Transverse Myelitis Secondary To Coexistent Lyme Disease And Babesiosis

Abstract

Objective: To describe transverse myelitis secondary to coexistent Lyme disease and babesiosis.

Method: Case report.

Background: A 7 4-year-old man presented with rapid onset of weakness, numbness, and tingling in his legs, with symptoms ascending to his hands and forearms within days. He recalled an insect bite to his scapular area 2 weeks earlier.

Findings: T2-weighted magnetic resonance imaging demonstrated diffuse hyperintensity from T1 through T1 2. Western blot and enzyme-linked immunosorbent assay identified infection with Borrelia burgdorferi, the spirochete responsible for Lyme disease. Giemsa-stained blood smears identified ring forms later recognized by polymerase chain reaction as Babesia microti, the piroplasm responsible for babesiosis. Initial examination revealed C7 motor and T3 sensory complete tetraplegia, with recovery to T 4 paraplegia by 2 months.

Conclusion: The history, physical examination, imaging, and serologic studies were consistent with transverse myelitis related to Lyme disease and babesiosis. The severity and permanence of this patient’s deficits were greater than those reported in the majority of previous cases of transverse myelitis due to Lyme disease alone, suggesting a possible role for coinfection with babesiosis.     

Development and Application of a Loop‐mediated Isothermal Amplification Assay for Rapid Detection of Borrelia burgdorferi s. l. in Ticks

A loop‐mediated isothermal amplification (LAMP) assay was developed to detect Borrelia burgdorferi s. l. in ticks, which is a pathogen that causes Lyme disease. Cross‐reactions with Chlamydia psittaci, Mycoplasma mycoides subsp. capri and some tick‐borne pathogens were excluded. Analytical sensitivity of LAMP showed its detection limit was from 0.02 to 0.2 pg of DNA in detection of the reference samples at 65°C for 40 min. The performance of LAMP was assessed by testing 110 samples from susceptible tick species and comparing the results with conventional and nested PCR tests previously described. The results demonstrated that LAMP was significantly more sensitive than the conventional PCR (32.7% versus 15.5%, P < 0.05) and slightly more sensitive, although not significantly so, than nested PCR (32.7% versus 26.4%, P > 0.05). The assay was used to analyse a total of 1052 ticks collected from eight provinces in China. The results showed that the infection rates of B. burgdorferi s. l. varied from 12.5% to 88.9% across the different geographical sites. Selected positive samples were subjected to sequencing and sequence analysis for conformation of the accuracy of the assay. Here we report a highly sensitive, specific and easy diagnostic assay based on LAMP technology. These data indicate that LAMP is a useful approach for detecting B. burgdorferi s. l. in field‐collected ticks and has the potential as an alternative tool for the ecological and epidemiological surveillance of Lyme disease.     

No association of seropositivity for anti-Borrelia IgG antibody with mental and physical complaints

Undiagnosed chronic Lyme disease caused by Borrelia burgdorferi is considered a differential diagnoses in medically unexplained symptoms like arthralgias, distal paresthesias, depressive symptoms, lack of concentration and fatigue. The aims of the study were to assess the association of mental and physical complaints with seropositivity for anti-Borrelia IgG in a general population sample. Seropositivity indicated an infection with Borrelia in the past. The Study of Health in Pomerania was conducted in a community living in a region with endemic Lyme disease. Mental and physical complaints were assessed on 38 items with the von Zerssen's complaint scale. IgG antibodies to Borrelia were determined by ELISA in 4264 individuals. Seropositivity was analyzed applying two cut-off scores (>5 and >10 IU/ml). IgG antibodies to Borrelia were found positive in 388 subjects (9.1%) applying the >5 IU/ml cut-off and in 130 subjects (3.0%) applying the >10 IU/ml cut-off. In multivariate analyses (MANCOVA), both definitions of seropositivity were not associated with increased mental or physical complaints while adjusting for gender, age, employment status, rural residency, physical activity, diabetes mellitus and number of chronic diseases. In the general population, seropositivity for anti-Borrelia IgG antibodies was not associated with an increase of self-rated mental or physical complaints or impairments. Therefore, clinicians should not overvalue seropositivity for anti-Borrelia IgG as a medical cause for unexplained mental or physical complaints.     

