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- Borrelia extollendam is a gram negative, anaerobic, zoonotic bacteria that causes amplification of physical feelings in the nerves.
- It was first isolated in Canada in 1988 during an outbreak.
- The disease caused is nervous extollendam. This commonly shows itself as amplified pain.
- Ex: If you stubbed a toe and described the pain level as 2, with nervous extollendam, the pain level would be closer to a 7.
- This bacterial infection is treatable with antibiotics.

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Zoonotic disease based off of the migration of the Canadian Goose and mosquito Culex tarsalis.

Infection happens from late Spring to mid Fall. Higher incidence of infection happens in late summer.

Men are more likely to get infected.

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Vector borne disease:
.  Canadian Geese are natural reservoir.
.  Culex tarsalis is the mosquito vector.

Transmission:
.  C. tarsalis transmits through blood meals on humans.
.  Transmissible through contact with dead animals.
.  No transmission human to human

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Borrelia extollindam transmission cycle (1)

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A variety of virulence factors promote infection. Involved in the virulence of B. extollendam include batrachotoxin, agr quorum sensing system for spore regulation, outer membrane protein AX for biofilm formation, and flagellum to promote motility.

Batrachotoxin (BTS):

Toxin promoting prolonged opening of sodium/potassium channels

Leads to irreversible depolarization of nerves

Also found in frog species

Agr Quorum Sensing System:

Controls virulence factor chain promoting sporulation

Overexpression regulates colonization

OMPAX:

Outer Membrane Protein AX

Stimulates the formation of a biofilm on axons in coordination with the quorum sensing system

Flagellum:

Motility to reach axons efficiently and travel efficiently though blood stream

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From infected Canadian geese, a mosquito becomes a vector and transfers the bacteria to other Canadian geese or to a human host. Borrelia extollendam gets into the blood stream and works its way into the nerves through the vasa nervorum where a biofilm, along the axons from OMPAX, is formed. This causes the nerve hype sensation.

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Causes Nervus Extollendam Syndrome:
extreme nerve amplification followed by the deadening of axon sensory capabilities

without treatment Nervus Extollendam syndrome lasts 1-3 months

followed by a healing period of 2-5 weeks of axon sensory deadening

axon sensory deadening often includes painful tingling all throughout the body

on rare occasion, this can be permanent

Very low mortality rate

10-15% without treatment

5-8% with treatment

Symptoms:
Humans and animals:

extreme nerve amplification all over the body that is often highly painful

bullseye rash at sight of infection

surrounds mosquito bite or wound in which the bacteria entered after contact with infected animal carcass

appears within 1-2 days of bite or contact with infected animal carcass

shingles like rashes often accompanied by the whites of the eyes turning red

1 week after onset of nerve amplification

Animals:

disorientation

trouble walking

self isolation from herd to avoid physical contact followed by the discontinuation of walking

Disease presentation:

within 1-2 weeks of infection when no co-infection is present

disease onset occurs faster when contracted via mosquito bite when compared to contraction due to open wound contact with an infected animal carcass

West Nile Co-infection:

occurs in some cases where the mosquito is the vector of transmission

great increase in mortality rate

25-30% without treatment

10-12% with treatment

extreme nerve and pain amplification

24-36 hours after infection

renders patient, essentially immobile

increased risk of permanent axon sensory deadening and tingling sensation

occurs in 80% of patients with a West Nile co-infection without treatment

occurs in 40% of patients with a West Nile co-infection with treatment

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- Borrelia extollendam is a zoonotic bacteria that is most commonly transmitted from animals to humans through contact with infected blood, most commonly by mosquitos.
- The Canadian Goose is the main reservoir for the pathogen, with the mosquito being the main vector.
- This bacteria causes nervous extollendam, which is extreme nerve amplification.
- Batrachotoxin, agr quorum sensing system, outer membrane protein AX, and flagellum are virulence factors.
- Serology tests and PCR are used to detect the pathogen in blood.
- Chloramphenicol is the antibiotic used to treat this disease. Insect repellent and clothing are effective methods to prevent mosquitos from biting.

Citations:
http://www.wyomosquito.org/mosquito_species.htm

“Chloramphenicol.” National Center for Biotechnology Information. PubChem Compound Database, U.S. National Library of Medicine, pubchem.ncbi.nlm.nih.gov/compound/Chloramphenicol.

Staniszewska M. (2020). Virulence Factors in Candida species. Current protein & peptide science, 21(3), 313–323. https://doi.org/10.2174/1389203720666190722152415

Tijerina-Rodríguez, L. D., Villarreal-Treviño, L. D., Baines, S. D., Morfín-Otero, R. D., Camacho-Ortíz, A. D., Flores-Treviño, S. D., . . . Garza-González, E. D. (2019, July 31). High sporulation and overexpression of virulence factors in biofilms and reduced susceptibility to vancomycin and linezolid in recurrent Clostridium [Clostridioides] difficile infection isolates. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220671

Chan, K., Casjens, S., & Parveen, N. (2012, April 01). Detection of Established Virulence Genes and Plasmids To Differentiate Borrelia burgdorferi Strains. Retrieved from https://iai.asm.org/content/80/4/1519

Czerwińska-Główka, D., & Krukiewicz, K. (2019, October 14). A journey in the complex interactions between electrochemistry and bacteriology: From electroactivity to electromodulation of bacterial biofilms. Retrieved from https://www.sciencedirect.com/science/article/pii/S1567539419304876

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PCR (polymerase chain reaction)
- very sensitive and accurate
1) DNA is denatured and the strands separate
2) A set of primers bind to the target DNA sequence
3) The DNA is amplified

Serology
- ELISA (enzyme-linked immunoassay)
- to detect the presence of antibodies in the blood
- analyzes the body's immune response to being infected by the bacteria

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Treatment:

- Borrelia extollendam is multi-drug resistant
- Chloramphenicol intravenously (IV) is a very effective antibiotic
- Broad spectrum antibiotic used for serious infections
- Bacteriostatic, binds to the 50S ribosomal subunit
- Interferes with the peptidyl transferase activity and blocks protein synthesis
- Also used to treat meningitis, plague, typhoid fever, and conjunctivitis
- Pain management
- No vaccine, still being researched

Prevention:

- