Tick-Borne Infections in Humans Aspects of Immunopathogenesis

Total Page:16

File Type:pdf, Size:1020Kb

Tick-Borne Infections in Humans Aspects of Immunopathogenesis Linköping University Medical Dissertations No. 1315 Tick-Borne Infections in Humans Aspects of immunopathogenesis, diagnosis and co-infections with Borrelia burgdorferi and Anaplasma phagocytophilum Marika Nordberg Division of Infectious Diseases and Clinical Immunology Department of Clinical and Experimental Medicine Faculty of Health Sciences Linköping University, Sweden Linköping 2012 Marika Nordberg, 2012 Cover photo: Mari-Anne Åkeson, Bengt-Arne Fredriksson, Linköping University, Sweden. Published articles have been reprinted with the permission of the respective copyright holders. Printed in Sweden by LiU-Tryck, Linköping, Sweden, 2012 ISBN 978-91-7519-852-1 ISSN 0345-0082 To my family worldwide För att man ska kunna flyga måste modet vara aningen större än rädslan och en gynnsam vind råda Ur: Instruktion för skalbaggar/ Margareta Ekstrand “The Borrelia war” by Aaron Nordberg, seven years old 2009. The immune system fight- ing against the Borrelia bacteria. Contents CONTENTS ABSTRACT .................................................................................................................... 1 SAMMANFATTNING PÅ SVENSKA ......................................................................... 3 LIST OF PAPERS ........................................................................................................... 5 ABBREVIATIONS ......................................................................................................... 6 INTRODUCTION ........................................................................................................... 7 Framework and context ............................................................................................ 7 Tick-borne infections ................................................................................................ 8 Tick – the vector ....................................................................................................... 9 Lyme borreliosis ..................................................................................................... 10 Borrelia burgdorferi sensu lato – the pathogen ..................................................... 11 Epidemiology.......................................................................................................... 12 Tick-borne infections on the Åland Islands ...................................................... 13 Clinical manifestations of Lyme borreliosis .......................................................... 14 Erythema migrans ............................................................................................ 15 Lymphocytoma .................................................................................................. 17 Acrodermatitis chronica atrophicans ............................................................... 17 Neuroborreliosis ............................................................................................... 18 Lyme arthritis ................................................................................................... 19 Other Lyme borreliosis manifestations ............................................................ 19 Laboratory methods of detecting B. burgdorferi .................................................... 20 Direct detection ................................................................................................ 20 Indirect detection .............................................................................................. 21 Treatment ................................................................................................................ 23 Persisting symptoms after treatment ................................................................ 24 Human granulocytic anaplasmosis (HGA) ............................................................. 25 Anaplasma phagocytophilum – the pathogen ......................................................... 25 Epidemiology.......................................................................................................... 27 Clinical manifestations of HGA ............................................................................. 28 Methods of detecting A. phagocytophilum ............................................................. 29 Contents Direct detection ................................................................................................ 29 Indirect detection .............................................................................................. 30 Treatment ................................................................................................................ 31 Differences between Europe and the USA ............................................................. 32 Tick-borne encephalitis (TBE) ............................................................................... 32 Epidemiology.......................................................................................................... 33 Clinical manifestations of TBE .............................................................................. 34 Co-infections and other tick-borne infections ........................................................ 34 Co-infections and immunology ......................................................................... 35 Immunology ............................................................................................................ 36 Innate immune system ...................................................................................... 36 Adaptive immune system .................................................................................. 