< Back to Research Top Published Date 04/12/2020 "Repurposing" Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years' Experience in One Medical Practice Journal Antibiotics (Basel) Citation Antibiotics 2020, 9(12), 868 DOI 10.3390/antibiotics9120868 Authors Gao J, Gong Z, Montesano D, Glazer E, Liegner K Abstract A total of 71 patients with Lyme disease were identified for analysis in whom treatment with disulfiram was initiated between 15 March 2017 and 15 March 2020. Four patients were lost to follow-up, leaving 67 evaluable patients. Our retrospective review found patients to fall into a "high-dose" group (?4 mg/kg/day) and a "low-dose" group (<4 mg/kg/day). In total, 62 of 67 (92.5%) patients treated with disulfiram were able to endorse a net benefit of the treatment with regard to their symptoms. Moreover, 12 of 33 (36.4%) patients who completed one or two courses of "high-dose" therapy enjoyed an "enduring remission", defined as remaining clinically well for ?6 months without further anti-infective treatment. The most common adverse reactions from disulfiram treatment in the high-dose group were fatigue (66.7%), psychiatric symptoms (48.5%), peripheral neuropathy (27.3%), and mild to moderate elevation of liver enzymes (15.2%). We observed that although patients on high dose experienced a higher risk for adverse reactions than those on a low dose, high-dose patients were significantly more likely to achieve enduring remission. URL Previous https://www.mdpi.com/2079-6382/9/12/868 No Review Needed? Next

< Back to Research Top Published Date 04/11/2015 Quantification of Borrelia burgdorferi Membrane Proteins in Human Serum: A New Concept for Detection of Bacterial Infection Journal Analytical Chemistry Citation Anal Chem. 2015 Nov 17;87(22):11383-8 DOI 10.1021/acs.analchem.5b02803 Authors Cheung CS, Anderson KW, Benitez KY, Soloski MJ, Aucott JN, Phinney KW, Turko IV Abstract The Borrelia burgdorferi spirochete is the causative agent of Lyme disease, the most common tick-borne disease in the United States. The low abundance of bacterial proteins in human serum during infection imposes a challenge for early proteomic detection of Lyme disease. To address this challenge, we propose to detect membrane proteins released from bacteria due to disruption of their plasma membrane triggered by the innate immune system. These membrane proteins can be separated from the bulk of serum proteins by high-speed centrifugation causing substantial sample enrichment prior to targeted protein quantification using multiple reaction monitoring mass spectrometry. This new approach was first applied to detection of B. burgdorferi membrane proteins supplemented in human serum. Our results indicated that detection of B. burgdorferi membrane proteins, which are ?10(7) lower in abundance than major serum proteins, is feasible. Therefore, quantitative analysis was also carried out for serum samples from three patients with acute Lyme disease. We were able to demonstrate the detection of ospA, the major B. burgdorferi lipoprotein at the level of 4.0 fmol of ospA/mg of serum protein. The results confirm the concept and suggest that the proposed approach can be expanded to detect other bacterial infections in humans, particularly where existing diagnostics are unreliable. URL Previous https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809138 No Review Needed? Next

< Back to Research Top Published Date 15/01/2021 A Case of Glomerulonephritis Caused by Bartonella spp. Infective Endocarditis: The Difficulty and Importance of Differentiation from Anti-neutrophil Cytoplasmic Antibody-related Rapidly Progressive Glomerulonephritis Journal Internal Medicine Citation 10.2169/internalmedicine.5608-20 DOI 10.2169/internalmedicine.5608-20 Authors Yoshifuji A, Hibino Y, Komatsu M, Yasuda S, Hosoya K, Kobayashi E, Baba Y, Hirose S, Hashiguchi A, Kanno Y, Ryuzaki M Abstract A 65-year-old man with valvular disorder presented to his physician because of widespread purpura in both lower extremities. Blood tests showed elevated serum creatinine levels and proteinase 3-anti-neutrophil cytoplasmic antibody (ANCA) with hematuria, suggesting ANCA-related rapidly progressive glomerulonephritis (RPGN). Although multiple blood cultures were negative, transthoracic echocardiography revealed warts in the valves, and a renal biopsy also showed findings of glomerular infiltration by mononuclear leukocytes and C3 deposition in the glomeruli, suggesting infection-related glomerulonephritis. Later, Bartonella antibody turned positive. Antimicrobial treatment improved the purpura and renal function without any recurrence. ANCA-positive RPGN requires the exclusion of infective endocarditis, especially that induced by Bartonella spp. Keywords: ANCA; Bartonella; infective endocarditis; rapidly progressive glomerulonephritis. URL Previous https://pubmed.ncbi.nlm.nih.gov/33456034/ No Review Needed? Next

