Assessment of Borrelia miyamotoi in febrile patients and ticks in Alsace, an endemic area for Lyme borreliosis in France

Abstract

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.

The emerging tick-borne pathogen Neoehrlichia mikurensis: first French case series and vector epidemiology

“…Indeed, the highest prevalence for B. burgdorferi s.l. and B. miyamotoi was found in site B [ 19 , 26 ]. Since these last two bacteria seem to share the same reservoir as N. mikurensis [ 27 ], the same distribution for the three microorganisms between the four sites would have been expected.…”

“…Ticks were collected in four sites in the Alsace region. These sites were previously investigated in different studies [ 16 , 18 , 19 ] and were selected because they display various types of vegetation, environments and ecosystems (i.e. natural or suburban).…”

Borrelia miyamotoi—An Emerging Human Tick-Borne Pathogen in Europe

“…I. pacificus is known as a B. miyamotoi vector in the western USA and I. scapularis in the north-central USA and Canada [ 43 , 44 , 45 , 46 , 47 ]. In Europe, vector competence for B. miyamotoi has been demonstrated for I. ricinus and I. persulcatus [ 12 , 36 , 45 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ] ( Table 1 ). Worldwide, B. miyamotoi prevalence in questing Ixodes ticks ranges from 0.2 to 10% [ 42 , 43 , 44 ...…”

“…Few studies in Europe have dealt with the serological evidence of B. miyamotoi . This exposure was found among forestry workers in the Netherlands and febrile patients in Alsace, France [ 65 , 98 ]. More recently, a case of post-tick bite febrile syndrome has been reported in western Europe and serological results suggest that B. miyamotoi was the causative agent of the patient’s symptoms [ 37 ].…”

“…In ELISA and a confirmatory Western blot, specific antibodies against GlpQ protein, as a non-reactive antigen from B. burgdorferi s.l. [ 65 , 94 , 98 ], in human serum [ 10 , 65 , 96 , 98 ] and in CSF samples [ 94 ] were used. Sometimes, however, GlpQ-based B. miyamotoi serology as a single marker does not hold specificity or sensitivity [ 13 , 99 ].…”