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Nucleic Acid Amplification Techniques
Acute Respiratory Distress Syndrome
Restriction Fragment Length Polymorphism
Antimicrobial Susceptibility Testing
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Two genera of ticks are vectors for relapsing fever and LB: (a) and (b).

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Scanning electron micrograph of (provided by Gerhard Wanner, Munich, Germany).

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spirochetes. (A) in a thin smear of patient blood (bright-field microscopy, Giemsa stain); (B) culture (dark-field microscopy).

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Two-step approach for serodiagnosis.

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Whole-cell immunoblot for identification of diagnostic bands with MAbs. The antigen used is strain PKo. Lanes: G, IgG blot from a patient with late disease; M, IgM blot from a patient with early disease; 1 to 11, different MAbs against the respective reactive proteins. (Modified from reference )

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1. Afzelius, A. 1921. Erythema chronicum migrans. Acta. Dermato-Venereol. 2:120125.
2. Aguero-Rosenfeld, M. E.,, J. Nowakowski,, S. Bittker,, D. Cooper,, R. B. Nadelman,, and G. P. Wormser. 1996. Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans. J. Clin. Microbiol. 34:19.
3. Aguero-Rosenfeld, M. E.,, J. Roberge,, C. A. Carbonaro,, J. Nowakowski,, R. B. Nadelman,, and G. P. Wormser. 1999. Effects of OspA vaccination on Lyme disease serologic testing. J. Clin. Microbiol. 37:37183721.
4. Aguero-Rosenfeld, M. E.,, G. Wang,, I. Schwartz,, and G. P. Wormser. 2005. Diagnosis of Lyme borreliosis. Clin. Microbiol. Rev. 18:484509.
5. Akin, E.,, G. L. McHugh,, R. A. Flavell,, E. Fikrig,, and A. C. Steere. 1999. The immunoglobulin (IgG) antibody response to OspA and OspB correlates with severe and prolonged Lyme arthritis and the IgG response to P35 correlates with mild and brief arthritis. Infect. Immun. 67:173181.
6. Alban, P. S.,, P. W. Johnson,, and D. R. Nelson. 2000. Serum- starvation-induced changes in protein synthesis and morphology of Borrelia burgdorferi. Microbiology 146: 119127.
7. Asbrink, E.,, and A. Hovmark. 1988. Early and late cutaneous manifestations in Ixodes-borne borreliosis (erythema migrans borreliosis, Lyme borreliosis). Ann. N. Y. Acad. Sci. 539:415.
8. Assous, M. V.,, and A. Wilamowski. 2009. Relapsing fever in Eurasia—forgotten, but certainly not gone! Clin. Microbiol. Infect. 15:407414.
9. Bacon, R. M.,, B. J. Biggerstaff,, M. E. Schriefer,, R. D. Gilmore, Jr.,, M. T. Philipp,, A. C. Steere,, G. P. Wormser,, A. R. Marques,, and B. J. Johnson. 2003. Serodiagnosis of Lyme disease by kinetic enzyme-linked immunosorbent assay using recombinant VlsE1 or peptide antigens of Borrelia burgdorferi compared with 2-tiered testing using whole-cell lysates. J. Infect. Dis. 187:11871199.
10. Bacon, R. M.,, K. J. Kugeler,, and P. S. Mead. 2008. Surveillance for Lyme disease—United States, 1992-2006. MMWR Surveill. Summ. 57:19.
11. Bankhead, T.,, and G. Chaconas. 2007. The role of VlsE antigenic variation in the Lyme disease spirochete: persistence through a mechanism that differs from other pathogens. Mol. Microbiol. 65:15471558.
12. Baranton, G.,, D. Postic,, G. Saint,, I. P. Boerlin,, J. C. Piffaretti,, M. Assous,, and P. A. Grimont. 1992. Delineation of Borrelia burgdorferi sensu stricto, Borrelia garinii sp. nov., and group VS461 associated with Lyme borreliosis. Int. J. Syst. Bacteriol. 42:378383.
13. Barbour, A. G. 1984. Isolation and cultivation of Lyme disease spirochetes. Yale J. Biol. Med. 57:521525.
14. Barbour, A. G.,, and S. F. Hayes. 1986. Biology of Borrelia species. Microbiol. Rev. 50:381400.
15. Belfaiza, J.,, D. Postic,, E. Bellenger,, G. Baranton,, and I. S. Girons. 1993. Genomic fingerprinting of Borrelia burgdorferi sensu lato by pulsed-field gel electrophoresis. J. Clin. Microbiol. 31:28732877.
16. Berger, B. W.,, R. C. Johnson,, C. Kodner,, and L. Coleman. 1992. Cultivation of Borrelia burgdorferi from erythema migrans lesions and perilesional skin. J. Clin. Microbiol. 30:359361.