38 T helper cell subpopulations ............................................................................ 38 Cytotoxic mechanisms ...................................................................................... 40 Cytokines and chemokines ................................................................................ 42 Immunology of Lyme borreliosis ...................................................................... 44 Immunology of human granulocytic anaplasmosis .......................................... 46 HYPOTHESIS ............................................................................................................... 49 AIMS ............................................................................................................................. 50 MATERIALS AND METHODS .................................................................................. 51 Subjects (paper I-IV) .............................................................................................. 51 Patients and controls ........................................................................................ 51 Case definitions used in this thesis ................................................................... 55 Excluded subjects ............................................................................................. 57 Controls ............................................................................................................ 58 Evaluation of data ............................................................................................ 58 Methods .................................................................................................................. 59 Borrelia antibody analyses in serum (Papers I-IV) ......................................... 59 CSF analyses (Papers II, IV) ............................................................................ 59 TBEV serology .................................................................................................. 59 Preparation of cells in blood and CSF (Papers I, II, IV) ................................. 60 Preparation of Borrelia outer surface protein antigen (Papers I, II, IV) ........ 60 ELISPOT- enzyme-linked immunospot assay (Papers I, II, IV) ....................... 60 Contents Indirect immunofluorescence assay (Paper III) ............................................... 64 Polymerase chain reaction (Paper III) ............................................................ 66 Statistics .................................................................................................................. 68 Ethical considerations ............................................................................................. 68 RESULTS AND DISCUSSION .................................................................................... 69 Lyme neuroborreliosis; clinical manifestations, immunopathogenesis and diagnostic aspects (Papers II, IV) ........................................................................... 69 Patient characteristics (Papers II, IV) ............................................................. 69 Clinical manifestations of Lyme neuroborreliosis (Paper II) .......................... 69 Immune responses in adults with Lyme neuroborreliosis (Paper II) ............... 72 IL-17 in CSF in patients diagnosed with LNB (Paper II) ................................ 75 ELISPOT assay in laboratory diagnosis of Lyme neuroborreliosis in clinical practice (Paper IV) .............................................................................. 77 Diagnostic performance of ELISPOT-test ....................................................... 78 Methodological considerations – ELISPOT assay ........................................... 79 Tick-borne co-infections; epidemiology and immunological mechanisms (Papers I, III) ..........................................................................................................
Recommended publications
  • Naeglaria and Brain Infections
    Can bacteria shrink tumors? Cancer Therapy: The Microbial Approach n this age of advanced injected live Streptococcus medical science and into cancer patients but after I technology, we still the recipients unfortunately continue to hunt for died from subsequent innovative cancer therapies infections, Coley decided to that prove effective and safe. use heat killed bacteria. He Treatments that successfully made a mixture of two heat- eradicate tumors while at the killed bacterial species, By Alan Barajas same time cause as little Streptococcus pyogenes and damage as possible to normal Serratia marcescens. This Alani Barajas is a Research and tissue are the ultimate goal, concoction was termed Development Technician at Hardy but are also not easy to find. “Coley’s toxins.” Bacteria Diagnostics. She earned her bachelor's degree in Microbiology at were either injected into Cal Poly, San Luis Obispo. The use of microorganisms in tumors or into the cancer therapy is not a new bloodstream. During her studies at Cal Poly, much idea but it is currently a of her time was spent as part of the undergraduate research team for the buzzing topic in cancer Cal Poly Dairy Products Technology therapy research. Center studying spore-forming bacteria in dairy products. In the late 1800s, German Currently she is working on new physicians W. Busch and F. chromogenic media formulations for Fehleisen both individually Hardy Diagnostics, both in the observed that certain cancers prepared and powdered forms. began to regress when patients acquired accidental erysipelas (cellulitis) caused by Streptococcus pyogenes. William Coley was the first to use New York surgeon William bacterial injections to treat cancer www.HardyDiagnostics.com patients.
