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Replogle AJ, Sexton C, Young J, Kingry LC, Schriefer ME, Dolan M, Johnson TL, Connally NP, Padgett KA, Petersen JM. Isolation of Borrelia miyamotoi and other Borreliae using a modified BSK medium. Sci Rep 2021; 11:1926. [PMID: 33479281 PMCID: PMC7820315 DOI: 10.1038/s41598-021-81252-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
Borrelia spirochetes are the causative agents of Lyme borreliosis (LB) and relapsing fever (RF). Despite the steady rise in infections and the identification of new species causing human illness over the last decade, isolation of borreliae in culture has become increasingly rare. A modified Barbour-Stoenner-Kelly (BSK) media formulation, BSK-R, was developed for isolation of the emerging RF pathogen, Borrelia miyamotoi. BSK-R is a diluted BSK-II derivative supplemented with Lebovitz’s L-15, mouse and fetal calf serum. Decreasing the concentration of CMRL 1066 and other components was essential for growth of North American B. miyamotoi. Sixteen B. miyamotoi isolates, originating from Ixodes scapularis ticks, rodent and human blood collected in the eastern and upper midwestern United States, were isolated and propagated to densities > 108 spirochetes/mL. Growth of five other RF and ten different LB borreliae readily occurred in BSK-R. Additionally, primary culture recovery of 20 isolates of Borrelia hermsii, Borrelia turicatae, Borrelia burgdorferi and Borrelia mayonii was achieved in BSK-R using whole blood from infected patients. These data indicate this broadly encompassing borreliae media can aid in in vitro culture recovery of RF and LB spirochetes, including the direct isolation of new and emerging human pathogens.
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Affiliation(s)
- Adam J Replogle
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA
| | - Christopher Sexton
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA
| | - John Young
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA
| | - Luke C Kingry
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA
| | - Martin E Schriefer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA
| | - Marc Dolan
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA
| | - Tammi L Johnson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA.,Texas A&M AgriLife Research, Uvalde, TX, 78801, USA
| | - Neeta P Connally
- Department of Biological and Environmental Sciences, Western Connecticut State University, Danbury, CT, 06810, USA
| | - Kerry A Padgett
- California Department of Public Health, Infectious Diseases Branch/Vector-Borne Disease Section, Marina Bay Parkway, Richmond, CA, 94804, USA
| | - Jeannine M Petersen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, 80521, USA.
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2
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Schutzer SE, Body BA, Boyle J, Branson BM, Dattwyler RJ, Fikrig E, Gerald NJ, Gomes-Solecki M, Kintrup M, Ledizet M, Levin AE, Lewinski M, Liotta LA, Marques A, Mead PS, Mongodin EF, Pillai S, Rao P, Robinson WH, Roth KM, Schriefer ME, Slezak T, Snyder JL, Steere AC, Witkowski J, Wong SJ, Branda JA. Direct Diagnostic Tests for Lyme Disease. Clin Infect Dis 2019; 68:1052-1057. [PMID: 30307486 PMCID: PMC6399434 DOI: 10.1093/cid/ciy614] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/03/2018] [Indexed: 12/15/2022] Open
Abstract
Borrelia burgdorferi was discovered to be the cause of Lyme disease in 1983, leading to seroassays. The 1994 serodiagnostic testing guidelines predated a full understanding of key B. burgdorferi antigens and have a number of shortcomings. These serologic tests cannot distinguish active infection, past infection, or reinfection. Reliable direct-detection methods for active B. burgdorferi infection have been lacking in the past but are needed and appear achievable. New approaches have effectively been applied to other emerging infections and show promise in direct detection of B. burgdorferi infections.
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Affiliation(s)
- Steven E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Newark,Correspondence: S. E. Schutzer, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103 ()
| | - Barbara A Body
- Laboratory Corporation of America, Burlington, North Carolina,Retired
| | | | | | | | - Erol Fikrig
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Noel J Gerald
- Office of In Vitro Diagnostics and Radiological Health, Food and Drug Administration, Department of Health and Human Services, Silver Spring, Maryland
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis
| | | | | | | | | | - Lance A Liotta
- Center for Applied Proteomics and Molecular Medicine, College of Science, George Mason University, Manassas, Virginia
| | - Adriana Marques
- Clinical Studies Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul S Mead
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Emmanuel F Mongodin
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Segaran Pillai
- Office of Laboratory Science and Safety, US Food and Drug Administration, Department of Health and Human Services, Silver Spring, Maryland
| | - Prasad Rao
- Office of In Vitro Diagnostics and Radiological Health, Food and Drug Administration, Department of Health and Human Services, Silver Spring, Maryland
| | - William H Robinson
- Department of Medicine, Stanford University School of Medicine, California
| | - Kristian M Roth
- Office of In Vitro Diagnostics and Radiological Health, Food and Drug Administration, Department of Health and Human Services, Silver Spring, Maryland
| | - Martin E Schriefer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | | | - Allen C Steere
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | | | - Susan J Wong
- Wadsworth Center, New York State Department of Health, Albany
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston
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3
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Bissett JD, Ledet S, Krishnavajhala A, Armstrong BA, Klioueva A, Sexton C, Replogle A, Schriefer ME, Lopez JE. Detection of Tickborne Relapsing Fever Spirochete, Austin, Texas, USA. Emerg Infect Dis 2018; 24:2003-2009. [PMID: 30160650 PMCID: PMC6199987 DOI: 10.3201/eid2411.172033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In March 2017, a patient became febrile within 4 days after visiting a rustic conference center in Austin, Texas, USA, where Austin Public Health suspected an outbreak of tickborne relapsing fever a month earlier. Evaluation of a patient blood smear and molecular diagnostic assays identified Borrelia turicatae as the causative agent. We could not gain access to the property to collect ticks. Thus, we focused efforts at a nearby public park, <1 mile from the suspected exposure site. We trapped Ornithodoros turicata ticks from 2 locations in the park, and laboratory evaluation resulted in cultivation of 3 B. turicatae isolates. Multilocus sequencing of 3 chromosomal loci (flaB, rrs, and gyrB) indicated that the isolates were identical to those of B. turicatae 91E135 (a tick isolate) and BTE5EL (a human isolate). We identified the endemicity of O. turicata ticks and likely emergence of B. turicatae in this city.
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4
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Brown JA, Allman R, Herwaldt BL, Gray E, Rivera HN, Qvarnstrom Y, Kwit N, Schriefer ME, Hinckley A, Pontones P. Notes from the Field: Reference Laboratory Investigation of Patients with Clinically Diagnosed Lyme Disease and Babesiosis — Indiana, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:1160-1161. [PMID: 30335739 PMCID: PMC6193689 DOI: 10.15585/mmwr.mm6741a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Branda JA, Body BA, Boyle J, Branson BM, Dattwyler RJ, Fikrig E, Gerald NJ, Gomes-Solecki M, Kintrup M, Ledizet M, Levin AE, Lewinski M, Liotta LA, Marques A, Mead PS, Mongodin EF, Pillai S, Rao P, Robinson WH, Roth KM, Schriefer ME, Slezak T, Snyder J, Steere AC, Witkowski J, Wong SJ, Schutzer SE. Advances in Serodiagnostic Testing for Lyme Disease Are at Hand. Clin Infect Dis 2018; 66:1133-1139. [PMID: 29228208 PMCID: PMC6019075 DOI: 10.1093/cid/cix943] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022] Open
Abstract
The cause of Lyme disease, Borrelia burgdorferi, was discovered in 1983. A 2-tiered testing protocol was established for serodiagnosis in 1994, involving an enzyme immunoassay (EIA) or indirect fluorescence antibody, followed (if reactive) by immunoglobulin M and immunoglobulin G Western immunoblots. These assays were prepared from whole-cell cultured B. burgdorferi, lacking key in vivo expressed antigens and expressing antigens that can bind non-Borrelia antibodies. Additional drawbacks, particular to the Western immunoblot component, include low sensitivity in early infection, technical complexity, and subjective interpretation when scored by visual examination. Nevertheless, 2-tiered testing with immunoblotting remains the benchmark for evaluation of new methods or approaches. Next-generation serologic assays, prepared with recombinant proteins or synthetic peptides, and alternative testing protocols, can now overcome or circumvent many of these past drawbacks. This article describes next-generation serodiagnostic testing for Lyme disease, focusing on methods that are currently available or near-at-hand.
