Detection of Borrelia burgdorferi infected Ixodes scapularis (Acari: Ixodidae) associated with local Lyme disease transmission in Nebraska, USA, 2021.

In August 2021, the Nebraska Department of Health and Human Services was notified by a local public health department of a cluster of two Lyme disease cases in patients with local exposure to wooded areas in a county located in their jurisdiction. Epidemiological investigations revealed that the two patients had similar symptom onset dates and had likely exposure to ticks at wooded sites located directly adjacent to one another. Two environmental investigations were completed in October 2021 and consisted of tick surveys at the patients' reported sites of tick exposure. 12 ticks were collected across the two surveys and identified the black-legged tick (Ixodes scapularis). During subsequent testing of the collected ticks, spirochete bacteria were isolated, cultured and confirmed as Borrelia burgdorferi sensu stricto by PCR. In total, 7 of 12 (58.3%) I. scapularis ticks tested positive for B. burgdorferi s.s. The results of this study document the fourth known established population of I. scapularis in Nebraska and confirms the first detection of B. burgdorferi s.s. in field collected ticks from Nebraska. The epidemiological and environmental investigation data provide the first evidence for local Lyme disease transmission occurring within Nebraska. These findings highlight the need for continued surveillance of I. scapularis and its associated pathogens in Nebraska to further characterize human risk and monitor emergence into other areas of the state.

Aedes aegypti Identified in York, Nebraska, Through Routine Arboviral Surveillance-August-October 2019.

On August 27, 2019, Aedes aegypti mosquitoes were identified in a neighborhood located in York, NE, through routine arboviral surveillance. Expanded surveillance using traps and morphologic identification revealed 118 adult Ae. aegypti throughout the adjacent neighborhood, including identification from larval sampling. Our findings describe the first recorded Ae. aegypti introduction in Nebraska and provide evidence of a breeding mosquito population, which suggests suitable habitat and the risk of potential establishment, raising concerns about prevention of arboviral diseases in Nebraska.

CNS Melioidosis in a Traveler Returning from Cabo, Mexico.

Melioidosis is caused by the gram-negative bacillus Burkholderia pseudomallei, endemic to northern Australia and Southeast Asia. We present a patient who traveled to Mexico, returned to the United States, and developed progressive manifestations of melioidosis, culminating as central nervous system disease. Standard therapy was contraindicated, and a prolonged intensive phase was employed.