TY - JOUR
T1 - Surveillance for and Discovery of Borrelia Species in US Patients Suspected of Tickborne Illness
AU - Kingry, Luke C.
AU - Anacker, Melissa
AU - Pritt, Bobbi
AU - Bjork, Jenna
AU - Respicio-Kingry, Laurel
AU - Liu, Gongping
AU - Sheldon, Sarah
AU - Boxrud, David
AU - Strain, Anna
AU - Oatman, Stephanie
AU - Berry, Jon
AU - Sloan, Lynne
AU - Mead, Paul
AU - Neitzel, David
AU - Kugeler, Kiersten J.
AU - Petersen, Jeannine M.
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background. Tick-transmitted Borrelia fall into 2 heterogeneous bacterial complexes comprised of multiple species, the relapsing fever (RF) group and the Borrelia burgdorferi sensu lato group, which are the causative agents of Lyme borreliosis (LB), the most common tickborne disease in the Northern Hemisphere. Geographic expansion of LB in the United States and discovery of emerging Borrelia pathogens underscores the importance of surveillance for disease-causing Borrelia. Methods. De-identifed clinical specimens, submitted by providers throughout the United States, for patients suspected of LB, anaplasmosis, ehrlichiosis, or babesiosis were screened using a Borrelia genus-level TaqMan polymerase chain reaction (PCR). Borrelia species and sequence types (STs) were characterized by multilocus sequence typing (MLST) utilizing next-generation sequencing. Results. Among 7292 specimens tested, 5 Borrelia species were identifed: 2 causing LB, B. burgdorferi (n = 25) and B. mayonii (n = 9), and 3 RF borreliae, B. hermsii (n = 1), B. miyamotoi (n = 8), and Candidatus B. johnsonii (n = 1), a species previously detected only in the bat tick, Carios kelleyi. ST diversity was greatest for B. burgdorferi-positive specimens, with new STs identifed primarily among synovial fluids. Conclusions. Tese results demonstrate that broad PCR screening followed by MLST is a powerful surveillance tool for uncovering the spectrum of disease-causing Borrelia species, understanding their geographic distribution, and investigating the correlation between B. burgdorferi STs and joint involvement. Detection of Candidatus B. johnsonii in a patient with suspected tickborne disease suggests this species may be a previously undetected cause of illness in humans exposed to bat ticks.
AB - Background. Tick-transmitted Borrelia fall into 2 heterogeneous bacterial complexes comprised of multiple species, the relapsing fever (RF) group and the Borrelia burgdorferi sensu lato group, which are the causative agents of Lyme borreliosis (LB), the most common tickborne disease in the Northern Hemisphere. Geographic expansion of LB in the United States and discovery of emerging Borrelia pathogens underscores the importance of surveillance for disease-causing Borrelia. Methods. De-identifed clinical specimens, submitted by providers throughout the United States, for patients suspected of LB, anaplasmosis, ehrlichiosis, or babesiosis were screened using a Borrelia genus-level TaqMan polymerase chain reaction (PCR). Borrelia species and sequence types (STs) were characterized by multilocus sequence typing (MLST) utilizing next-generation sequencing. Results. Among 7292 specimens tested, 5 Borrelia species were identifed: 2 causing LB, B. burgdorferi (n = 25) and B. mayonii (n = 9), and 3 RF borreliae, B. hermsii (n = 1), B. miyamotoi (n = 8), and Candidatus B. johnsonii (n = 1), a species previously detected only in the bat tick, Carios kelleyi. ST diversity was greatest for B. burgdorferi-positive specimens, with new STs identifed primarily among synovial fluids. Conclusions. Tese results demonstrate that broad PCR screening followed by MLST is a powerful surveillance tool for uncovering the spectrum of disease-causing Borrelia species, understanding their geographic distribution, and investigating the correlation between B. burgdorferi STs and joint involvement. Detection of Candidatus B. johnsonii in a patient with suspected tickborne disease suggests this species may be a previously undetected cause of illness in humans exposed to bat ticks.
KW - Borrelia
KW - Lyme disease
KW - amplicon sequencing
KW - molecular surveillance
KW - relapsing fever
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UR - http://www.scopus.com/inward/citedby.url?scp=85048002705&partnerID=8YFLogxK
U2 - 10.1093/cid/cix1107
DO - 10.1093/cid/cix1107
M3 - Article
C2 - 29272385
AN - SCOPUS:85048002705
SN - 1058-4838
VL - 66
SP - 1864
EP - 1871
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -