Human Borrelia miyamotoi infection in California: Serodiagnosis is complicated by multiple endemic Borrelia species.

Peter J Krause,Sukanya Narasimhan,Madeleine Carroll,Janna Brancato,Erol Fikrig,Fredua Akosa,Robert S Lane,Natalia Fedorova,Cecilia Dumouchel,Brian Stevenson

doi:10.1371/journal.pone.0191725

Peter J Krause, Sukanya Narasimhan + Show 8 more

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https://doi.org/10.1371/journal.pone.0191725

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Journal: PloS one	Publication Date: Feb 8, 2018
Citations: 41	License type: CC BY 4.0

Affiliation: Yale University, University of California, Berkeley

Abstract

To determine whether human Borrelia miyamotoi infection occurs in the far-western United States, we tested archived sera from northwestern California residents for antibodies to this emerging relapsing fever spirochete. These residents frequently were exposed to I. pacificus ticks in a region where B. miyamotoi tick infection has been reported. We used a two-step B. miyamotoi rGlpQ assay and a B. miyamotoi whole-cell lysate (WCL) assay to detect B. miyamotoi antibody. We also employed Borrelia hermsii and Borrelia burgdorferi WCL assays to examine if these Borrelia induce cross reacting antibody to B. miyamotoi. Sera were collected from 101 residents in each of two consecutive years. The sera of 12 and 14 residents in years one and two, respectively, were B. miyamotoi rGlpQ seroreactive. Sufficient sera were available to test 15 of the 26 seropositive samples using B. miyamotoi and B. hermsii WCL assays. Two residents in year one and seven residents in year two were seroreactive to both Borrelia antigens. Although discernible differences in seroreactivity were evident between the B. miyamotoi and B. hermsii WCL assays, infection with one or the other could not be determined with certainty. Sera from two Borrelia burgdorferi /B. miyamotoi seropositive subjects reacted strongly against B. miyamotoi and B. hermsii WCL antigens. Ecological, epidemiological, and clinical data implicated B. miyamotoi as the probable cause of infection among those whose sera reacted against both antigens. Our findings suggest that human B. miyamotoi infection occurs in northern California and that B. hermsii and B. burgdorferi infections produce antibodies that cross-react with B. miyamotoi antigens. Health care professionals in the far-western United States should be aware that B. miyamotoi disease may occur throughout the geographic distribution of I. pacificus and that improved relapsing fever group spirochete antibody assays are urgently needed.

Highlights

Borrelia miyamotoi is a relapsing fever-group spirochete that was discovered in Ixodes persulcatus ticks in Japan more than 20 years ago and later determined to cause clinical illness in humans [1,2,3,4,5,6,7,8,9]
Discernible differences in seroreactivity against B. miyamotoi and B. hermsii whole-cell lysate (WCL) were noted between the CHR study subjects, infection with one or the other of them could not be distinguished with certainty (Fig 1)
We found that B. burgdorferi, like B. hermsii, can elicit cross-reacting antibody against B. miyamotoi antigens, none of our putative B. miyamotoi seropositive CHR residents could have had Lyme disease alone because they reacted against B. miyamotoi GlpQ antigen and B. burgdorferi does not produce GlpQ [20]

Summary

Introduction

Borrelia miyamotoi is a relapsing fever-group spirochete that was discovered in Ixodes persulcatus ticks in Japan more than 20 years ago and later determined to cause clinical illness in humans [1,2,3,4,5,6,7,8,9]. This spirochete can cause a febrile viral-like illness that relapses in up to 10% of patients [2, 5,6]. No human cases of B. miyamotoi previously have been reported from the western United States even though I. pacificus ticks in northern California have a spirochete-infection prevalence similar to or exceeding that of I. scapularis ticks in the Northeast and upper Midwest [11,12,13,14,15,16]

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