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Lyme Disease in Georgia

  1. J Clin Microbiol. 2009 Dec;47(12):3875-80. Epub 2009 Oct 21.

    Delineation of a new species of the Borrelia burgdorferi Sensu Lato Complex, Borrelia americana sp. nov.

    Rudenko N, Golovchenko M, Lin T, Gao L, Grubhoffer L, Oliver JH Jr.

    Georgia Southern University, James H.Oliver, Jr Institute of Arthropodology and Parasitology, Statesboro, Georgia 30460-8056, USA. natasha@paru.cas.cz

    Analysis of borrelia isolates collected from ticks, birds, and rodents from the southeastern United States revealed the presence of well-established populations of Borrelia burgdorferi sensu stricto, Borrelia bissettii, Borrelia carolinensis, and Borrelia sp. nov. Multilocus sequence analysis of five genomic loci from seven samples representing Borrelia sp. nov. isolated from nymphal Ixodes minor collected in South Carolina showed their close relatedness to California strains known as genomospecies 1 and separation from any other known species of the B. burgdorferi sensu lato complex. One nucleotide difference in the size of the 5S-23S intergenic spacer region, one substitution in 16S rRNA gene signature nucleotides, and silent nucleotide substitutions in sequences of the gene encoding flagellin and the gene p66 clearly separate Borrelia sp. nov. isolates from South Carolina into two subgroups. The sequences of isolates of each subgroup share the same restriction fragment length polymorphism patterns of the 5S-23S intergenic spacer region and contain unique signature nucleotides in the 16S rRNA gene. We propose that seven Borrelia sp. nov. isolates from South Carolina and two California isolates designated as genomospecies 1 comprise a single species, which we name Borrelia americana sp. nov. The currently recognized geographic distribution of B. americana is South Carolina and California. All strains are associated with Ixodes pacificus or Ixodes minor and their rodent and bird hosts.

    PMCID: PMC2786643 [Available on 2010/6/1] PMID: 19846628 [PubMed - indexed for MEDLINE]

  2. Clin Pediatr (Phila). 2010 Jan;49(1):82-5. Epub 2009 Feb 3.

    Asymptomatic, transient complete heart block in a pediatric patient with Lyme disease.

    Heckler AK, Shmorhun D.

    National Capitol Military Children's Center, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Washington, DC 20307, USA. alan.heckler@nccpeds.com

    Lyme Disease, caused by the spirochete Borrellia burgdorferi, is the most common vector-borne disease in the United States. Clinically, it primarily affects the skin, joints, nervous system, and heart. Lyme carditis occurs in 4%-10% of adults with Lyme disease. Transient variable-level atrioventricular blocks, occurring in 77% of adults with Lyme carditis, are the most common cardiac manifestation. Up to 50% of Lyme carditis patients may develop complete heart block. The incidence of Lyme carditis in the pediatric population is not well established. We present a pediatric patient with a transient asymptomatic complete heart block resulting from Lyme carditis, an under-recognized complication of Lyme disease in the pediatric population.

    PMID: 19190204 [PubMed - indexed for MEDLINE]

  3. Am J Emerg Med. 2008 Nov;26(9):1069.e5-6.

    Acute ataxia in a 4-year-old boy: a case of Lyme disease neuroborreliosis.

    Lopez MD, Wise C.

    Departments of Emergency Medicine and Pediatrics Medical College of Georgia, Augusta, CA 30912, USA. mlopez@mcg.edu

    We present a case of a 4-year-old who presented to the emergency department with an unsteady gait for 2 days. Ataxia is a rare but known manifestation of cerebellar involvement in Lyme disease. A 4-year-old (17 kg) boy with no significant medical history presented to the emergency department (ED) with history of nonbloody emesis for 2 weeks and an unsteady gait for 2 days. Over the past 2 days, his gait had gotten progressively worse until he was unable to walk without assistance. The vomiting would usually occur 1 hour after eating meals. He had also complained of a single headache, which occurred approximately 10 days before admission. The headache did not occur in the early morning hours or wake him up from his sleep. His appetite for the weeks before admission had progressively decreased, and he had also become more irritable, especially when stimulated. He had increased fatigue for the week before presentation. His parents denied any fever, rhinorrhea, cough, diarrhea, rash, bruising, bleeding, or hematuria. The patient denied any abdominal pain or headache while in the ED.

    PMID: 19091290 [PubMed - indexed for MEDLINE]

  4. J Parasitol. 2008 Dec;94(6):1351-6.

    Comparison of the spirochete Borrelia burgdorferi S. L. isolated from the tick Ixodes scapularis in southeastern and northeastern United States.

    Oliver JH, Gao L, Lin T.

    Georgia Southern University, Institute of Arthropodology and Parasitology, Statesboro, Georgia, USA. joliver@georgiasouthern.edu

    Thirty-five strains of the Lyme disease spirochete Borrelia burgdorferi sensu lato (B. burgdorferi s. l.) were isolated from the blacklegged tick vector Ixodes scapularis in South Carolina, Georgia, Florida, and Rhode Island. They were characterized by PCR-restriction fragment length polymorphism (RFLP) analysis of rrf (5S)-rrl (23S) intergenic spacer amplicons. PCR-RFLP analysis indicated that the strains represented at least 3 genospecies (including a possible novel genospecies) and 4 different restriction patterns. Thirty strains belonged to the genospecies B. burgdorferi sensu stricto (B. burgdorferi s. s.), 4 southern strains were identified as B. bissettii, and strain SCCH-5 from South Carolina exhibited MseI and DraI restriction patterns different from those of previously reported genospecies. Complete sequences of rrf-rrl intergenic spacers from 14 southeastern and northeastern strains were determined and the phylogenetic relationships of these strains were compared. The 14 strains clustered into 3 separate lineages on the basis of sequence analysis. These results were confirmed by phylogenetic analysis based on 16S rDNA sequence analysis.

    PMID: 18576863 [PubMed - indexed for MEDLINE]

  5. Exp Appl Acarol. 2008 Jun;45(1-2):85-110. Epub 2008 Apr 22.

    The tick fauna of Sulawesi, Indonesia (Acari: Ixodoidea: Argasidae and Ixodidae).

    Durden LA, Merker S, Beati L.

    Department of Biology and Institute of Arthropodology & Parasitology, Georgia Southern University, Statesboro, GA 30460-8042, USA. ldurden@georgiasouthern.edu

    Twenty-six species of ticks are reported from the island of Sulawesi (Celebes), Indonesia. These include two species of soft ticks (Argasidae), Carios batuensis and C. vespertilionis, and the following 24 species of hard ticks (Ixodidae): Amblyomma babirussae, A. breviscutatum, A. cordiferum, A. fimbriatum, A. helvolum, A. testudinarium, A. trimaculatum, A. varanense, Dermacentor atrosignatus, D. steini, Haemaphysalis celebensis, H. hystricis, H. kadarsani, H. papuana, H. psalistos, H. renschi, H. toxopei, H. wellingtoni, Ixodes cordifer, I. granulatus, Rhipicephalus haemaphysaloides, R. (Boophilus) microplus, R. pilans and R. sanguineus. This represents an almost three-fold increase in the number of tick species recorded (9) from Sulawesi since the last available list in 1950. The tick records reported herein represent a culmination of data from specimens in the U.S. National Tick Collection, new records of ticks from endemic tarsiers and associated vertebrates, and literature reviews. Collectively, the tick fauna of Sulawesi shows most affinities with the fauna of southeast Asia but there are distinct faunal elements that show relationships with other Indonesian islands, the Philippines or Australasia, as well as a few tick species with widespread geographical distributions. Some ticks known from Sulawesi have known or potential medical-veterinary significance. These include R. (B.) microplus which is a significant pest of cattle and a vector of the agents of bovine anaplasmosis, I. granulatus which is a vector of Langat virus and Lyme disease spirochetes and has been shown to harbor pathogenic rickettsiae in other parts of its range, and R. sanguineus which is a globally widespread ectoparasite of canines and a vector of canine pathogens and parasites.

    PMID: 18427937 [PubMed - indexed for MEDLINE]

  6. Ger Med Sci. 2008 Jun 10;6:Doc04.

    Subacute transverse myelitis with Lyme profile dissociation.

    Walid MS, Ajjan M, Ulm AJ.

    Medical Center of Central Georgia, Macon, GA, USA.

    Introduction: Transverse myelitis is a very rare neurologic syndrome with an incidence per year of 1-5 per million population. We are presenting an interesting case of subacute transverse myelitis with its MRI (magnetic resonance imaging) and CSF (cerebrospinal fluid) findings.Case: A 46-year-old African-American woman presented with decreased sensation in the lower extremities which started three weeks ago when she had a 36-hour episode of sore throat. She reported numbness up to the level just below the breasts. Lyme disease antibodies total IgG (immunoglobulin G) and IgM (immunoglobulin M) in the blood was positive. Antinuclear antibody profile was within normal limits. MRI of the cervical spine showed swelling in the lower cervical cord with contrast enhancement. Cerebrospinal fluid was clear with negative Borrelia Burgdorferi IgG and IgM. Herpes simplex, mycoplasma, coxiella, anaplasma, cryptococcus and hepatitis B were all negative. No oligoclonal bands were detected. Quick improvement ensued after she was given IV Ceftriaxone for 7 days. The patient was discharged on the 8(th) day in stable condition. She continued on doxycycline for 21 days.Conclusions: Transverse myelitis should be included in the differential diagnosis of any patient presenting with acute or subacute myelopathy in association with localized contrast enhancement in the spinal cord especially if flu-like prodromal symptoms were reported. Lyme disease serology is indicated in patients with neurological symptoms keeping in mind that dissociation in Lyme antibody titers between the blood and the CSF is possible.

    PMCID: PMC2703261 PMID: 19675732 [PubMed - in process]

  7. Emerg Infect Dis. 2006 Apr;12(4):653-60.

    Economic impact of Lyme disease.

    Zhang X, Meltzer MI, Peña CA, Hopkins AB, Wroth L, Fix AD.

    Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. XZhang4@cdc.gov

    To assess the economic impact of Lyme disease (LD), the most common vectorborne inflammatory disease in the United States, cost data were collected in 5 counties of the Maryland Eastern Shore from 1997 to 2000. Patients were divided into 5 diagnosis groups, clinically defined early-stage LD, clinically defined late-stage LD, suspected LD, tick bite, and other related complaints. From 1997 to 2000, the mean per patient direct medical cost of early-stage LD decreased from $1,609 to $464 (p<0.05), and the mean per patient direct medical cost of late-stage LD decreased from $4,240 to $1,380 (p<0.05). The expected median of all costs (direct medical cost, indirect medical cost, nonmedical cost, and productivity loss), aggregated across all diagnosis groups of patients, was approximately $281 per patient. These findings will help assess the economics of current and future prevention and control efforts.

    PMID: 16704815 [PubMed - indexed for MEDLINE]

  8. Vet Microbiol. 2006 Jun 15;115(1-3):229-36. Epub 2006 Feb 3.

    White-tailed deer (Odocoileus virginianus) develop spirochetemia following experimental infection with Borrelia lonestari.

    Moyer PL, Varela AS, Luttrell MP, Moore VA 4th, Stallknecht DE, Little SE.

    Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.

    Borrelia lonestari is considered a putative agent of southern tick-associated rash illness (STARI) and is known to occur naturally only in lone star ticks (Amblyomma americanum) and white-tailed deer (Odocoileus virginianus). We used a low passage isolate of B. lonestari (LS-1) to inoculate white-tailed deer, C3H mice, Holstein cattle, and beagles. Animals were monitored via examination of Giemsa and acridine orange stained blood smears, polymerase chain reaction (PCR), indirect fluorescent antibody (IFA) test, and/or culture isolation. Spirochetes were visualized in blood smears of both deer on days post-inoculation (DPI) 6, 8, 12 and one deer on DPI 15. Whole blood collected from deer tested PCR positive starting on DPI 4 and remained positive as long as DPI 28. Both deer developed antibody titers of >64, with a maximum IFA titer of 1024. The organism was reisolated from the blood of both deer on DPI 6 and one deer on DPI 12. All isolation attempts from mice, calves, or dogs were negative, although one of seven mice was transiently PCR positive. Mice and dogs developed an IFA titer > or =64, while calves lacked a detectable antibody response. These preliminary experimental infection trials show that white-tailed deer are susceptible to infection with B. lonestari and develop a spirochetemia following needle-inoculation, while C3H mice, calves, and dogs do not. Results suggest that deer may serve as a vertebrate reservoir host. Tick transmission studies are needed to confirm that this organism can be maintained in a natural cycle involving deer and A. americanum.

    PMID: 16459029 [PubMed - indexed for MEDLINE]

  9. J Parasitol. 2004 Dec;90(6):1293-7.

    Ectoparasites and other epifaunistic arthropods of sympatric cotton mice and golden mice: comparisons and implications for vector-borne zoonotic diseases.

    Durden LA, Polur RN, Nims T, Banks CW, Oliver JH Jr.