< Back to Research Top Published Date 01/05/2019 Erosive vulvovaginitis associated with Borrelia burgdorferi infection Journal Journal of Investigative Medicine High Impact Case Reports Citation J Investig Med High Impact Case Rep. 2019 Jan-Dec;7:2324709619842901 DOI 10.1177/2324709619842901 Authors Fesler MC, Middelveen MJ, Burke JM, Stricker RB Abstract We describe a case of acute erosive vulvovaginitis accompanying Borrelia burgdorferi infection. The patient is a 57-year-old woman previously diagnosed with Lyme disease who presented with a painful erosive genital lesion. At the time of the outbreak, she was being treated with oral antibiotics,and she tested serologically positive for B burgdorferi and serologically negative for syphilis. Histological examination of biopsy tissue from the lesion was not characteristic of dermatopathological patterns typical of erosive vulvar conditions. Dieterle-stained biopsy sections revealed visible spirochetes throughout the stratum spinosum and stratum basale, and anti- B burgdorferi immunostaining was positive. Motile spirochetes were observed by darkfield microscopy and cultured in Barbour-Stoner-Kelly-complete medium inoculated with skin scrapings from the lesion. Cultured spirochetes were identified genetically as B burgdorferi sensu stricto by polymerase chain reaction, while polymerase chain reaction amplification of treponemal gene targets was negative. The condition resolved after treatment with additional systemic antibiotic therapy and topical antibiotics. In cases of genital ulceration that have no identifiable etiology, the possibility of B burgdorferi spirochetal infection should be considered. URL Previous https://journals.sagepub.com/doi/full/10.1177/2324709619842901 No Review Needed? Next

< Back to Research Top Published Date 19/04/2019 Human Bartonellosis: An Underappreciated Public Health Problem? Journal Tropical Medicine and Infectious Disease Citation Trop Med Infect Dis. 2019 Apr 19;4(2). pii: E69 DOI 10.3390/tropicalmed4020069 Authors Cheslock MA, Embers ME Abstract Bartonella spp. bacteria can be found around the globe and are the causative agents of multiple human diseases. The most well-known infection is called cat-scratch disease, which causes mild lymphadenopathy and fever. As our knowledge of these bacteria grows, new presentations of the disease have been recognized, with serious manifestations. Not only has more severe disease been associated with these bacteria but also Bartonella species have been discovered in a wide range of mammals, and the pathogens' DNA can be found in multiple vectors. This review will focus on some common mammalian reservoirs as well as the suspected vectors in relation to the disease transmission and prevalence. Understanding the complex interactions between these bacteria, their vectors, and their reservoirs, as well as the breadth of infection by Bartonella around the world will help to assess the impact of Bartonellosis on public health. URL Previous https://www.mdpi.com/2414-6366/4/2/69 No Review Needed? Next

< Back to Research Top Published Date 01/03/2020 Passive Tick Surveillance: Exploring Spatiotemporal Associations of Borrelia burgdorferi (Spirochaetales: Spirochaetaceae), Babesia microti (Piroplasmida: Babesiidae), and Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae) Infection in Ixodes scap Journal Vector-Borne and Zoonotic Diseases Citation 20(3):177-186 DOI 10.1089/vbz.2019.2509 Authors Little EAH, Molaei G Abstract Ixodes scapularis transmits a group of pathogens, including Borrelia burgdorferi, Babesia microti, and Anaplasma phagocytophilum, the causative agents for Lyme disease, babesiosis, and anaplasmosis, respectively. I. scapularis ticks submitted by state residents to the Connecticut Agricultural Experiment Station-Tick Testing Laboratory between 2015 and 2018 were screened using standard PCR and pathogen-specific primers. Infection and coinfection prevalence in I. scapularis was estimated to assess differences in infection status by life stage (nymph or adult female), county, and year, as well as whether infection with B. burgdorferi changes the likelihood of infection with either B. microti or A. phagocytophilum. Of the 11,254 I. scapularis acquired in Connecticut, 40.7% tested positive for at least one pathogen and the remaining 59.3% were negative. Most I. scapularis ticks tested positive for a single pathogen (33.6%), and only 7.2% were infected with more than one pathogen, of which 93.2% were identified with dual infection and 6.8% tested positive for all three pathogens. Adults were more likely than nymphs to be infected or coinfected with these pathogens. Furthermore, we found that ticks were 74% more likely to be infected with B. microti and 98% more likely to be infected with A. phagocytophilum if infected with B. burgdorferi compared with those not infected. We did not find spatial differences in infection or coinfection prevalence, but between 2015 and 2018, the likelihood that a tick was coinfected increased with time. These results from Connecticut, an endemic state for Lyme disease with long-established populations of I. scapularis, suggest that the increased likelihood of coinfection prevalence over time may have significant implications for clinical diagnosis, course, severity, and treatment of human disease cases. Keywords: Anaplasma phagocytophilum; Babesia microti; Borrelia burgdorferi; Connecticut; Ixodes scapularis; passive surveillance. URL Previous https://pubmed.ncbi.nlm.nih.gov/31580216/ No Review Needed? Next