    [Show full text]
  • Diagnostic Code Descriptions (ICD9)
    INFECTIONS AND PARASITIC DISEASES INTESTINAL AND INFECTIOUS DISEASES (001 – 009.3) 001 CHOLERA 001.0 DUE TO VIBRIO CHOLERAE 001.1 DUE TO VIBRIO CHOLERAE EL TOR 001.9 UNSPECIFIED 002 TYPHOID AND PARATYPHOID FEVERS 002.0 TYPHOID FEVER 002.1 PARATYPHOID FEVER 'A' 002.2 PARATYPHOID FEVER 'B' 002.3 PARATYPHOID FEVER 'C' 002.9 PARATYPHOID FEVER, UNSPECIFIED 003 OTHER SALMONELLA INFECTIONS 003.0 SALMONELLA GASTROENTERITIS 003.1 SALMONELLA SEPTICAEMIA 003.2 LOCALIZED SALMONELLA INFECTIONS 003.8 OTHER 003.9 UNSPECIFIED 004 SHIGELLOSIS 004.0 SHIGELLA DYSENTERIAE 004.1 SHIGELLA FLEXNERI 004.2 SHIGELLA BOYDII 004.3 SHIGELLA SONNEI 004.8 OTHER 004.9 UNSPECIFIED 005 OTHER FOOD POISONING (BACTERIAL) 005.0 STAPHYLOCOCCAL FOOD POISONING 005.1 BOTULISM 005.2 FOOD POISONING DUE TO CLOSTRIDIUM PERFRINGENS (CL.WELCHII) 005.3 FOOD POISONING DUE TO OTHER CLOSTRIDIA 005.4 FOOD POISONING DUE TO VIBRIO PARAHAEMOLYTICUS 005.8 OTHER BACTERIAL FOOD POISONING 005.9 FOOD POISONING, UNSPECIFIED 006 AMOEBIASIS 006.0 ACUTE AMOEBIC DYSENTERY WITHOUT MENTION OF ABSCESS 006.1 CHRONIC INTESTINAL AMOEBIASIS WITHOUT MENTION OF ABSCESS 006.2 AMOEBIC NONDYSENTERIC COLITIS 006.3 AMOEBIC LIVER ABSCESS 006.4 AMOEBIC LUNG ABSCESS 006.5 AMOEBIC BRAIN ABSCESS 006.6 AMOEBIC SKIN ULCERATION 006.8 AMOEBIC INFECTION OF OTHER SITES 006.9 AMOEBIASIS, UNSPECIFIED 007 OTHER PROTOZOAL INTESTINAL DISEASES 007.0 BALANTIDIASIS 007.1 GIARDIASIS 007.2 COCCIDIOSIS 007.3 INTESTINAL TRICHOMONIASIS 007.8 OTHER PROTOZOAL INTESTINAL DISEASES 007.9 UNSPECIFIED 008 INTESTINAL INFECTIONS DUE TO OTHER ORGANISMS
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Borrelia Burgdorferi Sensu Lato in Questing and Engorged Ticks from Different Habitat Types in Southern Germany
    microorganisms Article Borrelia burgdorferi Sensu Lato in Questing and Engorged Ticks from Different Habitat Types in Southern Germany Cristian Răileanu 1,† , Cornelia Silaghi 1,2,*,†, Volker Fingerle 3 , Gabriele Margos 3, Claudia Thiel 2, Kurt Pfister 2 and Evelyn Overzier 2 1 Institute of Infectology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany; cristian.raileanu@fli.de 2 Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universität München, 80805 Munich, Germany; [email protected] (C.T.); kurt.pfi[email protected] (K.P.); [email protected] (E.O.) 3 National Reference Center for Borrelia, Bavarian Health and Food Safety Authority (LGL), 85764 Oberschleißheim, Germany; volker.fi[email protected] (V.F.); [email protected] (G.M.) * Correspondence: cornelia.silaghi@fli.de † Contributed equally. Abstract: Borrelia burgdorferi sensu lato (s.l.) causes the most common tick-borne infection in Europe, with Germany being amongst the countries with the highest incidences in humans. This study aimed at (1) comparing infection rates of B. burgdorferi s.l. in questing Ixodes ricinus ticks from different habitat types in Southern Germany, (2) analysing genospecies distribution by habitat type, and (3) Citation: R˘aileanu,C.; Silaghi, C.; testing tissue and ticks from hosts for B. burgdorferi s.l. Questing ticks from urban, pasture, and natural Fingerle, V.; Margos, G.; Thiel, C.; habitats together with feeding ticks from cattle (pasture) and ticks and tissue samples from wild boars Pfister, K.; Overzier, E. Borrelia and roe deer (natural site) were tested by PCR and RFLP for species differentiation.