17. Bergstrom, S.,, V. G. Bundoc,, and A. G. Barbour. 1989. Molecular analysis of linear plasmid-encoded major surface proteins, OspA and OspB, of the Lyme disease spirochaete Borrelia burgdorferi. Mol. Microbiol. 3:479486.
18. Blanc, F.,, B. Jaulhac,, M. Fleury,, J. de Seze,, S. J. de Martino,, V. Remy,, G. Blaison,, Y. Hansmann,, D. Christmann,, and C. Tranchant. 2007. Relevance of the antibody index to diagnose Lyme neuroborreliosis among seropositive patients. Neurology 69:953958.
19. Bradley, J. F.,, R. C. Johnson,, and J. L. Goodman. 1994. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann. Intern. Med. 120:487489.
20. Brettschneider, S.,, H. Bruckbauer,, N. Klugbauer,, and H. Hofmann. 1998. Diagnostic value of PCR for detection of Borrelia burgdorferi in skin biopsy and urine samples from patients with skin borreliosis. J. Clin. Microbiol. 36:26582665.
21. Brorson, O.,, and S. H. Brorson. 1998. In vitro conversion of Borrelia burgdorferi to cystic forms in spinal fluid, and transformation to mobile spirochetes by incubation in BSKH medium. Infection 26:144150.
22. Brunner, M.,, and L. H. Sigal. 2001. Use of serum immune complexes in a new test that accurately confirms early Lyme disease and active infection with Borrelia burgdorferi. J. Clin. Microbiol. 39:32133221.
23. Burgdorfer, W.,, A. G. Barbour,, S. F. Hayes,, J. L. Benach,, E. Grunwaldt,, and J. P. Davis. 1982. Lyme disease—a tickborne spirochetosis? Science 216:13171319.
24. Carlisle, R. J. 1906. Two cases of relapsing fever with notes on the occurrence of the disease throughout the world at the present day. J. Infect. Dis. 3:233265.
25.Centers for Disease Control and Prevention. 1995. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. Morb. Mortal. Wkly. Rep. 44:590.
26.Centers for Disease Control and Prevention. 2005. Caution regarding testing for Lyme disease. Morb. Mortal. Wkly. Rep. 54:125.
27.Centers for Disease Control and Prevention. 2007. Acute respiratory distress syndrome in persons with tick-borne relapsing fever—three states, 2004-2005. Morb. Mortal. Wkly. Rep. 56:10731076.
28. Collares-Pereira, M.,, S. Couceiro,, I. Franca,, K. Kurtenbach,, S. M. Schafer,, L. Vitorino,, L. Goncalves,, S. Baptista,, M. L. Vieira,, and C. Cunha. 2004. First isolation of Borrelia lusitaniae from a human patient. J. Clin. Microbiol. 42:13161318.
29. Coyle, P. K.,, S. E. Schutzer,, A. L. Belman,, L. B. Krupp,, and Z. Dheng,. 1992. Cerebrospinal fluid immunologic parameters in neurologic Lyme disease, p. 3144. In S. E. Schutzer (ed.), Lyme Disease: Molecular and Immunologic Approaches. Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y.
30. Cutler, S. J.,, A. Abdissa,, and J. F. Trape. 2009. New concepts for the old challenge of African relapsing fever borreliosis. Clin. Microbiol. Infect. 15:400406.
31. Cutler, S. J.,, J. Moss,, M. Fukunaga,, D. J. Wright,, D. Fekade,, and D. Warrell. 1997. Borrelia recurrentis characterization and comparison with relapsing-fever, Lyme-associated, and other Borrelia spp. Int. J. Syst. Bacteriol. 47:958968.
32. de Silva, A. M.,, and E. Fikrig. 1995. Growth and migration of Borrelia burgdorferi in Ixodes ticks during blood feeding. Am. J. Trop. Med. Hyg. 53:397404.
33. Dressler, F.,, R. Ackermann,, and A. C. Steere. 1994. Antibody responses to the three genomic groups of Borrelia burgdorferi in European Lyme borreliosis. J. Infect. Dis. 169:313318.
34. Dressler, F.,, J. A. Whalen,, B. N. Reinhardt,, and A. C. Steere. 1993. Western blotting in the serodiagnosis of Lyme disease. J. Infect. Dis. 167:392400.
35. Dumler, J. S. 2001. Molecular diagnosis of Lyme disease: review and meta-analysis. Mol. Diagn. 6:111.
36. Dutton, J. E.,, and J. L. Todd. 1905. The nature of tick fever in the eastern part of the Congo Free State, with notes on the distribution and bionomics of the ticks. Br. Med. J. 2:12591260.
37. Dworkin, M. S.,, T. G. Schwan,, D. E. Anderson, Jr.,, and S. M. Borchardt. 2008. Tick-borne relapsing fever. Infect. Dis. Clin. N. Am. 22:449468, viii.
38. Eiffert, H.,, A. Karsten,, R. Thomssen,, and H. J. Christen. 1998. Characterization of Borrelia burgdorferi strains in Lyme arthritis. Scand. J. Infect. Dis. 30:265268.
39. Eiffert, H.,, A. Ohlenbusch,, H. J. Christen,, R. Thomssen,, A. Spielman,, and F. R. Matuschka. 1995. Nondifferentiation between Lyme disease spirochetes from vector ticks and human cerebrospinal fluid. J. Infect. Dis. 171:476479.
40. Engstrom, S. M.,, E. Shoop,, and R. C. Johnson. 1995. Immunoblot interpretation criteria for serodiagnosis of early Lyme disease. J. Clin. Microbiol. 33:419427.
41. Felsenfeld, O. 1965. Borrelia; Strains, Vectors, Human and Animal Borreliosis. Warren H. Green, Inc., St. Louis, MO.
42. Fleming, R. V.,, A. R. Marques,, M. S. Klempner,, C. H. Schmid,, L. G. Dally,, D. S. Martin,, and M. T. Philipp. 2004. Pre-treatment and post-treatment assessment of the C(6) test in patients with persistent symptoms and a history of Lyme borreliosis. Eur. J. Clin. Microbiol. Infect. Dis. 23:615618.
43. Fraser, C. M.,, S. Casjens,, W. M. Huang,, G. G. Sutton,, R. Clayton,, R. Lathigra,, O. White,, K. A. Ketchum,, R. Dodson,, E. K. Hickey,, M. Gwinn,, B. Dougherty,, J. F. Tomb,, R. D. Fleischmann,, D. Richardson,, J. Peterson,, A. R. Kerlavage,, J. Quackenbush,, S. Salzberg,, M. Hanson,, R. van Vugt,, N. Palmer,, M. D. Adams,, J. Gocayne,, J. Weidman,, T. Utterback,, L. Watthey,, L. McDonald,, P. Artiach,, C. Bowman,, S. Garland,, C. Fuji,, M.D. Cotton,, K. Horst,, K. Roberts,, B. Hatch,, H. O. Smith,, and J. C. Venter. 1997. Genomic sequence of a Lyme disease spirochaete, Borrelia burgdorferi. Nature 390:580586.
44. Gern, L. 2009. Life cycle of Borrelia burgdorferi sensu lato and transmission to humans. Curr. Probl. Dermatol. 37:1830.
45. Glöckner, G.,, R. Lehmann,, A. Romualdi,, S. Pradella,, U. Schulte-Spechtel,, M. Schilhabel,, B. Wilske,, J. Suhnel,, and M. Platzer. 2004. Comparative analysis of the Borrelia garinii genome. Nucleic Acids Res. 32:60386046.
46. Goettner, G.,, U. Schulte-Spechtel,, R. Hillermann,, G. Liegl,, B. Wilske,, and V. Fingerle. 2005. Improvement of Lyme borreliosis serodiagnosis by a newly developed recombinant IgG and IgM line immunoblot and addition of VlsE and DbpA homologues. J. Clin. Microbiol. 43:36023609.
47. Goodman, J. L.,, J. F. Bradley,, A. E. Ross,, P. Goellner,, A. Lagus,, B. Vitale,, B. W. Berger,, S. Luger,, and R. C. Johnson. 1995. Bloodstream invasion in early Lyme disease: results from a prospective, controlled, blinded study using the polymerase chain reaction. Am. J. Med. 99:612.
48. Gruntar, I.,, T. Malovrh,, R. Murgia,, and M. Cinco. 2001. Conversion of Borrelia garinii cystic forms to motile spirochetes in vivo. APMIS 109:383388.
49. Halperin, J. J. 2008. Nervous system Lyme disease. Infect. Dis. Clin. N. Am. 22:261274, vi.
50. Hansen, K.,, P. Hindersson,, and N. S. Pedersen. 1988. Measurement of antibodies to the Borrelia burgdorferi flagellum improves serodiagnosis in Lyme disease. J. Clin. Microbiol. 26:338346.
51. Hansen, K.,, and A. M. Lebech. 1991. Lyme neuroborreliosis: a new sensitive diagnostic assay for intrathecal synthesis of Borrelia burgdorferi—specific immunoglobulin G, A, and M. Ann. Neurol. 30:197205.
52. Hansen, K.,, K. Pii,, and A. M. Lebech. 1991. Improved immunoglobulin M serodiagnosis in Lyme borreliosis by using a m-capture enzyme-linked immunosorbent assay with biotinylated Borrelia burgdorferi flagella. J. Clin. Microbiol. 29:166173.
53. Hauser, U.,, G. Lehnert,, R. Lobentanzer,, and B. Wilske. 1997. Interpretation criteria for standardized Western blots for three European species of Borrelia burgdorferi sensu lato. J. Clin. Microbiol. 35:14331444.
54. Hildenbrand, P.,, D. E. Craven,, R. Jones,, and P. Nemeskal. 2009. Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis. AJNR Am. J. Neuroradiol. 30:10791087.
55. Hodzic, E.,, S. Feng,, K. J. Freet,, D. L. Borjesson,, and S. W. Barthold. 2002. Borrelia burgdorferi population kinetics and selected gene expression at the host-vector interface. Infect. Immun. 70:33823388.
56. Hollstrom, E. 1951 Successful treatment of erythema migrans Afzelius. Acta. Derm. Venereol. 31:235243.
