not have homologs in other organisms and are distributed across multiple linear and circular plasmids. The functional significance of most of the plasmid-borne genes and the multipartite genome organization itself remains unknown. Here we sequenced, assembled, and analyzed whole genomes of 47 Borrelia isolates from around the world, including multiple isolates of the human pathogenic species. Our analysis elucidates the evolutionary origins, historical migration, and sources of genomic variability of these clinically important pathogens. We have developed web-based software tools (BorreliaBase.org) to facilitate dissemination and continued comparative analysis of Borrelia genomes to identify determinants of human pathogenicity.
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Affiliation(s)
- Saymon Akther
- Graduate Center and Hunter College, City University of New York, New York, New York, USA
| | | | | | - Lia Di
- Graduate Center and Hunter College, City University of New York, New York, New York, USA
| | - Xiaohua Yang
- Department of Medicine, Renaissance School of Medicine, Stony Brook University (SUNY), Stony Brook, New York, USA
| | - Maryna Golovchenko
- Biology Centre Czech Academy of Sciences, Institute of Parasitology, České Budějovice, Czech Republic
| | - Natalie Rudenko
- Biology Centre Czech Academy of Sciences, Institute of Parasitology, České Budějovice, Czech Republic
| | - Gabriele Margos
- Bavarian Health and Food Safety Authority and German National Reference Centre for Borrelia, Oberschleissheim, Bavaria, Germany
| | - Sabrina Hepner
- Bavarian Health and Food Safety Authority and German National Reference Centre for Borrelia, Oberschleissheim, Bavaria, Germany
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority and German National Reference Centre for Borrelia, Oberschleissheim, Bavaria, Germany
| | | | - Ana Cláudia Norte
- Department of Life Sciences, University of Coimbra, MARE-Marine and Environmental Sciences Centre, Coimbra, Portugal
| | | | - Maria Sofia Núncio
- Centre for Vector and Infectious Diseases Research, Águas de Moura, Portugal
| | - Adriana Marques
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Claire M Fraser
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Benjamin J Luft
- Department of Medicine, Renaissance School of Medicine, Stony Brook University (SUNY), Stony Brook, New York, USA
| | - Sherwood R Casjens
- University of Utah School of Medicine and School of Biological Sciences, Salt Lake City, Utah, USA
| | - Weigang Qiu
- Graduate Center and Hunter College, City University of New York, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
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Kulisz J, Hoeks S, Kunc-Kozioł R, Woźniak A, Zając Z, Schipper AM, Cabezas-Cruz A, Huijbregts MAJ. Spatiotemporal trends and covariates of Lyme borreliosis incidence in Poland, 2010-2019. Sci Rep 2024; 14:10768. [PMID: 38730239 PMCID: PMC11087522 DOI: 10.1038/s41598-024-61349-z] [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: 01/12/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024] Open
Abstract
Lyme borreliosis (LB) is the most commonly diagnosed tick-borne disease in the northern hemisphere. Since an efficient vaccine is not yet available, prevention of transmission is essential. This, in turn, requires a thorough comprehension of the spatiotemporal dynamics of LB transmission as well as underlying drivers. This study aims to identify spatiotemporal trends and unravel environmental and socio-economic covariates of LB incidence in Poland, using consistent monitoring data from 2010 through 2019 obtained for 320 (aggregated) districts. Using yearly LB incidence values, we identified an overall increase in LB incidence from 2010 to 2019. Additionally, we observed a large variation of LB incidences between the Polish districts, with the highest risks of LB in the eastern districts. We applied spatiotemporal Bayesian models in an all-subsets modeling framework to evaluate potential associations between LB incidence and various potentially relevant environmental and socio-economic variables, including climatic conditions as well as characteristics of the vegetation and the density of tick host species. The best-supported spatiotemporal model identified positive relationships between LB incidence and forest cover, the share of parks and green areas, minimum monthly temperature, mean monthly precipitation, and gross primary productivity. A negative relationship was found with human population density. The findings of our study indicate that LB incidence in Poland might increase as a result of ongoing climate change, notably increases in minimum monthly temperature. Our results may aid in the development of targeted prevention strategies.
