Quantitative real-time PCR in Borrelia persica tick-borne relapsing fever demonstrates correlation with the Jarisch-Herxheimer reaction

Breuer, Adin; Megged, Orli; Kashat, Livnat; Assous, Marc V.

doi:10.1007/s10096-020-04148-4

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Relapsing fever is a notifiable disease in humans in Israel, and its incidence was reported to be 0.11/100,000 population among civilians and 6.4/100,000 population among military personnel (8); however, the disease is probably underreported, as B. persica is susceptible to many types of antibiotics, and patients with high fever are often treated before diagnosis is complete (9). From 2004 to 2018, 92 patients, including 30 children, were diagnosed with relapsing fever caused by B. persica in two hospitals in Jerusalem (10), and 47 patients were diagnosed with this infection in a single Jerusalem hospital between 2009 and 2019 (11). The transmission of B. persica in O. tholozani has been reported to be transovarial, as described also for other TBRF Borrelia spp., and it has been suggested that the tick itself may act as a reservoir for infection, passing it on between generations of ticks and occasionally transmitting it to humans (12,13).…”

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confidence: 98%

Transmission of the Human Relapsing Fever Spirochete Borrelia persica by the Argasid Tick Ornithodoros tholozani Involves Blood Meals from Wildlife Animal Reservoirs and Mainly Transstadial Transfer

Kleinerman

Eshed

Nachum‐Biala

et al. 2021

Appl Environ Microbiol

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Borrelia persica transmitted by the argasid tick Ornithodoros tholozani causes human tick-borne relapsing fever in the Middle East and Central Asia. Infection is acquired often when visiting tick-infested caves and reported to be transmitted mainly transovarially between ticks occasionally infecting humans. To study the epidemiology of this infection, ticks were trapped in 24 caves in 12 geographic zones covering all of Israel and identified morphologically. DNA was extracted from larvae, nymphs and adult stages from each location and PCR followed by DNA sequencing was performed to identify Borrelia infection, tick species, and tick blood-meal sources. 51,472 argasid ticks were collected from 16 of 24 caves surveyed. 2,774 O. tholozani were analyzed and 72 (2.6%) from nine caves were PCR-positive for B. persica. Infection rates in male, female and nymphal ticks (4.4%, 3% and 3.2%, respectively) were higher than in larva (p<0.001) with only 3 (0.04%) positive larvae. Presence of blood-meal was associated with B. persica infection in ticks (p=0.003), and blood-meals of golden jackals, red foxes and Cairo spiny mouse were associated with infection (p≤0.043). PCR survey of 402 wild mammals revealed B. persica infection with the highest rate in social voles (22%), red foxes (16%), golden jackals (8%) and Cairo spiny mice (3%). In conclusion, although transovarial tick transmission of B. persica occurs at low levels, ticks apparently acquire infection mainly from wildlife canid and rodents and may eventually transmit relapsing fever borreliosis to humans who enter their habitat. Importance Borrelia persica is a spirochete that causes tick-borne relapsing fever in humans in an area that spans from India to the Mediterranean. Until now it was thought that the soft tick vector of this infection, Orhinthodoros tholozani, is also its main reservoir and it transmits B. persica mostly transovarially between tick generations. This study showed that tick infection with B. persica is associated with feeding blood from wild jackals, foxes and rodents, and that transovarial transmission is minimal. Since O. tholozani ticks are found in isolated caves and ruins, it is assumed that wild canids who migrate over long distances have a major role in the transmission of B. persica between remote tick populations, and its then maintained locally also by rodents and eventually transferred to humans during tick bites. Prevention of human infection could be achieved by restricting entrance of canines and humans to habitats with O. tholozani populations.

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confidence: 98%

Transmission of the Human Relapsing Fever Spirochete Borrelia persica by the Argasid Tick Ornithodoros tholozani Involves Blood Meals from Wildlife Animal Reservoirs and Mainly Transstadial Transfer

Kleinerman

Eshed

Nachum‐Biala

et al. 2021

Appl Environ Microbiol

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“…Particularly, penicillin- or cephalosporin-related antibiotics used for infectious diseases had a partial effect on syphilis by reducing the loads of TP in the body. The occurrence of JHR might depend on the spirochete loads in the body [ 3 , 27 ]. Our finding that previous syphilis treatment was a protective factor (0.126-fold risk) could verify this viewpoint.…”

Section: Discussionmentioning

confidence: 99%

An observational prospective study based on a large cohort of HIV-negative neurosyphilis patients with particular reference to the Jarisch-Herxheimer reaction

