Dynamics of Spirochetemia and Early PCR Detection of Borrelia miyamotoi

Abstract

We investigated whether Borrelia miyamotoi disease can be detected in its early stage by using PCR for borrelial 16S rRNA, which molecule (DNA or RNA) is the best choice for this test, and whether spirochetes are present in blood during the acute phase of B. miyamotoi disease. A total of 473 patients with a suspected tickborne infection in Yekaterinburg, Russia, in 2009, 2010, and 2015 were enrolled in this study. Blood samples were analyzed by using quantitative PCR or ELISA, and a diagnosis of borreliosis was confirmed for 310 patients. For patients with erythema migrans, 5 (3%) of 167 were positive for B. miyamotoi by PCR; for patients without erythema migrans, 65 (45%) of 143 were positive for B. miyamotoi by PCR. The median concentration for RNA was 3.8 times that for DNA. Median time for detection of B. miyamotoi in blood was 4 days.

Keywords: Borrelia burgdorferi; Borrelia miyamotoi; Lyme disease; PCR; Russia; bacteria; borreliosis; detection; diagnosis; dynamics; erythema migrans; relapsing fever; spirochetemia; tickborne diseases; vector-borne infections; zoonoses.

Figure 1

Concentration of Borrelia miyamotoi A) RNA and B) DNA in blood samples from patients with B. miyamotoi disease during disease progression, Yekaterinburg, Russia, 2009–2010. Blood samples were obtained before antimicrobial drug therapy was given. Boxes indicate interquartile ranges (IQRs), horizontal bars indicate medians, and error bars indicate 1.5× IQR. Circles indicate moderate outliers (1.5×–3× IQR, 238,700 copies/mL), and asterisks indicate extreme outliers (>3× IQR, 280,000–420,000 copies/mL).

Figure 2

Distribution of PCR positive blood samples obtained after onset of symptoms for patients infected with A) Borrelia miyamotoi or B) B. burgdorferi sensu lato, Yekaterinburg, Russia, 2009–2010. Blood samples were obtained before antimicrobial drug therapy was given.

Figure 3

Kaplan–Meier estimates of Borrelia miyamotoi RNA or DNA in blood samples from patients with B. miyamotoi disease (solid line), Yekaterinburg, Russia, 2009–2010. Dashed line indicates 95% CIs, and dotted line indicates median. Observations during antimicrobial drug therapy represent incomplete data (right censored).