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Affiliation(s)
- John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Barbara A Body
- Laboratory Corporation of America (LabCorp) (retired), Burlington, North Carolina
| | | | | | | | - Erol Fikrig
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Noel J Gerald
- Office of In Vitro Diagnostics and Radiological Health, Food and Drug Administration, Department of Health and Human Services, Washington, DC
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Knoxville
| | | | | | | | | | - Lance A Liotta
- Center for Applied Proteomics and Molecular Medicine, College of Science, George Mason University, Fairfax, Virginia
| | - Adriana Marques
- Clinical Studies Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul S Mead
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Emmanuel F Mongodin
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Segaran Pillai
- Office of Laboratory Science and Safety, Food and Drug Administration, Department of Health and Human Services, Washington, DC
| | - Prasad Rao
- Office of In Vitro Diagnostics and Radiological Health, Food and Drug Administration, Department of Health and Human Services, Washington, DC
| | | | - Kristian M Roth
- Office of In Vitro Diagnostics and Radiological Health, Food and Drug Administration, Department of Health and Human Services, Washington, DC
| | - Martin E Schriefer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | | | - Allen C Steere
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | | | - Susan J Wong
- Wadsworth Center, New York State Department of Health, Albany
| | - Steven E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School,Correspondence: S. E. Schutzer, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103 ()
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Boegler KA, Atiku LA, Enscore RE, Apangu T, Mpanga JT, Acayo S, Kaggwa J, Mead PS, Yockey BM, Kugeler KJ, Schriefer ME, Horiuchi K, Gage KL, Eisen RJ. Rat Fall Surveillance Coupled with Vector Control and Community Education as a Plague Prevention Strategy in the West Nile Region, Uganda. Am J Trop Med Hyg 2018; 98:238-247. [PMID: 29141768 PMCID: PMC5928726 DOI: 10.4269/ajtmh.17-0502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/01/2017] [Indexed: 11/07/2022] Open
Abstract
Plague, primarily a disease of rodents, is most frequently transmitted by fleas and causes potentially fatal infections in humans. In Uganda, plague is endemic to the West Nile region. Primary prevention for plague includes control of rodent hosts or flea vectors, but targeting these efforts is difficult given the sporadic nature of plague epizootics in the region and limited resource availability. Here, we present a community-based strategy to detect and report rodent deaths (rat fall), an early sign of epizootics. Laboratory testing of rodent carcasses is used to trigger primary and secondary prevention measures: indoor residual spraying (IRS) and community-based plague education, respectively. During the first 3 years of the program, individuals from 142 villages reported 580 small mammal deaths; 24 of these tested presumptive positive for Yersinia pestis by fluorescence microscopy. In response, for each of the 17 affected communities, village-wide IRS was conducted to control rodent-associated fleas within homes, and community sensitization was conducted to raise awareness of plague signs and prevention strategies. No additional presumptive Y. pestis-positive carcasses were detected in these villages within the 2-month expected duration of residual activity for the insecticide used in IRS. Despite comparatively high historic case counts, no human plague cases were reported from villages participating in the surveillance program; five cases were reported from elsewhere in the districts. We evaluate community participation and timeliness of response, report the frequency of human plague cases in participating and surrounding villages, and evaluate whether a program such as this could provide a sustainable model for plague prevention in endemic areas.
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Affiliation(s)
- Karen A. Boegler
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | | | - Russell E. Enscore
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Titus Apangu
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Sarah Acayo
- Uganda Virus Research Institute, Entebbe, Uganda
| | - John Kaggwa
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Paul S. Mead
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Brook M. Yockey
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Kiersten J. Kugeler
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Martin E. Schriefer
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Kalanthe Horiuchi
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Kenneth L. Gage
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Rebecca J. Eisen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
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7
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Christensen AM, Pietralczyk E, Lopez JE, Brooks C, Schriefer ME, Wozniak E, Stermole B. Diagnosis and Management of Borrelia turicatae Infection in Febrile Soldier, Texas, USA. Emerg Infect Dis 2017; 23:883-884. [PMID: 28418310 PMCID: PMC5403040 DOI: 10.3201/eid2305.162069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In August 2015, a soldier returned from field exercises in Texas, USA, with nonspecific febrile illness. Culture and sequencing of spirochetes from peripheral blood diagnosed Borrelia turicatae infection. The patient recovered after receiving doxycycline. No illness occurred in asymptomatic soldiers potentially exposed to the vector tick and prophylactically given treatment.
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Abstract
Serology is the mainstay of confirmation of Lyme borreliosis; direct detection has limited application. Because standardized 2-tier testing (STTT) has been commonly used since the mid 1990s, standardization and performance have improved. STTT detection of early, localized infection is poor; that of late disease is good. The best indicator of stage 1 infection, erythema migrans, is presented in the majority of US cases and should prompt treatment without testing. Clinical and epidemiologic correlates should be carefully assessed before ordering STTT. STTT has great value in confirming extracutaneous infection. Recent developments promise to improve performance, particularly in early disease detection.
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Affiliation(s)
- Martin E Schriefer
- Bacterial Disease Branch, Division of Vector-Borne Disease, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA.
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9
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Sudhindra P, Wang G, Schriefer ME, McKenna D, Zhuge J, Krause PJ, Marques AR, Wormser GP. Insights into Borrelia miyamotoi infection from an untreated case demonstrating relapsing fever, monocytosis and a positive C6 Lyme serology. Diagn Microbiol Infect Dis 2016; 86:93-6. [PMID: 27412815 PMCID: PMC4993640 DOI: 10.1016/j.diagmicrobio.2016.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 01/13/2023]
Abstract
We describe a patient from the United States with PCR- and serology-confirmed Borrelia miyamotoi infection who recovered without antibiotics. Our findings suggest that B. miyamotoi infection may cause relapsing fever, blood monocytosis and antibody reactivity to the C6 peptide. Further studies are required to better define the spectrum of clinical and laboratory findings for this emerging tick-transmitted infection.
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Affiliation(s)
- Praveen Sudhindra
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, 10595, USA
| | - Guiqing Wang
- Department of Pathology, New York Medical College, Valhalla, NY, 10595, USA; Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, NY, 10595, USA
| | | | - Donna McKenna
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, 10595, USA
| | - Jian Zhuge
- Department of Pathology, New York Medical College, Valhalla, NY, 10595, USA; Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, NY, 10595, USA
| | - Peter J Krause
- Yale School of Public Health and Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Adriana R Marques
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, 10595, USA.
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Pritt BS, Respicio-Kingry LB, Sloan LM, Schriefer ME, Replogle AJ, Bjork J, Liu G, Kingry LC, Mead PS, Neitzel DF, Schiffman E, Hoang Johnson DK, Davis JP, Paskewitz SM, Boxrud D, Deedon A, Lee X, Miller TK, Feist MA, Steward CR, Theel ES, Patel R, Irish CL, Petersen JM. Borrelia mayonii sp. nov., a member of the Borrelia burgdorferi sensu lato complex, detected in patients and ticks in the upper midwestern United States. Int J Syst Evol Microbiol 2016; 66:4878-4880. [PMID: 27558626 DOI: 10.1099/ijsem.0.001445] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lyme borreliosis (LB) is a multisystem disease caused by spirochetes in the Borrelia burgdorferisensu lato (Bbsl) genospecies complex. We previously described a novel Bbsl genospecies (type strain MN14-1420T) that causes LB among patients with exposures to ticks in the upper midwestern USA. Patients infected with the novel Bbsl genospecies demonstrated higher levels of spirochetemia and somewhat differing clinical symptoms as compared with those infected with other Bbsl genospecies. The organism was detected from human specimens using PCR, microscopy, serology and culture. The taxonomic status was determined using an eight-housekeeping-gene (uvrA, rplB, recG, pyrG, pepX, clpX, clpA and nifS) multi-locus sequence analysis (MLSA) and comparison of 16S rRNA gene, flaB, rrf-rrl, ospC and oppA2 nucleotide sequences. Using a system threshold of 98.3 % similarity for delineation of Bbsl genospecies by MLSA, we demonstrated that the novel species is a member of the Bbsl genospecies complex, most closely related to B. burgdorferisensu stricto (94.7-94.9 % similarity). This same species was identified in Ixodes scapularis ticks collected in Minnesota and Wisconsin. This novel species, Borrelia mayonii sp. nov, is formally described here. The type strain, MN14-1420, is available through the Deutsche Sammlung von Mikroorganismen und Zelkulturen GmbH (DSM 102811) and the American Type Culture Collection (ATCC BAA-2743).
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Affiliation(s)
- Bobbi S Pritt
- Department of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laurel B Respicio-Kingry
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Lynne M Sloan
- Department of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin E Schriefer
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Adam J Replogle
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Jenna Bjork
- Minnesota Department of Health, St. Paul, MN, USA
| | - Gongping Liu
- Minnesota Department of Health, St. Paul, MN, USA
| | - Luke C Kingry
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Paul S Mead
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | | | | | | | | | | | - David Boxrud
- Minnesota Department of Health, St. Paul, MN, USA
| | - Alecia Deedon
- Wisconsin Department of Health Services, Madison, WI, USA
| | - Xia Lee
- University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Elitza S Theel
- Department of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Department of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cole L Irish
- Department of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeannine M Petersen
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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11
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Muehlenbachs A, Bollweg BC, Schulz TJ, Forrester JD, DeLeon Carnes M, Molins C, Ray GS, Cummings PM, Ritter JM, Blau DM, Andrew TA, Prial M, Ng DL, Prahlow JA, Sanders JH, Shieh WJ, Paddock CD, Schriefer ME, Mead P, Zaki SR. Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. Am J Pathol 2016; 186:1195-205. [PMID: 26968341 DOI: 10.1016/j.ajpath.2015.12.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 12/17/2022]
Abstract
Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men. Autopsy tissue samples were evaluated by light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin. Post-mortem blood was tested by serology. Interstitial lymphocytic pancarditis in a relatively characteristic road map distribution was present in all cases. Cardiomyocyte necrosis was minimal, T cells outnumbered B cells, plasma cells were prominent, and mild fibrosis was present. Spirochetes in the cardiac interstitium associated with collagen fibers and co-localized with decorin. Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry. Spirochetes were not seen in other organs examined, and joint tissue was not available for evaluation. Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity and is characterized by pancarditis and marked tropism of spirochetes for cardiac tissues.
