< Back to Research Top Published Date 30/07/2019 Incidence of Lyme disease in the UK: a population-based cohort study Journal BMJ Open Citation BMJ Open. 2019 Jul 30;9(8):e025916 DOI 10.1136/bmjopen-2018-025916 Authors Cairns V, Wallenhorst C, Rietbrock S, Martinez C Abstract OBJECTIVES: The purpose of this study was to estimate the annual incidence of Lyme disease (LD) in the UK. DESIGN: This was a retrospective descriptive cohort study. SETTING: Study data were extracted from the Clinical Practice Research Datalink (CPRD), a primary care database covering about 8% of the population in the UK in 658 primary care practices. PARTICIPANTS: Cohort of 8.4 million individuals registered with general practitioners with 52.4 million person-years of observation between 1 January 2001 and 31 December 2012. PRIMARY AND SECONDARY OUTCOME MEASURES: LD was identified from recorded medical codes, notes indicating LD, laboratory tests and use of specific antibiotics. Annual incidence rates and the estimated total number of LD cases were calculated separately for each UK region. RESULTS: The number of cases of LD increased rapidly over the years 2001 to 2012, leading to an estimated incidence rate of 12.1 (95% CI 11.1 to 13.2) per 100?000 individuals per year and a UK total of 7738 LD cases in 2012. LD was detected in every UK region with highest incidence rates and largest number of cases in Scotland followed by South West and South England. If the number of cases has continued to rise since the end of the study period, then the number in the UK in 2019 could be over 8000. CONCLUSIONS: The incidence of LD is about threefold higher than previously estimated, and people are at risk throughout the UK. These results should lead to increased awareness of the need for preventive measures. TRIAL REGISTRATION NUMBER: This study was approved by the Independent Scientific Advisory Committee for CPRD research (Protocol number 13_210R). URL Previous https://bmjopen.bmj.com/content/9/8/e025916 No Review Needed? Next

< Back to Research Top Published Date 14/01/2020 Lyme Aortitis Journal BMJ Case Reports Citation 13(1):e231957 DOI 10.1136/bcr-2019-231957. Authors Correia RR, Cruz F, Martin S, Andre ME Abstract A 72-year-old man was admitted with complaints of sudden-onset oppressive precordial pain radiating to the back for 1 hour. He had hypotension, peripheral cyanosis and cold extremities. An initial assessment was done and acute coronary syndrome was excluded. After the patient was admitted, he developed fever and increased levels of inflammatory markers. Data obtained from CT angiography and transoesophageal echocardiogram revealed diffuse parietal thickening of the arch and the descending thoracic aorta, as well as dilatation of the aortic root and the proximal ascending aorta. In addition, the test for Borrelia burgdorferi was positive, and the patient was diagnosed with Lyme vasculitis of the thoracic aorta. He was treated with doxycycline for 3 weeks. Two months later, the patient exhibited a Stanford type A aortic dissection (clinically stable), which was treated by prosthesis replacement. The patient has remained asymptomatic for 1 year after the episode, performing his routine daily activities. Keywords: cardiovascular system; infections. URL Previous https://casereports.bmj.com/content/13/1/e231957.long No Review Needed? Next

< Back to Research Top Published Date 16/04/2015 Historic evidence to support a causal relationship between spirochetal infections and Alzheimer's disease Journal Frontiers in Aging Neuroscience Citation Front Aging Neurosci. 2015 Apr 16;7:46 DOI 10.3389/fnagi.2015.00046 Authors Miklossy J Abstract Following previous observations a statistically significant association between various types of spirochetes and Alzheimer's disease (AD) fulfilled Hill's criteria in favor of a causal relationship. If spirochetal infections can indeed cause AD, the pathological and biological hallmarks of AD should also occur in syphilitic dementia. To answer this question, observations and illustrations on the detection of spirochetes in the atrophic form of general paresis, which is known to be associated with slowly progressive dementia, were reviewed and compared with the characteristic pathology of AD. Historic observations and illustrations published in the first half of the 20th Century indeed confirm that the pathological hallmarks, which define AD, are also present in syphilitic dementia. Cortical spirochetalcolonies are made up by innumerable tightly spiraled Treponema pallidum spirochetes, which are morphologically indistinguishable from senile plaques, using conventional light microscopy. Local brain amyloidosis also occurs in general paresis and, as in AD, corresponds to amyloid beta. These historic observations enable us to conclude that chronic spirochetal infections can cause dementia and reproduce the defining hallmarks of AD. They represent further evidence in support a causal relationship between various spirochetalinfections and AD. They also indicate that local invasion of the brain by these helically shaped bacteria reproduce the filamentous pathology characteristic of AD. Chronic infection by spirochetes, and co-infection with other bacteria and viruses should be included in our current view on the etiology of AD. Prompt action is needed as AD might be prevented. URL Previous https://www.frontiersin.org/articles/10.3389/fnagi.2015.00046/full No Review Needed? Next