Peng,

Wu,

Zhao

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose The purpose of this study is to outline a complete picture of Jarisch-Herxheimer reaction (JHR) in the central nervous system among HIV-negative neurosyphilis patients. Methods A prospective study cohort of 772 cases with almost all stages of neurosyphilis depicted the features of JHR including occurrence rate, risk profiles, clinical manifestations, medical management and prognosis. Results The total occurrence rate of JHR was 9.3% (95% CI, 7.3-11.4%), including 4.1% (95% CI, 2.7-5.6%) with severe JHR. The reaction started 5 h after treatment initiation, peaked after 8 h, and subsided after 18 h. Patients with severe JHR experienced a longer recovery time (26 h). Patients with general paresis (OR = 6.825), ocular syphilis (OR = 3.974), pleocytosis (OR = 2.426), or a high CSF-VDRL titre (per log2 titre increase, OR = 2.235) were more likely to experience JHR. Patients with general paresis had an 11.759-fold increased risk of severe JHR. Worsening symptoms included cognitive impairment, mania, nonsense speech, and dysphoria, while symptoms of hallucination, urination disorder, seizures, myoclonus, or aphasia appeared as new-onset symptoms. Neurosyphilis treatment did not need to be interrupted in most patients with JHR and could be reinstated in patients with seizures under supportive medication when JHR subsided. Conclusion Severe JHR displayed a 4.1% occurrence rate and clinicians should pay particular attention to patients at a higher risk of JHR. The neurosyphilis treatment regime can be restarted under intensive observation for patients with severe JHR and, if necessary, supportive medication should be initiated and continued until the end of therapy.

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“…TBRF was described in Israel in the 1920s [ 7 ] and is often referred to as “cave fever” since caves and abandoned buildings are common locations for acquiring infection. In three different studies, 64, 71 and 83%, respectively, of the patients diagnosed with TBRF reported visiting a cave prior to developing disease symptoms [ 2 , 8 , 9 ]. According to reports of the Epidemiological Department of the Israeli Ministry of Health, the incidence of TBRF in the Israeli population ranges from 1 to 3 cases per 100,000 people annually [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Infection and seroprevalence of Borrelia persica in domestic cats and dogs in Israel

et al. 2022

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Background Relapsing fever borreliosis is an infectious disease caused by bacteria of the genus Borrelia, inflicting recurrent episodes of fever and spirochetemia in humans. Borrelia persica, the causative agent of relapsing fever in Israel, is prevalent over a broad geographic area that extends from India to Egypt. It is transmitted by the soft tick Ornithodoros tholozani and causes disease in humans as well as domestic cats and dogs. The goal of this study was to survey domestic dogs and cats in Israel for infection with B. persica. Methods Blood, sera and demographic and clinical data were collected from dogs and cats brought for veterinary care in central Israel. PCR followed by DNA sequencing was used to detect B. persica DNA in blood samples, and an enzyme-linked immunosorbent assay (ELISA) was used to detect antibodies reactive with B. persica antigens in sera from the same animals. This is the first serological survey of B. persica in dogs and the first survey for antibodies reactive with a relapsing fever Borrelia sp. in cats globally. Results Four of the 208 dogs (1.9%) and three of 103 cats (2.9%) sampled were positive by PCR for B. persica DNA, and 24 dogs (11.5%) and 18 cats (17.5%) were seropositive for B. persica antigen by ELISA. The ratio between PCR-positivity and seropositivity in both the dog and cat populations was 1:6. All four PCR-positive dogs and two of three PCR-positive cats were seronegative, suggesting a probable recent infection. Thrombocytopenia showed significant association with seropositivity in dogs (P = 0.003). In cats, anemia had a significant association with seropositivity (P = 0.0001), and thrombocytopenia was associated with the combined prevalence of seropositivity or PCR-positivity (P = 0.022). Conclusions Borrelia persica infection is more prevalent and widespread in domestic canine and feline populations in Israel than previously thought. Dogs and cats may play a role as reservoirs and sentinels for human infection. Precautions should be taken to prevent transfusion-transmitted infection between blood donor and recipient animals. Graphic Abstract

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Quantitative real-time PCR in Borrelia persica tick-borne relapsing fever demonstrates correlation with the Jarisch-Herxheimer reaction

Cited by 3 publications

References 12 publications

Transmission of the Human Relapsing Fever Spirochete Borrelia persica by the Argasid Tick Ornithodoros tholozani Involves Blood Meals from Wildlife Animal Reservoirs and Mainly Transstadial Transfer

Transmission of the Human Relapsing Fever Spirochete Borrelia persica by the Argasid Tick Ornithodoros tholozani Involves Blood Meals from Wildlife Animal Reservoirs and Mainly Transstadial Transfer

An observational prospective study based on a large cohort of HIV-negative neurosyphilis patients with particular reference to the Jarisch-Herxheimer reaction

Infection and seroprevalence of Borrelia persica in domestic cats and dogs in Israel

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