Comparative analysis of the Borrelia garinii genome.

Three members of the genus Borrelia (B.burgdorferi, B.garinii, B.afzelii) cause tick-borne borreliosis. Depending on the Borrelia species involved, the borreliosis differs in its clinical symptoms. Comparative genomics opens up a way to elucidate the underlying differences in Borrelia species. We analysed a low redundancy whole-genome shotgun (WGS) assembly of a B.garinii strain isolated from a patient with neuroborreliosis in comparison to the B.burgdorferi genome. This analysis reveals that most of the chromosome is conserved (92.7% identity on DNA as well as on amino acid level) in the two species, and no chromosomal rearrangement or larger insertions/deletions could be observed. Furthermore, two collinear plasmids (lp54 and cp26) seem to belong to the basic genome inventory of Borrelia species. These three collinear parts of the Borrelia genome encode 861 genes, which are orthologous in the two species examined. The majority of the genetic information of the other plasmids of B.burgdorferii is also present in B.garinii although orthology is not easy to define due to a high redundancy of the plasmid fraction. Yet, we did not find counterparts of the B.burgdorferi plasmids lp36 and lp38 or their respective gene repertoire in the B.garinii genome. Thus, phenotypic differences between the two species could be attributable to the presence or absence of these two plasmids as well as to the potentially positively selected genes.

[Ticks, tick bites and how best to remove the tick]. / Machen Sie dem Märchen vom Linksgewinde ein Ende.

As a rule, the tick, Ixodes ricinus, is picked up when its victim walks through low vegetation and brushes it off a leaf or blade of grass. Often hours later, the tick scores the skin at the site it selects and then pushes its barbed hypostome into the tiny wound to anchor itself to its victim with the aid of a cement-like substance and the barbs. While it sucks up blood, Borrelia burgdorferi spirochetes pass out of the tick's intestine into its salivary glands and thence into the host. It is therefore of decisive importance that the tick be removed with a special forceps as early as possible. The use of such substances as glue, alcohol or nail varnish to remove the tick must be discouraged. Currently, antibiotic prophylaxis, examination of the tick for the presence of B. burgdorferi, or serological follow-up tests are not recommended.

[Stage-oriented treatment of Lyme borreliosis]. / Stadiengerechte Therapie der Lyme-Borreliose. So setzen Sie die Antibiotika richtig ein.

Every manifestation of Lyme borreliosis needs to be treated with antibiotics. The type of antibiotic applied and duration of treatment will depend on the stage and severity of the disease. Erythema migrans, Borrelia lymphocytoma, Lyme arthritis and acrodermatitis chronica atrophicans are primarily treated orally. If neurological symptoms, severe Lyme carditis or eye manifestations are present, intravenous treatment is initially recommended. For oral therapy, doxycycline, amoxicillin, cefuroxime and, if intolerance is shown, azithromycin, are available. For intravenous treatment ceftriaxone, cefotaxime or penicillin G is employed. The overall prognosis for treated Lyme borreliosis is good. However, in particular when manifestations with substantial organic injury have persisted, incomplete healing must be expected. With the exception of erythema migrans, every manifestation should be subjected to a careful diagnostic work-up prior to the start of treatment, because premature antibiotic administration is not only associated with an elevated risk for the patient, but can also mask important diagnostic signs.

Phagocytosis of microorganisms by means of overshooting pseudopods: where do we stand?

During the endocytic uptake of particulate material such as microorganisms, the transition from the engulfment step to the internalization step of phagocytosis may be disturbed. Thus, the pseudopods flanking the particles do not close to a phagosome, but lie on top of each other. This uncoupling of pseudopod extension and phagosome formation provides useful information about the regular course of phagocytosis. Experimental models on the phenomena of coiling and overlapping phagocytosis have so far been established with legionellas, spirochetes, trypanosomatids, fungal cells, and zymosan.

Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study.