    Department of Biology and Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro, Georgia 30460-8042, USA. ldurden@georgiasouthern.edu

    Ectoparasite and epifaunistic arthropod biodiversity and infestation parameters were compared between 2 sympatric small rodent species, the cotton mouse (Peromyscus gossypinus (Le Conte)) and golden mouse (Ochrotomys nuttalli (Harlan)), in southern Georgia from 1992 to 2003. Because the cotton mouse is known to be a reservoir of more vector-borne zoonotic pathogens than the golden mouse, we hypothesized that it would be parasitized by more ectoparasites that are known to be vectors of these pathogens. Cotton mice (n = 202) were parasitized by 19 species of arthropods, whereas golden mice (n = 46) were parasitized by 12 species. Eleven species of arthropods were recovered from both host species, whereas 7 were recorded only from cotton mice, and 1 species only from golden mice. Infestation prevalences (percent of mice parasitized) were significantly higher for 1 species of arthropod (the tropical rat mite Ornithonyssus bacoti (Hirst)) infesting cotton mice and for 4 species (the flea Peromyscopsylla scotti Fox and the mites Glycyphagus hypudaei Koch, Androlaelaps casalis (Berlese), and Androlaelaps fahrenholzi (Berlese)) infesting golden mice. Mean intensities (mean per infested mouse) were significantly higher for 2 species (the flea Orchopeas leucopus (Baker) and the blacklegged tick Ixodes scapularis Say) infesting cotton mice and for 2 species (G. hypudaei and A. fahrenholzi) infesting golden mice. Ectoparasites that are known to be vectors of zoonotic pathogens were significantly more common on cotton mice than on golden mice. These ectoparasites included the rhopalopsyllid flea Polygenis gwyni (Fox), a vector of the agent of murine typhus; I. scapularis, the principal vector of the agents of Lyme borreliosis, human granulocytic ehrlichiosis, and human babesiosis; and O. bacoti, a laboratory vector of several zoonotic pathogens. However, 2 species of ixodid ticks that can transmit zoonotic pathogens were recovered from both host species. These were the American dog tick Dermacentor variabilis (Say), the principal vector of the agent of Rocky Mountain spotted fever in eastern North America, and Ixodes minor Neumann, an enzootic vector of the agent of Lyme borreliosis. Overall, the cotton mouse was parasitized by significantly more ectoparasites that are known to be vectors of zoonotic pathogens than was the golden mouse. These data support the hypothesis that the cotton mouse has greater epidemiological importance for zoonotic vector-borne pathogen transmission than does the golden mouse.

    PMID: 15715219 [PubMed - indexed for MEDLINE]

  10. J Clin Microbiol. 2004 Mar;42(3):1163-9.

    First culture isolation of Borrelia lonestari, putative agent of southern tick-associated rash illness.

    Varela AS, Luttrell MP, Howerth EW, Moore VA, Davidson WR, Stallknecht DE, Little SE.

    Department of Medical Microbiology and Parasitology, University of Georgia, Athens, Georgia 30602, USA.

    Southern tick-associated rash illness (STARI) is a Lyme disease-like infection described in patients in the southeastern and south-central United States, where classic Lyme disease is relatively rare. STARI develops following the bite of a lone star tick (Amblyomma americanum) and is thought to be caused by infection with an "uncultivable" spirochete tentatively named Borrelia lonestari. In this study, wild lone star ticks collected from an area where B. lonestari is endemic were cocultured in an established embryonic tick cell line (ISE6). The cultures were examined by dark-field microscopy for evidence of infection, and spirochete identity and morphology were evaluated by flagellin B and 16S rRNA gene sequence, by reaction to Borrelia-wide and B. burgdorferi-specific monoclonal antibodies, and by electron microscopy. Live spirochetes were first visualized in primary culture of A. americanum ticks by dark-field microscopy 14 days after the cell culture was inoculated. The sequences of the flagellin B and 16S rRNA genes of cultured spirochetes were consistent with previously reported sequences of B. lonestari. The cultured spirochetes reacted with a Borrelia-wide flagellin antibody, but did not react with an OspA antibody specific to B. burgdorferi, by indirect fluorescent antibody testing. Electron microscopy demonstrated organisms that were free and associated with ISE6 cells, with characteristic Borrelia sp. morphology. This study describes the first successful isolation of B. lonestari in culture, providing a much needed source of organisms for the development of diagnostic assays and forming a basis for future studies investigating the role of the organism as a human disease agent.

    PMCID: PMC356874 PMID: 15004069 [PubMed - indexed for MEDLINE]

  11. Curr Opin Rheumatol. 2004 Mar;16(2):119-24.

    Prevention research and rheumatic disease.

    Rao JK, Hootman JM.

    Health Care and Aging Studies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. jrao@cdc.gov

    PURPOSE OF REVIEW: Prevention may occur in clinical, community, or population settings and is often classified into primary, secondary, and tertiary types. To provide a context for this review, we define the three types and provide general and arthritis-specific examples of prevention strategies. Next, we highlight recently published longitudinal cohort and intervention studies that focus on arthritis prevention in the following topic areas: cognitive and behavioral strategies, obesity, exercise, and occupational injury prevention. RECENT FINDINGS: Few studies examined primary prevention strategies. In one study, an educational intervention significantly changed tick-related knowledge and behaviors among a population at risk of Lyme disease. Another population-based study used a mailed, stage-based educational program to successfully increase physical activity levels; this intervention may have practical application as a primary or tertiary prevention strategy for arthritis. Tertiary prevention research received much attention: Recent studies extend the benefits of exercise and cognitive-behavioral interventions to persons with different rheumatic conditions (eg, neck pain, low back pain, systemic lupus erythematosus, fibromyalgia). Longitudinal cohort studies improve our understanding of the relationships between computer use and carpal tunnel syndrome among office workers, birth weight and hand osteoarthritis, and baseline balance and functional declines among older adults with knee pain. SUMMARY: Prevention of arthritis and its complications is an active focus of investigation. Primary prevention research remains a challenge because of the prolonged time frame for disease expression. Scientific evidence continues to provide support for tertiary prevention strategies among people with documented rheumatic disease.

    PMID: 14770096 [PubMed - indexed for MEDLINE]

  12. Am J Prev Med. 2004 Feb;26(2):135-40.

    Risk perceptions regarding ticks and Lyme disease: a national survey.

    Herrington JE.

    Office of Global Health, Centers of Disease Control and Prevention, Atlanta, Georgia 30333, USA. jherrington@cdc.gov

    BACKGROUND: Lyme disease (LD) is caused by the tickborne bacterium Borrelia burgdorferi and, in 2000, accounted for >90% of all reported cases of vectorborne illness in the United States. Aside from anecdotal and indirect evidence, little empirical evidence exists regarding what the U.S. public knows, says, or does about preventing LD. OBJECTIVES: To examine knowledge, perceptions, and practices regarding prevention of tick bites and LD. METHODS: In 1998, a random-digit-dial frame was used to collect a cross-sectional sample (n =1500) from the 48 coterminous states plus the District of Columbia, and an over-sample (n =250) from six states with the highest incidence of LD. RESULTS: Forty percent of respondents reported doing something to avoid being bitten by ticks. Less than half (41%) used insect repellent. Ninety-two percent of those who had heard about LD stated their likelihood of ever getting the disease was
    PMID: 14751325 [PubMed - indexed for MEDLINE]

  13. FEMS Microbiol Lett. 2003 Nov 21;228(2):249-57.

    Comparative analysis of Borrelia isolates from southeastern USA based on randomly amplified polymorphic DNA fingerprint and 16S ribosomal gene sequence analyses.

    Lin T, Oliver JH Jr, Gao L.

    Institute of Arthropodology and Parasitology, PO Box 8056, Georgia Southern University, Statesboro, GA 30460-8056, USA.

    Fifty-three southern USA Borrelia isolates were characterized using randomly amplified polymorphic DNA fingerprinting analysis (RAPD). Twenty-nine types were recognized among 37 B. andersonii strains, seven types among eight B. bissettii strains, and seven types among seven B. burgdorferi sensu stricto strains. Strain TXW-1 formed a separate RAPD type. Nearly complete sequences of the rrs genes from 17 representative southern Borrelia were determined. The similarity values were found to be 96-100% within the B. burgdorferi sensu lato (s.l.) complex, 94-99% among the relapsing fever borreliae, and 93-99% between the two complexes. Phylogenetic analysis indicated that all the Borrelia strains we analyzed could be divided into two parts: the B. burgdorferi s.l. complex and the relapsing fever borreliae complex. TXW-1 segregated with the North American relapsing fever borreliae and formed a separate subbranch.

    PMID: 14638431 [PubMed - indexed for MEDLINE]

  14. Proc Natl Acad Sci U S A. 2003 Sep 30;100(20):11642-5. Epub 2003 Sep 19.

    An enzootic transmission cycle of Lyme borreliosis spirochetes in the southeastern United States.

    Oliver JH Jr, Lin T, Gao L, Clark KL, Banks CW, Durden LA, James AM, Chandler FW Jr.

    Institute of Arthropodology and Parasitology and Department of Biology, Georgia Southern University, Statesboro, GA 30460-8056, USA. joliver@gasou.edu

    Lyme borreliosis, or Lyme disease (LD), is a tick-borne zoonotic infection of biomedical significance, caused by Borrelia burgdorferi sensu lato (s.l.) spirochetes and transmitted by Ixodes species ticks. It usually circulates among wildlife vertebrate reservoirs and vector ticks but may infect humans, causing multisystem problems. In far western and northern North America, the host reservoirs, tick vectors, and genospecies of Borrelia are well known but not so in the southern U.S., where there is controversy as to the presence of "true" LD. Here we report the presence of the LD spirochete B. burgdorferi sensu stricto (s.s.) and Borrelia bissettii, three main reservoir hosts, and two enzootic tick vectors in the southeastern U.S. The two enzootic tick vectors, Ixodes affinis and Ixodes minor, rarely bite humans but are more important than the human biting "bridge" vector, Ixodes scapularis, in maintaining the enzootic spirochete cycle in nature. We also report extraordinary longevities and infections in the reservoir rodents Peromyscus gossypinus, Sigmodon hispidus, and Neotoma floridana.

    PMCID: PMC208811 PMID: 14500917 [PubMed - indexed for MEDLINE]

  15. J Parasitol. 2003 Jun;89(3):452-7.

    Molecular phylogenetic analyses indicate that the Ixodes ricinus complex is a paraphyletic group.

    Xu G, Fang QQ, Keirans JE, Durden LA.

    Department of Biology and Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro, Georgia 30460-8042, USA.

    The Ixodes ricinus species complex is a group of ticks distributed in almost all geographic regions of the world. Lyme borreliosis spirochetes are primarily transmitted by tick species within this complex. It has been hypothesized that the Lyme vector ticks around the world are closely related and represent a monophyletic group. This implies that vector competence in ixodid ticks for Lyme agents might have evolved only once. To test this hypothesis, we used a molecular phylogenetic approach. Two fragments of mitochondrial 16S ribosomal deoxyribonucleic acid were sequenced from 11 species in the I. ricinus complex and from 16 other species of Ixodes. Phylogenetic analysis using Bayesian methodology indicated that the I. ricinus complex is not a monophyletic group unless 3 additional Ixodes species are included in it. The known major vectors of Lyme disease agents in different areas of the world are not sister taxa. This suggests that acquisition of the ability to transmit borreliosis agents in species of Ixodes may have multiple origins.

    PMID: 12880241 [PubMed - indexed for MEDLINE]

  16. Ann N Y Acad Sci. 2003 Jun;990:369-70.

    Multiplex Taqman PCR assay for rapid detection of Anaplasma phagocytophila and Borrelia burgdorferi.

    Courtney JW, Massung RF.

    Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

    PMID: 12860656 [PubMed - indexed for MEDLINE]

  17. Ann N Y Acad Sci. 2003 Jun;990:80-9.

    National surveillance for the human ehrlichioses in the United States, 1997-2001, and proposed methods for evaluation of data quality.

    Gardner SL, Holman RC, Krebs JW, Berkelman R, Childs JE.

    Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30333, USA.

    This report describes the data accumulated during the first 5 years of national surveillance for the human ehrlichioses in the United States and territories, from its initiation in 1997 through 2001. Reported cases of human monocytic and granulocytic ehrlichiosis (HME and HGE) and cases of "other ehrlichiosis" (OE), where the agent was unspecified, originated from 30 states. As anticipated, most HME cases were from the south-central and southeastern United States, while HGE was most commonly reported from the northeastern and upper-Midwestern region. State-level incident reports of 487 HME, 1,091 HGE, and 11 OE cases were evaluated. The average annual incidences of HME, HGE, and OE per million persons residing in states reporting disease were 0.7, 1.6, and 0.2, respectively. The median ages of HME (53 yr) and HGE cases (51 yr) were consistent with published patient series. Most (> 57%) ehrlichiosis patients were male. The results suggest that national surveillance for the ehrlichioses, although imperfect in coverage, will help define endemic regions and may be useful for monitoring long-term trends. Although the data appear representative of the demographic profiles established for HME and HGE, rigorous evaluation of the system is required. Methods are proposed for evaluating the quality and representativeness of HME and HGE surveillance data, using well-established surveillance systems for Rocky Mountain spotted fever and Lyme disease.

    PMID: 12860604 [PubMed - indexed for MEDLINE]

  18. Exp Appl Acarol. 2002;26(3-4):257-66.

    Parasitism of lizards by immature stages of the blacklegged tick, Ixodes scapularis (Acari, Ixodidae).

    Durden LA, Oliver JH Jr, Banks CW, Vogel GN.

