Neuroborrelios (NB) kan förekomma när Borrelia garinii, som är en del av artkomplexet Borrelia burgdorferi sensu lato (s.l), infekterar nervsystemet. När immuncellerna utsätts för borreliaantigen bildas antikroppar i plasma och intratekalt. NB ger även upphov till mononukleär pleocytos i cerebrospinalvätska (CSV). Neurologiska symptom, pleocytos och antikroppsindex (AI), som indikerar intratekal syntes av borreliaantikroppar, vägleder nuvarande NB-diagnostik på Klinisk Mikrobiologi i Kalmar. Diagnostiken försvåras vid tidig NB när AI är negativ och pleocytos positiv. För att komplettera tidig NB-diagnostik kan kemokinet C-X-C motif ligand 13 (CXCL13) mätas i CSV. I nuläget utförs CXCL13 enzymkopplad immunadsorberande analys (ELISA) på ett externt laboratorium. Mätning av CXCL13 kan även utföras med en snabb semi-kvantitativ ReaScan+ CXCL13 metod som bygger på lateral flödesimmunanalys (LFIA). Syftet var att verifiera ReaScan+ CXCL13, kontrollera linjäritet, CXCL13 stabilitet och bestämma diagnostisk specificitet och sensitivitet. CSV-proverna indelades i fyra grupper baserat på pleocytos och AI samt tre kategorier utifrån kriterier till NB-diagnos (n=31). Metodjämförelsen genomfördes mellan ReaScan+ LFIA och CXCL13 ELISA (n=25). Linjäritetsanalys utfördes på prov med hög CXCL13-koncentration i CSV och CXCL13-stabiliteten kontrollerades på två patientprover vid frys- och kylförvaring. Beräkning av sensitivitet och specificitet baserades på definitiv (n=20) och ej NB (n=5). Metodjämförelsen visade en fullständig överensstämmelse och Spearman´s korrelationskoefficienten var 0,949. Determinationskoefficienten för linjäritetsanalysen var 0,963. Diagnostisk sensitivitet var 80% och specificitet 100%. Hög prestanda, acceptabla stabilitets- och linjäritetsresultat samt ReaScan+ potentiella förmågan att särskilja mellan definitiv och ej NB, indikerar att metoden kan införas på Klinisk Mikrobiologi i Kalmar och komplettera nuvarande diagnostik av tidig NB. / Lyme neuroborreliosis (LNB) occurs when Borrelia garinii, part of the Borrelia burgdorferi sensu lato (s.l) species complex, infects the nervous system. Upon exposure, immune cells produce antibodies that can be measured in serum or cerebrospinal fluid (CSF). LNB also cause mononuclear pleocytosis in CSF. Neurological symptoms, pleocytosis and antibody index (AI), which indicate intrathecal synthesis of Borrelia antibodies, guide current diagnosis of LNB at the Clinical Microbiology in Kalmar. The diagnosis is complex in early LNB, especially when AI is negative and pleocytosis is positive. Expression of chemokine C-X-C motif ligand 13 (CXCL13) in CSF can be used as an additional marker to early LNB. Analysis is currently performed at an external laboratory using enzyme-linked immunosorbent assay (ELISA). The aim of this project was to evaluate the performance of the rapid semi-quantitative lateral flow immunoassay (LFIA) ReaScan+ CXCL13 test using 31 patient samples divided into four groups based on pleocytosis and AI. Linearity assay was performed on samples with high CXCL13 concentrations and stability was tested on two CSF samples after freezing and refrigeration. Estimation of sensitivity and specificity was based on definite (n=20) and non-LNB (n=5). Method comparison showed a complete agreement and Spearman's correlation coefficient was 0,949. The R2 for linearity was 0,963. Sensitivity was 80% and specificity 100%. Strong agreement, acceptable stability and linearity results as well as ReaScan+ potential ability to distinguish between definite and non-NB, indicate that the method can be introduced at Clinical Microbiology in Kalmar and used as a supplement in early LNB diagnostics.

Many zoonotic pathogens of concern to human and veterinary health are maintained in the environment within small mammal reservoirs and vectored to new hosts by ectoparasitic arthropods. While the ecological relationships among small mammals, ectoparasites, and disease-causing symbiotic microorganisms are important to these dynamics, little is known about them across much of North America. The sylvatic cycle of Borrelia burgdorferi, the etiologic agent of Lyme disease, is of particular interest because Lyme disease is the most common vector-borne disease of humans in the United States. However, cases of Lyme disease are primarily confined to the northeastern and Midwestern United States, with only sporadic cases extending into the southeast. As a result, much of what is known of the ecology of Lyme disease comes from studies conducted in those regions. The goal of this study was to examine the ecological dynamics of the B. burgdorferi/vector/reservoir system in south-central Kentucky and gain insight into the relative paucity of Lyme disease in Kentucky. Small mammals were captured using live traps in three 200x50 m trapping grids within Western Kentucky University’s Green River Preserve from November 2014-October 2015. Captured small mammals were identified to species and standard measurements were recorded. Ectoparasites were removed and retained for identification. Collected blood and tissue were examined for B. burgdorferi DNA by polymerase chain reaction with primers specific to the OspA gene. The Bray-Curtis dissimilarity index, Schnabel population estimates, and the Shannon-Wiener diversity index were used to assess the structure of the small mammal communities. Parasite infestation was low but was affected by age and sex of the host, site, and season in different parasite taxa. Infestation by Ixodes scapularis, the primary vector for B. burgdorferi, was uncommon and prevalence of B. burgdorferi in blood was similar to the lowest prevalence previously observed in the Lyme disease endemic regions. We found that life history characteristics of hosts and ectoparasites drive their associations. We also suggest that the lack of an efficient vector for B. burgdorferi is the likely explanation for the few reported cases of Lyme disease in Kentucky.

The Lyme disease spirochete, B. burgdorferi is atypical in that a large portion of its genome is in the form of plasmids. Many of the plasmid-carried genes form extensive paralogous gene families and encode outer-surface proteins. In this report we have assessed the humoral immune response to proteins belonging to the paralogous protein family, family 163. We have cloned and expressed BBP39, BBO40, BBQ47 and BBN39 and used these recombinant proteins to monitor the temporal nature of the antibody response to these antigens during experimental infection of mice. The immunodominant regions of each protein have also been assessed through immunoblot analyses of a series of truncations of each protein. These analyses have led to the delineation of the targets of the antibody response during infection and of the specificity of the antibody response to family 163 proteins. In addition, we quantified the expression of each gene using real time RT-PCR.

Introduction: Lyme disease is caused by the tick-borne spirochete Borrelia burgdorferi. Research has shown that dogs can be used as sentinels for human infection of Lyme disease. The purpose of this 5-year, retrospective study was to determine if there was any evidence that the incidence of canine Lyme disease has increased between 2000 and 2005 in Accomack and Northampton counties. An increased incidence in Lyme disease in dogs may indicate an increased present or future risk of Lyme disease in humans.Methods: Cases of canine Lyme disease were identified via practice invoicing systems and dogs that received doxycycline were entered into the database. Demographic information and the absence or presence of clinical signs such as fever, lameness, articular swelling, lymphadenomegaly, anorexia, general malaise and improvement after antibiotic use were collected. Testing history also was recorded.Results: Cases of canine Lyme disease that met any definition were identified (n=1048). Over the 5-year period the number of positive ELISA test results increased and the frequency of clinical signs decreased. The incidence of disease meeting the practitioner's definition increased until 2004 when the incidence dropped from 105.33 cases per 1,000 dogs to 56.93 cases per 1,000. The incidence of disease based on the study probable definition remained fairly constant with a high in 2002 of 2.94 cases per 1,000 dogs.Discussion: Trends of canine Lyme disease coincided with the introduction and use of the in-house ELISA test. Practitioners could identify more dogs exposed to Borrelia burgdorferi. The areas with the highest frequency of canine cases of Lyme disease also had the highest frequency of human cases reported to the Virginia Department of Health. Further study could identify animals that tested positive and later developed clinical signs. Using dogs as sentinels for human infection allows public health workers to identify endemic areas regardless of human case reports.

The aim of the study was to obtain and elaborate information focused on metamorphoses of Borrelia burgdorferi sensu lato (s.l.) spirochetes. The research included detection of various stress conditions for production of dormant forms of Borrelia burgdorferi s.l. spirochetes in vitro. Subsequently, metamorphoses from dormant to motile stages was observed under favourable conditions. Proper PCR method for primers aimed to detect dormant forms of Borrelia was delevoped. The infectious potential of dormant spirochetes of Borrelia burgdorferi sensu stricto (s.s.) complex was observed in vivo. Transformations of spirochetes have also been observed in real time and individual stages have been recorded.

Lyme borreliosis (LB) is the most frequent vectorborne disease in the Northern Hemisphere. It is a complex bacterial zoonosis involving vertebrate hosts and hard ticks of the genus Ixodes. The causative agents, bacteria of the LB group of spirochaetes, form a species complex comprising 17 named species. As is the case for most microbial pathogens, epidemiological and ecological studies require appropriate genotyping. Although the use of single loci may provide rapid results, there are serious disadvantages, in particular when inferring evolutionary relationships or geographic population structure. A novel multilocus sequence analysis (MLSA) system of the LB group spirochaetes has been developed based on housekeeping genes to overcome these problems. Here, the system is optimized and tested using extracted spirochaetal DNA directly from ticks and then utilized to obtain insights into the migration and spread of individual species as well as to investigate the evolutionary origins of the species complex. Species belonging to the LB group of spirochetes display different patterns and levels of host specialisation which makes this an ideal system to study the impact of host associations on spread of zoonotic tickborne diseases. For example, Borrelia valaisiana and B. garinii are transmitted exclusively by birds while B. afzelii is transmitted by rodents. I demonstrate that the migration of the LB species is dependent on, and limited by, the migration of their respective hosts. I also show the presence of B. afzelii strains in England and, through the use of the MLSA scheme, demonstrate that the strains are highly structured. A close evolutionary relationship between B. afzelii and its rodent host species is shown. Furthermore, through phylogenetic analyses, some evidence of a coevolutionary relationship between the LB group species and their major group of vector species, the Ixodes persulcatus species complex, is presented and a Eurasian origin for the species group is suggested.

Borrelia burgdorferi, the causative agent of Lyme disease, exists in a defined enzootic cycle involving Ixodes scapularis ticks and various vertebrates. Humans can serve as an accidental host, if a tick colonized with B. burgdorferi happens to feed on a human. B. burgdorferi are also accidental pathogens: they do not make toxins, or destroy host tissue by other mechanisms. They merely transmit between vector and host to survive. In order to do this, they must effectively sense their current environment, and appropriately alter cellular processes. Understanding the regulatory mechanisms of how B. burgdorferi manages to do this has been a focus of the Stevenson lab for many years. Previous work identified SpoVG as a DNA-binding protein. Although a homologue of this protein had been implicated to serve a regulatory role in other bacteria, the Stevenson lab was the first to demonstrate a function for the protein, both for B. burgdorferi and two other bacteria. Studies contained in this body of work aim to provide insight into regulation of SpoVG by B. burgdorferi as well the impact that it has on gene regulation. By using genetic mutants, we determined that SpoVG is regulated at the levels of transcription and translation in culture by growth rate, temperature, and other regulatory factors. Additionally, we provide evidence that SpoVG regulates its own expression. Numerous genes are under control of SpoVG. Biochemical analyses revealed that SpoVG specifically interacts with DNAs and RNAs associated with genes found to be under its regulatory control. Finally, we provide evidence for SpoVG acting in concert with other known regulatory factors such as other DNA-binding proteins and the cyclic di-nucleotide second messengers cyclic-di-GMP and cyclic-di-AMP. All together, these studies provide insight into how B. burgdorferi broadly regulates cellular processes during different stages of the enzootic cycle. We hypothesize that SpoVG does this through globally manipulating the three-dimensional structure of the bacterial chromosome, and that exactly how SpoVG acts at any given point will be dependent on the other regulatory factors that are also present in the cell.

In der vorliegenden Arbeit sollten die unterschiedlichen Manifestationsformen der Borreliose anhand verschiedener Parameter verglichen und der Verlauf einer Borrelioseerkrankung analysiert werden. Dabei konnte gezeigt werden, dass es sich um eine ganzjährige Erkrankung handelt, die jedoch - je nach Manifestationsform - verschiedene jahreszeitliche Gipfel aufweist. So kommen die Neuroborreliose und die Frühborreliose gehäuft im Frühling und im Sommer vor, während die Lyme Arthritis durchweg ganzjährig auftritt. Da die Borrelien erst nach ca. 12 Stunden Latenz auf den Wirt übertragen werden, sind es vor allem die unbemerkten Zeckenstiche, die eine Infektion verursachen. Deshalb ist es nicht verwunderlich, dass sich nur rund 55 % der Patienten an einen zurück liegenden Zeckenstich erinnern konnten. Bei der Untersuchung der verschiedenen Laborparameter ergaben sich keine wesentlichen Unterschiede zwischen den Manifestationsformen bezüglich Hämoglobingehalt, Blutsenkungsgeschwindigkeit, Thrombozyten und Leukozyten im Serum. Desweiteren ergaben sich keine Hinweise auf eine Beteiligung des Rheumafaktors oder antinukleärer Antikörper an den immunologischen Prozessen während einer Lyme Arthritis Erkrankung. IL-17 konnte mittels ELISA weder in Serum/Plasma noch in Synovialflüssigkeit signifikant erhöht nachgewiesen werden. Es bleibt jedoch unklar, ob dies aufgrund einer langen Lagerung der Proben der Fall war oder ob IL-17 tatsächlich nicht signifikant erhöht vorlag. Aus der Literatur kann man entnehmen, dass IL-17 bei den Abläufen einer Infektion mit B. burgdorferi eine wichtige Rolle zu spielen scheint. Dies könnte einen Ansatz für neue Behandlungsmethoden der Lyme Arthritis darstellen, weshalb die Durchführung weitere Untersuchungen wichtig ist. Durch die Analyse der initialen Serologie konnte die Antikörperreaktion während einer Infektion mit B. burgdorferi veranschaulicht werden, die mit der Bildung von IgM- Antikörpern beginnt und dann einen Shift zu IgG-Antikörpern vollzieht. Die Antigene p19, p31/34, p39 und p65 scheinen hierbei vor allem bei der Lyme Arthritis im Vordergrund zu stehen. Weiterhin konnte bei dieser Analyse beobachtet werden, dass teilweise zahlreiche serologische Untersuchungen bei ein und demselbem Patienten statt fanden, was darauf schließen lässt, dass diese Untersuchung zur Verlaufskontrolle benutzt wurde. Grundsätzlich ist die Serologie hierzu jedoch nicht geeignet. Vielmehr sollte sie lediglich zur Diagnosestellung dienen. In dieser Funktion ist sie bei korrekter Interpretation ein hervorragendenes diagnostisches Mittel. Leider werden serologische Untersuchungen jedoch häufig falsch interpretiert und angewendet, was dazu führt, dass Patienten häufiger oder auch länger als nötig antibiotisch behandelt werden. So erhielten auch rund 8 % der Lyme Arthritis Patienten mehr als 2 Zyklen antibiotischer Therapie. Die Nebenwirkungen dieser langwierigen antibiotischen Behandlung sind nicht zu vernachlässigen. Die aktuellen Leitlinien sehen im Gegensatz dazu nämlich nach dem zweiten antibiotischen Zyklus den Beginn einer Therapie mit DMARD ́s vor, selten kommen auch intraartikuläre Steroide zum Einsatz. Diese beobachtete „Überdiagnostik und Übertherapie“ der Borrelioseerkrankung spiegelt vermutlich die Angst vor chronischen Verlaufsformen in der Bevölkerung und teilweise auch unter Ärzten wider. Bereits in anderen Studien konnte die Existenz einer therapieresistenten Verlaufsform der Borreliose - insbesondere der Lyme Arthritis – nachgewiesen werden. In der vorliegenden Arbeit litten 24 % der Lyme Arthritis Patienten nach einer adäquaten antibiotischen Behandlung laut eigenen Angaben zum Zeitpunkt der Umfrage noch unter Gelenkbeschwerden. Ob es sich hierbei nun um eine schwerwiegendere Verlaufsform in Europa handelt, bleibt zunächst offen. Zur Objektivierung der Beschwerden, zum Ausschluss einer Zweitinfektion oder aber auch einer Fibromyalgie als mögliche Differentialdiagnose sind prospektive Studien mit klinischer Untersuchung der Patienten im Verlauf nötig. Eindeutig ist jedoch, dass durch eine frühzeitige antibiotische Behandlung nach Infektion das Fortschreiten der Erkrankung effektiv verhindert werden kann. Chronische Beschwerden gaben hingegen auch die Patienten mit zurückliegender Neuroborreliose an. Rund 20% der Patienten litten nach eigener Angabe unter Allgemeinsymptomen, die ihre Lebensqualität subjektiv wesentlich einschränkten. Der spezifische Zusammenhang zwischen diesen