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Microbiological Features Distinguishing Lyme Disease and Relapsing Fever Spirochetes

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Microbiological Features Distinguishing Lyme Disease and Relapsing Fever Spirochetes Lyme Borreliosis Wien Klin Wochenschr (2018) 130:484–490 https://doi.org/10.1007/s00508-018-1368-2 Microbiological features distinguishing Lyme disease and relapsing fever spirochetes Sven Bergström · Johan Normark Received: 6 July 2018 / Accepted: 13 July 2018 / Published online: 3 August 2018 © The Author(s) 2018 Summary The recent proposal of splitting the genus Keywords Borrelia · Borreliella · Lyme borreliosis · Borrelia into two genera in the newly formed family Relapsing fever · Taxonomy of Borreliaceae,i.e.Borrelia and Borreliella has moti- vated us to reflect upon how these organisms has been Introduction characterized and differentiated. This article therefore aims to take a closer look on the biology and virulence Recent molecular analysis of Borrelia spirochetes attributes of the two suggested genera, i.e. those caus- has suggested a new taxonomic classification. Thus, ing Lyme borreliosis and relapsing fever borreliosis. spirochetes within the family Borreliaceae [1], which Both genera have much in common with similar infec- belongs to the order Spirochetales, has recently tion biological features. They are both characterized been reclassified and now been suggested to con- as bacterial zoonoses, transmitted by hematophagous tain two different genera; Borrelia,andBorreliella arthropods with almost identical microbiological ap- [2]. The genealogical separation of relapsing fever pearance. Nevertheless, a closer look at the genotypic and Lyme disease spirochetes has been debated and and phenotypic characteristics clearly reveals several questioned among researchers, clinicians and stake differences that might motivate the suggested split. holders within the borreliosis community [3, 4]. The On the other hand, a change of this well-established suggested split is based on an in-depth molecular classification within the genus Borrelia might impose analysis of phylogenetic and phenotypic characteris- an economical burden as well as a great confusion in tics, i.e. genome and proteome comparison of the society, including medical and scientific societies as increasingly available omics data. The results from the well as the general population. comparative analyses partly support this separation, which will be further discussed in this review. Although relapsing fever (RF) was described during antiquity it acquired its current name much later. About 430 BC Hippocrates described an epidemic Prof.S.Bergström() fever that was probably related to RF. Several out- Department of Molecular Biology, Umeå University, 6K och breaks of an “epidemic fever” during the following 6L, Sjukhusområdet, 901 87 Umeå, Sweden centuries have been attributed to RF mainly because [email protected] of the disease symptoms [5]. The first description of J. Normark clinical features associated to RF was documented in Department of Clinical Microbiology, Umeå University, the middle of the eighteenth century from an out- Umeå, Sweden break in Ireland. This epidemic spread all over the [email protected] British Isles and the disease was for the first time Prof.S.Bergström labelled “relapsing fever” in 1843 [5, 6]. The dis- Umeå Center for Microbial Research, Umeå University, ease was then further disseminated to the European Umeå, Sweden continent and the USA. The outbreaks continued for Prof.S.Bergström·J.Normark decades and plagued large parts of the world [5]: Molecular Infection Medicine Sweden, Umeå University, however, it is important to remember that at this time Umeå, Sweden other microorganisms could have been the etiologic 484 Microbiological features distinguishing Lyme disease and relapsing fever spirochetes K Lyme Borreliosis agent for this recurrent fever, including Rickettsiae, Nevertheless, Lyme borreliosis is characterized by the malarial parasites or various viruses. None of these deleterious effects on specific tissues, including the historical descriptions are definite but are of course skin, central nervous system, joints and the heart. In interesting from an epidemiological point of view. contrast to the tissue specificity of Lyme disease, re- The suspected RF infection was most often found in lapsing fever (RF) borreliosis initially starts as a blood- poor and overpopulated areas, and therefore the body borne disease and is characterised by a high concen- louse was assumed to spread the disease. The impor- tration of spirochetes in the blood and intermittent tance of the body louse, Pediculus humanus humanus attacks of high fever. In essence, the main disease in transmitting RF was later shown experimentally by manifestation is a recurring fever that coincides with inoculating monkeys with crushed lice from human high