    Institute of Arthropodology and Parasitology, Georgia Southern University, PO Box 8056, Statesboro, Georgia 30460, USA. ldurden@gsvms2.cc.gasou.edu

    From 1982-1985 and 1993-1999, a total of 309 individual reptiles, mostly lizards and snakes, belonging to 12 species (American alligator, six lizard species, five snake species) was captured on St. Catherine's Island, Liberty County, Georgia, USA, and examined for ticks. Three lizard species, the broad-headed skink Eumeces laticeps, southeastern 5-lined skink Eumeces inexpectatus, and eastern glass lizard Ophisaurus ventralis, were severely infested with larvae and nymphs of the blacklegged tick, Ixodes scapularis. Ticks were not found on any of the other reptile species. Overall, 80% of 65 E. inexpectatus examined were parasitized by a mean intensity of 21.5 larvae and 88% were parasitized by a mean intensity of 4.8 nymphs. Corresponding figures for E. laticeps (n=56) were 93% and 51.3 for larvae and 89% and 7.4 for nymphs, and for O. ventralis (n=3) were 67% and 22.5 for larvae and 100% and 21.3 for nymphs. Larvae and nymphs attached along the lateral grooves of O. ventralis. Nymphs attached mainly behind the ears and in the foreleg axillae whereas larvae mainly attached to these sites and on the hindlegs in Eumeces spp. Seasonally, both larvae and nymphs were recorded on lizards from April through October. A unimodal larval peak was recorded in May or June. Seasonal data for nymphs did not reveal any distinct peaks but small bimodal peaks in mean intensities may have occurred (one in early summer, the other in late summer) suggesting that some ticks complete their life cycle in one year, and others in two years, on St. Catherine's Island. Potential epidemiological consequences of these findings with respect to Lyme disease in the southeastern United States are briefly addressed.

    PMID: 12537298 [PubMed - indexed for MEDLINE]

  19. J Community Health. 2002 Dec;27(6):395-402.

    Patterns of Lyme disease diagnosis and treatment by family physicians in a southeastern state.

    Boltri JM, Hash RB, Vogel RL.

    Mercer University School of Medicine, Family Health Center, 3780 Eisenhower Parkway, Macon, GA 31206, USA. boltri.john@mccg.org

    This study examined how often physicians in Georgia diagnose and treat Lyme disease as well as the criteria they use to reach a diagnosis of Lyme disease. A survey was sent to 1,331 family physicians in Georgia concerning how many cases of Lyme disease the physicians diagnosed, and the criteria used to make the diagnosis, during the preceding 12 months. Of 710 responses, 167 physicians treated 316 cases of Lyme disease without a firm diagnosis. In addition, 125 physicians diagnosed 262 cases of Lyme disease, 130 without serologic testing and 132 with serologic testing. Family Physicians in Georgia diagnose Lyme disease at a rate 40 times greater than the surveillance case rate reported in Georgia.

    PMID: 12458782 [PubMed - indexed for MEDLINE]

  20. J Clin Microbiol. 2002 Jul;40(7):2572-83.

    Genetic diversity of the outer surface protein C gene of southern Borrelia isolates and its possible epidemiological, clinical, and pathogenetic implications.

    Lin T, Oliver JH Jr, Gao L.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro, Georgia 30460-8056, USA.

    The ospC genes of 20 southern Borrelia strains were sequenced. The strains consisted of B. burgdorferi sensu stricto, B. andersonii, B. bissettii, one undescribed genospecies, MI-8, and one probably new Borrelia species, TXW-1. A high degree of similarity exists between B. burgdorferi sensu stricto and B. bissettii and between B. bissettii and B. andersonii. Lateral transfers of the ospC gene probably occurred between B. burgdorferi sensu stricto and B. bissettii and between B. bissettii and B. andersonii. Internal gene recombination appears to occur among them. The highest degree of genetic diversity among them was observed in the two variable domains (V1 and V2), semivariable domain (SV), and the species-specific epitopes (between amino acids 28 and 31). Differences in ospC sequences among southern strains reflect diversity at the strain and genospecies levels. MI-8, which was recognized as an undescribed genospecies in our previous reports, remains distinguishable in our current analysis of ospC genes and is distinct from B. burgdorferi sensu stricto. Interestingly, another undescribed southern isolate, TXW-1, was not amplified under various PCR conditions. Compared to European B. burgdorferi sensu stricto strains, American B. burgdorferi sensu stricto strains show greater genetic heterogeneity. Southern B. burgdorferi sensu stricto, B. andersonii, and B. bissettii isolates were intermixed with each other in the phylogenetic trees. In the derived trees in our work, at least one southeastern strain of B. burgdorferi, MI-2, most closely aligns with a so-called invasive cluster that possesses many proven human-invasive strains. Transmission experiments show that MI-2 and the strains in this group of southern spirochetes are able to infect mice and hamsters and that the typical vector of Lyme disease, Ixodes scapularis, can acquire the spirochetes from infected mammals. Currently, strain MI-2 appears to be the only southern isolate among the 20 we analyzed that clusters with an OspC invasive group and thus might be invasive for humans.

    PMCID: PMC120588 PMID: 12089279 [PubMed - indexed for MEDLINE]

  21. J Clin Microbiol. 2001 Jul;39(7):2500-7.

    Genetic heterogeneity of Borrelia burgdorferi sensu lato in the southern United States based on restriction fragment length polymorphism and sequence analysis.

    Lin T, Oliver JH Jr, Gao L, Kollars TM Jr, Clark KL.

    Institute of Arthropodology and Parasitology, Department of Biology, Georgia Southern University, Statesboro, Georgia 30460-8056, USA.

    Fifty-six strains of Borrelia burgdorferi sensu lato, isolated from ticks and vertebrate animals in Missouri, South Carolina, Georgia, Florida, and Texas, were identified and characterized by PCR-restriction fragment length polymorphism (RFLP) analysis of rrf (5S)-rrl (23S) intergenic spacer amplicons. A total of 241 to 258 bp of intergenic spacers between tandemly duplicated rrf (5S) and rrl (23S) was amplified by PCR. MseI and DraI restriction fragment polymorphisms were used to analyze these strains. PCR-RFLP analysis results indicated that the strains represented at least three genospecies and 10 different restriction patterns. Most of the strains isolated from the tick Ixodes dentatus in Missouri and Georgia belonged to the genospecies Borrelia andersonii. Excluding the I. dentatus strains, most southern strains, isolated from the ticks Ixodes scapularis and Ixodes affinis, the cotton rat (Sigmodon hispidus), and cotton mouse (Peromyscus gossypinus) in Georgia and Florida, belonged to Borrelia burgdorferi sensu stricto. Seven strains, isolated from Ixodes minor, the wood rat (Neotoma floridana), the cotton rat, and the cotton mouse in South Carolina and Florida, belonged to Borrelia bissettii. Two strains, MI-8 from Florida and TXW-1 from Texas, exhibited MseI and DraI restriction patterns different from those of previously reported genospecies. Eight Missouri tick strains (MOK-3a group) had MseI patterns similar to that of B. andersonii reference strain 21038 but had a DraI restriction site in the spacer. Strain SCGT-8a had DraI restriction patterns identical to that of strain 25015 (B. bissettii) but differed from strain 25015 in its MseI restriction pattern. Strain AI-1 had the same DraI pattern as other southern strains in the B. bissettii genospecies but had a distinct MseI profile. The taxonomic status of these atypical strains needs to be further evaluated. To clarify the taxonomic positions of these atypical Borrelia strains, the complete sequences of rrf-rrl intergenic spacers from 20 southeastern and Missouri strains were determined. The evolutionary and phylogenetic relationships of these strains were compared with those of the described genospecies in the B. burgdorferi sensu lato species complex. The 20 strains clustered into five separate lineages on the basis of sequence analysis. MI-8 and TXW-1 appeared to belong to two different undescribed genospecies, although TXW-1 was closely related to Borrelia garinii. The MOK-3a group separated into a distinct deep branch in the B. andersonii lineage. PCR-RFLP analysis results and the results of sequence analyses of the rrf-rrl intergenic spacer confirm that greater genetic heterogeneity exists among B. burgdorferi sensu lato strains isolated from the southern United States than among strains isolated from the northern United States. The B. andersonii genospecies and its MOK-3a subgroup are associated with the I. dentatus-cottontail rabbit enzootic cycle, but I. scapularis was also found to harbor a strain of this genospecies. Strains that appear to be B. bissettii in our study were isolated from I. minor and the cotton mouse, cotton rat, and wood rat. The B. burgdorferi sensu stricto strains from the south are genetically and phenotypically similar to the B31 reference strain.

    PMCID: PMC88176 PMID: 11427560 [PubMed - indexed for MEDLINE]

  22. Infect Dis Clin North Am. 2001 Mar;15(1):171-87.

    Lyme vaccine: issues and controversies.

    Rahn DW.

    Department of Clinical Affairs, Medical College of Georgia, Augusta, Georgia, USA.

    The development of an effective vaccine for Lyme disease represents a major advance in the control of the most prevalent vector-borne disease in the United States. It has a definite place in the total approach to control of this disease. Its use should be restricted to individuals who are at moderate to high risk of exposure to infected vector ticks. Vaccinated individuals should not be complacent about other personal protection measures, because the vaccine is not uniformly effective and protective antibody levels decay rapidly. Booster doses will be necessary, but the intervals have not yet been determined. There is a theoretical concern about the possible induction of inflammatory arthritis through an autoimmune mechanism, but there is no evidence that this condition has clinical relevance. The impact of the current lawsuits on vaccine recommendations and use remains to be determined. Continued surveillance for rare long-term side effects should address the medical risk issue. Alternative primary vaccine administration schedules are currently under study, and could lead to regimens permitting achievement of protective immunity in 6 months or less. Vaccine is not approved for use in children under the age of 15 years.

    PMID: 11301814 [PubMed - indexed for MEDLINE]

  23. J Mol Microbiol Biotechnol. 2000 Oct;2(4):447-54.

    The role of genomics in approaching the study of Borrelia DNA replication.

    García-Lara J, Picardeau M, Hinnebusch BJ, Huang WM, Casjens S.

    Department of Microbiology, University of Georgia, Athens 30602, USA. jgarcial@panda.uchc.edu

    The identification of chromosomal and episomal origins of replication in the genome of the causative agent of Lyme disease, the spirochete Borrelia burgdorferi, has been greatly facilitated by genomics. Analysis of genome features, including strand compositional asymmetries, organizational similarities to other bacterial origins of replication, and the presence of homologues of genes involved in replication and partitioning, have contributed to the identification of a collection of putative origins of replication within the Borrelia genome. This analysis has provided the basis for the experimental verification of origins in the linear chromosome and in the linear plasmid Ip28-2. Information generated during the study of these origins will significantly contribute to the understanding of the mechanisms of replication and partitioning in Borrelia.

    PMID: 11075917 [PubMed - indexed for MEDLINE]

  24. Science. 2000 Jun 2;288(5471):1651-3.

    Lack of a role for iron in the Lyme disease pathogen.

    Posey JE, Gherardini FC.

    Department of Microbiology, University of Georgia, Athens, GA 30602, USA.

    A fundamental tenet of microbial pathogenesis is that bacterial pathogens must overcome host iron limitation to establish a successful infection. Surprisingly, the Lyme disease pathogen Borrelia burgdorferi has bypassed this host defense by eliminating the need for iron. B. burgdorferi grew normally and did not alter gene expression in the presence of iron chelators. Furthermore, typical bacterial iron-containing proteins were not detected in cell lysates, nor were the genes encoding such proteins identified in the genome sequence. The intracellular concentration of iron in B. burgdorferi was estimated to be less than 10 atoms per cell, well below a physiologically relevant concentration.

    PMID: 10834845 [PubMed - indexed for MEDLINE]

  25. J Parasitol. 2000 Apr;86(2):251-4.

    Tick infestations of birds in coastal Georgia and Alabama.

    Kinsey AA, Durden LA, Oliver JH Jr.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460, USA.

    Mist-netted birds were examined for ticks on Jekyll Island, Glynn Co., Georgia (32 bird species) in 1996-1998, and at Fort Morgan, Baldwin Co., Alabama (36 species) in 1998 during fall migration. Sixty-two (14.7%) of 423 birds from Jekyll Island and 22 (13.3%) of 165 birds from Fort Morgan were infested with ticks. The mean number of ticks per infested bird was 2.0 on Jekyll Island and 6.3 at Fort Morgan. Ten species of birds were infested with ticks on Jekyl1 Island where 87% of all ticks were recovered from 3 species: the common yellowthroat (Geothlypis trichas), gray catbird (Dumetella carolinensis), and northern waterthrush (Seiurus noveboracensis). Eight species of birds were infested with ticks at Fort Morgan where 83% of all ticks were recovered from 3 species: the brown thrasher (Toxostoma rufum), swamp sparrow (Melospiza georgiana), and common yellowthroat. Six species of ticks (Amblyomma americanum, Amblyomma maculatum, Haemaphysalis leporispalustris, Ixodes brunneus, Ixodes minor, and Ixodes scapularis) were recovered from the Georgia birds, whereas 3 species (A. maculatum, H. leporispalustris, and Ixodes dentatus) were recovered from the Alabama birds. Attempts to isolate Borrelia burgdorferi sensu stricto, the etiologic agent of Lyme borreliosis, from Ixodes spp. ticks recovered from birds were unsuccessful.

    PMID: 10780541 [PubMed - indexed for MEDLINE]

  26. J Clin Microbiol. 2000 Jan;38(1):120-4.

    Isolation, cultivation, and characterization of Borrelia burgdorferi from rodents and ticks in the Charleston area of South Carolina.

    Oliver JH Jr, Clark KL, Chandler FW Jr, Tao L, James AM, Banks CW, Huey LO, Banks AR, Williams DC, Durden LA.

