The aim of this study was to determine the cause of illness in several human patients residing in Florida and Georgia, USA, with suspected Lyme disease based upon EM-like skin lesions and/or symptoms consistent with early localized or late disseminated Lyme borreliosis. Using polymerase chain reaction (PCR) assays developed specifically for Lyme group Borrelia spp., followed by DNA sequencing for confirmation, we identified Borrelia burgdorferi sensu lato DNA in samples of blood and skin and also in lone star ticks (Amblyomma americanum) removed from several patients who either live in or were exposed to ticks in Florida or Georgia. This is the first report to present combined PCR and DNA sequence evidence of infection with Lyme Borrelia spp. in human patients in the southern U.S., and to demonstrate that several B. burgdorferi sensu lato species may be associated with Lyme disease-like signs and symptoms in southern states. Based on the findings of this study, we suggest that human Lyme borreliosis occurs in Florida and Georgia, and that some cases of Lyme-like illness referred to as southern tick associated rash illness (STARI) in the southern U.S. may be attributable to previously undetected B. burgdorferi sensu lato infections.
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Only two studies have reported culture isolation of B. burgdorferi spirochetes from human patients in the southern U.S. Rawlings et al. [23] isolated Borrelia spirochetes from 14 patients in Texas. Several of the isolates were determined to be Lyme Borrelia spirochetes based on reactivity with ospA monoclonal antibody H5332 specific for B. burgdorferi. Felz et al. [22] isolated a B. garinii strain from a patient with known I. scapularis exposure in southern Georgia (USA), but he had also traveled in Europe in the weeks prior to onset of EM, thus confounding attempts to exactly determine the exposure location. To date, attempts by the UNF Lab to isolate Borrelia from human patients in the southern U.S. presenting with Lyme-like signs and symptoms have been unsuccessful. In this study we failed to isolate spirochetes from blood and skin biopsies from several patients from Florida and Georgia, despite identifying B. burgdorferi sensu lato DNA in their blood, skin, or previously attached ticks. This may have been due to using a low volume of patient fluid samples, a low number of spirochetes in the samples that could not be detected via culture, or perhaps the strains infecting patients in this region do not grow well in BSK-H medium. Culture isolation in BSK medium is known to be selective for specific genotypes of B. burgdorferi sensu lato [57].
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http://www.medsci.org/v10p0915.htm
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Only two studies have reported culture isolation of B. burgdorferi spirochetes from human patients in the southern U.S. Rawlings et al. [23] isolated Borrelia spirochetes from 14 patients in Texas. Several of the isolates were determined to be Lyme Borrelia spirochetes based on reactivity with ospA monoclonal antibody H5332 specific for B. burgdorferi. Felz et al. [22] isolated a B. garinii strain from a patient with known I. scapularis exposure in southern Georgia (USA), but he had also traveled in Europe in the weeks prior to onset of EM, thus confounding attempts to exactly determine the exposure location. To date, attempts by the UNF Lab to isolate Borrelia from human patients in the southern U.S. presenting with Lyme-like signs and symptoms have been unsuccessful. In this study we failed to isolate spirochetes from blood and skin biopsies from several patients from Florida and Georgia, despite identifying B. burgdorferi sensu lato DNA in their blood, skin, or previously attached ticks. This may have been due to using a low volume of patient fluid samples, a low number of spirochetes in the samples that could not be detected via culture, or perhaps the strains infecting patients in this region do not grow well in BSK-H medium. Culture isolation in BSK medium is known to be selective for specific genotypes of B. burgdorferi sensu lato [57].
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http://www.medsci.org/v10p0915.htm
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