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Ahead of Print -Borrelia miyamotoi sensu lato Seroreactivity and Seroprevalence in the Northeastern United States - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

Borrelia miyamotoi sensu lato Seroreactivity and Seroprevalence in the Northeastern United States

Peter J. Krause

, Sukanya Narasimhan, Gary P. Wormser, Alan G. Barbour, Alexander E. Platonov, Janna Brancato, Timothy Lepore, Kenneth Dardick, Mark Mamula, Lindsay Rollend, Tanner K. Steeves, Maria Diuk-Wasser, Sahar Usmani-Brown, Phillip Williamson, Denis S. Sarksyan, Erol Fikrig, Durland Fish, and the Tick Borne Diseases Group

Author affiliations: Yale School of Public Health, New Haven, Connecticut, USA (P.J. Krause, J. Brancato, L. Rollend, T.K. Steeves, M. Diuk-Wasser, D. Fish); Yale School of Medicine, New Haven (P.J. Krause, S. Narasimhan, M. Mamula, E. Fikrig); New York Medical College, Valhalla, New York, USA (G.P. Wormser);University of California, Irvine, California, USA (A.G. Barbour);Central Research Institute of Epidemiology, Moscow, Russia (A.E. Platonov); Nantucket Cottage Hospital, Nantucket, Massachusetts, USA (T. Lepore); Mansfield Family Practice, Mansfield, Connecticut, USA (K. Dardick); L2 Diagnostics, LLC, New Haven (S. Usmani-Brown); Creative Testing Solutions, Tempe, Arizona, USA (P. Williamson); State Medical Academy, Izhevsk, Russia (D.S. Sarksyan)

Abstract

Borrelia miyamotoi sensu lato, a relapsing fever Borrelia sp., is transmitted by the same ticks that transmit B. burgdorferi (the Lyme disease pathogen) and occurs in all Lyme disease–endemic areas of the United States. To determine the seroprevalence of IgG against B. miyamotoi sensu lato in the northeastern United States and assess whether serum from B. miyamotoi sensu lato–infected persons is reactive to B. burgdorferi antigens, we tested archived serum samples from area residents during 1991–2012. Of 639 samples from healthy persons, 25 were positive for B. miyamotoi sensu lato and 60 for B. burgdorferi. Samples from ≈10% of B. miyamotoi sensu lato–seropositive persons without a recent history of Lyme disease were seropositive for B. burgdorferi. Our resultsA suggest thatA human B. miyamotoiA sensu latoA infection may be common in southern New England and that B. burgdorferi antibody testing is not an effective surrogate for detecting B. miyamotoisensu lato infection.

Relapsing fever, an arthropod-borne infection caused by several Borrelia spp. spirochetes, is transmitted by ticks and lice (1,2). In 1995, Fukunaga et al. (3) discovered a novel relapsing fever spirochete in the hard-bodied (ixodid) tick Ixodes persulcatus and named it Borrelia miyamotoi. This discovery greatly expanded the potential geographic range of relapsing fever borreliae for humans. Before this finding, only soft-bodied ticks were known to transmit tick-borne relapsing fever spirochetes to humans. In 2001, a related spirochete was detected in I. scapularis ticks in the northeastern United States (4); this and similar organisms have been designated B. miyamotoi sensu lato to distinguish them from the B. miyamotoi sensu stricto isolates from Japan (5). A subsequent study showed that ticks in 15 states in the northeastern and northern midwestern regions of the United States are infected with B. miyamotoi sensu lato and have an average prevalence of infection of 1.9% (range 0–10.5%) (6). B. miyamotoi sensu lato has now been found in all tick species known to be vectors of Lyme disease, including I. pacificus in the western United States, I. ricinus in Europe, and I. persulcatus and I. ricinus in Russia (7–9). The first human cases of B. miyamotoi sensu lato infection were reported from central Russia in 2011 (9). Several reports of B. miyamotoi sensu lato infection in humans have subsequently been published, including 3 in the United States, 1 in Europe, and 1 in Russia (10–14). Some of these reports suggest that B. miyamotoi sensu lato infection causes a nonspecific, virus-like illness. B. miyamotoi sensu lato and B. burgdorferi, the agent of Lyme disease, share several antigens that might cause cross-reactivity during serologic testing, which could lead to a misdiagnosis.

There are few data on the seroprevalence of B. miyamotoi sensu lato infection. To increase knowledge of the seroprevalence of this infection, we used assays for antibodies against B. miyamotoi sensu lato glycerophosphodiester phosphodiesterase (GlpQ), a protein that is absent from all Lyme disease Borrelia species (15), for evaluation of >1,000 archived serum samples from persons living in a Lyme disease–endemic region of the United States. We also performed standard 2-tiered testing for B. burgdorferi antibodies (16). Our aim was to compare the seroprevalence of B. miyamotoi sensu lato with that of B. burgdorferi. We also sought to determine whether persons seropositive for B. miyamotoi sensu lato would also have positive results for standard B. burgdorferi antibody testing.

Dr Krause is a Senior Research Scientist in the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health and the Yale School of Medicine. His research focuses on tick-borne diseases, especially those caused by Borrelia miyamotoiand Babesia microti.

Acknowledgments

Members of the Tick Borne Diseases Group: Michel Ledizet and Mary Lou Breitenstein (L2 Diagnostics, LLC, New Haven, Connecticut, USA); Thomas Clay and Kathleen Stanton (Brimfield Family Health Center, Brimfield, Massachusetts, USA); Joseph Gadbaw (Lawrence and Memorial Hospital, New London, Connecticut); Janice Miller (Island Medical Center, Block Island, Rhode Island, USA); Ludmila S. Karan (Central Research Institute of Epidemiology, Moscow, Russia); and Kristen Brao (Yale School of Public Health, New Haven).

We thank Francesica Tizard at the Yale School of Public Health for help with manuscript preparation.

This work was supported by grants (AI088079 to D.F. and P.J.K. and AI100236 to A.G.B.) from the National Institute of Allergy and Infectious Diseases, National Institutes of Health. Additional support was provided by the Gordon and Llura Gund Foundation and the G. Harold and Leila Y. Mathers Charitable Foundation.

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Suggested citation for this article: Krause PJ, Narasimhan S, Wormser GP, Barbour AG, Platonov AE, Brancato J, et al. Borrelia miyamotoi sensu lato seroreactivity and seroprevalence in the northeastern United States. Emerg Infect Dis. 2014 July [date cited].http://dx.doi.org/10.3201/eid2007.131587