[CanLyme Note: This is a very interesting and important study and we are pleased that this is being looked at but there are some glaring omissions in the document.
Not made clear in the results is that a significant percentage of obviously symptomatic patients (why their blood was tested in the first place) would be completely missed using the current two tier testing algorithm. They showed that of the 250 samples, 24 were positive for B. miyamotoi using a specific Elisa that is not typical. Of the 24 that tested positive, only 11 tested positive for both B. burgdorferi and B. miyamotoi. The remaining 13 of the 24 were positive for only B. miyamotoi and would have been completely missed using the standard two-tier testing model. That represents a significant percentage (5.2%).
Applying the 5.2% to the 12,000 samples run in that four year period 2011 to 2014 (only those tested from May to October?) means that 600 Manitoban’s with B. miyamotoi were not diagnosed and likely not treated appropriately.
Could it be that some of those with B.miyamotoi who were missed did not show the required minimum of 5 bands on the current confirmatory western blot, but may have shown 2, 3, or 4 bands? No one knows because those banding results are not reported to physicians and patients, meaning that effectively it is a microbiologist who has never seen the patient making the diagnosis in the lab. The physician, who is the one looking at the symptomatic patient and listening to the patient’s history, is kept in the dark. There is something disturbingly wrong with this.
What about other strains of Borrelia? ]
September 7, 2017 Canadian Medical Association Journal
Kamran Kadkhoda, PhD, D(ABMM), Cecilia Dumouchel, BA, Janna Brancato, RN, Ainsley Gretchen, BSc, Peter J. Krause, MD
Peter Krause, firstname.lastname@example.org
Background: Hard tick-borne relapsing fever caused by Borrelia miyamotoi has been reported in Russia, the Netherlands, Germany, Japan and the northeastern and upper midwestern United States. We sought to investigate the presence of B. miyamotoiinfection in humans in Manitoba, Canada.
Methods: Two hundred fifty sera collected from residents of Manitoba with suspected Lyme disease between 2011 and 2014 were tested for Borrelia burgdorferi antibody using a C6 peptide enzyme-linked immunosorbent assay (ELISA) followed by Western blot. Residual sera were then anonymized, stored at -80°C and subsequently thawed and tested for B. miyamotoi antibody using a 2-step glycerosphosphodiester phosphodiesterase-based ELISA and Western blot assay.
Results: Twenty-four of the 250 (9.6%) sera tested positive for B. miyamotoiimmunoglobulin G. Participants who were B. miyamotoi seropositive were predominantly male (54%) and younger on average than those who were seronegative (32 and 44 yr of age, respectively). Participants who were seropositive for B. burgdorferiwere significantly more likely to be B. miyamotoi seropositive than those who were B. burgdorferi seronegative (20.3% v. 6.6%, respectively, odds ratio 3.6, 95% confidence interval 1.5-8.5).
Interpretation: This initial report of human B. miyamotoi infection in Canada should raise awareness of hard tick-borne relapsing fever among clinicians and residents of areas in Canada and western North America where Lyme disease is endemic.