    Institute of Arthropodology, Department of Biology, Georgia Southern University, Statesboro, Georgia 30460-8056, USA. JOliver@GaSou.edu

    Twenty-eight Borrelia burgdorferi isolates from the Charleston, S.C., area are described. This represents the first report and characterization of the Lyme disease spirochete from that state. The isolates were obtained from December 1994 through December 1995 from the tick Ixodes scapularis, collected from vegetation, and from the rodents Peromyscus gossypinus (cotton mouse), Neotoma floridana (eastern wood rat), and Sigmodon hispidus (cotton rat). All isolates were screened immunologically by indirect immunofluorescence with monoclonal antibodies to B. burgdorferi-specific outer surface protein A (OspA) (antibodies H5332 and H3TS) and B. burgdorferi-specific OspB (antibodies H6831 and H614), a Borrelia (genus)-specific antiflagellin antibody (H9724), Borrelia hermsii-specific antibodies (H9826 and H4825), and two polyclonal antibodies (one to Borrelia species and another to B. burgdorferi). Six of the isolates were analyzed by exposing Western blots to monoclonal antibodies H5332, H3TS, H6831, and H9724. All isolates were also analyzed by PCR with five pairs of primers known to amplify selected DNA target sequences specifically reported to be present in the reference strain, B. burgdorferi B-31. The protein profiles of six of the isolates (two from ticks, one from a cotton mouse, two from wood rats, and one from a cotton rat) also were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. We conclude that the 28 Charleston isolates are B. burgdorferi sensu stricto based on their similarities to the B. burgdorferi B-31 reference strain.

    PMCID: PMC86035 PMID: 10618074 [PubMed - indexed for MEDLINE]

  27. J Med Entomol. 1999 Nov;36(6):720-6.

    Seasonal activity and host associations of Ixodes scapularis (Acari: Ixodidae) in southeastern Missouri.

    Kollars TM Jr, Oliver JH Jr, Kollars PG, Durden LA.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460, USA.

    Based on tick collections recovered from wild vertebrates and by dragging, the seasonal occurrence of adult blacklegged ticks, Ixodes scapularis Say, extended from October through May in southeastern Missouri. Adult activity was bimodal with the higher peak occurring in November followed by a lower peak in February. The activity of immature I. scapularis had the general pattern of that found in the Northeast where Lyme disease is hyperendemic, with larval activity (July) peaking after that of nymphs (May and June). Vertebrates varied in their importance as hosts of I. scapularis. White-tailed deer, Odocoileus virginanus (Zimmerman), and coyotes, Canis latrans Say, were the primary hosts of adult I. scapularis. Broad-headed skinks, Eumeces laticeps (Schneider), and eastern fence lizards, Sceloporus undulatus (Latreille), were the primary hosts of nymphal I. scapularis. The broad-headed skink, 5-lined skink, Eumeces fasciatus (L.), and Carolina wren, Thryothorus ludovicianus (Latham), were the primary hosts of larval I. scapularis. Homeotherms were important hosts of immature I. scapularis, accounting for 30% of nymphs and 39% of larvae collected. The eastern cottontail rabbit, Sylvilagus floridanus (Allen), may play an important role in the epidemiology of Lyme disease in Missouri. Isolates of Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner were made from ticks recovered from rabbits, making the cottontail rabbit a key species for further study of the epidemiology of Lyme borreliosis in Missouri.

    PMID: 10593072 [PubMed - indexed for MEDLINE]

  28. Arch Dermatol. 1999 Nov;135(11):1317-26.

    Solitary erythema migrans in Georgia and South Carolina.

    Felz MW, Chandler FW Jr, Oliver JH Jr, Rahn DW, Schriefer ME.

    Department of Family Medicine, Medical College of Georgia, Augusta 30912-3500, USA. mfelz@mail.mcg.edu

    Comment in: Arch Dermatol. 1999 Nov;135(11):1398-400.

    OBJECTIVE: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states. DESIGN: Prospective case series. SETTING: Family medicine practice at academic center. PATIENTS: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease. INTERVENTIONS: Patients underwent clinical and serologic evaluation for evidence of B burgdorferi infection. All lesions underwent photography, biopsy, culture and histopathologic and polymerase chain reaction analysis for B burgdorferi infection. Patients were treated with doxycycline hyclate and followed up clinically and serologically. MAIN OUTCOME MEASURES: Disappearance of EM lesions and associated clinical symptoms in response to antibiotic therapy; short-term and follow-up serologic assays for diagnostic antibody; growth of spirochetes from tissue biopsy specimens in Barbour-Stoenner-Kelly II media; special histopathologic stains of tissue for spirochetes; and polymerase chain reaction assays of tissue biopsy specimens for established DNA sequences of B burgdorferi. RESULTS: The EM lesions ranged from 5 to 20 cm (average, 9.6 cm). Five patients (22%) had mild systemic symptoms. All lesions and associated symptoms resolved with antibiotic therapy. Overall, 7 patients (30%) had some evidence of B burgdorferi infection. Cultures from 1 patient (4%) yielded spirochetes, characterized as Borrelia garinii, a European strain not known to occur in the United States; 3 patients (13%) demonstrated spirochetallike forms on special histologic stains; 5 patients (22%) had positive polymerase chain reaction findings with primers for flagellin DNA sequences; and 2 patients (9%) were seropositive for B burgdorferi infection using recommended 2-step CDC methods. No late clinical sequelae were observed after treatment. CONCLUSIONS: The EM lesions we observed are consistent with early Lyme disease occurring elsewhere, but laboratory confirmation of B burgdorferi infection is lacking in at least 16 cases (70%) analyzed using available methods. Genetically variable strains of B burgdorferi, alternative Borrelia species, or novel, uncharacterized infectious agents may account for most of the observed EM lesions.

    PMID: 10566829 [PubMed - indexed for MEDLINE]

  29. J Med Entomol. 1999 Sep;36(5):578-87.

    Ticks and antibodies to Borrelia burgdorferi from mammals at Cape Hatteras, NC and Assateague Island, MD and VA.

    Oliver JH Jr, Magnarelli LA, Hutcheson HJ, Anderson JF.

    Institute of Arthropodology & Parasitology, Georgia Southern University, Statesboro 30460, USA.

    Results of a survey for ixodid ticks and/or serum antibodies to Borrelia burgdorferi from 14 species of small to large mammals from eastern coastal areas of the United States are presented. Most samples were obtained from July 1987 through June 1989 (excluding December-March) at 3 locales: Assateague Is. National Seashore, Worcester Co., MD., and Accomack Co., VA. (approximately 38 degrees 05' N 75 degrees 10' W), and Cape Hatteras National Seashore, Dare Co., NC (approximately 35 degrees 30' N 76 degrees 35' W). Hosts sampled included opossums (Didelphis virginiana), least shrews (Cryptotis parva), gray foxes (Urocyon cinereoargenteus), red foxes (Vulpes vulpes), raccoons (Procyon lotor), feral cats (Felis sylvestris), feral horses (Equus caballus), sika deer (Cervus nippon), rice rats (Oryzomys palustris), white-footed mice (Peromyscus leucopus), meadow voles (Microtus pennsylvanicus), house mice (Mus musculus), norway rats (Rattus norvegicus) and jumping mice (Zapus hudsonius). An indirect fluorescent antibody test was used for testing sera from opossums, raccoons, and feral cats; enzyme-linked immunosorbent assays were used for sera from foxes, horses, deer, and house and white-footed mice. Antibodies to B. burgdorferi were found in all species tested from each locale. Seasonal data reinforce the contention that P. leucopus is a suitable sentinel species for B. burgdorferi. Ticks on hosts included Ixodes scapularis Say, I. texanus Banks, Dermacentor variabilis (Say), D. albipictus (Packard), and Amblyomma americanum (L.). Males comprised approximately 0-22 and 60-81% of Ixodes sp. and Amblyomma-Dermacentor adults collected from hosts, respectively. All stages of A. americanum, adult D. variabilis, and larval I. scapularis were collected from vegetation. The highest seropositivity rate (67%) was recorded for 45 P. leucopus at Assateague during July, approximately 1 mo. after peak nymphal I. scapularis intensity. Borrelia burgdorferi was isolated from 6 nymphal and 12 female I. scapularis collected from P. leucopus and C. nippon, respectively, on Assateague.

    PMID: 10534951 [PubMed - indexed for MEDLINE]

  30. J Vector Ecol. 1999 Jun;24(1):91-8.

    Geographic survey of vector ticks (Ixodes scapularis and Ixodes pacificus) for infection with the Lyme disease spirochete, Borrelia burgdorferi.

    Piesman J, Clark KL, Dolan MC, Happ CM, Burkot TR.

    Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Dept. Health and Human Services, Ft. Collins, CO 80522, USA.

    Populations of adult Ixodes scapularis and Ixodes pacificus, the two principal vectors of Lyme disease spirochetes in the United States, were collected from 17 sites in 12 states. Female ticks were fed on experimental rabbits; ticks and rabbits were subsequently examined for infection with Borrelia burgdorferi. Fourteen rabbits were exposed to I. scapularis ticks from the northeastern states of Connecticut, New York, New Jersey, and Maryland; all 14 rabbits became infected with B. burgdorferi. A total of 165/226 (73%) of these northeastern ticks was infected. Similarly, ticks from the midwestern states of Michigan, Wisconsin, and Minnesota transmitted infection to all three exposed rabbits; 29/51 (57%) of these midwestern I. scapularis were infected. In marked contrast, none of the 12 rabbits exposed to I. scapularis ticks from the southeastern states of South Carolina, Georgia, Florida, and Mississippi acquired infection with B. burgdorferi, and 0/284 (0%) of these ticks contained spirochetes. Four rabbits were exposed to I. pacificus collected from one location in California; 2/4 of these rabbits acquired infection and 2/57 (4%) of the I. pacificus were infected with B. burgdorferi. The antigenic profiles of all 58 strains tested were consistent with an identity of B. burgdorferi sensu lato. The availability of a human Lyme disease vaccine adds urgency to our efforts to calculate the ecological transmission risk throughout the United States, as an aid to the judicious use of such a vaccine.

    PMID: 10436883 [PubMed - indexed for MEDLINE]

  31. J Parasitol. 1999 Jun;85(3):426-30.

    Investigation of venereal, transplacental, and contact transmission of the Lyme disease spirochete, Borrelia burgdorferi, in Syrian hamsters.

    Woodrum JE, Oliver JH Jr.

    Institute of Arthropodology and Parasitology, Department of Biology, Georgia Southern University, Statesboro 30460, USA.

    A hamster was inoculated with the SI-1 strain of Borrelia burgdorferi and subsequently served as a host to larval Ixodes scapularis Say. Approximately 68% of the nymphs resulting from the fed larvae were infected. Nymphs from this group were fed on uninfected hamsters, and 3 of 4 males and 6 of 6 females became infected. The infected hamsters were allowed to mate with uninfected partners to test for venereal transmission. Six infected females were mated with 6 uninfected males, whereas 3 infected males were mated with 6 uninfected females. None of the uninfected hamsters became infected after mating. Two protocols were used to determine if transplacental transmission of B. burgdorferi occurred. One group included 6 nonpregnant infected females that were subsequently mated and became pregnant. Three of the females were allowed to carry to full term, whereas the other 3 were killed prior to parturition. All fetuses and offspring were negative for B. burgdorferi based on cultures and monoclonal antibody assays. Another group of 6 females was infected via tick bite after becoming pregnant; those females were allowed to carry fetuses to birth and all were negative. Attempts at contact transmission of B. burgdorferi from 2 infected females to 2 uninfected male and 2 uninfected female hamsters and from 2 infected males to 2 uninfected male and uninfected female hamsters via urine or feces failed.

    PMID: 10386432 [PubMed - indexed for MEDLINE]

  32. Postgrad Med. 1999 Jun;105(7):21.

    Lyme disease vaccine safe for all?

    Rahn DW.

    Medical College of Georgia, Augusta, USA.

    PMID: 10376044 [PubMed - indexed for MEDLINE]

  33. Emerg Infect Dis. 1999 May-Jun;5(3):321-8.

    The cost effectiveness of vaccinating against Lyme disease.

    Meltzer MI, Dennis DT, Orloski KA.

    Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. qzm4@cdc.gov

    Comment in: Emerg Infect Dis. 1999 Sep-Oct;5(5):727-8.

    To determine the cost effectiveness of vaccinating against Lyme disease, we used a decision tree to examine the impact on society of six key components. The main measure of outcome was the cost per case averted. Assuming a 0.80 probability of diagnosing and treating early Lyme disease, a 0.005 probability of contracting Lyme disease, and a vaccination cost of $50 per year, the mean cost of vaccination per case averted was $4,466. When we increased the probability of contracting Lyme disease to 0.03 and the cost of vaccination to $100 per year, the mean net savings per case averted was $3,377. Since few communities have average annual incidences of Lyme disease >0. 005, economic benefits will be greatest when vaccination is used on the basis of individual risk, specifically, in persons whose probability of contracting Lyme disease is >0.01.

    PMCID: PMC2640763 PMID: 10341168 [PubMed - indexed for MEDLINE]

  34. J Med Entomol. 1999 May;36(3):361-4.

    Attachment sites of four tick species (Acari: Ixodidae) parasitizing humans in Georgia and South Carolina.

    Felz MW, Durden LA.

    Department of Family Medicine, Medical College of Georgia, Augusta 30912, USA.

    From June 1995 through January 1998, 677 tick specimens were submitted by 521 humans from 14 states. Analysis was limited to specimens originating in Georgia and South Carolina, representing 87.3% of total submissions. Attachment sites were specified in 367 specimens (62.3%). The American dog tick, Dermacentor variabilis (Say), a vector of the agent of Rocky Mountain spotted fever, favored the head and neck in 59% of attached specimens. The lone star tick, Amblyomma americanum (L.), a strongly implicated vector of the agent of human monocytic ehrlichiosis, favored the lower extremities, buttocks, and groin in 54% of specimens. The blacklegged tick, Ixodes scapularis Say, the main eastern vector of the Lyme disease spirochete, had widely distributed attachment sites with no apparent site preference. The Gulf Coast tick, A. maculatum Koch, parasitized humans in too few instances for analysis. In the southeastern United States, prevention of tick bites and tickborne illnesses such as Rocky Mountain spotted fever, ehrlichiosis, and Lyme disease may be enhanced by personal practices and public health measures based on knowledge of preferred attachment sites of potentially infectious tick species.