    [Show full text]
  • Skin and Soft Tissue Infections Ohsuerin Bonura, MD, MCR Oregon Health & Science University Objectives
    Difficult Skin and Soft tissue Infections OHSUErin Bonura, MD, MCR Oregon Health & Science University Objectives • Compare and contrast the epidemiology and clinical presentation of common skin and soft tissue diseases • State the management for skin and soft tissue infections OHSU• Differentiate true infection from infectious disease mimics of the skin Casey Casey is a 2 year old boy who presents with this rash. What is the best treatment? A. Soap and Water B. Ibuprofen, it will self OHSUresolve C. Dicloxacillin D. Mupirocin OHSUImpetigo Impetigo Epidemiology and Treatment OHSU Ellen Ellen is a 54 year old morbidly obese woman with DM, HTN and venous stasis who presented with a painful left leg and fever. She has had 3 episodes in the last 6 months. What do you recommend? A. Cefazolin followed by oral amoxicillin prophylaxis B. Vancomycin – this is likely OHSUMRSA C. Amoxicillin – this is likely erysipelas D. Clindamycin to cover staph and strep cellulitis Impetigo OHSUErysipelas Erysipelas Risk: lymphedema, stasis, obesity, paresis, DM, ETOH OHSURecurrence rate: 30% in 3 yrs Treatment: Penicillin Impetigo Erysipelas OHSUCellulitis Cellulitis • DEEPER than erysipelas • Microbiology: – 6-48hrs post op: think GAS… too early for staph (days in the making)! – Periorbital – Staph, Strep pneumoniae, GAS OHSU– Post Varicella - GAS – Skin popping – Staph + almost anything! Framework for Skin and Soft Tissue Infections (SSTIs) NONPurulent Purulent Necrotizing/Cellulitis/Erysipelas Furuncle/Carbuncle/Abscess Severe Moderate Mild Severe Moderate Mild I&D I&D I&D I&D IV Rx Oral Rx C&S C&S C&S C&S Vanc + Pip-tazo OHSUEmpiric IV Empiric MRSA Oral MRSA TMP/SMX Doxy What Are Your “Go-To” Oral Options For Non-Purulent SSTI? Amoxicillin Doxycycline OHSUCephalexin Doxycycline Trimethoprim-Sulfamethoxazole OHSU Miller LG, et al.
    [Show full text]
  • Early History of Infectious Disease 
    © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION CHAPTER ONE EARLY HISTORY OF INFECTIOUS 1 DISEASE Kenrad E. Nelson, Carolyn F. Williams Epidemics of infectious diseases have been documented throughout history. In ancient Greece and Egypt accounts describe epidemics of smallpox, leprosy, tuberculosis, meningococcal infections, and diphtheria.1 The morbidity and mortality of infectious diseases profoundly shaped politics, commerce, and culture. In epidemics, none were spared. Smallpox likely disfigured and killed Ramses V in 1157 BCE, although his mummy has a significant head wound as well.2 At times political upheavals exasperated the spread of disease. The Spartan wars caused massive dislocation of Greeks into Athens triggering the Athens epidemic of 430–427 BCE that killed up to one half of the population of ancient Athens.3 Thucydides’ vivid descriptions of this epidemic make clear its political and cultural impact, as well as the clinical details of the epidemic.4 Several modern epidemiologists have hypothesized on the causative agent. Langmuir et al.,5 favor a combined influenza and toxin-producing staphylococcus epidemic, while Morrens and Chu suggest Rift Valley Fever.6 A third researcher, Holladay believes the agent no longer exists.7 From the earliest times, man has sought to understand the natural forces and risk factors affecting the patterns of illness and death in society. These theories have evolved as our understanding of the natural world has advanced, sometimes slowly, sometimes, when there are profound break- throughs, with incredible speed. Remarkably, advances in knowledge and changes in theory have not always proceeded in synchrony. Although wrong theories or knowledge have hindered advances in understanding, there are also examples of great creativity when scientists have successfully pursued their theories beyond the knowledge of the time.
