Borrelia miyamotoi BipA-like protein, BipM, is a candidate serodiagnostic antigen distinguishing between Lyme disease and relapsing fever Borrelia infections

A Borrelia miyamotoi gene with partial homology to bipA of relapsing fever spirochetes Borrelia hermsii and Borrelia turicatae was identified by a GenBank basic alignment search analysis. We hypothesized that this gene product may be an immunogenic antigen as described for other relapsing fever Borrelia (RFB) and could serve as a serological marker for B. miyamotoi infections. The B. miyamotoi gene was a truncated version about half the size of the B. hermsii and B. turicatae bipA with a coding sequence of 894 base pairs. The gene product had a calculated molecular size of 32.7 kDa (including the signal peptide). Amino acid alignments with B. hermsii and B. turicatae BipA proteins and with other B. miyamotoi isolates showed conservation at the carboxyl end. We cloned the B. miyamotoi bipA-like gene (herein named bipM) and generated recombinant protein for serological characterization and for antiserum production. Protease protection analysis demonstrated that BipM was surface exposed. Serologic analyses using anti-B. miyamotoi serum samples from tick bite-infected and needle inoculated mice showed 94 % positivity against BipM. The 4 BipM negative serum samples were blotted against another B. miyamotoi antigen, BmaA, and two of them were seropositive resulting in 97 % positivity with both antigens. Serum samples from B. burgdorferi sensu stricto (s.s.)-infected mice were non-reactive against rBipM by immunoblot. Serum samples from Lyme disease patients were also serologically negative against BipM except for 1 sample which may have indicated a possible co-infection. A recently published study demonstrated that B. miyamotoi BipM was non-reactive against serum samples from B. hermsii, Borrelia parkeri, and B. turicatae infected animals. These results show that BipM has potential for a B. miyamotoi-infection specific and sensitive serodiagnostic to differentiate between Lyme disease and various RFB infections.

Evaluation of Immunocompetent Mouse Models for Borrelia miyamotoi Infection

Borrelia miyamotoi is a relapsing fever spirochete that is harbored by Ixodes spp. ticks and is virtually uncharacterized, compared to other relapsing fever Borrelia vectored by Ornithodoros spp. ticks. There is not an immunocompetent mouse model for studying B. miyamotoi infection in vivo or for transmission in the vector-host cycle. Our goal was to evaluate B. miyamotoi infections in multiple mouse breeds/strains as a prelude to the ascertainment of the best experimental infection model. Two B. miyamotoi strains, namely, LB-2001 and CT13-2396, as well as three mouse models, namely, CD-1, C3H/HeJ, and BALB/c, were evaluated. We were unable to observe B. miyamotoi LB-2001 spirochetes in the blood via darkfield microscopy or to detect DNA via real-time PCR post needle inoculation in the CD-1 and C3H/HeJ mice. However, LB-2001 DNA was detected via real-time PCR in the blood of the BALB/c mice after needle inoculation, although spirochetes were not observed via microscopy. CD-1, C3H/HeJ, and BALB/c mice generated an antibody response to B. miyamotoi LB-2001 following needle inoculation, but established infections were not detected, and the I. scapularis larvae failed to acquire spirochetes from the exposed CD-1 mice. In contrast, B. miyamotoi CT13-2396 was visualized in the blood of the CD-1 and C3H/HeJ mice via darkfield microscopy and detected by real-time PCR post needle inoculation. Both mouse strains seroconverted. However, no established infection was detected in the mouse organs, and the I. scapularis larvae failed to acquire Borrelia after feeding on CT13-2396 exposed CD-1 or C3H/HeJ mice. These findings underscore the challenges in establishing an experimental B. miyamotoi infection model in immunocompetent laboratory mice. IMPORTANCE Borrelia miyamotoi is a causative agent of hard tick relapsing fever, was first identified in the early 1990s, and was characterized as a human pathogen in 2011. Unlike other relapsing fever Borrelia species, B. miyamotoi spread by means of Ixodes ticks. The relatively recent recognition of this human pathogen means that B. miyamotoi is virtually uncharacterized, compared to other Borrelia species. Currently there is no standard mouse-tick model with which to study the interactions of the pathogen within its vector and hosts. We evaluated two B. miyamotoi isolates and three immunocompetent mouse models to identify an appropriate model with which to study tick-host-pathogen interactions. With the increased prevalence of human exposure to Ixodes ticks, having an appropriate model with which to study B. miyamotoi will be critical for the future development of diagnostics and intervention strategies.

