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Joppe W Hovius - One of the best experts on this subject based on the ideXlab platform.
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to test or not to test laboratory support for the diagnosis of Lyme Borreliosis a position paper of esgbor the escmid study group for Lyme Borreliosis
Clinical Microbiology and Infection, 2017Co-Authors: Ram Benny Dessau, Joppe W Hovius, Benoit Jaulhac, J S Gray, Wolfgang Kristoferitsch, Volker Fingerle, A P Van Dam, Kp Hunfeld, Olaf Kahl, Pereric LindgrenAbstract:Abstract Background Lyme Borreliosis (LB) is a tick-borne infection caused by Borrelia burgdorferi sensu lato . The most frequent clinical manifestations are erythema migrans and Lyme neuroBorreliosis. Currently, a large volume of diagnostic testing for LB is reported, whereas the incidence of clinically relevant disease manifestations is low. This indicates overuse of diagnostic testing for LB with implications for patient care and cost-effective health management. Aim The recommendations provided in this review are intended to support both the clinical diagnosis and initiatives for a more rational use of laboratory testing in patients with clinically suspected LB. Sources This is a narrative review combining various aspects of the clinical and laboratory diagnosis with an educational purpose. The literature search was based on existing systematic reviews, national and international guidelines and supplemented with specific citations. Implications The main recommendations according to current European case definitions for LB are as follows. Typical erythema migrans should be diagnosed clinically and does not require laboratory testing. The diagnosis of Lyme neuroBorreliosis requires laboratory investigation of the spinal fluid including intrathecal antibody production, and the remaining disease manifestations require testing for serum antibodies to B. burgdorferi . Testing individuals with non-specific subjective symptoms is not recommended, because of a low positive predictive value.
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enzootic origins for clinical manifestations of Lyme Borreliosis
Infection Genetics and Evolution, 2017Co-Authors: Setareh Jahfari, Joppe W Hovius, Hein Sprong, Manoj Fonville, Aleksandra I Krawczyk, Claudia E Coipan, Katsuhisa TakumiAbstract:Both early localized and late disseminated forms of Lyme Borreliosis are caused by Borrelia burgdorferi senso lato. Differentiating between the spirochetes that only cause localized skin infection from those that cause disseminated infection, and tracing the group of medically-important spirochetes to a specific vertebrate host species, are two critical issues in disease risk assessment and management. Borrelia burgdorferi senso lato isolates from Lyme Borreliosis cases with distinct clinical manifestations (erythema migrans, neuroBorreliosis, acrodermatitis chronica atrophicans, and Lyme arthritis) and isolates from Ixodes ricinus ticks feeding on rodents, birds and hedgehogs were typed to the genospecies level by sequencing part of the intergenic spacer region. In-depth molecular typing was performed by sequencing eight additional loci with different characteristics (plasmid-bound, regulatory, and housekeeping genes). The most abundant genospecies and genotypes in the clinical isolates were identified by using odds ratio as a measure of dominance. Borrelia afzelii was the most common genospecies in acrodermatitis patients and engorged ticks from rodents. Borrelia burgdorferi senso stricto was widespread in erythema migrans patients. Borrelia bavariensis was widespread in neuroBorreliosis patients and in ticks from hedgehogs, but rare in erythema migrans patients. Borrelia garinii was the dominant genospecies in ticks feeding on birds. Spirochetes in ticks feeding on hedgehogs were overrepresented in genotypes of the plasmid gene ospC from spirochetes in erythema migrans patients. Spirochetes in ticks feeding on hedgehogs were overrepresented in genotypes of ospA from spirochetes in acrodermatitis patients. Spirochetes from ticks feeding on birds were overrepresented in genotypes of the plasmid and regulatory genes dbpA, rpoN and rpoS from spirochetes in neuroBorreliosis patients. Overall, the analyses of our datasets support the existence of at least three transmission pathways from an enzootic cycle to a clinical manifestation of Lyme Borreliosis. Based on the observations with these nine loci, it seems to be justified to consider the population structure of B. burgdorferi senso lato as being predominantly clonal.