57. Horowitz, H. W.,, C. S. Pavia,, S. Bittker,, G. Forseter,, D. Cooper,, R. B. Nadelman,, D. Byrne,, R. C. Johnson,, and G. P. Wormser. 1994. Sustained cellular immune responses to Borrelia burgdorferi: lack of correlation with clinical presentation and serology. Clin. Diagn. Lab. Immunol. 1:373378.
58. Hubalek, Z. 2009. Epidemiology of lyme borreliosis. Curr. Probl. Dermatol. 37:3150.
59. Humair, P.,, and L. Gern. 2000. The wild hidden face of Lyme borreliosis in Europe. Microbes Infect. 2:915922.
60. Hyde, F. W.,, R. C. Johnson,, T. J. White,, and C. E. Shelburne. 1989. Detection of antigens in urine of mice and humans infected with Borrelia burgdorferi, etiologic agent of Lyme disease. J. Clin. Microbiol. 27:5861.
61. Ivanova, L.,, I. Christova,, V. Neves,, M. Aroso,, L. Meirelles,, D. Brisson,, and M. Gomes-Solecki. 2009. Comprehensive seroprofiling of sixteen B. burgdorferi OspC: implications for Lyme disease diagnostics design. Clin. Immunol. 132:393400.
62. Jauris-Heipke, S.,, G. Liegl,, V. Preac-Mursic,, D. Rössler,, E. Schwab,, E. Soutschek,, G. Will,, and B. Wilske. 1995. Molecular analysis of genes encoding outer surface protein C (OspC) of Borrelia burgdorferi sensu lato: relationship to ospA genotype and evidence of lateral gene exchange of ospC. J. Clin. Microbiol. 33:18601866.
63. Johnson, B. J., 2006. Lyme disease: serologic assays for antibodies to Borrelia burgdorferi, p. 493500. In B. Detrick,, R. G. Hamilton,, and J. D. Folds (ed.), Manual of Molecular and Clinical Laboratory Immunology, 7th ed. ASM Press, Washington, DC.
64. Johnson, B. J.,, K. E. Robbins,, R. E. Bailey,, B. L. Cao,, S. L. Sviat,, R. B. Craven,, L. W. Mayer,, and D. T. Dennis. 1996. Serodiagnosis of Lyme disease: accuracy of a two-step approach using a flagella-based ELISA and immunoblotting. J. Infect. Dis. 174:346353.
65. Johnson, R. C., 1998. Borrelia, p. 12771286. In L. H. Collier, and W. W. Topley (ed.), Topley & Wilson’s Microbiology and Microbial Infections. Arnold, London, Great Britain.
66. Johnson, W. D., Jr., 1995. Borrelia species (relapsing fever), p. 21412143. In G. L. Mandell,, J. E. Bennett,, and R. Dolin (ed.), Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 4th ed. Churchill Livingstone, New York, NY.
67. Kahl, O.,, C. Janetzki-Mittmann,, J. S. Gray,, R. Jonas,, J. Stein,, and R. de Boer. 1998. Risk of infection with Borrelia burgdorferi sensu lato for a host in relation to the duration of nymphal Ixodes ricinus feeding and the method of tick removal. Zentbl. Bakteriol. 287:4152.
68. Kaiser, R.,, and S. Rauer. 1999. Advantage of recombinant borrelial proteins for serodiagnosis of neuroborreliosis. J. Med. Microbiol. 48:510.
69. Kaiser, R.,, and S. Rauer. 1999. Serodiagnosis of neuroborreliosis: comparison of reliability of three confirmatory assays. Infection 27:177182.
70. Kalish, R. A.,, J. M. Leong,, and A. C. Steere. 1993. Association of treatment-resistant chronic Lyme arthritis with HLADR4 and antibody reactivity to OspA and OspB of Borrelia burgdorferi. Infect. Immun. 61:27742779.
71. Kalish, R. S.,, J. A. Wood,, W. Golde,, R. Bernard,, L. E. Davis,, R. C. Grimson,, P. K. Coyle,, and B. J. Luft. 2003. Human T lymphocyte response to Borrelia burgdorferi infection: no correlation between human leukocyte function antigen type 1 peptide response and clinical status. J. Infect. Dis. 187:102108.
72. Klempner, M. S.,, C. H. Schmid,, L. Hu,, A. C. Steere,, G. Johnson,, B. McCloud,, R. Noring,, and A. Weinstein. 2001. Intralaboratory reliability of serologic and urine testing for Lyme disease. Am. J. Med. 110:217219.
73. Kraiczy, P.,, J. Hellwage,, C. Skerka,, H. Becker,, M. Kirschfink,, M. M. Simon,, V. Brade,, P. F. Zipfel,, and R. Wallich. 2004. Complement resistance of Borrelia burgdorferi correlates with the expression of BbCRASP-1, a novel linear plasmid-encoded surface protein that interacts with human factor H and FHL-1 and is unrelated to Erp proteins. J. Biol. Chem. 279:24212429.
