Post by LymeEnigma on Aug 16, 2008 10:27:53 GMT -8
Isolation of Borrelia burgdorferi
From Ticks in Southern California
HILDY B. MEYERS, MD, MPH
DOUGLAS F. MOORE, PhD
GEORGE GELLERT, MD, MPH, MPA
Santa Ana, California
GARY L. EULER, DrPH
THOMAS J. PRENDERGAST, MD, MPH
MAHER BADRI, MD, MPH
San Bemardino, Califomia
JAMES P. WEBB, PhD
CARRIE L FOGARTY
Garden Grove, Califomia
SINCE ITS INITIAL DESCRIPHION in 1975, Lyme disease has
been reported from 46 states, although the causative agent of
Lyme disease, Borrelia burgdorferi, has not been as widely
identified.1 Three regions in the United States have accounted
for the vast majority of cases: the northeastern
United States (from Massachusetts to Maryland), the Midwest
(Wisconsin and Minnesota), and the West (Oregon and
northern California). Until early 1991, no cases of endemic
Lyme disease were documented and B burgdorferi had not
been isolated in southern California.
Borrelia burgdorferi Identification in Orange County
From 1984 through August 1991, the Vector Control District
ofOrange County captured and tested 328 Ixodespacificus
ticks, the vector of Lyme disease in California, for B
burgdorferi. In February 1991, 31 I pacificus ticks were
(Meyers HB, Moore DF, Gellert G, et al: Isolation of Borrelia burgdorferi
from ticks in southern California. West J Med 1992 Oct; 157:455-456)
From the Orange County Health Care Agency, Santa Ana; the Preventive Medical
Services Division, Department of Public Health, San Bernardino County, San Bernardino;
and the Orange County Vector Control District, Garden Grove, California.
Reprint requests to Hildy B. Meyers, MD, MPH, Medical Director, Communicable
Disease Control and Epidemiology, Orange County Health Care Agency, PO Box
6128, Santa Ana, CA 97206-0128,
collected from a ravine in San Clemente, near the border with
San Diego County. One tick was culture-positive for B
burgdorferi. This organism grew in Kelly-Stoner-Barbour II
medium and was confirmed as B burgdorferi by the California
Department of Health Services (CDHS) Microbial
Disease Laboratory. The identity was confirmed by immunofluorescent
microscopy using monoclonal antibodies
H5332 (directed against OspA) and H68 (directed against
OspB), both of which are specific for B burgdorferi.* This
was the first isolation ofB burgdorferi from a tick in southern
California.
Lyme Disease Reported in San Bernardino County
In April 1991 a case of possible Lyme disease meeting
surveillance criteria was reported to the San Bernardino
County Department of Public Health. The patient, a 55-yearold
man, gave a history of a tick bite February 24, 1991,
while hiking in Cucamonga Canyon in the San Gabriel
Mountains (including an area known locally as "Tick Overlook").
The tick was removed from the lower left abdomen.
An erythematous rash occurred on February 26 that eventually
reached 8 cm in diameter. No fever, myalgia, or other
symptoms were noted. The patient sought medical care the
same day, and Lyme disease was diagnosed. A regimen of
tetracycline, 500 mg four times a day for ten days, was
prescribed. A serologic test on April 3 was negative (total
antibody by enzyme immunoassay [EIA], 0.33; positive
>0.80). On June 13 the patient was examined by another
health care provider because of swelling and pain in the left
knee. A second EIA was negative (0.29). The left knee
symptoms subsided after five days.
The tick was identified as Ixodespacificus by an entomologist
with Vector Control in San Bernardino and by the
CDHS Microbial Disease Laboratory. Borrelia burgdorferi
was not cultured from this tick. This may have been a falsenegative
result due to the improper preservation of the tick.
This case report, however, led to the trapping of ticks in the
same vicinity in March 1991. Subsequent culture of these
ticks was positive for B burgdorferi at the CDHS Microbial
Disease Laboratory. This is the first positive identification of
this organism from ticks in San Bernardino County.
Discussion
Lyme disease became legally reportable in California in
April 1989. From April 1989 through April 1991, San
Bernardino and Orange counties reported 14 and 12 cases,
respectively. Of these, five cases from San Bernardino and
two cases from Orange may have been locally acquired (no
out-of-county travel histories). Only three cases presented
with the characteristic lesion of erythema migrans, and in
none of these patients was it possible to isolate the causative
organism.
Ixodes pacificus, or the western black-legged tick, can be
found in many areas of San Bernardino and Orange counties.
The data presented here, however, show a low prevalence of
B burgdorferi in ticks in Orange County. This rate is even
lower than that reported in northern California (1% to 2%
overall, Robert Murray, DrPH, CDHS, oral communication,
April 1992). Both these rates are lower than those seen in the
northeastern United States. These lower rates may be due to a
difference in the host-parasite relationship. Immature stages
of Ipacificus, unlike those of Ixodes dammini, the northern
deer tick of the northeastern and midwestern United States,
feed on lizards and small mammals. This may play a role in
reducing B burgdorferi transmission because it is thought
that lizards do not sustain infection with B burgdorferi. For
these reasons a Lyme disease incidence of a similar magnitude
to that observed in the northeastern US is not expected in
southern California.
