Review article about an important new tick-borne coinfection, Borrelia miyamotoi, which has recently been discovered to be causing illness in humans.
All traditional tests for Lyme disease or Borrelia burgdorferi will not detect B. miyamotoi. The Milford Hospital Lab does offer a Lyme Disease DNA sequencing test that can detect Borrelia miyamotoi: http://www.dnalymetest.com/
Due to additional restrictions on licensing, this test is not available to either New York state residents or their physicians. NYS residents will have to go to an out-of-state physician and give an out-of-state address.
KarlaL
----- Original Message ----- From: Rick Laferriere rlaferriere@... [LymeInfo] To: [email protected] Sent: Tuesday, February 24, 2015 9:01 AM Subject: [LymeInfo] [sci] Borrelia miyamotoi infection in Nature and in humans
Borrelia miyamotoi infection in Nature and in humans Krause PJ, Fish D, Narasimhan S, Barbour AG. Clinical Microbiology and Infection, pii: S1198-743X(15)00294-3. Online before print, 2015 Feb 17.
Borrelia miyamotoi is a relapsing fever Borrelia group spirochete that is transmitted by the same hard-bodied (ixodid) tick species that transmit the agents of Lyme disease. It was discovered in 1994 in Ixodes persulcatus ticks in Japan. B. miyamotoi species phylogenetically cluster with the relapsing fever group spirochetes, which usually are transmitted by soft-bodied (argasid) ticks or lice.
B. miyamotoi infects at least six Ixodes tick species in North America and Eurasia that transmit Lyme disease group spirochetes and may use small rodents and birds as reservoirs. Human cases of B. miyamotoi infection were first reported in 2011 in Russia and subsequently in the United States, Europe, and Japan. These reports document the public health importance of B. miyamotoi, as human B. miyamotoi infection appears to be comparable in frequency to babesiosis or human granulocytic anaplasmosis in some areas and may cause severe disease, including meningoencephalitis.
The most common clinical manifestations of B. miyamotoi infection are fever, fatigue, headache, chills, myalgia, arthralgia, and nausea. Symptoms of B. miyamotoi infection generally resolve within a week of the start of antibiotic therapy. B. miyamotoi infection should be considered in patients with acute febrile illness who have been exposed to Ixodes ticks in a region where Lyme disease occurs. Because clinical manifestations are non-specific, etiologic diagnosis requires confirmation by blood smear examination, PCR, antibody assay, in vitro cultivation, and/or isolation by animal inoculation. Antibiotics that have been used effectively include doxycycline for uncomplicated B. miyamotoi infection in adults and ceftriaxone or penicillin G for meningoencephalitis.
B. miyamotoi is a relapsing fever spirochete. That means it has a surface protein known as VMP ( something like the Vlse protein in BB ) that keeps changing such that the immune system creates antibodies toward it and then it changes.
That change causes the "relapse" which in turn often is associated with a fever. But other that distinction, Bm seems to cause an infection not unlike Lyme in terms of many symptoms.
These relapses tend to occur early in an infection and when they are occurring, the number of spirochetes in the blood increases enormously and then drops like pulses. If one uses the PCR based test during one of these relapses, its easy to catch.
But the Milford test probably doesn't catch Bm once it disseminates and the immune system keeps the number of spirochetes in the blood low. Then its like trying to catch Lyme which hides and is only occasionally found in the blood in any quantity.
IGenex is now offering a similar PCR but almost certainly suffers from the same problem.
To date their is only one antibody test for Bm which is not available to most doctors. Recent studies have shown Bm may be more common than Lyme or Bb in CA which traditionally has been deemed a lower risk state. PCR tests are not very reliable when the number of bacteria in the blood is very low. That is because the test only looks in a very small volume of the blood taken.
So Bm may very well be a very large problem and so far only the tip of the iceberg has been seen. This could be one of the many reasons so many people have a Lyme-like illness but test negative.
The current ELISA and Western Blot are very genotype sensitive so they most likely will not catch varied genotypes like Bm and others.
The FDA is all up in arms about Lyme tests being FDA approved but 13 of the 14 tick-borne infections do not have FDA approved tests like Bm. What a nutty world....