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Journal of Clinical Microbiology
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Bacteriology

Molecular Microbiological and Immune Characterization of a Cohort of Patients Diagnosed with Early Lyme Disease

Michael R. Mosel, Alison W. Rebman, Heather E. Carolan, Tristan Montenegro, Robert Lovari, Steven E. Schutzer, David J. Ecker, Ting Yang, Nitya S. Ramadoss, William H. Robinson, Mark J. Soloski, Mark W. Eshoo, John N. Aucott
Brad Fenwick, Editor
Michael R. Mosel
aJanus-I Science, Inc., Vista, California, USA
iIbis Biosciences, Carlsbad, California, USA
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Alison W. Rebman
bThe Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Heather E. Carolan
cChromaCode, Carlsbad, California, USA
iIbis Biosciences, Carlsbad, California, USA
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Tristan Montenegro
dAbbott Rapid Diagnostics, Carlsbad, California, USA
iIbis Biosciences, Carlsbad, California, USA
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Robert Lovari
iIbis Biosciences, Carlsbad, California, USA
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Steven E. Schutzer
eDepartment of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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David J. Ecker
aJanus-I Science, Inc., Vista, California, USA
iIbis Biosciences, Carlsbad, California, USA
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Ting Yang
bThe Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Nitya S. Ramadoss
fDivision of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
gVeterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
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William H. Robinson
fDivision of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
gVeterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
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Mark J. Soloski
bThe Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mark W. Eshoo
hBlueArc Biosciences, San Diego, California, USA
iIbis Biosciences, Carlsbad, California, USA
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John N. Aucott
bThe Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Brad Fenwick
University of Tennessee at Knoxville
Roles: Editor
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DOI: 10.1128/JCM.00615-20
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ABSTRACT

Lyme disease is a tick-borne infection caused by the bacteria Borrelia burgdorferi. Current diagnosis of early Lyme disease relies heavily on clinical criteria, including the presence of an erythema migrans rash. The sensitivity of current gold-standard diagnostic tests relies upon antibody formation, which is typically delayed and thus of limited utility in early infection. We conducted a study of blood and skin biopsy specimens from 57 patients with a clinical diagnosis of erythema migrans. Samples collected at the time of diagnosis were analyzed using an ultrasensitive, PCR-based assay employing an isothermal amplification step and multiple primers. In 75.4% of patients, we directly detected one or more B. burgdorferi genotypes in the skin. Two-tier testing showed that 20 (46.5%) of those found to be PCR positive remained serologically negative at both acute and convalescent time points. Multiple genotypes were found in three (8%) of those where a specific genotype could be identified. The 13 participants who lacked PCR and serologic evidence for exposure to B. burgdorferi could be differentiated as a group from PCR-positive participants by their levels of several immune markers as well as by clinical descriptors such as the number of acute symptoms and the pattern of their erythema migrans rash. These results suggest that within a Mid-Atlantic cohort, patient subgroups can be identified using PCR-based direct detection approaches. This may be particularly useful in future research such as vaccine trials and public health surveillance of tick-borne disease patterns.

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Molecular Microbiological and Immune Characterization of a Cohort of Patients Diagnosed with Early Lyme Disease
Michael R. Mosel, Alison W. Rebman, Heather E. Carolan, Tristan Montenegro, Robert Lovari, Steven E. Schutzer, David J. Ecker, Ting Yang, Nitya S. Ramadoss, William H. Robinson, Mark J. Soloski, Mark W. Eshoo, John N. Aucott
Journal of Clinical Microbiology Dec 2020, 59 (1) e00615-20; DOI: 10.1128/JCM.00615-20

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Molecular Microbiological and Immune Characterization of a Cohort of Patients Diagnosed with Early Lyme Disease
Michael R. Mosel, Alison W. Rebman, Heather E. Carolan, Tristan Montenegro, Robert Lovari, Steven E. Schutzer, David J. Ecker, Ting Yang, Nitya S. Ramadoss, William H. Robinson, Mark J. Soloski, Mark W. Eshoo, John N. Aucott
Journal of Clinical Microbiology Dec 2020, 59 (1) e00615-20; DOI: 10.1128/JCM.00615-20
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KEYWORDS

Lyme disease
diagnosis
polymerase chain reaction
host response
immunology

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