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coinfection with borrelia burgdorferi sensu stricto and borrelia garinii alters the course of murine Lyme Borreliosis
Fems Immunology and Medical Microbiology, 2007Co-Authors: Joppe W Hovius, Stephen W Barthold, Peter Speelman, Erol Fikrig, Nandhini Ramamoorthi, Tom Van Der Poll, Xin LiAbstract:Ixodes ricinus ticks and mice can be infected with both Borrelia burgdorferi sensu stricto and Borrelia garinii. The effect of coinfection with these two Borrelia species on the development of murine Lyme Borreliosis is unknown. Therefore, we investigated whether coinfection with the nonarthritogenic B. garinii strain PBi and the arthritogenic B. burgdorferi sensu stricto strain B31 alters murine Lyme Borreliosis. Mice simultaneously infected with PBi and B31 showed significantly more paw swelling and arthritis, long-standing spirochetemia, and higher numbers of B31 spirochetes than did mice infected with B31 alone. However, the number of PBi spirochetes was significantly lower in coinfected mice than in mice infected with PBi alone. In conclusion, simultaneous infection with B. garinii and B. burgdorferi sensu stricto results in more severe Lyme Borreliosis. Moreover, we suggest that competition of the two Borrelia species within the reservoir host could have led to preferential maintenance, and a rising prevalence, of B. burgdorferi sensu stricto in European I. ricinus populations.
Erol Fikrig - One of the best experts on this subject based on the ideXlab platform.
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coinfection with borrelia burgdorferi sensu stricto and borrelia garinii alters the course of murine Lyme Borreliosis
Fems Immunology and Medical Microbiology, 2007Co-Authors: Joppe W Hovius, Stephen W Barthold, Peter Speelman, Erol Fikrig, Nandhini Ramamoorthi, Tom Van Der Poll, Xin LiAbstract:Ixodes ricinus ticks and mice can be infected with both Borrelia burgdorferi sensu stricto and Borrelia garinii. The effect of coinfection with these two Borrelia species on the development of murine Lyme Borreliosis is unknown. Therefore, we investigated whether coinfection with the nonarthritogenic B. garinii strain PBi and the arthritogenic B. burgdorferi sensu stricto strain B31 alters murine Lyme Borreliosis. Mice simultaneously infected with PBi and B31 showed significantly more paw swelling and arthritis, long-standing spirochetemia, and higher numbers of B31 spirochetes than did mice infected with B31 alone. However, the number of PBi spirochetes was significantly lower in coinfected mice than in mice infected with PBi alone. In conclusion, simultaneous infection with B. garinii and B. burgdorferi sensu stricto results in more severe Lyme Borreliosis. Moreover, we suggest that competition of the two Borrelia species within the reservoir host could have led to preferential maintenance, and a rising prevalence, of B. burgdorferi sensu stricto in European I. ricinus populations.
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coexistence of antibodies to tick borne pathogens of babesiosis ehrlichiosis and Lyme Borreliosis in human sera
Journal of Clinical Microbiology, 1995Co-Authors: Louis A Magnarelli, J S Dumler, John F Anderson, Russell C Johnson, Erol FikrigAbstract:Serum specimens from persons with or without Lyme Borreliosis were analyzed by indirect fluorescent antibody staining methods for total immunoglobulins to Babesia microti, Ehrlichia chaffeensis (Arkansas strain), and Ehrlichia equi (MRK strain). There was serologic evidence of human exposure to multiple tick-borne agents in 15 (6.6%) of 227 serum samples obtained in Connecticut and Minnesota. Of these, 10 serum samples were from Connecticut patients who had erythema migrans and antibodies to Borrelia burgdorferi (range, 1:160 to 1:40, 960). A maximal antibody titer of 1:640 was noted for a B. microti infection, whereas titration end points of 1:640 and 1:1,280 were recorded for E. chaffeensis and E. equi seropositives, respectively. In specificity tests, there was no cross-reactivity among the antisera and antigens tested for the four tick-borne pathogens. On the basis of serologic testing, a small group of persons who had Lyme Borreliosis had been exposed to one or more other tick-borne agents, but there was no clinical diagnosis of babesiosis or ehrlichiosis. Therefore, if the clinical picture is unclear or multiple tick-associated illnesses are suspected, more extensive laboratory testing is suggested.
Jeanlouis Chapuis - One of the best experts on this subject based on the ideXlab platform.
