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Philippe C, Geebelen L, Hermy MRG, Dufrasne FE, Tersago K, Pellegrino A, Fonville M, Sprong H, Mori M, Lernout T. The prevalence of pathogens in ticks collected from humans in Belgium, 2021, versus 2017. Parasit Vectors 2024; 17:380. [PMID: 39238018 PMCID: PMC11378490 DOI: 10.1186/s13071-024-06427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/27/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Ticks carry a variety of microorganisms, some of which are pathogenic to humans. The human risk of tick-borne diseases depends on, among others, the prevalence of pathogens in ticks biting humans. To follow-up on this prevalence over time, a Belgian study from 2017 was repeated in 2021. METHODS During the tick season 2021, citizens were invited to have ticks removed from their skin, send them and fill in a short questionnaire on an existing citizen science platform for the notification of tick bites (TekenNet). Ticks were morphologically identified to species and life stage level and screened using multiplex qPCR targeting, among others, Borrelia burgdorferi (sensu lato), Anaplasma phagocytophilum, Borrelia miyamotoi, Neoehrlichia mikurensis, Babesia spp., Rickettsia helvetica and tick-borne encephalitis virus (TBEV). The same methodology as in 2017 was used. RESULTS In 2021, the same tick species as in 2017 were identified in similar proportions; of 1094 ticks, 98.7% were Ixodes ricinus, 0.8% Ixodes hexagonus and 0.5% Dermacentor reticulatus. A total of 928 nymphs and adults could be screened for the presence of pathogens. Borrelia burgdorferi (s.l.) was detected in 9.9% (95% CI 8.2-12.0%), which is significantly lower than the prevalence of 13.9% (95% CI 12.2-15.7%) in 2017 (P = 0.004). The prevalences of A. phagocytophilum (4.7%; 95% CI 3.5-6.3%) and R. helvetica (13.3%; 95% CI 11.2-15.6%) in 2021 were significantly higher compared to 2017 (1.8%; 95% CI 1.3-2.7% and 6.8%; 95% CI 5.6-8.2% respectively) (P < 0.001 for both). For the other pathogens tested, no statistical differences compared to 2017 were found, with prevalences ranging between 1.5 and 2.9% in 2021. Rickettsia raoultii was again found in D. reticulatus ticks (n = 3/5 in 2021). Similar to 2017, no TBEV was detected in the ticks. Co-infections were found in 5.1% of ticks. When combining co-infection occurrence in 2017 and 2021, a positive correlation was observed between B. burgdorferi (s.l.) and N. mikurensis and B. burgdorferi (s.l.) and B. miyamotoi (P < 0.001 for both). CONCLUSIONS Although the 2021 prevalences fell within expectations, differences were found compared to 2017. Further research to understand the explanations behind these differences is needed.
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Affiliation(s)
- Camille Philippe
- Sciensano, Belgian Institute for Health, Brussels, Belgium
- Laboratory of Immunology, Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | | | | | - Katrien Tersago
- Division of Preventive Health Policy, Flemish Department of Care, Environmental Healthcare, Brussels, Belgium
| | - Alessandro Pellegrino
- Infectious Disease Surveillance Unit, Agence pour une Vie de Qualité (AVIQ), Charleroi, Belgium
| | - Manoj Fonville
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Marcella Mori
- Sciensano, Belgian Institute for Health, Brussels, Belgium
| | - Tinne Lernout
- Sciensano, Belgian Institute for Health, Brussels, Belgium
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Król N, Chitimia-Dobler L, Dobler G, Kiewra D, Czułowska A, Obiegala A, Zajkowska J, Juretzek T, Pfeffer M. Identification of New Microfoci and Genetic Characterization of Tick-Borne Encephalitis Virus Isolates from Eastern Germany and Western Poland. Viruses 2024; 16:637. [PMID: 38675977 PMCID: PMC11055073 DOI: 10.3390/v16040637] [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: 03/04/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Tick-borne encephalitis (TBE) is the most important tick-borne viral disease in Eurasia, although effective vaccines are available. Caused by the tick-borne encephalitis virus (TBEV, syn. Orthoflavivirus encephalitidis), in Europe, it is transmitted by ticks like Ixodes ricinus and Dermacentor reticulatus. TBEV circulates in natural foci, making it endemic to specific regions, such as southern Germany and northeastern Poland. Our study aimed to identify new TBEV natural foci and genetically characterize strains in ticks in previously nonendemic areas in Eastern Germany and Western Poland. (2) Methods: Ticks were collected from vegetation in areas reported by TBE patients. After identification, ticks were tested for TBEV in pools of a maximum of 10 specimens using real-time RT-PCR. From the positive TBEV samples, E genes were sequenced. (3) Results: Among 8400 ticks from 19 sites, I. ricinus (n = 4784; 56.9%) was predominant, followed by D. reticulatus (n = 3506; 41.7%), Haemaphysalis concinna (n = 108; 1.3%), and I. frontalis (n = 2; <0.1%). TBEV was detected in 19 pools originating in six sites. The phylogenetic analyses revealed that TBEV strains from Germany and Poland clustered with other German strains, as well as those from Finland and Estonia. (4) Conclusions: Although there are still only a few cases are reported from these areas, people spending much time outdoors should consider TBE vaccination.
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Affiliation(s)
- Nina Król
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany (M.P.)
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark
- Clinical Center for Emerging and Vector-Borne Infections, Odense University Hospital, 5000 Odense, Denmark
| | - Lidia Chitimia-Dobler
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
- Fraunhofer Institute of Immunology, Infection and Pandemic Research, 80799 Munich, Germany
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
- Department of Parasitology, Institute of Biology, University of Hohenheim, 70599 Stuttgart, Germany
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University Munich, 80336 Munich, Germany
| | - Dorota Kiewra
- Department of Microbial Ecology and Acaroentomology, University of Wrocław, 51-148 Wrocław, Poland
| | - Aleksandra Czułowska
- Department of Microbial Ecology and Acaroentomology, University of Wrocław, 51-148 Wrocław, Poland
| | - Anna Obiegala
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany (M.P.)
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University in Białystok, 15-089 Białystok, Poland;
| | - Thomas Juretzek
- Center for Laboratory Medicine, Microbiology and Hospital Hygiene, Carl-Thiem-Klinikum Cottbus gGmbH, 03048 Cottbus, Germany
| | - Martin Pfeffer
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany (M.P.)
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Vrijmoeth HD, Ursinus J, Botey-Bataller J, Kuijpers Y, Chu X, van de Schoor FR, Scicluna BP, Xu CJ, Netea MG, Kullberg BJ, van den Wijngaard CC, Li Y, Hovius JW, Joosten LAB. Genome-wide analyses in Lyme borreliosis: identification of a genetic variant associated with disease susceptibility and its immunological implications. BMC Infect Dis 2024; 24:337. [PMID: 38515037 PMCID: PMC10956190 DOI: 10.1186/s12879-024-09217-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: 08/22/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Genetic variation underly inter-individual variation in host immune responses to infectious diseases, and may affect susceptibility or the course of signs and symptoms. METHODS We performed genome-wide association studies in a prospective cohort of 1138 patients with physician-confirmed Lyme borreliosis (LB), the most common tick-borne disease in the Northern hemisphere caused by the bacterium Borrelia burgdorferi sensu lato. Genome-wide variants in LB patients-divided into a discovery and validation cohort-were compared to two healthy cohorts. Additionally, ex vivo monocyte-derived cytokine responses of peripheral blood mononuclear cells to several stimuli including Borrelia burgdorferi were performed in both LB patient and healthy control samples, as were stimulation experiments using mechanistic/mammalian target of rapamycin (mTOR) inhibitors. In addition, for LB patients, anti-Borrelia antibody responses were measured. Finally, in a subset of LB patients, gene expression was analysed using RNA-sequencing data from the ex vivo stimulation experiments. RESULTS We identified a previously unknown genetic variant, rs1061632, that was associated with enhanced LB susceptibility. This polymorphism was an eQTL for KCTD20 and ETV7 genes, and its major risk allele was associated with upregulation of the mTOR pathway and cytokine responses, and lower anti-Borrelia antibody production. In addition, we replicated the recently reported SCGB1D2 locus that was suggested to have a protective effect on B. burgdorferi infection, and associated this locus with higher Borrelia burgdorferi antibody indexes and lower IL-10 responses. CONCLUSIONS Susceptibility for LB was associated with higher anti-inflammatory responses and reduced anti-Borrelia antibody production, which in turn may negatively impact bacterial clearance. These findings provide important insights into the immunogenetic susceptibility for LB and may guide future studies on development of preventive or therapeutic measures. TRIAL REGISTRATION The LymeProspect study was registered with the International Clinical Trials Registry Platform (NTR4998, registration date 2015-02-13).
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Affiliation(s)
- Hedwig D Vrijmoeth
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
| | - Jeanine Ursinus
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Location AMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100 DD, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Javier Botey-Bataller
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
- Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
| | - Yunus Kuijpers
- Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
| | - Xiaojing Chu
- Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
| | - Freek R van de Schoor
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
| | - Brendon P Scicluna
- Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, MSD 2080, Msida, Malta
- Centre for Molecular Medicine and Biobanking, Biomedical Sciences, University of Malta, MSD 2080, Msida, Malta
| | - Cheng-Jian Xu
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
- Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
| | - Mihai G Netea
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, 53113, Bonn, Germany
| | - Bart Jan Kullberg
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
| | - Cees C van den Wijngaard
- National Institute for Public Health and Environment (RIVM), Center for Infectious Disease Control, Bilthoven, 3720 BA, the Netherlands
| | - Yang Li
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands
- Department of Computational Biology for Individualised Infection Medicine, Centre for Individualised Infection Medicine, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, 30625, Hannover, Germany
| | - Joppe W Hovius
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Location AMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100 DD, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, the Netherlands.
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Sahina S, Sithalakshmi S, Balasubramanian R. Prevalence of ixodid ticks on goats and risk factors for tick-borne diseases in humans in the Kyasanur forest disease endemic area of Kerala, India. Parasitol Res 2024; 123:131. [PMID: 38353765 DOI: 10.1007/s00436-024-08151-y] [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: 05/19/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
In India, tick-borne diseases are prevalent in many states due to the presence of tick vectors. However, information on disease-causing ticks from domestic animals and the associated risk factors for residents living in the disease-endemic area is lacking. Therefore, we conducted this study to identify ixodid ticks in goats and human risk factors in three villages of the Wayanad district of Kerala. We examined 202 goats and collected 741 ticks, of which 69.8% were ticks belonging to the genus Haemaphysalis. The maximum number of ticks was collected from Thirunelli (81.3%), followed by Noolpuzha (76.27%) and Pulpally (45.6%). Overall, H. bispinosa Neumann, 1897 (54.6%), was the most common species, followed by H. turturis Nuttall and Warburton, 1915 (38.0%), H. spinigera Neumann, 1897 (5.4%), and H. intermedia Warburton and Nuttall, 1909 (1.8%). We included 428 participants (men and women) in this study. The average age of the respondents was 43 years. We found significant associations between accessing the forest for cattle grazing and other activities and tick-borne diseases (χ2 = 9.5, p = 0.002), between workers who were bitten by ticks and tick-borne diseases (χ2 = 3.8, p = 0.05), and between number of tick bites per day > 6 and tick-borne diseases (χ2 = 12.1, p = 0.001). The high frequency of Haemaphysalis spp. found in goats highlighted the risk of tick exposure and tick-borne diseases, such as Kyasanur forest disease in humans, and the need for the development and implementation of effective measures to control ticks.
