[Prevalence of Borrelia burgdorferi sensu lato species among patients in the Czech Republic; direct sequencing analysis and real-time polymerase chain reaction].

The spread of borreliosis depends on geographical, environmental and climatic factors as well as on the pathogenesis of the causative agent of the group of Borrelia burgdorferi sensu lato. The rise in the incidence of the disease and emergence of new symptoms are of concern. Relationships between genospecies and symptoms, their geographical spread and possible interference of other pathogens are the subject of the present study. Eighty-seven patients with borreliosis from Central and Eastern Bohemia and Moravia were enrolled in the study. Forty-nine patients of group 1 showed clinical positivity, 21 patients of group 2 tested positive at PCR screening and 17 patients of group 3 were culture positive. Forty-eight patients and 17 isolated strains showed positivity for plasmids and the Borrelia burgdorferi sensu lato genome in conventional nested PCR. Borrelial genotypes and subtypes were detected by direct sequencing of OspA and OspC products. Quantitative data were determined from specific product melting temperature curves for real time PCR. Based on sequencing of the OspA gene, B. garinii (subtypes 6, 5, 4 and 3), B. burgdorferi s.s. and B. afzelii were detected in 14 (51.8%), 8 (29.6%) and 5 (18.5%) out of 27 Central Bohemian patients, respectively. Eastern Bohemian patients showed predominance of B. garinii subtype 5 and co-infection with Anaplasmaphagocytophilum in 7.6%. The predominant causative agent in 25 Moravian patients was B. afzelii (11 patients, i.e. 44%), followed by B. burgdorferi s.s. (9 patients, 36%) and B. garinii 5 patients, i.e. 20%). Sequences of two hypervariable regions of the OspA and OspC genes and distances in phylogenetic trees showed differences not only between genospecies and subtypes but also between wild strains detected by direct sequencing from patient specimens and in vitro cultured strains. The greatest differences were found for patients with long-term borrelial infection.