1
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Offutt A, Breitschwerdt EB. Case report: Substantial improvement of autism spectrum disorder in a child with learning disabilities in conjunction with treatment for poly-microbial vector borne infections. Front Psychiatry 2023; 14:1205545. [PMID: 37663607 PMCID: PMC10473095 DOI: 10.3389/fpsyt.2023.1205545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/03/2023] [Indexed: 09/05/2023] Open
Abstract
Poly-microbial vector-borne infections may have contributed to neuropsychiatric symptoms in a boy diagnosed with autism spectrum disorder. Targeted antimicrobial treatment resulted in substantial improvement in cognitive (such as learning disabilities, focus, concentration) and neurobehavioral (such as oppositional, defiant, anti-social, disordered mood, immaturity, tics) symptoms.
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Affiliation(s)
- Amy Offutt
- Heart and Soul Integrative Health, Marble Falls, TX, United States
| | - Edward B. Breitschwerdt
- Intracellular Pathogens Research Laboratory, Department of Clinical Sciences, and the Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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2
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Rudenko N, Golovchenko M. Sexual Transmission of Lyme Borreliosis? The Question That Calls for an Answer. Trop Med Infect Dis 2021; 6:tropicalmed6020087. [PMID: 34074046 PMCID: PMC8163173 DOI: 10.3390/tropicalmed6020087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/28/2022] Open
Abstract
Transmission of the causative agents of numerous infectious diseases might be potentially conducted by various routes if this is supported by the genetics of the pathogen. Various transmission modes occur in related pathogens, reflecting a complex process that is specific for each particular host-pathogen system that relies on and is affected by pathogen and host genetics and ecology, ensuring the epidemiological spread of the pathogen. The recent dramatic rise in diagnosed cases of Lyme borreliosis might be due to several factors: the shifting of the distributional range of tick vectors caused by climate change; dispersal of infected ticks due to host animal migration; recent urbanization; an increasing overlap of humans' habitat with wildlife reservoirs and the environment of tick vectors of Borrelia; improvements in disease diagnosis; or establishment of adequate surveillance. The involvement of other bloodsucking arthropod vectors and/or other routes of transmission (human-to-human) of the causative agent of Lyme borreliosis, the spirochetes from the Borrelia burgdorferi sensu lato complex, has been speculated to be contributing to increased disease burden. It does not matter how controversial the idea of vector-free spirochete transmission might seem in the beginning. As long as evidence of sexual transmission of Borrelia burgdorferi both between vertebrate hosts and between tick vectors exists, this question must be addressed. In order to confirm or refute the existence of this phenomenon, which could have important implications for Lyme borreliosis epidemiology, the need of extensive research is obvious and required.
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3
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Middelveen MJ, Haggblad JS, Lewis J, Robichaud GA, Martinez RM, Shah JS, Du Cruz I, Fesler MC, Stricker RB. Dermatological and Genital Manifestations of Lyme Disease Including Morgellons Disease. Clin Cosmet Investig Dermatol 2021; 14:425-436. [PMID: 33986606 PMCID: PMC8110212 DOI: 10.2147/ccid.s299526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/09/2021] [Indexed: 12/02/2022]
Abstract
Although the erythema migrans (EM) skin rash is traditionally considered a hallmark of Lyme disease, other dermatological manifestations of the tickborne disease are less well known. We describe a 49-year-old woman with erosive genital ulcerations, secondary EM rashes and jagged skin lesions associated with Lyme disease. The skin rashes exhibited fibers characteristic of Morgellons disease. Molecular testing confirmed the presence of Borrelia DNA in both vaginal culture and serum specimens. In further studies on a secondary EM lesion containing filaments, Gömöri trichrome staining revealed the presence of collagen in the filaments, while Dieterle and anti-Borrelia immunostaining revealed intracellular and extracellular Borrelia organisms. Intracellular staining for Borrelia was also observed in lymphocytic infiltrates. Lyme disease may present with a variety of genital lesions and dermatological manifestations including Morgellons disease. Careful evaluation is required to determine the presence of Borrelia organisms associated with these dermopathies.
