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Borrelia and Babesia in wild vertebrates, ticks, and humans in Florida. Kerry L. Clark, M.P.H., Ph.D. Associate Professor of Epidemiology Department of Public Health University of North Florida. Topics for Discussion. Evidence of Borrelia and Babesia species in vertebrates and ticks - PowerPoint PPT Presentation
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Borrelia and Babesia in wild vertebrates,ticks, and humans in Florida
Kerry L. Clark, M.P.H., Ph.D.Associate Professor of Epidemiology
Department of Public HealthUniversity of North Florida
Topics for Discussion
Evidence of Borrelia and Babesia species in vertebrates and ticksPrimarily molecular dataGeographic distributionSpecies distribution and infection
prevalenceVertebrates: mammals and reptilesTicks
Borreliosis and babesiosis case reportsSummary of present data
Rocky Mountain Spotted FeverHuman Monocytic Ehrlichiosis (HME)Human Anaplasmosis (formerly HGE)Lyme BorreliosisRelapsing Fever Borreliosis?Human Babesiosis? Babesiosis?
Major Tick-Borne Diseases in the Southeastern USA
Lyme diseaseMost common vector-borne
disease in U.S.Over 23,700 cases reported in
2002
Lyme Borreliosis
Lyme Disease: Major ManifestationsSkin:
Erythema migrans rash; later disseminated rash
Musculoskeletal: Myalgias, arthralgias, recurrent arthritis in
large jointsNeurologic:
Headache, Bell’s palsy, concentrationCardiacConstitutional:
Flu-like symptoms, malaise, fatigue
Geographic Distribution of LD in USA
Lyme Disease in Florida
*2002 data are provisional; standard case definition began in 1991.
Reported Cases of Lyme Disease in Florida, 1985-2002*
(http://www.lyme.org/resources/stats/2000_04.html)
2 0 1 0
6 7
35
24
30 28
17
55 56
71
5954
43
79
0
10
20
30
40
50
60
70
80
90
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Nu
mb
er
of
Ca
se
s
LD Spirochete, Borrelia burgdorferi
Lyme borreliosis group pathogensAt least 11 species (B. burgdorferi s.l.)
3 confirmed pathogensB. burgdorferi sensu stricto (USA)
B. garinii (Europe/Asia)
B. afzelii (Europe/Asia)
Other pathogenic species?B. bissettii, B. andersonii in USA
LD Vector: Blacklegged (Deer) Tick, Ixodes scapularis
Geographic Distribution of LD Vectors
B. burgdorferi Life Cycle
? ?
LD Seasonal Distribution (USA overall)
LD Seasonal Risk
Note: These estimates are based primarily on data from the northeastern USA
Materials and MethodsSite and habitat selection
Materials and MethodsVertebrate and tick sampling
Methods: DNA TestingDNA extractions
Host-seeking adult ticksRodent ear tissueRaccoon, rodent, lizard blood (“Nobutos”)
Qiagen Dneasy Tissue kitEpicentre Masterpure kit
Screening PCR for B. burgdorferi s.l. flagellin (flaB)389-bp. nested PCR productDNA sequencing
Borrelia burgdorferi flagellin DNA among host-seeking adult ticks collected in northern Florida, 1999-2005
No. positive/County Site Tick species No. tested Prevalence
Duval Univ. North Florida lone star tick 4/118 3.4%
Lake Alexander Springs lone star tick 1/27 3.7%
River Forest lone star tick 0/35 0%
St. Johns Guana River lone star tick 0/63 0%
Species total lone star tick 19/622 3.1%
Duval Univ. North Florida blacklegged tick 5/108 4.6%
St. Johns Guana River blacklegged tick 5/108 4.6%
Species total blacklegged tick 10/216 4.6%(Clark 2004. J. Clin. Microbiol. 42: 5076-5086)
Results:
Prevalence of Borrelia burgdorferi flagellin DNA among small mammals collected in Florida, 1999.