Occurrence and transmission efficiencies of Borrelia burgdorferi ospC types in avian and mammalian wildlife

Borrelia burgdorferi s.s., the bacterium that causes Lyme disease in North America, circulates among a suite of vertebrate hosts and their tick vector. The bacterium can be differentiated at the outer surface protein C (ospC) locus into 25 genotypes. Wildlife hosts can be infected with a suite of ospC types but knowledge on the transmission efficiencies of these naturally infected hosts to ticks is still lacking. To evaluate the occupancy and detection of ospC types in wildlife hosts, we adapted a likelihood-based species patch occupancy model to test for the occurrence probabilities (ψ – “occupancy”) and transmission efficiencies (ε – “detection”) of each ospC type. We detected differences in ospC occurrence and transmission efficiencies from the null models with HIS (human invasive strains) types A and K having the highest occurrence estimates, but both HIS and non-HIS types having high transmission efficiencies. We also examined ospC frequency patterns with respect to strains known to be invasive in humans across the host species and phylogenetic groups. We found that shrews and to a lesser extent, birds, were important host groups supporting relatively greater frequencies of HIS to non-HIS types. This novel method of simultaneously assessing occurrence and transmission of ospC types provides a powerful tool in assessing disease risk at the genotypic level in naturally infected wildlife hosts and offers the opportunity to examine disease risk at the community level.     

Lyme disease and post-treatment Lyme disease syndrome: the neglected disease in our own backyard

Objectives

A survey was developed to assess experience and opinions about Lyme disease and post-treatment Lyme disease syndrome (PTLDS) among faculties in public health. No previous surveys of public health faculties have been found in the literature.

Study design

This is a cross sectional study of public health school faculty members designed to measure knowledge and experience with Lyme disease and PTLDS using an internet survey instrument.

Methods

Participants were recruited using all the publicly available e-mail addresses of faculty members in all the 50 accredited Schools of Public Health in the United States.

Results

A 15% response rate was seen for the survey. 50% of respondents were from Lyme endemic states. Less than 5% of faculty members consider themselves expert in Lyme or PTLDS. Many faculty members had known someone with Lyme disease or PTLDS, but few had been diagnosed themselves. Most believe that PTLDS can be severe and chronic, is not easy to treat, and does not resolve on its own, but were uncertain about its aetiology. Most respondents also felt that the incidence of Lyme disease will increase and that more education is needed.

Conclusions

The need for further understanding and communication presents an opportunity for public health research and education in Lyme disease and the sequelae of PTLDS.     

Demonstration of Borrelia burgdorferi sensu stricto infection in ticks from the northeast of Mexico

Borrelia burgdorferi sensu lato infection has been confirmed in clinical cases in the northeast of Mexico; however, the bacterium has not been identified as infecting the tick vector Ixodes , Amblyomma and Dermacentor ticks were collected from mammals and plants in northeastern Mexico and examined for Borrelia . Eighteen of 214 ticks were PCR-positive for the fla and 16S rRNA genes and 15 for the ospA gene. Southern blotting with a fla probe and sequencing of ospA genes confirmed infection with B. burgdorferi sensu stricto . These findings, together with reports of indigenous cases, fulfil the criteria that allow northeastern Mexico to be considered as a zone endemic for Lyme disease.     

Clinical association: Lyme disease and Guillain-Barre syndrome

Guillain-Barre Syndrome (GBS) is a life-threatening condition in which patients may present to the Emergency Department in respiratory distress leading to death. The early identification and treatment of such a condition is paramount in preventing mortality. While there are many infections associated with GBS, the association with Lyme disease is uncommon. Through our case we aim to highlight Borrelia burgdorferi as an important antecedent infection associated with the development of GBS. In this case we report a 31-year-old male who was diagnosed with Lyme disease and GBS with relevant clinical presentation including progressive numbness and weakness in bilateral hands and feet for the past 1 week along with areflexia. Initiation of medical therapy with intravenous immunoglobulin and parenteral ceftriaxone resulted in resolution of his symptoms. The treatment of both diseases early can help prevent further central nervous complications leading to high morbidity and mortality.     

承德地区莱姆病自然疫源性特征分析

目的了解承德地区莱姆病自然疫源地存在状况。方法于承德林区捕鼠、采蜱；巴伯-斯托纳-凯利培养基(BSK)分离蜱内病原体；PCR扩增蜱、鼠体内目的片段及序列测定；对林区居民及动物牛、羊进行血清抗体检测。结果全沟硬蜱为优势蜱种，从中PCR扩增出目的片段，基因序列同源性比较，提示此感染菌株与欧亚大陆常见的莱姆病螺旋体Borrelia afzelii种具有高度同源性。林区居民及动物牛、羊血清抗体检出阳性率较高，分别为13．3％，23．3％，30％。结论全沟硬蜱是承德地区的优势蜱种；并发现其感染有致病性莱姆病螺旋体Borrelia afzelii种。林区羊、牛为重要的贮存宿主。林区人群存在莱姆病螺旋体自然感染，可初步认定承德地区为莱姆病自然疫源地。