74. Lahdenne, P.,, J. Panelius,, H. Saxen,, T. Heikkila,, H. Sillanpaa,, M. Peltomaa,, M. Arnez,, H. I. Huppertz,, and I. J. Seppala. 2003. Improved serodiagnosis of erythema migrans using novel recombinant borrelial BBK32 antigens. J. Med. Microbiol. 52:563567.
75. Lawrenz, M. B.,, J. M. Hardham,, R. T. Owens,, J. Nowakowski,, A. C. Steere,, G. P. Wormser,, and S. J. Norris. 1999. Human antibody responses to VlsE antigenic variation protein of Borrelia burgdorferi. J. Clin. Microbiol. 37:39974004.
76. Lebech, A. M.,, K. Hansen,, F. Brandrup,, O. Clemmensen,, and L. Halkier-Sorensen. 2000. Diagnostic value of PCR for detection of Borrelia burgdorferi DNA in clinical specimens from patients with erythema migrans and Lyme neuroborreliosis. Mol. Diagn. 5:139150.
77. Le Fleche, A.,, D. Postic,, K. Girardet,, O. Peter,, and G. Baranton. 1997. Characterization of Borrelia lusitaniae sp. nov. by 16S ribosomal DNA sequence analysis. Int. J. Syst. Bacteriol. 47:921925.
78. Liang, F. T.,, E. Aberer,, M. Cinco,, L. Gern,, C. M. Hu,, Y. N. Lobet,, M. Ruscio,, P. E. Voet, Jr.,, V. E. Weynants,, and M. T. Philipp. 2000. Antigenic conservation of an immunodominant invariable region of the VlsE lipoprotein among European pathogenic genospecies of Borrelia burgdorferi SL. J. Infect. Dis. 182:14551462.
79. Luft, B. J.,, C. R. Steinman,, H. C. Neimark,, B. Muralidhar,, T. Rush,, M. F. Finkel,, M. Kunkel,, and R. J. Dattwyler. 1992. Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection. JAMA 267:13641367.
80. Marques, A. R.,, R. L. Hornung,, L. Dally,, and M. T. Philipp. 2005. Detection of immune complexes is not independent of detection of antibodies in Lyme disease patients and does not confirm active infection with Borrelia burgdorferi. Clin. Diagn. Lab. Immunol. 12:10361040.
81. Mathiesen, M. J.,, M. Christiansen,, K. Hansen,, A. Holm,, E. Asbrink,, and M. Theisen. 1998. Peptide-based OspC enzyme-linked immunosorbent assay for serodiagnosis of Lyme borreliosis. J. Clin. Microbiol. 36:34743479.
82. Nocton, J. J.,, F. Dressler,, B. J. Rutledge,, P. N. Rys,, D. H. Persing,, and A. C. Steere. 1994. Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis. N. Engl. J. Med. 330:229234.
83. Norris, S. J. 2006. Antigenic variation with a twist-the Borrelia story. Mol. Microbiol. 60:13191322.
84. Ojaimi, C.,, C. Brooks,, S. Casjens,, P. Rosa,, A. Elias,, A. Barbour,, A. Jasinskas,, J. Benach,, L. Katona,, J. Radolf,, M. Caimano,, J. Skare,, K. Swingle,, D. Akins,, and I. Schwartz. 2003. Profiling of temperature-induced changes in Borrelia burgdorferi gene expression by using whole genome arrays. Infect. Immun. 71:16891705.
85. Pachner, A. R.,, and I. Steiner. 2007. Lyme neuroborreliosis: infection, immunity, and inflammation. Lancet Neurol. 6:544552.
86. Panelius, J.,, P. Lahdenne,, H. Saxen,, S. A. Carlsson,, T. Heikkila,, M. Peltomaa,, A. Lauhio,, and I. Seppala. 2003. Diagnosis of Lyme neuroborreliosis with antibodies to recombinant proteins DbpA, BBK32, and OspC, and VlsE IR6 peptide. J. Neurol. 250:13181327.
87. Peltomaa, M.,, G. McHugh,, and A. C. Steere. 2003. Persistence of the antibody response to the VlsE sixth invariant region (IR6) peptide of Borrelia burgdorferi after successful antibiotic treatment of Lyme disease. J. Infect. Dis. 187:11781186.
88. Persing, D. H.,, B. J. Rutledge,, P. N. Rys,, D. S. Podzorski,, P. D. Mitchell,, K. D. Reed,, B. Liu,, E. Fikrig,, and S. E. Malawista. 1994. Target imbalance: disparity of Borrelia burgdorferi genetic material in synovial fluid from Lyme arthritis patients. J. Infect. Dis. 169:668672.
89. Philipp, M. T.,, A. R. Marques,, P. T. Fawcett,, L. G. Dally,, and D. S. Martin. 2003. C6 test as an indicator of therapy outcome for patients with localized or disseminated Lyme borreliosis. J. Clin. Microbiol. 41:49554960.
90. Phillips, S. E.,, L. H. Mattman,, D. Hulinska,, and H. Moayad. 1998. A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those previously aggressively treated. Infection 26:364367.
91. Picken, M. M.,, R. N. Picken,, D. Han,, Y. Cheng,, E. Ruzic- Sabljic,, J. Cimperman,, V. Maraspin,, S. Lotric-Furlan,, and F. Strle. 1997. A two year prospective study to compare culture and polymerase chain reaction amplification for the detection and diagnosis of Lyme borreliosis. Mol. Pathol. 50:186193.