Preventive measures for infection with B burgdorferi are
based on avoiding tick contact. This includes avoiding grass
and brush vegetation, wearing light-colored long-sleeved
shirts and long pants tucked into socks or boots, applying a
tick repellent to clothes, and doing frequent body checks for
ticks. Ticks adhering to skin should be removed with forceps
or tweezers using a gentle and steady pulling motion that
avoids crushing the tick and releasing its bodily fluids. The
tick may be kept alive by placing in a vial with a moist piece
of cotton for submission to a public health laboratory. Physicians
should contact their local health department for
the availability of tick identification and isolation of B burgdorferi.
The case reported in San Bernardino has not been proved
to be Lyme disease; however, the fact that the serologic test
was negative may have been due to early antibiotic treatment.
In one study, among ten patients with early Lyme disease
(erythema migrans only) who were treated early in their
course, only one had an antibody response.2 The importance
of this case is that it led to the identification of ticks positive
for B burgdorferi in an area previously thought to be free of
the organism. It also illustrates the difficulty in confirming
the diagnosis of Lyme disease when early treatment is instituted.
Readers are referred to several recent reviews of the
diagnosis and treatment of Lyme disease.3`5
Although the risk appears to be low, physicians should be
aware that Lyme disease may be contracted in San Bernardino
and Orange counties and perhaps other locations in
southern California. Public health authorities should continue
surveillance for infected tick vectors and human cases
of Lyme disease. The appearance of the causative agent of
Lyme disease in southern California indicates that reported
cases may not remain confined exclusively to previously endemic
areas of the country.
REFERENCES
1. Centers for Disease Control: Lyme disease surveillance-United States, 1989-
1990. MMWR 1991; 40:417-421
2. Shrestha M, Grodzicki RL, Steere AC: Diagnosing early Lyme disease. Am J
Med 1985; 78:235-240
3. Rahn DW, Malawista SE: Lyme disease. West J Med 1991; 154:706-714
4. Rahn DW, Malawista SE: Lyme disease: Recommendations for diagnosis and
treatment. Ann Intern Med 1991; 114:472-481
5. Malane MS, Grant-Kels JM, Feder HM, Luger SW: Diagnosis of Lyme disease
based on dermatologic manifestations. Ann Intern Med 1991; 114:490-498
456
ABBREVIATIONS USED IN TEXT
CDHS = California Department of Health Services
EIA = enzyme immunoassay
All emphasis mine.
www.pubmedcentral.nih.gov/picrender.fcgi?artid=1011317&blobtype=pdf
From Ticks in Southern California
HILDY B. MEYERS, MD, MPH
DOUGLAS F. MOORE, PhD
GEORGE GELLERT, MD, MPH, MPA
Santa Ana, California
GARY L. EULER, DrPH
THOMAS J. PRENDERGAST, MD, MPH
MAHER BADRI, MD, MPH
San Bemardino, Califomia
JAMES P. WEBB, PhD
CARRIE L FOGARTY
Garden Grove, Califomia
SINCE ITS INITIAL DESCRIPHION in 1975, Lyme disease has
been reported from 46 states, although the causative agent of
Lyme disease, Borrelia burgdorferi, has not been as widely
identified.1 Three regions in the United States have accounted
for the vast majority of cases: the northeastern
United States (from Massachusetts to Maryland), the Midwest
(Wisconsin and Minnesota), and the West (Oregon and
northern California). Until early 1991, no cases of endemic
Lyme disease were documented and B burgdorferi had not
been isolated in southern California.
Borrelia burgdorferi Identification in Orange County
From 1984 through August 1991, the Vector Control District
ofOrange County captured and tested 328 Ixodespacificus
ticks, the vector of Lyme disease in California, for B
burgdorferi. In February 1991, 31 I pacificus ticks were
(Meyers HB, Moore DF, Gellert G, et al: Isolation of Borrelia burgdorferi
from ticks in southern California. West J Med 1992 Oct; 157:455-456)
From the Orange County Health Care Agency, Santa Ana; the Preventive Medical
Services Division, Department of Public Health, San Bernardino County, San Bernardino;
and the Orange County Vector Control District, Garden Grove, California.
Reprint requests to Hildy B. Meyers, MD, MPH, Medical Director, Communicable
Disease Control and Epidemiology, Orange County Health Care Agency, PO Box
6128, Santa Ana, CA 97206-0128,
collected from a ravine in San Clemente, near the border with
San Diego County. One tick was culture-positive for B
burgdorferi. This organism grew in Kelly-Stoner-Barbour II
medium and was confirmed as B burgdorferi by the California
Department of Health Services (CDHS) Microbial
Disease Laboratory. The identity was confirmed by immunofluorescent
microscopy using monoclonal antibodies
H5332 (directed against OspA) and H68 (directed against
OspB), both of which are specific for B burgdorferi.* This
was the first isolation ofB burgdorferi from a tick in southern
California.