We randomly assigned 21 patients with painful Lyme neuroborreliosis radiculitis (Bannwarth's syndrome) and neuroborreliosis meningitis to a 10-day treatment with either penicillin G. 4 x 5 million U/d (n = 10) or cefotaxime sodium, 3 x 2 g/d (n = 11), intravenously. We were not able to demonstrate clinical differences between groups, either during the 10-day treatment period or at follow-up examination a mean of 7.7 months after antibiotic therapy. Cerebrospinal fluid cefotaxime concentrations reached the minimum inhibitory concentration at the 90% level for Borrelia burgdorferi in all patients, while none of the patients treated with penicillin G had cerebrospinal fluid concentrations above the minimum inhibitory concentration at the 90% value. We conclude that patients with acute neurologic manifestations of Lyme borreliosis may benefit from a 10-day treatment with cefotaxime or penicillin G. Cerebrospinal fluid antibiotic concentrations above the minimum inhibitory concentration at the 90% value, as observed in all patients treated with cefotaxime, offer the most hope for long-term prognosis.

Latent Lyme neuroborreliosis: presence of Borrelia burgdorferi in the cerebrospinal fluid without concurrent inflammatory signs.

Borrelia burgdorferi, the etiologic agent of Lyme borreliosis, was isolated from the CSF of a patient with elevated serum IgG antibody titers against B burgdorferi and a history of multiple tick bites. The absence of concurrent inflammatory signs of CSF as well as intrathecal antibody production indicates a phase of latent Lyme neuroborreliosis in which no tissue infection or reaction has yet occurred. Bilateral tinnitus was the only clinical symptom in this patient. The persistence of the bilateral tinnitus after antibiotic therapy did not support a causal relationship between this symptom and the borrelial infection.

Catatonic syndrome in acute severe encephalitis due to Borrelia burgdorferi infection.

We report a 19-year-old patient who presented with an acute encephalopathy manifested by catatonia. We isolated Borrelia burgdorferi from the CSF and demonstrated intrathecal production of IgG antibodies against B burgdorferi. The patient completely recovered after intravenous ceftriaxone therapy.

Long-term in vitro cultivation of Borrelia burgdorferi sensu lato strains: influence on plasmid patterns, genome stability and expression of proteins.

Low (7th) and high (298th/304th) in vitro passages (cultivated over a period of 3 years) of two human Borrelia burgdorferi sensu lato strains, PKo (B. afzelii) and PBi (B. garinii) were compared by pulse-field gel electrophoresis, Southern blot, sequencing of the ospA gene, SDS-PAGE and Western blot. Digestion of genomic DNA with ApaI, BssHII, KspI, MluI, SmaI and XhoI did not reveal any differences between low and high passages. The loss of two linear plasmids with sizes of 6 and 31 kbp was detected in strain PKo between passages 34-50 and 101-304, respectively, whereas the ospA-carrying plasmid remained unchanged. In contrast, analysis of linear plasmid profiles obtained from low and high passages of B. garinii strain PBi showed no differences. Sequence analysis of the ospA gene demonstrated no difference in the strain PBi and one nucleotide exchange in the strain PKo when low and high passages were compared. The observed transition (G-A) in the third codon position did not alter the amino acid sequence. However, the rate of expression of the outer surface proteins OspA, OspB and OspC of strain PKo during low and high stages of cultivation varied significantly. In summary, our data suggest that the B. burgdorferi sensu lato genome is stable during long-term in vitro cultivation.

Antigenic variation and strain heterogeneity in Borrelia spp.

Antigenic variation and strain heterogeneity have been demonstrated for the pathogenic Borrelia species, i.e. B. burgdorferi and the relapsing fever borreliae. In relapsing fever, new borrelia serotypes emerge at a high rate spontaneously, a mechanism that is caused by DNA rearrangements on linear plasmid translocating genes coding for variable major proteins from previous silent to expression sites (i.e. from inner sites to telomeric sites of the plasmid). As a result of this variation, the borreliae escape the immune response of the host, thus leading to the relapse phenomenon. In B. burgdorferi, which is the causative agent of the multisystem disorder Lyme borreliosis, there is also a growing body of findings that antigenic variation is involved in pathogenesis of the disease. Phenotypic variation of strains in vitro concerns the size and the amount of surface-associated proteins (OspA, OspB and pC). There are indications that OspA and OspB truncations are due to deletions within the ospAB operon caused by recombination events, and that OspA/OspB-less mutants lack the 49-kb plasmid that bears the ospAB operon. With the increasing number of isolates obtained from various geographic and biological sources, it became apparent that B. burgdorferi is immunologically and genetically more heterogeneous, as previously believed. The major outer surface proteins OspA and OspB (which have been efficient antigens in vaccine studies) are heterogeneous at a genetic level. The same degree of genetic non-identity was observed for the pC protein. Other proteins like flagellin and the highly specific immunodominant p100 range protein show a lower degree of non-identity. Recombinant OspA, pC, p100 range protein and flagellin have been hyperexpressed in E. coli and these proteins are immunologically reactive. This allows further research for development of vaccines and diagnostic tools. B. burgdorferi isolates have been investigated with genotyping (DNA hybridization, PCR and 16S rRNA analysis) as well as serotyping by various authors. Comparison of the different methods has shown good agreement when the same strains have been investigated. No correlation could be found between different phenotypic and genotypic groups with respect to the ability to cause arthritis in SCID mice. A serotyping system based on immunological differences in OspA detected by a panel of monoclonal antibodies has been proposed. Serotyping a large number of B. burgdorferi isolates has shown a striking predominance of the OspA serotype 2 among European isolates from human skin, in contrast to isolates from ticks or CSF.(ABSTRACT TRUNCATED AT 400 WORDS)