    [Show full text]
  • Listeriosis (“Circling Disease”) Extended Version
    Zuku Review FlashNotesTM Listeriosis (“circling disease”) Extended Version Classic case: Silage-fed adult cow, head tilt, circling, asymmetric sensation loss on face Presentation: Signalment and History Adult cattle, sheep, goats, (possibly camelids) . Indoors in winter with feeding of silage . Extremely rare in horses Poultry and pet birds Human listeria outbreaks Clinical signs (mammals) Head tilt Circling Dullness Sensory and motor dysfunction of trigeminal nerve . Asymmetric sensory loss on face . Weak jaw closure Purulent ophthalmitis Exposure keratitis Isolation from rest of herd Ocular and nasal discharge Listeriosis in a Holstein. Food remaining in mouth Note the head tilt and drooped ear Bloat Marked somnolence Tetraparesis, ataxia Poor to absent palpebral reflexes Difficulty swallowing/poor gag reflex Tongue paresis Obtundation, semicoma, death Clinical signs (avian listeriosis) Often subclinical Older birds and poultry (septicemia) . Depression, lethargy . Sudden death Younger birds and poultry (chronic form) . Torticollis . Paresis/paralysis DDX: Listeriosis in an ataxic goat Mammals Brainstem abscess, basilar empyema, otitis media/interna, Maedi-Visna, rabies, caprine arthritis-encephalitis, Parelaphostrongylus tenuis, scrapie Avian Colibacillosis, pasteurellosis, erysipelas, velogenic viscerotropic Newcastle disease 1 Zuku Review FlashNotesTM Listeriosis (“circling disease”) Extended Version Test(s) of choice: Mammals-Clinical signs and Cerebrospinal fluid (CSF) analysis . Mononuclear pleocytosis,
    [Show full text]
  • Lyme Disease: Diversity of Borrelia Species in California and Mexico Detected Using a Novel Immunoblot Assay
    healthcare Article Lyme Disease: Diversity of Borrelia Species in California and Mexico Detected Using a Novel Immunoblot Assay Melissa C. Fesler 1, Jyotsna S. Shah 2, Marianne J. Middelveen 3, Iris Du Cruz 2, Joseph J. Burrascano 2 and Raphael B. Stricker 1,* 1 Union Square Medical Associates, 450 Sutter Street, Suite 1504, San Francisco, CA 94108, USA; [email protected] 2 IGeneX Reference Laboratory, Milpitas, CA 95035, USA; [email protected] (J.S.S.); [email protected] (I.D.C.); [email protected] (J.J.B.) 3 Atkins Veterinary Services, Calgary, AB, T3B 4C9, Canada; [email protected] * Correspondence: [email protected] Received: 7 March 2020; Accepted: 10 April 2020; Published: 14 April 2020 Abstract: Background: With more than 300,000 new cases reported each year in the United States of America (USA), Lyme disease is a major public health concern. Borrelia burgdorferi sensu stricto (Bbss) is considered the primary agent of Lyme disease in North America. However, multiple genetically diverse Borrelia species encompassing the Borrelia burgdorferi sensu lato (Bbsl) complex and the Relapsing Fever Borrelia (RFB) group are capable of causing tickborne disease. We report preliminary results of a serological survey of previously undetected species of Bbsl and RFB in California and Mexico using a novel immunoblot technique. Methods: Serum samples were tested for seroreactivity to specific species of Bbsl and RFB using an immunoblot method based on recombinant Borrelia membrane proteins, as previously described. A sample was recorded as seropositive if it showed immunoglobulin M (IgM) and/or IgG reactivity with at least two proteins from a specific Borrelia species.
