LymeNet Newsletter Volume 7 Issue 03

Volume: 7
Issue: 03
Date: 24-Mar-99

Table of Contents:

I. MED MICROBIOL IMMUNOL: Heterogeneity of Borrelia burgdorferi sensu lato demonstrated by an ospA-type-specific PCR in synovial fluid from patients with Lyme arthritis. II. AM J TROP MED HYG: Human granulocytic ehrlichiosis in Bulgaria. III. MED MICROBIOL IMMUNOL: Expression of outer surface proteins A and C of Borrelia burgdorferi in Ixodes ricinus ticks removed from humans. IV. EUR J CLIN MICROBIOL INFECT DIS: Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. V. J MED MICROBIOL: Advantage of recombinant borrelial proteins for serodiagnosis of neuroborreliosis. VI. ABOUT THE LYMENET NEWSLETTER

Newsletter:

*********************************************************************** * The National Lyme Disease Network * * http://www.LymeNet.org/ * * LymeNet Newsletter * ***********************************************************************

Volume 7 / Number 03 / 24-MAR-1999 INDEX

I. MED MICROBIOL IMMUNOL: Heterogeneity of Borrelia burgdorferi sensu lato demonstrated by an ospA-type-specific PCR in synovial fluid from patients with Lyme arthritis. II. AM J TROP MED HYG: Human granulocytic ehrlichiosis in Bulgaria. III. MED MICROBIOL IMMUNOL: Expression of outer surface proteins A and C of Borrelia burgdorferi in Ixodes ricinus ticks removed from humans. IV. EUR J CLIN MICROBIOL INFECT DIS: Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. V. J MED MICROBIOL: Advantage of recombinant borrelial proteins for serodiagnosis of neuroborreliosis. VI. ABOUT THE LYMENET NEWSLETTER

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I. MED MICROBIOL IMMUNOL: Heterogeneity of Borrelia burgdorferi sensu lato demonstrated by an ospA-type-specific PCR in synovial fluid from patients with Lyme arthritis. ---------------------------------------------------------------------- AUTHORS: Vasiliu V, Herzer P, Rossler D, Lehnert G, Wilske B ORGANIZATION: Max von Pettenkofer-Institut fur Medizinische Mikrobiologie der Ludwig-Maximilians-Universitat Munchen, Munich, Germany. REFERENCE: Med Microbiol Immunol (Berl) 1998 Oct;187(2):97-102 ABSTRACT:

Borrelia burgdorferi sensu lato, the etiological agent of Lyme borreliosis, has been divided into three genospecies: B. burgdorferi sensu stricto (OspA-type 1), B. afzelii (OspA-type 2) and B. garinii (OspA-type 3-7). Whereas in Europe B. afzelii (OspA-type 2) is predominant among human skin isolates and B. garinii (OspA-type 3-7) among human CSF isolates, some previous serological studies suggested that Lyme arthritis is also associated with B. burgdorferi sensu stricto in Europe. In the present study we designed ospA type-specific PCRs and identified four different ospA types associated with Lyme arthritis. Our study group consisted of 20 patients with positive serology (ELISA and immunoblotting) and clinical criteria for Lyme arthritis. B. burgdorferi DNA was detected in 13 patients and in none of 10 control patients from synovial fluid. We identified ospA-type 1 (26.6%), ospA-type 2 (33.3%), ospA-type 4 (6.6%) and ospA-type 5 (33.3%). Our conclusion is that in Europe B. burgdorferi sensu lato
strains causing Lyme arthritis are considerably heterogeneous and that there is no prevalence of certain genospecies or OspA-types among this strains.

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II. AM J TROP MED HYG: Human granulocytic ehrlichiosis in Bulgaria. --------------------------------------------------------------------- AUTHORS: Christova IS, Dumler JS ORGANIZATION: Department of Microbiology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria. REFERENCE: Am J Trop Med Hyg 1999 Jan;60(1):58-61 ABSTRACT:

Human granulocytic ehrlichiosis (HGE) is a recently described rickettsiosis in the United States transmitted by Ixodes species ticks. In Europe, only a few studies on HGE exist. Two hundred Bulgarian patients with tick bites and 70 healthy blood donors were tested for HGE using an immunofluorescence assay with the HGE agent as an antigen. Elevated antibody titers (> or = 1:80) were found in 14 (9.7 %) of 145 patients with erythema migrans, two (8%) of 25 tick-exposed patients with lymphadenopathy only, one (20%) of five patients with tick bite with fever, chills, and headache, one (4%) of 25 healthy tick-exposed patients, and two (2.9%) of 70 blood donors. These results show for the first time that HGE is probably common in southeastern Europe. The study provides evidence of coinfection or concurrent infection of patients with Lyme disease and HGE, thus supporting the possible role of I. ricinus for transmitting the HGE agent.

