This post looks at various strains of borrelia, different strains can cause different symptoms. Some are known pathogenic, some are possibly pathogenic, many may not be picked up in present day testing…
Updated June 2015
Scored Antibody Reactivity Determined by Immunoblotting Shows an Association between Clinical Manifestations and Presence of Borrelia burgdorferi sensu stricto, B. garinii, B. afzelii, and B. Valaisianain Humans
J. Clin. Microbiol. December 1999 vol. 37 no. 12 4086-4092
Karine Ryffel1, Olivier Péter1,*, Bernard Rutti2, André Suard3, and Eric Dayer1
Maladies Infectieuses et Immunologie, Institut Central des Hôpitaux Valaisans, 1950 Sion-CH,1 Institut de Zoologie, Université de Neuchâtel, 2007 Neuchâtel-CH,2 and Rue du Bourg 1, 1870 Monthey,3 Switzerland
Among 31 serum samples from patients with neuroborreliosis, 16 were more reactive to B. garinii, 7 were more reactive to B. afzelii, 3 were more reactive to B. valaisiana, and 2 were more reactive to B. burgdorferi sensu stricto. Of 31 serum samples from patients with acrodermatitis, 26 showed a higher level of reactivity to B. afzelii. Of 34 serum samples from patients with Lyme arthritis, 21 were more reactive to B. burgdorferi sensu stricto, 10 were more reactive to B. afzelii, and 1 was more reactive to B. valaisiana. Our results suggest an organotropism of Borrelia species and provide some evidence of a pathogenic potential of B. valaisiana in humans.
Detection of Borrelia afzelii, Borrelia burgdorferi sensu stricto, Borrelia garinii and group VS116 by PCR in skin biopsies of patients with erythema migrans and acrodermatitis chronica atrophicans.
Clin Microbiol Infect. 1997 Feb;3(1):109-116.
Rijpkema SG1, Tazelaar DJ, Molkenboer MJ, Noordhoek GT, Plantinga G, Schouls LM, Schellekens JF.
1Research Laboratory for Infectious Diseases, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
To evaluate the diagnostic performance of two polymerase chain reaction (PCR) procedures using skin biopsies of 20 erythema migrans (EM) and 24 acrodermatitis chronica atrophicans (ACA) patients.
Among EM patients, both assays detected Borrelia DNA in 15 samples. Among ACA patients, the ospA PCR detected 15 positives and 10 samples were positive by 5S-23S PCR. In 19 samples one species was detected, 15 skin biopsies contained Borrelia afzelii, and Borrelia garinii was found in two patients. Group VS116 was detected in two EM patients, and therefore this group has pathogenic potential. Mixed infections of B. afzelii and B. garinii, group VS116 or B. burgdorferi sensu stricto were found in three EM and three ACA patients.
Diagnosis of EM and ACA by PCR is useful and knowledge of the presence of species may be used to predict the course of disease or the need for further antibiotics.
Borrelia miyamotoi in host-seeking Ixodes ricinus ticks in England
K. M. HANSFORDa1 c1, M. FONVILLEa2, S. JAHFARIa2, H. SPRONGa2 and J. M. MEDLOCKa1
a1 Medical Entomology & Zoonoses Ecology Group, MRA&BS, Emergency Response Department, Public Health England, Porton Down, UK
a2 Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Epidemiology and Infection / Volume 143 / Issue 05 / April 2015, pp 1079-1087
This paper reports the first detection of Borrelia miyamotoi in UK Ixodes ricinus ticks. It also reports on the presence and infection rates of I. ricinus for a number of other tick-borne pathogens of public health importance. Ticks from seven regions in southern England were screened for B. miyamotoi, Borrelia burgdorferi sensu lato (s.l.), Anaplasma phagocytophilum and Neoehrlichia mikurensis using qPCR. A total of 954 I. ricinus ticks were tested, 40 were positive for B. burgdorferi s.l., 22 positive for A. phagocytophilum and three positive for B. miyamotoi, with no N. mikurensis detected. The three positive B. miyamotoi ticks came from three geographically distinct areas, suggesting a widespread distribution, and from two separate years, suggesting some degree of endemicity. Understanding the prevalence of Borrelia and other tick-borne pathogens in ticks is crucial for locating high-risk areas of disease transmission.
