Prospective Clinical Evaluation of Patients from Missouri and New York with Erythema Migrans--Like Skin Lesions

Wormser, Gary P.; Masters, Edwin J.; Nowakowski, John; McKenna, Donna; Holmgren, Diane; Ma, Katherine; Ihde, Lauren; Cavaliere, Leonardo; Nadelman, Robert B.

doi:10.1086/432935

Cited by 108 publications

(73 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…B. miyamotoi was recently implicated as a cause of human disease in the United States (4), and the pathogenicity of B. davisii is unknown. B. lonestari was provisionally implicated in a single case of early Lyme disease-like illness (erythema migrans), but subsequent investigation has not established it as a human pathogen (5)(6)(7).…”

mentioning

confidence: 99%

“…For example, in 2001, when B. lonestari, an RF group Borrelia species found in A. americanum, was tentatively linked to a case of southern tick-associated rash illness (STARI) (5), HTTKP testing was modified to include testing for B. lonestari (21)(22)(23)(24). However, epidemiological studies of STARI patients did not support the hypothesized link between STARI and B. lonestari (6,7,25), so targeting of this Borrelia species in the HTTKP ended in 2009. As a summary of our program from 1997 to 2010, a total of 4,019 A. americanum adults, nymphs, and larvae were tested with nested primers expected to amplify B. burgdorferi, and 7,421 were tested with primers that would have amplified all Borrelia spp.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Borrelia burgdorferi Not Confirmed in Human-Biting Amblyomma americanum Ticks from the Southeastern United States

et al. 2015

View full text Add to dashboard Cite

The predominant human-biting tick throughout the southeastern United States is Amblyomma americanum. Its ability to transmit pathogens causing Lyme disease-like illnesses is a subject of ongoing controversy. Results of previous testing by the Department of Defense Human Tick Test Kit Program and other laboratories indicated that it is highly unlikely that A. americanum transmits any pathogen that causes Lyme disease. In contrast, a recent publication by Clark and colleagues (K. L. Clark, B. Leydet, and S. Hartman, Int. J. Med. Sci. 10:915-931, 2013) reported detection of Lyme group Borrelia in A. americanum using a nested-flagellin-gene PCR. We evaluated this assay by using it and other assays to test 1,097 A. americanum ticks collected from humans. Using the Clark assay, in most samples we observed nonspecific amplification and nonrepeatability of results on subsequent testing of samples. Lack of reaction specificity and repeatability is consistent with mispriming, likely due to high primer concentrations and low annealing temperatures in this protocol. In six suspect-positive samples, Borrelia lonestari was identified by sequencing of an independent gene region; this is not a Lyme group spirochete and is not considered zoonotic. B. burgdorferi was weakly amplified from one pool using some assays, but not others, and attempts to sequence the amplicon of this pool failed, as did attempts to amplify and sequence B. burgdorferi from the five individual samples comprising this pool. Therefore, B. burgdorferi was not confirmed in any sample. Our results do not support the hypothesis that A. americanum ticks are a vector for Lyme group Borrelia infections. T he vectors and etiologic agents of Lyme-like diseases in the southeastern United States are a subject of ongoing controversy (1, 2). In the United States, most Lyme disease is caused by infection with Borrelia burgdorferi sensu stricto, a bacterium that is phylogenetically within the B. burgdorferi sensu lato "Lyme group" of spirochetes vectored by hard ticks. The Lyme group also includes genospecies implicated as the etiologic agents of Lyme disease in other geographic regions, including B. garinii, B. afzelii, B. spielmanii, and B. valaisiana in Europe. Additional Lyme group genospecies continue to be described. In the United States, these include B. americana, B. andersonii, and B. carolinensis, all of unknown pathogenicity, and B. bissettii, which has been implicated in cases of human illness (1). In contrast to the Lyme group, the relapsing fever (RF) group spirochetes, many of which are vectored by soft ticks, are a separate phylogenetic cluster that includes agents associated with RF disease in humans. In the United States, genospecies within the RF group include B. hermsii, B. turicatae, and B. parkeri, vectored by soft ticks, and B. miyamotoi, B. davisii, and B. lonestari, vectored by hard ticks. B. hermsii is the main cause of tick-borne relapsing fever in the United States; B. turicatae and B. parkeri have also been associated with human disease (3). B...

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Borrelia burgdorferi Not Confirmed in Human-Biting Amblyomma americanum Ticks from the Southeastern United States

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Knowing whether the tick related to the EM rash was a lone star tick is important since I. scapularis and A. americanum have been sympatric in the North and Southeast for many years, and the EM rashes caused by each are indistinguishable among individuals [40]. In addition, long-term studies of untreated STARI patients have not been conducted, so lack of long-term effects from STARI should not be assumed.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Case Reports of Two Central North Carolina Residents

Herman-Giddens

2017

North Carolina Medical Journal

View full text Add to dashboard Cite

“…Wormser et al 9,10 compared microbiologic and clinical characteristics of patients who had EM rashes in New York (an area endemic for Lyme disease) and Missouri (a nonendemic area). Although 75% of patients from New York were seropositive for antibodies to B. burgdorferi, all patents with EM from Missouri were seronegative.…”

mentioning

confidence: 99%

“…In addition, Missouri patients had a milder illness with a shorter duration and fewer symptoms. 10 Several studies have investigated the role of Borrelia lonestari and Rickettsia amblyommii as possible etiologic agents of STARI, but the results have indicated that they are unlikely to be the causal agents. 9,11,12 Without an understanding of the etiology of STARI, development of clinical and surveillance case definitions and laboratory methods to differentiate STARI from early Lyme disease is not possible.…”

mentioning

confidence: 99%

Practice-Based Research Network Partnership with CDC to Acquire Clinical Specimens to Study the Etiology of Southern Tick-Associated Rash Illness (STARI)

Vaughn¹,

Sloane²,

Knierim³

et al. 2010

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Introduction: Erythema migrans (EM) is an annular, erythematous, expanding rash that is characteristic of early Lyme disease. In the southern United States, however, many cases of EM seem to have an etiology different from that of Lyme disease. This little-understood condition is called Southern tickassociated rash illness.Methods: With the goal of obtaining biological specimens and clinical histories from 12 to 20 STARI patients for use in etiologic research, microbiologists from the Centers for Disease Control and Prevention contacted the North Carolina Network Consortium, a statewide consortium of practice-based research networks. This article describes the methods by which the North Carolina Network Consortium successfully identified and enrolled Southern tick-associated rash illness patients into a primary carebased research protocol.Results: A total of 23 patients were enrolled, with 100% attainment of the desired specimens. After an initial lack of success, the revised protocol identified and trained physicians practicing in endemic areas for the illness, used a coordinator with 24-hour availability, recruited participants using newspaper notices and medical providers, and provided regular reminders and progress updates.

show abstract

Prospective Clinical Evaluation of Patients from Missouri and New York with Erythema Migrans--Like Skin Lesions

Abstract: Cases of EM-like skin lesion in patients from Missouri and New York have distinct clinical presentations.

Cited by 108 publications

References 36 publications

Borrelia burgdorferi Not Confirmed in Human-Biting Amblyomma americanum Ticks from the Southeastern United States

Borrelia burgdorferi Not Confirmed in Human-Biting Amblyomma americanum Ticks from the Southeastern United States

Retrospective Case Reports of Two Central North Carolina Residents

Practice-Based Research Network Partnership with CDC to Acquire Clinical Specimens to Study the Etiology of Southern Tick-Associated Rash Illness (STARI)

Contact Info

Product

Resources

About