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Affiliation(s)
- S Sahina
- ICMR-National Institute of Virology, Kerala Unit, Alappuzha, Kerala, India
| | - S Sithalakshmi
- ICMR-National Institute of Virology, Kerala Unit, Alappuzha, Kerala, India
| | - R Balasubramanian
- ICMR-National Institute of Virology, Kerala Unit, Alappuzha, Kerala, India.
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Colby E, Olsen J, Angulo FJ, Kelly P, Halsby K, Pilz A, Sot U, Chmielewski T, Pancer K, Moïsi JC, Jodar L, Stark JH. Estimated Incidence of Symptomatic Lyme Borreliosis Cases in Lublin, Poland in 2021. Microorganisms 2023; 11:2481. [PMID: 37894139 PMCID: PMC10608808 DOI: 10.3390/microorganisms11102481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Lyme borreliosis (LB), the most common tick-borne disease in Europe, is endemic to Poland. Despite public health surveillance with mandatory reporting of LB cases by physicians and laboratories, many symptomatic LB cases are not included in surveillance in Poland. We estimated the extent of the under-ascertainment of symptomatic LB cases via surveillance in the Polish province of Lublin to better understand Poland's LB burden. The number of incident symptomatic LB cases in Lublin in 2010 was estimated from two seroprevalence studies conducted among adults in Lublin, as well as estimates of the proportion of asymptomatic LB cases and the duration of LB antibody persistence. The estimated number of incident symptomatic LB cases was compared to the number of surveillance-reported cases in Lublin to derive an under-ascertainment multiplier. This multiplier was applied to the number of surveillance-reported cases in 2021 to estimate the number and population-based incidence of symptomatic LB cases in Lublin in 2021. We estimate that there are 5.9 symptomatic LB cases for every surveillance-reported LB case in Lublin. Adjusting for under-ascertainment, the estimated number of symptomatic LB cases in Lublin in 2021 was 6204 (population-based incidence: 467.6/100,000). After adjustment for under-ascertainment, the incidence of symptomatic LB in Lublin, Poland, is high.
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Affiliation(s)
- Emily Colby
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Julia Olsen
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Frederick J. Angulo
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Patrick Kelly
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - Kate Halsby
- Pfizer Vaccines, Tadworth, Surrey KT20 7NS, UK
| | - Andreas Pilz
- Vaccines, Pfizer Corporation Austria, 1210 Vienna, Austria
| | - Urszula Sot
- Vaccine Medical Affairs, Pfizer Poland Inc., 02-092 Warsaw, Poland
| | | | | | | | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Collegeville, PA 19426, USA
| | - James H. Stark
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, Cambridge, MA 02139, USA
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Ter Hofstede H, Haex J, Belias M, Oosting M, Joosten LAB, Stelma FF. Lyme Borreliosis Serology: A Prospective Cohort Study of Forestry Service Workers in the Netherlands over 8 Years (2008 to 2016) of Follow-Up. Life (Basel) 2023; 13:life13051143. [PMID: 37240788 DOI: 10.3390/life13051143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
There is little known about the dynamics within responses to Borrelia spp. upon repeated exposure to tick bites and the development of serological markers over time. Most studies have investigated antibody development in risk populations over a short period of time. Therefore, we aimed to study the dynamics of anti-Borrelia antibodies in forestry service workers over 8 years in association with tick bite exposure. METHODS Blood samples from 106 forestry service workers originally included in the 200 Functional Genomics Project (Radboudumc, Nijmegen, the Netherlands) were followed for 8 years and tested annually for anti-Borrelia antibodies (ELISA and Western blot). IgG seroconversion was related to the number of tick bites in the previous year, which was obtained through annual questionnaires. The hazard ratio for Borrelia IgG seroconversion was calculated using Cox regression survival analysis and a logistic regression model, both adjusting for age, gender and smoking. RESULTS Borrelia IgG seropositivity in the study population did not vary significantly between years and the average prevalence was 13.4%. Of the 27 subjects that underwent seroconversion during the study period, 22 reconverted from positive to negative. Eleven subjects seroconverted a second time. The total seroconversion rate per year (negative to positive) was 4.5%. Active smoking was associated with IgG seroconversion in the >5 tick bites group (p < 0.05). According to the two models used, the risks of IgG seroconversion in the >5 tick bites group were HR = 2.93 (p = 0.10) and OR = 3.36 (p < 0.0005). CONCLUSIONS Borrelia IgG seroconversion in forestry service workers was significantly related to increasing tick bite exposure in a survival and logistic regression model adjusting for age, gender and smoking.
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Affiliation(s)
- Hadewych Ter Hofstede
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jeroen Haex
- Department of Medical Microbiology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Michael Belias
- Department for Health Evidence, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Mailbox 133, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marije Oosting
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Foekje F Stelma
- Department of Medical Microbiology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Olsen J, Angulo FJ, Pilz A, Halsby K, Kelly P, Brestrich G, Stark JH, Jodar L. Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment. Public Health 2023; 219:1-9. [PMID: 37075486 DOI: 10.1016/j.puhe.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment. METHODS Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany. RESULTS Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case. CONCLUSIONS We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.
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Affiliation(s)
- J Olsen
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
| | - F J Angulo
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - A Pilz
- Vaccines, Pfizer Corporation Austria, Floridsdorfer Hauptstrasse 1, 1210 Wien, Vienna, Austria
| | - K Halsby
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - P Kelly
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - G Brestrich
- Vaccines, Pfizer Pharma GmbH, Linkstrasse 10, 10785 Berlin, Germany
| | - J H Stark
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
| | - L Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA
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Thalmann P, Ehrhard S, Summerfield A, Ricklin ME. Retrospective Study of Tick Bites Associated with Neurological Disease in a Level Three University Hospital in Switzerland. Infect Dis Rep 2023; 15:150-157. [PMID: 36960968 PMCID: PMC10037620 DOI: 10.3390/idr15020016] [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: 11/05/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Ticks represent very important vectors of human and zoonotic pathogens, and tick-borne diseases (TBDs) are diagnosed with increasing frequency. Therefore, the aim of this retrospective study was to describe patients presenting with a complaint of tick bite in the emergency department (ED) of a large university hospital in Switzerland. METHODS Data were collected by searching for keywords in the routine clinic database to identify cases from 1 July 2012 to 30 June 2020. The patients' data were screened for preexisting diseases and demographic and clinical characteristics. RESULTS We included 415 patients collected over a period of 8 years, with highest admission frequencies from May to July. Of these, 82% were outpatients, 15.9% admitted to a hospital ward, and five to intensive care. The patients were allocated to three groups. The first group represented patients with erythema chronica migrans (ECM), which is pathognomonic for Lyme borreliosis (n = 45). Accordingly, 89% of cases in this group of patients were treated with antibiotics. The second group represented patients with other tick bite-associated erythema (n = 139). In this group, no particular clinical symptoms or laboratory findings were found. Finally, the largest group represented patients in which the tick bite was no longer visible (n = 201). This group of patients had significantly more evidence of neurological disorders (52%) and were treated at a higher rate with non-steroidal anti-inflammatory (29%) or antiviral (13%) drugs. Although the vaccination status for tick-borne encephalitis virus (TBEV) was not systematically evaluated, at least 10% of the latter group was vaccinated, indicating another source for neurological disease. Furthermore, only 14% of the tested patients were positive for IgM or IgG against TBEV. CONCLUSION This retrospective study indicates the presence of many undiagnosed neurological diseases following tick bites that could be caused by TBEV or an unknown infectious agent. Taken together, although tick bites were not very frequently seen in the present tertiary ED, the frequent presence of neurological symptoms demands a more systematic assessment of vaccination status and TBEV serology as well as further diagnostic evaluations in patients that report tick bites and neurological symptoms.
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Affiliation(s)
- Patrick Thalmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Simone Ehrhard
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Artur Summerfield
- Department of Immunology, Institute of Virology and Immunology, 3147 Mittelhäusern, Switzerland
- Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, 3001 Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Hallerstrasse 6, 3012 Bern, Switzerland
| | - Meret Elisabeth Ricklin
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Azagi T, Harms M, Swart A, Fonville M, Hoornstra D, Mughini-Gras L, Hovius JW, Sprong H, van den Wijngaard C. Self-reported symptoms and health complaints associated with exposure to Ixodes ricinus-borne pathogens. Parasit Vectors 2022; 15:93. [PMID: 35303944 PMCID: PMC8931963 DOI: 10.1186/s13071-022-05228-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of infections with tick-borne pathogens (TBPs) other than Borrelia burgdorferi (s.l.) and tick-borne encephalitis virus (TBEV) on public health in Europe remains unclear. Our goal is to evaluate whether the presence of these TBPs in ticks can be associated with self-reported health complaints. METHODS We enrolled individuals who were bitten by I. ricinus between 2012 and 2015 and collected their relevant demographic and clinical information using a self-administered online questionnaire. A total of 4163 I. ricinus ticks sent by the participants were subject to molecular analyses for detection of specific TBPs. Associations between the presence of TBPs in ticks and self-reported complaints and symptoms were evaluated by means of a stepwise approach using a generalized linear model (GLM). RESULTS Of 17 self-reported complaints and symptoms significant in the univariate analyses, 3 had a highly significant association (P < 0.01) with at least one TBP in the multivariate analysis. Self-reported Lyme borreliosis was significantly associated (P < 0.001) with B. burgdorferi (s.l.) infection. Facial paralysis was associated (P < 0.01) with infection with B. miyamotoi, N. mikurensis and R. helvetica. Finally, a significant association (P < 0.001) was found between nocturnal sweating and A. phagocytophilum. CONCLUSIONS We found associations between the presence of TBPs in ticks feeding on humans and self-reported symptoms. Due to the subjective nature of such reports and the fact that infection was determined in the ticks and not in the patient samples, further prospective studies utilizing diagnostic modalities should be performed before any clinical outcome can be causally linked to infection with TBPs.
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Affiliation(s)
- Tal Azagi
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
| | - Margriet Harms
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Arno Swart
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Manoj Fonville
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hein Sprong
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Cees van den Wijngaard
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
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Ho BM, Davis HE, Forrester JD, Sheele JM, Haston T, Sanders L, Lee MC, Lareau S, Caudell M, Davis CB. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Management of Tick-Borne Illness in the United States. Wilderness Environ Med 2021; 32:474-494. [PMID: 34642107 DOI: 10.1016/j.wem.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention and management of tick-borne illness (TBI). Recommendations are graded based on quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. The guidelines include a brief review of the clinical presentation, epidemiology, prevention, and management of TBI in the United States, with a primary focus on interventions that are appropriate for resource-limited settings. Strong recommendations are provided for the use of DEET, picaridin, and permethrin; tick checks; washing and drying clothing at high temperatures; mechanical tick removal within 36 h of attachment; single-dose doxycycline for high-risk Lyme disease exposures versus "watchful waiting;" evacuation from backcountry settings for symptomatic tick exposures; and TBI education programs. Weak recommendations are provided for the use of light-colored clothing; insect repellents other than DEET, picaridin, and permethrin; and showering after exposure to tick habitat. Weak recommendations are also provided against passive methods of tick removal, including the use of systemic and local treatments. There was insufficient evidence to support the use of long-sleeved clothing and the avoidance of tick habitat such as long grasses and leaf litter. Although there was sound evidence supporting Lyme disease vaccination, a grade was not offered as the vaccine is not currently available for use in the United States.