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Affiliation(s)
- Atis Muehlenbachs
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Brigid C Bollweg
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Joseph D Forrester
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Marlene DeLeon Carnes
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Claudia Molins
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | | | | | - Jana M Ritter
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dianna M Blau
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas A Andrew
- Office of the Chief Medical Examiner, Concord, New Hampshire
| | | | - Dianna L Ng
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph A Prahlow
- The Medical Foundation, South Bend, Indiana; Indiana University School of Medicine-South Bend, South Bend, Indiana
| | - Jeanine H Sanders
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wun Ju Shieh
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher D Paddock
- Rickettsial Zoonotic Diseases Branch, Division of Vector Borne Infectious Diseases, Atlanta, Georgia
| | - Martin E Schriefer
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Paul Mead
- Bacterial Diseases Branch, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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Pritt BS, Mead PS, Johnson DKH, Neitzel DF, Respicio-Kingry LB, Davis JP, Schiffman E, Sloan LM, Schriefer ME, Replogle AJ, Paskewitz SM, Ray JA, Bjork J, Steward CR, Deedon A, Lee X, Kingry LC, Miller TK, Feist MA, Theel ES, Patel R, Irish CL, Petersen JM. Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study. Lancet Infect Dis 2016; 16:556-564. [PMID: 26856777 DOI: 10.1016/s1473-3099(15)00464-8] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is a multisystem disease caused by Borrelia burgdorferi sensu lato genospecies and characterised by tissue localisation and low spirochaetaemia. In this study we aimed to describe a novel Borrelia 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 oppA1 gene of B burgdorferi 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 Ixodes scapularis ticks from regions of suspected patient tick exposure and tested them by oppA1 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 oppA1 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 oppA1 copy number was 180 times higher than that in 13 specimens that tested positive for B burgdorferi sensu stricto during the same time period. Multigene sequencing identified the spirochaete as a novel B burgdorferi sensu lato genospecies. This same genospecies was detected in ticks collected at a probable patient exposure site. INTERPRETATION We describe a new pathogenic Borrelia burgdorferi sensu lato genospecies (candidatus Borrelia mayonii) in the upper midwestern USA, which causes Lyme borreliosis with unusually high spirochaetaemia. Clinicians should be aware of this new B burgdorferi sensu lato genospecies, its distinct clinical features, and the usefulness of oppA1 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.
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Affiliation(s)
| | - Paul S Mead
- Division of Vector Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | | | | | - Laurel B Respicio-Kingry
- Division of Vector Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | | | | | | | - Martin E Schriefer
- Division of Vector Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Adam J Replogle
- Division of Vector Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | | | - Julie A Ray
- Mayo Clinic, Rochester, MN, USA; Minnesota Department of Health, St Paul, MN, USA
| | - Jenna Bjork
- Minnesota Department of Health, St Paul, MN, USA
| | | | - Alecia Deedon
- Wisconsin Department of Health Services, Madison, WI, USA
| | - Xia Lee
- University of Wisconsin-Madison, Madison, WI, USA
| | - Luke C Kingry
- Division of Vector Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | | | | | | | | | | | - Jeannine M Petersen
- Division of Vector Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Kingry LC, Rowe LA, Respicio-Kingry LB, Beard CB, Schriefer ME, Petersen JM. Whole genome multilocus sequence typing as an epidemiologic tool for Yersinia pestis. Diagn Microbiol Infect Dis 2015; 84:275-80. [PMID: 26778487 DOI: 10.1016/j.diagmicrobio.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/19/2015] [Accepted: 12/10/2015] [Indexed: 01/14/2023]
Abstract
Human plague is a severe and often fatal zoonotic disease caused by Yersinia pestis. For public health investigations of human cases, nonintensive whole genome molecular typing tools, capable of defining epidemiologic relationships, are advantageous. Whole genome multilocus sequence typing (wgMLST) is a recently developed methodology that simplifies genomic analyses by transforming millions of base pairs of sequence into character data for each gene. We sequenced 13 US Y. pestis isolates with known epidemiologic relationships. Sequences were assembled de novo, and multilocus sequence typing alleles were assigned by comparison against 3979 open reading frames from the reference strain CO92. Allele-based cluster analysis accurately grouped the 13 isolates, as well as 9 publicly available Y. pestis isolates, by their epidemiologic relationships. Our findings indicate wgMLST is a simplified, sensitive, and scalable tool for epidemiologic analysis of Y. pestis strains.
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Affiliation(s)
- Luke C Kingry
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO 80523
| | - Lori A Rowe
- Division of Scientific Resources, Biotechnology Core Facility Branch, Centers for Disease Prevention and Control, Atlanta, GA 30329
| | - Laurel B Respicio-Kingry
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO 80523
| | - Charles B Beard
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO 80523
| | - Martin E Schriefer
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO 80523
| | - Jeannine M Petersen
- Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO 80523.
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Molins CR, Ashton LV, Wormser GP, Hess AM, Delorey MJ, Mahapatra S, Schriefer ME, Belisle JT. Development of a metabolic biosignature for detection of early Lyme disease. Clin Infect Dis 2015; 60:1767-75. [PMID: 25761869 PMCID: PMC4810808 DOI: 10.1093/cid/civ185] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/25/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Early Lyme disease patients often present to the clinic prior to developing a detectable antibody response to Borrelia burgdorferi, the etiologic agent. Thus, existing 2-tier serology-based assays yield low sensitivities (29%-40%) for early infection. The lack of an accurate laboratory test for early Lyme disease contributes to misconceptions about diagnosis and treatment, and underscores the need for new diagnostic approaches. METHODS Retrospective serum samples from patients with early Lyme disease, other diseases, and healthy controls were analyzed for small molecule metabolites by liquid chromatography-mass spectrometry (LC-MS). A metabolomics data workflow was applied to select a biosignature for classifying early Lyme disease and non-Lyme disease patients. A statistical model of the biosignature was trained using the patients' LC-MS data, and subsequently applied as an experimental diagnostic tool with LC-MS data from additional patient sera. The accuracy of this method was compared with standard 2-tier serology. RESULTS Metabolic biosignature development selected 95 molecular features that distinguished early Lyme disease patients from healthy controls. Statistical modeling reduced the biosignature to 44 molecular features, and correctly classified early Lyme disease patients and healthy controls with a sensitivity of 88% (84%-95%), and a specificity of 95% (90%-100%). Importantly, the metabolic biosignature correctly classified 77%-95% of the of serology negative Lyme disease patients. CONCLUSIONS The data provide proof-of-concept that metabolic profiling for early Lyme disease can achieve significantly greater (P < .0001) diagnostic sensitivity than current 2-tier serology, while retaining high specificity.
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Affiliation(s)
- Claudia R. Molins
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention
| | - Laura V. Ashton
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins
| | - Gary P. Wormser
- Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, New York
| | - Ann M. Hess
- Department of Statistics, Colorado State University, Fort Collins
| | - Mark J. Delorey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention
| | - Sebabrata Mahapatra
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins
| | - Martin E. Schriefer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention
| | - John T. Belisle
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins
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15
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Molins CR, Delorey MJ, Yockey BM, Young JW, Belisle JT, Schriefer ME, Petersen JM. Virulence difference between the prototypic Schu S4 strain (A1a) and Francisella tularensis A1a, A1b, A2 and type B strains in a murine model of infection. BMC Infect Dis 2014; 14:67. [PMID: 24502661 PMCID: PMC3923427 DOI: 10.1186/1471-2334-14-67] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of prototypic strains is common among laboratories studying infectious agents as it promotes consistency for data comparability among and between laboratories. Schu S4 is the prototypic virulent strain of Francisella tularensis and has been used extensively as such over the past six decades. Studies have demonstrated virulence differences among the two clinically relevant subspecies of F. tularensis, tularensis (type A) and holarctica (type B) and more recently between type A subpopulations (A1a, A1b and A2). Schu S4 belongs to the most virulent subspecies of F. tularensis, subspecies tularensis. METHODS In this study, we investigated the relative virulence of Schu S4 in comparison to A1a, A1b, A2 and type B strains using a temperature-based murine model of infection. Mice were inoculated intradermally and a hypothermic drop point was used as a surrogate for death. Survival curves and the length of temperature phases were compared for all infections. Bacterial burdens were also compared between the most virulent type A subpopulation, A1b, and Schu S4 at drop point. RESULTS Survival curve comparisons demonstrate that the Schu S4 strain used in this study resembles the virulence of type B strains, and is significantly less virulent than all other type A (A1a, A1b and A2) strains tested. Additionally, when bacterial burdens were compared between mice infected with Schu S4 or MA00-2987 (A1b) significantly higher burdens were present in the blood and spleen of mice infected with MA00-2987. CONCLUSIONS The knowledge gained from using Schu S4 as a prototypic virulent strain has unquestionably advanced the field of tularemia research. The findings of this study, however, indicate that careful consideration of F. tularensis strain selection must occur when the overall virulence of the strain used could impact the outcome and interpretation of results.
