Borrelia Burgdorferi in Ixodes Scapularis Ticks, Chicago Area

LETTERS

Borrelia burgdorferi in Ixodes scapularis Ticks, Chicago Area To the Editor: Lyme disease is a multisystem disorder associated with skin, myocardial, musculoskeletal, and central and peripheral nervous system manifestations caused by infection with Borrelia burgdorferi sensu lato spirochetes (1). In the United States, the illness is caused by transmission of B. burgdorferi sensu stricto from the bite of infected Ixodes scapularis (deer) ticks found primari- ly in the northeastern and upper mid- western United States (2). B. burgdorferi–infected ticks have also been recovered in portions of northern Illinois but have not yet been reported in the Chicago region (3). In fact, a Figure. Geographic distribution in Guatemala of horses showing previous infections with West Nile virus (WNV), Saint Louis encephalitis virus (SLEV), or undifferentiated flavivirus previous survey (4) of forested areas as confirmed by plaque reduction neutralization test. Each location may have multiple in the heavily populated regions positive horses. immediately adjacent to Chicago confirmed a low risk of contracting Lyme Maria Eugenia Morales-Betoulle,* tion in human and mosquitoes, Mexico. disease. Researchers failed to recover Herber Morales,† Emerg Infect Dis. 2005;11:1449–52. deer ticks from 7 sampling sites and 4. Calisher CH, Karabatsos N, Dalrymple JM, Bradley J. Blitvich,‡ recovered only a single Borrelia iso- Shope RE, Porterfield JS, Westaway EG, et late from well-described B. burgdor- Ann M. Powers,§ E. Ann Davis,¶ al. Antigenic relationships between fla- Robert Klein,* viviruses as determined by cross-neutral- feri sensu stricto rodent reservoirs and Celia Cordón-Rosales* ization tests with polyclonal antisera. J Gen (mice, voles, chipmunks) captured Virol. 1989;70:37–43. *Universidad del Valle de Guatemala, from 5 sampling sites. A subsequent 5. Cupp EW, Scherer WF, Lok JB, Brenner genetic analysis confirmed the isolate Guatemala City, Guatemala; †Ministry of RJ, Dziem GM, Ordonez JV. Agriculture and Livestock, Guatemala City, Entomological studies at an enzootic was B. bissettii (5), a genomic group Guatemala; ‡Colorado State University, Venezuelan equine encephalitis virus focus that is likely nonpathogenic to Fort Collins, Colorado, USA; §Centers for in Guatemala, 1977–1980. Am J Trop Med humans in the United States. Disease Control and Prevention, Fort Hyg. 1986;35:851–9. However, the area of the Midwest Collins, Colorado, USA; and ¶US 6. Blitvich BJ, Bowen RA, Marlenee NL, Hall Department of Agriculture-Animal and RA, Bunning ML, Beaty BJ. Epitope- where Lyme disease is endemic has Plant Health Inspection Service, blocking enzyme-linked immunosorbent continued to expand from its origin in Guatemala City, Guatemala assays for detection of West Nile virus anti- northeastern Minnesota and north- bodies in domestic mammals. J Clin western Wisconsin (2,6). The Chicago References Microbiol. 2003;41:2676–9. 7. Beaty BJ, Calisher CH, Shope RE. metropolitan region has numerous 1. Komar N, Clark G. West Nile virus activity Arboviruses. In: Lennette EH, Lennette DA, parks and natural areas that are bio- in Latin America and the Caribbean. Rev Lennette ET, editors. Diagnostic procedures logically similar to the known mid- Panam Salud Publica. 2006;19:112–7. for viral, rickettsial, and chlamydial infec- western focus (7), and these areas tions. 7th ed. Washington: American Public 2. Estrada-Franco JG, Navarro-Lopez R, support a large population of white- Beasley DW, Coffey L, Carrara AS, Health Association; 1995. p. 189–212. Travassos da Rosa A, et al. West Nile virus tailed deer. Moreover, we have seen in Mexico: evidence of widespread circula- Address for correspondence: Maria Eugenia anecdotal reports of persons with clin- tion since July 2002. Emerg Infect Dis. Morales-Betoulle, Arbovirology Laboratory, ical signs and symptoms of Lyme dis- 2003;9:1604–7. CDC-CAP, Universidad del Valle de ease and epidemiologic evidence that 3. Elizondo-Quiroga D, Davis TC, Fernandaz- Salas I, Escobar-Lopez R, Olmos DV, Guatemala, Guatemala City, Guatemala; email: suggests local acquisition. Two ticks Gastalum LCS, et al. West Nile virus isola- [email protected] submitted by a resident who had hiked