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Affiliation(s)
- Benjamin M Ho
- Southern Wisconsin Emergency Associates, Janesville, Wisconsin.
| | - Hillary E Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado; Department of Emergency Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | | | | | - Taylor Haston
- Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia
| | - Linda Sanders
- Department of Emergency Medicine, Memorial Hospital, Colorado Springs, Colorado
| | - Mary Caroll Lee
- Department of Emergency Medicine, Virginia Tech-Carilion Clinic, Roanoke, Virginia
| | - Stephanie Lareau
- Department of Emergency Medicine, Virginia Tech-Carilion Clinic, Roanoke, Virginia
| | - Michael Caudell
- Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia
| | - Christopher B Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
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11
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Garcia-Vozmediano A, Giglio G, Ramassa E, Nobili F, Rossi L, Tomassone L. Low Risk Perception about Ticks and Tick-Borne Diseases in an Area Recently Invaded by Ticks in Northwestern Italy. Vet Sci 2021; 8:vetsci8070131. [PMID: 34357923 PMCID: PMC8310202 DOI: 10.3390/vetsci8070131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/30/2022] Open
Abstract
Risk perception, together with the adoption of measures to prevent tick bites, may strongly influence human exposure to ticks and transmitted pathogens. We created a questionnaire to evaluate how people perceive the health risk posed by ticks in an area recently invaded by these arthropods, in the western Italian Alps. Moreover, through a collaborative effort with park rangers and physicians, we investigated which tick species bite humans and their infection with pathogens (Borrelia burgdorferi s.l., Anaplasma phagocytophilum, and spotted-fever group Rickettsiae). Apart from two Dermacentor marginatus bites, we identified Ixodes ricinus (n = 124) as the main species responsible for tick bites. The investigated pathogens infected 25.4% of tested I. ricinus. The evaluation of the engorgement rate of biting I. ricinus revealed that they had been likely feeding on humans for 24 h or more, suggesting a high probability of pathogen transmission. Indeed, the questionnaires revealed that people infrequently adopt preventive measures, such as inspecting the body for ticks, although most respondents claimed that ticks are a threat to human health. Having suffered from previous tick bites was positively associated with the adoption of personal protection measures. Given the increasing incidence of tick-borne diseases in the region, the public should be better informed about the possibility of being bitten by infected ticks in order to mitigate the risk.
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Affiliation(s)
- Aitor Garcia-Vozmediano
- Department of Veterinary Sciences, University of Turin, L.go Braccini, 2, 10095 Grugliasco, Italy; (A.G.-V.); (G.G.); (L.R.)
| | - Giorgia Giglio
- Department of Veterinary Sciences, University of Turin, L.go Braccini, 2, 10095 Grugliasco, Italy; (A.G.-V.); (G.G.); (L.R.)
| | - Elisa Ramassa
- Ente di Gestione delle Aree Protette delle Alpi Cozie, Via Fransuà Fontan, 1, 10050 Salbertrand, Italy;
| | - Fabrizio Nobili
- Ente di Gestione delle Aree Protette del Po Torinese, Corso Trieste 98, 10024 Moncalieri, Italy;
| | - Luca Rossi
- Department of Veterinary Sciences, University of Turin, L.go Braccini, 2, 10095 Grugliasco, Italy; (A.G.-V.); (G.G.); (L.R.)
| | - Laura Tomassone
- Department of Veterinary Sciences, University of Turin, L.go Braccini, 2, 10095 Grugliasco, Italy; (A.G.-V.); (G.G.); (L.R.)
- Correspondence: ; Tel.: +39-011-670-9195
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12
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Markowicz M, Schötta AM, Höss D, Kundi M, Schray C, Stockinger H, Stanek G. Infections with Tickborne Pathogens after Tick Bite, Austria, 2015-2018. Emerg Infect Dis 2021; 27. [PMID: 33755546 PMCID: PMC8007293 DOI: 10.3201/eid2704.203366] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Knowledge about outcomes of tick bites is crucial because infections with emerging pathogens might be underestimated. The aim of this prospective study was to assess the risk for tickborne infections after a tick bite. A total of 489 persons bitten by 1,295 ticks were assessed for occurrence of infections with Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia spp., Babesia spp., Candidatus Neoehrlichia mikurensis, and relapsing fever borreliae. B. burgdorferi s.l. infection was found in 25 (5.1%) participants, of whom 15 had erythema migrans. Eleven (2.3%) participants were positive by PCR for Candidatus N. mikurensis. One asymptomatic participant infected with B. miyamotoi was identified. Full engorgement of the tick (odds ratio 9.52) and confirmation of B. burgdorferi s.l. in the tick by PCR (odds ratio 4.39) increased the risk for infection. Rickettsia helvetica was highly abundant in ticks but not pathogenic to humans. Knowledge about the outcome of tick bites is crucial because infections with emerging pathogens might be underestimated because of limited laboratory facilities.
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13
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Lenart M, Simoniti M, Strašek-Smrdel K, Špik VC, Selič-Kurinčič T, Avšič-Županc T. Case report: first symptomatic Candidatus Neoehrlichia mikurensis infection in Slovenia. BMC Infect Dis 2021; 21:579. [PMID: 34130635 PMCID: PMC8207769 DOI: 10.1186/s12879-021-06297-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Candidatus Neoehrlichia mikurensis (CNM) is an emerging tick-born pathogen and usually causes symptomatic infection only in immunocompromised patients. Apart from one described case found in the literature where cultivation was successful, all cases so far were diagnosed by using broad-range 16S rDNA PCR. Case presentation Our patient presented with a prolonged febrile state of unknown origin. Clinical presentation, extensive medical workup and classic microbiologic testing were non-conclusive. Several infectious agents and other causes for the febrile state were excluded. In the end, a broad-range 16S rDNA PCR was to be performed to confirm the diagnosis of CNM infection. Treatment was successful with doxycycline. Conclusions Due to the obscurity of the pathogen, diagnostic workup in CNM is prolonged and challenging. More awareness is need about this emerging infectious disease in countries with high prevalence of tick-borne diseases as standard microbiological methods are not successful in confirming the diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06297-z.
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Affiliation(s)
- Mitja Lenart
- Department of Infectious diseases, General Hospital Celje, Oblakova ulica 5, 3000, Celje, Slovenia.
| | - Miha Simoniti
- Department of Infectious diseases, General Hospital Celje, Oblakova ulica 5, 3000, Celje, Slovenia
| | - Katja Strašek-Smrdel
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška cesta 4, Ljubljana, 1000, Slovenia
| | - Vesna Cvitković Špik
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška cesta 4, Ljubljana, 1000, Slovenia
| | - Tanja Selič-Kurinčič
- Department of Infectious diseases, General Hospital Celje, Oblakova ulica 5, 3000, Celje, Slovenia
| | - Tatjana Avšič-Županc
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška cesta 4, Ljubljana, 1000, Slovenia
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14
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Hoornstra D, Harms MG, Gauw SA, Wagemakers A, Azagi T, Kremer K, Sprong H, van den Wijngaard CC, Hovius JW. Ticking on Pandora's box: a prospective case-control study into 'other' tick-borne diseases. BMC Infect Dis 2021; 21:501. [PMID: 34051756 PMCID: PMC8164744 DOI: 10.1186/s12879-021-06190-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tick-borne pathogens other than Borrelia burgdorferi sensu lato - the causative agent of Lyme borreliosis - are common in Ixodes ricinus ticks. How often these pathogens cause human disease is unknown. In addition, diagnostic tools to identify such diseases are lacking or reserved to research laboratories. To elucidate their prevalence and disease burden, the study 'Ticking on Pandora's Box' has been initiated, a collaborative effort between Amsterdam University Medical Center and the National Institute for Public Health and the Environment. METHODS The study investigates how often the tick-borne pathogens Anaplasma phagocytophilum, Babesia species, Borrelia miyamotoi, Neoehrlichia mikurensis, spotted fever group Rickettsia species and/or tick-borne encephalitis virus cause an acute febrile illness after tick-bite. We aim to determine the impact and severity of these tick-borne diseases in the Netherlands by measuring their prevalence and describing their clinical picture and course of disease. The study is designed as a prospective case-control study. We aim to include 150 cases - individuals clinically suspected of a tick-borne disease - and 3 matched healthy control groups of 200 persons each. The controls consist respectively of a group of individuals with either a tick-bite without complaints, the general population and of healthy blood donors. During a one-year follow-up we will acquire blood, urine and skin biopsy samples and ticks at baseline, 4 and 12 weeks. Additionally, participants answer modified versions of validated questionnaires to assess self-reported symptoms, among which the SF-36, on a 3 monthly basis. DISCUSSION This article describes the background and design of the study protocol of 'Ticking on Pandora's Box'. With our study we hope to provide insight into the prevalence, clinical presentation and disease burden of the tick-borne diseases anaplasmosis, babesiosis, B. miyamotoi disease, neoehrlichiosis, rickettsiosis and tick-borne encephalitis and to assist in test development as well as provide recommendations for national guidelines. TRIAL REGISTRATION NL9258 (retrospectively registered at Netherlands Trial Register, trialregister.nl in in February 2021).
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Affiliation(s)
- D Hoornstra
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands.
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands.
| | - M G Harms
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - S A Gauw
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands
| | - A Wagemakers
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands
| | - T Azagi
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - K Kremer
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - H Sprong
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - C C van den Wijngaard
- National Institute for Public Health and the Environment (RIVM), Center of Infectious Disease Control, P.O. Box 1 (3720 BA), Bilthoven, The Netherlands
| | - J W Hovius
- Amsterdam UMC, Center for Experimental and Molecular Medicine, Amsterdam Institute of Infection and Immunology, University of Amsterdam, P.O. Box 22660 (1100 DD), Amsterdam, The Netherlands
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15
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Pradelli L, Pinciroli M, Houshmand H, Grassi B, Bonelli F, Calleri M, Ruscio M. Comparative Cost and Effectiveness of a New Algorithm for Early Lyme Disease Diagnosis: Evaluation in US, Germany, and Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:437-451. [PMID: 34079307 PMCID: PMC8165099 DOI: 10.2147/ceor.s306391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This Lyme disease early detection economic model, for patients with suspected Lyme disease without erythema migrans (EM), compares outcomes of standard two-tier testing (sTTT), modified two-tier testing (mTTT) and the DiaSorin Lyme Detection Algorithm (LDA), a combination of both serology tests and Interferon-ɤ Release Assay. Patients and Methods A patient-level simulation model was built to incorporate effectiveness estimation from a structured focused literature review, and health-care cost inputs for the United States, Germany, and Italy. Simulated clinical outcomes were 1) percent of patients with timely and correct diagnosis, 2) patients appropriately treated and exposed to antibiotics therapy, and 3) patients with late Lyme disease manifestations. Expected health outcomes were expressed in terms of differences in quality-adjusted life years (QALYs) due to disseminated Lyme disease and persisting symptoms, and economic outcomes were analyzed from a third-party payer perspective. Results The DiaSorin LDA resulted in a better sensitivity compared to sTTT and mTTT, 84% vs 49% and 45%, respectively, in the base case (13% of infected patients in the tested population). Due to the improved diagnostic performance, the LDA-based strategy is expected to be more effective, providing mean incremental 0.024 QALYs per tested patient, or 0.19 per infected patient. Furthermore, from a third-party payer perspective, the adoption of the LDA-based strategy would reduce the expected health-care cost for suspected and confirmed Lyme disease by roughly 40%, ie about $410, €130, and €170 per tested patient in the United States, Germany, and Italy, respectively, compared to sTTT. The results are most sensitive to the infection rate in the tested population, with LDA maintaining a cost advantage for Lyme disease active infection rates ≥0.8-2.5%. Conclusion LDA early diagnostic testing and subsequent treatment of subjects with early Lyme disease without EM are expected to outperform traditional management strategies both clinically and economically in the US, Germany, and Italy.
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Affiliation(s)
| | | | | | | | | | | | - Maurizio Ruscio
- Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASU GI), Trieste, Italy
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Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1-e48. [PMID: 33417672 DOI: 10.1093/cid/ciaa1215] [Citation(s) in RCA: 153] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
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Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Yngve T Falck-Ytter
- Case Western Reserve University, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | | | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Baldwin
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Kiran K Belani
- Childrens Hospital and Clinical of Minnesota, Minneapolis, Minnesota, USA
| | - William R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David B Clifford
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Peter J Krause
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | | | | | - Amy A Pruitt
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Rips
- Consumer Representative, Omaha, Nebraska, USA
| | | | | | | | - Allen C Steere
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franc Strle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Sundel
- Boston Children's Hospital Boston, Massachusetts, USA
| | - Jean Tsao
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Lawrence S Zemel
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Ponosheci-Biçaku A, Ahmeti S, Trkulja V, Biçaku A, Tešović G. First Data on Human Lyme Borreliosis in Kosovo: Prospective Evaluation of the Disease from a Tick Bite Perspective. Vector Borne Zoonotic Dis 2021; 21:247-255. [PMID: 33534638 DOI: 10.1089/vbz.2020.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Lyme borreliosis (LB) occurs throughout Europe. No clinical and seroprevalence studies for LB in Kosovo have been publicly available thus far. Therefore, this study aimed to investigate LB from a tick bite perspective in the Pristina region, Kosovo. Methods: This single-center prospective observational study enrolled consecutive adult participants (≥18 years of age) with tick bite (embedded tick in the skin), who were examined at the Clinic of Infectious Diseases, Pristina, between January 2015 and August 2018. At the first visit related to the index tick bite, ticks (the complete ticks or parts of the ticks) were removed from the skin, blood samples were taken for serological tests, and antibiotic treatment was started when deemed necessary. The complete, undamaged ticks removed were proceeded for entomological identification. Participants were followed up at 2 months (serological tests were repeated) and 6 months after the index event for the development of clinical manifestations of LB and/or seroconversion against Borrelia burgdorferi. Results: A total of 380 subjects were included in the study. Most cases were seen in May and June in all study years. All 117 preserved ticks were identified as Ixodes ricinus. Immunoglobulin G seroprevalence among subjects during the first visit in the study was 28/380 (7.4%). Erythema migrans (EM) was clinically diagnosed in 74/380 patients (19.5%, 95% confidence interval 15.6-23.8). Only 15 clinically diagnosed EM (in seronegative patients) were serologically confirmed with seroconversion (2 months later), 3.9% of all subjects included in the study. There were three cases with clinical manifestation between the second and third visit: EM recidivans, multiple erythema, or several nonspecific systemic symptoms. Doxycycline and amoxicillin were mainly used for the treatment of borrelial skin lesions. Conclusion: This assessment can help indicate the need for disease awareness and reinforce the importance of primary prevention measures, early diagnosis, and appropriate treatment.
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Affiliation(s)
- Albina Ponosheci-Biçaku
- Faculty of Medicine, Clinic of Infectious Diseases, University Clinical Center of Kosovo, University of Pristina "Hasan Pristina," Pristina, Kosovo
| | - Salih Ahmeti
- Faculty of Medicine, Clinic of Infectious Diseases, University Clinical Center of Kosovo, University of Pristina "Hasan Pristina," Pristina, Kosovo
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ardian Biçaku
- Department of Radiology, Faculty of Medicine, University Clinical Center of Kosovo, University of Pristina "Hasan Pristina," Pristina, Kosovo
| | - Goran Tešović
- Department of Pediatric Infectious Diseases, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Harms M, Hofhuis A, Sprong H, Bennema S, Ferreira J, Fonville M, Docters van Leeuwen A, Assendelft W, Van Weert H, Van Pelt W, Van den Wijngaard C. A single dose of doxycycline after an ixodes ricinus tick bite to prevent Lyme borreliosis: An open-label randomized controlled trial. J Infect 2021; 82:98-104. [DOI: 10.1016/j.jinf.2020.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 11/29/2022]
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Cutler SJ, Vayssier-Taussat M, Estrada-Peña A, Potkonjak A, Mihalca AD, Zeller H. Tick-borne diseases and co-infection: Current considerations. Ticks Tick Borne Dis 2020; 12:101607. [PMID: 33220628 DOI: 10.1016/j.ttbdis.2020.101607] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/10/2020] [Accepted: 11/05/2020] [Indexed: 02/08/2023]
Abstract
Over recent years, a multitude of pathogens have been reported to be tick-borne. Given this, it is unsurprising that these might co-exist within the same tick, however our understanding of the interactions of these agents both within the tick and vertebrate host remains poorly defined. Despite the rich diversity of ticks, relatively few regularly feed on humans, 12 belonging to argasid and 20 ixodid species, and literature on co-infection is only available for a few of these species. The interplay of various pathogen combinations upon the vertebrate host and tick vector represents a current knowledge gap. The impact of co-infection in humans further extends into diagnostic challenges arising when multiple pathogens are encountered and we have little current data upon which to make therapeutic recommendations for those with multiple infections. Despite these short-comings, there is now increasing recognition of co-infections and current research efforts are providing valuable insights into dynamics of pathogen interactions whether they facilitate or antagonise each other. Much of this existing data is focussed upon simultaneous infection, however the consequences of sequential infection also need to be addressed. To this end, it is timely to review current understanding and highlight those areas still to address.
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Affiliation(s)
- Sally J Cutler
- School of Health, Sport & Bioscience, University of East London, London, E15 4LZ, UK.
| | | | - Agustín Estrada-Peña
- Department of Animal Health, Faculty of Veterinary Medicine, University of Zaragoza, Spain
| | - Aleksandar Potkonjak
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Serbia
| | - Andrei D Mihalca
- Department of Parasitology and Parasitic Diseases, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Romania
| | - Hervé Zeller
- European Centre for Disease Prevention and Control, Solna, Sweden
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Gillingham EL, Cull B, Pietzsch ME, Phipps LP, Medlock JM, Hansford K. The Unexpected Holiday Souvenir: The Public Health Risk to UK Travellers from Ticks Acquired Overseas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7957. [PMID: 33138220 PMCID: PMC7663673 DOI: 10.3390/ijerph17217957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022]
Abstract
Overseas travel to regions where ticks are found can increase travellers' exposure to ticks and pathogens that may be unfamiliar to medical professionals in their home countries. Previous studies have detailed non-native tick species removed from recently returned travellers, occasionally leading to travel-associated human cases of exotic tick-borne disease. There are 20 species of tick endemic to the UK, yet UK travellers can be exposed to many other non-native species whilst overseas. Here, we report ticks received by Public Health England's Tick Surveillance Scheme from humans with recent travel history between January 2006 and December 2018. Altogether, 16 tick species were received from people who had recently travelled overseas. Confirmed imports (acquired outside of the UK) were received from people who recently travelled to 22 countries. Possible imports (acquired abroad or within the UK) were received from people who had recently travelled to eight European countries. Species-specific literature reviews highlighted nine of the sixteen tick species are known to vector at least one tick-borne pathogen to humans in the country of acquisition, suggesting travellers exposed to ticks may be at risk of being bitten by a species that is a known vector, with implications for novel tick-borne disease transmission to travellers.
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Affiliation(s)
- Emma L. Gillingham
- Medical Entomology and Zoonoses Ecology, Emergency Response Department, Public Health England, Porton Down, Salisbury SP4 0JG, UK; (B.C.); (M.E.P.); (J.M.M.); (K.H.)
| | - Benjamin Cull
- Medical Entomology and Zoonoses Ecology, Emergency Response Department, Public Health England, Porton Down, Salisbury SP4 0JG, UK; (B.C.); (M.E.P.); (J.M.M.); (K.H.)
| | - Maaike E. Pietzsch
- Medical Entomology and Zoonoses Ecology, Emergency Response Department, Public Health England, Porton Down, Salisbury SP4 0JG, UK; (B.C.); (M.E.P.); (J.M.M.); (K.H.)
| | - L. Paul Phipps
- Wildlife Zoonoses and Vector-Borne Research Group, Department of Virology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK;
| | - Jolyon M. Medlock
- Medical Entomology and Zoonoses Ecology, Emergency Response Department, Public Health England, Porton Down, Salisbury SP4 0JG, UK; (B.C.); (M.E.P.); (J.M.M.); (K.H.)
| | - Kayleigh Hansford
- Medical Entomology and Zoonoses Ecology, Emergency Response Department, Public Health England, Porton Down, Salisbury SP4 0JG, UK; (B.C.); (M.E.P.); (J.M.M.); (K.H.)
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21
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Han S, Hickling GJ, Ogden NH, Ginsberg HS, Kobbekaduwa V, Rulison EL, Beati L, Tsao JI. Seasonality of acarological risk of exposure to Borrelia miyamotoi from questing life stages of Ixodes scapularis collected from Wisconsin and Massachusetts, USA. Ticks Tick Borne Dis 2020; 12:101556. [PMID: 33035757 DOI: 10.1016/j.ttbdis.2020.101556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
Measures of acarological risk of exposure to Ixodes scapularis-borne disease agents typically focus on nymphs; however, the relapsing fever group spirochete Borrelia miyamotoi can be passed transovarially, and I. scapularis larvae are capable of transmitting B. miyamotoi to their hosts. To quantify the larval contribution to acarological risk, relative to nymphs and adults, we collected questing I. scapularis for 3 yr at Fort McCoy, Wisconsin (WI, n = 23,367 ticks), and Cape Cod, Massachusetts (MA, n = 4190) in the United States. Borrelia miyamotoi infection prevalence was estimated for I. scapularis larvae, nymphs, females, and males, respectively, as 0.88, 2.05, 0.63, and 1.22 % from the WI site and 0.33, 2.32, 2.83, and 2.11 % from the MA site. Densities of B. miyamotoi-infected ticks (DIT, per 1000 m2) were estimated for larvae, nymphs, females, and males, respectively, as 0.36, 0.14, 0.01, and 0.03 from the WI site and 0.05, 0.06, 0.03, and 0.02 from the MA site. Thus, although larval infection prevalence with B. miyamotoi was significantly lower than that of nymphs and similar to that of adults, because of their higher abundance, the larval contribution to the overall DIT was similar to that of nymphs and trended towards a greater contribution than adults. Assuming homogenous contact rates with humans, these results suggest that eco-epidemiological investigations of B. miyamotoi disease in North America should include larvae. A fuller appreciation of the epidemiological implications of these results, therefore, requires an examination of the heterogeneity in contact rates with humans among life stages.
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Affiliation(s)
- Seungeun Han
- Comparative Medicine and Integrative Biology program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, United States.
| | - Graham J Hickling
- Center for Wildlife Health, University of Tennessee Institute of Agriculture, Knoxville, TN 37996, United States.
| | - Nicholas H Ogden
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, QC J2S 2M2, Canada.
| | - Howard S Ginsberg
- U.S. Geological Survey, Patuxent Wildlife Research Center, Kingston, RI 02881, United States.
| | - Vishvapali Kobbekaduwa
- Comparative Medicine and Integrative Biology program, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, United States.
| | - Eric L Rulison
- California Department of Transportation, Redding, CA 96001, United States.
| | - Lorenza Beati
- Department of Biology, Georgia Southern University, Statesboro, GA 30460, United States.
| | - Jean I Tsao
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, 48824, United States; Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, 48824, United States.