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mapping human risk of infection with borrelia burgdorferi sensu lato the agent of Lyme Borreliosis in a periurban forest in france
Ticks and Tick-borne Diseases, 2016Co-Authors: Gwenael Vourch, Sebastien Masseglia, Benoit Pisanu, David Abrial, Severine Bord, Maude Jacquot, Valerie Poux, Xavier Bailly, Jeanlouis ChapuisAbstract:Lyme Borreliosis is a major zoonosis in Europe, with estimates of over 26,000 cases per year in France alone. The etiological agents are spirochete bacteria that belong to the Borrelia burgdorferi sensu lato (s. l.) complex and are transmitted by hard ticks among a large range of vertebrate hosts. In Europe, the tick Ixodes ricinus is the main vector. In the absence of a vaccine and given the current difficulties to diagnose and treat chronic Lyme syndromes, there is urgent need for prevention. In this context, accurate information on the spatial patterns of risk of exposure to ticks is of prime importance for public health. The objective of our study was to provide a snapshot map of the risk of human infection with B. burgdorferi s. l. pathogens in a periurban forest at a high resolution, and to analyze the factors that contribute to variation in this risk. Field monitoring took place over three weeks in May 2011 in the suburban Senart forest (3,200 ha; southeast of Paris), which receives over 3 million people annually. We sampled ticks over the entire forest area (from 220 forest stands with a total area of 35,200 m2) and quantified the density of questing nymphs (DON), the prevalence of infection among nymphs (NIP), and the density of infected nymphs (DIN), which is the most important predictor of the human risk of Lyme Borreliosis. For each of these response variables, we explored the relative roles of weather (saturation deficit), hosts (abundance indices of ungulates and Tamias sibiricus, an introduced rodent species), vegetation and forest cover, superficial soil composition, and the distance to forest roads. In total, 19,546 questing nymphs were collected and the presence of B. burgdorferi s. l. was tested in 3,903 nymphs by qPCR. The mean DON was 5.6 nymphs per 10 m2 (standard deviation = 10.4) with an average NIP of 10.1% (standard deviation = 0.11). The highest DIN was 8.9 infected nymphs per 10 m2, with a mean of 0.59 (standard deviation = 0.6). Our mapping and modeling revealed a strong heterogeneity of risk within the forest. The highest risk was found in the eastern part of the forest and localized patches in the northwestern part. Lyme Borreliosis risk was positively associated with stands of deciduous trees (mainly oaks) and roe deer abundance. Contrary to expectations, DIN actually increased with distance from the point of introduction of T. sibiricus (i.e., DIN was higher in areas with potentially lower abundances of T. sibiricus). Thus, despite the fact that T. sibiricus is an important reservoir host for B. burgdorferi s. l., our study found that other explanatory factors played a more important role in determining the density of infected ticks. Precise mapping of the risk of exposure to Lyme Borreliosis in a highly visited forest represents an important tool for targeting prevention and control measures, as well as making the general public and local health officials aware of the risks.
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introduced siberian chipmunks tamias sibiricus barberi contribute more to Lyme Borreliosis risk than native reservoir rodents
PLOS ONE, 2013Co-Authors: Elisabeth Ferquel, Maud Marsot, Jeanlouis Chapuis, Patrick Gasqui, Anne Dozieres, Sebastien Masseglia, Benoit Pisanu, Gwenael VourchAbstract:The variation of the composition in species of host communities can modify the risk of disease transmission. In particular, the introduction of a new host species can increase health threats by adding a new reservoir and/or by amplifying the circulation of either exotic or native pathogens. Lyme Borreliosis is a multi-host vector-borne disease caused by bacteria belonging to the Borrelia burgdorferi sensu lato complex. It is transmitted by the bite of hard ticks, especially Ixodes ricinus in Europe. Previous studies showed that the Siberian chipmunk, Tamias sibiricus barberi, an introduced ground squirrel in the Forest of Senart (near Paris, France) was highly infested by I. ricinus, and consequently infected by B. burgdorferi sl. An index of the contribution of chipmunks to the density of infected questing nymphs on the vegetation (i.e., the acarological risk for humans) was compared to that of bank voles (Myodes glareolus) and of wood mice (Apodemus sylvaticus), two known native and sympatric competent reservoir hosts. Chipmunks produced nearly 8.5 times more infected questing nymphs than voles and mice. Furthermore, they contribute to a higher diversity of B. burgdorferi sl genospecies (B. afzelii, B. burgdorferi sensu stricto and B. garinii). The contribution of chipmunks varied between years and seasons, according to tick availability. As T. s. barberi must be a competent reservoir, it should amplify B. burgdorferi sl infection, hence increasing the risk of Lyme Borreliosis in humans.