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III. MED MICROBIOL IMMUNOL: Expression of outer surface proteins A and C of Borrelia burgdorferi in Ixodes ricinus ticks removed from humans. ------------------------------------------------------------------- AUTHORS: Fingerle V, Liegl G, Munderloh U, Wilske B ORGANIZATION: Max von Pettenkofer-Institut fur Hygiene und Medizinische Mikrobiologie der Ludwig-Maximilians-Universitat Munchen, Germany. [email protected] REFERENCE: Med Microbiol Immunol (Berl) 1998 Oct;187(2):121-6 ABSTRACT:

A total of 131 Ixodes ricinus (51 females, 1 male and 79 nymphs) removed from persons living in Southern Germany were investigated by immunofluorescence assay for the presence of Borrelia burgdorferi with a polyvalent rabbit immune serum and monoclonal antibodies specific for outer surface proteins (Osp) A or C. Borreliae were detectable in 48 (36.6%) of the ticks. Infection rates of these adults and nymphs were significantly higher than infection rates of unfed ticks from Southern Germany. Borreliae in 31.3% (n=15) of the infected ticks expressed solely OspA, solely OspC in 12.5% (n=6), and both OspA and OspC in 39.6% (n=19) of ticks, while in 16.7% (n=8) of ticks neither were expressed. Presentation of OspC by B. burgdorferi in I. ricinus was correlated with tick weight: in females, OspC was detectable only in ticks with a minimum weight of about 3.5 mg, and in nymphs weighing at least 1 mg. These results indicate that in I. ricinus removed from humans OspC is up-regulated during the blood meal of the tick, but in
most ticks OspA is still detectable and might even be present in the absence of OspC expression in the midgut and salivary glands of nearly fully engorged nymphal ticks. Furthermore, we found strong evidence that borreliae expressing solely OspA while in the salivary glands can cause Lyme borreliosis. Our findings indicate that during tick feeding, humans are exposed to borreliae that may express either OspA or OspC or both, or lack both OspA and C. These findings suggests that, at the minimum, both OspA and C should be considered as vaccine candidates for prophylaxis of Lyme borreliosis in Europe.

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IV. EUR J CLIN MICROBIOL INFECT DIS: Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. ---------------------------------------------------------------------- AUTHORS: Oksi J, Nikoskelainen J, Viljanen MK ORGANIZATION: Department of Medicine, Turku University Central Hospital, Finland. REFERENCE: Eur J Clin Microbiol Infect Dis 1998 Oct;17(10):715-9 ABSTRACT:

Two treatment regimens for disseminated Lyme borreliosis (mainly neurologic and musculoskeletal manifestations) were compared in a randomized trial. A group of 30 patients received oral cefixime 200 mg combined with probenecid 500 mg three times daily for 100 days. Another group of 30 patients received intravenous ceftriaxone 2 g daily for 14 days followed by oral amoxicillin 500 mg combined with probenecid 500 mg three times daily for 100 days. There was no statistically significant difference in the outcome of infection between the two groups. However, the total number of patients with relapses or no response at all and the number of positive polymerase chain reaction findings after therapy were greater in the cefixime group. The general outcomes of infection in patients with disseminated Lyme borreliosis after 3-4 months of therapy indicate that prolonged courses of antibiotics may be beneficial in this setting, since 90% of the patients showed excellent or good treatment responses.

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V. J MED MICROBIOL: Advantage of recombinant borrelial proteins for serodiagnosis of neuroborreliosis. ---------------------------------------------------------------------- AUTHORS: Kaiser R, Rauer S ORGANIZATION: Neurologische Klinik und Poliklinik der Albert-Ludwigs-Universitat Freiburg, Germany. REFERENCE: J Med Microbiol 1999 Jan;48(1):5-10 ABSTRACT:

Two enzyme immunoassay (EIA) systems were compared for their ability to detect Borrelia burgdorferi sensu lato specific IgG and IgM antibodies and to differentiate between symptomatic (83 patients with neuroborreliosis) and asymptomatic seropositive subjects (80 healthy controls). Antibody concentrations were determined by EIA; the antigens used were either a sonicate of B. burgdorferi or three recombinant borrelial proteins: the 14-kDa flagellin fragment, the outer surface protein C (22 kDa) and the high molecular mass protein p83 (83 kDa). In the sonicate, EIA, IgG or IgM antibodies to B. burgdorferi, or both, were detected in all patients with neuroborreliosis and in all controls. Pre-absorption of sera with Treponema phagedenis sonicate diminished the sensitivity of detection of borrelial specific IgG (IgG or IgM or both) antibodies in patients with neuroborreliosis from 80 to 57% (100 to 82%) and in the controls from 100 to 32% (100 to 37%). While being specific for B. burgdorferi, the recombinant EIAs proved to be significantly more sensitive than
the sonicate EIA: IgG or IgM, or both antibodies against any of the recombinant antigens were detected in 92% of patients with neuroborreliosis and in 24% of controls. The increase in sensitivity in patients with neuroborreliosis was mostly due to the higher detection rate of IgM antibodies in the recombinant EIA (77% versus 48% in the sonicate EIA), while IgG antibodies were demonstrated with similar frequencies in both EIA systems (57% versus 60%). It was concluded that the recombinant EIAs are superior to the sonicate EIA with pre-absorption of cross-reactive antibodies in the confirmation of an acute borrelial infection and in the differentiation between symptomatic and asymptomatic infections.

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