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22
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Cutler S, Vayssier-Taussat M, Estrada-Peña A, Potkonjak A, Mihalca AD, Zeller H. A new Borrelia on the block: Borrelia miyamotoi - a human health risk? ACTA ACUST UNITED AC 2020; 24. [PMID: 31064634 PMCID: PMC6505184 DOI: 10.2807/1560-7917.es.2019.24.18.1800170] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Borrelia miyamotoi clusters phylogenetically among relapsing fever borreliae, but is transmitted by hard ticks. Recent recognition as a human pathogen has intensified research into its ecology and pathogenic potential. Aims We aimed to provide a timely critical integrative evaluation of our knowledge on B. miyamotoi, to assess its public health relevance and guide future research. Methods This narrative review used peer-reviewed literature in English from January 1994 to December 2018. Results Borrelia miyamotoi occurs in the world’s northern hemisphere where it co-circulates with B. burgdorferi sensu lato, which causes Lyme disease. The two borreliae have overlapping vertebrate and tick hosts. While ticks serve as vectors for both species, they are also reservoirs for B. miyamotoi. Three B. miyamotoi genotypes are described, but further diversity is being recognised. The lack of sufficient cultivable isolates and vertebrate models compromise investigation of human infection and its consequences. Our understanding mainly originates from limited case series. In these, human infections mostly present as influenza-like illness, with relapsing fever in sporadic cases and neurological disease reported in immunocompromised patients. Unspecific clinical presentation, also occasionally resulting from Lyme- or other co-infections, complicates diagnosis, likely contributing to under-reporting. Diagnostics mainly employ PCR and serology. Borrelia miyamotoi infections are treated with antimicrobials according to regimes used for Lyme disease. Conclusions With co-infection of tick-borne pathogens being commonplace, diagnostic improvements remain important. Developing in vivo models might allow more insight into human pathogenesis. Continued ecological and human case studies are key to better epidemiological understanding, guiding intervention strategies.
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Affiliation(s)
- Sally Cutler
- School of Health, Sport & Bioscience, University of East London, London, United Kingdom
| | | | - Agustín Estrada-Peña
- Department of Animal Health, Faculty of Veterinary Medicine, University of Zaragoza, Spain
| | - Aleksandar Potkonjak
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Serbia
| | - Andrei Daniel Mihalca
- Department of Parasitology and Parasitic Diseases, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Romania
| | - Hervé Zeller
- European Centre for Disease Prevention and Control, Solna, Sweden
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23
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Moysa C, Murtagh R, Lambert JS. Potential Persistent Borrelia Infection and Response to Antibiotic Therapy; a Clinical Case Study and Review of Recent Literature. Antibiotics (Basel) 2019; 8:antibiotics8040223. [PMID: 31739409 PMCID: PMC6963185 DOI: 10.3390/antibiotics8040223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 11/23/2022] Open
Abstract
This report describes the case of an individual who was clinically diagnosed with Lyme borreliosis and initially responded to standard antibiotic therapy. Subsequent to treatment cessation, the patient experienced symptomatic rebound and failed to respond to a second course of the same antibiotic. The patient was eventually diagnosed with both Borrelia and Anaplasma infections by serological testing performed in a private laboratory. Following a two-month course of combination antibiotic therapy, the patient responded clinically, with a return to almost normal functioning. We discuss this case in the context of recent pre-clinical research examining potential Borrelial persistence despite antibiotic therapy.
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Affiliation(s)
- Cozette Moysa
- Independent Researcher, San Juan Capistrano, CA 92675, USA;
| | - Ross Murtagh
- School of Medicine, University College Dublin, D07 A8NN Dublin, Ireland
| | - John S. Lambert
- School of Medicine, University College Dublin, D07 A8NN Dublin, Ireland
- Infectious Diseases Department, Mater Misericordiae University Hospital, D07 K201 Dublin, Ireland
- Correspondence:
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24
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Impact of vertebrate communities on Ixodes ricinus-borne disease risk in forest areas. Parasit Vectors 2019; 12:434. [PMID: 31492171 PMCID: PMC6731612 DOI: 10.1186/s13071-019-3700-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022] Open
Abstract
Background The density of questing ticks infected with tick-borne pathogens is an important parameter that determines tick-borne disease risk. An important factor determining this density is the availability of different wildlife species as hosts for ticks and their pathogens. Here, we investigated how wildlife communities contribute to tick-borne disease risk. The density of Ixodes ricinus nymphs infected with Borrelia burgdorferi (sensu lato), Borrelia miyamotoi, Neoehrlichia mikurensis and Anaplasma phagocytophilum among 19 forest sites were correlated to the encounter probability of different vertebrate hosts, determined by encounter rates as measured by (camera) trapping and mathematical modeling. Result We found that the density of any tick life stage was proportional to the encounter probability of ungulates. Moreover, the density of nymphs decreased with the encounter probability of hare, rabbit and red fox. The density of nymphs infected with the transovarially-transmitted B. miyamotoi increased with the density of questing nymphs and the encounter probability of bank vole. The density of nymphs infected with all other pathogens increased with the encounter probability of competent hosts: bank vole for Borrelia afzelii and N. mikurensis, ungulates for A. phagocytophilum and blackbird for Borrelia garinii and Borrelia valaisiana. The negative relationship we found was a decrease in the density of nymphs infected with B. garinii and B. valaisiana with the encounter probability of wood mouse. Conclusions Only a few animal species drive the densities of infected nymphs in forested areas. There, foxes and leporids have negative effects on tick abundance, and consequently on the density of infected nymphs. The abundance of competent hosts generally drives the abundances of their tick-borne pathogen. A dilution effect was only observed for bird-associated Lyme spirochetes.![]()
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25
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Feyeux D, Fantin B. [Insights on the management of Lyme disease]. Rev Med Interne 2018; 40:226-231. [PMID: 30587410 DOI: 10.1016/j.revmed.2018.11.014] [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: 08/06/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Lyme disease is currently a hot topic in France due to a high incidence in some areas. Its clinical polymorphism can lead to misdiagnosis on one hand and to unjustified treatment on the other hand. Clinical symptoms vary considerably according to involved organs (skin, central and/or peripheral nervous system, joints, heart, eyes) and may be limited to or associated with general non-specific signs. Biological exams must be guided by clinical symptoms to help diagnosis and treatment decision according to clinical history, presentation, time of onset and duration of symptoms. However, to date, no serologic test can discriminate between past and active disease. The role of the internist is two-fold: make a diagnosis when faced with general or focal symptoms and avoid inappropriate attribution to Lyme disease of symptoms related to alternate diagnoses.
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Affiliation(s)
- D Feyeux
- Service de médecine interne, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - B Fantin
- Service de médecine interne, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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26
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van den Wijngaard CC, Hofhuis A, Wong A, Harms MG, de Wit GA, Lugnér AK, Suijkerbuijk AWM, Mangen MJJ, van Pelt W. The cost of Lyme borreliosis. Eur J Public Health 2018; 27:538-547. [PMID: 28444236 DOI: 10.1093/eurpub/ckw269] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Lyme borreliosis (LB) is the most frequently reported tick-borne infection in Europe and North America. The aim of this study was to estimate the cost-of-illness of LB in the Netherlands. We used available incidence estimates from 2010 for tick bite consultations and three symptomatic LB outcomes: erythema migrans (EM), disseminated LB and Lyme-related persisting symptoms. The cost was estimated using these incidences and the average cost per patient as derived from a patient questionnaire. We estimated the cost from a societal perspective, including healthcare cost, patient cost and production loss, using the friction cost method and a 4% annual discount rate. Tick bites and LB in 2010 led to a societal cost of €19.3 million (95% CI 15.6-23.4; 16.6 million population) for the Netherlands. Healthcare cost and production loss each constituted 48% of the total cost (€9.3 and €9.2 million/year), and patient cost 4% (€0.8 million/year). Of the total cost, 37% was related to disseminated LB, followed by 27% for persisting symptoms, 22% for tick bites and 14% for EM. Per outcome, for an individual case the mean cost of disseminated LB and Lyme-related persisting symptoms was both around €5700; for EM and GP consultations for tick bites this was €122 and €53. As an alternative to the friction cost method, the human capital method resulted in a total cost of €23.5 million/year. LB leads to a substantial societal cost. Further research should therefore focus on additional preventive interventions.
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Affiliation(s)
- Cees C van den Wijngaard
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Agnetha Hofhuis
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Albert Wong
- National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
| | - Margriet G Harms
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - G Ardine de Wit
- National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Hospital Utrecht, The Netherlands
| | - Anna K Lugnér
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Anita W M Suijkerbuijk
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Marie-Josée J Mangen
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Hospital Utrecht, The Netherlands
| | - Wilfrid van Pelt
- National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
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Geebelen L, Lernout T, Kabamba-Mukadi B, Saegeman V, Sprong H, Van Gucht S, Beutels P, Speybroeck N, Tersago K. The HUMTICK study: protocol for a prospective cohort study on post-treatment Lyme disease syndrome and the disease and cost burden of Lyme borreliosis in Belgium. ACTA ACUST UNITED AC 2017; 75:42. [PMID: 28794875 PMCID: PMC5545865 DOI: 10.1186/s13690-017-0202-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Belgium, different routine surveillance systems are in place to follow-up Lyme borreliosis trends. However, accurate data on the disease and monetary burden for the different clinical manifestations are lacking. Despite recommended antibiotic treatment, a proportion of Lyme patients report persisting aspecific symptoms for six months or more (e.g. fatigue, widespread musculoskeletal pain, cognitive difficulties), a syndrome now named "post-treatment Lyme disease syndrome" (PTLDS). Controversy exists on the cause, incidence and severity of PTLDS. This study aims to estimate the incidence of PTLDS in patients with Lyme borreliosis and to quantify the disease burden and economic costs associated with the different clinical manifestations of Lyme borreliosis in Belgium. METHODS The project is a prospective cohort study in which about 600 patients with an erythema migrans and 100 patients with disseminated Lyme borreliosis will be followed up. Questionnaires, including the SF-36 vitality and pain subscale, the Cognitive Failure Questionnaire and the EQ-5D-5L, will be used to collect information on acute and persisting symptoms and the impact on quality of life. Symptom frequency and severity will be compared with self-reported pre-Lyme health status, a control group and existing Belgian population norms. Additionally, information on the associated costs and possible risk factors for the development of PTLDS will be collected. DISCUSSION A study of the health burden will allow evaluation of the relative importance of Lyme borreliosis in Belgium and information on the economic cost will help to formulate cost-effective measures. There are only few prospective studies conducted estimating the incidence of PTLDS and even though discussion exists about the prevalence of subjective symptoms in the general population, a control group of non-Lyme borreliosis participants has often not been included.