Beschwerden und einer Neuroborreliose bzw. einer Borrelioseerkrankung im Allgemeinen ließ sich jedoch nicht endgültig klären. Es wäre hierfür der Vergleich mit einer gesunden Kohorte und die Anwendung spezieller neuropsychologischer Untersuchungen nötig. / This paper should compare different manifestations of borreliosis based on various parameters as well as analyze the development of a borreliosis infection. It could be shown that it is a year-round disease reaching different seasonal peaks depending on its manifestation. As an example, neuro borreliosis and early borreliosis occur frequently in spring and summer, whereas lyme arthritis infections occur during the whole year. As borrelia are transmitted to the host only after 12 hours of latency, especially tick bites that go unnoticed cause infections. That is why it does not come as a surprise that only 55% of the patients were able to remember a tick bite in the past. Examining the different laboratory parameters, no substantial differences between the different types of manifestation regarding haemoglobin content, erythrocyte sedimentation rate, thrombocytes and leucocytes in the serum were discovered. In addition, there were no hints as to a contribution of the rheumatic factor or antinuclear antibodies to immunologic processes during a lyme arthritis infection. Using ELISA, IL-17 could neither be detected in serum/plasma nor in synovial liquid in significantly increased concentrations. However, it remains unclear whether this was due to the long storage of the samples or whether IL-17 was actually not significantly increased. According to literature on this topic, IL-17 seems to play a major role during the course of an infection with B. burgdorferi. This could be a starting point for new ways of treating lyme arthritis and makes further research necessary. By analyzing initial serology, the antibody reaction during an infection with B. burgdorferi could be shown. It starts with the creation of IgM antibodies and then shifts to IgG antibodies. The antigenes p19, p31/34, p39 and p65 seem to be especially important when it comes to lyme arthritis. The analysis also made it clear that in some cases a single patient was exposed to numerous serological examinations what makes it probable that this examination was used to control the course of the infection. Basically, serology is not a suitable instrument to do so. It should rather be used to diagnose. Interpreting it correctly, it is in that function an excellent means of diagnosing. Unfortunately, serological examinations are often interpreted and applied in the wrong way, what leads to a more frequent or unnecessarily long antibiotics treatment of patients. Around 8% of lyme arthritis patients received more than two cycles of antibiotics treatment. The side effects of this longsome antibiotics treatment are not to be neglected. In contrast, current guidelines recommend a DMARDs therapy after the second cycle of antibiotics treatment, in rare cases intraarticular steroids are used. This observed “overdiagnostics and overtherapy” of borreliosis infections presumably reflects the fear of chronic infections among the population and partly among doctors. There have already been other studies proving the existence of a form of borreliosis infection resistant to therapy – especially regarding lyme arthritis. According to this paper, 24% of lyme arthritis patients said, when they were interrogated, that they were still suffering from arthralgia after an adequate antibiotics treatment. It remains open whether this is just a more serious progression in Europe. To come to an objective judgement of the pains, to exclude a second infection or a fibromyalgia as a potential differential diagnosis, prospective studies invoving clinical examinations of the patients are necessary. However, it is beyond any doubt that an early antibiotics treatment after the infection can effectively prevent the progress of the infection. Nevertheless, also patients with an overcome neuroborreliosis reported chronic pains. About 20% of the patients reported that they were suffering from general syndromes limiting their quality of life subjectively essentially. The specific connection between these pains and a neuroborreliosis respectively a borreliosis infection in general could, however, not be proven in the end. For this, it would be necessary to make a comparison with a healthy cohort and to apply special neuropsychological studies.

