Dig Deeper – Coinfection

Concomitant human granulocytic anaplasmosis and Lyme neuroborreliosis

Abstract:

Tick-transmitted zoonoses such as human granulocytic anaplasmosis (HGA), Lyme borreliosis and tick-borne encephalitis (TBE) are endemic in several European countries, including Slovenia. Ixodes ricinus, the most prevalent species of hard ticks in Slovenia, is the principal vector for Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum and TBE virus. Information on clinically manifested co-infections with tick-transmitted pathogens is incomplete. Findings from the USA indicate that the frequency of simultaneous diseases caused by infection with more than one tick-borne pathogen is low and varies among geographic regions.

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Bartonella sp. Bacteremia in Patients with Neurological and Neurocognitive Dysfunction

Abstract:

E. B. Breitschwerdt, R. G. Maggi, W. L. Nicholson, N. A. Cherry, and C. W. Woods — We detected infection with a Bartonella species in blood samples from six immunocompetent patients who presented with a chronic neurological or neurocognitive syndrome including seizures, ataxia, memory loss, and/or tremors. Each of these patients had substantial animal contact or recent arthropod exposure as a potential risk factor for Bartonella infection. Additional studies should be performed to clarify the potential role of Bartonella spp. as a cause of chronic neurological and neurocognitive dysfunction.

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Human Coinfection with Bartonella henselae and Two Hemotropic Mycoplasma Variants

Abstract:

Jane E. Sykes, LeAnn L. Lindsay, Ricardo G. Maggi, and Edward B. Breitschwerdt —- Two variants of an organism resembling the ovine hemoplasma, Mycoplasma ovis, were detected by PCR in blood samples from a veterinarian in Texas. Coinfection with similar variants has been described in sheep. This represents the first report of human infection with this organism. The veterinarian was co-infected with Bartonella henselae.

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Bartonella spp. Bacteremia and Rheumatic Symptoms in Patients from Lyme Disease–endemic Region

Abstract:

Ricardo G. Maggi, B. Robert Mozayeni, Elizabeth L. Pultorak, Barbara C. Hegarty, Julie M. Bradley, Maria Correa, and Edward B. Breitschwerdt —- Bartonella spp. infection has been reported in association with an expanding spectrum of symptoms and lesions. Among 296 patients examined by a rheumatologist, prevalence of antibodies against Bartonella henselae, B. koehlerae, or B. vinsonii subsp. berkhoffii (185 [62%]) and Bartonella spp. bacteremia (122 [41.1%]) was high. Conditions diagnosed before referral included Lyme disease (46.6%), arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and fi bromyalgia (6.1%). B. henselae bacteremia was signifi cantly associated with prior referral to a neurologist, most often for blurred vision, subcortical neurologic deficits, or numbness in the extremities, whereas B. koehlerae bacteremia was associated with examination by an infectious disease physician. This cross-sectional study cannot establish a causal link between Bartonella spp. infection and the high frequency of neurologic symptoms, myalgia, joint pain, or progressive arthropathy in this population; however, the contribution of Bartonella spp. infection, if any, to these symptoms should be systematically investigated.

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Is Lyme disease always poly microbial?

Abstract:

David C. Owen —- Summary Lyme disease is considered to be caused by Borrelia species of bacteria but slowly evidence is accumulating which suggests that Lyme disease is a far more complex condition than Borreliosis alone. This hypothesis suggests that it may be more appropriate to regard Lyme disease as a tick borne disease complex. Over recent years numerous different microbes have been found in ticks which are known to be zoonotic and can coinfect the human host. The hypothesis suggests that multiple coinfections are invariably present in the clinical syndromes associated with Lyme disease and it is suggested that these act synergistically in complex ways. It may be that patterns of coinfection and host factors are the main determinants of the variable clinical features of Lyme disease rather than Borrelia types. An analogy with a jigsaw puzzle is presented with pieces representing Borreliae, coinfections and host factors. It is suggested that many pieces of the puzzle are missing and our knowledge of how the pieces fit together is rudimentary. It is hoped that the hypothesis will help our understanding of this complex, enigmatic condition.