< Back to Research Top Published Date 15/04/2019 Metagenomic 16S rRNA gene sequencing survey of Borrelia species in Irish samples of Ixodes ricinus ticks Journal PLoS One Citation PLoS One. 2019 Apr 15;14(4):e0209881 DOI 10.1371/journal.pone.0209881 Authors Lambert JS, Cook MJ, Healy JE, Murtagh R, Avramovic G, Lee SH Abstract The spirochetal bacterium Borrelia miyamotoi is a human pathogen and has been identified in many countries throughout the world. This study reports for the first time the presence of Borrelia miyamotoi in Ireland, and confirms prior work with the detection of B. garinii and B. valaisiana infected ticks. Questing Ixodes ricinus nymph samples were taken at six localities within Ireland. DNA extraction followed by Sanger sequencing was used to identify the species and strains present in each tick. The overall rate of borrelial infection in the Irishtick population was 5%, with a range from 2% to 12% depending on the locations of tick collection. The most prevalent species detected was B. garinii (70%) followed by B. valaisiana (20%) and B. miyamotoi (10%). Knowledge of Borrelia species prevalence is important and will guide appropriate selection of antigens for serology test kit manufacture, help define the risk of infection, and allow medical authorities to formulate appropriate strategies and guidelines for diagnosis and treatment of Borrelia diseases. URL Previous https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209881 No Review Needed? Next

< Back to Research Top Published Date 09/06/2010 The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines Journal Philosophy, Ethics, and Humanities in Medicine (PEHM) Citation Philos Ethics Humanit Med. 2010 Jun 9;5:9 DOI 10.1186/1747-5341-5-9 Authors Johnson L, Stricker RB Abstract Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future. URL Previous https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-5-9 No Review Needed? Next

< Back to Research Top Published Date 01/02/2017 Detection of Borrelia Genomospecies 2 in Ixodes spinipalpis Ticks Collected from a Rabbit in Canada Journal The Journal of Parasitology Citation J Parasitol. 2017 Feb;103(1):38-46 DOI 10.1645/16-127 Authors Scott JD, Clark KL, Foley JE, Anderson JF, Durden LA, Manord JM, Smith ML Abstract Lyme disease is a serious health problem, with many patients requiring in-depth clinical assessment and extended treatment. In the present study, we provide the first records of the western blacklegged tick, Ixodes pacificus , and Ixodes spinipalpis parasitizing eastern cottontails, Sylvilagus floridanus . We also documented a triple co-infestation of 3 tick species (Ixodes angustus, I. pacificus , I. spinipalpis) feeding on an eastern cottontail. Notably, we discovered a unique member of the Lyme disease bacterium, Borrelia burgdorferi sensu lato (s.l.) in Canada. Ixodes spinipalpis ticks, which were collected from an eastern cottontail on Vancouver Island, British Columbia (BC), were positive for B. burgdorferi s.l. With the use of polymerase chain reaction amplification on the tick extracts and DNA sequencing on the borrelial amplicons, we detected Borrelia genomospecies 2, a novel subgroup of the B. burgdorferi s.l. complex. Based on 416 nucleotides of the flagellin B (flaB) gene, our amplicons are identical to the Borrelia genomospecies 2 type strain CA28. Borrelia genomospecies 2 is closely related genetically to other B. burgdorferi s.l. genospecies, namely Borrelia americana, Borrelia andersonii, and B. burgdorferi sensu stricto (s.s.) that cause Lyme disease. Like some other borrelial strains, Borrelia genomospecies 2 can be missed by current Lyme disease serology. Health-care providers must be aware that Borrelia genomospecies 2 is present in I. pacificus and I. spinipalpis ticks in far-western North America, and patients with clinical symptoms of Lyme disease need to be assessed for potential infection with this pathogen. URL Previous https://bioone.org/journals/journal-of-parasitology/volume-103/issue-1/16-127/Detection-of-Borrelia-Genomospecies-2-in-Ixodes-spinipalpis-Ticks-Collected/10.1645/16-127.full No Review Needed? Next