92. Pollack, R. J.,, S. R. Telford III,, and A. Spielman. 1993. Standardization of medium for culturing Lyme disease spirochetes. J. Clin. Microbiol. 31:12511255.
93. Postic, D.,, M. V. Assous,, P. A. Grimont,, and G. Baranton. 1994. Diversity of Borrelia burgdorferi sensu lato evidenced by restriction fragment length polymorphism of rrf (5S)-rrl (23S) intergenic spacer amplicons. Int. J. Syst. Bacteriol. 44:743752.
94. Prasad, A.,, and D. Sankar. 1999. Overdiagnosis and overtreatment of Lyme neuroborreliosis are preventable. Postgrad. Med. J. 75:650656.
95. Preac-Mursic, V., 1993. Antibiotic susceptibility of Borrelia burgdorferi, in vitro and in vivo, p. 301311. In K. Weber, and W. Burgdorfer (ed.), Aspects of Lyme Borreliosis. Springer Verlag, Berlin, Germany.
96. Preac-Mursic, V.,, B. Wilske,, and S. Reinhardt. 1991. Culture of Borrelia burgdorferi on six solid media. Eur. J. Clin. Microbiol. Infect. Dis. 10:10761079.
97. Priem, S.,, M. G. Rittig,, T. Kamradt,, G. R. Burmester,, and A. Krause. 1997. An optimized PCR leads to rapid and highly sensitive detection of Borrelia burgdorferi in patients with Lyme borreliosis. J. Clin. Microbiol. 35:685690.
98. Ramos, J. M.,, E. Malmierca,, F. Reyes,, W. Wolde,, A. Galata,, A. Tesfamariam,, and M. Gorgolas. 2004. Characteristics of louse-borne relapsing fever in Ethiopian children and adults. Ann. Trop. Med. Parasitol. 98:191196.
99. Rauter, C.,, M. Mueller,, I. Diterich,, S. Zeller,, D. Hassler,, T. Meergans,, and T. Hartung. 2005. Critical evaluation of urine-based PCR assay for diagnosis of Lyme borreliosis. Clin. Diagn. Lab. Immunol. 12:910917.
100. Richter, D.,, D. Postic,, N. Sertour,, I. Livey,, F.-R. Matuschka,, and G. Baranton. 2006. Delineation of Borrelia burgdorferi sensu lato species by multilocus sequence analysis and confirmation of the delineation of B. spielmanii sp. nov. Int. J. Syst. Evol. Microbiol. 56:873881.
101. Rijpkema, S. G.,, D. J. Tazelaar,, M. J. Molkenboer,, G. T. Noordhoek,, G. Plantinga,, L. M. Schouls,, and J. F. Schellekens. 1997. 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. 3:109116.
102. Roth, A.,, H. Mauch,, and U. B. Göbel. 1997. MIQ 1, nucleic acid amplification techniques. In H. Mauch and (ed.), Qualitätsstandards in der Mikrobiologisch-Infektiologischen Diagnostik. Gustav Fischer Verlag, Stuttgart, Germany. (In German.).
103. Russell, H.,, J. S. Sampson,, G. P. Schmid,, H. W. Wilkinson,, and B. Plikaytis. 1984. Enzyme-linked immunosorbent assay and indirect immunofluorescence assay for Lyme disease. J. Infect. Dis. 149:465470.
104. Ruzic-Sabljic, E.,, V. Maraspin,, S. Lotric-Furlan,, T. Jurca,, M. Logar,, A. Pikelj-Pecnik,, and F. Strle. 2002. Characterization of Borrelia burgdorferi sensu lato strains isolated from human material in Slovenia. Wien. Klin. Wochenschr. 114:544550.
105. Schmidt, B. L. 1997. PCR in laboratory diagnosis of human Borrelia burgdorferi infections. Clin. Microbiol. Rev. 10:185201.
106. Schulte-Spechtel, U.,, G. Lehnert,, G. Liegl,, V. Fingerle,, C. Heimerl,, B. J. Johnson,, and B. Wilske. 2003. Significant improvement of the recombinant Borrelia-specific immunoglobulin G immunoblot test by addition of VlsE and a DbpA homologue derived from Borrelia garinii for diagnosis of early neuroborreliosis. J. Clin. Microbiol. 41:12991303.
107. Schutzer, S. E.,, P. K. Coyle,, P. Reid,, and B. Holland. 1999. Borrelia burgdorferi-specific immune complexes in acute Lyme disease. JAMA 282:19421946.
108. Schwan, T. G. 2003. Temporal regulation of outer surface proteins of the Lyme-disease spirochaete Borrelia burgdorferi. Biochem. Soc. Trans. 31:108112.
109. Schwartz, J. J.,, A. Gazumyan,, and I. Schwartz. 1992. rRNA gene organization in the Lyme disease spirochete, Borrelia burgdorferi. J. Bacteriol. 174:37573765.
110. Scrimenti, R. J. 1970. Erythema chronicum migrans. Arch. Dermatol. 102:104105.
111. Seinost, G.,, D. E. Dykhuizen,, R. J. Dattwyler,, W. T. Golde,, J. J. Dunn,, I. N. Wang,, G. P. Wormser,, M. E. Schriefer,, and B. J. Luft. 1999. Four clones of Borrelia burgdorferi sensu stricto cause invasive infection in humans. Infect. Immun. 67:35183524.