< Back to Research Top Published Date 08/04/2010 Bartonella vinsonii subsp. berkhoffii and Bartonella henselae bacteremia in a father and daughter with neurological disease Journal Parasites & Vectors Citation Parasit Vectors. 2010 Apr 8;3(1):29 DOI 10.1186/1756-3305-3-29 Authors Breitschwerdt EB, Maggi RG, Lantos PM, Woods CW, Hegarty BC, Bradley JM Abstract BACKGROUND: Bartonella vinsonii subsp. berkhoffii is an important, emerging, intravascular bacterial pathogen that has been recently isolated from immunocompetent patients with endocarditis, arthritis, neurological disease and vasoproliferative neoplasia. Vector transmission is suspected among dogs and wild canines, which are the primary reservoir hosts. This investigation was initiated to determine if pets and family members were infected with one or more Bartonella species. METHODS: PCR and enrichment blood culture in Bartonella alpha Proteobacteria growth medium (BAPGM) was used to determine infection status. Antibody titers to B. vinsonii subsp. berkhoffii genotypes I-III and B. henselae were determined using a previously described indirect fluorescent antibody test. Two patients were tested sequentially for over a year to assess the response to antibiotic treatment. RESULTS: Intravascular infection with B. vinsonii subsp. berkhoffii genotype II and Bartonella henselae (Houston 1 strain) were confirmed in a veterinarian and his daughter by enrichment blood culture, followed by PCR and DNA sequencing. Symptoms included progressive weight loss, muscle weakness, lack of coordination (the father) and headaches, muscle pain and insomnia (the daughter). B. vinsonii subsp. berkhoffii genotype II was also sequenced from a cerebrospinal fluid BAPGM enrichment culture and from a periodontal swab sample. After repeated courses of antibiotics, post-treatment blood cultures were negative, there was a decremental decrease in antibody titers to non-detectable levels and symptoms resolved in both patients. CONCLUSIONS: B. vinsonii subsp. berkhoffii and B. henselae are zoonotic pathogens that can be isolated from the blood of immunocompetent family members with arthralgias, fatigue and neurological symptoms. Therapeutic elimination of Bartonella spp. infections can be challenging, and follow-up testing is recommended. An increasing number of arthropod vectors, including biting flies, fleas, keds, lice, sandflies and ticks have been confirmed or are suspected as the primary mode of transmission of Bartonella species among animal populations and may also pose a risk to human beings. URL Previous https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859367 No Review Needed? Next

< Back to Research Top Published Date 14/06/2011 Healthcare access and burden of care for patients with Lyme disease: a large United States survey Journal Health Policy Citation Health Policy. 2011 Sep;102(1):64-71 DOI 10.1016/j.healthpol.2011.05.007 Authors Johnson L, Aylward A, Stricker RB Abstract OBJECTIVE: To evaluate the challenges faced by Lyme disease patients in obtaining adequate healthcare. METHODS: A web-based survey conducted over nine months was analyzed for the study. The survey focused on medical status, access to healthcare, and burden of illness. For inclusion in the study, survey respondents had to reside in the United States, be more than 10 years old, and have clinically diagnosed Lyme disease with chronic symptoms and positive laboratory testing. RESULTS: Responses from 2424 patients were included in the study. Half of the respondents reported seeing at least seven physicians before the diagnosis of Lyme disease was made. Nearly half had Lyme disease for more than 10 years and traveled over 50 miles to obtain treatment. Most respondents experienced symptoms lasting six months or more despite receiving at least 21 days of antibiotic treatment. A quarter of respondents had been on public support or received disability benefits due to Lyme disease symptoms, and over half had visited an emergency room at least once as a result of these symptoms. CONCLUSIONS:Lyme disease patients frequently endure extensive delays in obtaining an initial diagnosis, have poor access to healthcare and suffer a severe burden of illness. URL Previous https://www.ncbi.nlm.nih.gov/pubmed/21676482 No Review Needed? Next