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Affiliation(s)
| | | | - Julie Lewis
- Department of Chemistry and Biochemistry, Université de Moncton, Moncton, NB, Canada
| | - Gilles A Robichaud
- Department of Chemistry and Biochemistry, Université de Moncton, Moncton, NB, Canada
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4
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Fesler MC, Middelveen MJ, Burke JM, Stricker RB. Erosive Vulvovaginitis Associated With Borrelia burgdorferi Infection. J Investig Med High Impact Case Rep 2020; 7:2324709619842901. [PMID: 31043089 PMCID: PMC6498767 DOI: 10.1177/2324709619842901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe a case of acute erosive vulvovaginitis accompanying Borrelia
burgdorferi infection. The patient is a 57-year-old woman
previously diagnosed with Lyme disease who presented with a painful erosive
genital lesion. At the time of the outbreak, she was being treated with oral
antibiotics, and she tested serologically positive for B
burgdorferi and serologically negative for syphilis. Histological
examination of biopsy tissue from the lesion was not characteristic of
dermatopathological patterns typical of erosive vulvar conditions.
Dieterle-stained biopsy sections revealed visible spirochetes throughout the
stratum spinosum and stratum basale, and anti–B burgdorferi
immunostaining was positive. Motile spirochetes were observed by darkfield
microscopy and cultured in Barbour-Stoner-Kelly–complete medium inoculated with
skin scrapings from the lesion. Cultured spirochetes were identified genetically
as B burgdorferi sensu stricto by polymerase chain reaction,
while polymerase chain reaction amplification of treponemal gene targets was
negative. The condition resolved after treatment with additional systemic
antibiotic therapy and topical antibiotics. In cases of genital ulceration that
have no identifiable etiology, the possibility of B burgdorferi
spirochetal infection should be considered.
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Affiliation(s)
| | | | - Jennie M Burke
- 3 Australian Biologics, Sydney, New South Wales, Australia
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5
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Scott JD, Clark KL, Durden LA. Presence of Babesia odocoilei and Borrelia burgdorferi Sensu Stricto in a Tick and Dual Parasitism of Amblyomma inornatum and Ixodes scapularis on a Bird in Canada. Healthcare (Basel) 2019; 7:healthcare7010046. [PMID: 30897803 PMCID: PMC6473902 DOI: 10.3390/healthcare7010046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 12/20/2022] Open
Abstract
Wild birds transport ticks into Canada that harbor a diversity of zoonotic pathogens. However, medical practitioners often question how these zoonotic pathogens are present in their locality. In this study, we provide the first report of an Amblyomma inornatum tick cofeeding with a blacklegged tick, Ixodes scapularis, which parasitized a Veery, Catharus fuscescens—a neotropical songbird. Using the flagellin (flaB) gene of the Lyme disease bacterium, Borrelia burgdorferi sensu lato, and the 18S rRNA gene of the Babesia piroplasm, a malaria-like microorganism, we detected Borrelia burgdorferi sensu stricto and Babesia odocoilei, respectively, in an I. scapularis nymph. After the molt, these ticks can bite humans. Furthermore, this is the first documentation of B. odocoilei in a tick parasitizing a bird. Our findings substantiate the fact that migratory songbirds transport neotropical ticks long distances, and import them into Canada during northward spring migration. Health care practitioners need to be aware that migratory songbirds transport pathogen-laden ticks into Canada annually, and pose an unforeseen health risk to Canadians.
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Affiliation(s)
- John D Scott
- International Lyme and Associated Diseases Society, 2 Wisconsin Circle, Suite 700, Chevy Chase, MD 20185-7007, USA.
| | - Kerry L Clark
- Environmental Epidemiology Research Laboratory, Department of Public Health, University of North Florida, Jacksonville, FL 32224, USA.
| | - Lance A Durden
- Department of Biology, Georgia Southern University, Statesboro, GA 30458, USA.
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6
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Scott JD, Clark KL, Foley JE, Bierman BC, Durden LA. Far-Reaching Dispersal of Borrelia burgdorferi Sensu Lato-Infected Blacklegged Ticks by Migratory Songbirds in Canada. Healthcare (Basel) 2018; 6:E89. [PMID: 30044388 PMCID: PMC6164468 DOI: 10.3390/healthcare6030089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022] Open
Abstract
Lyme disease has been documented in northern areas of Canada, but the source of the etiological bacterium, Borrelia burgdorferi sensu lato (Bbsl) has been in doubt. We collected 87 ticks from 44 songbirds during 2017, and 24 (39%) of 62 nymphs of the blacklegged tick, Ixodes scapularis, were positive for Bbsl. We provide the first report of Bbsl-infected, songbird-transported I. scapularis in Cape Breton, Nova Scotia; Newfoundland and Labrador; north-central Manitoba, and Alberta. Notably, we report the northernmost account of Bbsl-infected ticks parasitizing a bird in Canada. DNA extraction, PCR amplification, and DNA sequencing reveal that these Bbsl amplicons belong to Borrelia burgdorferi sensu stricto (Bbss), which is pathogenic to humans. Based on our findings, health-care providers should be aware that migratory songbirds widely disperse B. burgdorferi-infected I. scapularis in Canada's North, and local residents do not have to visit an endemic area to contract Lyme disease.
