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Detection of Borrelia burgdorferi sequences in a biopsy from a Tennessee patient.

Article Excerpt
ABSTRACT -- Borrelia burgdorferi is the causative agent of Lyme



disease and is transmitted by the black-legged tick, Ixodes scapularis. Clinical diagnosis of Lyme disease is often made on the basis of a characteristic Erythema Migrans (EM) rash. Lyme disease cases have been reported in Tennessee since 1991 when Lyme became a nationally notifiable disease. However, to date, there have been no reports of B. burgdorferi isolation in culture or detection of genetic sequences characteristic of B. burgdorferi in Tennessee. A syndrome related to Lyme disease, southern tick associated rash illness (STARI), has been described and also manifests an EM rash. The putative agent of STARI, which is not a reportable illness, is Borrelia lonestari. The presence of B. lonestari has been documented in the state. A skin biopsy was taken from an EM rash from a patient in East Tennessee. This study was undertaken to determine if Borreliae were present in the biopsy. Following nucleic acid extraction and amplification, a sequence for the Borrelia flagellin gene was obtained. There was 98-99% sequence identity between the biopsy and other reported B. burgdorferi flagellin gene sequences. This represents the first detection of genetic sequences of B. burgdorferi in Tennessee.

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Lyme disease is the most common vector borne disease in the United States and is endemic in the northeastern United States. The causative agent is Borrelia burgdorferi, which was isolated in culture in 1982 (Burgdorfer et al., 1982). Borrelia burgdorferi spirochetes are transmitted by Ixodes scapularis ticks (black-legged tick, deer tick) throughout the central and eastern United States. The hallmark symptom of Lyme disease is a characteristic "bull's-eye" rash, Erythema Migrans (EM), which occurs in nearly 80% of patients one to two weeks after I. scapularis feeding (CDC, 1997). Erythema Migrans rashes also have been documented at feeding sites of Amblyomma americanum, the Lone Star tick (Schulze...

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