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Affiliation(s)
- Claudia R Molins
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bacterial Diseases Branch, 3156 Rampart Road, Fort Collins, CO 80521 USA
| | - Mark J Delorey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bacterial Diseases Branch, 3156 Rampart Road, Fort Collins, CO 80521 USA
| | - Brook M Yockey
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bacterial Diseases Branch, 3156 Rampart Road, Fort Collins, CO 80521 USA
| | - John W Young
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bacterial Diseases Branch, 3156 Rampart Road, Fort Collins, CO 80521 USA
| | - John T Belisle
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523 USA
| | - Martin E Schriefer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bacterial Diseases Branch, 3156 Rampart Road, Fort Collins, CO 80521 USA
| | - Jeannine M Petersen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Bacterial Diseases Branch, 3156 Rampart Road, Fort Collins, CO 80521 USA
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Molins CR, Delorey MJ, Young JW, Yockey BM, Belisle JT, Schriefer ME, Petersen JM. Use of temperature for standardizing the progression of Francisella tularensis in mice. PLoS One 2012; 7:e45310. [PMID: 23028924 PMCID: PMC3454384 DOI: 10.1371/journal.pone.0045310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/21/2012] [Indexed: 11/19/2022] Open
Abstract
The study of infectious agents, their pathogenesis, the host response and the evaluation of newly developed countermeasures often requires the use of a living system. Murine models are frequently used to undertake such investigations with the caveat that non-biased measurements to assess the progression of infection are underutilized. Instead, murine models predominantly rely on symptomology exhibited by the animal to evaluate the state of the animal's health and to determine when euthanasia should be performed. In this study, we used subcutaneous temperature as a non-subjective measurement to follow and compare infection in mice inoculated with Francisella tularensis, a Gram-negative pathogen that produces an acute and fatal illness in mice. A reproducible temperature pattern defined by three temperature phases (normal, febrile and hypothermic) was identified in all mice infected with F. tularensis, regardless of the infecting strain. More importantly and for the first time a non-subjective, ethical, and easily determined surrogate endpoint for death based on a temperature, termed drop point, was identified and validated with statistical models. In comparative survival curve analyses for F. tularensis strains with differing virulence, the drop point temperature yielded the same results as those obtained using observed time to death. Incorporation of temperature measurements to evaluate F. tularensis was standardized based on statistical models to provide a new level of robustness for comparative analyses in mice. These findings should be generally applicable to other pathogens that produce acute febrile disease in animal models and offers an important tool for understanding and following the infection process.
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Affiliation(s)
- Claudia R Molins
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United State of America.
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17
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Urich SK, Chalcraft L, Schriefer ME, Yockey BM, Petersen JM. Lack of antimicrobial resistance in Yersinia pestis isolates from 17 countries in the Americas, Africa, and Asia. Antimicrob Agents Chemother 2012; 56:555-8. [PMID: 22024826 PMCID: PMC3256048 DOI: 10.1128/aac.05043-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/17/2011] [Indexed: 11/20/2022] Open
Abstract
Yersinia pestis is the causative agent of plague, a fulminant disease that is often fatal without antimicrobial treatment. Plasmid (IncA/C)-mediated multidrug resistance in Y. pestis was reported in 1995 in Madagascar and has generated considerable public health concern, most recently because of the identification of IncA/C multidrug-resistant plasmids in other zoonotic pathogens. Here, we demonstrate no resistance in 392 Y. pestis isolates from 17 countries to eight antimicrobials used for treatment or prophylaxis of plague.
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Affiliation(s)
- Sandra K Urich
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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18
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Brown HE, Levy CE, Enscore RE, Schriefer ME, DeLiberto TJ, Gage KL, Eisen RJ. Annual seroprevalence of Yersinia pestis in coyotes as predictors of interannual variation in reports of human plague cases in Arizona, United States. Vector Borne Zoonotic Dis 2011; 11:1439-46. [PMID: 21756031 DOI: 10.1089/vbz.2010.0196] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although several health departments collect coyote blood samples for plague surveillance, the association between reported human cases and coyote seroprevalence rates remains anecdotal. Using data from an endemic region of the United States, we sought to quantify this association. From 1974 to 1998, about 2,276 coyote blood samples from four Arizona counties were tested for serological evidence of exposure to Yersinia pestis, the causative agent of plague. Using a titer threshold presumed to be indicative of recent infection (serum titers of ≥1:256), we found a statistically significant relationship between years with >17% sero-positive coyotes and years with two or more human cases reported. Moreover, when the annual coyote seroprevalence rates were dichotomized at 17%, 84% of the years were correctly classified using four biologically relevant meteorological variables in a linear regression. This is the first time a statistically significant temporal association between human plague cases and coyote seroprevalence rates has been shown. However, issues with data resolution and surveillance effort that potentially limit the public health utility of using coyote seroprevalence rates are discussed.
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Affiliation(s)
- Heidi E Brown
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
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Eisen RJ, Griffith KS, Borchert JN, MacMillan K, Apangu T, Owor N, Acayo S, Acidri R, Zielinski-Gutierrez E, Winters AM, Enscore RE, Schriefer ME, Beard CB, Gage KL, Mead PS. Assessing human risk of exposure to plague bacteria in northwestern Uganda based on remotely sensed predictors. Am J Trop Med Hyg 2010; 82:904-11. [PMID: 20439974 PMCID: PMC2861378 DOI: 10.4269/ajtmh.2010.09-0737] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 02/01/2010] [Indexed: 11/07/2022] Open
Abstract
Plague, a life-threatening flea-borne zoonosis caused by Yersinia pestis, has most commonly been reported from eastern Africa and Madagascar in recent decades. In these regions and elsewhere, prevention and control efforts are typically targeted at fine spatial scales, yet risk maps for the disease are often presented at coarse spatial resolutions that are of limited value in allocating scarce prevention and control resources. In our study, we sought to identify sub-village level remotely sensed correlates of elevated risk of human exposure to plague bacteria and to project the model across the plague-endemic West Nile region of Uganda and into neighboring regions of the Democratic Republic of Congo. Our model yielded an overall accuracy of 81%, with sensitivities and specificities of 89% and 71%, respectively. Risk was higher above 1,300 meters than below, and the remotely sensed covariates that were included in the model implied that localities that are wetter, with less vegetative growth and more bare soil during the dry month of January (when agricultural plots are typically fallow) pose an increased risk of plague case occurrence. Our results suggest that environmental and landscape features play a large part in classifying an area as ecologically conducive to plague activity. However, it is clear that future studies aimed at identifying behavioral and fine-scale ecological risk factors in the West Nile region are required to fully assess the risk of human exposure to Y. pestis.
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Affiliation(s)
- Rebecca J. Eisen
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Uganda Virus Research Institute, Entebbe, Uganda
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20
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Molins CR, Delorey MJ, Yockey BM, Young JW, Sheldon SW, Reese SM, Schriefer ME, Petersen JM. Virulence differences among Francisella tularensis subsp. tularensis clades in mice. PLoS One 2010; 5:e10205. [PMID: 20419133 PMCID: PMC2855709 DOI: 10.1371/journal.pone.0010205] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 02/01/2010] [Indexed: 11/18/2022] Open
Abstract
Francisella tularensis subspecies tularensis (type A) and holarctica (type B) are of clinical importance in causing tularemia. Molecular typing methods have further separated type A strains into three genetically distinct clades, A1a, A1b and A2. Epidemiological analyses of human infections in the United States suggest that A1b infections are associated with a significantly higher mortality rate as compared to infections caused by A1a, A2 and type B. To determine if genetic differences as defined by molecular typing directly correlate with differences in virulence, A1a, A1b, A2 and type B strains were compared in C57BL/6 mice. Here we demonstrate significant differences between survival curves for infections caused by A1b versus A1a, A2 and type B, with A1b infected mice dying earlier than mice infected with A1a, A2 or type B; these results were conserved among multiple strains. Differences were also detected among type A clades as well as between type A clades and type B with respect to bacterial burdens, and gross anatomy in infected mice. Our results indicate that clades defined within F. tularensis subsp. tularensis by molecular typing methods correlate with virulence differences, with A1b strains more virulent than A1a, A2 and type B strains. These findings indicate type A strains are not equivalent with respect to virulence and have important implications for public health as well as basic research programs.
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Affiliation(s)
- Claudia R. Molins
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Mark J. Delorey
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Brook M. Yockey
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - John W. Young
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Sarah W. Sheldon
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Sara M. Reese
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Martin E. Schriefer
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Jeannine M. Petersen
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
- * E-mail:
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Bevins SN, Tracey JA, Franklin SP, Schmit VL, Macmillan ML, Gage KL, Schriefer ME, Logan KA, Sweanor LL, Alldredge MW, Krumm C, Boyce WM, Vickers W, Riley SPD, Lyren LM, Boydston EE, Fisher RN, Roelke ME, Salman M, Crooks KR, Vandewoude S. Wild felids as hosts for human plague, Western United States. Emerg Infect Dis 2010; 15:2021-4. [PMID: 19961691 PMCID: PMC3044529 DOI: 10.3201/eid1512.090526] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Plague seroprevalence was estimated in populations of pumas and bobcats in the western United States. High levels of exposure in plague-endemic regions indicate the need to consider the ecology and pathobiology of plague in nondomestic felid hosts to better understand the role of these species in disease persistence and transmission.
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Affiliation(s)
- Sarah N Bevins
- Microbiology, Immunology, and Pathology Department, Colorado State University, Fort Collins, CO 80523-1619, USA.
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22
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Pandya GA, Holmes MH, Petersen JM, Pradhan S, Karamycheva SA, Wolcott MJ, Molins C, Jones M, Schriefer ME, Fleischmann RD, Peterson SN. Whole genome single nucleotide polymorphism based phylogeny of Francisella tularensis and its application to the development of a strain typing assay. BMC Microbiol 2009; 9:213. [PMID: 19811647 PMCID: PMC2767358 DOI: 10.1186/1471-2180-9-213] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 10/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A low genetic diversity in Francisella tularensis has been documented. Current DNA based genotyping methods for typing F. tularensis offer a limited and varying degree of subspecies, clade and strain level discrimination power. Whole genome sequencing is the most accurate and reliable method to identify, type and determine phylogenetic relationships among strains of a species. However, lower cost typing schemes are necessary in order to enable typing of hundreds or even thousands of isolates. RESULTS We have generated a high-resolution phylogenetic tree from 40 Francisella isolates, including 13 F. tularensis subspecies holarctica (type B) strains, 26 F. tularensis subsp. tularensis (type A) strains and a single F. novicida strain. The tree was generated from global multi-strain single nucleotide polymorphism (SNP) data collected using a set of six Affymetrix GeneChip resequencing arrays with the non-repetitive portion of LVS (type B) as the reference sequence complemented with unique sequences of SCHU S4 (type A). Global SNP based phylogenetic clustering was able to resolve all non-related strains. The phylogenetic tree was used to guide the selection of informative SNPs specific to major nodes in the tree for development of a genotyping assay for identification of F. tularensis subspecies and clades. We designed and validated an assay that uses these SNPs to accurately genotype 39 additional F. tularensis strains as type A (A1, A2, A1a or A1b) or type B (B1 or B2). CONCLUSION Whole-genome SNP based clustering was shown to accurately identify SNPs for differentiation of F. tularensis subspecies and clades, emphasizing the potential power and utility of this methodology for selecting SNPs for typing of F. tularensis to the strain level. Additionally, whole genome sequence based SNP information gained from a representative population of strains may be used to perform evolutionary or phylogenetic comparisons of strains, or selection of unique strains for whole-genome sequencing projects.