Lyme Disease Reported in San Bernardino County
In April 1991 a case of possible Lyme disease meeting
surveillance criteria was reported to the San Bernardino
County Department of Public Health. The patient, a 55-yearold
man, gave a history of a tick bite February 24, 1991,
while hiking in Cucamonga Canyon in the San Gabriel
Mountains (including an area known locally as "Tick Overlook").
The tick was removed from the lower left abdomen.
An erythematous rash occurred on February 26 that eventually
reached 8 cm in diameter. No fever, myalgia, or other
symptoms were noted. The patient sought medical care the
same day, and Lyme disease was diagnosed. A regimen of
tetracycline, 500 mg four times a day for ten days, was
prescribed. A serologic test on April 3 was negative (total
antibody by enzyme immunoassay [EIA], 0.33; positive
>0.80). On June 13 the patient was examined by another
health care provider because of swelling and pain in the left
knee. A second EIA was negative (0.29). The left knee
symptoms subsided after five days.
The tick was identified as Ixodespacificus by an entomologist
with Vector Control in San Bernardino and by the
CDHS Microbial Disease Laboratory. Borrelia burgdorferi
was not cultured from this tick. This may have been a falsenegative
result due to the improper preservation of the tick.
This case report, however, led to the trapping of ticks in the
same vicinity in March 1991. Subsequent culture of these
ticks was positive for B burgdorferi at the CDHS Microbial
Disease Laboratory. This is the first positive identification of
this organism from ticks in San Bernardino County.
Discussion
Lyme disease became legally reportable in California in
April 1989. From April 1989 through April 1991, San
Bernardino and Orange counties reported 14 and 12 cases,
respectively. Of these, five cases from San Bernardino and
two cases from Orange may have been locally acquired (no
out-of-county travel histories). Only three cases presented
with the characteristic lesion of erythema migrans, and in
none of these patients was it possible to isolate the causative
organism.
Ixodes pacificus, or the western black-legged tick, can be
found in many areas of San Bernardino and Orange counties.
The data presented here, however, show a low prevalence of
B burgdorferi in ticks in Orange County. This rate is even
lower than that reported in northern California (1% to 2%
overall, Robert Murray, DrPH, CDHS, oral communication,
April 1992). Both these rates are lower than those seen in the
northeastern United States. These lower rates may be due to a
difference in the host-parasite relationship. Immature stages
of Ipacificus, unlike those of Ixodes dammini, the northern
deer tick of the northeastern and midwestern United States,
feed on lizards and small mammals. This may play a role in
reducing B burgdorferi transmission because it is thought
that lizards do not sustain infection with B burgdorferi. For
these reasons a Lyme disease incidence of a similar magnitude
to that observed in the northeastern US is not expected in
southern California.
Preventive measures for infection with B burgdorferi are
based on avoiding tick contact. This includes avoiding grass
and brush vegetation, wearing light-colored long-sleeved
shirts and long pants tucked into socks or boots, applying a
tick repellent to clothes, and doing frequent body checks for
ticks. Ticks adhering to skin should be removed with forceps
or tweezers using a gentle and steady pulling motion that
avoids crushing the tick and releasing its bodily fluids. The
tick may be kept alive by placing in a vial with a moist piece
of cotton for submission to a public health laboratory. Physicians
should contact their local health department for
the availability of tick identification and isolation of B burgdorferi.
The case reported in San Bernardino has not been proved
to be Lyme disease; however, the fact that the serologic test
was negative may have been due to early antibiotic treatment.
In one study, among ten patients with early Lyme disease
(erythema migrans only) who were treated early in their
course, only one had an antibody response.2 The importance
of this case is that it led to the identification of ticks positive
for B burgdorferi in an area previously thought to be free of
the organism. It also illustrates the difficulty in confirming
the diagnosis of Lyme disease when early treatment is instituted.
Readers are referred to several recent reviews of the
diagnosis and treatment of Lyme disease.3`5
Although the risk appears to be low, physicians should be
aware that Lyme disease may be contracted in San Bernardino
and Orange counties and perhaps other locations in
southern California. Public health authorities should continue
surveillance for infected tick vectors and human cases
of Lyme disease. The appearance of the causative agent of
Lyme disease in southern California indicates that reported
cases may not remain confined exclusively to previously endemic
areas of the country.
REFERENCES
1. Centers for Disease Control: Lyme disease surveillance-United States, 1989-
1990. MMWR 1991; 40:417-421
2. Shrestha M, Grodzicki RL, Steere AC: Diagnosing early Lyme disease. Am J
Med 1985; 78:235-240
3. Rahn DW, Malawista SE: Lyme disease. West J Med 1991; 154:706-714
4. Rahn DW, Malawista SE: Lyme disease: Recommendations for diagnosis and
treatment. Ann Intern Med 1991; 114:472-481
5. Malane MS, Grant-Kels JM, Feder HM, Luger SW: Diagnosis of Lyme disease
based on dermatologic manifestations. Ann Intern Med 1991; 114:490-498
456
ABBREVIATIONS USED IN TEXT
CDHS = California Department of Health Services
EIA = enzyme immunoassay
All emphasis mine.
www.pubmedcentral.nih.gov/picrender.fcgi?artid=1011317&blobtype=pdf