    PMID: 10337108 [PubMed - indexed for MEDLINE]

  35. Emerg Infect Dis. 1998 Jul-Sep;4(3):423-6.

    Host genes and infectious diseases.

    McNicholl J.

    Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

    PMCID: PMC2640306 PMID: 9716963 [PubMed - indexed for MEDLINE]

  36. J Parasitol. 1998 Jun;84(3):629-31.

    First records of Amblyomma americanum, Ixodes (Ixodes) dentatus, and Ixodes (Ceratixodes) uriae (Acari: Ixodidae) from Maine.

    Keirans JE, Lacombe EH.

    U.S. National Tick Collection, Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460, USA.

    The first records of 3 ixodid tick species collected in the state of Maine are reported. A total of 23 records of the lone star tick, Amblyomma americanum (L., 1758), in 11 counties from hosts with no history of travel outside the state demonstrates that this tick is now a resident of Maine. Ixodes dentatus Marx, 1899 is recorded from Waldo and Lincoln counties, and Ixodes uriae White, 1852 is recorded from Matinicus Rock in Knox County. This is the first report of I. uriae from the eastern United States. Disease agents such as those causing human monocytic ehrlichiosis, Lyme disease, Rocky Mountain spotted fever, and several arboviruses have been recorded from 1 or more of these tick species.

    PMID: 9645873 [PubMed - indexed for MEDLINE]

  37. J Womens Health. 1998 May;7(4):451-8.

    Differences in notifiable infectious disease morbidity among adult women--United States, 1992-1994.

    Niskar AS, Koo D.

    Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

    By 1990, all 50 states were using the Centers for Disease Control and Prevention (CDC) National Electronic Telecommunications System for Surveillance to report individual case data that included demographic information (without personal identifiers) about most notifiable diseases. This analysis of National Notifiable Diseases Surveillance System (NNDSS) data is useful for evaluating the distribution of reported notifiable infectious diseases among adult women by age and race. The number of cases of the 48 nationally notifiable infectious diseases reported among adult women (i.e., women > or = 15 years of age) were compiled for 1992-1994. These data were then analyzed by age and race, and rates per 100,000 adult women were calculated. During 1992-1994, the 10 most commonly reported nationally notifiable diseases among adult women in the United States were, in descending order of frequency, gonorrhea, primary/secondary syphilis, acquired immunodeficiency syndrome (AIDS), salmonellosis, tuberculosis, hepatitis A, hepatitis B, shigellosis, Lyme disease, and hepatitis C/non-A non-B. Gonorrhea was the most commonly reported notifiable infectious disease for women of all ages, except those ages > or = 55 years, and for women of all races, except Asian/Pacific Islanders. Tuberculosis was the most commonly reported infectious disease among women of Asian/Pacific Island descent. Analysis of NNDSS data provides information about the relative reported burden of diseases among women of all ages and different races. This information may be used for targeting research, prevention, and control efforts.

    PMID: 9611703 [PubMed - indexed for MEDLINE]

  38. Postgrad Med. 1998 May;103(5):51-4, 57-9, 63-4 passim.

    Lyme disease update. Current approach to early, disseminated, and late disease.

    Rahn DW, Felz MW.

    Section of General Internal Medicine, Medical College of Georgia School of Medicine, Augusta 30912-3104, USA. deptmed.drahn@mail.mcg.edu

    A rational approach to diagnosis and treatment of Lyme disease requires an understanding of the endemic range of the tick vectors for B burgdorferi, the epidemiologic risk factors, and the spectrum of clinical manifestations. A two-step approach to serologic testing (ELISA followed by Western blot analysis of positive or equivocal results) can be useful if the pretest likelihood of Lyme disease is higher than 20%. Consideration should be given to the possibility of (1) a noninfectious disease with clinical features similar to those of Lyme disease or (2) coinfection with a second tick-transmitted organism. Late Lyme disease must be distinguished by clinical characteristics from fibromyalgia (the commonest source of misdiagnosis in several studies). Antibiotic therapy should be tailored to the extent of disease and limited to 4 weeks in most cases. Human vaccines based on an outer-surface protein from B burgdorferi have been tested in large-scale US clinical trials and may soon be approved for use in persons whose occupational or recreational activities place them at risk for B burgdorferi exposure.

    PMID: 9590986 [PubMed - indexed for MEDLINE]

  39. J Clin Microbiol. 1998 Jan;36(1):1-5.

    First isolation and cultivation of Borrelia burgdorferi sensu lato from Missouri.

    Oliver JH Jr, Kollars TM Jr, Chandler FW Jr, James AM, Masters EJ, Lane RS, Huey LO.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460-8056, USA. JOliver@gasou.edu

    Five Borrelia burgdorferi sensu lato isolates from Missouri are described. This represents the first report and characterization of such isolates from that state. The isolates were obtained from either Ixodes dentatus or Amblyomma americanum ticks that had been feeding on cottontail rabbits (Sylvilagus floridanus) from a farm in Bollinger County, Mo., where a human case of Lyme disease had been reported. All isolates were screened immunologically by indirect immunofluorescence by using monoclonal antibodies to B. burgdorferi-specific outer surface protein A (OspA) (antibodies H3TS and H5332), B. burgdorferi-specific OspB (antibody H6831), Borrelia (genus)-specific antiflagellin (antibody H9724), and Borrelia hermsii-specific antibody (antibody H9826). Analysis of the isolates also involved a comparison of their protein profiles by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Finally, the isolates were analyzed by PCR with six pairs of primers known to amplify selected DNA target sequences specifically found in the reference strain B. burgdorferi B-31. Although some genetic variability was detected among the five isolates as well as between them and the B-31 strain, enough similarities were found to classify them as B. burgdorferi sensu lato.

    PMCID: PMC124796 PMID: 9431909 [PubMed - indexed for MEDLINE]

  40. J Parasitol. 1997 Dec;83(6):1178-82.

    Ticks, Lyme disease spirochetes, trypanosomes, and antibody to encephalitis viruses in wild birds from coastal Georgia and South Carolina.

    Durden LA, McLean RG, Oliver JH Jr, Ubico SR, James AM.

    Institute of Anthropodology and Parasitology, Georgia Southern University, Statesboro 30460, USA.

    Ticks and blood samples were collected from wild birds mist-netted on St. Catherine's Island, Georgia, and at the Wedge Plantation in coastal South Carolina in 1994 and 1995. Immature stages of 5 species of ixodid ticks were recovered from 10 of 148 (7%) birds belonging to 6 species in Georgia, whereas 6 ixodid species were recovered from 45 of 259 (17%) birds representing 10 avian species in South Carolina. Borrelia burgdorferi sensu lato was isolated from 27 of 120 (23%) screened ticks (Ixodes scapularis and Ixodes minor) recovered from South Carolina birds, but from none of 16 screened ticks removed from Georgia birds. This spirochete was also isolated from 1 of 97 (1%) birds in South Carolina. In 1995, neither eastern equine encephalitis (EEE) virus nor St. Louis encephalitis (SLE) virus was isolated from any of 218 bird sera screened, but serum neutralizing antibodies were found to EEE virus in 4 of 121 (3%) sera and to SLE virus in 2 of 121 (2%) sera from South Carolina. No antibody to either virus was detected in 51 avian sera screened from Georgia. Trypanosomes (probably Trypanosoma avium) were isolated from 1 of 51 (2%) birds from Georgia and from 13 of 97 (13%) birds from South Carolina. Our data suggest that some wild birds may be reservoir hosts for the Lyme disease spirochete and for encephalitis viruses in coastal Georgia and South Carolina and that migrating birds can disperse immature ticks infected with B. burgdorferi.

    PMID: 9406799 [PubMed - indexed for MEDLINE]

  41. J Med Entomol. 1997 Jul;34(4):451-6.

    Ability of the Lyme disease spirochete Borrelia burgdorferi to infect rodents and three species of human-biting ticks (blacklegged tick, American dog tick, lone star tick) (Acari:Ixodidae).

    Piesman J, Happ CM.

    Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80522, USA.

    The infectivity of a diverse collection of Borrelia burgdorferi strains from North America for mice was determined as a prelude to vector competence experiments with the 3 primary human-biting tick species in the eastern United States (Ixodes scapularis Say, Dermacentor variabilis (Say), Amblyomma americanum (L.)]. Of the 34 B. burgdorferi strains inoculated into mice, 29 were infectious; the exceptions were 5 isolates from Texas. Vector competence experiments were conducted with 2 strains from the southern United States (North Carolina and Georgia). Both strains were extremely infectious to I. scapularis larvae. Moreover, I. scapularis efficiently maintained these spirochetes transstadially and transmitted infection as nymphs. D. variabilis larvae were intermediate in susceptibility but generally did not maintain the infection transstadially. A. americanum larvae were completely refractory to infection with these 2 southern B. burgdorferi strains. Three isolates from Michigan D. variabilis were inoculated into mice, subsequently exposed to I. scapularis and D. variabilis larvae. Larval I. scapularis were 5-fold more susceptible to infection with these strains than were larval D. variabilis. Although nymphal I. scapularis efficiently transmitted a Michigan isolate, nymphal D. variabilis did not. In all these experiments, I. scapularis was the only species that proved to be vector competent for B. burgdorferi.

    PMID: 9220680 [PubMed - indexed for MEDLINE]

  42. J Parasitol. 1996 Dec;82(6):936-40.

    Unusual strain of Borrelia burgdorferi isolated from Ixodes dentatus in central Georgia.

    Oliver JH Jr, Chandler FW Jr, James AM, Huey LO, Vogel GN, Sanders FH Jr.

    Department of Biology, Georgia Southern University, Statesboro 30460-8056, USA.

    A new, unusual spirochete was cultured in Barbour-Stoenner-Kelly (BSK II) medium from the midgut and other tissues of the tick Ixodes dentatus. The tick was collected from leaf litter in an oak-pine wood lot in Bibb County approximately 7.2 km from Macon in central Georgia during February 1993. Characterization by indirect immunofluorescence using 5 murine monoclonal antibodies, by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole spirochetal lysates, and by polymerase chain reaction assay for several known DNA target sequences indicates that the spirochete is Borrelia burgdorferi sensu lato. It is genetically different from the B-31 reference strain of B. burgdorferi sensu stricto that is typical of strains causing Lyme borreliosis in North America. Range of infectivity and pathogenesis of the Bibb County isolate (BC-1) are unknown but being investigated. The BC-1 strain is the first B. burgdorferi isolate from I. dentatus in the southeastern United States (I. dentatus is not the common vector for Lyme borreliosis in humans). Additionally, the collection site was approximately 322 km from the Atlantic coast, far distant from where most B. burgdorferi isolates have been obtained.

    PMID: 8973402 [PubMed - indexed for MEDLINE]

  43. J Parasitol. 1996 Dec;82(6):926-35.

    Lyme borreliosis in the southern United States: a review.

    Oliver JH Jr.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460-8056, USA.

    Lyme borreliosis (Lyme disease) is the most often reported arthropod transmitted disease in humans in the U.S.A. Although it has been reported from 43 states, cases are especially abundant in the mid-Atlantic and northeastern regions. Borrelia burgdorferi, the etiologic agent, is transmitted primarily by the western blacklegged tick (Ixodes pacificus) in far western North America, and by the blacklegged tick (Ixodes scapularis) in eastern North America. Although Lyme disease cases have been reported from southern states, some researchers doubt the presence of B. burgdorferi or of human Lyme disease in the south. However, new data show that B. burgdorferi is widely distributed in the south and that strains are genetically more varied than in the north. Moreover, B. burgdorferi enzootic cycles appear to be more complex and more tick species are identified as vectors of the spirochete in the southern states.

    PMID: 8973401 [PubMed - indexed for MEDLINE]

  44. Clin Infect Dis. 1996 Sep;23(3):639-40.

    Optic disk edema as the presenting sign of Lyme disease.

    Fedorowski JJ, Hyman C.

    Memorial Medical Center, Savannah, Georgia, USA.

    PMID: 8879795 [PubMed - indexed for MEDLINE]

  45. Parasitology. 1996 Aug;113 ( Pt 2):97-103.

    The effect of infection with Lyme disease spirochetes (Borrelia burgdorferi) on the phototaxis, activity, and questing height of the tick vector Ixodes scapularis.

    Lefcort H, Durden LA.

    Department of Biology, Georgia Southern University, Statesboro 30460-8042, USA. LEFCORT@GONZAGA.EDU

    Little is known about the effects of infection with Borrelia burgdorferi, the bacterium that causes Lyme disease, on its tick vectors. The purpose of this study was to determine the behavioural and ecological effects of infection by the bacterium in nymphal and adult black-legged (Ixodes scapularis) ticks. We found that the effects of infection were more pronounced in adults than in nymphs. Compared to uninfected adults, infected adults were less able to overcome physical obstacles, avoided vertical surfaces, were less active and quested at lower heights. Infected nymphs showed increased phototaxis and attraction to vertical surfaces. Infected nymphs also showed trends toward increased questing height and a greater tendency to overcome physical obstacles although these trends were not statistically significant. These altered behaviours in an infected tick may affect survival or pathogen transmission and may reflect kin selection in the bacterial pathogen.

    PMID: 8760310 [PubMed - indexed for MEDLINE]

  46. J Med Entomol. 1996 May;33(3):319-27.

    Ixodes (Ixodes) jellisoni and I. (I.) neotomae (Acari:Ixodidae): descriptions of the immature stages from California.