< Back to Research Top Published Date 30/06/2020 A novel Borrelia species, intermediate between Lyme disease and relapsing fever groups, in neotropical passerine-associated ticks Journal Scientific Reports Citation 10(1):10596 DOI 10.1038/s41598-020-66828-7 Authors Binetruy F, Garnier S, Boulanger N, Talagrand-Reboul e, Loire E, Faivre B, Buysse M, Duron O, Noel V Abstract Lyme disease (LD) and relapsing fevers (RF) are vector-borne diseases caused by bacteria of the Borrelia genus. Here, we report on the widespread infection by a non-described Borrelia species in passerine-associated ticks in tropical rainforests of French Guiana, South America. This novel Borrelia species is common in two tick species, Amblyomma longirostre and A. geayi, which feed on a broad variety of neotropical mammal and bird species, including migratory species moving to North America. The novel Borrelia species is divergent from the LD and RF species, and is more closely related to the reptile- and echidna-associated Borrelia group that was recently described. Genome sequencing showed that this novel Borrelia sp. has a relatively small genome consisting of a 0.9-Mb-large chromosome and an additional 0.3 Mb dispersed on plasmids. It harbors an RF-like genomic organization but with a unique mixture of LD- and RF-specific genes, including genes used by RF Borrelia for the multiphasic antigen-switching system and a number of immune-reactive protein genes used for the diagnosis of LD. Overall, our data indicate that this novel Borrelia is an intermediate taxon between the LD and RF species that may impact a large host spectrum, including American mammals. The designation "Candidatus Borrelia mahuryensis" is proposed for this species. URL Previous https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327063/ No Review Needed? Next

< Back to Research Top Published Date 17/03/2020 The Borrelia burgdorferi VlsE Lipoprotein Prevents Antibody Binding to an Arthritis-Related Surface Antigen Journal Cell Rep Citation 30(11):3663-3670.e5 DOI 10.1016/j.celrep.2020.02.081 Authors Lone AG, Bankhead T Abstract Arp is an immunogenic protein of the Lyme disease spirochete Borrelia burgdorferi and contributes to joint inflammation during infection. Despite Arp eliciting a strong humoral response, antibodies fail to clear the infection. Given previous evidence of immune avoidance mediated by the antigenically variable lipoprotein of B. burgdorferi, VlsE, we use passive immunization assays to examine whether VlsE protects the pathogen from anti-Arp antibodies. The results show that spirochetes are only able to successfully infect passively immunized mice when VlsE is expressed. Subsequent immunofluorescence assays reveal that VlsE prevents binding of Arp-specific antibodies, thereby providing an explanation for the failure of Arp antisera to clear the infection. The results also show that the shielding effect of VlsE is not universal for all B. burgdorferi cell-surface antigens. The findings reported here represent a direct demonstration of VlsE-mediated protection of a specific B. burgdorferi surface antigen through a possible epitope-shielding mechanism. Keywords: Borrelia; Lyme disease; VlsE; epitope shielding; immune evasion; spirochete URL Previous https://www.cell.com/cell-reports/fulltext/S2211-1247(20)30255-2?_returnURL=https%3A//linkinghub.elsevier.com/retrieve/pii/S2211124720302552%3Fshowall%3Dtrue No Review Needed? Next

< Back to Research Top Published Date 08/05/2012 Direct molecular detection and genotyping of Borrelia burgdorferi from whole blood of patients with early Lyme disease Journal PLoS One Citation PLoS One. 2012;7(5):e3682 DOI 10.1371/journal.pone.0036825 Authors Eshoo MW, Crowder CC, Rebman AW, Rounds MA, Matthews HE, Picuri JM, Soloski MJ, Ecker DJ, Schutzer SE, Aucott JN Abstract Direct molecular tests in blood for early Lyme disease can be insensitive due to low amount of circulating Borrelia burgdorferi DNA. To address this challenge, we have developed a sensitive strategy to both detect and genotype B. burgdorferi directly from whole blood collected during the initial patient visit. This strategy improved sensitivity by employing 1.25 mL of whole blood, a novel pre-enrichment of the entire specimen extract for Borrelia DNA prior to a multi-locus PCR and electrospray ionization mass spectrometry detection assay. We evaluated the assay on blood collected at the initial presentation from 21 endemic area patients who had both physician-diagnosed erythema migrans (EM) and positive two-tiered serology either at the initial visit or at a follow-up visit after three weeks of antibiotic therapy. Results of this DNA analysis showed detection of B. burgdorferi in 13 of 21 patients (62%). In most cases the new assay also provided the B. burgdorferigenotype. The combined results of our direct detection assay with initial physician visit serology resulted in the detection of early Lymedisease in 19 of 21 (90%) of patients at the initial visit. In 5 of 21 cases we demonstrate the ability to detect B. burgdorferi in early Lymedisease directly from whole blood specimens prior to seroconversion. URL Previous https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036825 No Review Needed? Next

< Back to Research Top Published Date 22/06/2020 A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy Journal Revisita da Sociedade Brasileira de Medicina Tropical Citation 53:e20190516 DOI 10.1590/0037-8682-0516-2019 Authors Eyer-Silva WA, Wutke LSC, Paiva ACM, Silva GARD, Ferry FRA, Signorini DJHP, Oliveira JG, Lemos ERS Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy. URL Previous https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310359/ No Review Needed? Next