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Affiliation(s)
- Gagan A Pandya
- Pathogen Functional Genomics Resource Center, J. Craig Venter Institute, Rockville, MD 20850, USA.
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Wong D, Wild MA, Walburger MA, Higgins CL, Callahan M, Czarnecki LA, Lawaczeck EW, Levy CE, Patterson JG, Sunenshine R, Adem P, Paddock CD, Zaki SR, Petersen JM, Schriefer ME, Eisen RJ, Gage KL, Griffith KS, Weber IB, Spraker TR, Mead PS. Primary pneumonic plague contracted from a mountain lion carcass. Clin Infect Dis 2009; 49:e33-8. [PMID: 19555287 DOI: 10.1086/600818] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Primary pneumonic plague is a rare but often fatal form of Yersinia pestis infection that results from direct inhalation of bacteria and is potentially transmissible from person to person. We describe a case of primary pneumonic plague in a wildlife biologist who was found deceased in his residence 1 week after conducting a necropsy on a mountain lion. METHODS To determine cause of death, a postmortem examination was conducted, and friends and colleagues were interviewed. Physical evidence was reviewed, including specimens from the mountain lion and the biologist's medical chart, camera, and computer. Human and animal tissues were submitted for testing. Persons in close contact (within 2 meters) to the biologist after he had developed symptoms were identified and offered chemoprophylaxis. RESULTS The biologist conducted the necropsy in his garage without the use of personal protective equipment. Three days later, he developed fever and hemoptysis and died approximately 6 days after exposure. Gross examination showed consolidation and hemorrhagic fluid in the lungs; no buboes were noted. Plague was diagnosed presumptively by polymerase chain reaction and confirmed by culture. Tissues from the mountain lion tested positive for Y. pestis, and isolates from the biologist and mountain lion were indistinguishable by pulsed-field gel electrophoresis. Among 49 contacts who received chemoprophylaxis, none developed symptoms consistent with plague. CONCLUSIONS The biologist likely acquired pneumonic plague through inhalation of aerosols generated during postmortem examination of an infected mountain lion. Enhanced awareness of zoonotic diseases and appropriate use of personal protective equipment are needed for biologists and others who handle wildlife.
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Affiliation(s)
- David Wong
- Office of Public Health, National Park Service, Albuquerque, New Mexico, USA.
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Ball R, Shadomy SV, Meyer A, Huber BT, Leffell MS, Zachary A, Belotto M, Hilton E, Bryant-Genevier M, Schriefer ME, Miller FW, Braun MM. HLA type and immune response to Borrelia burgdorferi outer surface protein a in people in whom arthritis developed after Lyme disease vaccination. ACTA ACUST UNITED AC 2009; 60:1179-86. [PMID: 19333928 DOI: 10.1002/art.24418] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether persons with treatment-resistant Lyme arthritis-associated HLA alleles might develop arthritis as a result of an autoimmune reaction triggered by Borrelia burgdorferi outer surface protein A (OspA), the Lyme disease vaccine antigen. METHODS Persons in whom inflammatory arthritis had developed after Lyme disease vaccine (cases) were compared with 3 control groups: 1) inflammatory arthritis but not Lyme disease vaccine (arthritis controls), 2) Lyme disease vaccine but not inflammatory arthritis (vaccine controls), and 3) neither Lyme disease vaccine nor inflammatory arthritis (normal controls). HLA-DRB1 allele typing, Western blotting for Lyme antigen, and T cell reactivity testing were performed. RESULTS Twenty-seven cases were matched with 162 controls (54 in each control group). Odds ratios (ORs) for the presence of 1 or 2 treatment-resistant Lyme arthritis alleles were 0.8 (95% confidence interval [95% CI] 0.3-2.1), 1.6 (95% CI 0.5-4.4), and 1.75 (95% CI 0.6-5.3) in cases versus arthritis controls, vaccine controls, and normal controls, respectively. There were no significant differences in the frequency of DRB1 alleles. T cell response to OspA was similar between cases and vaccine controls, as measured using the stimulation index (OR 1.6 [95% CI 0.5-5.1]) or change in uptake of tritiated thymidine (counts per minute) (OR 0.7 [95% CI 0.2-2.3]), but cases were less likely to have IgG antibodies to OspA (OR 0.3 [95% CI 0.1-0.8]). Cases were sampled closer to the time of vaccination (median 3.59 years versus 5.48 years), and fewer cases had received 3 doses of vaccine (37% versus 93%). CONCLUSION Treatment-resistant Lyme arthritis alleles were not found more commonly in persons who developed arthritis after Lyme disease vaccination, and immune responses to OspA were not significantly more common in arthritis cases. These results suggest that Lyme disease vaccine is not a major factor in the development of arthritis in these cases.
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Affiliation(s)
- Robert Ball
- Center for Biologics Evaluation and Research, FDA, Rockville, Maryland, USA.
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25
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Lowell JL, Eisen RJ, Schotthoefer AM, Xiaocheng L, Montenieri JA, Tanda D, Pape J, Schriefer ME, Antolin MF, Gage KL. Colorado animal-based plague surveillance systems: relationships between targeted animal species and prediction efficacy of areas at risk for humans. J Vector Ecol 2009; 34:22-31. [PMID: 20836802 DOI: 10.1111/j.1948-7134.2009.00004.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Human plague risks (Yersinia pestis infection) are greatest when epizootics cause high mortality among this bacterium's natural rodent hosts. Therefore, health departments in plague-endemic areas commonly establish animal-based surveillance programs to monitor Y. pestis infection among plague hosts and vectors. The primary objectives of our study were to determine whether passive animal-based plague surveillance samples collected in Colorado from 1991 to 2005 were sampled from high human plague risk areas and whether these samples provided information useful for predicting human plague case locations. By comparing locations of plague-positive animal samples with a previously constructed GIS-based plague risk model, we determined that the majority of plague-positive Gunnison's prairie dogs (100%) and non-prairie dog sciurids (85.82%), and moderately high percentages of sigmodontine rodents (71.4%), domestic cats (69.3%), coyotes (62.9%), and domestic dogs (62.5%) were recovered within 1 km of the nearest area posing high peridomestic risk to humans. In contrast, the majority of white-tailed prairie dog (66.7%), leporid (cottontailed and jack rabbits) (71.4%), and black-tailed prairie dog (93.0%) samples originated more than 1 km from the nearest human risk habitat. Plague-positive animals or their fleas were rarely (one of 19 cases) collected within 2 km of a case exposure site during the 24 months preceding the dates of illness onset for these cases. Low spatial accuracy for identifying epizootic activity prior to human plague cases suggested that other mammalian species or their fleas are likely more important sources of human infection in high plague risk areas. To address this issue, epidemiological observations and multi-locus variable number tandem repeat analyses (MLVA) were used to preliminarily identify chipmunks as an under-sampled, but potentially important, species for human plague risk in Colorado.
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Affiliation(s)
- Jennifer L Lowell
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80522, USA
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Abstract
Arthropod transmission of tularemia occurs throughout the northern hemisphere. Few pathogens show the adaptability of Francisella tularensis to such a wide array of arthropod vectors. Nonetheless, arthropod transmission of F. tularensis was last actively investigated in the first half of the 20th century. This review will focus on arthropod transmission to humans with respect to vector species, modes of transmission, geographic differences and F. tularensis subspecies and clades.
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Affiliation(s)
- Jeannine M Petersen
- Division of Vector-Borne Infectious Disease, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Ft. Collins, CO 80521, USA.
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27
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Eisen RJ, Schriefer ME, Yockey B, Petersen JM, Piesman J, Young J, Reese SM, Beard CB. Time Course of Hematogenous Dissemination of Francisella tularensis A1, A2, and Type B in Laboratory Mice. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.80.259] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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28
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Eisen RJ, Yockey B, Young J, Reese SM, Piesman J, Schriefer ME, Beard CB, Petersen JM. Short report: time course of hematogenous dissemination of Francisella tularensis A1, A2, and Type B in laboratory mice. Am J Trop Med Hyg 2009; 80:259-262. [PMID: 19190224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Tularemia is a tick-borne zoonotic bacterial disease. In the United States, human tularemia infections are caused by Francisella tularensis subspecies tularensis (Type A, clades A1 and A2) or F. tularensis subspecies holarctica (Type B). We developed a mouse model that can be used to study the ability of ticks to acquire and transmit fully virulent strains of F. tularensis (A1, A2, and Type B). We showed that 1) bacteremia was evident by 2 days post-infection (dpi) for A1, A2, and B, 2) bacteremia was expected to reach levels of > 10(8) cfu/mL by 3 dpi for A1 and A2 but not until 4 dpi for Type B, and 3) illness onset was delayed for mice exposed to Type B compared with A1 and A2. To maximize the likelihood of ticks acquiring infection from laboratory-infected mice before they become moribund and must be euthanized, ticks should be placed on mice so that periods of rapid engorgement occur 3-4 dpi for A1 and A2 and 4-5 dpi for Type B. Rigorous experimental studies of tick vector competence and efficiency conducted under standardized conditions are required to address several significant public health issues related to preventing and controlling tularemia. Our study provides the basis for a mouse model needed as the starting point to address these questions.
