A tuberculose é considerada um problema emergente de saúde pública. Este estudo tem como objetivo avaliar a associação da patogenicidade/virulência e propriedades imunomoduladoras de isolados clínicos de Mbv (cepas B2 e MP287/03) e Mtb (cepa Beijing 1471), e da cepa de Mtb H37Rv, como referência de virulência. Os isolados, MP287/03 e Beijing 1471, apresentaram maior virulência em relação às demais cepas, levando os camundongos à morte ainda na fase aguda de infecção. Foi verificada baixa produção de mediadores pró-inflamatórios nos animais infectados com o isolado MP287/03, enquanto nos infectados com o isolado Beijing 1471 os níveis destes mediadores foram exacerbados. O desbalanço na produção destes mediadores pode ter contribuído para morte precoce dos animais. Baseado nesse estudo, nós podemos concluir que as propriedades que conferem hipervirulência aos isolados clínicos de Mbv e Mtb estão principalmente relacionadas à alta capacidade de crescimento intracelular das bactérias, que parece ser pouco alterada pela presença de citocinas pró-inflamatórias. Sendo assim, as infecções por isolados hipervirulentos podem acarretar consequências semelhantes, mesmo quando associadas a diferentes padrões de modulação da resposta imune. / Tuberculosis is an emergent problem of public health. This study aimed to evaluate the association between pathogenicity/virulence and immunemodulatory ability of Mbv (B2 and MP287/03) and Mtb (Beijing 1471) clinical isolates, using H37Rv strain as reference of virulence. The virulence was assessed in C57BL/6 mice infected with a low dose of bacilli (~100 bacteria) via intratracheal route. MP287/03 and Beijing 1471 isolates showed higher virulence than all others strains, leading to mice death during the acute phase. It was verified low production of pro-inflammatory mediators in mice infected by MP287/03 bacteria, whereas in mice infected by Beijing 1471 bacteria were observed exacerbated levels of pro-inflammatory mediators. The disbalance of these mediators may have contributed to the early mouse death. Based on this study, we concluded that the properties that confer hypervirulence to Mbv and Mtb clinical isolates are primarily related to the high intracellular growth capacity of the bacteria, which seems to be marginally affected by the presence of pro-inflammatory cytokines. Therefore, the infection by hypervirulent isolates can lead to similar outcomes, even when associated to different patterns of modulation of the immune response.

Ureaplasmas são comumente isolados do trato urogenital humano. O objetivo do estudo foi detectar ureaplasmas em mulheres sexualmente ativas, relacionar aos aspectos de saúde sexual, e com polimorfismo das citocinas IL-6 e IL-1b. Foram incluídas amostras de swab vaginal e sangue periférico de 302 mulheres. A frequência de detecção por PCR foi de 76,2% para Mollicutes, 7,0% para U. urealyticum e 52,0% para U. parvum. Na qPCR foi encontrada frequência de 16,6% para U. urealyticum e 60,6% U. parvum. As amostras de U. parvum foram subtipadas e os sorotipos 6 e 3/14 foram os mais freqüentes, seguidos do sorotipo 1. A frequência encontrada para Trichomonas vaginalis, Neisseria gonorrhoeae, Gardnerella vaginalis e Chlamydia trachomatis foi de 3,0%, 21,5%, 42,4% e 1,7%, respectivamente. No polimorfismo para IL-6, o genótipo GG foi o mais frequente e para o polimorfismo de IL-1b, o genótipo CC apresentou maior prevalência. Não foi observado diferenças entre os níveis das citocinas no plasma sanguíneo entre mulheres do grupo caso e controle. / Ureaplasmas are commonly isolated from the human urogenital tract. The purpose of this study was to detect the presence of ureaplasmas in sexually active women and relate to sexual health, and polymorphism of cytokines IL-6 and IL-1b. It was included samples of vaginal swab and peripheral blood of 302 women. The frequency of detection by PCR was 76.2% for Mollicutes, 7.0% to U. urealyticum and 52.0% for U. parvum. In the qPCR the frequency found was of 16.6% to U. urealyticum and 60.6% U. parvum. Samples of U. parvum were subtyped and serotypes 6 and 3/14 were the most frequent, followed by serotype 1. The frequency found for Trichomonas vaginalis, Neisseria gonorrhoeae, Gardnerella vaginalis and Chlamydia trachomatis was 3.0%, 21.5%, 42.4% and 1.7%, respectively. In the polymorphism for IL-6, GG genotype was the most frequent and the polymorphism of IL-1b, the CC genotype presented higher prevalence. No differences were observed between the levels of cytokines in the blood plasma of women in the case group and control.

Orientador: Brenda Paula Figueiredo de Almeida Gomes / Tese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-21T23:48:44Z (GMT). No. of bitstreams: 1 Endo_MarcosSergio_D.pdf: 3037856 bytes, checksum: a21ebec8d8ad677c201694383adabc1c (MD5) Previous issue date: 2012 / Resumo: Introdução: Microrganismos resistentes à terapia endodôntica ou que invadiram o sistema de canais radiculares após os procedimentos clínicos de desinfecção são considerados as principais causas do insucesso endodôntico. Objetivos: 1) investigar a prevalência de Enterococcus faecalis nos casos de retratamento endodôntico e lesão periapical utilizando a técnica de cultura, PCR tradicional e nested PCR, e avaliar a suscetibilidade antimicrobiana e os fatores de virulência dos E. faecalis isolados dos canais radiculares investigados (Capítulo 1); 2) quantificar bactérias viáveis e endotoxinas em dentes com infecções endodônticas secundárias e correlacionar seus níveis com aspectos clínicos e radiográficos, e também avaliar o efeito do preparo químico-mecânico (PQM) com clorexidina 2% gel + EDTA 17% na redução de bactérias e endotoxinas. Também visou investigar determinadas espécies bacterianas Gram-negativas por meio da técnica de PCR (Capítulo 2). Métodos: Amostras microbiológicas foram coletadas de 30 canais radiculares de dentes com tratamento endodôntico prévio e lesão periapical após a remoção da guta-percha (C1) e após o PQM (C2). Técnicas de cultura microbiana, PCR (16S rDNA) e nested PCR foram empregadas para investigação de E. faecalis. Determinadas espécies bacterianas Gram-negativas foram investigadas por meio da técnica de PCR. Níveis de endotoxinas e unidades formadoras de colônias (UFCs) foram monitorados em C1 e C2, utilizando o método LAL e cultura, respectivamente. Cepas clínicas de E. faecalis foram testadas quanto sua suscetibilidade antimicrobiana frente a 12 tipos de antibióticos por meio do E-test. Fatores de virulência (efaA, ace, asa, asa373, gelE, esp e cylA) dos E. faecalis isolados foram investigados pela técnica de PCR. Resultados: E. faecalis foi encontrado pela técnica de cultura (7/30), PCR tradicional (13/30) e nested PCR (23/30). PCR tradicional e nested PCR revelaram maior sensibilidade do que a cultura na detecção de E. faecalis (p<0,05, teste McNemar). P. nigrescens (4/15), P. intermedia (2/15), F. nucleatum (1/15), T. denticola (1/15), T. socranskii (1/15) e T. forsythia (2/15) foram detectadas nos canais radiculares. Endotoxinas foram detectados em todos os casos (C1 e C2). Correlação positiva entre níveis de endotoxinas e destruição óssea periapical foi observada (p<0,05). E. faecalis apresentou-se suscetível frente à Amoxicilina, Amoxicilina + ácido clavulânico, Benzilpenicilina, Moxifloxacina e Vancomicina, entretanto algumas cepas mostraram resistência contra Eritromicina (3/12), Azitromicina (8/12), Rifampicina (4/12), Tetraciclina (2/12) e Doxiciclina (1/12). Foram encontrados os seguintes fatores de virulência nos E. faecalis isolados: ace e efaA (100%), gelE (91,6%), asa (83,3%), esp (25%) e cylA (16,6%). Conclusão: 1) A percentagem de E. faecalis encontrada variou dependendo da técnica empregada. Todos os E. faecalis isolados apresentaram fatores de virulência relacionados à aderência (genes ace e efa). Foi observada resistência frente a alguns antibióticos comumente utilizados na Odontologia (Capítulo 1); 2) Foram encontrados microrganismos e endotoxinas em todos os canais radiculares, antes e após o PQM. Os níveis de endotoxinas presentes inicialmente nos canais apresentaram associação com o tamanho da lesão periapical. O PQM com clorexidina 2% gel + EDTA 17% foi efetivo na redução da carga bacteriana e dos níveis de endotoxinas nos casos de infecção endodôntica secundária. (Capítulo 2) / Abstract: Introduction: Microorganisms resistant to the endodontic therapy or that invaded the root canal system after clinical disinfection procedures are considered the main causes of endodontic failure. Aims: 1) to investigate the prevalence of E. faecalis in cases of endodontic retreatment with periapical lesions using culture technique, traditional PCR and nested PCR; and also to evaluate the antimicrobial susceptibility and virulence factors of E. faecalis isolates (Chapter 1); 2) to quantify cultivable bacteria and endotoxin in root canals with secondary endodontic infection correlating their levels with the presence of clinical features; and also to evaluate the effect of chemomechanical preparation (CMP) with 2% chlorhexidine-gel + 17% EDTA on bacterial and endotoxin removal. Moreover, it was also aimed to investigate the presence of target strict Gram-negative anaerobic