Comparison of Borrelia burgdorferi Sensu Lato Strains Isolated from Specimens Obtained Simultaneously from Two Different Sites of Infection in Individual Patients

Abstract

The aim of the present study was to analyze and compare Borrelia strains isolated from two different specimens obtained simultaneously from individual patients with Lyme borreliosis. Fifty such patients and 50 corresponding pairs of Borrelia isolates (100 low-propagated strains) were subjected to genotypic and phenotypic analysis, including pulsed-field gel electrophoresis for species identification and plasmid profile determination and protein profile electrophoresis for the assessment of the presence and molecular masses of separated proteins. The strains were isolated from two distinct skin lesions (12 patients), skin and blood (28 patients), skin and cerebrospinal fluid (8 patients), and blood and cerebrospinal fluid (2 patients). Out of 100 isolates, 63 were typed as B. afzelii and 37 as B. garinii. From each individual specimen only a single Borrelia species was cultured. Comparison of 50 Borrelia strain pairs isolated from two different specimens of an individual patient revealed that 12/50 (24%) patients were simultaneously infected with two different Borrelia strains; in 3/50 (6%) patients strains differed at the species level, in 4 out of the remaining 47 (9%) patients a strain difference in plasmid profile was established, while 5 out of the remaining 43 (11%) patient strain pairs differed in regard to the protein profiles of the two concurrently isolated strains. The results of the present study indicate that human patients with Lyme borreliosis may simultaneously harbor different B. burgdorferi sensu lato strains.

Approaches for Reverse Line Blot-Based Detection of Microbial Pathogens in Ixodes ricinus Ticks Collected in Austria and Impact of the Chosen Method

“…So far, there have been no reports of cultivation of more than one Borrelia genospecies from a single infection site, such as from erythema migrans; however, different genospecies have been cultivated from different body sites in individual patients. No evidence exists for an ambiguous course that might impede the clinical diagnosis (48).…”

Understanding Barriers to Borrelia burgdorferi Dissemination during Infection Using Massively Parallel Sequencing

“…Although experimental studies on B. burgdorferi are frequently carried out using a single strain, field studies have shown that mixed infections with different B. burgdorferi genotypes occur in ticks and mammalian reservoir hosts (46)(47)(48)(49). In humans, different strains have been isolated from individual Lyme disease patients (50,51). The observed lack of host barriers to dissemination in mice may contribute to the frequency of heterogeneous infections observed in environmental studies.…”

Isolation of Borrelia burgdorferi sensu lato from blood of adult patients with borrelial lymphocytoma, Lyme neuroborreliosis, Lyme arthritis and acrodermatitis chronica atrophicans

“…These results, indicating double infections, are somewhat surprising but corroborate previous findings. Information obtained predominantly from PCR [20][21][22] but also from culture results [15,23] indicates that an individual patient with Lyme borreliosis may simultaneously harbor more than one Borrelia strain of the same species and even more than one Borrelia species.…”