<i>B</i>. <i>miyamotoi</i> rGlpQ ELISA and Western blot test results among CHR subjects.

<p><i>B</i>. <i>miyamotoi</i> rGlpQ ELISA and Western blot test results among CHR subjects.</p

<i>B</i>. <i>burgdorferi</i> and <i>B</i>. <i>miyamotoi</i> WCL Western blot reactivity in serum samples from New England residents whose sera were reactive against <i>B</i>. <i>burgdorferi</i> and <i>B</i>. <i>miyamotoi</i> antigen.

<p><b>2A.</b><i>B</i>. <i>miyamotoi</i> rGlpQ Western blot results of sera from patients who previously had <i>B</i>. <i>miyamotoi</i> sensu lato infection alone (Bmsl positive control subject, PCR confirmed <i>B</i>. <i>miyamotoi</i> infection) or Lyme disease alone (Bb positive control, erythema migrans rash and <i>B</i>. <i>burgdorferi</i> seropositive using the standard two-step ELISA and Western blot assay). The arrow indicates the rGlpQ specific band. <b>2B.</b> <i>B</i>. <i>miyamotoi</i> and <i>B</i>. <i>burgdorferi</i> WCL Western blot results of sera from the same patients as in Fig 2A.</p

Human <i>Borrelia miyamotoi</i> infection in California: Serodiagnosis is complicated by multiple endemic <i>Borrelia</i> species

<div><p>To determine whether human <i>Borrelia miyamotoi</i> infection occurs in the far-western United States, we tested archived sera from northwestern California residents for antibodies to this emerging relapsing fever spirochete. These residents frequently were exposed to <i>I</i>. <i>pacificus</i> ticks in a region where <i>B</i>. <i>miyamotoi</i> tick infection has been reported. We used a two-step <i>B</i>. <i>miyamotoi</i> rGlpQ assay and a <i>B</i>. <i>miyamotoi</i> whole-cell lysate (WCL) assay to detect <i>B</i>. <i>miyamotoi</i> antibody. We also employed <i>Borrelia hermsii</i> and <i>Borrelia burgdorferi</i> WCL assays to examine if these <i>Borrelia</i> induce cross reacting antibody to <i>B</i>. <i>miyamotoi</i>. Sera were collected from 101 residents in each of two consecutive years. The sera of 12 and 14 residents in years one and two, respectively, were <i>B</i>. <i>miyamotoi</i> rGlpQ seroreactive. Sufficient sera were available to test 15 of the 26 seropositive samples using <i>B</i>. <i>miyamotoi</i> and <i>B</i>. <i>hermsii</i> WCL assays. Two residents in year one and seven residents in year two were seroreactive to both <i>Borrelia</i> antigens. Although discernible differences in seroreactivity were evident between the <i>B</i>. <i>miyamotoi</i> and <i>B</i>. <i>hermsii</i> WCL assays, infection with one or the other could not be determined with certainty. Sera from two <i>Borrelia burgdorferi</i> /<i>B</i>. <i>miyamotoi</i> seropositive subjects reacted strongly against <i>B</i>. <i>miyamotoi</i> and <i>B</i>. <i>hermsii</i> WCL antigens. Ecological, epidemiological, and clinical data implicated <i>B</i>. <i>miyamotoi</i> as the probable cause of infection among those whose sera reacted against both antigens. Our findings suggest that human <i>B</i>. <i>miyamotoi</i> infection occurs in northern California and that <i>B</i>. <i>hermsii</i> and <i>B</i>. <i>burgdorferi</i> infections produce antibodies that cross-react with <i>B</i>. <i>miyamotoi</i> antigens. Health care professionals in the far-western United States should be aware that <i>B</i>. <i>miyamotoi</i> disease may occur throughout the geographic distribution of <i>I</i>. <i>pacificus</i> and that improved relapsing fever group spirochete antibody assays are urgently needed.</p></div