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Affiliation(s)
- John D Scott
- International Lyme and Associated Diseases Society, Bethesda, MD 20827, USA.
| | - Kerry L Clark
- Epidemiology & Environmental Health, University of North Florida, Jacksonville, FL 32224, USA.
| | - Janet E Foley
- Vector-borne Disease Epidemiology and Department of Veterinary Medicine, University of California, Davis, CA 95616, USA.
| | - Bradley C Bierman
- Epidemiology & Environmental Health, University of North Florida, Jacksonville, FL 32224, USA.
| | - Lance A Durden
- Department of Biology, Georgia Southern University, Statesboro, GA 30458, USA.
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7
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Scott JD, Foley JE, Anderson JF, Clark KL, Durden LA. Detection of Lyme Disease Bacterium, Borrelia burgdorferi sensu lato, in Blacklegged Ticks Collected in the Grand River Valley, Ontario, Canada. Int J Med Sci 2017; 14:150-158. [PMID: 28260991 PMCID: PMC5332844 DOI: 10.7150/ijms.17763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/28/2016] [Indexed: 01/08/2023] Open
Abstract
We document the presence of blacklegged ticks, Ixodes scapularis, in the Grand River valley, Centre Wellington, Ontario. Overall, 15 (36%) of 42 I. scapularis adults collected from 41 mammalian hosts (dogs, cats, humans) were positive for the Lyme disease bacterium, Borrelia burgdorferi sensu lato (s.l.). Using real-time PCR testing and DNA sequencing of the flagellin (fla) gene, we determined that Borrelia amplicons extracted from I. scapularis adults belonged to B. burgdorferi sensu stricto (s.s.), which is pathogenic to humans and certain domestic animals. Based on the distribution of I. scapularis adults within the river basin, it appears likely that migratory birds provide an annual influx of I. scapularis immatures during northward spring migration. Health-care providers need to be aware that local residents can present with Lyme disease symptoms anytime during the year.
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Affiliation(s)
- John D Scott
- Research Division, Lyme Ontario, Fergus, Ontario Canada N1M 2L7
| | - Janet E Foley
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, USA 95616
| | - John F Anderson
- Department of Entomology and Center for Vector Ecology and Zoonotic Diseases. The Connecticut Agricultural Experiment Station, New Haven, Connecticut, USA 06504
| | - Kerry L Clark
- Epidemiology & Environmental Health, Department of Public Health, University of North Florida, Jacksonville, USA 32224
| | - Lance A Durden
- Department of Biology, Georgia Southern University, Statesboro, Georgia 30458, USA
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8
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Stricker RB, Johnson L. Lyme disease: the promise of Big Data, companion diagnostics and precision medicine. Infect Drug Resist 2016; 9:215-9. [PMID: 27672336 PMCID: PMC5024771 DOI: 10.2147/idr.s114770] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Lyme disease caused by the spirochete Borrelia burgdorferi has become a major worldwide epidemic. Recent studies based on Big Data registries show that >300,000 people are diagnosed with Lyme disease each year in the USA, and up to two-thirds of individuals infected with B. burgdorferi will fail conventional 30-year-old antibiotic therapy for Lyme disease. In addition, animal and human evidence suggests that sexual transmission of the Lyme spirochete may occur. Improved companion diagnostic tests for Lyme disease need to be implemented, and novel treatment approaches are urgently needed to combat the epidemic. In particular, therapies based on the principles of precision medicine could be modeled on successful "designer drug" treatment for HIV/AIDS and hepatitis C virus infection featuring targeted protease inhibitors. The use of Big Data registries, companion diagnostics and precision medicine will revolutionize the diagnosis and treatment of Lyme disease.
