Borrelia miyamotoi infection in Nature and in humans.
Krause PJ1, Fish D2, Narasimhan S3, Barbour AG4.
http://www.ncbi.nlm.nih.gov/pubmed/25700888
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Borrelia miyamotoi is a relapsing fever Borrelia group spirochete that is transmitted by the same hard-bodied (ixodid) tick species that transmit the agents of Lyme disease.
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B. miyamotoi species phylogenetically cluster with the relapsing fever group spirochetes, which usually are transmitted by soft-bodied (argasid) ticks or lice.
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Human cases of B. miyamotoi infection were first reported in 2011 in Russia and subsequently in the United States, Europe, and Japan. These reports document the public health importance of B. miyamotoi, as human B. miyamotoi infection appears to be comparable in frequency to babesiosis or human granulocytic anaplasmosis in some areas and may cause severe disease, including meningoencephalitis.
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Because clinical manifestations are non-specific, etiologic diagnosis requires confirmation by blood smear examination, PCR, antibody assay, in vitro cultivation, and/or isolation by animal inoculation.
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B. miyamotoi has been found in several of the tick species known to be vectors of Lyme disease group Borrelia species. These include (…) Ixodes ricinus in Europe, and Ixodes persulcatus in Europe and Asia (Figure 2) [1-10,14-30].
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In Europe, the range of B. miyamotoi infection rates reported in I. ricinus nymphal ticks is 0-3.2% [3,9,15-16,18,22-26,30].
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A similar B. miyamotoi seroprevalence rate of 2% was noted in healthy (blood donor) residents of the Netherlands, while higher rates were noted in forestry workers (10%), and patients experiencing HGA (14.6%) and Lyme disease (7.4%) [38].
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A recent study showed that B. miyamotoi can be transmitted through blood transfusion in a mouse experimental model [57].
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B. miyamotoi and B. burgdorferi coinfection has been documented in reports from the United States and Japan [34,37]. In the Russian B. miyamotoi case series, 9 of the 46 cases had an erythema migrans rash. Although there was no confirmation, B. burgdorferi coinfection was the most likely cause because erythema migrans rash has not been associated with soft tick transmitted relapsing fever [10, 58].
Previous studies have shown that coinfections of B. burgdorferi with either Babesia microti or with Anaplasma phagocytophilum are associated with more severe disease compared with that B. burgdorferi infection alone [59-61].
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Diagnosis of B. miyamotoi infection should be considered in any patient who resides in or has recently traveled to a region where Lyme disease is endemic in the North American or Eurasian continents during tick disease transmitting season and develops fever. Unlike Lyme disease, babesiosis, and HGA, it is conceivable that B. miyamotoi infection can be acquired by humans from the bite of a larval tick, because of transovarial transmission [29].
Consistent clinical findings such as fever, fatigue, and headache provide support for the diagnosis but similar symptoms may occur with other Ixodes transmitted diseases (such as Lyme disease, babesiosis, human granulocytic anaplasmosis, tick-borne encephalitis in Eurasia and deer tick virus encephalitis in North America) and acute viral infections. Diagnosis therefore requires confirmation using specific laboratory tests that include blood smear, polymerase chain reaction (PCR), and/or antibody determination [10,32-38]. At least one commercial laboratory is offering an antibody and a PCR test for B. miyamotoi and these tests are likely to be available in the near future from other commercial companies.
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There have been no therapeutic trials nor any experimental data published on the antibiotic susceptibility either in vitro or in vivo of B. miyamotoi. Therefore, optimal antibiotics of choice, their dosages, and treatment duration have yet to be determined.
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Antibiotics that have been used effectively include doxycycline for uncomplicated B. miyamotoi infection in adults and ceftriaxone or penicillin G for meningoencephalitis.
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The most common antimicrobial agents that have been used to achieve cure are doxycycline and ceftriaxone, but other antibiotics that are used to treat tick-borne relapsing fever and Lyme disease are likely to be as effective as well.
Treatment duration have yet to be determined.
Josie