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Borrelia burgdorferi and Babesia microti Coinfection in a 79-Year-Old Camper

Abstract:

Russell A. Rawling, M.S.,et al. —– This case report describes a 79-yearold patient who acquired a coinfection with B. burgdorferi and B. microti while on a 2-week family camping trip in Massachusetts.

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Concurrent Lyme Disease and Babesiosis

Abstract:

Peter J. Krause, MD; Sam R. Telford III, ScD; et al. —- Objective: To determine whether patients coinfected with Lyme disease and babesiosis in sites where both diseases are zoonotic experience a greater number of symptoms for a longer period of time than those with either infection alone.

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Disease-Specific Diagnosis of Coinfecting Tickborne Diseases

Abstract:

Peter J. Krause, Kathleen McKay, et al. —- To determine whether a unique group of clinical and laboratory manifestations characterize certain major deer tick-transmitted human pathogens in North America. We compared the symptoms, short-term complications, and laboratory test results of New England residents who became ill due to more than one of these pathogens. Patients completed a uniformly structured questionnaire and submitted blood samples for serologic and polymerase chain reaction (PCR) testing after developing symptoms of Lyme disease, human babesiosis or human granulocytic ehrlichiosis (HGE). Complete blood count with thin blood smear, PCR, and immunoglobulin M antibody tests helped differentiate the acute manifestations of these diseases. Physicians should consider use of tests designed to diagnose babesiosis and HGE in patients with Lyme disease who experience a prolonged flulike illness that fails to respond to appropriate antiborrelial therapy.

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Severe babesiosis and Borrelia burgdorferi co-infection

Abstract:

C. MARTI´NEZ-BALZANO, M. HESS, A. MALHOTRA and R. LENOX —- Case report A 73-year-old man from upstate New York visited his primary care physician with a bull’s eye rash in his right arm and fatigue. He traveled to the state of Massachusetts in the week before the lesion’s appearance, where he spent most of his time outdoors and had a tick bite in that same arm. He was initially diagnosed with Lyme disease and was given a prescription for amoxicillin. The fatigue persisted, and 3 weeks later, he presented to our hospital with intermittent fever (38.88C), chills and night sweats.

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Babesiosis in Pregnancy

Abstract:

BACKGROUND: Babesiosis is an emerging infectious disease caused by a tick-borne parasite that infects red blood cells. Pregnancy is a relatively immunocompromised state that can underlie severe manifestations of parasitic disease. CASE: A healthy primiparous patient in the second trimester developed nonspecific symptoms after a tick bite. Evaluation by obstetrics, primary care, and neurology over 4 weeks yielded diagnoses of Lyme disease, upper respiratory infection, migraine, and medication overuse headache. Babesiosis was diagnosed only after she became acutely ill with hemolysis. She was treated with standard antibiotics and had an uncomplicated pregnancy and healthy newborn.

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New Tick-borne Disease, Borrelia miyamotoi, Found in US and Europe

Abstract:

Borrelia miyamotoi, a relapsing fever-related spirochete transmitted by Ixodes ticks, has been recently shown to be a human pathogen. To characterize the prevalence of this organism in questing Ixodes ticks, we tested 2,754 ticks for a variety of tickborne pathogens by PCR and electrospray- ionization mass spectrometry. Ticks were collected from California, New York, Connecticut, Pennsylvania, and Indiana in the United States and from Germany and the Czech Republic in Europe from 2008 through 2012. In addition, an isolate from Japan was characterized.

We found 3 distinct genotypes, 1 for North America, 1 for Europe, and 1 for Japan. We found B. miyamotoi infection in ticks in 16 of the 26 sites surveyed, with infection prevalence as high as 15.4%. These results show the widespread distribution of the pathogen, indicating an exposure risk to humans in areas where Ixodes ticks reside.

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