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9
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Scott JD, Foley JE, Clark KL, Anderson JF, Durden LA, Manord JM, Smith ML. Established Population of Blacklegged Ticks with High Infection Prevalence for the Lyme Disease Bacterium, Borrelia burgdorferi Sensu Lato, on Corkscrew Island, Kenora District, Ontario. Int J Med Sci 2016; 13:881-891. [PMID: 27877080 PMCID: PMC5118759 DOI: 10.7150/ijms.16922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/26/2016] [Indexed: 12/24/2022] Open
Abstract
We document an established population of blacklegged ticks, Ixodes scapularis, on Corkscrew Island, Kenora District, Ontario, Canada. Primers of the outer surface protein A (OspA) gene, the flagellin (fla) gene, and the flagellin B (flaB) gene were used in the PCR assays to detect Borrelia burgdorferi sensu lato (s.l.), the Lyme disease bacterium. In all, 60 (73%) of 82 adult I. scapularis, were infected with B. burgdorferi s.l. As well, 6 (43%) of 14 unfed I. scapularis nymphs were positive for B. burgdorferi s.l. An I. scapularis larva was also collected from a deer mouse, and several unfed larvae were gathered by flagging leaf litter. Based on DNA sequencing of randomly selected Borrelia amplicons from six nymphal and adult I. scapularis ticks, primers for the flagellin (fla) and flagellin B (flaB) genes reveal the presence of B. burgdorferi sensu stricto (s.s.), a genospecies pathogenic to humans and certain domestic animals. We collected all 3 host-feeding life stages of I. scapularis in a single year, and report the northernmost established population of I. scapularis in Ontario. Corkscrew Island is hyperendemic for Lyme disease and has the highest prevalence of B. burgdorferi s.l. for any established population in Canada. Because of this very high infection prevalence, this population of I. scapularis has likely been established for decades. Of epidemiological significance, cottage owners, island visitors, outdoors enthusiasts, and medical professionals must be vigilant that B. burgdorferi s.l.-infected I. scapularis on Corkscrew Island pose a serious public health risk.
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Affiliation(s)
- John D Scott
- Lyme Ontario, Research Division, 365 St. David St. South, Fergus, Ontario, Canada N1M 2L7
| | - Janet E Foley
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California 95616, United States of America
| | - Kerry L Clark
- Epidemiology & Environmental Health, Department of Public Health, University of North Florida, 1 UNF Drive, Jacksonville, Florida 32224, United States of America
| | - John F Anderson
- Department of Entomology and Center for Vector Ecology and Zoonotic Diseases. The Connecticut Agricultural Experiment Station, P.O. Box 1106, New Haven, Connecticut 06504-1106, United States of America
| | - Lance A Durden
- Department of Biology, Georgia Southern University, 4324 Old Register Road, Statesboro, Georgia 30458, United States of America
| | - Jodi M Manord
- Epidemiology & Environmental Health, Department of Public Health, University of North Florida, 1 UNF Drive, Jacksonville, Florida 32224, United States of America
| | - Morgan L Smith
- Epidemiology & Environmental Health, Department of Public Health, University of North Florida, 1 UNF Drive, Jacksonville, Florida 32224, United States of America
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10
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Stricker RB, Middelveen MJ. Sexual transmission of Lyme disease: challenging the tickborne disease paradigm. Expert Rev Anti Infect Ther 2015; 13:1303-6. [PMID: 26489537 DOI: 10.1586/14787210.2015.1081056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lyme disease caused by the spirochete Borrelia burgdorferi has become a major worldwide epidemic. In this article, we explore the clinical, epidemiological and experimental evidence for sexual transmission of Lyme disease in animal models and humans. Although the likelihood of sexual transmission of the Lyme spirochete remains speculative, the possibility of Lyme disease transmission via intimate human contact merits further study.
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Affiliation(s)
- Raphael B Stricker
- a International Lyme and Associated Diseases Society, P.O. Box 341461, Bethesda, MD 20827-1461, USA
| | - Marianne J Middelveen
- a International Lyme and Associated Diseases Society, P.O. Box 341461, Bethesda, MD 20827-1461, USA
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Middelveen MJ, Burke J, Sapi E, Bandoski C, Filush KR, Wang Y, Franco A, Timmaraju A, Schlinger HA, Mayne PJ, Stricker RB. Culture and identification of Borrelia spirochetes in human vaginal and seminal secretions. F1000Res 2014; 3:309. [PMID: 28690828 PMCID: PMC5482345 DOI: 10.12688/f1000research.5778.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 12/22/2022] Open
Abstract
Background: Recent reports indicate that more than 300,000 cases of Lyme disease are diagnosed yearly in the USA. Preliminary clinical, epidemiological and immunological studies suggest that infection with the Lyme disease spirochete
Borrelia burgdorferi (Bb) could be transferred from person to person via intimate human contact without a tick vector. Failure to detect viable
Borrelia spirochetes in vaginal and seminal secretions would argue against this hypothesis. Methods: Patients with and without a history of Lyme disease were selected for the study after informed consent was obtained. Serological testing for Bb was performed on all subjects. Semen or vaginal secretions were inoculated into BSK-H medium and cultured for four weeks. Examination of genital cultures and culture concentrates for the presence of spirochetes was performed using light and darkfield microscopy, and spirochete concentrates were subjected to Dieterle silver staining, anti-Bb immunohistochemical staining, molecular hybridization and PCR analysis for further characterization. Immunohistochemical and molecular testing was performed in three independent laboratories in a blinded fashion. Positive and negative controls were included in all experiments. Results: Control subjects who were asymptomatic and seronegative for Bb had no detectable spirochetes in genital secretions by PCR analysis. In contrast, spirochetes were observed in cultures of genital secretions from 11 of 13 subjects diagnosed with Lyme disease, and motile spirochetes were detected in genital culture concentrates from 12 of 13 Lyme disease patients using light and darkfield microscopy. Morphological features of spirochetes were confirmed by Dieterle silver staining and immunohistochemical staining of culture concentrates. Molecular hybridization and PCR testing confirmed that the spirochetes isolated from semen and vaginal secretions were strains of
Borrelia, and all cultures were negative for treponemal spirochetes. PCR sequencing of cultured spirochetes from three couples having unprotected sex indicated that two couples had identical strains of Bb
sensu stricto in their semen and vaginal secretions, while the third couple had identical strains of
B. hermsii detected in their genital secretions. Conclusions: The culture of viable
Borrelia spirochetes in genital secretions suggests that Lyme disease could be transmitted by intimate contact from person to person. Further studies are needed to evaluate this hypothesis.