numbers of spirochetes in the blood. The severity RF patients [6]. In 1868 the RF microorganism was of the infection ranges from asymptomatic to serious. discovered and described by the German doctor Otto Despite the suggestion to separate the spirochetes Obermeier and initially designated “Spirocheta Ober- of the new family Borreliaceae into two genera, they meieri,” but finally denoted its current name Borrelia still have several general microbiological features in recurrentis [5]. common. They are characteristically spiral shaped, Lyme disease is of much later date, i.e. the date approximately 25–30µm long and 1µm thick [14]. of when the disease was defined and its etiologic A second typical feature of the organisms is the lo- agent was proven and described. The Lyme borre- comotor organ that contains a bundle of flagellae liosis era started when several cases of arthritis were attached to the poles. The flagellae are located in reported and described in 1977 in the town of Old the periplasmic space and wrapped around the cell Lyme,Connecticut,USA.Thiscamefromanepi- cylinder, giving it its characteristic shape [14–16]. The demic of oligoarthritis in children, which first was outer membrane is Gram-negative, meaning that it misdiagnosed as being juvenile arthritis [7]. Inter- has a diderm structure that contains a cytoplasmic- estingly, the patients often developed an expanding and an outer membrane separated by the periplasm skin rash prior to onset of arthritis. Therefore, these [17, 18]. The spirochaetal outer membrane is regarded findings led to the suspicion that the diagnosis was as more fluid than other Gram-negative bacteria with incorrect. This pathognomonic skin rash, termed a 45–62% protein, 23–50% lipid and 3–4% carbo- erythema migrans, was first reported by a Swedish hydrate content [14]. Another important difference dermatologist Arvid Afzelius in the year 1909 [8]. He compared to other Gram-negative bacteria is the ab- suggested that a tick bite caused this particular type of sence of lipopolysaccharides on the outer surface. skin lesion. Similar to the finding by Afzelius, Steere Instead, Borrelia spirocheteshavealargeamount et al. also believed that ticks were involved in the of surface located lipoproteins and as much as ~8% transmission of this novel disease [9]. Therefore, it of the open reading frames in Borreliae encodes for was proposed that the symptoms resulted from trans- lipoproteins [14, 18, 19]. Many of the surface located mission of an infectious agent by an arthropod vector. lipoproteins are thought to be important for the life Subsequently, a spirally formed bacteria could be iso- style of the Borreliae and therefore important factor(s) lated from the American Deer tick, Ixodes scapularis during infection. and a similar organism was later isolated from the blood and cerebrospinal fluid from patients with ery- Virulence factors thema migrans [9–12]. Further microbiological and biochemical characterization of this microorganism Lyme borreliosis Several factors important for the suggested that the spirochete-like organism belonged pathogenesis of the various species within the family to the genus Borrelia. Thus, these investigators now of Borreliaceae has been described and characterised suggested this novel microorganism to be a Borrelia both in vitro and in vivo. Virulence factors are de- spirochete because of its microbiological and micro- fined as any specialized virulence trait that separates scopically resemblance to RF Borrelia. This Borrelia- an infectious bacteria from a non-virulent variant. like spirochete was then named Borrelia burgdorferi Typically, those factors are involved in adhesion, col- after one of its co-discoverers, Willy Burgdorfer [12]. onization, invasion and toxin production. Several virulence factors important for Lyme borreliosis has Basic characteristics been described and investigated during the last few decades. The investigation of Lyme borreliosis vir- The typical symptom of Lyme borreliosis is the char- ulence traits took off with the publication of the acteristic skin rash denoted erythema migrans. Un- B. burgdorferi genome by Fraser et al. [18], and with treated, the disease can in certain individuals dis- the subsequent full genomic annotation in 2000 [20]. seminate and cause symptoms in the nervous system Many unique virulence factors that operate during or joints as well as the more persistent skin disor- Lyme borreliosis have been characterized and de- der acrodermatitis chronica athrophicans. For a more fined. These factors include various outer surface thorough description of the various clinical symptoms molecules that interact with the mammalian host. of Lyme borreliosis see Review by Stanek et al. [13]. Among these are several cell surface outer mem- K Microbiological features distinguishing Lyme disease and relapsing fever spirochetes 485 Lyme Borreliosis
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