Borrelia miyamotoi strain LB-2001 retains plasmids and infectious phenotype throughout continuous culture passages as evaluated by multiplex PCR

Borrelia miyamotoi is a tick-borne spirochete of the relapsing fever borrelia group and an emerging pathogen of public health significance. The genomes of relapsing fever borreliae and Lyme disease borreliae consist of multiple linear and circular plasmids in addition to the chromosome. Previous work with B. burgdorferi sensu lato found diminished infectivity upon continuous in vitro culture passage that was attributable to plasmid loss. The effect of long-term culture passage on B. miyamotoi is not known. We generated a series of plasmid-specific primer sets and developed a multiplex PCR assay to detect the 14 known plasmids of B. miyamotoi North American strains LB-2001 and CT13-2396. We assessed the plasmid content of B. miyamotoi LB-2001 over 64 culture passages spanning 15 months and determined that strain LB-2001 retained all plasmids upon prolonged in vitro cultivation and remained infectious in mice. We also found that strain LB-2001 lacks plasmid lp20-1 which is present in strain CT13-2396. These results suggest that B. miyamotoi remains genetically stable when cultured and passaged in vitro.

Trypanosoma (Herpetosoma) diversity in rodents and lagomorphs of New Mexico with a focus on epizootological aspects of infection in Southern Plains woodrats (Neotoma micropus)

Protozoan parasites of the genus Trypanosoma infect a broad diversity of vertebrates and several species cause significant illness in humans. However, understanding of the phylogenetic diversity, host associations, and infection dynamics of Trypanosoma species in naturally infected animals is incomplete. This study investigated the presence of Trypanosoma spp. in wild rodents and lagomorphs in northern New Mexico, United States, as well as phylogenetic relationships among these parasites. A total of 458 samples from 13 rodent and one lagomorph species collected between November 2002 and July 2004 were tested by nested PCR targeting the 18S ribosomal RNA gene (18S rRNA). Trypanosoma DNA was detected in 25.1% of all samples, with the highest rates of 50% in Sylvilagus audubonii, 33.1% in Neotoma micropus, and 32% in Peromyscus leucopus. Phylogenetic analysis of Trypanosoma sequences revealed five haplotypes within the subgenus Herpetosoma (T. lewisi clade). Focused analysis on the large number of samples from N. micropus showed that Trypanosoma infection varied by age class and that the same Trypanosoma haplotype could be detected in recaptured individuals over multiple months. This is the first report of Trypanosoma infections in Dipodomys ordii and Otospermophilus variegatus, and the first detection of a haplotype phylogenetically related to T. nabiasi in North America in S. audubonii. This study lends important new insight into the diversity of Trypanosoma species, their geographic ranges and host associations, and the dynamics of infection in natural populations.

Characterization of a Borrelia miyamotoi membrane antigen (BmaA) for serodiagnosis of Borrelia miyamotoi disease

Borrelia miyamotoi is a tick-borne pathogen that causes Borrelia miyamotoi disease (BMD), an emerging infectious disease of increasing public health significance. B. miyamotoi is transmitted by the same tick vector (Ixodes spp.) as B. burgdorferi sensu lato (s.l.), the causative agent of Lyme disease, therefore laboratory assays to differentiate BMD from Lyme disease are needed to avoid misdiagnoses and for disease confirmation. We previously performed a global immunoproteomic analysis of the murine host antibody response against B. miyamotoi infection to discover antigens that could serologically distinguish the two infections. An initial assessment identified a putative lipoprotein antigen, here termed BmaA, as a promising candidate to augment current research-based serological assays. In this study, we show that BmaA is an outer surface-associated protein by its susceptibility to protease digestion. Synthesis of BmaA in culture was independent of temperature at either 23 °C or 34 °C. The BmaA gene is present in two identical loci harbored on separate plasmids in North American strains LB-2001 and CT13-2396. bmaA-like sequences are present in other B. miyamotoi strains and relapsing fever borrelia as multicopy genes and as paralogous or orthologous gene families. IgM and IgG antibodies in pooled serum from BMD patients reacted with native BmaA fractionated by 2-dimensional gel electrophoresis and identified by mass spectrometry. IgG against recombinant BmaA was detected in 4 of 5 BMD patient serum samples as compared with 1 of 23 serum samples collected from patients with various stages of Lyme disease. Human anti-B. turicatae serum did not seroreact with recombinant BmaA suggesting a role as a species-specific diagnostic antigen. These results demonstrated that BmaA elicits a human host antibody response during B. miyamotoi infection but not in a tested group of B. burgdorferi-infected Lyme disease patients, thereby providing a potentially useful addition for developing BMD serodiagnostic tests.