    Keirans JE, Brown RN, Lane RS.

    U.S. National Tick Collection, Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460-8056, USA.

    Nymphal and larval stages of Ixodes (Ixodes) jellisoni Cooley & Kohls and I. (I.) neotomae Cooley are described for the first time. These 2 tick species occur only in the western United States, predominantly in California. The primary host for I. jellisoni is the California kangaroo rat, Dipodomys californicus (Merriam); that for I. neotomae is the dusky-footed woodrat, Neotoma fuscipes Baird. The etiologic agent of Lyme disease Borrelia burgdorferi Johnson, Schmidt, Hyde, Steigerwalt & Brenner has recently been isolated from both tick species, and I. neotomae was proven a competent enzootic vector of the Lyme disease spirochete.

    PMID: 8667376 [PubMed - indexed for MEDLINE]

  47. J Med Entomol. 1996 May;33(3):297-318.

    Ixodes (Ixodes) scapularis (Acari:Ixodidae): redescription of all active stages, distribution, hosts, geographical variation, and medical and veterinary importance.

    Keirans JE, Hutcheson HJ, Durden LA, Klompen JS.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460-8056, USA.

    The blacklegged tick, Ixodes (Ixodes) scapularis Say, 1821, is redescribed, based on laboratory reared specimens originating in Bulloch County, Georgia. Information on distribution, host associations, morphological variation, and medical/veterinary importance is also presented. A great deal of recent work has focused on this species because it is the principal vector of the agent of Lyme disease (Borrelia burgdorferi Johnson, Schmidt, Hyde, Steigerwaldt & Brenner) in eastern North America. Its distribution appears to be expanding, and includes the state of Florida in the southeastern United States north to the provinces of Nova Scotia and Prince Edward Island, Canada, west to North and South Dakota, United States, and south to the state of Coahuila, Mexico. Although I. scapularis feeds on at least 125 species of North American vertebrates (54 mammalian, 57 avian, and 14 lizard species), analysis of the U.S. National Tick Collection holdings show that white-tailed deer, Odocoileus virginianus (Zimmermann), cattle, Bos taurus L., dogs, Canis lupus L., and other medium-to-large sized mammals are important hosts for adults as are native mice and other small mammals, certain ground-frequenting birds, skinks, and glass lizards for nymphs and larvae. This tick is a polytypic species exhibiting north-south and east-west morphological clines. Analysis of variance and Student-Newman-Keuls multiple comparisons revealed significant interpopulational variation that is expressed most significantly in the nymphal stage. Nymphs from northern (Minnesota, Massachusetts, Maryland) populations had relatively larger basis capituli with shorter cornua (except Maryland) than southern (North Carolina, Georgia) populations. Midwestern populations (Minnesota, Missouri) differed from eastern populations (Massachusetts, Maryland, North Carolina, Georgia) in idiosomal characters (broader scuta, larger coxae III, and IV). In addition to Lyme disease, this tick is also a primary vector of the agent of human and rodent babesiosis, Babesia microti Franca. Under laboratory conditions it has transmitted the agents of deer babesiosis, Babesia odocoilei Emerson & Wright, tularemia, Francisella tularensis McCoy & Chapin, and anaplasmosis, Anaplasma marginale Theiler. Moreover, I. scapularis can reach pest proportions on livestock, and females can cause tick paralysis in dogs.

    PMID: 8667375 [PubMed - indexed for MEDLINE]

  48. Stat Med. 1996 Apr 15-May 15;15(7-9):783-806.

    Realistic power simulations compare point- and area-based disease cluster tests.

    Oden N, Jacquez G, Grimson R.

    Applied Biomathematics, Inc., Setauket, N.Y., 11733, USA.

    One can roughly divide disease cluster tests into area-based (using regional data) and point-based (using exact locations). We have compared the power of two area-based methods (Moran's I and I* (pop), a new method) to that of two point-based methods (the Cuzick-Edwards test and Grimson's test), using three realistic simulations of disease (fox rabies in England, childhood leukaemia in North Humberside, England, and Lyme disease in Georgia). The naive belief that point-based methods should be better is not supported: for the complex data simulated here, I* (pop) and the Cuzick-Edwards test had higher power than Grimson's method or Moran's I. I* (pop) capitalizes on high inter-region variability, while Moran's I cannot.

    PMID: 9132905 [PubMed - indexed for MEDLINE]

  49. J Parasitol. 1996 Feb;82(1):174-5.

    Nocturnal questing by adult blacklegged ticks, Ixodes scapularis (Acari: Ixodidae).

    Durden LA, Vogel GN, Oliver JH Jr.

    Department of Biology, Georgia Southern University, Statesboro 30460, USA.

    Quantitative tick drag samples were taken at various times during the day and night from February through April 1994 on St. Catherines Island or on Sapelo Island, Georgia. For each month, there was no statistical difference between the numbers of adult blacklegged ticks, Ixodes scapularis, collected during any hour of daylight or darkness on St. Catherines Island, Adult I. scapularis also quested during both day and night on Sapelo Island, but on this island significantly more ticks were collected in 1 nocturnal sample during March. Nocturnal questing may partially explain why hosts that are principally nocturnal or that are active during both day and night are often heavily parasitized by adult I. scapularis. This observation could be epidemiologically important with respect to tickborne zoonoses such as Lyme disease and babesiosis.

    PMID: 8627491 [PubMed - indexed for MEDLINE]

  50. Infect Immun. 1996 Feb;64(2):392-8.

    Membrane protein variations associated with in vitro passage of Borrelia burgdorferi.

    Carroll JA, Gherardini FC.

    Department of Microbiology, University of Georgia, Athens 30602-2605, USA.

    Borrelia burgdorferi, the causative agent of Lyme disease, undergoes a loss in virulence with repeated passage in vitro. Defining the changes which occur after conversion to avirulence may assist in identifying virulence factors and mechanisms of pathogenesis. We have used a cross-adsorption technique and two-dimensional nonequilibrium pH gradient electrophoresis to compare virulent (low-passage) and avirulent (high-passage) variants of B. Burgdorferi B31. Using cross-adsorbed rabbit sera to probe immunoblots, we identified 10 low-passage-associated proteins (relative molecular masses of 78, 58, 49, 34, 33, 28, 24, 20, and 16 kDa) unique to the virulent strain B31. Cross-adsorbed human serum detected five proteins of similar sizes (78, 58, 34, 28, and 20 kDa), suggesting that several of of these proteins were expressed during human infection. By probing inner and outer membranes, two proteins (58 and 33 kDa) that localized specifically to the outer membrane were observed. An additional low-passage-associated protein (28 kDa) was identified when outer membranes from low- and high-pressure variants of strain B31 were compared by two-dimensional nonequilibrium pH gradient electrophoresis.

    PMCID: PMC173776 PMID: 8550182 [PubMed - indexed for MEDLINE]

  51. J Med Entomol. 1995 Nov;32(6):827-42.

    Multivariate morphometric discrimination of nymphal and adult forms of the blacklegged tick (Acari: Ixodidae), a principal vector of the agent of Lyme disease in eastern North America.

    Hutcheson HJ, Oliver JH Jr, Houck MA, Strauss RE.

    Institute of Arthorpodology and Parasitology, Georgia Southern University, Stateboro 30460, USA.

    A morphological study of postlarval stages of the blacklegged tick, Ixodes scapularis Say, was conducted to examine congruence between northern (formerly I. dammini Spielman, Clifford, Piesman & Corwin) and southern morphotypes. The character set totaled 17 for females, 25 for males, and 28 for nymphs. Populations from 6 geographic areas, F1 progeny from reciprocal crosses between I. scapularis from Massachusetts and Georgia, and I. pacificus Cooley & Kohls from California were measured. Characters, except cornua length in nymphs, were positively correlated with PC1, indicating it was a general-size eigenvector. Characters used previously by others to distinguish northern and southern forms had a highly positive allometric relationship to general size. In canonical variate analysis (CVA) of nymphs, canonical score 1 (CAN1) discriminated I. pacificus from all other groups, canonical score 2 (CAN2) discriminated the remaining groups in a pattern that correlated with latitude, and canonical score 3 (CAN3) separated the western (Minnesota and Missouri) from the eastern groups. Size-free CVA indicated that north-south discrimination was size dependent, but that variation between Missouri and all other groups was not size related. Mahalanobis distances between groups within stages were significant with the exception of the 2 groups of female progeny of reciprocal crosses (Massachusetts x Georgia). Analysis of variance and Student-Newman-Keuls tests revealed that each geographic population differed from all other groups in at least 1 nymphal character. Nymphs from northern areas (Minnesota, Massachusetts, Maryland) differed from those from southern areas (Missouri, North Carolina, Georgia) in characters associated with the basis capitulum (longer intercornua and interauricular distances, basis capituli, and hypostome internal files, larger auriculae, but shorter cornua). Western populations (Minnesota, Missouri) differed from eastern populations in idiosomal characters (broader scutum, larger coxae III and IV). Frequency polygons of characters with the greatest differences indicated that data are continuous and geographic variation is overlapping. Thus, the data support the previous contention of conspecificity of I. scapularis and I. dammini. I. scapularis appears to be a polytypic species with a widespread geographic distribution exhibiting north-south and east-west morphological clines in eastern North America.

    PMID: 8551506 [PubMed - indexed for MEDLINE]

  52. J Med Entomol. 1995 Jul;32(4):402-6.

    Evaluation of Ixodes scapularis, Amblyomma americanum, and Dermacentor variabilis (Acari: Ixodidae) from Georgia as vectors of a Florida strain of the Lyme disease spirochete, Borrelia burgdorferi.

    Sanders FH Jr, Oliver JH Jr.

    Department of Biology, Georgia Southern University, Statesboro 30460-8056, USA.

    The ability of three common tick species from Georgia to maintain and transmit the causative agent of Lyme disease, Borrelia burgdorferi, was compared under laboratory conditions. A B. burgdorferi cotton rat isolate (MI-6) from Florida was selected as a strain from the south, and the SH2-82 isolate from New York was used as a positive control. Amblyomma americanum (L.) and Dermacentor variabilis (Say) did not transmit the MI-6 isolate from inoculated hamsters to naive laboratory mice, and nymphal ticks did not maintain this isolate transstadially. Ixodes scapularis Say transmitted both isolates to laboratory mice. There was a significant difference in the percentage of transmission of the two isolates. I. scapularis also transmitted the MI-6 isolate to two of three cotton rats. This study adds support to the premise that I. scapularis is probably the main tick vector of B. burgdorferi in the southeastern United States.

    PMID: 7650697 [PubMed - indexed for MEDLINE]

    53.
  53. Natural occurrence and characterization of the Lyme disease spirochete, Borrelia burgdorferi, in cotton rats (Sigmodon hispidus) from Georgia and Florida.

    Oliver JH Jr, Chandler FW Jr, James AM, Sanders FH Jr, Hutcheson HJ, Huey LO, McGuire BS, Lane RS.

    Department of Biology, Georgia Southern University, Statesboro 30460-8056.

    This is the first report of natural infection by Borrelia burgdorferi in the cotton rat Sigmodon hispidus. Nine B. burgdorferi isolates were obtained from ear tissues, urinary bladders, or both, by culturing tissues in BSKII medium. The rat from which the SI-3 isolate was cultured was from the same site (Sapelo Island, Georgia) as an infected cotton mouse Peromyscus gossypinus and Ixodes scapularis tick reported previously. The 8 B. burgdorferi isolates from rats in Florida included 1 (AI-1) from Amelia Island, 1 (FD-1) from Faver-Dykes State Park, and 6 (MI-3 through MI-8) from Merritt Island. The distance between Sapelo Island and Merritt Island is approximately 400 km. All B. burgdorferi isolates were characterized by indirect immunofluorescence using monoclonal antibodies to OspA (H3TS, H5332) and OspB (H5TS, H6831), polymerase chain reaction detection of specific B. burgdorferi B-31 DNA target sequences (ospA, fla, and a random chromosomal sequence), and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of spirochetal proteins. The phenotypic and genotypic characteristics of the isolates are discussed, as well as the probable importance of the cotton rat as a reservoir for B. burgdorferi in the southern United States.

    PMID: 7876974 [PubMed - indexed for MEDLINE]

  54. Stat Med. 1995 Jan 15;14(1):17-26.

    Adjusting Moran's I for population density.

    Oden N.

    EMMES Corporation, Potomac, MD 20854.

    Comment in: Stat Med. 1998 May 15;17(9):1055-62. Stat Med. 1996 Jul 30;15(14):1591-4.

    I derive two new statistics, Ipop and Ipop*, that adjust Moran's I to study clustering of disease cases in areas (for example, counties) with different, known population densities. A simulation of Lyme disease in Georgia suggests that these new statistics can be more powerful than those currently in use. This is because they consider both spatial pattern and non-binomial variance in rates as evidence supporting disease clusters.

    PMID: 7701154 [PubMed - indexed for MEDLINE]

  55. J Wildl Dis. 1994 Apr;30(2):146-54.

    Experimental infection of Borrelia burgdorferi in white-tailed deer.

    Luttrell MP, Nakagaki K, Howerth EW, Stallknecht DE, Lee KA.

    Department of Parasitology, College of Veterinary Medicine, University of Georgia, Athens 30602.

    Four white-tailed deer (Odocoileus virginianus) were experimentally inoculated with Borrelia burgdorferi to determine serologic response by enzyme-linked immunosorbent assay (ELISA) and immunoblotting. Deer had antibodies by ELISA by 2 to 3 wk post-inoculation (PI) and remained positive for 10 wk. Deer demonstrated immunoblotting reactivity between 10 and 14 days PI and consistently showed antibody response to nine B. burgdorferi antigens. Attempts were made to recover the spirochete from blood and tissues; B. burgdorferi was isolated from an ear punch biopsy from one of the inoculated deer.