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 6, June 2006 1039 LETTERS in DuPage County near the east scapularis were collected from the Laragen, Inc., Los Angeles, CA, branch of the DuPage River were I. remaining 2 sites, and spirochetes USA). The sequences were identical scapularis. We therefore began were recovered from 3 (3%) of the to that of B. burgdorferi sensu stricto searching for questing ticks in this tick midgut cultures. Because of these isolate B-31 (9). area and 9 other geographically findings and anecdotal reports of deer The results confirmed that I. diverse areas of DuPage County. The ticks in Cook County, we also sur- scapularis ticks infected with B. 10 sites were flagged by dragging veyed 3 sites in Cook County during burgdorferi sensu stricto were recov- white cotton sheets through the under- the fall of 2005. Deer ticks were not ered from forested areas surrounding brush for 2- to 10-hour intervals dur- found at 2 sites, but 37 adult I. scapu- Chicago. Additional studies to define ing the spring of 2005. We timed these laris ticks were collected from a site the extent and severity of the risk are collections on the basis of information in the southwestern portion of Cook necessary, but clinicians and the pub- that adult deer ticks were questing in County, and spirochetes were recov- lic should be aware of the possibility Wisconsin. Recovered ticks were ered from 2 (5%) cultures. of acquiring Lyme disease in the placed in sealed vials and transported We first examined the protein pro- Chicago metropolitan region. to the North Park University files to identify the spirochetes. Laboratory where their identity was Sodium dodecyl sulfate–polyacry- Acknowledgments confirmed. The midguts were then lamide gel electrophoresis analyses of We thank Joan Bestudik and Linn D. removed aseptically, and each was 4 of the 5 isolates (1 isolate lost via- Haramis for initiating the project; John placed into a separate vial that con- bility before analysis) showed that and Tammie Bouseman, Mike O’Driscoll, tained 2 mL modified Barbour- they were distinctly different from the Curt Colwell, Barb O’Meara, Peter Stoenner-Kelly medium that could B. bissettii isolate recovered previous- Gianakis, Rachael Griffin, and our 16 stu- support the growth of small numbers ly from Cook County (4), but the iso- dent participants for fieldwork; John of B. burgdorferi sensu stricto (8). lates were strikingly similar to B. Bouseman for tick identification; and Cultures were incubated for 6 weeks burgdorferi sensu stricto (Figure). We Steve Callister for guidance and manu- at 35°C and examined weekly for then amplified an intergenic spacer script review. spirochetes by darkfield microscopy. region of the rrf-rrl portion of the Partial funding for this work was Deer ticks were not found at 8 of rRNA from 2 isolates by a previously received from the DuPage County Health the DuPage County sample sites. described method (9) and sequenced Department (to J.A.N.). However, 90 adult or nymphal I. the amplified products (sequencing by

Dean A. Jobe,* Steven D. Lovrich,* Jeffrey A. Nelson,† Tom C. Velat,‡ Chris Anchor,§ Tad Koeune,¶ and Stephen A. Martin, Jr# *Gundersen Lutheran Medical Center, La Crosse, Wisconsin, USA; †North Park University, Chicago, Illinois, USA; ‡Forest Preserve District of DuPage County, Wheaton, Illinois, USA; §Forest Preserve District of Cook County, Elgin, Illinois, USA; ¶DuPage County Department of Health, Wheaton, Illinois, USA; and #Cook County Department of Public Health, Oak Park, Illinois, USA

References

1. Auwaerter PG, Aucott J, Dumler JS. Lyme borreliosis (Lyme disease): molecular and cellular pathobiology and prospects for prevention, diagnosis, and treatment. Expert Rev Mol Med. 2004;6:1–22. 2. Centers for Disease Control and Prevention. Lyme disease—United States, Figure. Protein profiles of Borrelia burgdorferi sensu stricto (lane A), B. bissettii (lane B), 2001–2002. MMWR Morb Mortal Wkly and spirochetes from Ixodes scapularis ticks collected from DuPage County (lanes C, D) Rep. 2004;53:365–8. or Cook County (lanes E, F), Illinois.