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Affiliation(s)
| | - Jennie Burke
- Australian Biologics, Sydney, NSW 2000, Australia
| | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Cheryl Bandoski
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Katherine R Filush
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Yean Wang
- Australian Biologics, Sydney, NSW 2000, Australia
| | | | - Arun Timmaraju
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Hilary A Schlinger
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827-1461, USA
| | - Peter J Mayne
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827-1461, USA
| | - Raphael B Stricker
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827-1461, USA
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12
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Middelveen MJ, Burke J, Sapi E, Bandoski C, Filush KR, Wang Y, Franco A, Timmaraju A, Schlinger HA, Mayne PJ, Stricker RB. Culture and identification of Borrelia spirochetes in human vaginal and seminal secretions. F1000Res 2014; 3:309. [PMID: 28690828 DOI: 10.12688/f1000research.5778.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 01/22/2023] Open
Abstract
Background: Recent reports indicate that more than 300,000 cases of Lyme disease are diagnosed yearly in the USA. Preliminary clinical, epidemiological and immunological studies suggest that infection with the Lyme disease spirochete Borrelia burgdorferi (Bb) could be transferred from person to person via intimate human contact without a tick vector. Failure to detect viable Borrelia spirochetes in vaginal and seminal secretions would argue against this hypothesis. Methods: Patients with and without a history of Lyme disease were selected for the study after informed consent was obtained. Serological testing for Bb was performed on all subjects. Semen or vaginal secretions were inoculated into BSK-H medium and cultured for four weeks. Examination of genital cultures and culture concentrates for the presence of spirochetes was performed using light and darkfield microscopy, and spirochete concentrates were subjected to Dieterle silver staining, anti-Bb immunohistochemical staining, molecular hybridization and PCR analysis for further characterization. Immunohistochemical and molecular testing was performed in three independent laboratories in a blinded fashion. Positive and negative controls were included in all experiments. Results: Control subjects who were asymptomatic and seronegative for Bb had no detectable spirochetes in genital secretions by PCR analysis. In contrast, spirochetes were observed in cultures of genital secretions from 11 of 13 subjects diagnosed with Lyme disease, and motile spirochetes were detected in genital culture concentrates from 12 of 13 Lyme disease patients using light and darkfield microscopy. Morphological features of spirochetes were confirmed by Dieterle silver staining and immunohistochemical staining of culture concentrates. Molecular hybridization and PCR testing confirmed that the spirochetes isolated from semen and vaginal secretions were strains of Borrelia, and all cultures were negative for treponemal spirochetes. PCR sequencing of cultured spirochetes from three couples having unprotected sex indicated that two couples had identical strains of Bb sensu stricto in their semen and vaginal secretions, while the third couple had identical strains of B. hermsii detected in their genital secretions. Conclusions: The culture of viable Borrelia spirochetes in genital secretions suggests that Lyme disease could be transmitted by intimate contact from person to person. Further studies are needed to evaluate this hypothesis.
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Affiliation(s)
| | - Jennie Burke
- Australian Biologics, Sydney, NSW 2000, Australia
| | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Cheryl Bandoski
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Katherine R Filush
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Yean Wang
- Australian Biologics, Sydney, NSW 2000, Australia
| | | | - Arun Timmaraju
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Hilary A Schlinger
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827-1461, USA
| | - Peter J Mayne
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827-1461, USA
| | - Raphael B Stricker
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827-1461, USA
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