    PMID: 8028097 [PubMed - indexed for MEDLINE]

  56. J Vet Diagn Invest. 1993 Oct;5(4):548-54.

    Optimization of polymerase chain reaction for the detection of Borrelia burgdorferi in biologic specimens.

    Kaufman AC, Greene CE, McGraw RA.

    Department of Small Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens 30602.

    This study describes the use of a newly constructed set of primers that amplifies an 85-base pair (bp) segment of Borrelia burgdorferi chromosomal DNA. This 85-bp product is not produced when other Borrelia species, Leptospira, or other bacteria are subjected to polymerase chain reaction (PCR). We also describe a rapid method of optimizing the amplification of B. burgdorferi DNA from canine ethylenediaminetetraacetic acid-treated blood and urine samples that circumvents some of the problems encountered due to low number of spirochetes in clinical specimens and that removes inhibiting substances, which improves the PCR diagnosis of canine Lyme borreliosis.

    PMID: 8286453 [PubMed - indexed for MEDLINE]

  57. Stat Med. 1993 Oct;12(19-20):1795-805.

    Assessing directional effects in spatial data.

    Oden NL.

    Applied Biomathematics, Setauket, New York 11733.

    A variable is measured at two locations separated by a given distance. Are the values more similar to each other if the locations are oriented in one direction than another? This question has application to studies of human genetics, epidemics, and acid rain. One obvious analytic approach, regression on latitude and longitude, fails when data are non-directional (isotropic) but spatially autocorrelated. Moreover, although non-zero slope implies similarity between neighbours, the converse is not true. IDIFF, a statistic derived from Moran's coefficient of spatial autocorrelation, is developed to detect general directional effects that apply to the collection of data points. Simulations suggest that, when data have isotropic spatial autocorrelation but are incorrectly assumed to be independent, IDIFF will at worst reject too little. IDIFF has good power to distinguish epidemics that spread non-directionally from those that spread in a favoured direction.

    PMID: 8272661 [PubMed - indexed for MEDLINE]

  58. Proc Natl Acad Sci U S A. 1993 Aug 1;90(15):7371-5.

    Isolation and transmission of the Lyme disease spirochete from the southeastern United States.

    Oliver JH Jr, Chandler FW Jr, Luttrell MP, James AM, Stallknecht DE, McGuire BS, Hutcheson HJ, Cummins GA, Lane RS.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460.

    The isolation of the Lyme disease spirochete (Borrelia burgdorferi) from the southeastern United States is reported. Three isolates, two from cotton mice (Peromyscus gossypinus) and one from the black-legged tick (Ixodes scapularis), were recovered from Sapelo Island, Georgia, in July and September 1991. The spirochetes were characterized by indirect fluorescent antibody assay using a battery of five monoclonal antibodies, by sodium dodecyl sulfate/polyacrylamide gel electrophoresis (SDS/PAGE) of whole cell lysates, and by the polymerase chain reaction (PCR) assay using primers for three DNA target sequences found in B. burgdorferi reference strain B-31. Transmission experiments indicate that the three Georgia isolates can infect experimentally inoculated hamsters and mice. Tick transmission of one of the isolates has been attempted so far; I. scapularis transmitted isolate SI-1 from hamsters to mice, but the lone-star tick, Amblyomma americanum, did not.

    PMCID: PMC47139 PMID: 8346258 [PubMed - indexed for MEDLINE]

  59. J Wildl Dis. 1993 Apr;29(2):230-6.

    Serologic survey for antibodies to Borrelia burgdorferi in white-tailed deer in Georgia.

    Mahnke GL, Stallknecht DE, Greene CE, Nettles VF, Marks MA.

    College of Veterinary Medicine, University of Georgia, Athens 30602.

    A serologic survey for antibodies to Borrelia burgdorferi utilizing an enzyme-linked immunosorbent assay (ELISA) was conducted on white-tailed deer (Odocoileus virginianus) serum samples collected in Georgia (USA) from 1979 to 1990. Serologic results from four regions (Barrier Islands, Coastal Plain, Piedmont, and Mountain) and three age classes (0.5, 1.5, and > or = 2.5 yr) were compared. Antibody prevalence, as determined by positive results at a 1:64 dilution or higher, was 36% in the Barrier Islands, 14% in the Coastal Plain, 8% in the Piedmont, and 4% in the Mountain regions. Statewide antibody prevalence was 19%. Antibody titers generally were low, and if a more conservative cutoff titer of 1:128 were used, the statewide prevalence estimate would have been reduced to 5%. Antibody prevalence as determined at this higher cutoff value, however, still remained highest in the Barrier Islands and lowest in the Mountains. Prevalence estimates were lower in the 0.5-yr age class than in the 1.5-yr or > or = 2.5-yr age class (P < 0.05). A more in-depth retrospective study of the Barrier Islands region from 1971 to 1985 revealed a 50% overall antibody prevalence; positive results were found in every year represented except 1990. Based on these results, we propose that B. burgdorferi has been present in Georgia since at least 1971.

    PMID: 8487372 [PubMed - indexed for MEDLINE]

  60. J Med Entomol. 1993 Jan;30(1):54-63.

    Conspecificity of the ticks Ixodes scapularis and I. dammini (Acari: Ixodidae).

    Oliver JH Jr, Owsley MR, Hutcheson HJ, James AM, Chen C, Irby WS, Dotson EM, McLain DK.

    Institute of Arthropodology and Parasitology, Georgia Southern University, Statesboro 30460.

    Reciprocal crosses between Ixodes dammini Spielman, Clifford, Piesman & Corwin from Massachusetts and Ixodes scapularis Say from Georgia produced offspring through the F3 generation when the experiment was discontinued. Reciprocal I. dammini x Ixodes pacificus Cooley & Kohls (California) and I. scapularis x I. pacificus crosses produced F1 progeny; however, all progeny were sterile. Assortative mating experiments between I. dammini and I. scapularis indicated that males and females of both species mated with the opposite sex of heterospecific or conspecific ticks when there was a choice. Conventional discriminant analysis of morphometric measurements of ticks from Georgia, North Carolina, Maryland, Massachusetts, and two populations of F1 hybrids indicated that there were recognizable differences. However, size-free (sheared) discriminant analysis indicated that these differences were largely size-dependent, with much overlap of the four eastern and two hybrid populations but no overlap with I. pacificus from California. Analysis of chromosomes (morphology and C band) indicated no differences between the Georgia and Massachusetts populations but showed a difference between them and the California population of I. pacificus. Analysis of isozymes showed that the genetic identity value for the Georgia and Massachusetts populations was within the normal range for conspecific populations, whereas the California population indicated congeneric but not conspecific relatedness to the Georgia and Massachusetts populations. Life cycle data collected under similar laboratory conditions showed no differences in length of feeding and molting periods among Georgia, Massachusetts, and California populations. These data and results of the work of other authors on tick host preferences and vector competence indicate that I. dammini is not a valid species separate from I. scapularis. Because the name Ixodes scapularis Say, 1821, has priority over the name Ixodes dammini Spielman, Clifford, Piesman & Corwin, 1979, I. dammini is relegated to a junior subjective synonym of I. scapularis (based on Article 23 of the International Code of Zoological Nomenclature).

    PMID: 8433346 [PubMed - indexed for MEDLINE]

  61. J Med Entomol. 1992 Nov;29(6):980-4.

    Detection of Borrelia burgdorferi in laboratory-reared Ixodes dammini (Acari: Ixodidae) fed on experimentally inoculated white-tailed deer.

    Oliver JH Jr, Stallknecht D, Chandler FW, James AM, McGuire BS, Howerth E.

    Department of Biology, Georgia Southern University, Statesboro 30460.

    Larvae and nymphs of Ixodes dammini Spielman, Piesman, Clifford & Corwin from a laboratory colony were fed on two white-tailed deer, Odocoileus virginianus (Zimmerman) inoculated with either the SH2-82 or JD-1 strains of Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner. Ticks were exposed to one deer 43 and 69 d after inoculation of the spirochete and to a second deer 35 and 61 d after inoculation. Polymerase chain reaction assays amplified the 158 bp OspA DNA target sequence in 11.1% (n = 9) of fed larvae and 3.3% (n = 30) of nymphs from the deer inoculated with the SH2-82 strain, and 22.7% (n = 22) of larvae and 0% (n = 21) of nymphs from a second deer inoculated with the JD-1 strain of B. burgdorferi. One of three females derived from nymphs fed on one of the inoculated deer showed presence of B. burgdorferi DNA, but none of four males was positive. Experimentally inoculated deer can serve as a source of at least two geographic strains of B. burgdorferi to I. dammini larvae and nymphs for at least several weeks.

    PMID: 1460639 [PubMed - indexed for MEDLINE]

  62. J Clin Microbiol. 1992 Jun;30(6):1449-52.

    Antibodies to Borrelia burgdorferi in rodents in the eastern and southern United States.

    Magnarelli LA, Oliver JH Jr, Hutcheson HJ, Boone JL, Anderson JF.

    Department of Entomology, Connecticut Agricultural Experiment Station, New Haven 06504.

    Serologic studies were conducted to determine whether white-footed mice (Peromyscus leucopus) and cotton mice (Peromyscus gossypinus) contained serum antibodies to Borrelia burgdorferi, the causative agent of Lyme borreliosis. Enzyme-linked immunosorbent assays detected antibodies to this spirochete in 35.7 and 27.3% of 56 P. leucopus and 535 P. gossypinus serum samples, respectively, collected in Connecticut, North Carolina, South Carolina, Georgia, Florida, Alabama, and Mississippi. Antibody titers ranged from 1:160 to greater than or equal to 1:40,960. On the basis of adsorption tests, the antibodies detected appeared to be specific to Borrelia spirochetes. Seropositive rodents in the eastern and southern United States, areas where human cases of Lyme borreliosis have been reported, indicate a widespread geographic distribution of B. burgdorferi or a closely related spirochete.

    PMCID: PMC265308 PMID: 1624561 [PubMed - indexed for MEDLINE]

  63. Contemp Intern Med. 1992 Jul-Aug;4(7):19-32.

    Sensible laboratory testing for suspected Lyme disease.

    Rahn DW.

    Department of Medicine, The Medical College of Georgia, Augusta.

    PMID: 10171613 [PubMed - indexed for MEDLINE]

  64. Postgrad Med. 1992 May 15;91(7):57-64.

    Antibiotic treatment of Lyme disease. Current recommendations by stage and extent of infection.

    Rahn DW.

    Department of Medicine, Medical College of Georgia School of Medicine, Augusta 30912.

    Much has been learned about Lyme disease over the past several years, but much remains to be learned. Careful clinical observation has led to elucidation of the natural history of this disease, and further clinical observations are needed to unravel the remaining areas of uncertainty. It is by no means clear that all the symptoms attributed to Lyme disease today actually represent true manifestations of Borrelia burgdorferi infection or that patients with well-documented Lyme disease whose symptoms do not respond to antibiotic therapy have persistent infection. Immunologically mediated mechanisms may be responsible for the chronic disease manifestations that seem so resistant to antibiotics. Uncovering answers to these questions requires the close collaboration of astute practicing physicians and biomedical scientists working together for their patients' benefit.

    PMID: 1589368 [PubMed - indexed for MEDLINE]

  65. J Am Acad Dermatol. 1992 Feb;26(2 Pt 1):267-8.

    Polymerase chain reaction confirmation of Borrelia burgdorferi in benign lymphocytic infiltrate of dermis.

    Rabb DC, Lesher JL Jr, Chandler FW.

    Department of Dermatology, Medical College of Georgia, Augusta 30912.

    PMID: 1552070 [PubMed - indexed for MEDLINE]

  66. Pathobiology. 1992;60(3):163-7.

    Detection of Borrelia burgdorferi in human blood and urine using the polymerase chain reaction.

    McGuire BS, Chandler FW, Felz MW, Huey LO, Field RS.

    Department of Pathology, Medical College of Georgia, Augusta 30912.

    We investigated the use of the polymerase chain reaction (PCR) to detect Borrelia burgdorferi strain B-31 in human blood and urine experimentally inoculated with 5 and 1 borreliae/cm3, respectively, and to biotinylate a DNA probe specific for B. burgdorferi in the dot blot and Southern blot assays. When the blood and urine samples were subjected to PCR, a 370-bp amplified product was consistently visible on agarose gel electrophoresis after 30 and 45 cycles, respectively. The total human genomic DNA extracted from a 1-cm3 sample of inoculated blood was approximately 6.25 micrograms, and the total amount of B. burgdorferi DNA was estimated to be 0.01 pg/6.25 micrograms of the human DNA. For PCR, 2.5 micrograms of human DNA which contained the equivalent of 0.004 pg of borrelia DNA (approximately two borreliae) were used for enzymatic amplification. When 1/20 or 1/10 of the PCR-amplified products were used either for dot blot or Southern blot hybridization, the accessible copies of amplified B. burgdorferi DNA were sufficient for detectable hybridization to occur. PCR amplification of B. burgdorferi DNA in clinical specimens followed by dot blot hybridization may be a valuable adjunct or alternative to current but inadequate laboratory methods for the diagnosis of Lyme disease.

    PMID: 1627262 [PubMed - indexed for MEDLINE]

  67. J Wildl Dis. 1991 Oct;27(4):562-8.

    Antibodies to Borrelia burgdorferi in deer and raccoons.

    Magnarelli LA, Oliver JH Jr, Hutcheson HJ, Anderson JF.

    Department of Entomology, Connecticut Agricultural Experiment Station, New Haven 06504.