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Affiliation(s)
- Joanna Kulisz
- Chair and Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska St. 11, 20-080, Lublin, Poland.
| | - Selwyn Hoeks
- Department of Environmental Science, Radboud Institute for Biological and Environmental Sciences, Radboud University, P.O. Box 9010, 6500, Nijmegen, GL, The Netherlands
| | - Renata Kunc-Kozioł
- Chair and Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska St. 11, 20-080, Lublin, Poland
| | - Aneta Woźniak
- Chair and Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska St. 11, 20-080, Lublin, Poland
| | - Zbigniew Zając
- Chair and Department of Biology and Parasitology, Medical University of Lublin, Radziwiłłowska St. 11, 20-080, Lublin, Poland
| | - Aafke M Schipper
- Department of Environmental Science, Radboud Institute for Biological and Environmental Sciences, Radboud University, P.O. Box 9010, 6500, Nijmegen, GL, The Netherlands
| | - Alejandro Cabezas-Cruz
- Anses, UMR BIPAR, Laboratoire de Santé Animale, INRAE, Ecole Nationale Vétérinaire d'Alfort, 94700, Maisons-Alfort, France
| | - Mark A J Huijbregts
- Department of Environmental Science, Radboud Institute for Biological and Environmental Sciences, Radboud University, P.O. Box 9010, 6500, Nijmegen, GL, The Netherlands
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3
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Grąźlewska W, Holec-Gąsior L, Sołowińska K, Chmielewski T, Fiecek B, Contreras M. Epitope Mapping of BmpA and BBK32 Borrelia burgdorferi Sensu Stricto Antigens for the Design of Chimeric Proteins with Potential Diagnostic Value. ACS Infect Dis 2023; 9:2160-2172. [PMID: 37803965 PMCID: PMC10722512 DOI: 10.1021/acsinfecdis.3c00258] [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: 06/03/2023] [Indexed: 10/08/2023]
Abstract
Lyme disease is a tick-borne zoonosis caused by Gram-negative bacteria belonging to the Borrelia burgdorferi sensu lato (s.l.) group. In this study, IgM- and IgG-specific linear epitopes of two B. burgdorferi sensu stricto (s.s.) antigens BmpA and BBK32 were mapped using a polypeptide array. Subsequently, two chimeric proteins BmpA-BBK32-M and BmpA-BBK32-G were designed to validate the construction of chimeras using the identified epitopes for the detection of IgM and IgG, respectively, by ELISA. IgG-ELISA based on the BmpA-BBK32-G antigen showed 71% sensitivity and 95% specificity, whereas a slightly lower diagnostic utility was obtained for IgM-ELISA based on BmpA-BBK32-M, where the sensitivity was also 71% but the specificity decreased to 89%. The reactivity of chimeric proteins with nondedicated antibodies was much lower. These results suggest that the identified epitopes may be useful in the design of new forms of antigens to increase the effectiveness of Lyme disease serodiagnosis. It has also been proven that appropriate selection of epitopes enables the construction of chimeric proteins exhibiting reactivity with a specific antibody isotype.
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Affiliation(s)
- Weronika Grąźlewska
- Department
of Molecular Biotechnology and Microbiology, Faculty of Chemistry, University of Gdańsk Technology, 80-233 Gdańsk, Poland
- SaBio,
Instituto de Investigación en Recursos Cinegéticos IREC−CSIC-UCLM-JCCM, 13005 Ciudad Real, Spain
| | - Lucyna Holec-Gąsior
- Department
of Molecular Biotechnology and Microbiology, Faculty of Chemistry, University of Gdańsk Technology, 80-233 Gdańsk, Poland
| | - Karolina Sołowińska
- Department
of Molecular Biotechnology and Microbiology, Faculty of Chemistry, University of Gdańsk Technology, 80-233 Gdańsk, Poland
| | - Tomasz Chmielewski
- Department
of Parasitology and Diseases Transmitted by Vectors, National Institute of Public Health NIH - National Research Institute, 00-791 Warsaw, Poland
| | - Beata Fiecek
- Department
of Parasitology and Diseases Transmitted by Vectors, National Institute of Public Health NIH - National Research Institute, 00-791 Warsaw, Poland
| | - Marinela Contreras
- SaBio,
Instituto de Investigación en Recursos Cinegéticos IREC−CSIC-UCLM-JCCM, 13005 Ciudad Real, Spain
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4
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Laison EKE, Hamza Ibrahim M, Boligarla S, Li J, Mahadevan R, Ng A, Muthuramalingam V, Lee WY, Yin Y, Nasri BR. Identifying Potential Lyme Disease Cases Using Self-Reported Worldwide Tweets: Deep Learning Modeling Approach Enhanced With Sentimental Words Through Emojis. J Med Internet Res 2023; 25:e47014. [PMID: 37843893 PMCID: PMC10616745 DOI: 10.2196/47014] [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: 03/13/2023] [Revised: 07/26/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Lyme disease is among the most reported tick-borne diseases worldwide, making it a major ongoing public health concern. An effective Lyme disease case reporting system depends on timely diagnosis and reporting by health care professionals, and accurate laboratory testing and interpretation for clinical diagnosis validation. A lack of these can lead to delayed diagnosis