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Affiliation(s)
- Laurence Geebelen
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Tinne Lernout
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Benoît Kabamba-Mukadi
- Laboratory of Medical Microbiology, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Veroniek Saegeman
- Department of Microbiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Steven Van Gucht
- Viral Diseases, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Katrien Tersago
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
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Hofhuis A, van de Kassteele J, Sprong H, van den Wijngaard CC, Harms MG, Fonville M, Docters van Leeuwen A, Simões M, van Pelt W. Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model. PLoS One 2017; 12:e0181807. [PMID: 28742149 PMCID: PMC5524385 DOI: 10.1371/journal.pone.0181807] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and quantification of the risk of Lyme borreliosis after a tick bite can aid development of prevention strategies against Lyme borreliosis. METHODS We used 3,525 single tick bite reports from three large prospective studies on the transmission risk of tick-borne pathogens to humans, with 50 reports of Lyme borreliosis during the follow-up period, among 1,973 reports with known outcome. A structural equation model was applied to estimate the risk of Lyme borreliosis after a tick bite, and quantify the influence of: developmental stage of the tick, detection of Borrelia burgdorferi s.l. DNA in the tick by PCR, tick engorgement, patient-estimated duration of tick attachment, and patient age. RESULTS The overall risk of developing Lyme borreliosis after a tick bite was 2.6% (95%CI 1.4-5.1). The risk increased with: - Tick engorgement: 1.4% (95%CI 0.7%-2.3%) for low engorgement to 5.5% (95%CI 2.8%-9.2%) for substantially engorged ticks;- Rising patient-estimated tick attachment duration: 2.0% (95%CI 1.3%-2.8%) after <12 hours, to 5.2% (95%CI 3.0%-8.9%) after ≥4 days;- Detection of Borrelia burgdorferi s.l. DNA in ticks: 6.7% (95%CI 3.6%-13.5%), versus 1.4% (95%CI 0.7%-2.9%) when ticks tested negative.The highest observed risk of Lyme borreliosis was 14.4% (95%CI 6.8%-24.6%) after one tick bite of a substantially engorged tick that tested positive for Borrelia burgdorferi s.l. DNA, which corresponds to one new case of Lyme borreliosis per 7 (95%CI 4-15) of such tick bites. CONCLUSIONS An individual's risk of Lyme borreliosis after a tick bite can be predicted with tick engorgement, patient-estimated duration of tick attachment, and detection of Borrelia burgdorferi s.l. DNA in the tick.
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Affiliation(s)
- Agnetha Hofhuis
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jan van de Kassteele
- Department of Statistics, Informatics and Mathematical Modeling, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hein Sprong
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Cees C van den Wijngaard
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Margriet G Harms
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Manoj Fonville
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Arieke Docters van Leeuwen
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mariana Simões
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Wilfrid van Pelt
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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29
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Cutler SJ, Rudenko N, Golovchenko M, Cramaro WJ, Kirpach J, Savic S, Christova I, Amaro A. Diagnosing Borreliosis. Vector Borne Zoonotic Dis 2017; 17:2-11. [PMID: 28055580 DOI: 10.1089/vbz.2016.1962] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Borrelia species fall into two groups, the Borrelia burgdorferi sensu lato (Bbsl) complex, the cause of Lyme borreliosis (also known as Lyme disease), and the relapsing fever group. Both groups exhibit inter- and intraspecies diversity and thus have variations in both clinical presentation and diagnostic approaches. A further layer of complexity is derived from the fact that ticks may carry multiple infectious agents and are able to transmit them to the host during blood feeding, with potential overlapping clinical manifestations. Besides this, pathogens like Borrelia have developed strategies to evade the host immune system, which allows them to persist within the host, including humans. Diagnostics can be applied at different times during the clinical course and utilize sample types, each with their own advantages and limitations. These differing methods should always be considered in conjunction with potential exposure and compatible clinical features. Throughout this review, we aim to explore different approaches providing the reader with an overview of methods appropriate for various situations. This review will cover human pathogenic members of Bbsl and relapsing fever borreliae, including newly recognized Borrelia miyamotoi spirochetes.
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Affiliation(s)
- Sally J Cutler
- 1 School of Health, Sport & Bioscience, University of East London , London, United Kingdom
| | - Nataliia Rudenko
- 2 Biology Centre CAS, Institute of Parasitology , Ceske Budejovice, Czech Republic
| | - Maryna Golovchenko
- 2 Biology Centre CAS, Institute of Parasitology , Ceske Budejovice, Czech Republic
| | - Wibke J Cramaro
- 3 Department of Infection and Immunity, Luxembourg Institute of Health , Esch-sur-Alzette, Luxembourg
| | - Josiane Kirpach
- 3 Department of Infection and Immunity, Luxembourg Institute of Health , Esch-sur-Alzette, Luxembourg
| | - Sara Savic
- 4 Scientific Veterinary Institute "Novi Sad ," Rumenacki put 20, Novi Sad, Serbia
| | - Iva Christova
- 5 Department of Microbiology, National Center of Infectious and Parasitic Diseases , Sofia, Bulgaria
| | - Ana Amaro
- 6 National Institute for Agrarian and Veterinarian Research (INIAV) , Lisboa, Portugal
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Guven O, Satilmis D, Sonmez FT, Demir B, Erdogan Ö. TICK INFESTATION: A 200-PATIENTS' SERIES. Afr J Infect Dis 2017; 11:62-67. [PMID: 28670641 PMCID: PMC5476814 DOI: 10.21010/ajid.v11i2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: A great number of zoonotic diseases with high mortality rate are transmitted by ticks. We performed this study in order to investigate patients admitted to emergency department following a tick bite. We examined the patients and get knowledge about the infestation and we followed up them for possible tick-conducted disease symptoms and laboratory findings both clinically and serologically. Materials and Methods: The study presented was hold for one year, between 01.01.2012 and 31.12.2012. 200 tick infested cases, admitted to Emergency Department of Haydarpasa Numune Training and Research Hospital, were subjected in the study. Demographic patterns of the patients and the region they come from, infested area on body, admission time and blood analyzing results were detected. Results: Rate of adult patients to pediatric was 2:1; gender distribution was similar to each other. The most common body areas that ticks were removed from were lower extremity. The highest tick bite incidence was in summer and on weekends. No tick bite incident of Istanbul surrounding from the year 2012 progressed to a zoonotic disease. Conclusions: Although non-of the patients of our study has been diagnosed with Crimean-Congo hemorrhagic fever we informed all of them for the incubation period and call for observation during the time. Tick borne infections may present with vary of symptoms, the most sever of which is hemorrhagic diathesis and patients should be informed for the risks. Knowledge of local area fauna risks may guide physicians so studies on this topic are essential.
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Affiliation(s)
- Oya Guven
- Haydarpasa Numune Training and Research Hospital, Department of Emergency Medicine, Turkey
| | - Dilay Satilmis
- Haydarpasa Numune Training and Research Hospital, Department of Emergency Medicine, Turkey
| | - Feruza Turan Sonmez
- Duzce University School of Medicine, Department of Emergency Medicine, Turkey
| | - Bilgehan Demir
- Malatya State Hospital, Department of Emergency Medicine, Turkey
| | - Özgür Erdogan
- Haydarpasa Numune Training and Research Hospital, Department of Emergency Medicine, Turkey
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Eliassen KE, Hjetland R, Reiso H, Lindbæk M, Tschudi-Madsen H. Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice. Scand J Prim Health Care 2017; 35:75-83. [PMID: 28277054 PMCID: PMC5361422 DOI: 10.1080/02813432.2017.1288812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Promptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment. DESIGN Prospective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts. SETTING Norwegian general practice. SUBJECTS A total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study. MAIN OUTCOME MEASURES Individual symptoms, symptom load and general function. RESULTS Mild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM. CONCLUSION The symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function. IMPLICATION Monitoring patients' symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB. Key points Erythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment. This increase does not affect general function. The levels of subjective health complaints in patients treated for erythema migrans are comparable to the background population.
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Affiliation(s)
- Knut Eirik Eliassen
- Department of General Practice, Norwegian Antibiotic Centre for Primary Care, University of Oslo, Oslo, Norway
- CONTACT Knut Eirik Eliassen Department of General Practice, Norwegian Antibiotic Centre for Primary Care, University of Oslo, PO Box 1130 Blindern, N-0318 Oslo, Norway
| | - Reidar Hjetland
- Department of Microbiology, Førde General Hospital, Førde Health Trust, Førde, Norway
| | - Harald Reiso
- Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital, Arendal, Norway
| | - Morten Lindbæk
- Department of General Practice, Norwegian Antibiotic Centre for Primary Care, University of Oslo, Oslo, Norway
| | - Hedda Tschudi-Madsen
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Reiter M, Knecht C, Müller A, Schötta AM, Leschnik M, Wijnveld M, Weissenböck H, Stockinger H, Stanek G, Sipos W. The domestic pig as a potential model for Borrelia skin infection. Ticks Tick Borne Dis 2016; 8:300-308. [PMID: 27986402 DOI: 10.1016/j.ttbdis.2016.12.003] [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: 08/01/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
The skin lesion erythema migrans is a characteristic early manifestation of Lyme borreliosis in humans. However, the pathomechanisms leading to development of this erythema are not fully understood. Models that mimic human skin would enhance research in this field. Human and porcine skin structures strongly resemble each other. Therefore, we attempted to induce erythema migrans lesions in experimental Borrelia burgdorferi sensu lato infection in the skin of domestic pigs. The formation of erythema migrans-like lesions was observed after intradermal injection of these spirochetes, with the lesions forming very clearly in 2/6 animals when a strain of B. garinii was used. However, no molecular or clinical proof of systemic infection of the pigs with B. afzelii, B. burgdorferi sensu stricto, or B. garinii could be achieved.
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Affiliation(s)
- Michael Reiter
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria.
| | - Christian Knecht
- University Clinic for Swine, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Austria
| | - Andreas Müller
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Anna-Margarita Schötta
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Michael Leschnik
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna, Austria
| | - Michiel Wijnveld
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Herbert Weissenböck
- Institute for Pathology and Forensic Veterinary Medicine, University of Veterinary Medicine Vienna, Austria
| | - Hannes Stockinger
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Gerold Stanek
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Wolfgang Sipos
- University Clinic for Swine, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Austria
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Abstract
A 5-year-old Massachusetts resident developed hard tick-borne relapsing fever caused by Borrelia miyamotoi. A partially engorged Ixodes scapularis tick was removed from her scalp and identified as infected with B. miyamotoi using polymerase chain reaction. Two weeks later, she developed an illness compatible with B. miyamotoi infection that included fatigue and recurrent fever. The diagnosis was confirmed by B. miyamotoi seroconversion.
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Briciu VT, Flonta M, Ţăţulescu DF, Meyer F, Sebah D, Cârstina D, Mihalca AD, Gherman CM, Hizo-Teufel C, Huber I, Fingerle V, Lupșe M. Clinical and serological one-year follow-up of patients after the bite of Ixodes ricinus ticks infected with Borrelia burgdorferi sensu lato. Infect Dis (Lond) 2016; 49:277-285. [PMID: 27866446 DOI: 10.1080/23744235.2016.1258488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The risk of developing Lyme borreliosis (LB) after the bite of a Borrelia (B.) burgdorferi sensu lato (s.l.) infected tick in Romania is unknown. METHODS The present prospective study, performed in 2010-2011 in a hospital in Romania, has followed-up clinical and serological outcome of patients that presented with B. burgdorferi positive Ixodes (I.) ricinus bite. A second group of patients, including age, sex and residence-matched individuals bitten by B. burgdorferi negative ticks, was followed-up as a control group. The subjects' outcome was evaluated one year after the tick bite. RESULTS Forty-three out of 389 ticks detached from patients were positive by hbb Real-Time PCR (RT-PCR) for B. burgdorferi s.l. (mainly B. afzelii, but also B. garinii, B. burgdorferi sensu stricto, B. spielmanii/B. valaisiana and B. lusitaniae). Twenty patients bitten by B. burgdorferi positive ticks and twenty matched control patients returned for the one year follow-up. Two patients from the B. burgdorferi positive group developed clinical manifestations of acute LB (erythema migrans) and 5 patients seroconverted (two from the B. burgdorferi positive group and three from the B. burgdorferi negative group). Borrelia afzelii was identified in ticks collected from persons that developed erythema migrans (EM). Comparing the two groups of patients, no statistical significant differences were found regarding presence of clinical symptoms or seroconversion. CONCLUSIONS No outcome differences were found between the group of patients bitten by B. burgdorferi positive ticks and the group of patients bitten by B. burgdorferi negative ticks.
