No molecular detection of tick-borne pathogens in the blood of patients with erythema migrans in Belgium

Abstract

Background: A number of tick-borne pathogens circulate in the Belgian tick population in addition to the causative agent of Lyme borreliosis. However, so far, only a few patients with tick-borne diseases other than Lyme borreliosis have been reported in Belgium. The aim of this study was to investigate the occurrence of other human tick-borne infections in Belgium and their possible clinical manifestation.

Methods: Patients with fever (> 37.5 °C) after a tick bite or those with erythema migrans (EM) were included in the study. EDTA-blood samples were screened for the presence of DNA from Borrelia burgdorferi sensu lato, Borrelia miyamotoi, Anaplasma phagocytophilum, Neoehrlichia mikurensis, spotted fever group rickettsiae (genus Rickettsia), Babesia spp., Bartonella spp., Spiroplasma ixodetis and tick-borne encephalitis virus, using multiplex PCR methods. A questionnaire on, among others, demographics and clinical symptoms, was also filled in.

Results: Over a period of 3 years, 119 patients with EM and 14 patients with fever after a recent tick bite were enrolled in the study. Three samples initially tested positive for N. mikurensis by quantitative PCR (qPCR), but the results could not be confirmed by other PCR methods, and repetition of the DNA extraction procedure and qPCR test was not successful. The qPCR test results for the other tick-borne pathogens were negative.

Conclusions: In general, only a few patients with fever after a tick bite could be identified. Although no tick-borne pathogens were detected, their occurrence cannot be excluded based on the limited number of patients and the limitations inherent to current methodologies. This study underscores the possibility of false-positive PCR results and the necessity for the development of multiple independent tools for the sensitive and specific detection of emerging tick-borne pathogens.

Keywords: Erythema migrans; Ixodes ricinus; Lyme borreliosis; Neoehrlichosis; Neoerhlichia mikurensis; Tick-borne pathogens.

Fig. 1

Flow chart of patient inclusion. ^aOne patient was included in the group of patients with fever after a recent tick bite but was switched to the EM group as the GP also reported multiple EM. ^bEM diagnosis was later disputed by the patient’s GP. ^cEM < 5 cm without recall of tick bite (n =  5) or a known delay in appearance of < 2 days (n = 1). Abbreviations: d, days; EM, erythema migrans; GP, general practitioner; ICD, informed consent document; NA, missing data