and treatment, which can exacerbate the severity of Lyme disease symptoms. Therefore, there is a need to improve the monitoring of Lyme disease by using other data sources, such as web-based data. OBJECTIVE We analyzed global Twitter data to understand its potential and limitations as a tool for Lyme disease surveillance. We propose a transformer-based classification system to identify potential Lyme disease cases using self-reported tweets. METHODS Our initial sample included 20,000 tweets collected worldwide from a database of over 1.3 million Lyme disease tweets. After preprocessing and geolocating tweets, tweets in a subset of the initial sample were manually labeled as potential Lyme disease cases or non-Lyme disease cases using carefully selected keywords. Emojis were converted to sentiment words, which were then replaced in the tweets. This labeled tweet set was used for the training, validation, and performance testing of DistilBERT (distilled version of BERT [Bidirectional Encoder Representations from Transformers]), ALBERT (A Lite BERT), and BERTweet (BERT for English Tweets) classifiers. RESULTS The empirical results showed that BERTweet was the best classifier among all evaluated models (average F1-score of 89.3%, classification accuracy of 90.0%, and precision of 97.1%). However, for recall, term frequency-inverse document frequency and k-nearest neighbors performed better (93.2% and 82.6%, respectively). On using emojis to enrich the tweet embeddings, BERTweet had an increased recall (8% increase), DistilBERT had an increased F1-score of 93.8% (4% increase) and classification accuracy of 94.1% (4% increase), and ALBERT had an increased F1-score of 93.1% (5% increase) and classification accuracy of 93.9% (5% increase). The general awareness of Lyme disease was high in the United States, the United Kingdom, Australia, and Canada, with self-reported potential cases of Lyme disease from these countries accounting for around 50% (9939/20,000) of the collected English-language tweets, whereas Lyme disease-related tweets were rare in countries from Africa and Asia. The most reported Lyme disease-related symptoms in the data were rash, fatigue, fever, and arthritis, while symptoms, such as lymphadenopathy, palpitations, swollen lymph nodes, neck stiffness, and arrythmia, were uncommon, in accordance with Lyme disease symptom frequency. CONCLUSIONS The study highlights the robustness of BERTweet and DistilBERT as classifiers for potential cases of Lyme disease from self-reported data. The results demonstrated that emojis are effective for enrichment, thereby improving the accuracy of tweet embeddings and the performance of classifiers. Specifically, emojis reflecting sadness, empathy, and encouragement can reduce false negatives.
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Affiliation(s)
- Elda Kokoe Elolo Laison
- Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | | | - Srikanth Boligarla
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Jiaxin Li
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Raja Mahadevan
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Austen Ng
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | | | - Wee Yi Lee
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Yijun Yin
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Bouchra R Nasri
- Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
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5
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Grąźlewska W, Holec-Gąsior L. Antibody Cross-Reactivity in Serodiagnosis of Lyme Disease. Antibodies (Basel) 2023; 12:63. [PMID: 37873860 PMCID: PMC10594444 DOI: 10.3390/antib12040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
Lyme disease is a tick-borne disease caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex. The disease is characterized by a varied course; therefore, the basis for diagnosis is laboratory methods. Currently, a two-tiered serological test is recommended, using an ELISA as a screening test and a Western blot as a confirmatory test. This approach was introduced due to the relatively high number of false-positive results obtained when using an ELISA alone. However, even this approach has not entirely solved the problem of false-positive results caused by cross-reactive antibodies. Many highly immunogenic B. burgdorferi s.l. proteins are recognized nonspecifically by antibodies directed against other pathogens. This also applies to antigens, such as OspC, BmpA, VlsE, and FlaB, i.e., those commonly used in serodiagnostic assays. Cross-reactions can be caused by both bacterial (relapsing fever Borrelia, Treponema pallidum) and viral (Epstein-Baar virus, Cytomegalovirus) infections. Additionally, a rheumatoid factor has also been shown to nonspecifically recognize B. burgdorferi s.l. proteins, resulting in false-positive results. Therefore, it is necessary to carefully interpret the results of serodiagnostic tests so as to avoid overdiagnosis of Lyme disease, which causes unnecessary implementations of strong antibiotic therapies and delays in the correct diagnosis.