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Affiliation(s)
- Rebecca J Eisen
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado 80522, USA.
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29
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Schneider BS, Schriefer ME, Dietrich G, Dolan MC, Morshed MG, Zeidner NS. Borrelia bissettii isolates induce pathology in a murine model of disease. Vector Borne Zoonotic Dis 2008; 8:623-33. [PMID: 18454594 DOI: 10.1089/vbz.2007.0251] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The spirochete Borrelia burgdorferi is a tick-borne pathogen that causes Lyme disease. Although B. burgdorferi sensu lato is a diverse group of bacteria, only three genospecies, B. burgdorferi sensu stricto, Borrelia afzelii, and Borrelia garinii, are known to be pathogenic and commonly recognized to cause human disease. To assess the potential of another common genospecies, Borrelia bissettii, to induce disease, a mouse model was employed. Two Colorado isolates of B. bissettii (CO-Bb) induced lesions of the bladder, heart, and femorotibial joint 8 weeks after inoculation into mice. In contrast, two British Columbia (BC-Bb) isolates, could not be cultured or amplified by PCR from target organs, and did not induce lesions. Consistent with pathology and culture results, the antibody response in mice to BC-Bb was minimal compared to CO-Bb, indicating either transient localized infection or rapid immune clearance of BC-Bb. Although sequence analysis of the rrf (5S)-rrl (23S) intergenic spacer region indicated 99% homology between CO-Bb and BC-Bb, polyacrylamide gel electrophoresis (PAGE) analysis indicated five distinct protein differences between these low-passage isolates. These studies support the prospect that B. bissettii may indeed be the causative agent of Lyme borreliosis cases in Eastern Europe, associated with the atypical Borrelia strain 25015, and in other regions. To our knowledge, this is the first evidence that B. bissettii can induce pathology in a vertebrate host.
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Affiliation(s)
- Bradley S Schneider
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
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30
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Eisen RJ, Petersen JM, Higgins CL, Wong D, Levy CE, Mead PS, Schriefer ME, Griffith KS, Gage KL, Beard CB. Persistence of Yersinia pestis in soil under natural conditions. Emerg Infect Dis 2008; 14:941-3. [PMID: 18507908 PMCID: PMC2600287 DOI: 10.3201/eid1406.080029] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
As part of a fatal human plague case investigation, we showed that the plague bacterium, Yersinia pestis, can survive for at least 24 days in contaminated soil under natural conditions. These results have implications for defining plague foci, persistence, transmission, and bioremediation after a natural or intentional exposure to Y. pestis.
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Affiliation(s)
- Rebecca J Eisen
- Centers for Disease Control and Prevention, Fort Collins, Colorado 80521, USA.
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31
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Kenny JH, Zhou Y, Schriefer ME, Bearden SW. Detection of viable Yersinia pestis by fluorescence in situ hybridization using peptide nucleic acid probes. J Microbiol Methods 2008; 75:293-301. [PMID: 18655809 DOI: 10.1016/j.mimet.2008.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 06/19/2008] [Accepted: 06/24/2008] [Indexed: 11/28/2022]
Abstract
A successful method has been developed for the detection of live Yersinia pestis, the plague bacillus, which incorporates nascent RNA synthesis. A fluorescent in situ hybridization (FISH) assay using peptide nucleic acid (PNA) probes was developed specifically to differentiate Y. pestis strains from closely related bacteria. PNA probes were chosen to target high copy mRNA of the Y. pestis caf1 gene, encoding the Fraction 1 (F1) antigen, and 16S ribosomal RNA. Among Yersinia strains tested, PNA probes Yp-16S-426 and Yp-F1-55 exhibited binding specificities of 100% and 98%, respectively. Y. pestis grown in the presence of competing bacteria, as might be encountered when recovering Y. pestis from environmental surfaces in a post-release bioterrorism event, was recognized by PNA probes and neither hybridization nor fluorescence was inhibited by competing bacterial strains which exhibited faster growth rates. Using fluorescence microscopy, individual Y. pestis bacteria were clearly differentiated from competing bacteria with an average detection sensitivity of 7.9x10(3) cells by fluorescence microscopy. In the current system, this would require an average of 2.56x10(5) viable Y. pestis organisms be recovered from a post-release environmental sample in order to achieve the minimum threshold for detection. The PNA-FISH assays described in this study allow for the sensitive and specific detection of viable Y. pestis bacteria in a timely manner.
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Affiliation(s)
- John H Kenny
- Bacterial Diseases Branch, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, United States
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32
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Qiu WG, Bruno JF, McCaig WD, Xu Y, Livey I, Schriefer ME, Luft BJ. Wide Distribution of a High-VirulenceBorrelia burgdorferiClone in Europe and North America. Emerg Infect Dis 2008. [DOI: 10.3201/eid/1407.070880] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Wei-Gang Qiu
- Hunter College of the City University of New York, New York, New York, USA
| | | | - William D. McCaig
- Hunter College of the City University of New York, New York, New York, USA
| | - Yun Xu
- Stony Brook University, Stony Brook, New York, USA
| | - Ian Livey
- Baxter Innovations GmBH, Orth/Donau, Austria
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33
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Qiu WG, Bruno JF, McCaig WD, Xu Y, Livey I, Schriefer ME, Luft BJ. Wide distribution of a high-virulence Borrelia burgdorferi clone in Europe and North America. Emerg Infect Dis 2008; 14:1097-104. [PMID: 18598631 PMCID: PMC2600328 DOI: 10.3201/eid1407.070880] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The A and B clones of Borrelia burgdorferi sensu stricto, distinguished by outer surface protein C (ospC) gene sequences, are commonly associated with disseminated Lyme disease. To resolve phylogenetic relationships among isolates, we sequenced 68 isolates from Europe and North America at 1 chromosomal locus (16S-23S ribosomal RNA spacer) and 3 plasmid loci (ospC,dbpA, and BBD14). The ospC-A clone appeared to be highly prevalent on both continents, and isolates of this clone were uniform in DNA sequences, which suggests a recent trans-oceanic migration. The genetic homogeneity of ospC-A isolates was confirmed by sequences at 6 additional chromosomal housekeeping loci (gap, alr, glpA, xylB, ackA, and tgt). In contrast, the ospC-B group consists of genotypes distinct to each continent, indicating geographic isolation. We conclude that the ospC-A clone has dispersed rapidly and widely in the recent past. The spread of the ospC-A clone may have contributed, and likely continues to contribute, to the rise of Lyme disease incidence.
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Affiliation(s)
- Wei-Gang Qiu
- Hunter College of the City University of New York, New York, New York, USA
| | | | - William D. McCaig
- Hunter College of the City University of New York, New York, New York, USA
| | - Yun Xu
- Stony Brook University, Stony Brook, New York, USA
| | - Ian Livey
- Baxter Innovations GmBH, Orth/Donau, Austria
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34
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Hovis KM, Schriefer ME, Sadlon T, Gordon DL, Marconi RT. Molecular and immunological analyses of the Borrelia hermsii factor H/FHL-1 binding protein, FhbA. Mol Immunol 2007. [DOI: 10.1016/j.molimm.2006.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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35
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Hovis KM, Schriefer ME, Bahlani S, Marconi RT. Immunological and molecular analyses of the Borrelia hermsii factor H and factor H-like protein 1 binding protein, FhbA: demonstration of its utility as a diagnostic marker and epidemiological tool for tick-borne relapsing fever. Infect Immun 2006; 74:4519-29. [PMID: 16861638 PMCID: PMC1539583 DOI: 10.1128/iai.00377-06] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It has been demonstrated that Borrelia hermsii, a causative agent of relapsing fever, produces a factor H (FH) and FH-like protein 1 (FHL-1) binding protein. The binding protein has been designated FhbA. To determine if FH/FHL-1 binding is widespread among B. hermsii isolates, a diverse panel of strains was tested for the FH/FHL-1 binding phenotype and FhbA production. Most isolates (23/24) produced FhbA and bound FH/FHL-1. Potential variation in FhbA among isolates was analyzed by DNA sequence analyses. Two genetically distinct FhbA types, designated fhbA1 and fhbA2, were delineated, and type-specific PCR primers were generated to allow for rapid differentiation. Pulsed-field gel electrophoresis and hybridization analyses demonstrated that all isolates that possess the gene carry it on a 200-kb linear plasmid (lp200), whereas isolates that lack the gene lack lp200 and instead carry an lp170. To determine if FhbA is antigenic during infection and to assess the specificity of the response, recombinant FhbA1 (rFhbA1) and rFhbA2 were screened with serum from infected mice and humans. FhbA was found to be expressed and antigenic and to elicit a potentially type-specific FhbA response. To localize the epitopes of FhbA1 and FhbA2, truncations were generated and screened with infection serum. The epitopes were determined to be conformationally defined. Collectively, these analyses indicate that FH/FHL-1 binding is a widespread virulence mechanism for B. hermsii and provide insight into the genetic and antigenic structure of FhbA. The data also have potential implications for understanding the epidemiology of relapsing fever in North America and can be applied to the future development of species-specific diagnostic tools.