bacteria by PCR/ nested PCR (Chapter 2). Methods: Microbial samples were collected from 30 root-filled canals of teeth with secondary endodontic infection after removal of gutta-percha (S1) and after CMP (S2). Microbial culture techniques, PCR (16S rDNA) and nested PCR were used to investigate the presence of E. faecalis. Target Gram-negative bacteria species were investigated by PCR. Levels of endotoxin and CFU were monitored in S1 and S2, using the LAL assay and culture, respectively. Clinical strains of E. faecalis were tested for their antimicrobial susceptibility to 12 types of antibiotics by E-test. The virulence factors (efaA, ace, asa, asa373, gelE, esp and cylA) of E. faecalis isolates were investigated by PCR technique. Results: E. faecalis was found by culture technique (7/30), traditional PCR (13/30) and nested PCR (23/30). The traditional PCR and nested PCR technique revealed higher sensitivity for detection of E. faecalis than culture (p<0.05, McNemar's test). P. nigrescens (4/15), P. intermedia (2/15), F. nucleatum (1/15) T. denticola (1/15) T. socranskii (1/15) and T. forsythia (2/15) were detected in the root canals investigated. Endotoxins were detected in all cases (S1 and S2). Positive correlation between endotoxin levels and periapical bone destruction was observed (p <0.05). All E. faecalis strains were susceptible to Amoxicillin, Amoxicillin + clavulanic acid, Benzylpenicillin, Vancomycin and Moxifloxacin, however some strains showed resistant to Erythromycin (3/12), Azithromycin (8/12), Rifampicin (4/12), Tetracycline (2/12) and Doxycycline (1/12). The virulence factors of the E. faecalis strains were ace and efaA (100%), gelE (91.6%), asa (83.3%), esp (25%) and cylA (16.6%). Conclusion: 1) The percentage of E. faecalis found varied according to the technique employed. All E. faecalis isolated showed virulence factors related to adherence (genes ace and efa). They also showed resistance to some antibiotics commonly used in dentistry (Chapter 1); 2) Microorganisms and endotoxins were found in all root canals investigated, before and after CMP. The endotoxin levels initially found in the infected root canals were associated with a larger size of periapical radiolucent area. CMP with 2% chlorhexidine-gel + 17% EDTA was effective in reducing both bacterial load and endotoxin contents in the post-treatment apical periodontitis (Chapter 2) / Doutorado / Endodontia / Doutor em Clínica Odontológica

Neste estudo focamos no papel de cinco transportadores da família ABC (ATP-binding cassete) envolvidos com a captação ativa de oligopeptídeos, poliaminas, fosfato inorgânico, glutamato e glutamina, em duas espécies bacterianas: Streptococcus mutans, que causa a cárie, e Escherichia coli enterohemorrágica (EHEC), responsável por diarreias e síndrome hemolítica urêmica em humanos. Com relação a inativação do sistema de transporte de oligopeptídeos de S. mutans não observamos alteração do crescimento bacteriano ou da aderência à superfícies abióticas. A deleção do sistema de captação de poliaminas não interferiu com o crescimento em meio rico, porém aumentou a resistência à ambiente ácidos. Inativação do sistema de transporte de fosfato inorgânico reduziu a aderência de S. mutans. Sobre os sistemas de transporte de glutamato e glutamina, mutantes de S. mutans apresentaram alterações nas taxas de crescimento e adesão à superfícies. Inativação da proteína OppA de EHEC não afetou a produção da toxina Stx bem como a patogenicidade in vitro e in vivo de EHEC. Em suma, o presente estudo demonstra que o papel dos transportadores ABC na fisiologia e patogenicidade de bactérias pode variar de acordo com a espécies bem como com o substrato transportado. / This study focuses on the role of five ABC (ATP-binding cassette) transport systems related to active uptake of oligopeptides, polyamines, inorganic phosphate, glutamate and glutamine. In this work we study two bacterial species: Streptococcus mutans, which causes caries, and enterohaemorrhagic Escherichia coli (EHEC), responsible for diarrhea and hemolytic uremic syndrome in humans. The inactivation of the S. mutans oligopeptide transport system did not change the bacterial growth and adherence to abiotic surfaces. Inactivation of the polyamine uptake system did not interfere with growth in rich medium, but increased the survival of bacteria in acid environments. Inactivation of the inorganic phosphate transport system reduced the adherence of S. mutans. Regarding the glutamate and glutamine transport systems, the S. mutans mutants showed changes in growth rates and adhesion to abiotic surfaces. Inactivation of the EHEC OppA protein, did not affect the production of the Stx toxin neither affected the in vitro and in vivo pathogenicity of the strain. Collectively, the present study shows that the roles of ABC transporters in the physiology and pathogenicity of bacteria may vary according to the species involved as well as the substrate transported.