Lyme and associated tick-borne diseases: global challenges in the context of a public health threat
Front. Cell. Infect. Microbiol., 03 June 2014 | http://dx.doi.org/10.3389/fcimb.2014.00074
Christian Perronne: Infectious Diseases Unit, Hôpitaux Universitaires Paris-Ile de France-Ouest, Assistance Publique – Hôpitaux de Paris, University of Versailles – Saint Quentin en Yvelines, Garches, France
The lack of a gold standard for diagnosis makes producing accurate statistics difficult. Some pathogenic strains belonging to the B. burgdorferi sensu lato complex have a worldwide distribution, yet they are rarely considered or tested for (Varela et al., 2004; Lopes de Carvalho et al., 2009; Rudenko et al., 2009; Stanek and Reiter, 2011; Branda and Rosenberg, 2013; Clark et al., 2013; Lee et al., 2014; Margos et al., 2014). Borrelia miyamotoi, for instance, phylogenetically close to relapsing fever borreliae, is now recognized as a cause of Lyme-like disease and relapsing fever in Asia, Europe and North America. It usually does not cross react with B. burgdorferi tests (Branda and Rosenberg, 2013; Lee et al., 2014). A novel isolate of Borrelia has been isolated by PCR in a post-treatment serum from a patient with neurologic Lyme disease (Lee et al., 2014).
Quoted from our lyme leaflet (PDF):
In Ireland the types of infection carried by ticks include Borrelia garinii (usually resulting in neurological problems) and Borrelia afzelii (usually resulting in skin manifestations such as rashes and ACA – a thinning of the skin).
Borrelia sensu stricto is widely found in North America however cases have been identified in Europe. This strain commonly causes long term arthritis though neurological complications do occur. A tick may transmit several other co-infections including Mycoplasma, Babesia, Bartonella and Anaplasmosis.
For more information on co-infections go to: https://ticktalkireland.wordpress.com/lyme-links/co-infections/
In Ireland another strain of concern which is not widely known is strain VS116 (Borrelia valaisiana). It is important to note that the lesser known strains may not be picked up in antibody testing:
From a survey in Killarney National Park (Co. Kerry, Ireland) in the summer of 1995: ‘The prevalence of ticks infected with B. burgdorferi sensu lato was significantly variable between the five locations, ranging from 11.5 to 28.9%. Four genomospecies were identified as B. burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii, and VS116. Additionally, untypeable B. burgdorferi sensu lato genomospecies were identified in two nymphs.
VS116 was the most prevalent of the genomospecies and was identified in 50% of the infected ticks. Prevalences of B. garinii and B. burgdorferi sensu stricto were similar (17 and 18%, respectively); however, significant differences were observed in the prevalence of these genomospecies in mixed infections (58.8 and 23.5%, respectively).’
In another study published 1997 Prof Gray’s team looked at six locations across Ireland & found that ‘The most prevalent B. burgdorferi genomospecies identified were VS116 (34.6%), B. garinii (24.3%) and B. burgdorferi sensu stricto (18.4%). B. afzelii was uncommon (6.6%).
Multiple infections were observed in 13.2% of the infected ticks.‘
The studies below shows possible pathogenic* problems regarding this strain so we maybe missing many patients by not testing for it..
*Group VS116 was detected in two EM patients, and therefore this group has pathogenic potential. Mixed infections of B. afzelii and B. garinii, group VS116 or B. burgdorferi sensu stricto were found in three EM and three ACA patients.
*Indirect evidence suggests that B. valaisiana is involved in some chronic clinical manifestations. We report the genetic detection of B. valaisianain the CSF of a 61-year- old man with a history of spastic paraparesis, which is strong clinical evidence of advanced neuroborreliosis.
What other strains maybe of significance in Europe?
Molecular Typing of Borrelia burgdorferi Sensu Lato : Taxonomic , Epidemiological , and Clinical Implications.
Wang, G., Alje, P. & Dankert, J., Clin Microbiol Rev. 1999 October; 12(4): 633–653 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88929/
B. bissettii sp. nov. isolates may represent the fourth Borrelia species that could cause human LB. B. valaisiana is widely distributed in European countries as well as in Asia. B. valaisiana has been cultured or detected in ticks or avian reservoirs from at least eight European countries, including the United Kingdom, Ireland, The Netherlands, Switzerland, Germany, Italy, Croatia, and the Czech Republic. This species seems abundantly present in ticks in Ireland, Germany, and Croatia. Only a few B. lusitaniae strains have been isolated in Portugal, the Czech Republic, Moldova, and Ukraine. Nine isolates with genotypic and phenotypic similarity to B. bissettii sp. nov. have been cultured in Slovenia. Mixed infections of multiple B. burgdorferi sensu lato species have been found in ticks, reservoir hosts and in patients with LB. The prevalence of mixed infections in ticks varies from 5 to 40% in different geographic regions.
With regards to testing the paper goes on to say ‘the high percentage of seronegativity in 20 to 50% of patients, probably dependent on the stage of LB, remains a problem and limits the value of serological tests. In addition, the antigenic heterogeneity of B. burgdorferi sensu lato may influence the sensitivity and specificity of serological tests for LB, especially on the European continent, where three pathogenic species of B. burgdorferi sensu lato and at least eight OspA serotypes are well documented…*Differences in the regional distributions of borrelial species may also affect preferential reactivities of sera from patients with LB.* Several studies have shown differences in the reactivity patterns in Western blot analysis, depending on the species, strain, or serotype used as the source of antigen.’
