title: Co-infection of Borrelia burgdorferi sensu lato and Rickettsia species in ticks and in an erythema migrans patient.
abstract: BACKGROUND
  Lyme borreliosis is the most prevalent tick-borne disease in Europe. Ixodes ricinus also carries other pathogenic bacteria, but corresponding human diseases are rarely reported. Here, we compared the exposure to Rickettsia helvetica and Rickettsia monacensis with that to Lyme borreliosis spirochetes. We assumed that their exposure corresponds to their infection rate in questing I. ricinus.
  
  
  RESULTS
  Three Rickettsia species were detected in ticks with a total prevalence of 7.9%, of which the majority was R. helvetica (78%) and R. monacensis (21%). From the same geographic area, skin biopsies of erythema migrans patients were investigated for possible co-infections with Rickettsia spp.. Forty-seven out of 67 skin biopsies were PCR positive for Borrelia burgdorferi s.l. and one sample was positive for R. monacensis. The Borrelia genospecies from the R. monacensis positive patient was identified as Borrelia afzelii. The patient did not show any symptoms associated with rickettsiosis.
  
  
  CONCLUSIONS
  Co-infections of I. ricinus with Rickettsia spp. and B. burgdorferi s.l. were as high as expected from the individual prevalence of both pathogens. Co-infection rate in erythema migrans patients corresponded well with tick infection rates. To our knowledge, this is the first reported co-infection of B. afzelii and R. monacensis.
authors: Centre for Infectious Disease Control Netherlands, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands. Ellen.TijsseKlasen@gmail.com.
authors: Ellen
authors: E
authors: Tijsse-Klasen
authors: Hein
authors: H
authors: Sprong
authors: Nenad
authors: N
authors: Pandak
mesh_terms: D000818:Animals; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D002648:Child; D060085:Coinfection / Q000382:microbiology*; D017523:Croatia / Q000453:epidemiology; D005260:Female; D005929:Glossitis, Benign Migratory / Q000382:microbiology*; D006801:Humans; D018884:Ixodes / Q000382:microbiology*; D008193:Lyme Disease / Q000453:epidemiology / Q000382:microbiology; D012281:Rickettsia / Q000145:classification / Q000302:isolation & purification*; D012282:Rickettsia Infections / Q000453:epidemiology / Q000382:microbiology