Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study

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• 作者：Bobbi S Pritt ; MD^a ; ^{pritt.bobbi@mayo.edu" class="auth_mail" title="E-mail the corresponding author} ; Paul S Mead ; MD^b ; Diep K Hoang Johnson ; BS^c ; David F Neitzel ; MS^d ; Laurel B Respicio-Kingry ; MS^b ; Prof Jeffrey P Davis ; MD^c ; Elizabeth Schiffman ; MPH^d ; Lynne M Sloan ; MT^a ; Martin E Schriefer ; PhD^b ; Adam J Replogle ; BS^b ; Prof Susan M Paskewitz ; PhD^e ; Julie A Ray ; MPH^a ; ^d ; Jenna Bjork ; DVM^d ; Christopher R Steward ; MPH^c ; Alecia Deedon ; BS^c ; Xia Lee ; MS^e ; Luke C Kingry ; PhD^b ; Tracy K Miller ; PhD^f ; Michelle A Feist ; BS^f ; Elitza S Theel ; PhD^a ; Prof Robin Patel ; MD^a ; Cole L Irish ; BS^a ; Jeannine M Petersen ; PhD^b
• 刊名：The Lancet Infectious Diseases
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：16
• 期：5
• 页码：556-564
• 全文大小：1206 K

文摘

Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is a multisystem disease caused by m>Borrelia burgdorferim> sensu lato genospecies and characterised by tissue localisation and low spirochaetaemia. In this study we aimed to describe a novel m>Borreliam> species causing Lyme borreliosis in the USA.

Methods

At the Mayo clinic, from 2003 to 2014, we tested routine clinical diagnostic specimens from patients in the USA with PCR targeting the m>oppA1m> gene of m>B burgdorferim> sensu lato. We identified positive specimens with an atypical PCR result (melting temperature outside of the expected range) by sequencing, microscopy, or culture. We collected m>Ixodes scapularism> ticks from regions of suspected patient tick exposure and tested them by m>oppA1m> PCR.

Findings

100 545 specimens were submitted by physicians for routine PCR from Jan 1, 2003 to Sept 30, 2014. From these samples, six clinical specimens (five blood, one synovial fluid) yielded an atypical m>oppA1m> PCR product, but no atypical results were detected before 2012. Five of the six patients with atypical PCR results had presented with fever, four had diffuse or focal rash, three had symptoms suggestive of neurological inclusion, and two were admitted to hospital. The sixth patient presented with knee pain and swelling. Motile spirochaetes were seen in blood samples from one patient and cultured from blood samples from two patients. Among the five blood specimens, the median m>oppA1m> copy number was 180 times higher than that in 13 specimens that tested positive for m>B burgdorferim> sensu stricto during the same time period. Multigene sequencing identified the spirochaete as a novel m>B burgdorferim> sensu lato genospecies. This same genospecies was detected in ticks collected at a probable patient exposure site.

Interpretation

We describe a new pathogenic m>Borrelia burgdorferim> sensu lato genospecies (candidatus m>Borrelia mayoniim>) in the upper midwestern USA, which causes Lyme borreliosis with unusually high spirochaetaemia. Clinicians should be aware of this new m>B burgdorferim> sensu lato genospecies, its distinct clinical features, and the usefulness of m>oppA1m> PCR for diagnosis.

Funding

US Centers for Disease Control and Prevention Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement and Mayo Clinic Small Grant programme.