lonestari was likely to be the cause 33, because the investigators were unable to culture spirochetes from skin biopsy specimens from any of the patients. For example, a microbiologic study of 30 Missouri patients with erythema migrans (EM)-like skin lesions concluded that neither B. However, despite the efforts to date, very little evidence has been obtained that supports the notion that B. This organism has been considered and investigated as the possible cause of Lyme-like illness, often referred to as southern tick associated rash illness (STARI), in humans in the southern U.S. where it has been shown to commonly infect lone star ticks ( Amblyomma americanum) 25 - 31. lonestari 24, numerous studies have been published describing its presence throughout the eastern U.S. Since the first report describing molecular detection of the hard tick relapsing fever group Borrelia species B. burgdorferi sensu lato have been isolated in culture from only a few human cases in the region 22 - 23. Despite hundreds of reported cases of human Lyme disease from southern states each year, however, B.
Borrelia burgdorferi sensu lato spirochetes have been isolated from birds, rodents, and ticks in southern and western states 6, 7, 17 - 19, and have been detected by molecular methods in wild lizards in Florida, South Carolina, and Maryland 20, 21.
burgdorferi feed primarily on lizards 14, 15, 16. In the southern and western U.S., immature stages of the Ixodes spp. burgdorferi spirochetes are transmitted to humans most commonly by nymphal stages of the blacklegged tick, Ixodes scapularis 11, and maintained in nature primarily by small rodents 7, 12 - 13. bissettii have been identified in serum of several human cases in California using molecular methods 10. Borrelia burgdorferi has been widely reported as the only genospecies responsible for human disease in the U.S. burgdorferi sensu stricto (hereafter referred to as just B. Borrelia burgdorferi sensu lato includes at least 20 genospecies worldwide, seven of which are present in North America: B. Lyme borreliosis (LB), the most frequently reported arthropod-borne infection in the United States 1, is caused by several species within the Borrelia burgdorferi sensu lato genogroup. may be attributable to previously undetected B. Based on the findings of this study, we suggest that human Lyme borreliosis occurs in Florida and Georgia, and that some cases of Lyme-like illness referred to as southern tick associated rash illness (STARI) in the southern U.S. burgdorferi sensu lato species may be associated with Lyme disease-like signs and symptoms in southern states. in human patients in the southern U.S., and to demonstrate that several B. This is the first report to present combined PCR and DNA sequence evidence of infection with Lyme Borrelia spp. Using polymerase chain reaction (PCR) assays developed specifically for Lyme group Borrelia spp., followed by DNA sequencing for confirmation, we identified Borrelia burgdorferi sensu lato DNA in samples of blood and skin and also in lone star ticks ( Amblyomma americanum) removed from several patients who either live in or were exposed to ticks in Florida or Georgia. The aim of this study was to determine the cause of illness in several human patients residing in Florida and Georgia, USA, with suspected Lyme disease based upon EM-like skin lesions and/or symptoms consistent with early localized or late disseminated Lyme borreliosis.