    An enzyme-linked immunosorbent assay (ELISA) was developed to detect serum antibodies to Borrelia burgdorferi, the causative agent of Lyme borreliosis, in deer (Odocoileus virginianus) and raccoons (Procyon lotor). Blood samples were collected from these mammals in Connecticut, Maryland, North Carolina, Georgia and Florida. Seropositivity for deer was highest in Connecticut (56% of 353 sera) and Maryland (51% of 35 sera). Raccoons in Connecticut, Maryland, North Carolina, and Florida also had antibodies to B. burgdorferi, but prevalence of positive sera was highest in Maryland (79% of 14 samples). Based on adsorption tests, the immunoglobulins detected in these mammals were probably specific to B. burgdorferi. The ELISA was more sensitive than an indirect fluorescent antibody staining method and was more suitable for analyzing large numbers of serum samples.

    PMID: 1758022 [PubMed - indexed for MEDLINE]

  68. MMWR Morb Mortal Wkly Rep. 1991 Jun 28;40(25):417-21.

    Lyme disease surveillance--United States, 1989-1990.

    Centers for Disease Control (CDC).

    Surveillance for Lyme disease (LD) was initiated by CDC in 1982 (1), and in January 1991, LD became nationally reportable (2). Forty-six states reported cases in 1989 and 1990 (Figure 1), but the occurrence in nature of the causative bacterium, Borrelia burgdorferi, has not been documented in all of these states. From 1982 through 1989, the annual reported number of cases of LD increased 18-fold (from 497 to 8803, respectively) and from 1986 through 1989, nearly doubled each year (Figure 2). The provisional total of 7997 cases for 1990 suggests a plateau in this trend of rapid annual increase. This report summarizes surveillance of LD during 1990 in Connecticut, Georgia, Michigan, Missouri, New Jersey, and Wisconsin.

    PMID: 2046649 [PubMed - indexed for MEDLINE]

  69. Am Clin Lab. 1991 May;10(4):14-6.

    Diagnosis of Lyme disease: evaluation of an enzyme-linked immunobinding assay.

    Kiefer CR.

    Department of Cell and Molecular Biology, Medical College of Georgia, Augusta.

    PMID: 10148234 [PubMed - indexed for MEDLINE]

  70. J Am Acad Dermatol. 1990 Sep;23(3 Pt 1):401-10.

    The many faces and phases of borreliosis II.

    Abele DC, Anders KH.

    Department of Dermatology, Medical College of Georgia, Augusta 30912.

    Borrelia burgdorferi, the etiologic agent of Lyme disease, has also been associated with other cutaneous conditions. Acrodermatitis chronica atrophicans and lymphadenosis benigna cutis are also caused by B. burgdorferi. Recent evidence links some cases of progressive facial hemiatrophy of Parry-Romberg, benign lymphocytic infiltrate of the skin (Jessner-Kanof), lichen sclerosus et atrophicus, morphea, and Shulman syndrome with borreliae. This article reviews the manifestations of the diseases definitely linked to borreliosis and the evidence linking borreliae to progressive facial hemiatrophy, benign lymphocytic infiltrate, lichen sclerosus et atrophicus, morphea, and Shulman syndrome.

    PMID: 2212138 [PubMed - indexed for MEDLINE]

  71. J Infect Dis. 1990 Aug;162(2):557-9.

    Borrelia burgdorferi: survival in experimentally infected human blood processed for transfusion.

    Johnson SE, Swaminathan B, Moore P, Broome CV, Parvin M.

    Meningitis and Special Pathogens Branch, Centers for Disease Control, Atlanta, Georgia 30333.

    The isolation of Borrelia burgdorferi from blood raises the possibility of bloodborne transmission of Lyme borreliosis through transfusions. To assess this possibility, the ability of B. burgdorferi to survive in human blood processed for transfusion was studied. Human blood was inoculated with B. burgdorferi type strain B-31 (ATCC 35210) at 0.2, 20, or 2000 viable cells/ml, processed by conventional blood banking procedures, stored at 4 degrees C, and cultured for B. burgdorferi at 12, 23, 36, and 48 days of storage. After processing, most B. burgdorferi were found in the packed cell fraction. At inoculum levels of 20 or 2000 viable cells/ml, B. burgdorferi survived in processed blood through 48 days of storage at 4 degrees C. B. burgdorferi was isolated from packed cells after 36 days of storage at 4 degrees C even when the initial inoculum level was as low as 0.2 cells/ml. The data demonstrate that B. burgdorferi can survive the blood processing procedures normally applied to transfused blood in the USA. Since hematogenous spread of the spirochete seems to occur early in the illness, primarily in symptomatic patients, the risk of transfusion-associated Lyme disease may be small. However, the possibility of survival of B. burgdorferi under blood banking conditions warrants a heightened awareness of this potential problem.

    PMID: 2373880 [PubMed - indexed for MEDLINE]

  72. J Am Acad Dermatol. 1990 Aug;23(2 Pt 1):167-86.

    The many faces and phases of borreliosis. I. Lyme disease.

    Abele DC, Anders KH.

    Department of Dermatology, Medical College of Georgia, Augusta 30912.

    Erratum in: J Am Acad Dermatol 1991 Apr;24(4):663.

    Comment in: J Am Acad Dermatol. 1991 Apr;24(4):663. J Am Acad Dermatol. 1991 May;24(5 Pt 1):799-801.

    Lyme disease is increasingly being reported throughout the United States and many parts of the world. Borrelia burgdorferi, the etiologic agent of Lyme disease, is a spirochete that, not unlike the treponema of syphilis, can cause a spectrum of disease from the initial skin lesion, through widely varied symptoms and signs, to chronic neurologic and arthritic disability. The borrelial spirochete and Lyme disease are the subject of this review. A subsequent article will review other definite and possible cutaneous manifestations of borreliosis.

    PMID: 2212114 [PubMed - indexed for MEDLINE]

  73. MMWR Morb Mortal Wkly Rep. 1990 Jun 15;39(23):397-9.

    Tickborne diseases--Georgia, 1989.

    Centers for Disease Control (CDC).

    PMID: 2111875 [PubMed - indexed for MEDLINE]

  74. J Med Assoc Ga. 1989 Oct;78(10):665-6.

    Lyme disease--the great imitator.

    Bailey JP Jr, Oliver JH Jr.

    PMID: 2794806 [PubMed - indexed for MEDLINE]

  75. Rev Infect Dis. 1989 Sep-Oct;11 Suppl 6:S1460-9.

    Epidemiology and clinical similarities of human spirochetal diseases.

    Schmid GP.

    Division of Sexually Transmitted Diseases, Centers for Disease Control, Atlanta, Georgia 30333.

    Lyme disease, first identified in 1975, is the most recently recognized of the seven human spirochetal diseases; the evolving clinical picture of Lyme disease indicates it shares many features with the other diseases. These similarities are striking in view of the diverse epidemiology of the seven diseases, which are caused by Treponema species (spread by human-to-human contact) or Leptospira or Borrelia species (zoonoses). These similarities include the following: (1) skin or mucous membrane as portal of entry; (2) spirochetemia early in the course of disease, with wide dissemination through tissue and body fluid; and (3) one or more subsequent stages of disease, often with intervening latent periods. Lyme disease shares with many spirochetal diseases a tropism for skin and neurologic and cardiovascular manifestations, whereas chronic arthritis is unique to Lyme disease. These similarities and dissimilarities offer opportunities to discover which properties unique to the pathogenic spirochetes are responsible for clinical manifestations and suggest that certain clinical features of patients with spirochetal diseases other than Lyme disease may someday be recognized in patients with Lyme disease.

    PMID: 2682958 [PubMed - indexed for MEDLINE]

  76. Rev Infect Dis. 1989 Sep-Oct;11 Suppl 6:S1435-41.

    Lyme disease surveillance in the United States, 1983-1986.

    Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV.

    Epidemiology Section, Centers for Disease Control, Atlanta, Georgia 30333.

    During 1983-1986, 5,016 cases of Lyme disease were reported to the Centers for Disease Control. Cases were acquired in 31 states; however, 86% of the cases were acquired in seven states: Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Wisconsin, and Minnesota. For 63% of patients the disease began in summer; 52% recalled a tick bite. Erythema chronicum migrans (ECM) occurred in 91% of the patients; arthritis, in 57%; neurologic complications, in 18%; and cardiac manifestations, in 10%. When serum samples were obtained greater than or equal to 21 days after onset of symptoms, 14% (6 of 42) with ECM alone and 19% (17 of 89) with complicated Lyme disease (ECM plus organ-system involvement) had positive serologic tests. Antimicrobial therapy did not appear to affect serologic response. Lyme disease is now the most commonly reported tick-borne illness in the United States and has been reported from 32 states since 1980. Physicians nationwide need to be familiar with the protean signs and symptoms associated with Lyme disease and with the limitations of current serologic techniques in diagnosing early illness.

    PMID: 2682955 [PubMed - indexed for MEDLINE]

  77. Yale J Biol Med. 1989 May-Jun;62(3):253-62.

    Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut.

    Petersen LR, Sweeney AH, Checko PJ, Magnarelli LA, Mshar PA, Gunn RA, Hadler JL.

    Division of Field Services, Centers for Disease Control, Atlanta, Georgia 30333.

    Laboratory-based surveillance of Lyme disease in Connecticut during 1984 and 1985 identified 3,098 persons with suspected Lyme disease; 1,149 were defined as cases. Lyme disease incidence in Connecticut towns ranged from none to 1,407 cases per 100,000 population in 1985. A comparison of 1985 data with data from 1977 epidemiologic studies indicated that incidence increased by 129 percent to 453 percent in towns previously known to be endemic for Lyme disease and that Lyme disease had spread northward into towns thought to be free of Lyme disease in 1977. Children aged five to 14 years had the highest incidence. Of persons with Lyme disease, 83 percent had erythema migrans, 24 percent had arthritis, 8 percent had neurologic sequelae, and 2 percent had cardiac sequelae. The distribution of symptoms was age-dependent: case-persons less than 20 years old were almost twice as likely to have arthritis than older case-persons (35 percent versus 18 percent). Of persons with arthritis, 92 percent of those less than 20 years of age, compared to 68 percent of older persons, did not have antecedent erythema migrans. We conclude that Lyme disease is increasing in incidence and geographic distribution in Connecticut. Of those with Lyme disease, children may be more likely than adults to develop arthritis and have it as their first major disease manifestation.

    PMCID: PMC2589115 PMID: 2683415 [PubMed - indexed for MEDLINE]

  78. Am J Ophthalmol. 1989 Jan 15;107(1):77-80.

    The expanding ophthalmologic spectrum of Lyme disease.

    Aaberg TM.

    Emory University School of Medicine, Atlanta, Georgia 30322.

    Comment in: Am J Ophthalmol. 1989 Jun 15;107(6):684-5. Am J Ophthalmol. 1991 Oct 15;112(4):462-3.

    PMID: 2912121 [PubMed - indexed for MEDLINE]

  79. Ann N Y Acad Sci. 1988;539:289-301.

    Occupational risk of Lyme disease in endemic areas of New York State.

    Smith PF, Benach JL, White DJ, Stroup DF, Morse DL.

    Centers for Disease Control, Atlanta, Georgia 30333.

    Although Lyme disease (LD) is the most common tick-borne disease in the United States, little is known about the frequency of and risk factors for infection with Borrelia burgdorferi in occupational groups. In 1986, we recruited primarily outdoor workers from six employee groups in southeastern New York where LD is endemic. Of 414 participants who completed questionnaires and had blood samples tested for antibodies against B. burgdorferi by ELISA and Western immunoblot, 27 (6.5%) were seropositive, but only 14 of the 27 reported previous symptoms of LD. Persons who spent more than 30 hours per week outdoors during leisure were 2.5 times more likely to be seropositive than those who did not (p = .02). Those with a history of outdoor employment were twice as likely to be seropositive as those without such a history, although this finding was not statistically significant (p = .70). However, the seroprevalence rate for the employees was 5.9 times higher than the rate for a comparison group of anonymous blood donors from the same region of New York (p less than .001). These results suggest that there was a relatively high rate of seropositivity for the employee groups and that infection was frequently asymptomatic and associated with outdoor exposure.

    PMID: 3190100 [PubMed - indexed for MEDLINE]

  80. Ann N Y Acad Sci. 1988;539:283-8.

    The geographic distribution of Lyme disease in the United States.

    Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV.

    Epidemiology Section, Division of Bacterial Diseases, Centers for Disease Control, Atlanta, Georgia 30333.

    In 1982, national surveillance for Lyme disease was established by the Centers for Disease Control to monitor trends and determine endemic geographic areas. Initially, the endemic areas corresponded to the known distribution of Ixodes dammini, a five-state area of the northeastern seaboard (New York, New Jersey, Connecticut, Rhode Island, and Massachusetts) and Wisconsin and Minnesota. Increasing numbers of cases have been reported outside these areas, however, 86% of the provisional 5731 cases reported to CDC were acquired in these seven states. The number of reported cases increased from 491 in 1982 to approximately 1500 per year in 1984-1986, making Lyme disease the most commonly reported tick-borne illness in the United States. The apparently widening distribution of Lyme disease indicates that physicians in all regions of the country should be familiar with its signs and symptoms. Investigations of the vector in areas endemic for Lyme disease where Ixodes ticks are not found are warranted.

    PMID: 3190099 [PubMed - indexed for MEDLINE]

  81. J Med Assoc Ga. 1987 Jul;76(7):493, 530.

    Tickborne diseases in Georgia, 1986.

    [No authors listed]

    PMID: 3625055 [PubMed - indexed for MEDLINE]
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