    [Show full text]
  • Identification of Borrelia Burgdorferigenospecies Isolated
    Annals of Agricultural and Environmental Medicine 2015, Vol 22, No 4, 637–641 ORIGINAL ARTICLE www.aaem.pl Identification ofBorrelia burgdorferi genospecies isolated from Ixodes ricinus ticks in the South Moravian region of the Czech Republic Ondřej Bonczek1,2, Alena Žákovská3, Lýdia Vargová1, Omar Šerý1,2 1 Laboratory of DNA diagnostics, Department of Biochemistry, Faculty of Science, Masaryk University, Brno, Czech Republic 2 Laboratory of Animal Embryology, Institute of Animal Physiology and Genetics, The Academy of Sciences of The Czech Republic, Brno, Czech Republic 3 Department of Comparative Animal Physiology and General Zoology, Faculty of Science, Masaryk University, Brno, Czech Republic Bonczek O, Žákovská A, Vargová L, Šerý O. Identification of Borrelia burgdorferi genospecies isolated from Ixodes ricinus ticks in the South Moravian region of the Czech Republic. Ann Agric Environ Med. 2015; 22(4): 637–641. doi: 10.5604/12321966.1185766 Abstract Introduction. During 2008–2012, a total of 466 ticks Ixodes ricinus removed from humans were collected and tested for the presence of Borrelia burgdorferi sensu lato (Bbsl). Ticks were collected in all districts of the South Moravian region of the Czech Republic (CZ). Objective. The aim of this study was to determine the infestation of Bbsl in ticks Ixodes ricinus and the identification of genospecies of Bbsl group by DNA sequencing. Material and methods. DNA isolation from homogenates was performed by UltraClean BloodSpin DNA kit (MoBio) and by automated instrument Prepito (Perkin-Elmer). Detection of spirochetes was carried out by RealTime PCR kit EliGene Borrelia LC (Elisabeth Pharmacon). Finally, all the positive samples were sequenced on an ABI 3130 Genetic Analyzer (Life Technologies) and identified in the BLAST (NCBI) database.
    [Show full text]
  • Circulation of Pathogenic Spirochetes in the Genus Borrelia
    CIRCULATION OF PATHOGENIC SPIROCHETES IN THE GENUS BORRELIA WITHIN TICKS AND SEABIRDS IN BREEDING COLONIES OF NEWFOUNDLAND AND LABRADOR by © Hannah Jarvis Munro A Thesis submitted to the School of Graduate Studies in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Biology Memorial University of Newfoundland May 2018 St. John’s, Newfoundland and Labrador ABSTRACT Birds are the reservoir hosts of Borrelia garinii, the primary causative agent of neurological Lyme disease. In 1991 it was also discovered in the seabird tick, Ixodes uriae, in a seabird colony in Sweden, and subsequently has been found in seabird ticks globally. In 2005, the bacterium was found in seabird colonies in Newfoundland and Labrador (NL); representing its first documentation in the western Atlantic and North America. In this thesis, aspects of enzootic B. garinii transmission cycles were studied at five seabird colonies in NL. First, seasonality of I. uriae ticks in seabird colonies observed from 2011 to 2015 was elucidated using qualitative model-based statistics. All instars were found throughout the June-August study period, although larvae had one peak in June, and adults had two peaks (in June and August). Tick numbers varied across sites, year, and with climate. Second, Borrelia transmission cycles were explored by polymerase chain reaction (PCR) to assess Borrelia spp. infection prevalence in the ticks and by serological methods to assess evidence of infection in seabirds. Of the ticks, 7.5% were PCR-positive for B. garinii, and 78.8% of seabirds were sero-positive, indicating that B. garinii transmission cycles are occurring in the colonies studied.