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Affiliation(s)
- Violeta T Briciu
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania.,c Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine , University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania.,d National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Mirela Flonta
- b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania
| | - Doina F Ţăţulescu
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania
| | - Fabian Meyer
- e Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Daniela Sebah
- e Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Dumitru Cârstina
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Andrei D Mihalca
- c Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine , University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania
| | - Călin M Gherman
- c Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine , University of Agricultural Sciences and Veterinary Medicine , Cluj-Napoca , Romania
| | - Cecilia Hizo-Teufel
- d National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Ingrid Huber
- e Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Volker Fingerle
- d National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Mihaela Lupșe
- a Department of Infectious Diseases , Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania.,b Clinical Hospital of Infectious Diseases , Cluj-Napoca , Romania
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Jahfari S, Hofhuis A, Fonville M, van der Giessen J, van Pelt W, Sprong H. Molecular Detection of Tick-Borne Pathogens in Humans with Tick Bites and Erythema Migrans, in the Netherlands. PLoS Negl Trop Dis 2016; 10:e0005042. [PMID: 27706159 PMCID: PMC5051699 DOI: 10.1371/journal.pntd.0005042] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Tick-borne diseases are the most prevalent vector-borne diseases in Europe. Knowledge on the incidence and clinical presentation of other tick-borne diseases than Lyme borreliosis and tick-borne encephalitis is minimal, despite the high human exposure to these pathogens through tick bites. Using molecular detection techniques, the frequency of tick-borne infections after exposure through tick bites was estimated. METHODS Ticks, blood samples and questionnaires on health status were collected from patients that visited their general practitioner with a tick bite or erythema migrans in 2007 and 2008. The presence of several tick-borne pathogens in 314 ticks and 626 blood samples of this cohort were analyzed using PCR-based methods. Using multivariate logistic regression, associations were explored between pathogens detected in blood and self-reported symptoms at enrolment and during a three-month follow-up period. RESULTS Half of the ticks removed from humans tested positive for Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Candidatus Neoehrlichia mikurensis, Rickettsia helvetica, Rickettsia monacensis, Borrelia miyamotoi and several Babesia species. Among 92 Borrelia burgdorferi s. l. positive ticks, 33% carried another pathogen from a different genus. In blood of sixteen out of 626 persons with tick bites or erythema migrans, DNA was detected from Candidatus Neoehrlichia mikurensis (n = 7), Anaplasma phagocytophilum (n = 5), Babesia divergens (n = 3), Borrelia miyamotoi (n = 1) and Borrelia burgdorferi s. l. (n = 1). None of these sixteen individuals reported any overt symptoms that would indicate a corresponding illness during the three-month follow-up period. No associations were found between the presence of pathogen DNA in blood and; self-reported symptoms, with pathogen DNA in the corresponding ticks (n = 8), reported tick attachment duration, tick engorgement, or antibiotic treatment at enrolment. CONCLUSIONS Based on molecular detection techniques, the probability of infection with a tick-borne pathogen other than Lyme spirochetes after a tick bite is roughly 2.4%, in the Netherlands. Similarly, among patients with erythema migrans, the probability of a co-infection with another tick-borne pathogen is approximately 2.7%. How often these infections cause disease symptoms or to what extend co-infections affect the course of Lyme borreliosis needs further investigations.
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Affiliation(s)
- Setareh Jahfari
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Agnetha Hofhuis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Manoj Fonville
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joke van der Giessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Wilfrid van Pelt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Sarksyan DS, Platonov AE, Karan LS, Shipulin GA, Sprong H, Hovius JWR. Probability of Spirochete Borrelia miyamotoi Transmission from Ticks to Humans. Emerg Infect Dis 2016; 21:2273-4. [PMID: 26584357 PMCID: PMC4672439 DOI: 10.3201/eid2112.151097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Hofhuis A, Bennema S, Harms M, van Vliet AJH, Takken W, van den Wijngaard CC, van Pelt W. Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase. BMC Public Health 2016; 16:425. [PMID: 27216719 PMCID: PMC4877959 DOI: 10.1186/s12889-016-3105-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nationwide surveys have shown a threefold increase in general practitioner (GP) consultations for tick bites and early Lyme borreliosis from 1994 to 2009 in the Netherlands. We now report an update on 2014, with identical methods as for the preceding GP surveys. METHODS To all GPs in the Netherlands, a postal questionnaire was sent inquiring about the number of consultations for tick bites and erythema migrans diagnoses (most common manifestation of early Lyme borreliosis) in 2014, and the size of their practice populations. RESULTS Contrasting to the previously rising incidence of consultations for tick bites between 1994 and 2009, the incidence decreased in 2014 to 488 consultations for tick bites per 100,000 inhabitants, i.e., 82,000 patients nationwide. This survey revealed a first sign of stabilization of the previously rising trend in GP diagnosed erythema migrans, with 140 diagnoses per 100,000 inhabitants of the Netherlands. This equals about 23,500 annual diagnoses of erythema migrans nationwide in 2014. CONCLUSIONS In contrast to the constantly rising incidence of GP consultations for tick bites and erythema migrans diagnoses in the Netherlands between 1994 and 2009, the current survey of 2014 showed a first sign of stabilization of erythema migrans diagnoses and a decreased incidence for tick bite consultations.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Sita Bennema
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Margriet Harms
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands
| | - Cees C van den Wijngaard
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Aubry C, Socolovschi C, Raoult D, Parola P. Bacterial agents in 248 ticks removed from people from 2002 to 2013. Ticks Tick Borne Dis 2016; 7:475-81. [DOI: 10.1016/j.ttbdis.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 01/18/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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van Duijvendijk G, Coipan C, Wagemakers A, Fonville M, Ersöz J, Oei A, Földvári G, Hovius J, Takken W, Sprong H. Larvae of Ixodes ricinus transmit Borrelia afzelii and B. miyamotoi to vertebrate hosts. Parasit Vectors 2016; 9:97. [PMID: 26896940 PMCID: PMC4761128 DOI: 10.1186/s13071-016-1389-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/17/2016] [Indexed: 11/22/2022] Open
Abstract
Background Lyme borreliosis is the most common tick-borne human disease and is caused by Borrelia burgdorferi sensu lato (s.l.). Borrelia miyamotoi, a relapsing fever spirochaete, is transmitted transovarially, whereas this has not been shown for B. burgdorferi (s.l). Therefore, B. burgdorferi (s.l) is considered to cycle from nymphs to larvae through vertebrates. Larvae of Ixodes ricinus are occasionally B. burgdorferi (s.l) infected, but their vector competence has never been studied. Methods We challenged 20 laboratory mice with field-collected larvae of I. ricinus. A subset of these larvae was analysed for infections with B. burgdorferi (s.l) and B. miyamotoi. After three to four challenges, mice were sacrificed and skin and spleen samples were analysed for infection by PCR and culture. Results Field-collected larvae were naturally infected with B. burgdorferi (s.l) (0.62 %) and B. miyamotoi (2.0 %). Two mice acquired a B. afzelii infection and four mice acquired a B. miyamotoi infection during the larval challenges. Conclusion We showed that larvae of I. ricinus transmit B. afzelii and B. miyamotoi to rodents and calculated that rodents have a considerable chance of acquiring infections from larvae compared to nymphs. As a result, B. afzelii can cycle between larvae through rodents. Our findings further imply that larval bites on humans, which easily go unnoticed, can cause Lyme borreliosis and Borrelia miyamotoi disease.
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Affiliation(s)
- Gilian van Duijvendijk
- Laboratory of Entomology, Wageningen University, PO box 16, 6700, AA, Wageningen, The Netherlands.
| | - Claudia Coipan
- Laboratory for Zoonosis and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
| | - Alex Wagemakers
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Manoj Fonville
- Laboratory for Zoonosis and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
| | - Jasmin Ersöz
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Anneke Oei
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands.
| | - Gábor Földvári
- Department of Parasitology and Zoology, Faculty of Veterinary Science, SzentIstvan University, Budapest, Hungary.
| | - Joppe Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, PO box 16, 6700, AA, Wageningen, The Netherlands.
| | - Hein Sprong
- Laboratory for Zoonosis and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
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A prospective study on the incidence of Borrelia burgdorferi sensu lato infection after a tick bite in Sweden and on the Åland Islands, Finland (2008-2009). Ticks Tick Borne Dis 2015; 7:71-79. [PMID: 26341726 DOI: 10.1016/j.ttbdis.2015.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 07/20/2015] [Accepted: 08/20/2015] [Indexed: 01/28/2023]
Abstract
Lyme borreliosis (LB) is a common and increasing tick-borne disease in Europe. The risk of acquiring a Borrelia infection after a tick bite is not fully known. Therefore, we investigated the incidence of Borrelia infection after a bite by a Borrelia-infected tick and if the Borrelia load and/or the duration of tick-feeding influenced the risk of infection. During 2008-2009, ticks and blood samples were collected from 1546 tick-bitten persons from Sweden and the Åland Islands, Finland. Follow-up blood samples were taken 3 months after the tick bite. The duration of tick feeding was microscopically estimated and Borrelia was detected and quantified in ticks by real-time PCR. Anti-Borrelia antibodies were detected in sera using ELISA tests and immunoblot. Five percent (78/1546) of the study participants developed Borrelia infection (LB diagnosis and/or seroconversion) after a tick bite (45% bitten by Borrelia-infected ticks and 55% bitten by uninfected ticks). Of these, 33 developed LB (whereof 9 also seroconverted) while 45 participants seroconverted only. Experience of non-specific symptoms was more frequently reported by Borrelia-infected participants compared to uninfected participants. All who seroconverted removed "their" ticks significantly later than those who did not. The Borrelia load in the ticks did not explain the risk of seroconversion. Regional and sex differences in the Borrelia seroprevalence were found. The risk of developing a Borrelia infection after a bite by a Borrelia-infected tick is small but increases with the duration of tick feeding.
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Ang CW, Brandenburg AH, van Burgel ND, Bijlmer HA, Herremans T, Stelma F, Lunel FV, van Dam AP. A Dutch nationwide evaluation of serological assays for detection of Borrelia antibodies in clinically well-defined patients. Diagn Microbiol Infect Dis 2015; 83:222-8. [PMID: 26286381 DOI: 10.1016/j.diagmicrobio.2015.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
Abstract
Numerous tests for the detection of antibodies against Borrelia burgdorferi are commercially available. Manufacturer-derived data invariably report a high sensitivity and specificity, but comparative studies demonstrate large differences in clinical practice, especially with regard to specificity. We retrospectively collected data from validation studies for B. burgdorferi antibody assays from 8 laboratories in the Netherlands. The total number of samples was 809. Samples were selected based on clinical and laboratory parameters. We included samples from patients with erythema migrans, acrodermatitis chronicum atrophicans, and neuroborreliosis; cross-reactivity controls; and healthy controls. Data are presented from 10 enzyme-linked immunosorbent assays and 5 immunoblots. For manifestations of B. burgdorferi infection with short disease duration, the positivity rate of the assays varied significantly. In patients with long disease duration, the positivity rate differed only marginally. In cross-reactivity controls, there was significant variation in the reactivity rate. The majority of false-positive reactions are of the IgM isotype.