Molecular detection of Borrelia bissettii DNA in serum samples from patients in the Czech Republic with suspected borreliosis.
Rudenko, N. et al., 2009. FEMS microbiology letters, 292(2), pp.274-81.
Molecular analysis of 12 selected serum samples collected in the regional hospital confirmed the presence of B. bissettii DNA in cases of single and multiple infection in patients with symptomatic borreliosis or chronic borrelial infection. After the first isolation of B. bissettii from the samples of human origin in Slovenia, following the detection of this species in cardiac valve tissue of the patient with endocarditis and aortic valve stenosis in the Czech Republic, here we present additional molecular data supporting the involvement of B. bissettii in LB in Europe.
Relationships of a novel Lyme disease spirochete, Borrelia spielmani sp. nov., with its hosts in Central Europe.
Richter, D. et al., 2004. Applied and environmental microbiology, 70(11), pp.6414-9. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=525186
At least four Lyme disease genospecies, Borrelia burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii, and Borrelia bissettii, cause human disease in Central Europe. A fifth pathogenic variant, designated A14S [spielmani], has been isolated from a Dutch patient by culturing spirochetes from an erythema migrans lesion, and similar spirochetes have recently been identified in a German patient with chronic skin disease. The reactivity with monoclonal antibodies and the protein profile of this spirochetal variant are unique.
Inadequate binding of immune regulator factor H is associated with sensitivity of Borrelia lusitaniae to human complement.
Dieterich, R. et al., 2010. Infection and immunity, 78(11), pp.4467-76.
In central Europe, B. burgdorferi sensu stricto, B. afzelii, B. garinii, B. spielmanii, and B. bavariensis are the causative agents of Lyme disease, while the pathogenic potential for B. bissettii, B. valaisiana, and B. lusitaniae remains unclear. The isolation of B. lusitaniae from two Portuguese patients with clinical manifestations similar to the pathogenesis of Lyme disease suggests that this spirochete is pathogenic to humans. Compared to that of other genospecies in central or eastern Europe, the geographic distribution of B. lusitaniae is restricted to areas where lizards are widespread throughout Portugal, Spain, Morocco, and Tunisia or where they are distributed focally in Germany, Poland, France, and Switzerland.
there are so many strains of borrelia wordwide, some causing relapsing fevers, a new one b.miyamotoi.
According to wikipedia…Additional B. burgdorferi sensu lato genospecies suspected of causing illness, but not confirmed by culture, include B. japonica, B. tanukii and B. turdae (Japan); B. sinica (China); and B. andersonii (U.S.). Some of these species are carried by ticks not currently recognized as carriers of Lyme disease.
The B. miyamotoi spirochete, related to the relapsing fever group of spirochetes, is also suspected of causing illness in Japan. Spirochetes similar to B. miyamotoi have recently been found in both Ixodes ricinus ticks in Sweden and I. scapularis ticks in the U.S.
B. lonestari is suspected of causing southern tick-associated rash illness (STARI), also known as Masters disease in honor of its discoverer, Dr. Edwin Jordan Masters. The illness follows a lone star tick bite, and clinically resembles Lyme disease, but sufferers usually test negative for Lyme. There is currently no diagnostic test available for STARI/Masters, and no official treatment protocol, though antibiotics are generally prescribed.
Testing & strains
A final word from Ben Luft, a Stony Brook scientist “What we will find are proteins we never tested for on our ELISAs and Western blots—proteins we were never even aware of. But they will be the critical markers for invasive, infectious Lyme disease. Perhaps people who test negative on the old tests will become positive when we look for the right markers,” he adds.” (Interview with Cure Unknown author Pam Weintraub).
The summary of this post is that s.stricto, afzellii, garinii are known pathogenic strains, miyamotoi & lonestari also cause illness, VS116, bissettii, spielmanii & lusitaniae have been identified in symptomatic patients.
What is strain B31? B31 was the initial strain isolated as a basis for all current day testing. Per wiki: B. burgdorferi strain B31 was derived by limited dilutional cloning from the original Lyme-disease tick isolate derived by Alan Barbour.
Genospecies List below published 2011:
*Borrelia andersonii, Borrelia kurtenbachii, Borrelia californiensis, Borrelia americana and Borrelia carolinensis (North America)
*B. burgdorferi sensu stricto and Borrelia bissettii (North America/Europe)
*Borrelia afzelii, Borrelia garinii, Borrelia lusitaniae, Borrelia spielmanii, Borrelia bavariensis and Borrelia valaisiana (Europe)
*Borrelia japonica, Borrelia turdi, Borrelia sinica, Borrelia yangtze and Borrelia tanukii (Asia)