The opportunistic fungus, Aspergillus fumigatus, is a leading cause of morbidity and mortality among the immunocompromised population. Experimental and clinical findings have established that phagocytic defenses are critical in the recognition and clearance of A. fumigatus. Previous studies found that Toll-like receptors (TLRs), specifically TLR2 and TLR4, were essential in the detection of the mold. Furthermore, one study found that mice deficient in TLR9 lived longer than their wild-type counterparts following challenge with A. fumigatus. We sought to determine the role of TLR9 during A. fumigatus infection. Our results show that A. fumigatus contains unmethylated CpG DNA, the natural ligand of TLR9. Furthermore, A. fumigatus DNA stimulates a potent pro-inflammatory response in mouse bone marrow derived dendritic cells (BMDCs) and human plasmacytoid dendritic cells (pDCs). A genome wide analysis showed that A. fumigatus DNA contains 87 human and 23 mouse putative immunostimulatory motifs. The response to A. fumigatus DNA is TLR9-dependent, as BMDCs from TLR9-/- mice were unresponsive to the fungal DNA. In addition, HEK293 cells cotransfected with human TLR9 and NFκB driven Luciferase conferred responsiveness to A. fumigatus CpG-rich sequences found in the fungal DNA. Our results show that TLR9 detects A. fumigatus DNA, resulting in the secretion of proinflammatory cytokines. While pDCs secrete IFNα in response to A. fumigatus DNA, these cells have been mainly described to play critical roles in the antiviral responses. The role of pDCs during fungal infections remains to be elucidated. Our data show that CD304+ peripheral blood pDCs challenged with A. fumigatus hyphae secrete large concentrations of IFNα and TNFα in response to infection. Furthermore, the response appears to be TLR9- independent. However, pDCs spread over the hyphae and inhibit fungal growth. Furthermore, pDCs undergo cell lysis upon incubation with A. fumigatus. The antifungal activity of the pDCs was retained in the cell lysates, suggesting that this response was mediated by an intracellular factor. Addition of exogenous Zn2+, but not Fe3+, partially restores hyphal growth. In addition, western blot of pDC lysates show that these cells have the Zn2+-binding protein calprotectin. Over 60% cell death is observed in the pDC population following a 2 hour incubation with A. fumigatus. The observed pDC cell death can be partially attributed to gliotoxin, as pDCs challenged with A. fumigatus stains deficient in production of the mycotoxin result in decreased pDC cytotoxicity. Furthermore, pDC cell death occurs independent of contact with the mold, confirming that pDC cell death is mediated by a secreted fungal factor. In addition, our results show that pDCs are required for the host response against A. fumigatus. Mice depleted of their pDCs are more susceptible to A. fumigatus infection than the control counterparts, suggesting that pDCs play a role in the antifungal response. Also, we observe a 5-fold increase in the pDC population in the lungs of infected mice. Therefore, the possibility of these cells playing a role in recruiting and communicating with other immune cells cannot be eliminated. Upon maturation, pDCs acquire characteristics of conventional DCs (cDCs) such as upregulation of major histocompatability complex (MHC) and becoming more phagocytic. Whether mature pDCs are involved in the detection of and responses against fungal pathogens remains to be determined. Here we show that mature pDC secrete IFNα and TNFα in response to A. fumigatus conidia as early as 6 hours post-challenge. While cytokine secretion of mature pDCs against A. fumigatus does not require opsonization, it requires for A. fumigatus being alive and growing. Furthermore, supernatants from conidial growth induced cytokine secretion by the mature pDCs. The work presented in this thesis establishes that the nucleic acids in A. fumigatus serve as a pathogen associated molecular pattern (PAMP) that can induce a TLR9- dependent response. Furthermore, I show that pDCs secrete cytokines and induce an antifungal response against A. fumigatus conidia and hyphae. While the pDC population in the blood appears to be small, our work shows that these cells could be intimately involved in the antifungal responses against A. fumigatus.