112. Stanek, G.,, and F. Strle. 2003. Lyme borreliosis. Lancet 362:16391647.
113. Steere, A. C. 2006. Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut. Wien. Klin. Wochenschr. 118:625633.
114. Steere, A. C.,, V. P. Berardi,, K. E. Weeks,, E. L. Logigian,, and R. Ackermann. 1990. Evaluation of the intrathecal antibody response to Borrelia burgdorferi as a diagnostic test for Lyme neuroborreliosis. J. Infect. Dis. 161:12031209.
115. Steere, A. C.,, J. Coburn,, and L. Glickstein. 2004. The emergence of Lyme disease. J. Clin. Investig. 113:10931101.
116. Steere, A. C.,, S. E. Malawista,, D. R. Snydman,, R. E. Shope,, W. A. Andiman,, M. R. Ross,, and F. M. Steele. 1977. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum. 20:717.
117. Steere, A. C.,, G. McHugh,, N. Damle,, and V. K. Sikand. 2008. Prospective study of serologic tests for Lyme disease. Clin. Infect. Dis. 47:188195.
118. Strle, F.,, R. B. Nadelman,, J. Cimperman,, J. Nowakowski,, R. N. Picken,, I. Schwartz,, V. Maraspin,, M. E. Aguero- Rosenfeld,, S. Varde,, S. Lotric-Furlan,, and G. P. Wormser. 1999. Comparison of culture-confirmed erythema migrans caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia. Ann. Intern. Med. 130:3236.
119. Vasiliu, V.,, P. Herzer,, D. Rössler,, G. Lehnert,, and B. Wilske. 1998. Heterogeneity of Borrelia burgdorferi sensu lato demonstrated by an ospA-type-specific PCR in synovial fluid from patients with Lyme arthritis. Med. Microbiol. Immunol. 187:97102.
120. Vial, L.,, G. Diatta,, A. Tall,, H. Bael,, H. Bouganali,, P. Durand,, C. Sokhna,, C. Rogier,, F. Renaud,, and J. F. Trape. 2006. Incidence of tick-borne relapsing fever in west Africa: longitudinal study. Lancet 368:3743.
121. Wang, G.,, A. P. van Dam,, and J. Dankert. 1999. Phenotypic and genetic characterization of a novel Borrelia burgdorferi sensu lato isolate from a patient with lyme borreliosis. J. Clin. Microbiol. 37:30253028.
122. Wang, G.,, A. P. van Dam,, I. Schwartz,, and J. Dankert. 1999. Molecular typing of Borrelia burgdorferi sensu lato: taxonomic, epidemiological, and clinical implications. Clin. Microbiol. Rev. 12:633653.
123. Weber, K.,, and H. W. Pfister. 1994. Clinical management of Lyme borreliosis. Lancet 343:10171020.
123a.. Whitaker, J. A.,, E. G. Fort,, and D. M. Hamilton. January 2005. U.S. patent 6,838,247.
124. Wilske, B. 2005. Epidemiology and diagnosis of Lyme borreliosis. Ann. Med. 37:568579.
125. Wilske, B.,, U. Busch,, H. Eiffert,, V. Fingerle,, H. W. Pfister,, D. Rössler,, and V. Preac-Mursic. 1996. Diversity of OspA and OspC among cerebrospinal fluid isolates of Borrelia burgdorferi sensu lato from patients with neuroborreliosis in Germany. Med. Microbiol. Immunol. 184: 195201.
126. Wilske, B.,, U. Busch,, V. Fingerle,, S. Jauris-Heipke,, V. Preac Mursic,, D. Rössler,, and G. Will. 1996. Immunological and molecular variability of OspA and OspC. Implications for Borrelia vaccine development. Infection 24:208212.
127. Wilske, B.,, V. Fingerle,, P. Herzer,, A. Hofmann,, G. Lehnert,, H. Peters,, H. W. Pfister,, V. Preac-Mursic,, E. Soutschek,, and K. Weber. 1993. Recombinant immunoblot in the serodiagnosis of Lyme borreliosis. Comparison with indirect immunofluorescence and enzyme-linked immunosorbent assay. Med. Microbiol. Immunol. 182:255270.
128. Wilske, B.,, C. Habermann,, V. Fingerle,, B. Hillenbrand,, S. Jauris-Heipke,, G. Lehnert,, I. Pradel,, D. Rössler,, and U. Schulte-Spechtel. 1999. An improved recombinant IgG immunoblot for serodiagnosis of Lyme borreliosis. Med. Microbiol. Immunol. 188:139144.
129. Wilske, B.,, S. Jauris-Heipke,, R. Lobentanzer,, I. Pradel,, V. Preac-Mursic,, D. Rössler,, E. Soutschek,, and R. C. Johnson. 1995. Phenotypic analysis of outer surface protein C (OspC) of Borrelia burgdorferi sensu lato by monoclonal antibodies: relationship to genospecies and OspA serotype. J. Clin. Microbiol. 33:103109.
130. Wilske, B.,, V. Preac-Mursic,, U. B. Göbel,, B. Graf,, S. Jauris,, E. Soutschek,, E. Schwab,, and G. Zumstein. 1993. An OspA serotyping system for Borrelia burgdorferi based on reactivity with monoclonal antibodies and OspA sequence analysis. J. Clin. Microbiol. 31:340350.