James H Oliver - One of the best experts on this subject based on the ideXlab platform.
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isolation of live borrelia burgdorferi sensu lato spirochaetes from patients with undefined disorders and symptoms not typical for Lyme Borreliosis
Clinical Microbiology and Infection, 2016Co-Authors: Kerry L. Clark, Nataliia Rudenko, Maryna Golovchenko, Marie Vancova, Libor Grubhoffer, James H OliverAbstract:Lyme Borreliosis is a multisystem disorder with a diverse spectrum of clinical manifestations, caused by spirochaetes of the Borrelia burgdorferi sensu lato complex. It is an infectious disease that can be successfully cured by antibiotic therapy in the early stages; however, the possibility of the appearance of persistent signs and symptoms of disease following antibiotic treatment is recognized. It is known that Lyme Borreliosis mimics multiple diseases that were never proven to have a spirochaete aetiology. Using complete modified Kelly-Pettenkofer medium we succeeded in cultivating live B. burgdorferi sensu lato spirochaetes from samples taken from people who suffered from undefined disorders, had symptoms not typical for Lyme Borreliosis, but who had undergone antibiotic treatment due to a suspicion of having Lyme disease even though they were seronegative. We report the first recovery of live B. burgdorferi sensu stricto from residents of southeastern USA and the first successful cultivation of live Borrelia bissettii-like strain from residents of North America. Our results support the fact that B. bissettii is responsible for human Lyme Borreliosis worldwide along with B. burgdorferi s.s. The involvement of new spirochaete species in Lyme Borreliosis changes the understanding and recognition of clinical manifestations of this disease.
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REVIEW ARTICLE Lyme Borreliosis: insights into tick- / host-borrelia relations
2013Co-Authors: Libor Grubhoffer, Maryna Golovchenko, Marie Vancova, Klára Zacharovová-slavíčková, James H OliverAbstract:Abstract. Lyme Borreliosis (LB) is a serious infectious disease of humans and some domestic animals in temperate regions of the Northern Hemisphere. It is caused by certain spirochetes in the Borrelia burgdorferi sensu lato (s.l.) species complex. The complex consists of 11 species (genospecies). Borrelia burgdorferi sensu stricto (s.s.), Borrelia garinii and Borrelia afzelii are the major agents of human disease. Borrelia burgdorferi s.l. species are transmitted mainly by ticks belonging to the Ixodes ricinus species complex plus a few additional species not currently assigned to the complex. B. burgdorferi infections may produce an acute or chronic disease with a wide array of clinical symptoms such as erythema migrans (EM), carditis, arthritis, neuroBorreliosis, and acrodermatitis chronica atrophicans (ACA). Differences in LB spirochetes ‘genospecies ’ and strains/isolates determine the occurrence and severity of this multi-system disease. Accurate and reliable identification of the LB spirochetes in ticks as well as knowledge of their prevalence are essential for prevention against the disease and development of an effective vaccine. An overview of the knowledge of molecular factors with emphasis on potential protein-carbohydrate interactions in the tickborrelia system is the main focus of this review
Wilfrid Van Pelt - One of the best experts on this subject based on the ideXlab platform.
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predicting the risk of Lyme Borreliosis after a tick bite using a structural equation model
PLOS ONE, 2017Co-Authors: Agnetha Hofhuis, Hein Sprong, Jan Van De Kassteele, Cees C Van Den Wijngaard, Margriet Harms, Manoj Fonville, Arieke Docters Van Leeuwen, Mariana Simoes, Wilfrid Van PeltAbstract: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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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, 2016Co-Authors: Agnetha Hofhuis, Cees C Van Den Wijngaard, Margriet Harms, Sita Bennema, Arnold J H Van Vliet, Willem Takken, Wilfrid Van PeltAbstract: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. 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. 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. 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.