Orientador: Fernanda Lourenção Brighenti / Resumo: Este trabalho está dividido em 2 publicações cujos objetivos foram: a) realizar uma revisão sistemática da literatura, seguida de uma metanálise sobre a eficácia da terapia fotodinâmica (TFD) nos micro-organismos responsáveis pela cárie dentária (Publicação 1); b) avaliar o potencial in vitro dos óleos essenciais de Coffea arabica, Matricaria recutita e Eugenia uniflora e dos extratos vegetais de Senna splendida, Senna reticulata e Senna Macranthera para serem utilizados como monoterapia na terapia fotodinâmica sobre suspensões de micro-organismos de interesse médico-odontológico. Publicação 1: A questão de pesquisa e as palavras-chave foram construídas de acordo com a estratégia do PICO. A pesquisa do artigo foi realizada nas bases de dados Embase, Lilacs, Scielo, Medline, Scopus, Cochrane Library, Web of Science, Science Direct e Pubmed. Ensaios clínicos randomizados e estudos in vitro foram selecionados na revisão. O estudo foi conduzido de acordo com as diretrizes do PRISMA para revisão sistemática. Publicação 2: Foram utilizadas as seguintes cepas de referência em suspensão: Cutibacterium acnes ATCC 6919, Streptococcus mutans ATCC 35688, Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922 e Candida albicans ATCC 90028. Os materiais vegetais foram testados nas concentrações de 50 μg/mL (extratos) ou 2% (óleos essenciais). Foram estudados cinco grupos: controle negativo, material vegetal sem exposição a luz (FS-luz), material vegetal com exposição a luz (FS+luz),... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

When patients develop new-onset infections after hospital admission, the origin of the infection is typically assumed to be nosocomial; however, ambulances are potentially unexplored reservoirs for emerging pathogens. This study seeks to identify the scope of bacterial contamination in rural East Tennessee ambulances. Though universal precautions and cleaning procedures aim to reduce the spread of infectious diseases to provider and patient, little is known about the bacterial microbiome of ambulances. To the best of our knowledge, this is the first study of its kind to be performed in the state of Tennessee and the first since the introduction of UVGI units as an ambulance-based COVID-19 infection control measure. Our dissemination of post-pandemic findings may impact ambulance sanitation measures and will add to the national and global knowledge pertaining to the microbiome of emergency medical patient transport systems. Ambulances in East Tennessee were sampled using environmental sampling contact plates. At least one active ambulance unit for each EMS service underwent sampling. Three samples were obtained from each of three areas: the floor of the ambulance transport area, the rear door panel inside the transport area and stretcher. The plates were then incubated at 30-35C for 48 hours. Colony counts were manually performed before the plates were shipped for species identification via MALDI-TOF DNA analysis by MIDI laboratories (Newark, DE). One plate from each ambulance door and stretcher was sent for bacterial identification. Only one sample returned free of growth. All floor samples, several stretcher samples, and three door samples presented vast growth with colonies too numerous to count. The results from bacterial identification showed all flora were human commensal flora or environmental flora. The flora found on ambulance doors with opportunistic capabilities are as follows: Staphylococcus hominis, Staphylococcus epidermidis, Enterobacter cloacae, Enterobacter xinagfangensis, Bacillus cereus, Klebsiella oxytoca, and Bacillus subtilis; and the flora found on the stretchers with opportunistic capabilities are as follows: Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus cohnii ssp urealyticus, Bacillus cereus, Corynebaccterium mucifaciens, Staphylococcus pettenkoferi, Klebsiella oxytoca, Staphylococcus capitis, Bacillus subtillis, and Staphylococcus caprae. In this era of increasing antibiotic resistance, it is concerning that several microbes with pathogenicity were found, including species that often confer the spread of resistance such as Klebsiella oxytoca and Enterobacter cloacae. Overall, the finding of numerous diverse colonies does not support adequate sanitation of the ambulances. Further study is required to identify the most effective sanitation methods, and further metagenomic study is needed to explore the presence of genes that facilitate the spread of microbial resistance.