    [Show full text]
  • The Management of Cellulitis and Erysipelas at an Academic
    Emergency Care Journal 2017; volume 13:6343 The management of cellulitis and erysipelas at an academic Introduction Correspondence: Jeff Martin, Department of Visits for cellulitis and erysipelas repre- Family Medicine, Queen’s University, emergency department: current Kingston, 76 Stuart St, Kingston, ON K7L sent a large proportion of cases seen by practice versus the literature 2V7, Canada. emergency physicians. Basic emergency Tel: +613-548-3232. department management consists of antibi- E-mail: [email protected] Jeffrey W. Martin,1 Ruth Wilson,1 otics and appropriate supportive care, deter- Tim Chaplin2 mining if an admission to hospital is neces- Key words: Cellulitis, Antibiotics, Emergency medicine. 1Department of Family Medicine, Queen’s sary, and arranging appropriate follow-up. Antibiotic therapy targeted against beta- University, Kingston, Ontario; Acknowledgements: we thank David Barber hemolytic streptococci and Staphylococcus 2Department of Emergency Medicine, for assisting with electronic medical record aureus, methicillin-sensitive or methicillin- data collection. Queen’s University, Kingston, Ontario, resistant, is the mainstay of treatment for 1 Canada children and adults with these infections. Contributions: JWM contributed to study con- However, overall severity of illness and cept and design, acquisition of the data, analy- underlying comorbidities ultimately deter- sis and interpretation of the data, drafting of mine variables such as delivery route, the manuscript, and critical revision of the dosage, frequency, and class of agent.2 manuscript for important intellectual content. Abstract CRW and TC contributed to study concept and Cephalexin, a first generation design, critical revision of the manuscript for Cellulitis and erysipelas are common cephalosporin, is the preferred oral antibiot- important intellectual content, and study presentations to emergency departments ic for uncomplicated cellulitis without supervision.
    [Show full text]
  • And Intra-Specific Pan-Genomes of Borrelia Burgdorferi
    Mongodin et al. BMC Genomics 2013, 14:693 http://www.biomedcentral.com/1471-2164/14/693 RESEARCH ARTICLE Open Access Inter- and intra-specific pan-genomes of Borrelia burgdorferi sensu lato: genome stability and adaptive radiation Emmanuel F Mongodin1*, Sherwood R Casjens2, John F Bruno3, Yun Xu3, Elliott Franco Drabek1, David R Riley1, Brandi L Cantarel1, Pedro E Pagan4, Yozen A Hernandez4, Levy C Vargas4, John J Dunn5ˆ, Steven E Schutzer6, Claire M Fraser1, Wei-Gang Qiu4* and Benjamin J Luft3* Abstract Background: Lyme disease is caused by spirochete bacteria from the Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) species complex. To reconstruct the evolution of B. burgdorferi s.l. and identify the genomic basis of its human virulence, we compared the genomes of 23 B. burgdorferi s.l. isolates from Europe and the United States, including B. burgdorferi sensu stricto (B. burgdorferi s.s., 14 isolates), B. afzelii (2), B. garinii (2), B. “bavariensis” (1), B. spielmanii (1), B. valaisiana (1), B. bissettii (1), and B. “finlandensis” (1). Results: Robust B. burgdorferi s.s. and B. burgdorferi s.l. phylogenies were obtained using genome-wide single-nucleotide polymorphisms, despite recombination. Phylogeny-based pan-genome analysis showed that the rate of gene acquisition was higher between species than within species, suggesting adaptive speciation. Strong positive natural selection drives the sequence evolution of lipoproteins, including chromosomally-encoded genes 0102 and 0404, cp26-encoded ospC and b08, and lp54-encoded dbpA, a07, a22, a33, a53, a65. Computer simulations predicted rapid adaptive radiation of genomic groups as population size increases. Conclusions: Intra- and inter-specific pan-genome sizes of B.
    [Show full text]