评估发热患者和法国莱姆病流行地区阿尔萨斯的蜱中的伯氏疏螺旋体。
Assessment of Borrelia miyamotoi in febrile patients and ticks in Alsace, an endemic area for Lyme borreliosis in France.
机构信息
University of Strasbourg, Virulence bactérienne précoce UR7290-Lyme borreliosis group, FMTS - CHRU Strasbourg, Institut de Bactériologie, Strasbourg, France.
Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.
出版信息
Parasit Vectors. 2020 Apr 17;13(1):199. doi: 10.1186/s13071-020-04071-9.
BACKGROUND
Borrelia miyamotoi is a relapsing fever Borrelia species transmitted by ticks of the Ixodes ricinus complex. Human disease caused by B. miyamotoi was first described in Russia and later in the USA and Japan. Additionally, five cases of meningoencephalitis in immunocompromised patients and one case in an apparently immunocompetent patient were described.
METHODS
We investigated the presence of B. miyamotoi in I. ricinus nymphs and in patients suspected of human granulocytic anaplasmosis, in Alsace (France), an endemic area for I. ricinus ticks and Lyme borreliosis, using direct (PCR) and indirect diagnosis (glycerophosphoryldiester-phosphodiesterase (GlpQ) serology).
RESULTS
Borrelia miyamotoi was found in 2.2% of 4354 ticks collected between 2013 and 2016. None of the 575 blood samples, collected from the patients suspected of HGA, was found positive for B. miyamotoi by PCR. Acute and late sera from 138 of these 575 patients were available. These paired sera were tested for IgM and IgG antibodies against the B. miyamotoi GlpQ antigen. A total of 14 out of 138 patients had at least one positive parameter (i.e. anti-GlpQ IgG and/or IgM). One patient seroconverted for IgG, and three had isolated IgM in the acute serum. These three patients were treated with doxycycline which could have prevented seroconversion. After reviewing clinical data and other biological tests performed, co-exposure among different microorganisms vectored by ticks or serological cross-reactivity could not be ruled out in these different cases. One patient had persistent IgG, which strongly suggests previous exposure to B. miyamotoi.
CONCLUSIONS
Humans can be exposed to B. miyamotoi through tick bites in Alsace. We present serological data for possible B. miyamotoi exposure or infection of patients with fever after tick bite. Future studies should determine the incidence, clinical course and burden of this emerging tick-borne disease in other parts of Western Europe.
背景
伯氏疏螺旋体（Borrelia miyamotoi）是一种通过硬蜱属（Ixodes ricinus）复合种传播的回归热螺旋体。伯氏疏螺旋体引起的人类疾病最初在俄罗斯被描述，随后在美国和日本也有报道。此外，还描述了五例免疫功能低下患者的脑膜脑炎和一例疑似免疫功能正常患者的脑膜脑炎。
方法
我们在法国阿尔萨斯（Alsace），一个硬蜱属和莱姆病的流行地区，通过直接（PCR）和间接诊断（甘油磷酸二酯-磷酸二酯酶（GlpQ）血清学），对感染伯氏疏螺旋体的硬蜱若虫和疑似人类粒细胞无形体病（human granulocytic anaplasmosis，HGA）的患者进行了伯氏疏螺旋体的检测。
结果
在 2013 年至 2016 年间采集的 4354 只蜱中，发现 2.2%的蜱携带伯氏疏螺旋体。通过 PCR 检测，575 名疑似 HGA 患者的 575 份血液样本均未检测到伯氏疏螺旋体阳性。从这 575 名患者中获得了 138 名患者的急性和晚期血清。对这些配对血清进行了针对伯氏疏螺旋体 GlpQ 抗原的 IgM 和 IgG 抗体检测。共有 14 名患者的至少一个参数呈阳性（即抗 GlpQ IgG 和/或 IgM）。1 名患者 IgG 血清转化，3 名患者急性血清中出现孤立 IgM。这 3 名患者接受了多西环素治疗，这可能预防了血清转化。在回顾临床数据和其他进行的生物学检测后，在这些不同病例中不能排除不同微生物通过蜱传播的共暴露或血清学交叉反应。1 名患者出现持续性 IgG，强烈提示其以前曾接触过伯氏疏螺旋体。
结论
在阿尔萨斯，人类可能通过蜱叮咬接触到伯氏疏螺旋体。我们提出了可能接触伯氏疏螺旋体或蜱叮咬后发热患者感染的血清学数据。未来的研究应确定这种新出现的蜱传疾病在西欧其他地区的发病率、临床过程和负担。
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