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Affiliation(s)
- Kelley M Hovis
- Department of Microbiology and Immunology, Medical College of Virginia at Virginia Commonwealth University, 1112 E. Clay St., McGuire Hall, Richmond, Virginia 23298-0678, USA
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36
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Begier EM, Asiki G, Anywaine Z, Yockey B, Schriefer ME, Aleti P, Ogden-Odoi A, Staples JE, Sexton C, Bearden SW, Kool JL. Pneumonic plague cluster, Uganda, 2004. Emerg Infect Dis 2006; 12:460-7. [PMID: 16704785 PMCID: PMC3291454 DOI: 10.3201/eid1203.051051] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In a case cluster, pneumonic plague transmission was compatible with respiratory droplet rather than aerosol transmission. The public and clinicians have long-held beliefs that pneumonic plague is highly contagious; inappropriate alarm and panic have occurred during outbreaks. We investigated communicability in a naturally occurring pneumonic plague cluster. We defined a probable pneumonic plague case as an acute-onset respiratory illness with bloody sputum during December 2004 in Kango Subcounty, Uganda. A definite case was a probable case with laboratory evidence of Yersinia pestis infection. The cluster (1 definite and 3 probable cases) consisted of 2 concurrent index patient–caregiver pairs. Direct fluorescent antibody microscopy and polymerase chain reaction testing on the only surviving patient's sputum verified plague infection. Both index patients transmitted pneumonic plague to only 1 caregiver each, despite 23 additional untreated close contacts (attack rate 8%). Person-to-person transmission was compatible with transmission by respiratory droplets, rather than aerosols, and only a few close contacts, all within droplet range, became ill.
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Abstract
Francisella tularensis is a gram-negative coccobacillus and the etiologic agent of the zoonotic disease tularemia. First described in 1911 in Tulare County, California, it has since been reported throughout the Northern Hemisphere, with natural infections reported among an unusually wide range of vertebrates and invertebrates. In recent years, tularemia has emerged in new geographic locations, populations, and settings. This review will serve to highlight mechanisms contributing to the recent emergence of tularemia as well as a repertoire of diagnostic tools useful for detecting and diagnosing disease.
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Affiliation(s)
- Jeannine M Petersen
- Bacterial Zoonoses Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Foothills Campus, PO Box 2087, Ft. Collins, CO 80522, USA.
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38
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Loftis AD, Gill JS, Schriefer ME, Levin ML, Eremeeva ME, Gilchrist MJR, Dasch GA. Detection of Rickettsia, Borrelia, and Bartonella in Carios kelleyi (Acari: Argasidae). J Med Entomol 2005; 42:473-80. [PMID: 15962801 DOI: 10.1093/jmedent/42.3.473] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Carios kelleyi (Colley & Kohls 1941), a tick associated with bats and bat habitats, has been reported to feed on humans, but there is little published data regarding the presence of vector-borne pathogens in these ticks. C. kelleyi nymphs and adults were collected from residential and community buildings in Jackson County, Iowa, and tested by polymerase chain reaction for Rickettsia, Borrelia, Bartonella, Coxiella, and Anaplasma. Rickettsia DNA was detected in 28 of 31 live ticks. Sequences of the 17-kDa and rOmpA genes suggest that this agent is a novel spotted fever group Rickettsia. Transstadial and transovarial transmission of this Rickettsia were demonstrated. The flagellin gene of a Borrelia, closely related to B. turicatae, was detected in one of 31 live ticks. The 16S-23S intergenic spacer region of Bartonella henselae also was detected in one of 31 live ticks. Coxiella or A. phagocytophilum DNA were not detected in these ticks.
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Affiliation(s)
- Amanda D Loftis
- Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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39
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Loftis AD, Gill JS, Schriefer ME, Levin ML, Eremeeva ME, Gilchrist MJR, Dasch GA. Detection of Rickettsia, Borrelia, and Bartonella in Carios kelleyi (Acari: Argasidae). J Med Entomol 2005. [PMID: 15962801 DOI: 10.1603/0022-2585(2005)042[0473:dorbab]2.0.co;2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Carios kelleyi (Colley & Kohls 1941), a tick associated with bats and bat habitats, has been reported to feed on humans, but there is little published data regarding the presence of vector-borne pathogens in these ticks. C. kelleyi nymphs and adults were collected from residential and community buildings in Jackson County, Iowa, and tested by polymerase chain reaction for Rickettsia, Borrelia, Bartonella, Coxiella, and Anaplasma. Rickettsia DNA was detected in 28 of 31 live ticks. Sequences of the 17-kDa and rOmpA genes suggest that this agent is a novel spotted fever group Rickettsia. Transstadial and transovarial transmission of this Rickettsia were demonstrated. The flagellin gene of a Borrelia, closely related to B. turicatae, was detected in one of 31 live ticks. The 16S-23S intergenic spacer region of Bartonella henselae also was detected in one of 31 live ticks. Coxiella or A. phagocytophilum DNA were not detected in these ticks.
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Affiliation(s)
- Amanda D Loftis
- Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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40
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Petersen JM, Schriefer ME, Gage KL, Montenieri JA, Carter LG, Stanley M, Chu MC. Methods for enhanced culture recovery of Francisella tularensis. Appl Environ Microbiol 2004; 70:3733-5. [PMID: 15184180 PMCID: PMC427758 DOI: 10.1128/aem.70.6.3733-3735.2004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Francisella tularensis is found in a wide variety of hosts and extrahost environments, making culture recovery a diagnostic challenge. Here we demonstrate improved recovery times and good sensitivity (90%) when cultures were inoculated on the site of an investigation using fresh tissues. For contaminated specimens, antibiotic supplementation of enriched cysteine heart agar blood culture medium improved recovery of F. tularensis by 81.1%. For transport of tissues, immediate freezing yielded culture recovery rates as high as 94%.
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Affiliation(s)
- Jeannine M Petersen
- Diagnostic and Reference Section, Bacterial Zoonoses Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado 80522 , USA.
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Petersen JM, Schriefer ME, Carter LG, Zhou Y, Sealy T, Bawiec D, Yockey B, Urich S, Zeidner NS, Avashia S, Kool JL, Buck J, Lindley C, Celeda L, Monteneiri JA, Gage KL, Chu MC. Laboratory analysis of tularemia in wild-trapped, commercially traded prairie dogs, Texas, 2002. Emerg Infect Dis 2004; 10:419-25. [PMID: 15109407 PMCID: PMC3322795 DOI: 10.3201/eid1003.030504] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Oropharyngeal tularemia was identified as the cause of a die-off in captured wild prairie dogs at a commercial exotic animal facility in Texas. From this point source, Francisella tularensis-infected prairie dogs were traced to animals distributed to the Czech Republic and to a Texas pet shop. F. tularensis culture isolates were recovered tissue specimens from 63 prairie dogs, including one each from the secondary distribution sites. Molecular and biochemical subtyping indicated that all isolates were F. tularensis subsp. holarctica (Type B). Microagglutination assays detected antibodies against F. tularensis, with titers as great as 1:4,096 in some live animals. All seropositive animals remained culture positive, suggesting that prairie dogs may act as chronic carriers of F. tularensis. These findings demonstrate the need for additional studies of tularemia in prairie dogs, given the seriousness of the resulting disease, the fact that prairie dogs are sold commercially as pets, and the risk for pet-to-human transmission.
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Affiliation(s)
- Jeannine M Petersen
- Diagnostic and Reference Section, Bacterial Zoonoses Branch, Centers for Disease Control and Prevention, PO Box 2087, Rampart Road, Foothills Campus, Fort Collins, CO 80522, USA.
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42
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Fritz CL, Bronson LR, Smith CR, Schriefer ME, Tucker JR, Schwan TG. Isolation and characterization of Borrelia hermsii associated with two foci of tick-borne relapsing fever in California. J Clin Microbiol 2004; 42:1123-8. [PMID: 15004063 PMCID: PMC356836 DOI: 10.1128/jcm.42.3.1123-1128.2004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Relapsing fever, caused by the spirochete Borrelia hermsii and transmitted by the soft tick Ornithodoros hermsi, is endemic in many rural mountainous areas of California. Between 1996 and 1998, 12 cases of relapsing fever associated with two exposure sites in northern California were investigated. Follow-up at exposure sites included collection of soft ticks and serum specimens from sylvatic rodents. Attempts to cultivate spirochetes were made through inoculation of patient blood into mice and by feeding Ornithodoros ticks on mice. Three isolates of B. hermsii were recovered from two blood specimens and one pool of ticks. The protein and plasmid profiles of the three isolates were comparable to those of previous B. hermsii isolates from the western United States. Western immunoblotting of patient sera demonstrated an expanding immunologic response to antigens within four distinct molecular weight regions by 3 to 4 weeks postonset. Antibody to B. hermsii was detected in sera from 4 of 11 yellow-pine chipmunks (Tamias amoenus); no other rodent species collected were seropositive.
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Affiliation(s)
- Curtis L Fritz
- Division of Communicable Disease Control, California Department of Health Services, Sacramento, California 95899-7413, USA.
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43
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Avashia SB, Petersen JM, Lindley CM, Schriefer ME, Gage KL, Cetron M, DeMarcus TA, Kim DK, Buck J, Montenieri JA, Lowell JL, Antolin MF, Kosoy MY, Carter LG, Chu MC, Hendricks KA, Dennis DT, Kool JL. First reported prairie dog-to-human tularemia transmission, Texas, 2002. Emerg Infect Dis 2004; 10:483-6. [PMID: 15109417 PMCID: PMC3322778 DOI: 10.3201/eid1003.030695] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A tularemia outbreak, caused by Francisella tularensis type B, occurred among wild-caught, commercially traded prairie dogs. F. tularensis microagglutination titers in one exposed person indicated recent infection. These findings represent the first evidence for prairie-dog-to-human tularemia transmission and demonstrate potential human health risks of the exotic pet trade.