Antigenic variability of Borrelia burgdorferi.

Borrelia burgdorferi strains (six isolates from North America and 28 isolates from Europe) were analyzed by physicochemical and immunological methods. By SDS-PAGE, all Borrelia burgdorferi strains tested had two major proteins with constant molecular weights of 60 and 41 kDa and one, two, or three variable low molecular weight proteins (OspA = 30-32 kDa, OspB = 34-36 kDa, pC = 21-22 kDa). All combinations--except OspB alone or OspB/pC--were observed. Borrelia burgdorferi strains were different from relapsing fever borreliae by strong reactivity with OspA- and/or pC-specific polyclonal antibodies, whereas relapsing fever borreliae were only weakly reactive. Among 25 Borrelia burgdorferi isolates, seven different serotypes of Borrelia burgdorferi were defined according to their reactivity in the Western blot with three monoclonal OspA-specific antibodies (H5332, H3TS, and LA5), four OspA- or OspB-specific polyclonal antibodies, and 12 polyclonal antibodies against whole borreliae. Antigenic differences between European CSF and skin isolates were observed, all skin isolates (n = 11) belonging to serotype 2 in contrast to only two out of seven CSF isolates. CSF isolates were antigenically heterogenous (serotypes 1, 2, 3, 4, and 5). Serotypes 6 and 7 were represented by two tick isolates, and the other European tick isolates are not yet fully characterized. Antigenic differences between European and North American strains may play a role in differences in the clinical picture of Lyme borreliosis.

Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans.

In a study on 121 consecutive patients with erythema migrans, 65 patients obtained oral penicillin, 36 tetracyclines, and 20 amoxicillin-clavulanic-acid. Follow-up was carried out for a median of 29, 17, and 7 months, respectively. In another limited trial on 29 patients with acrodermatitis chronica atrophicans (ACA), 14 patients received oral penicillin, 9 parenteral penicillin, and 6 tetracyclines. There was no statistically significant difference among treatment groups in both therapeutic trials, with the exception of different follow-ups due to the nonrandomized study design and different occurrence of the Jarisch-Herxheimer reaction in patients with erythema migrans. Later extracutaneous manifestations developed in 27% of the patients with erythema migrans and in 47% of the patients with ACA despite antibiotic therapy. We could not prove the superiority of any antibiotic tested in either early or late European Lyme borreliosis.

Molecular characterization of the p100 gene of Borrelia burgdorferi strain PKo.

The p100 gene coding for the p100 protein of Borrelia burgdorferi strain PKo has been cloned, sequenced and expressed in Escherichia coli. An open reading frame including upstream and downstream sequences with potential translation and transcription signals could be identified. The reading frame consists of 1989 nucleotides corresponding to a protein of 663 amino acids and a calculated molecular mass of 75.8 kDa. The protein has a leader peptide and is processed without modification at the N-terminus. A high percentage of amino acid sequence identity could be found to the high-molecular mass protein p83/p93 of B. burgdorferi strain B31.

Guidelines for the diagnosis of tick-borne bacterial diseases in Europe.