< Back to Research Top Published Date 01/02/2020 Australian case of scrub typhus contracted while hiking in northern Taiwan Journal Journal of Formosan Medical Association Citation 19(2):662-663 DOI 10.1016/j.jfma.2019.08.036. Authors Minahan NT, C Davis RJ, Graves SR, Tsai KH Abstract No abstract available URL Previous https://pubmed.ncbi.nlm.nih.gov/31522969/ No Review Needed? Next

< Back to Research Top Published Date 27/11/2013 Next generation sequencing uncovers unexpected bacterial pathogens in ticks in western Europe Journal PLoS One Citation PLoS ONE 8(11): e81439 DOI 10.1371/journal.pone Authors Vayssier-Taussat M, Moutailler S, Michelet L, Devillers E, Bonnet S, Cheval J, Hebert C, Eloit M Abstract BACKGROUND AND AIMS: Ticks are highly susceptible to global environmental and socio-economical changes. Several tick-borne pathogens have been reported in new geographical regions while new species, strains or genetic variants of tick-borne microorganisms are continually being detected. However, tick-borne pathogens are still poorly understood, and it is estimated that half of all human tick-borne disease has an unknown origin. Therefore in order to prevent these diseases, more effort is required to identify unknown or unexpected tick-borne pathogens. Ixodes ricinus is the vector for a broad range of bacterial pathogens and the most prevalent tick in Europe. The aim of the present study was to evaluate the capability of Next Generation Sequencing (NGS) to extend the inventory of pathogenic bacteria carried by this species of tick in France. METHODS: RNA and DNA were extracted from 1450 I. ricinus questing nymphs collected by flagging in Alsace, France. RNA was pooled and used for NGS. Following de novo assembly, bacterial contigs were assigned to the closest known taxonomy. DNA was used for real time PCR to confirm taxonomic species assignment of NGS-derived contigs for the doubtful cases, and for determination of prevalence. RESULTS: We have generated a global in-depth picture of tick-borne bacteria. We identified RNA from the main pathogenic bacterial species known to be transmitted by I. ricinus. In addition we also identified unanticipated bacterial species for which we have estimated the prevalence within those ticks inhabiting the studied areas. CONCLUSIONS: The data obtained from this study has proven that NGS has an enormous potential to detect the unexpected and provides the means to monitor pathogen occurrence. URL Previous https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0081439 No Review Needed? Next

< Back to Research Top Published Date 28/10/2018 High seroprevalence of Babesia antibodies among Borrelia burgdorferi-infected humans in Sweden Journal Ticks and Tick-borne Diseases Citation Ticks Tick Borne Dis. 2019 Jan;10(1):186-190 DOI 10.1016/j.ttbdis.2018.10.007 Authors Svensson J, Hunfeld KP, Persson KEM Abstract In northern Europe, tick-borne diseases such as Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are well known. The actual incidence of Babesia infections, however, has remained elusive. In this study, the prevalence of antibodies against two Babesia spp. was investigated in a cohort of patients that were seropositive for Borrelia (B.) burgdorferi sensu lato (s.l.). Data were compared to a control group of healthy individuals. Sera were collected from 283 individuals residing in the southernmost region of Sweden, Sk?ne County. Almost one third of the sera were from patients with a confirmed seropositive reaction against B. burgdorferi s.l. All sera samples were assessed for IgG antibodies against Babesia (Ba.) microti and Ba. divergens by indirect fluorescent antibody (IFA) assays. Seropositive IgG titers for at least one of the Babesia spp. was significantly more common (p?<?0.05) in individuals seropositive for Borrelia (16.3%) compared to the healthy control group (2.5%). Our findings suggest that Babesia infections may indeed be quite common among individuals who have been exposed to tick bites. Furthermore, the results indicate that human babesiosis should be considered in patients that show relevant symptoms; particularly for splenectomized and other immunocompromised individuals. Finally, the data challenges current blood transfusion procedures and highlights the current lack of awareness of the parasite in northern Europe. URL Previous https://www.ncbi.nlm.nih.gov/pubmed/30389326 No Review Needed? Next

