ON THE ISSUE OF THE STANDARD DEFINITION OF TICK-BORNE RELAPSING FEVER CASE

Introduction. Tick-borne infections caused by Borrelia belonging to the Lyme borreliosis groups (B. burgdorferi sensu lato) and relapsing fevers, which include B. miyamotoi.

Objective. To develop a standard case definition for tick-borne relapsing fever, for differential diagnosis with infections with similar clinical manifestations, and for the general medical community to understand their clinical manifestations and laboratory features.

Materials and methods. We analyzed the clinical and epidemiological manifestations of confirmed cases of tick-borne relapsing fevers according to the literature, conducted a polymerase chain reaction study of 521 ticks collected from vegetation and 54 ticks removed from bitten individuals and the bitten themselves in dynamics, and analyzed 42 febrile patients using the immunochip method. The polymerase chain reaction was positive in 27/521 (5.2 %) and 1/54 (1.9 %) ticks, respectively. Of the 61 patient samples, 8.2 % (5/61) were positive for antibiotics targeting various Borrelia antigens.

Results. We used the definitions of suspected, probable, and confirmed cases, developed based on the literature, and identified cases of tick-borne relapsing fever that corresponded to the standard definitions.

Conclusions. Thus, tick-borne relapsing fevers are common among the group of fevers of unknown etiology and among people bitten by ticks, although this infection is not included in official registration and, accordingly, there is no epidemiological surveillance. To increase awareness and alertness among medical professionals, we have developed a standard definition of the case of tick-borne borreliosis relapsing fever, which, along with the developed laboratory diagnostic protocol, needs to be widely implemented in the system of tick-borne infection surveillance in the regions of the Republic of Kazakhstan.

1. Parte, A. C., Sardà Carbasse, J., Meier-Kolthoff, J. P., Reimer, L. C., & Göker, M. (2020). List of Prokaryotic names with Standing in Nomenclature (LPSN) moves to the DSMZ. International Journal of Systematic and Evolutionary Microbiology, 70(11), 5607–5612. https://doi.org/10.1099/ijsem.0.004332

2. Güner, E. S., Watanabe, M., Hashimoto, N., et al. (2004). Borrelia turcica sp. nov., isolated from the hard tick Hyalomma aegyptium in Turkey. International Journal of Systematic and Evolutionary Microbiology, 54(5), 1649–1652.

3. Loh, S. M., Gillett, A., Ryan, U., et al. (2017). Molecular characterization of Candidatus Borrelia tachyglossi (family Spirochaetaceae) in echidna ticks, Bothriocroton concolor. International Journal of Systematic and Evolutionary Microbiology, 67(4), 1075–1080. https://doi.org/10.1099/ijsem.0.001929

4. Loh, S. M., Gofton, A. W., Lo, N., et al. (2016). Novel Borrelia species detected in echidna ticks, Bothriocroton concolor, in Australia. Parasites & Vectors, 9(1), 339. https://doi.org/10.1186/s13071-016-1627-x

5. Panetta, J. L., Šíma, R., Calvani, N. E. D., et al. (2017). Reptile-associated Borrelia species in the goanna tick (Bothriocroton undatum) from Sydney, Australia. Parasites & Vectors, 10(1), 616. https://doi.org/10.1186/s13071-017-2579-5

6. Takano, A., Goka, K., Une, Y., et al. (2010). Isolation and characterization of a novel Borrelia group of tick-borne borreliae from imported reptiles and their associated ticks. Environmental Microbiology, 12(1), 134–146. https://doi.org/10.1111/j.1462-2920.2009.02054.x

7. Adeolu, M., & Gupta, R. S. (2014). A phylogenomic and molecular marker based proposal for the division of the genus Borrelia into two genera…. Antonie Van Leeuwenhoek, 105(6), 1049–1072. https://doi.org/10.1007/s10482-014-0164-x

8. Margos, G., Marosevic, D., Cutler, S., et al. (2017). There is inadequate evidence to support the division of the genus Borrelia. International Journal of Systematic and Evolutionary Microbiology, 67(4), 1081–1084. https://doi.org/10.1099/ijsem.0.001717

9. Chekanova, T. A., & Manzeniuk, I. N. (2021). Kleshchevoi vozvratnyi fever i genospecies diversity of Borrelia: Current status. Epidemiology and Vaccinal Prevention, 20(6), 108–116. https://doi.org/10.31631/2073-3046-2021-20-6-108-116 (In Russian)

10. Ostapchuk, Y. O., Bissenbay, A. O., Kuligin, A. V., et al. (2024). Survey of tick-borne relapsing fever Borreliae in south and southeastern regions of Kazakhstan. Ticks and Tick-borne Diseases, 15(6), 102398. https://doi.org/10.1016/j.ttbdis.2024.102398

11. Binetruy, F., Garnier, S., Boulanger, N., et al. (2020). A novel Borrelia species in neotropical passerine-associated ticks. Scientific Reports, 10, 10596. https://doi.org/10.1038/s41598-020-66828-7

12. Dmitrovskiy, A. M., Ospanbekova, N. K., Eralieva, L. T., Shapiyeva, Zh. Zh., Skiba, Y. A., Ismagulova, G. A., Maltseva, E. R., Nizkorodova, A., Ostapchuk, E. O., Perfilyeva, Y. V., Naizabayeva, D. A., & Mamadaliev, S. M. (2020). Borrelioses: Etiology, distribution, pathogenesis, clinical aspects, treatment, epizootology, epidemiology, prevention, and system of epidemiological surveillance: Methodical recommendations. Almaty. (In Russian)

13. Hoornstra, D., Stukolova, O. A., Karan, L. S., et al. (2022). Development and validation of a protein array for detection of antibodies against Borrelia miyamotoi. Microbiology Spectrum, 10(6), e0203622. https://doi.org/10.1128/spectrum.02036-22

14. Ostapchuk, E. O., Bissenbay, A. O., Kuligin, A. V., Kan, S. A., Lushova, A. V., Zhigailov, A. V., Stukolova, O. A., Sayakova, Z. Z., Abdolla, N., Dmitrovskiy, A. M., Perfilyeva, Y. V., Mashzhan, A. S., Kuatbekova, S. A., Dosmagambet, Zh., Shapiyeva, Zh. Zh., Naizabayeva, D. A., Ospanbekova, N. K., & Skiba, Y. A. (2024, September 12–13). Prevalence of Borrelia miyamotoi in Almaty and Zhetysu regions of Kazakhstan. In Proceedings of the International Conference “Astana Biotech 2024” (p. 162). Astana. (In Russian)

15. Dmitrovskiy, A. M., Sharapov, M. B., Zheteeva, E. A., Zeman, V. V., Bumburidi, E. M., & Utepbergenova, G. A. (2008). Application of standard case definitions of especially dangerous infections: Textbook. Shymkent. (In Russian)