<p>This thesis examines seasonal, diel and vertical distribution patterns of activity of host-seeking <i>Ixodes ricinus</i> (L.) ticks at three localities in south-central Sweden. In addition, by examining the prevalence of infection in ticks with Lyme borreliosis (LB) spirochetes, <i>Borrelia burgdorferi</i> s.l, information for estimating relative LB risk in humans and the effect of control measures directed against this tick vector is provided.</p><p>The seasonal activity pattern of <i>I. ricinus</i> was, in general, bimodal with peaks of activity in May-June and August-September. Tick densities were generally high at Torö and low at Kungshamn-Morga. The greatest variation in tick density occurred at the sample site level, which indicated a patchy distribution of ticks. The diel activity of adult <i>I. ricinus</i> sampled at Bogesund showed a distinct nocturnal activity peak while nymphal ticks exhibited no particular diel variation. At the meadow site, there was a strong negative association between activity of each tick stage and ambient air temperature, and larval ticks also showed a nocturnal activity peak. <i>I. ricinus</i> of all stages were present in the vegetation up to at least 140 cm above ground level. At Torö, host-seeking larvae were found at significantly lower levels (below 20 cm) in the vegetation compared to nymphs and adults (50-59 and 60-79 cm, respectively). Vegetation structure is likely to be the main factor governing tick vertical distribution at this locality. The northern limit of the geographical distribution of <i>I. ricinus</i> in Sweden corresponds with the southern boundary of the taiga zone, as well as with several other climatic or vegetational isoclines primarily associated with the vegetation period.</p><p>The prevalence rates of <i>Borrelia</i> spirochetes, recorded by phase-contrast microscopy in host-seeking <i>I. ricinus</i>, were 0% in larvae, 5.8-13.1% in nymphs and 14.5-28.6% in adult ticks. The human LB risk, estimated by the number of <i>Borrelia</i>-infected nymphs per hectare, was greater at Torö than at Kungshamn-Morga and greater in woodland than in open areas. The risk also possessed a bimodal seasonal pattern similar to that of subadult host-seeking activity. Controlling the number of infected nymphs through de-ticking of reservoir hosts seems not to be an effective control measure in Sweden due to the ubiquitous availability of alternative reservoir hosts.</p>

This thesis examines seasonal, diel and vertical distribution patterns of activity of host-seeking Ixodes ricinus (L.) ticks at three localities in south-central Sweden. In addition, by examining the prevalence of infection in ticks with Lyme borreliosis (LB) spirochetes, Borrelia burgdorferi s.l, information for estimating relative LB risk in humans and the effect of control measures directed against this tick vector is provided. The seasonal activity pattern of I. ricinus was, in general, bimodal with peaks of activity in May-June and August-September. Tick densities were generally high at Torö and low at Kungshamn-Morga. The greatest variation in tick density occurred at the sample site level, which indicated a patchy distribution of ticks. The diel activity of adult I. ricinus sampled at Bogesund showed a distinct nocturnal activity peak while nymphal ticks exhibited no particular diel variation. At the meadow site, there was a strong negative association between activity of each tick stage and ambient air temperature, and larval ticks also showed a nocturnal activity peak. I. ricinus of all stages were present in the vegetation up to at least 140 cm above ground level. At Torö, host-seeking larvae were found at significantly lower levels (below 20 cm) in the vegetation compared to nymphs and adults (50-59 and 60-79 cm, respectively). Vegetation structure is likely to be the main factor governing tick vertical distribution at this locality. The northern limit of the geographical distribution of I. ricinus in Sweden corresponds with the southern boundary of the taiga zone, as well as with several other climatic or vegetational isoclines primarily associated with the vegetation period. The prevalence rates of Borrelia spirochetes, recorded by phase-contrast microscopy in host-seeking I. ricinus, were 0% in larvae, 5.8-13.1% in nymphs and 14.5-28.6% in adult ticks. The human LB risk, estimated by the number of Borrelia-infected nymphs per hectare, was greater at Torö than at Kungshamn-Morga and greater in woodland than in open areas. The risk also possessed a bimodal seasonal pattern similar to that of subadult host-seeking activity. Controlling the number of infected nymphs through de-ticking of reservoir hosts seems not to be an effective control measure in Sweden due to the ubiquitous availability of alternative reservoir hosts.