Ticks are obligate haematophagous acarines that parasitise every class of vertebrate (including man) and have a worldwide distribution. An increasing awareness of tick-borne diseases among clinicians and scientific researchers has led to the recent description of a number of emerging tick-borne bacterial diseases. Since the identification of Borrelia burgdorferi as the agent of Lyme disease in 1982, 11 tick-borne human bacterial pathogens have been described in Europe. Aetiological diagnosis of tick-transmitted diseases is often difficult and relies on specialised laboratories using very specific tools. Interpretation of laboratory data is very important in order to establish the diagnosis. These guidelines aim to help clinicians and microbiologists in diagnosing infection transmitted by tick bites and to provide the scientific and medical community with a better understanding of these infectious diseases.

The spirochetal etiology of lymphocytic meningoradiculitis of Bannwarth (Bannwarth's syndrome).

In all the sera of four patients with meningoradiculitis of Bannwarth admitted to the neurological department of the University Clinic Grosshadern in Munich in 1983, we found antibodies against Ixodes dammini spirochetes. In three patients antibodies were also present in the CSF. In one patient, we isolated spirochetes from the CSF and demonstrated specific IgG antibodies in serum and CSF. This spirochete was morphologically indistinguishable from the I. dammini spirochete and a spirochete isolated from the thick I. ricinus in the Munich area. Despite distinct differences in the clinical manifestation of Lyme disease when accompanied by neurological complications and meningoradiculitis of Bannwarth, we suggest that both diseases are caused by spirochetes.

Myositis caused by Borrelia burgdorferi: report of four cases.

Myositis was proven histopathologically in 4 patients (age range 36-66 years) who suffered from early or late stages of Borrelia burgdorferi infection. Muscle weakness was present in 3 patients, 1 complaining of additional myalgias. One man came to medical attention because of skin discoloration and swelling of one leg. Deep biopsy from skin, fascia and muscle revealed acrodermatitis chronica atrophicans, panniculitis, fasciitis, and myositis, respectively. Creatine kinase was slightly elevated in 3 cases and normal in one. Infiltrates were found in the perimysium and within the muscle bundles, mainly around small vessels. The infiltrates consisted of many B cells and T4 lymphocytes with fewer cytotoxic T cells, suggesting that Borrelia myositis might be due to a local immune response to unknown Borrelia antigens. Cultivation of Borrelia from muscle was not successful. Antibiotic therapy cured the myositis.

Increased anti-streptococcal antibodies in patients with Tourette's syndrome.

Infection or postinfectious phenomena have been postulated to play a role in the pathogenesis of children afflicted with the typical symptoms of Tourette's syndrome (TS). We investigated whether an increase of titers of antistreptococcal antibodies can be reproduced in our children with TS, and whether this increase is restricted to children. We examined the titers of two different antistreptococcal antibodies, antistreptolysin (ASL) and anitDNase B, both in children and adults. Titer s of ASO and antiDNase B were measured (1) in 13 children/adolescents suffering from TS and in an aged-matched comparison group;(2) in 23 adult patients, a comparison group of 23 aged-matched controls, and in another group of 17 aged-matched, non-medicated acute schizophrenics. ASO and antiDNase B titers were determined by laser nephelometry using a commercially available kit. Two antistreptococcal cut-off levels were compared (> 250 U/ml and 400 U/ml). As expected, increases ASO titers (>400 IU/ml) were found in a higher portion of children/adolescents with TS compared to controls. Regarding adults, titers >250 U/ml for both antistreptococcal antigens were found in significantly more TS patients than in schizophrenic patients or healthy control subjects. The mean values of ASO and antiDNase titers were significantly higher in both groups of TS patients compared to control children/adolescents, to the comparison groups of healthy adults and to schizophrenics. No difference in antistreptococcal titers was found between schizophrenics and the group of healthy adults. TS patients exhibited higher antistreptococcal titers than age-matched comparison groups of both children/adolescents and adults using different types of calculation. Our findings support the theory that a postinfectious immune mechanism may play a role in the pathogenesis of TS. The mechanism still needs to be elucidated.

Genospecies and their influence on immunoblot results.

