Surveillance for and Discovery of Borrelia Species in US Patients Suspected of Tickborne Illness

Luke C. Kingry, Melissa Anacker, Bobbi Pritt, Jenna Bjork, Laurel Respicio-Kingry, Gongping Liu, Sarah Sheldon, David Boxrud, Anna Strain, Stephanie Oatman, Jon Berry, Lynne Sloan, Paul Mead, David Neitzel, Kiersten J. Kugeler, Jeannine M. Petersen

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background. Tick-transmitted Borrelia fall into 2 heterogeneous bacterial complexes comprised of multiple species, the relapsing fever (RF) group and the Borrelia burgdorferi sensu lato group, which are the causative agents of Lyme borreliosis (LB), the most common tickborne disease in the Northern Hemisphere. Geographic expansion of LB in the United States and discovery of emerging Borrelia pathogens underscores the importance of surveillance for disease-causing Borrelia. Methods. De-identifed clinical specimens, submitted by providers throughout the United States, for patients suspected of LB, anaplasmosis, ehrlichiosis, or babesiosis were screened using a Borrelia genus-level TaqMan polymerase chain reaction (PCR). Borrelia species and sequence types (STs) were characterized by multilocus sequence typing (MLST) utilizing next-generation sequencing. Results. Among 7292 specimens tested, 5 Borrelia species were identifed: 2 causing LB, B. burgdorferi (n = 25) and B. mayonii (n = 9), and 3 RF borreliae, B. hermsii (n = 1), B. miyamotoi (n = 8), and Candidatus B. johnsonii (n = 1), a species previously detected only in the bat tick, Carios kelleyi. ST diversity was greatest for B. burgdorferi-positive specimens, with new STs identifed primarily among synovial fluids. Conclusions. Tese results demonstrate that broad PCR screening followed by MLST is a powerful surveillance tool for uncovering the spectrum of disease-causing Borrelia species, understanding their geographic distribution, and investigating the correlation between B. burgdorferi STs and joint involvement. Detection of Candidatus B. johnsonii in a patient with suspected tickborne disease suggests this species may be a previously undetected cause of illness in humans exposed to bat ticks.

Original languageEnglish (US)
Pages (from-to)1864-1871
Number of pages8
JournalClinical Infectious Diseases
Issue number12
StatePublished - Jun 1 2018


  • Borrelia
  • Lyme disease
  • amplicon sequencing
  • molecular surveillance
  • relapsing fever

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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