Results: vertebrate sampling and testing
No. of PCR positive animals/no. tested (%) of each species
Virginia Flying Golden Rice Cotton Cotton WoodCounty Site opossum squirrel† mouse† rat mouse rat rat TotalDuval UNF 1/1 1/1 2/2 ** 22/25 2/2 ** 28/31
(100) (100) (100) (88) (100) (90)St. Johns Guana 0/1 ** 1/1 3/3 9/10 9/13 1/2 23/30
River (0) (100) (100) (90) (69) (50) (77)Total 1/2 1/1 3/3 3/3 31/34 11/15 1/2 51/61
(50) (100) (100) (100) (91) (73) (50) (84)
† = New host record(Clark 2004. J. Clin. Microbiol. 42: 5076-5086)
Additional data:Duval Big Talbot Island Raccoon
0/17
FLGR11.Is(FL)
AA15pool(FL)
RET.KC9.On(FL)
FLTP1.Is(FL)
AA4Pool(FL)
FLCL3.Ia(FL)
RET.KC14.Gv(FL)
RET.KC1.Pg(FL)
FLNF26.Ia(FL)
B.b.ss.JD1.Is(MA)
RET.KC19.Dv(FL)
B.b.ss.SCI2.Pg(GA)
Bb.ss.SM1.Pg(GA)
B.b.ss.B31.Is(NY)
Bb.ss.HB19.HP(US)
B.b.ss.MI2.Pg(FL)
B.a.MOK3a.Id(MO)
B.a.21123.Id(US)
B.a.19857.Sf(US)
B.b.25015.Is(NY)
RET.FL42.Sh(FL)
RET.FL27.Sh(FL)
B.b.MI9.Pg(FL)
B.b.SCGT8a.I.m./N.f.(SC)
B.b.SCGT10.Nf(SC)
B.sp.MI8.Sh(FL)
B.garinii
B.afzelii
B.lonestari.Aa(TX)
B.miyamotoi
67
99
99
72
52
74
63
67
71
74
80
5667
91
40
18
52
25
54
56
0.02
Neighbor-Joining tree based on 390-bp of the flagellin gene amplified from Florida small mammals and ticks. The tree was rooted with relapsing fever group Borrelia spp. Bootstrap values are percentages of 1,000 replications. Florida B. burgdorferi strains were 98-99% similar to other USA strains of either B. burgdorferi sensu stricto or B. bissettii (Clark 2004. J. Clin. Microbiol. 42: 5076-5086).
Prevalence of B. burgdorferi s.l. flagellin (flaB) gene DNA among lizards from Florida and South Carolina
Number of PCR positive animals/number tested (%) of each species
Broad-headed skink
Brown anole
Fence lizard
Glass lizard
Scrub lizard
Green anole
Ground skink
Race-runner
Five-lined skink
Gecko
Total
Florida 8/18(44)
2/4(50)
3/9(33)
1/1(100)
6/14 (43)
7/17 (41)
5/7(71)
2/11(18)
3/8(38)
0/3(0)
37/92 (40)
South Carolina
13/18 (72)
NT NT 1/1(100)
NT 22/33 (67)
1/1(100)
NT 12/15(80)
NT 49/68 (72)
Total 21/36 (58)
2/4 (50)
3/9(33)
2/2(100)
6/14 (43)
29/50 (58)
6/8(75)
2/11(18)
15/23(65)
0/3(0)
86/160(53.8)
Results: lizard sampling and testing
(Clark et al. 2005. Appl. Environ. Microbiol. 71: 2616-2625)
FL204.As.Florida
FL71.Ac.Florida
FL66.Su.Florida
FL121.Sw.Florida
SC17-3I.s.N.SouthCarolina
FL139.Sw.Florida
B.b.s.s.Tr293.Ir.Turkey
B.b.s.s.SCI2.Pg.GA.USA
FL53.Ov.Florida
B.b.s.s.MI2.Sh.FL.USA
B.b.s.s.B31.Is.NY.USA
B.sp.SCW-30h.Im.SC.USA
B.andersonii.21038.Id.USA
SC194.Sl.SouthCarolina
B.andersonii.19857.Sf.USA
B.andersonii.SI-10.Is.GA.USA
FL118.Su.Florida
FL187.Sl.Florida
SC89.Ei.SouthCarolina
SC170.El.SouthCarolina