< Back to Research Top Published Date 01/05/2020 Disseminated Cat Scratch Disease in Pediatric Patients in Hawai'i Journal Hawaii Journal of Health & Social Welfare Citation 79(5 Suppl 1):64-70 DOI PMCID: PMC7260883 Authors Johnson SC, Kosut J, Ching N Abstract Cat scratch disease is known to be a generally benign, self-resolving illness associated with non-specific symptoms, including lymphadenopathy, fever, fatigue, anorexia, and headaches. However, it can also cause disseminated disease with a wide range of manifestations, including liver and spleen microabscesses, osteomyelitis, encephalitis, and uveitis. Eighteen pediatric cases of disseminated cat scratch disease at a single center in Hawai'i are described. This case series emphasizes the importance of disease recognition and use of appropriate diagnostic tools and disease management. The disease burden of pediatric patients with disseminated cat scratch disease in the state of Hawai'i has a high incidence and should be considered in pediatric patients with prolonged febrile illnesses. Keywords: Bartonella henselae; diagnosis; disseminated cat scratch disease; pediatrics, treatment. URL Previous https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260883/ No Review Needed? Next

< Back to Research Top Published Date 21/10/2010 Metamorphosis of Borrelia burgdorferi organisms-RNA, lipid and protein composition in context with the spirochete’s shape Journal Journal of Basic Microbiology Citation J Basic Microbiol. 2010 Dec;50 Suppl 1:S5-17 DOI doi: 10.1002/jobm.201000074 Authors Al-Robaiy S, Dihazi H, Kacza J, Seeger J, Schiller J, Huster D, Knauer J, Straubinger RK Abstract Borrelia burgdorferi, the agent of Lyme borreliosis, has the ability to undergo morphological transformation from a motile spirochetal to non-motile spherical shape when it encounters unfavorable conditions. However, little information is available on the mechanism that enables the bacterium to change its shape and whether major components of the cells--nucleic acids, proteins, lipids--are possibly modified during the process. Deducing from investigations utilizing electron microscopy, it seems that shape alteration begins with membrane budding followed by folding of the protoplasmatic cylinder inside the outer surface membrane. Scanning electron microscopy confirmed that a deficiency in producing functioning periplasmic flagella did not hinder sphere formation. Further, it was shown that the spirochetes' and spheres' lipid compositions were indistinguishable. Neither phosphatidylcholine nor phosphatidylglycerol were altered by the structural transformation. In addition, no changes in differential protein expression were detected during this process. However, minimal degradation of RNA and a reduced antigen-antibody binding activity were observed with advanced age of the spheres. The results of our comparisons and the failure to generate mutants lacking the ability to convert to spheres suggest that the metamorphosis of B. burgdorferi results in a conditional reconstruction of the outer membrane. The spheres, which appear to be more resistant to unfavorable conditions and exhibit reduced immune reactivity when compared to spirochetes, might allow the B. burgdorferi to escape complete clearance and possibly ensure long-term survival in the host. URL Previous https://www.ncbi.nlm.nih.gov/pubmed/20967786 No Review Needed? Next

< Back to Research Top Published Date 30/04/2015 Repellent efficacy of DEET, Icaridin, and EBAAP against Ixodes ricinus and Ixodes scapularis nymphs (Acari, Ixodidae) Journal Ticks and Tick-borne Diseases Citation Ticks Tick Borne Dis. 2015 Jun;6(4):494-8 DOI 10.1016/j.ttbdis.2015.03.019 Authors Bendin J, Gharbi A , Rahlenbeck S, Dautel H, Buchel K Abstract Repellent efficacy of 10% EBAAP (3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl ester) and 10% Icaridin ((2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester)) were evaluated against 20% DEET (N,N-diethyl-3-methylbenzamide) in human subject trials against ticks. Responses of host-seeking nymphs of the European castor bean tick (Ixodes ricinus L.; Acari: Ixodidae) and the North American blacklegged tick (I. scapularis Say; Acari: Ixodidae) were compared. Tests were carried out according to the US-EPA standard protocol with ethanolic solutions of the active ingredients of repellents being applied to the forearm of 10 volunteers. The upward movement of ticks was monitored until repellent failure taking up to 12.5 h. Application of 20% DEET resulted in median complete protection times (CPT; Kaplan-Meier median) between 4 and 4.5 h, while 10% EBAAP yielded CPTs of 3.5-4h. No significant differences were found between the efficacies of two repellents nor between the two species tested. The median of the CPT of a 10% Icaridin solution was 5h in nymphs of I. scapularis, but 8h in those of I. ricinus (P<0.01). Based on these studies, EBAAP and Icaridin are efficacious alternatives to DEET in their repellent activity against nymphs of the two Ixodes ticks with Icaridin demonstrating particularly promising results against I. ricinus. Future research should investigate whether similar results occur when adult Ixodes ticks or other tick species are tested. URL Previous https://www.ncbi.nlm.nih.gov/m/pubmed/25936273 No Review Needed? Next