Host survival during plague, caused by the Gram-negative bacterium Yersinia pestis, is favored by a robust early innate immune response initiated by IL-1β and IL-18. Precursors of these cytokines are expressed downstream of TLR signaling and are then enzymatically processed into mature bioactive forms, typically by caspase-1 which is activated through a process dependent on multi-molecular structures called inflammasomes. Y. pestis evades immune detection in part by using a Type three secretion system (T3SS) to inject effector proteins (Yops) into host cells and suppress IL-1β and IL-18 production. We investigated the cooperation between two effectors, YopM and YopJ, in regulating inflammasome activation, and found that Y. pestis lacking both YopM and YopJ triggers robust caspase-1 activation and IL-1Β/IL-18 production in vitro. Furthermore, this strain is attenuated in a manner dependent upon caspase-1, IL-1β and IL-18 in vivo, yet neither effector appears essential for full virulence. We then demonstrate that YopM fails to inhibit NLRP3/NLRC4 mediated caspase-1 activation and is not a general caspase-1 inhibitor. Instead, YopM specifically prevents the activation of a Pyrin-dependent inflammasome by the Rho-GTPase inhibiting effector YopE. Mutations rendering Pyrin hyperactive are implicated in the autoinflammatory disease Familial Mediterranean Fever (FMF) in humans, and we discuss the potential significance of this disease in relation to plague. Altogether, the Y. pestis T3SS activates and inhibits several inflammasome pathways, and the fact that so many T3SS components are involved in manipulating IL-1β/IL-18 underscores the importance of these mechanisms in plague.

Host cell attachment by pathogenic bacteria can play very different roles in the course of infection. The pathogenic spirochetes Borrelia hermsii and Borrelia burgdorferi sensu lato which cause relapsing fever and Lyme disease, respectively, are transmitted by the bite of infected ticks. After transmission, these spirochetes can cause systemic infection. Relapsing fever spirochetes remain largely in the bloodstream causing febrile episodes, while Lyme disease will often colonize a variety of tissues, such as the heart, joint and nervous system, resulting in a chronic multisystemic disorder. Borrelia species have the ability to bind to various cell types, a process which plays a crucial role in pathogenesis and may influence spirochetal clearance from the bloodstream. Colonization of multiple tissues and cell types is likely promoted by the ability to bind to components found in target tissues, and many B. burgdorferi adhesins have been shown to promote attachment to a wide variety of cells and extracellular matrix components. Different Lyme disease strains have been shown to preferentially colonize certain tissues, although the basis of this tissue tropism is not well understood. In this study we found that among different Lyme disease strains, allelic variation of the adhesin DbpA contributes to variation in its in vitro binding activities raising the possibility that this variation contributes to tissue tropism in vivo. In studying B. hermsii infection, we found evidence by both histological and fluorescence in situ hybridization (FISH) analysis of tissues that indicated that red blood cells were removed by tissue resident macrophages in infected mice. Spirochetes in the spleen and liver were often visualized associated with RBCs, lending support to the hypothesis that direct interaction of B. hermsii spirochetes with RBCs leads to clearance of bacteria from the bloodstream. Our findings indicate that host cell attachment play a key role in the establishment of Lyme disease infection, and in contrast contributes to the clearance of relapsing fever infection.

No description available.