SC152.Ac.SouthCarolina
B.bissettii.25015.Is.NY.USA
FL60.Sl.Florida
B.bissettii.SCGT8a.Im.SC.USA
B.bissettii.MI8.Sh.FL.USA
FL203.As.Florida
B.bissettii.DN127.Ip.CA.USA
B.japonica.HO14.Io.Japan
B.garinii.Ip90.Ip.Russia
B.sinica.CMN3.China
B.lusitaniae.PotiB2.Ir.Portugal
B.valaisiana.VS116.Ir.Switzerland
B.afzelii.ACA1.Hs.Sweden
B.lonestari.Aa.TX.USA
63
19
20
85
45
23
100
34
3972
18
9
73
38
36
72
89
85
37
43
65
95
17
25
47
23
39
64
0.02
Unrooted neighbor joining tree based on 389-bp of the flagellin gene amplified from Florida and South Carolina lizards. Bootstrap values are percentages of 1,000 replications. Lizard B. burgdorferi s.l. strains were ~98-99% similar to other USA strains of B. andersoni, B. bissettii, and B. burgdorferi sensu stricto. B. lonestari was included as an outgroup (Clark et al. 2005. Appl. Environ. Microbiol. 71: 2616-2625)
Emergence of Lyme-like illness in eastern USA (STARI: Master’s disease?) Associated with bites of lone star
ticks RFG Borrelia spirochetes found in
lone star ticks via DNA tests Named Borrelia barbouri /lonestari Responsible for cryptic Lyme-like
illnesses in southern USA?
Relapsing Fever Borreliosis
Environmental risk index (ERI*) data for relapsing fever group Borrelia and adult lone star ticks at localities in Florida, March 1999-September 2000.
Mean no. RFG Mean no. RFG BorreliaBorrelia ERI ERI
LocalityLocality ticks/hr. ticks/hr. prevalenceprevalence†† ERIERI risk ratiorisk ratio
Alexander SpringsAlexander Springs 22.6 22.6 0% 0% 0 0 ---- ----
Guana River WMAGuana River WMA 55.1 55.1 4.8% 4.8% 2.62.6 14.7 14.7
Juniper SpringsJuniper Springs 82.7 82.7 0% 0% 0 0 ----- -----
O’Leno State ParkO’Leno State Park 92.9 92.9 2.8% 2.8% 2.6 2.6 14.7 14.7
River ForestRiver Forest 19.4 19.4 0% 0% 0 0 ----- -----
Stephen Foster S.P.Stephen Foster S.P. 15 15 0% 0% 0 0 ----- -----
Tomoka State ParkTomoka State Park 37 37 2.2% 2.2% 0.810.81 4.5 4.5
Univ. North FLUniv. North FL 7.3 7.3 2.5% 2.5% 0.180.18 ReferentReferent
TotalTotal 27.5 27.5 2.0% 2.0% 0.550.55 ----- -----
*ERI = mean no. ticks encountered per hr. of collection effort x infection prevalence† Tick infection status with Borrelia spirochetes determined by nested PCR DNA tests(Clark 2004. J. Clin. Microbiol. 42: 5076-5086)
Neighbor-Joining tree based on 350-bp of the flagellin gene amplified from Florida lone star ticks. The tree was rooted with B. burgdorferi B31 and Florida lone star tick sample A.a. 4 pool. Bootstrap values are percentages of 1,000 replications. Florida B. lonestari flagellin sequences were more than 99% similar to B. lonestari sequences in GenBank(Clark 2004. J. Clin. Microbiol. 42: 5076-5086).