In Europe at least three human pathogenic species of Borrelia burgdorferi sensu lato are the causative agents of Lyme borreliosis. All three species have been isolated or detected by PCR from skin, CSF and synovial fluid of patients with skin lesions, neuroborreliosis and Lyme arthritis respectively. Studies using strains representing the three species as antigen for the immunoblot revealed that interpretation criteria depend strictly on the strain used as antigen. More than using certain species as antigen it is important to use strains (f.e. B. afzelii strain PKo) expressing certain immunodominant antigens like OspC and p17 which may not be expressed by other strains in vitro. Using strain PKo as antigen the two band criterium can be used without loss of too much sensitivity compared to using B. burgdorferi sensu stricto strain PKa2 and B. garinii strain PBi. The use of recombinant antigens allows selection of highly specific and combination of homologous antigens from different strains; however not all desirable antigens have been recombinantly expressed. Addition of p17 and p58 as antigens may improve the sensitivity of the hitherto described recombinant antigen immunoblots containing the antigens p83/100, p39, OspC and the p41 internal fragment.

Epidemiological aspects of human granulocytic Ehrlichiosis in southern Germany.

Human granulocytic Ehrlichiosis (HGE) is a newly emerging acute febrile illness which is likely transmitted by ticks of the Ixodes ricinus/I. persulcatus complex. First seroepidemiological surveys on the prevalence of HGE antibodies, detection of DNA of granulocytotropic Ehrlichiae in I. ricinus and one case of HGE from Slovenia confirmed by serology and PCR (polymerase chain reaction) suggest that HGE might exist all over Europe. The purpose of the present study was a) to determine the prevalence of antibodies against the HGE agent in sera collected from persons at high risk for exposure to I. ricinus with that of a control population and b) to determine the prevalence of granulocytic Ehrlichiae in I. ricinus ticks from Southern Germany. We studied sera from 150 forestry workers and 105 patients with an established diagnosis of Lyme disease as tick-exposed populations. Sera from 103 healthy blood donors without a history of known tick bites served as controls. A significantly higher prevalence of HGE antibodies (P < or = 0.01) was present among patients with Lyme borreliosis (12 of 105 were positive; 11.4%) and forestry workers (21 of 150 were positive; 14%) compared to blood donors (2 of 103 were positive; 1.9%). Furthermore, 510 adult and nymphal I. ricinus were investigated by PCR for the presence of granulocytic Ehrlichiae with primers specific for the E. phagocytophila group. In eight (1.6%) of the investigated ticks the expected amplification product was detectable, indicating a low prevalence of infected ticks especially when compared with B. burgdorferi. The presented data strongly suggests that the HGE agent or a closely related organism exists in Southern Germany and therefore HGE should be considered in the differential diagnosis of febrile illnesses. However, final evidence can be provided only after isolation of the organism from patients.

[Severe meningoencephalitis in Borrelia burgdorferi infection]. / Ciezkie zapalenie opon mózgowo-rdzeniowych i mózgu w przebiegu zakazenia Borrelia burgdorferi.

We present a case of borreliosis with severe impairment of central nervous system. The patient a 43-year-old man, presented with neurological signs and symptoms and severe psychiatric disorders. The diagnosis was established several months after the onset of neurological signs. CSF examination revealed lymphocyte pleocytosis and specific antibodies against B. burgdorferi in high titres. MRI of the brain showed inflammatory lesions. Due to the treatment with antibiotics, patient's state improved and pleocytosis in CSF disappeared. However, after 1- year follow-up, specific antibodies were still present in high titres. Clinical manifestations and the results of diagnostic procedures show multifocal encephalitis in the acute phase of the disease and encephalopathy as a residual syndrome.

[Diagnosis of Lyme borreliosis. How to corroborate suspected borreliosis]. / Diagnostik der Lyme-Borreliose. Wie Sie den Verdacht auf Borreliose erhärten.

Lyme borreliosis is a zoonosis transmitted via lxodes ticks. The causal agent--the spirochete Borrelia burgdorferi sensu lato--triggers a multisystem disease that manifests in particular in the skin, heart, nervous system and joints. Lyme borreliosis is the most common tick-borne infectious disease in the Northern hemisphere. In Europe the Lyme disease spirochetes are heterogeneous and comprise three species that infect humans: Borrelia burgdorferi sensu stricto, B. garinii and B. afzelii. The microbiological diagnosis is based primarily on the detection of antibodies, and secondarily on the detection of the pathogen. Suitable material for the detection of the pathogen are various body fluids (cerebrospinal fluid, joint fluid) and biopsy material (in particular skin). Antibodies are usually detected in the serum. Negative serology does not exclude an early manifestation, and a positive finding is no proof of a clinically manifest infection--it may simply reflect an earlier Lyme infection.