Evaluation of Six Recombinant Proteins for Serological Diagnosis of Lyme Borreliosis in China

Objective In this study, we evaluated the diagnostic efficiency of six recombinant proteins for the serodiagnosis of Lyme borreliosis （LB） and screened out the appropriate antigens to support the production of a Chinese clinical ELISA （enzyme-linked immunosorbent assay） kit for LB. Methods Six recombinant antigens, Fla B.g, OspC B.a, OspC B.g, P39 B.g, P83 B.g, and VlsE B.a, were used for ELISA to detect serum antibodies in LB, syphilis, and healthy controls. The ELISA results were used to generate receiver operating characteristic （ROC） curves, and the sensitivity and specificity of each protein was evaluated. All recombinant proteins were evaluated and screened by using logistic regression models. Results Two IgG （VISE and OspC B.g） and two IgM （OspC B.g and OspC B.a） antigens were left by the logistic regression model screened. VIsE had the highest specificity for syphilis samples in the IgG test （87.7%, P〈0.05）. OspC B.g had the highest diagnostic value in the IgM test （AUC=0.871）. Interactive effects between OspC B.a and Fla B.g could reduce the specificity of the ELISA. Conclusion Three recombinant antigens, OspC B.g, OspC B.a, and VisE B.a, were useful for ELISAs of LB. Additionally, the interaction between OspC B.a and Fla B.g should be examined in future research.

Lyme Borreliosis with Opthalmologic Presentation

Lyme disease is a tick-borne multisystemic disease with multiple clinical presentations including rheumatological conditions. We present a 12 year old girl complaining of fever, arthralgia and redness in her eyes which was found to be the result of panuveitis. Borrelia antibodies were positive and she received 21-day treatment regimen with Ceftriaxon with resolution of all complaints at the end of treatment. Lyme disease classically occurs in three stages starting with erythema migrans, however atypical presentations skipping this stage and presenting with opthalmologic involvement in form of uveitis can be seen.

Estimates for Lyme borreliosis infections based on models using sentinel canine and human seroprevalence data

Two models were developed to estimate Lyme borreliosis(LB)cases.One was based on the seroprevalence of Borrelia infections in human samples.This model used corrections for false negative and false positive results from published test sensitivity and specificity measures.A second model based on Borrelia infections in sentinel dogs was used to quantify the prevalence of Lyme disease Borrelia infections in humans;the reference baseline for this model was human and canine infections in Germany.A comparison of the two models is shown and differences discussed.The relationships between incidence,prevalence and total infection burden for LB were derived from published data and these were used in both models to calculate annual incidence,prevalence and total LB infections.The modelling was conservative and based on medical insurance records coded for erythema migrans.Linear model growth rates were used in place of the commonly adopted exponential growth.The mean of the two models was used to create estimates for various countries and continents.Examples from the analyses for LB estimated for 2018 include:incidence e USA 473,000/year,Germany 471,000/year,France 434,000/year and UK 132,000/year;prevalence e USA 2.4 million,Germany 2.4 million,France 2.2 million and UK 667,000;total infections e USA 10.1 million,Germany 10.0 million,France 9.3 million and UK 2.8 million.Estimates for the world for 2018 are:incidence 12.3 million/year;prevalence 62.1 million;and total infection burden 262.0 million.These figures are far higher than officially published data and reflect not only the underestimation of diagnosed cases,which is acknowledged by health agencies,but also undiagnosed and misdiagnosed cases.

Aetiology of Tick-Borne Infections in an Adult Swedish Population—Are Co-Infections with Multiple Agents Common?

In Scandinavia, tick-borne infections affecting humans include Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA). Each of these infections can present with unspecific symptoms. In this prospective clinical study, we recruited patients based on two independent inclusion criteria;1) patients with unspecific symptoms, i.e. fever (≥38.0℃) or a history of feverishness and/or any combination of headache, myalgia or arthralgia and 2) patients with erythema migrans (EM), following an observed tick bite or tick exposure within one month prior to onset of symptoms. A total of 206 patients fulfilled the study. Among these, we could identify 186 cases of LB (174 with EM), 18 confirmed and two probable cases of HGA and two cases of TBE. Thirteen of the HGA cases presented without fever. Furthermore, 22 of the EM patients had a sub-clinical co-infection with Anaplasma phagocytophilum, based on serology. Both TBE cases had co-infections, one with Borrelia burgdorferi and one with Anaplasma phagocytophilum. We conclude that it is important to consider several causative agents and possible co-infections in the clinical management of infectious diseases where ticks may be suspected as vectors.