B.parkeri
B.turicatae
Borr.TXW1
B.hermsii
B.coriaceae
B.anserina
B.sp.Spain
B.hispanica
B.crocidurae
B.recurrentis
B.duttonii
B.miyamotoi
B.l.TX
B.l.TN
B.l.NJ
B.l.aa1
AA207FL
B.l.NC.MD
AA15POOLFL
AA18POOLFL
AA97FL
AA115FL
B.b.B31
AA4POOLFL100
42
99
50
74
57
99
37
55
76
61
64
100
9
40
61
78
0.02
Geographic distribution of Borrelia spp. in ticks in Florida
= B. burgdorferi positive site
= B. lonestari positive site
Human Lyme borreliosis case in Florida
Adult female residing in JAX, FL
Tick bite in March 2003
Rash onset in April 2003
No travel outside JAX, FL/St. Mary’s GA region
Consultation in late May
Disseminated rash; no remarkable symptoms
Antibody testing
BSK blood culture
PCR testing
Examples of ErythemaMigrans
Florida Lyme borreliosis patient
PCR/DNA Sequence Analysis for human Lyme borreliosis case in Florida
B.b.s.l. flaB (350-bp)100% with B. andersonii strains (from lizards, I. dentatus, others)
B.b.s.l. ospA (320-bp)100% with FL 121 (scrub lizard from FL)
99.7% with SCW-30h (I.m. from bird in SC)
~96% with B.b. s.s. strains
B.b.s.l. p66 (275-bp)100% with B. bissettii 25015
98% with B. bissettii in rodents from FL
Human Lyme borreliosis case in Florida
Treatment
Late signs/symptoms
Follow up
Discussion
Antibody test result
PCR/DNA sequence resultsGenetic heterogeneity?
Multiple infection?
Human Babesiosis Babesiosis
Malaria-like syndrome caused by Babesia spp. (piroplasms) protozoans
First recognized in U.S. 1968 Hundreds of cases reported since, mostly in
Northeast, Upper MidwestBabesia microti most common agent in U.S.Babesia divergens in EuropeWA1 (B. divergens-like) in Pacific NorthwestMO1 (B. divergens-like) in Missouri
B. microti Life Cycle
B. microti image obtained from: http://medstat.med.utah.edu/parasitology/bmicrot.html
Babesiosis: Clinical FeaturesMany infections probably asymptomaticDisease manifestations
FeverChillsSweatingMyalgiasFatigueHepatosplenomegalyHemolytic anemia
Incubation period: 1 – 4 weeksDisease more severe in immunocompromised
Asplenic, elderly, HIV-infected
Babesiosis: Clinical FeaturesDiagnosis:
Microscopic examination of thick/thin blood smears
Antibody detection (indirect fluorescent antibody (IFA) test
PCR for 18S rRNA gene (SSrDNA)
Treatment:
Clindamycin plus quinine
Atovaquone plus azithromycin
Babesia Research in Vertebrates and Ticks
Screening PCR:
18S SSU rRNA gene nested PCR
Primers BAB1/4 (~238-bp) + BAB2/3 (~154-bp) (Persing et al. 1992)
Confirmatory PCRs
Other 18S SSU rRNA gene nested PCRs (500-1,000-bp)
Beta tubulin gene primers (modified from Zamoto et al. 2004; 500-700-bp)
DNA Sequence Analysis
BAB1-4 PCR Prevalence in vertebrates and ticks in FL and SC
Small mammals:
Rodents (cotton rats 8/15 = 53%; other species 0/54)Raccoons 15/17 = 88%
Lizards:
All species 85/150 = 57% (7 genera and 8 of 10 species tested)Anolis, Cnemidophorus, Eumeces, Hemidactylus, Ophisaurus,
Sceloporus, Scincella spp. Ticks:
Blacklegged ticksUNF 17/118 = 14.4%Guana River Site 11/118 = 9.3%
Lone star ticks 8/198 = 4%American dog ticks 3/81 = 4%Ixodes affinis 4/54 = 7%Gulf Coast ticks 1/24 = 4%
Babesia Sequence Data—Summary 18S SSU rRNA gene (154-238-bp)
Blacklegged, dog, Gulf Coast ticks, I. affinis; cotton rats; lizards
~99% similar to B. microti s.s. (e.g. Gray strain)
Raccoons
~99% with MA USA raccoon strain of B. microti
Beta-tubulin gene (700-bp)
Cotton rats
~99% similar to B. microti s.s.
Raccoons
~99% with MA USA raccoon strain of B. microti
Human case of babesiosis in FloridaBackground
Tampa area
Epidemiology
Confirmed tick species
DNA testing: tick and human blood
Results: B. microti strain? Other species?
Potentially pathogenic Borrelia and Babesia species
Human dataRare/unusual events?
Questions and answers
Clues to scope of risk in FL/Southeast
Research neededPresence, distribution, prevalence of tick-borne pathogens
Genetic data on strains from vertebrates, ticks
*More human case data
CONCLUSIONS