Longitudinal Study of Bacterial Infectious Agents in a Community of Small Mammals in New Mexico

Background and Objectives: Vector-borne bacterial diseases represent a substantial public health burden and rodents have been recognized as important reservoir hosts for many zoonotic pathogens. This study investigates bacterial pathogens in a small mammal community of the southwestern United States of America. Methods: A total of 473 samples from 13 wild rodent and 1 lagomorph species were tested for pathogens of public health significance: Bartonella, Brucella, Yersinia, Borrelia, Rickettsia spp., and Anaplasma phagocytophilum. Results: Three animals were positive for Yersinia pestis, and one Sylvilagus audubonii had a novel Borrelia sp. of the relapsing fever group. No Brucella, Rickettsia, or A. phagocytophilum infections were detected. Bartonella prevalence ranged between 0% and 87.5% by animal species, with 74.3% in the predominant Neotoma micropus and 78% in the second most abundant N. albigula. The mean duration of Bartonella bacteremia in mark-recaptured N. micropus and N. albigula was 4.4 months, ranging from <1 to 18 months, and differed among Bartonella genogroups. Phylogenetic analysis of the Bartonella citrate synthase gene (gltA) revealed 9 genogroups and 13 subgroups. Seven genogroups clustered with known or previously reported Bartonella species and strains while two were distant enough to represent new Bartonella species. We report, for the first time, the detection of Bartonella alsatica in North America in Sylvilagus audubonii and expand the known host range of Bartonella washoensis to include Otospermophilus variegatus. Interpretation and Conclusion: This work broadens our knowledge of the hosts and geographic range of bacterial pathogens that could guide future surveillance efforts and improves our understanding of the dynamics of Bartonella infection in wild small mammals.

Comparative Ecology of Bartonella and Brucella Infections in Wild Carnivores

Phylogenetic sister clades Bartonella and Brucella within the order Rhizobiales present some common biological characteristics as well as evident differences in adaptations to their mammalian reservoirs. We reviewed published data on Bartonella and Brucella infections in wild carnivores to compare the ecology of these bacteria in relatively similar host environments. Arthropod vectors are the main mechanism for Bartonella species transmission between mammalian hosts. The role of arthropods in transmission of Brucella remains disputed, however experimental studies and reported detection of Brucella in arthropods indicate potential vector transmission. More commonly, transmission of Brucella occurs via contact exposure to infected animals or the environment contaminated with their discharges. Of 26 species of carnivores tested for both Bartonella and Brucella, 58% harbored either. Among them were bobcats, African lions, golden jackals, coyotes, wolves, foxes, striped skunks, sea otters, raccoons, and harbor seals. The most common species of Bartonella in wild carnivores was B. henselae, found in 23 species, followed by B. rochalimae in 12, B. clarridgeiae in ten, and B. vinsonii subsp. berkhoffii in seven. Among Brucella species, Br. abortus was reported in over 30 terrestrial carnivore species, followed by Br. canis in seven. Marine carnivores, such as seals and sea lions, can host Br. pinnipedialis. In contrast, there is no evidence of a Bartonella strain specific for marine mammals. Bartonella species are present practically in every sampled species of wild felids, but of 14 Brucella studies of felids, only five reported Brucella and those were limited to detection of antibodies. We found no reports of Bartonella in bears while Brucella was detected in these animals. There is evident host-specificity of Bartonella species in wild carnivores (e.g., B. henselae in felids and B. vinsonii subsp. berkhoffii in canids). A co-adaptation of Brucella with terrestrial wild carnivore hosts is not as straightforward as in domestic animals. Wild carnivores often carry the same pathogens as their domesticated relatives (cats and dogs), but the risk of exposure varies widely because of differences in biology, distribution, and historical interactions.