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3. Nelson JA, Bouseman JK, Kitron U, H5N1 Influenza A A blood sample was collected from Callister SM, Harrison B, Bankowski MJ, the patient on December 7; anticoagu- et al. Isolation and characterization of Virus and Infected Borrelia burgdorferi from Illinois Ixodes lation was accomplished with ethyl- dammini. J Clin Microbiol. 1991;29: Human Plasma enediaminetetraacetic acid (EDTA) 1732–4. for repeated biochemistry analysis and 4. Callister SM, Nelson JA, Schell RF, Jobe To the Editor: Since January complete blood count. The plasma DA, Bautz R, Agger WA, et al. Survey for 2004, a total of 22 persons have been from the EDTA blood sample was sep- Ixodes spp. and Borrelia burgdorferi in confirmed infected with avian southeastern Wisconsin and northeastern arated 2 days later and stored at –20°C influenza A virus (H5N1) in Thailand; Illinois. J Clin Microbiol. 1991;29:403–6. for 12 days. The sample was subse- 5. Nardelli DT, Cloute JP, Luk KHK, 14 of these patients died. Three waves quently given to the Center of Torrealba J, Warner TF, Callister SM, et al. of outbreaks occurred during the past Excellence in Viral Hepatitis, Faculty CD4+ CD25+ T cells prevent arthritis asso- 2 years. The last patient of the third ciated with Borrelia vaccination and infec- of Medicine, Chulalongkorn wave was a 5-year-old boy whose tion. Clin Diagn Lab Immunol. University, for molecular diagnosis 2005;12:786–92. symptoms developed on November and then stored at –70°C, where spe- 6. Jackson CA, Lovrich SD, Agger WA, 28, 2005; he was hospitalized on cific precautions implemented for han- Callister SM. Reassessment of a midwest- December 5 and died 2 days later. The ern Lyme disease focus for Borrelia dling highly infectious disease speci- child resided in the Ongkharak burgdorferi and the human granulocytic mens such as H5N1 influenza virus ehrlichiosis agent. J Clin Microbiol. District, Nakhon Nayok Province, 70 were observed. Plasma was examined 2002;40:2070–3. km northeast of Bangkok. Villagers by multiplex reverse 7. Guerra M, Walker E, Jones C, Paskewitz S, informed the Department of Cortinas MR, Stancil A, et al. Predicting the transcription–polymerase chain reac- Livestock after the patient’s illness risk of Lyme disease: habitat suitability for tion (RT-PCR) (1) and multiplex real- Ixodes scapularis in the north central was diagnosed. Five dead chickens time RT-PCR (2), both of which United States. Emerg Infect Dis. had been reported in this area from showed positive results for H5N1 2002;8:289–97. November 28 to December 1, 2005. 8. Callister SM, Case KL, Agger WA, Schell virus. The virus titer obtained from the Samples from these chickens could RF, Johnson RC, Ellingson JL. Effects of plasma was 3.08 × 103 copies/mL. The bovine serum albumin on the ability of not be obtained, thus, no H5N1 test- plasma specimen was processed for Barbour-Stoenner-Kelly medium to detect ing was performed. The boy had virus isolation by embryonated egg Borrelia burgdorferi. J Clin Microbiol. fever, headache, and productive 1990;28:363–5. injection, according to the standard cough for 7 days before he was admit- 9. Postic D, Ras NM, Lane RS, Henderson M, protocol described by Harmon (3). Baranton G. Expanded diversity among ted to the Her Royal Highness Briefly, 100 µL 1:2 diluted plasma was Californian Borrelia isolates and descrip- Princess Maha Chakri Sirindhorn injected into the allantoic cavity of a tion of Borrelia bissettii sp. nov. (formerly Medical Center. Clinical examination Borrelia group DN 127). J Clin Microbiol. 9-day-old embryonated egg and incu- and chest radiograph showed evi- 1998;36:3497–504. bated at 37°C. The infected embryo dence of lobar pneumonia. He was died within 48 hours, and the allantoic Address for correspondence: Jeffrey A. treated with antimicrobial drugs fluid was shown to contain 2,048 Nelson, North Park University, 3225 W Foster (midecamycin and penicillin G) and hemagglutinin (HA) units; also, sub- Ave, Chicago, IL 60625, USA; email: supportive care, including oxygen type H5N1 was confirmed (1,2). [email protected] therapy. On December 7, the patient’s Whole genome sequencing was per- condition worsened, and severe pneu- formed and submitted to the GenBank monia with adult respiratory distress database under the strain syndrome developed. Laboratory tests A/Thailand/NK165/05 accession no. showed leukopenia (2,300 DQ 372591-8. The phylogenetic trees 3 cells/mm ), acidosis, and low blood of the HA and neuraminidase (NA) oxygen saturation by cutaneous pulse genes were constructed by using oximetry (81.6%). Oseltamivir was MEGA 3 (4) for comparison with administered after his parents H5N1 viruses isolated from humans, informed hospital staff about the tigers, and chickens from previous boy’s contact with the dead chicken. outbreaks in 2004 and 2005 (Figure). However, the boy died the same day; The sequence analyses of the viruses no autopsy was performed. On showed that the HA cleavage site con- December 9, the cause of death was tained SPQRERRKKR, which dif- declared by the Ministry of Public fered from the 2004 H5N1 virus by an Health to be H5N1 influenza virus. arginine-to-lysine substitution at posi-

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