Tuesday, October 23, 2012




    Wild birds contribute to maintenance and dissemination of vectors and microbes, including those that impact human, domestic animal, and wildlife health. Here we elucidate roles of wild passerine birds, eastern cottontail rabbits (Sylvilagus floridanus), and Ixodes dentatus ticks in enzootic cycles of two spirochetes, Borrelia miyamotoi and B. andersonii in a region of Michigan where the zoonotic pathogen B. burgdorferi co-circulates.


Over a four-year period, wild birds (n = 19,631) and rabbits (n = 20) were inspected for tick presence and ear tissue was obtained from rabbits. Samples were tested for Borrelia spirochetes using nested PCR of the 16S-23S rRNA intergenic spacer region (IGS) and bidirectional DNA sequencing. Natural xenodiagnosis was used to implicate wildlife reservoirs.


Ixodes dentatus, a tick that specializes on birds and rabbits and rarely bites humans, was the most common tick found, comprising 86.5% of the 12,432 ticks collected in the study. The relapsing fever group spirochete B. miyamotoi was documented for the first time in ticks removed from wild birds (0.7% minimum infection prevalence; MIP, in I. dentatus), and included two IGS strains. The majority of B. miyamotoi-positive ticks were removed from Northern Cardinals (Cardinalis cardinalis). Borrelia andersonii infected ticks removed from birds (1.6% MIP), ticks removed from rabbits (5.3% MIP), and rabbit ear biopsies (5%) comprised twelve novel IGS strains. Six species of wild birds were implicated as reservoirs for B. andersonii. Frequency of I. dentatus larval and nymphal co-feeding on birds was ten times greater than expected by chance. The relatively well-studied ecology of I. scapularis and the Lyme disease pathogen provides a context for understanding how the phenology of bird ticks may impact B. miyamotoi and B. andersonii prevalence and host associations.


Given the current invasion of I. scapularis, a human biting species that serves as a bridge vector for Borrelia spirochetes, human exposure to B. miyamotoi and B. andersonii in this region may increase. The presence of these spirochetes underscores the ecological complexity within which Borrelia organisms are maintained and the need for diagnostic tests to differentiate.


Probable late lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection.


Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jaucott2@jhmi.edu.


Lyme disease, a bacterial infection with the tick-borne spirochete Borrelia burgdorferi, can cause early and late manifestations. The category of probable Lyme disease was recently added to the CDC surveillance case definition to describe patients with serologic evidence of exposure and physician-diagnosed disease in the absence of objective signs. We present a retrospective case series of 13 untreated patients with persistent symptoms of greater than 12 weeks duration who meet these criteria and suggest a label of 'probable late Lyme disease' for this presentation.


The sample for this analysis draws from a retrospective chart review of consecutive, adult patients presenting between August 2002 and August 2007 to the author (JA), an infectious disease specialist. Patients were included in the analysis if their current illness had lasted greater than or equal to 12 weeks duration at the time of evaluation.


Probable late Lyme patients with positive IgG serology but no history of previous physician-documented Lyme disease or appropriateLyme treatment were found to represent 6% of our heterogeneous sample presenting with ≥ 12 weeks of symptom duration. Patients experienced a range of symptoms including fatigue, widespread pain, and cognitive complaints. Approximately one-third of this subset reported a patient-observed rash at illness onset, with a similar proportion having been exposed to non-recommended antibiotics or glucocorticosteroid treatment for their initialdisease. A clinically significant response to antibiotics treatment was noted in the majority of patients with probable late Lyme disease, although post-treatment symptom recurrence was common.


We suggest that patients with probable late Lyme disease share features with both confirmed late Lyme disease and post-treatment Lyme disease syndrome. Physicians should consider the recent inclusion of probable Lyme disease in the CDC Lyme disease surveillance criteria when evaluating patients, especially in patients with a history suggestive of misdiagnosed or inadequately treated early Lyme disease. Further studies are warranted to delineate later manifestations of Lyme disease and to quantify treatment benefit in this population.
[PubMed - in process] 
Free PMC Article
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September 5, 2011 Joe Burrascano, Jr., MD has announced a new lab test available for Lyme doctors to use in determining if Lyme is present. There is no need to wait for antibodies to form since this is a culture-based test. This should provide much faster and more accurate detection, and allow Lyme patients to receive treatment as soon as possible. Please read below for Dr. Burrascano's description of the new test:
In my work as a consultant, I have been working with a private lab located near Philadelphia, Advanced Laboratories, Inc. They wanted to develop a unique and high value test, and, with my interest in Lyme, I naturally encouraged them to work on a better Lyme Disease test.
As a result of some very intensive work on the part of a group of some very brilliant scientists, they have succeeded in developing a reliable and rapid blood culture for Borrelia! See the attached press release.
They actually have rolled out two separate panels- a basic one and an advanced one. In the basic panel, the blood sample is cultured and the positives are identified by histology and growth characteristics, and confirmed by fluorescent immunostaining. Positive reports will include a picture of the Bb growing in that very culture. The advanced panel will do this, but will also do PCR using well characterized and published DNA primer sets, and then all positive PCRs will be confirmed by DNA sequencing.
Remarkably, turn-around time can be as brief as ten days for the basic test, and seven to ten more days for the advanced panel.
This test is being rolled out gradually, with no big public announcements yet. That is why I am e-mailing you, so you can be among the first to be able to order this testing, before the lab gets swamped. Apparently you have to contact the lab to have test kits sent to you. The blood must be sent out the same day it is collected, and the lab provides a prepaid return FedEx mailer. As the lab is not yet accepting specimens over weekends, please do not collect blood on Fridays.
The bad news- New York being New York, this culture will not be available to NY State practitioners for several months. The States of California and Florida may have a delayed availability- I am not sure, so please contact the lab to get this info. However, all other states are OK.
I have no idea on pricing or on insurance issues- again, you will have to contact them for this info. The lab plans to have a booth at the conferences at LDA and at ILADS, so hopefully their presence will allow all to field questions.
The next step in their research is also equally exciting and ground breaking, but I am not at liberty to say yet what is being planned.
I will be travelling over the rest of this week, so I am afraid that I may not be able to answer any calls or e-mails until I get back, so if I do not respond to any contact efforts, please be patient.
As many of you recall, I learned the basics of true, clinical Lyme over 25 years ago thanks to Bb culturing that was available to me by Dr. Alan MacDonald. The new methods being used by this Pennsylvania lab go far beyond what MacDonald was able to do, so I am very excited to not only share this news with you, but I also cannot wait to see how it will change how we practice.
I also predict that Bb will be found in a lot of people, from mildly to severely ill, and that will redefine the role of the immunologist in Lyme to find out why some people recover and why others do not. Strain info as provided by the DNA sequencing data will be equally fascinating to follow.
So, enjoy the good news, and PLEASE, if you are going to begin culturing your patients, keep good records of your results. Data collection and tabulation has never been as important as it is now, with a quantum advance in testing technology.
Best wishes, from Dr. B................................!
To read the press release with contact information, Click here
For a Q&A on this new Lyme Test, Click here

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