Intracranial Approach to Suprasellar Rathke's Cleft Cyst

The occurrence of a symptomatic Rathke's cleft cyst without extension into the sella turcica is rare. The purpose of this report is to present such a case, with its clinical manifestation, diagnostic imaging characteristics, operative approach, pathology and review of the literature.

Computer modeling of cerebral blood flow following internal carotid artery occlusion

It is difficult to predict the adequacy of the collateral blood flow in patients who undergo internal carotid artery occlusion. In order to address this difficulty, the authors have created a computer model of the cerebral circulation. This model features individualized simulations of the Circle of Willis and its afferent and efferent branches which can predict changes in flow that will occur during internal carotid artery occlusion. Analysis of the flow predictions suggests that in patients with a symmetric Circle of Willis the anterior communicating artery is the major conduit of collateral blood supply. In patients with a small anterior communicating artery, the posterior communicating arteries become more important as sources of collateral flow, but they cannot supply as much flow as in the case of a normal anterior communicating artery. Sensitivity studies show that changes in the dimensions of each artery affect the flow throughout the system, such that the arteries in the cerebral circulation must be analyzed as a network rather than as isolated elements. This computer model of the cerebral circulation may help clinicians predict the adequacy of collateral blood supply in patients who undergo internal carotid artery occlusion.

Intracranial aneurysms: size, risk of rupture, and prophylactic surgical treatment

Intracranial saccular aneurysms frequently cause devastating neurologic injury when they rupture. With recent improvements in diagnostic imaging, however, an increasing number of aneurysms are now diagnosed in the unruptured state. Controversy exists regarding the appropriate management of these lesions. We have retrospectively examined a group of 86 patients from Connecticut with 104 intracranial aneurysms to determine whether small (less than 10 mm in greatest diameter) aneurysms have potential for rupture, and whether there is a role for prophylactic surgical therapy for these unruptured aneurysms. The majority of ruptured and unruptured aneurysms in the series measured less than 10 mm in greatest diameter. Out of a total of 82 patients who underwent surgical therapy, 44 had surgery for unruptured aneurysms. The major surgical morbidity in this group was 2%. We conclude that surgical therapy for small unruptured intracranial aneurysms may be beneficial since these lesions likely have substantial potential for rupture and because surgical treatment carries an acceptable risk.

Spontaneous spinal epidural hematoma

Two cases of the spontaneous occurrence of spinal epidural hematomas of the high thoracic area are reported. Both acute and subacute presentations of paraplegia are represented. Neither patient had experienced any significant antecedent trauma. No predisposing medical conditions were present. Both patients recovered to independent ambulation following timely operative intervention. The pertinent literature on spinal epidural hematomas is reviewed, and the differential diagnosis of this entity is discussed. The need for prompt diagnosis and surgical treatment to achieve the best neurological outcome is emphasized.

Pituitary surgery: current status, including transsphenoidal surgery

Advances in CT scanning and digital subtraction angiography have improved the accuracy of preoperative diagnosis of pituitary disease. Modern radioimmunoassay techniques are able to evaluate "subdivisions" and "relatives" of the classic pituitary hormones, including monomeric and oligomeric growth hormones, somatomedin C, beta-lipotropin, and beta-endorphin, as well as the alpha subunit of follicle-stimulating hormone. Pituitary pathologic states can now be identified immunologically in patients in whom results of radiologic studies are normal. Bromocriptine, a centrally active dopamine antagonist and ergot derivative, is effective in the treatment of prolactinomas, but it is not effective in the treatment of acromegaly. Transsphenoidal surgery remains the treatment of choice in adults with pituitary-dependent Cushing's disease. The surgical advantages of the sublabial, transseptal, transsphenoidal approach include wide-field pituitary accessibility via a midline exposure.

Sellar lesions

A thorough knowledge of the surgical anatomy of the sellar region is prerequisite to understanding the symptoms and the pathophysiology of diseases in this area. The differential diagnoses of sellar and parasellar lesions includes pituitary tumor, craniopharyngioma, carotid aneurysm, empty sellar syndrome, metastatic tumor, optic or hypothalamus glioma, meningioma, chordoma, mucocele, and bony tumor of the sphenoid sinus. The preoperative evaluation should encompass the consultations of an endocrinologist, an ophthalmologist, and a neurosurgeon.