Borrelia miyamotoi: 43 Cases Diagnosed in France by Real-Time PCR in Patients With Persistent Polymorphic Signs and Symptoms

Abstract

Background: Borrelia species are divided into three groups depending on the induced disease and the tick vector. Borrelia miyamotoi is a relapsing fever Borrelia but can induce symptoms related to Lyme disease. Discovered in 1995, it is found in ticks around the world. In France, this species of Borrelia has been isolated in ticks and rodents, but was not yet observed in humans. Objective: The aim of the study was to look for B. miyamotoi in symptomatic patients. Methods: Real-time PCR was performed on 824 blood samples from patients presenting symptoms of persistent polymorphic syndrome possibly due to tick bite, a syndrome recognized by the French Authority for Health, which is close to the post-treatment Lyme disease syndrome. PCR was also performed on 24 healthy control persons. The primers were specifically designed for this particular species of Borrelia. The sequence of interest of 94 bp is located on the glpQ gene. Sequencing of amplification products, randomly chosen, confirmed the amplification specificity. To better investigate cases, a clinical questionnaire was sent to the patients PCR-positive for B. miyamotoi and to their physician. Results: This search revealed a positive PCR for B. miyamotoi in the blood from 43 patients out of 824 (5.22%). PCR was negative in all control persons. A clinical chart was obtained from 31 of the 43 patients. A history of erythema migrans was reported in five of these 31 patients (16%). All patients complained about fatigue, joint pain and neuro-cognitive disorders. Some patients complained about respiratory problems (chest tightness and/or lack of air in 41.9%). Episodes of relapsing fever were reported by 11 of the 31 patients (35.5%). Chilliness, hot flushes and/or sweats were reported by around half of the patients. B. miyamotoi may not cross-react with B. burgdorferi serology. Conclusion: This study is the first to detect B. miyamotoi in human blood in France. This series of human B. miyamotoi infection is the largest in patients with long term persistent syndrome. Our data suggest that this infection may be persistent, even on the long term.

Response: Commentary: Borrelia miyamotoi: 43 Cases Diagnosed in France by Real-Time PCR in Patients With Persistent Polymorphic Signs and Symptoms

“…The arguments of Wagemakers et al leading them to reject our series and the discovery of Borrelia miyamotoi (1) have no scientific basis, (2) show a lack of familiarity with the clinical signs of patients presenting with tickborne disease, (3) suspect, without any well-founded argument, poor technical procedures.…”

Borrelia miyamotoi Serology in a Clinical Population With Persistent Symptoms and Suspected Tick-Borne Illness

“…miyamotoi infection is clinically similar to Lyme disease (5) with manifestations of fever, fatigue, headache, myalgia, chills, and nausea (2,4,6,7). Like Lyme disease, B. miyamotoi infection can lead to significant neurologic complications (5). However, unlike Lyme disease, erythema migrans rash, and arthralgias are uncommon (2).…”

“…Meningoencephalitis can also occur in immunocompromised patients (2,4). Relapsing fevers occur in a subset of patients with B. miyamotoi disease (2,5). Like Lyme disease, B. miyamotoi disease is treated with 2-4 weeks of antimicrobial therapy-most often doxycycline or amoxicillin (2,8,9).…”

“…PCR positivity rates have ranged from 17% among patients hospitalized for acute infection with suspected tick-borne disease in Russia (2), to 0.7-0.8% (3,6) among acutely ill patients in the Northeastern United States. A recent study in France showed that 43 of 824 patients (5.22%) with polymorphic signs and symptoms and suspected tick-borne illness were PCR positive for B. miyamotoi (5). Studies in North America using the GlpQ assay among patients with presumed tick-borne infection have revealed antibody seropositivity rates ranging from 3 to 21% Northeast (11), Canada (12), and California (13).…”

Commentary: Borrelia miyamotoi: 43 Cases Diagnosed in France by Real-Time PCR in Patients With Persistent Polymorphic Signs and Symptoms

“…The latter disease entity was first described in 2011 ( 1 ), and its clinical symptoms in patients in Asia, Europe, and the USA mostly consist of a flu-like illness ( 2 ). The recent Frontiers in Medicine article by Michel Franck et al claims to have detected Borrelia miyamotoi DNA in 43 out of 824 French patients with a complex of non-specific symptoms lasting at least 6 months ( 3 ). However, we have serious doubts about the author's findings and conclusions.…”