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Affiliation(s)
| | - Lucyna Holec-Gąsior
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdansk University of Technology, 80-233 Gdansk, Poland;
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6
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Colucci M, Fonzo M, Miccolis L, Amoruso I, Mondino S, Trevisan A, Cazzaro R, Baldovin T, Bertoncello C. Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6822. [PMID: 37835091 PMCID: PMC10572455 DOI: 10.3390/ijerph20196822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Tick-borne diseases (TBD) are endemic in Europe. However, surveillance is currently incomplete. Alternative strategies need to be considered. The aim of this study was to test an Emergency Department Syndromic Surveillance (EDSyS) system as a complementary data source to describe the impact of tick bites and TBD using a small-area analysis approach and to monitor the risk of TBD to target prevention. ED databases in the Local Health Authority 8 District (Veneto, Italy) were queried for tick-bite and TBD-related visits between January 2017 and December 2022. Hospitalisations were also collected. Events involving the resident population were used to calculate incidence rates. A total of 4187 ED visits for tick-bite and 143 for TBD were recorded; in addition, 62 TBD-related hospitalisations (of which 72.6% in over 50 s and 22.6% in over 65 s). ED visits peaked in spring and in autumn, followed by a 4-week lag in the increase in hospital admissions. The small-area analysis identified two areas at higher risk of bites and TBD. The use of a EDSyS system allowed two natural foci to be identified. This approach proved useful in predicting temporal and geographic risk of TBD and in identifying local endemic areas, thus enabling an effective multidisciplinary prevention strategy.
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Affiliation(s)
- Massimiliano Colucci
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Marco Fonzo
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Liana Miccolis
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Irene Amoruso
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Sara Mondino
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Andrea Trevisan
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Romina Cazzaro
- Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
| | - Chiara Bertoncello
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
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Ma Y, Kalantari Z, Destouni G. Infectious Disease Sensitivity to Climate and Other Driver-Pressure Changes: Research Effort and Gaps for Lyme Disease and Cryptosporidiosis. GEOHEALTH 2023; 7:e2022GH000760. [PMID: 37303696 PMCID: PMC10251199 DOI: 10.1029/2022gh000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
Climate sensitivity of infectious diseases is discussed in many studies. A quantitative basis for distinguishing and predicting the disease impacts of climate and other environmental and anthropogenic driver-pressure changes, however, is often lacking. To assess research effort and identify possible key gaps that can guide further research, we here apply a scoping review approach to two widespread infectious diseases: Lyme disease (LD) as a vector-borne and cryptosporidiosis as a water-borne disease. Based on the emerging publication data, we further structure and quantitatively assess the driver-pressure foci and interlinkages considered in the published research so far. This shows important research gaps for the roles of rarely investigated water-related and socioeconomic factors for LD, and land-related factors for cryptosporidiosis. For both diseases, the interactions of host and parasite communities with climate and other driver-pressure factors are understudied, as are also important world regions relative to the disease geographies; in particular, Asia and Africa emerge as main geographic gaps for LD and cryptosporidiosis research, respectively. The scoping approach developed and gaps identified in this study should be useful for further assessment and guidance of research on infectious disease sensitivity to climate and other environmental and anthropogenic changes around the world.
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Affiliation(s)
- Y. Ma
- Department of Physical GeographyStockholm UniversityStockholmSweden
| | - Z. Kalantari
- Department of Physical GeographyStockholm UniversityStockholmSweden
- Department of Sustainable DevelopmentEnvironmental Science and Engineering (SEED)KTH Royal Institute of TechnologyStockholmSweden
| | - G. Destouni
- Department of Physical GeographyStockholm UniversityStockholmSweden
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8
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Increasing spread of borreliosis in Europe. New Microbes New Infect 2022; 48:101022. [PMID: 36176541 PMCID: PMC9513809 DOI: 10.1016/j.nmni.2022.101022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/19/2022] [Indexed: 12/04/2022] Open
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