Presence of Borrelia miyamotoi infection in a highly endemic area of Lyme disease

Abstract

A series of cases in the Northeast of the US during 2013–2015 described a new Borrelia species, Borrelia miyamotoi, which is transmitted by the same tick species that transmits Lyme disease and causes a relapsing fever-like illness. The geographic expansion of B. miyamotoi in the US also extends to other Lyme endemic areas such as the Midwestern US. Co-infections with other tick borne diseases (TBD) may contribute to the severity of the disease. On Long Island, NY, 3–5% of ticks are infected by B. miyamotoi, but little is known about the frequency of B. miyamotoi infections in humans in this particular region. The aim of this study was to perform a chart review in all patients diagnosed with B. miyamotoi infection in Stony Brook Medicine (SBM) system to describe the clinical and epidemiological features of B. miyamotoi infection in Suffolk County, NY. In a 5 year time period (2013–2017), a total of 28 cases were positive for either IgG EIA (n = 19) or PCR (n = 9). All 9 PCR-positive cases (median age: 67; range: 22–90 years) had clinical findings suggestive of acute or relapsing infection. All these patients were thought to have a TBD, prompting the healthcare provider to order the TBD panel which includes a B. miyamotoi PCR test. In conclusion, B. miyamotoi infection should be considered in the differential diagnosis for flu-like syndromes during the summer after a deer tick bite and to prevent labeling a case with Lyme disease.

Prevalence and clinical manifestation of Borrelia miyamotoi in Ixodes ticks and humans in the northern hemisphere: a systematic review and meta-analysis

“…Discrepancy between the two authors who independently screened the studies was less than 2•5% (8 of 491 studies, 1•6%). Of the 146 included studies (appendix pp [23][24][25][26][27][28][29][30][31][32][33][34], 101 examined tick infection rates (27 in I scapularis, 11 in I pacificus, 59 in I ricinus, and 12 in I persulcatus; some studies examined more than one species), 28 assessed the prevalence of B miyamotoi infection in humans, and 28 described cases of B miyamotoi disease in humans.…”

“…Seroprevalence was established by measuring antibodies against recombinant glycerophosphodiester phosphodiesterase (rGlpQ) with ELISA, either as a one-tier test (6 of 14 studies) [22][23][24][25][26][27] or combined with a confirmatory rGlpQ or whole-cell-lysate western blot as a two-tier test (8 of 14 studies; appendix pp 21-22). [28][29][30][31][32][33][34][35] Molecular detection was accomplished by B miyamotoispecific quantitative PCR (qPCR), which was followed by amplicon sequencing, a confirmatory independent qPCR, or both.…”

“…10,35,47-54 30 cases were described elsewhere in Asia. 35,[52][53][54] In the USA, 101 cases were reported between 1991 and 2019, 12,22,24,28,29,[36][37][38][39][40][41][42][43][44] whereas in Europe, six cases have been described up to March 1, 2021. 11,13,14,45,46 The median incubation period was 14 days, with an IQR of 10-18 days.…”

Tick-Borne Pathogens in Questing Blacklegged Ticks (Acari: Ixodidae) From Pike County, Pennsylvania

“…Borrelia miyamotoi disease is not reportable and therefore little is known about human cases in tick endemic areas. Recent retrospective studies, using PCR testing from acutely febrile patients in the northeastern United States, found 0.19% to 0.84% positive B. miyamotoi blood samples ( Molloy et al 2015 , Marcos et al 2020 ). These retrospective studies indicate low prevalence of B. miyamotoi relative to the other TBPs in the northeastern region.…”

Determining the preferred attachment site of tick species endemic to New York State and the influence of pathogen infection on body-segment selection in the deer tick, Ixodes scapularis

“…Anaplasma phagocytophilum infection results in human granulocytic anaplasmosis (HGA), a potentially severe illness with thrombocytopenia and leukocytopenia [9,10]. Borrelia miyamotoi has only recently been associated with human illness [11] and produces a long-term period of cyclic febrile illness with some Lyme-like symptoms [12,13]. Ehrlichia muris eauclairensis is also transmitted by I. scapularis [14] and results in a version of human granulocytic ehrlichiosis (HGE), an illness similar to HGA with lymphopenia and thrombocytopenia [15].…”