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Affiliation(s)
- Swati B Avashia
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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44
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Ullmann AJ, Lane RS, Kurtenbach K, Miller M, Schriefer ME, Zeldner N, Piesman J. Bacteriolytic Activity of Selected Vertebrate Sera for Borrelia burgdorferi Sensu Stricto and Borrelia bissettii. J Parasitol 2003; 89:1256-7. [PMID: 14740924 DOI: 10.1645/ge-3081rn] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An in vitro assay to evaluate the bacteriolytic activity of the complement pathway was applied to 2 strains of Borrelia bissettii, CO501 and DN127, and compared with that of B. burgdorferi sensu stricto B31. Sera from mule deer (Odocoileus hemionus) and the Western Fence lizard (Sceloporus occidentalis) were completely borreliacidal for B. burgdorferi and for both strains of B. bissettii. Serum from Bobwhite quail (Colinus virginianus) was nonlytic for B. burgdorferi and partially lytic for B. bissettii strains, CO-501 and DN127. Serum from a New Zealand White rabbit (Oryctolagus cuniculus) was partially lytic for all 3 strains of Borrelia, whereas serum from white-footed mice (Peromyscus leucopus) were nonlytic for all 3 Borrelia strains. The spectrum of complement sensitivity of B. bissettii appears to be similar to that of European B. afzelii in that tested rodent serum is not lytic to these 2 genospecies. Interestingly, both B. bissettii and B. afzelii have been found to be closely associated with rodents. Complement sensitivity demonstrated in these experiments may suggest and possibly predict specific reservoir-host associations.
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Affiliation(s)
- Amy J Ullmann
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado 80522, USA.
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Bacon RM, Biggerstaff BJ, Schriefer ME, Gilmore RD, Philipp MT, Steere AC, Wormser GP, Marques AR, Johnson BJB. Serodiagnosis of Lyme disease by kinetic enzyme-linked immunosorbent assay using recombinant VlsE1 or peptide antigens of Borrelia burgdorferi compared with 2-tiered testing using whole-cell lysates. J Infect Dis 2003; 187:1187-99. [PMID: 12695997 PMCID: PMC7109709 DOI: 10.1086/374395] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2002] [Accepted: 12/03/2002] [Indexed: 11/06/2022] Open
Abstract
In a study of US patients with Lyme disease, immunoglobulin (Ig) G and IgM antibody responses to recombinant Borrelia burgdorferi antigen VlsE1 (rVlsE1), IgG responses to a synthetic peptide homologous to a conserved internal sequence of VlsE (C6), and IgM responses to a synthetic peptide comprising the C-terminal 10 amino acid residues of a B. burgdorferi outer-surface protein C (pepC10) were evaluated by kinetic enzyme-linked immunoassay. At 99% specificity, the overall sensitivities for detecting IgG antibody to rVlsE1 or C6 in samples from patients with diverse manifestations of Lyme disease were equivalent to that of 2-tiered testing. When data were considered in parallel, 2 combinations (IgG responses to either rVlsE1 or C6 in parallel with IgM responses to pepC10) maintained high specificity (98%) and were significantly more sensitive than 2-tiered analysis in detecting antibodies to B. burgdorferi in patients with acute erythema migrans. In later stages of Lyme disease, the sensitivities of the in parallel tests and 2-tiered testing were high and statistically equivalent.
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Affiliation(s)
- Rendi Murphree Bacon
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Brad J. Biggerstaff
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Martin E. Schriefer
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Robert D. Gilmore
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Mario T. Philipp
- Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana
| | - Allen C. Steere
- Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts
| | - Gary P. Wormser
- Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla
| | - Adriana R. Marques
- Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Barbara J. B. Johnson
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
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Feldman KA, Enscore RE, Lathrop SL, Matyas BT, McGuill M, Schriefer ME, Stiles-Enos D, Dennis DT, Petersen LR, Hayes EB. An outbreak of primary pneumonic tularemia on Martha's Vineyard. N Engl J Med 2001; 345:1601-6. [PMID: 11757506 DOI: 10.1056/nejmoa011374] [Citation(s) in RCA: 230] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the summer of 2000, an outbreak of primary pneumonic tularemia occurred on Martha's Vineyard, Massachusetts. The only previously reported outbreak of pneumonic tularemia in the United States also occurred on the island in 1978. METHODS We conducted a case-control study of adults with pneumonic tularemia and investigated the environment to identify risk factors for primary pneumonic tularemia. Patients with confirmed cases were residents of or visitors to Martha's Vineyard who had symptoms suggestive of primary pneumonic tularemia, were ill between May 15 and October 31, 2000, and had a positive laboratory test for tularemia. Controls were adults who had spent at least 15 days on Martha's Vineyard between May 15 and September 28, 2000. RESULTS We identified 15 patients with tularemia; 11 of these cases were primary pneumonic tularemia. Francisella tularensis type A was isolated from blood and lung tissue of the one man who died. Patients were more likely than controls to have used a lawn mower or brush cutter in the two weeks before the illness or before an interview, for controls (odds ratio, 9.2; 95 percent confidence interval, 1.6 to 68.0) and during the summer (odds ratio, undefined; 95 percent confidence interval, 1.8 to infinity). Lawn mowing and brush cutting remained significant risk factors after adjustment for other potentially confounding variables. Only one patient reported being exposed to a rabbit while cutting brush. Of 40 trapped animals, 1 striped skunk (Mephitis mephitis) and 1 Norway rat (Rattus norvegicus) were seropositive for antibodies against F. tularensis. CONCLUSIONS Study of this outbreak of primary pneumonic tularemia implicates lawn mowing and brush cutting as risk factors for this infection.
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Affiliation(s)
- K A Feldman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Fort Collins, Colo., USA.
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47
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Trevejo RT, Krause PJ, Schriefer ME, Dennis DT. Evaluation of a two-test serodiagnostic method for community assessment of Lyme disease in an endemic area. Am J Trop Med Hyg 2001; 65:563-6. [PMID: 11716115 DOI: 10.4269/ajtmh.2001.65.563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Epidemiological methods are needed to evaluate community exposure to Borrelia burgdorferi, the causative agent of Lyme disease (LD). For LD serodiagnosis, the Centers for Disease Control and Prevention (CDC) recommends a 2-test approach that involves enzyme immunoassay (EIA) testing and Western immunoblotting (WB) of EIA-equivocal and EIA-positive specimens. The specificity of this approach was evaluated among residents of a LD-endemic community and was compared with WB alone and with a simplified 2-test approach (WB of equivocal EIA only). Participants reporting no previous diagnosis of LD were recruited during a community-wide serosurvey on Block Island, Rhode Island. Of 80 eligible participants, 20 had received LD vaccine. Seven (35%) of 20 vaccinees and 22 (37%) of 60 nonvaccinees reported nonspecific symptoms compatible with LD in the previous year. In this highly LD-endemic community, the overall specificity of the CDC-recommended approach was highest (100%), followed by WB alone (98.7%), then the simplified approach (95%).
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Affiliation(s)
- R T Trevejo
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado 80522, USA
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48
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Porcella SF, Raffel SJ, Schrumpf ME, Schriefer ME, Dennis DT, Schwan TG. Serodiagnosis of Louse-Borne relapsing fever with glycerophosphodiester phosphodiesterase (GlpQ) from Borrelia recurrentis. J Clin Microbiol 2000; 38:3561-71. [PMID: 11015364 PMCID: PMC87437 DOI: 10.1128/jcm.38.10.3561-3571.2000] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human louse-borne relapsing fever occurs in sporadic outbreaks in central and eastern Africa that are characterized by significant morbidity and mortality. Isolates of the causative agent, Borrelia recurrentis, were obtained from the blood of four patients during a recent epidemic of the disease in southern Sudan. The glpQ gene, encoding glycerophosphodiester phosphodiesterase, from these isolates was sequenced and compared with the glpQ sequences obtained from other relapsing-fever spirochetes. Previously we showed that GlpQ of Borrelia hermsii is an immunogenic protein with utility as a serological test antigen for discriminating tick-borne relapsing fever from Lyme disease. In the present work, we cloned and expressed the glpQ gene from B. recurrentis and used recombinant GlpQ in serological tests. Acute- and convalescent-phase serum samples obtained from 42 patients with louse-borne relapsing fever were tested with an indirect immunofluorescence assay (IFA) and an enzyme-linked immunosorbent assay (ELISA) that used whole cells of B. recurrentis and with immunoblotting to whole-cell lysates of the spirochete and Escherichia coli producing recombinant GlpQ. The geometric mean titers of the acute- and convalescent-phase serum samples measured by IFA were 1:83 and 1:575, respectively. The immunoblot analysis identified a high level of reactivity and seroconversion to GlpQ, and the assay was more sensitive than the whole-cell IFA and ELISA using purified, recombinant histidine-tagged GlpQ. Serum antibodies to GlpQ and other antigens persisted for 27 years in one patient. We conclude that assessment of anti-GlpQ antibodies will allow serological confirmation of louse-borne relapsing fever and determination of disease prevalence.
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Affiliation(s)
- S F Porcella
- Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, USA
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Schriefer ME, Dennis DT, Gubler DJ, Hayes EB, Johnson BJ, Chu MC. Serologic testing for Lyme disease. JAMA 2000; 284:695-6. [PMID: 10927774 DOI: 10.1001/jama.284.6.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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50
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Affiliation(s)
- RT Trevejo
- Epidemiology Program, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
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