131. Wilske, B.,, G. Schierz,, V. Preac-Mursic,, K. von Busch,, R. Kuhbeck,, H. W. Pfister,, and K. Einhäupl. 1986. Intrathecal production of specific antibodies against Borrelia burgdorferi in patients with lymphocytic meningoradiculitis (Bannwarth’s syndrome). J. Infect. Dis. 153:304314.
132. Wilske, B.,, B. J. B. Johnson, and M. E. Schriefer,. 2007. Borrelia, p. 971986. In P. R. Murray,, E. J. Baron,, J. H. Jorgensen,, M. L. Landry,, and M. A. Pfaller (ed.), Manual of Clinical Microbiology, 9th ed. ASM Press, Washington, DC.
133. Wilske, B.,, L. Zöller,, V. Brade,, H. Eiffert,, U. B. Göbel,, G. Stanek,, and H. W. Pfister,. 2000. MIQ 12, Lyme-Borreliose, p. 159. In H. Mauch, and R. Lütticken (ed.), Qualitätsstandards in der Mikrobiologisch-Infektiologischen Diagnostik. Urban & Fischer Verlag, Munich, Germany.
134. Wormser, G. P. 2006. Early Lyme disease. N. Engl. J. Med. 354:27942801.
135. Wormser, G. P.,, S. Bittker,, D. Cooper,, J. Nowakowski,, R. B. Nadelman,, and C. Pavia. 2000. Comparison of the yields of blood cultures using serum or plasma from patients with early Lyme disease. J. Clin. Microbiol. 38:16481650.
136. Wormser, G. P.,, R. J. Dattwyler,, E. D. Shapiro,, J. J. Halperin,, A. C. Steere,, M. S. Klempner,, P. J. Krause,, J. S. Bakken,, F. Strle,, G. Stanek,, L. Bockenstedt,, D. Fish,, J. S. Dumler,, and R. B. Nadelman. 2006. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin. Infect. Dis. 43:10891134.
137. Wormser, G. P.,, D. Liveris,, K. Hanincova,, D. Brisson,, S. Ludin,, V. J. Stracuzzi,, M. E. Embers,, M. T. Philipp,, A. Levin,, M. Aguero-Rosenfeld,, and I. Schwartz. 2008. Effect of Borrelia burgdorferi genotype on the sensitivity of C6 and 2-tier testing in North American patients with culture-confirmed Lyme disease. Clin. Infect. Dis. 47: 910914.
138. Wormser, G. P.,, E. Masters,, D. Liveris,, J. Nowakowski,, R. B. Nadelman,, D. Holmgren,, S. Bittker,, D. Cooper,, G. Wang,, and I. Schwartz. 2005. Microbiologic evaluation of patients from Missouri with erythema migrans. Clin. Infect. Dis. 40:423428.
139. Zhang, J. R.,, J. M. Hardham,, A. G. Barbour,, and S. J. Norris. 1997. Antigenic variation in Lyme disease borreliae by promiscuous recombination of VMP-like sequence cassettes. Cell 89:275285.
140. Zore, A.,, E. Ruzic-Sabljic,, V. Maraspin,, J. Cimperman,, S. Lotric-Furlan,, A. Pikelj,, T. Jurca,, M. Logar,, and F. Strle. 2002. Sensitivity of culture and polymerase chain reaction for the etiologic diagnosis of erythema migrans. Wien. Klin. Wochenschr. 114:606609.
141. Zoschke, D. C.,, A. A. Skemp,, and D. L. Defosse. 1991. Lymphoproliferative responses to Borrelia burgdorferi in Lyme disease. Ann. Intern. Med. 114:285289.


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Characteristics of arthropod-borne borreliae

Modified from reference .

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Distribution of species of sensu lato in European isolates from CSF, skin, and synovial fluid specimens

Data from references , and .

sensu lato species identifications from CSF and skin are based on culture; species identification from synovial fluid samples is based on PCR results. Culture isolates from synovial fluid are too few to estimate species distribution.

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Specimen types used for the diagnosis of LB

From the same day for AI determination.

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Sensitivity of methods for pathogen detection (PCR and culture) in LB

Up to 50% in patients with disease duration of less than 2 weeks compared with only 13% in patients for whom the illness duration was greater than 2 weeks.

Higher sensitivity of direct pathogen detection from synovial biopsy specimen.

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Sensitivity of antibody detection methods in the diagnosis of Lyme disease

Negative only for patients with a very short duration of symptoms.


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