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Affiliation(s)
- C W Ang
- Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, The Netherlands.
| | - A H Brandenburg
- Center for Infectious Diseases, Izore, Leeuwarden, The Netherlands
| | - N D van Burgel
- Department of Medical Microbiology, Centre of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - H A Bijlmer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T Herremans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - F Stelma
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Verduyn Lunel
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A P van Dam
- OLVG/Public Health Laboratory, Amsterdam, The Netherlands
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43
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Wagemakers A, Staarink PJ, Sprong H, Hovius JWR. Borrelia miyamotoi: a widespread tick-borne relapsing fever spirochete. Trends Parasitol 2015; 31:260-9. [PMID: 25892254 DOI: 10.1016/j.pt.2015.03.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Borrelia miyamotoi is a relapsing fever spirochete that has only recently been identified as a human pathogen. Borrelia miyamotoi is genetically and ecologically distinct from Borrelia burgdorferi sensu lato, while both are present in Ixodes ticks. Over 50 patients with an acute febrile illness have been described with a B. miyamotoi infection, and two infected immunocompromised patients developed a meningoencephalitis. Seroprevalence studies indicate exposure in the general population and in specific risk groups, such as patients initially suspected of having human granulocytic anaplasmosis. Here, we review the available literature on B. miyamotoi, describing its presence in ticks, reservoir hosts, and humans, and discussing its potential impact on public health.
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Affiliation(s)
- Alex Wagemakers
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Pieter J Staarink
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Antonie van Leeuwenhoeklaan 9, PO Box 1, Bilthoven, The Netherlands
| | - Joppe W R Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Amsterdam Multidisciplinary Lyme Center, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
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44
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Affiliation(s)
- Sandra Pearson
- Independent consultant psychiatrist; medical director and trustee, Lyme Disease Action
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45
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Braks M, Medlock JM, Hubalek Z, Hjertqvist M, Perrin Y, Lancelot R, Duchyene E, Hendrickx G, Stroo A, Heyman P, Sprong H. Vector-borne disease intelligence: strategies to deal with disease burden and threats. Front Public Health 2014; 2:280. [PMID: 25566522 PMCID: PMC4273637 DOI: 10.3389/fpubh.2014.00280] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/01/2014] [Indexed: 01/22/2023] Open
Abstract
Owing to the complex nature of vector-borne diseases (VBDs), whereby monitoring of human case patients does not suffice, public health authorities experience challenges in surveillance and control of VBDs. Knowledge on the presence and distribution of vectors and the pathogens that they transmit is vital to the risk assessment process to permit effective early warning, surveillance, and control of VBDs. Upon accepting this reality, public health authorities face an ever-increasing range of possible surveillance targets and an associated prioritization process. Here, we propose a comprehensive approach that integrates three surveillance strategies: population-based surveillance, disease-based surveillance, and context-based surveillance for EU member states to tailor the best surveillance strategy for control of VBDs in their geographic region. By classifying the surveillance structure into five different contexts, we hope to provide guidance in optimizing surveillance efforts. Contextual surveillance strategies for VBDs entail combining organization and data collection approaches that result in disease intelligence rather than a preset static structure.
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Affiliation(s)
- Marieta Braks
- Centre for Zoonoses and Environmental Microbiology, Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Jolyon M. Medlock
- Medical Entomology Group, MRA, Emergency Response Department, Public Health England, Salisbury, UK
| | - Zdenek Hubalek
- Medical Zoology Laboratory, Institute of Vertebrate Biology, Academy of Sciences, v.v.i., Brno, Czech Republic
- Faculty of Science, Department of Experimental Biology, Masaryk University, Brno, Czech Republic
| | - Marika Hjertqvist
- Public Health Agency of Sweden (Folkhälsomyndigheten), Solna, Sweden
| | - Yvon Perrin
- Centre National d’Expertise sur les Vecteurs, Centre IRD de Montpellier, Montpellier, France
| | - Renaud Lancelot
- CIRAD, UMR CMAEE, Montpellier, France
- INRA, UMR CMAEE 1309, Montpellier, France
| | | | | | - Arjan Stroo
- Centre for Monitoring of Vectors, Netherlands Food and Consumer Product Safety Authority (NWVA), Wageningen, Netherlands
| | - Paul Heyman
- Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital, Brussels, Belgium
| | - Hein Sprong
- Centre for Zoonoses and Environmental Microbiology, Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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46
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Hofhuis A, Harms M, van den Wijngaard C, Sprong H, van Pelt W. Continuing increase of tick bites and Lyme disease between 1994 and 2009. Ticks Tick Borne Dis 2014; 6:69-74. [PMID: 25448421 DOI: 10.1016/j.ttbdis.2014.09.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nationwide cross-sectional retrospective studies have shown a continuous increase in general practitioner (GP) consultations for tick bites and diagnoses of erythema migrans between 1994 and 2005 in the Netherlands. In this paper, we report incidence estimates for GP consultations for tick bites and erythema migrans diagnoses in 2009, and we compare the observed increase in GP consultations to reports of tick bites in two retrospective cross-sectional surveys of the general population. METHODS All GPs in the Netherlands were asked to complete a postal questionnaire on the number of consultations for tick bites and erythema migrans diagnoses in 2009, and the size of their practice populations. To investigate how the incidence of GP consultation rates for tick bites and erythema migrans relate to the incidence of tick bites in the general population, questionnaire data on tick bites were analyzed from two large population surveys conducted to evaluate the national immunization program in 1995/1996 and 2006/2007. RESULTS The 2009 GP survey revealed a further increase, to 564 tick bite consultations per 100,000 inhabitants, and 134 erythema migrans diagnoses per 100,000 inhabitants of the Netherlands. The two population surveys from 1995/1996 and 2006/2007 exhibited an almost twofold increase of the incidence of tick bites in the general population from 4099 per 100,000 population in 1996, to 7198 per 100,000 population in 2007. People nationwide noticed approximately 1.1 million tick bites in 2007. CONCLUSIONS Our observation of increases in GP consultations for tick bites and erythema migrans diagnoses between 1994 and 2009 are confirmed by the parallel increase of tick bites reported by the general population, although consultation rates slightly increased. For every sixty tick bites in the general population in 2007, we observed one GP consult for erythema migrans. The increase in tick bites poses a progressive threat to public health.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Margriet Harms
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cees van den Wijngaard
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Jahfari S, Coipan EC, Fonville M, van Leeuwen AD, Hengeveld P, Heylen D, Heyman P, van Maanen C, Butler CM, Földvári G, Szekeres S, van Duijvendijk G, Tack W, Rijks JM, van der Giessen J, Takken W, van Wieren SE, Takumi K, Sprong H. Circulation of four Anaplasma phagocytophilum ecotypes in Europe. Parasit Vectors 2014; 7:365. [PMID: 25127547 PMCID: PMC4153903 DOI: 10.1186/1756-3305-7-365] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/27/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anaplasma phagocytophilum is the etiological agent of granulocytic anaplasmosis in humans and animals. Wild animals and ticks play key roles in the enzootic cycles of the pathogen. Potential ecotypes of A. phagocytophilum have been characterized genetically, but their host range, zoonotic potential and transmission dynamics has only incompletely been resolved. METHODS The presence of A. phagocytophilum DNA was determined in more than 6000 ixodid ticks collected from the vegetation and wildlife, in 289 tissue samples from wild and domestic animals, and 69 keds collected from deer, originating from various geographic locations in The Netherlands and Belgium. From the qPCR-positive lysates, a fragment of the groEL-gene was amplified and sequenced. Additional groEL sequences from ticks and animals from Europe were obtained from GenBank, and sequences from human cases were obtained through literature searches. Statistical analyses were performed to identify A. phagocytophilum ecotypes, to assess their host range and their zoonotic potential. The population dynamics of A. phagocytophilum ecotypes was investigated using population genetic analyses. RESULTS DNA of A. phagocytophilum was present in all stages of questing and feeding Ixodes ricinus, feeding I. hexagonus, I. frontalis, I. trianguliceps, and deer keds, but was absent in questing I. arboricola and Dermacentor reticulatus. DNA of A. phagocytophilum was present in feeding ticks and tissues from many vertebrates, including roe deer, mouflon, red foxes, wild boar, sheep and hedgehogs but was rarely found in rodents and birds and was absent in badgers and lizards. Four geographically dispersed A. phagocytophilum ecotypes were identified, that had significantly different host ranges. All sequences from human cases belonged to only one of these ecotypes. Based on population genetic parameters, the potentially zoonotic ecotype showed significant expansion. CONCLUSION Four ecotypes of A. phagocytophilum with differential enzootic cycles were identified. So far, all human cases clustered in only one of these ecotypes. The zoonotic ecotype has the broadest range of wildlife hosts. The expansion of the zoonotic A. phagocytophilum ecotype indicates a recent increase of the acarological risk of exposure of humans and animals.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Antonie van Leeuwenhoeklaan 9, P,O, Box 1, Bilthoven, The Netherlands.
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Tijsse-Klasen E, Koopmans MPG, Sprong H. Tick-borne pathogen - reversed and conventional discovery of disease. Front Public Health 2014; 2:73. [PMID: 25072045 PMCID: PMC4083466 DOI: 10.3389/fpubh.2014.00073] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/24/2014] [Indexed: 12/31/2022] Open
Abstract
Molecular methods have increased the number of known microorganisms associated with ticks significantly. Some of these newly identified microorganisms are readily linked to human disease while others are yet unknown to cause human disease. The face of tick-borne disease discovery has changed with more diseases now being discovered in a “reversed way,” detecting disease cases only years after the tick-borne microorganism was first discovered. Compared to the conventional discovery of infectious diseases, reverse order discovery presents researchers with new challenges. Estimating public health risks of such agents is especially challenging, as case definitions and diagnostic procedures may initially be missing. We discuss the advantages and shortcomings of molecular methods, serology, and epidemiological studies that might be used to study some fundamental questions regarding newly identified tick-borne diseases. With increased tick-exposure and improved detection methods, more tick-borne microorganisms will be added to the list of pathogens causing disease in humans in the future.
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Affiliation(s)
- Ellen Tijsse-Klasen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
| | - Marion P G Koopmans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands ; Erasmus Medical Center , Rotterdam , Netherlands
| | - Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM) , Bilthoven , Netherlands
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Sprong H, Docters van Leeuwen A, Fonville M, Harms M, van Vliet AJ, van Pelt W, Ferreira JA, van den Wijngaard CC. Sensitivity of a point of care tick-test for the development of Lyme borreliosis. Parasit Vectors 2013; 6:338. [PMID: 24304944 PMCID: PMC4235040 DOI: 10.1186/1756-3305-6-338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background A commercially available self-test for the detection of Borrelia burgdorferi sensu lato in ticks was evaluated for its ability to predict erythema migrans formation. Findings The self-test was performed on 127 Ixodes ricinus from 122 humans that reported tick bites at enrolment and occurrence of symptoms during follow-up. The self-test gave negative results on all the 122 individuals, 14 of whom reported erythema migrans (EM) at follow-up of which 10 were confirmed by their GP. The estimated sensitivity of the self-test for prediction of EM formation is 0% (95% CI: 0%-28%). Conclusions This self-test is not suitable for reducing the number needed to treat in a post-exposure prophylaxis setting as it already missed all the obvious early Lyme borreliosis cases.
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Affiliation(s)
- Hein Sprong
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and Environment, Antonie van Leeuwenhoeklaan 9 P,O, Box 1 3720 BA, Bilthoven, The Netherlands.
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