title: Borrelia miyamotoi Disease in the Northeastern United States: A Case Series.
abstract: BACKGROUND
  The first recognized cases of Borrelia miyamotoi disease (BMD) in North America were reported in the northeastern United States in 2013.
  
  
  OBJECTIVE
  To further describe the clinical spectrum and laboratory findings for BMD.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Patients presenting to primary care offices, emergency departments, or urgent care clinics in 2013 and 2014.
  
  
  METHODS
  Acutely febrile patients from the northeastern United States in whom the treating health care providers suspected and ordered testing for tick-transmitted infections.
  
  
  METHODS
  Whole-blood polymerase chain reaction (PCR) testing was performed for the presence of specific DNA sequences of common tickborne infections (including BMD). Serologic testing for B. miyamotoi was performed using a recombinant glycerophosphodiester phosphodiesterase (rGlpQ) protein. Clinical records were analyzed to identify the major features of acute disease.
  
  
  RESULTS
  Among 11,515 patients tested, 97 BMD cases were identified by PCR. Most of the 51 case patients on whom clinical histories were reviewed presented with high fever, chills, marked headache, and myalgia or arthralgia. Twenty-four percent were hospitalized. Elevated liver enzyme levels, neutropenia, and thrombocytopenia were common. At presentation, 16% of patients with BMD were seropositive for IgG and/or IgM antibody to B. miyamotoi rGlpQ. Most (78%) had seropositive convalescent specimens. Symptoms resolved after treatment with doxycycline, and no chronic sequelae or symptoms were observed.
  
  
  CONCLUSIONS
  Findings were based on specimens submitted for testing to a reference laboratory, and medical records of only 51 of the 97 case patients with BMD were reviewed.
  
  
  CONCLUSIONS
  Patients with BMD presented with nonspecific symptoms, including fever, headache, chills, myalgia, and arthralgia. Laboratory confirmation of BMD was possible by PCR on blood from acutely symptomatic patients who were seronegative at presentation. Borrelia miyamotoi disease may be an emerging tickborne infection in the northeastern United States.
  
  
  BACKGROUND
  IMUGEN.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Molloy
authors.forename: Sam R
authors.initials: SR
authors.lastname: Telford
authors.forename: Hanumara Ram
authors.initials: HR
authors.lastname: Chowdri
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Lepore
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Gugliotta
authors.forename: Karen E
authors.initials: KE
authors.lastname: Weeks
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Hewins
authors.forename: Heidi K
authors.initials: HK
authors.lastname: Goethert
authors.forename: Victor P
authors.initials: VP
authors.lastname: Berardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001898:Borrelia / Q000235:genetics / Q000302:isolation & purification; D001899:Borrelia Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D060085:Coinfection; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D010727:Phosphoric Diester Hydrolases / Q000276:immunology; D016133:Polymerase Chain Reaction; D011994:Recombinant Proteins / Q000276:immunology; D012621:Seasons; D012680:Sensitivity and Specificity; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D011994:Recombinant Proteins; D010727:Phosphoric Diester Hydrolases; C038133:glycerophosphodiester phosphodiesterase; D004318:Doxycycline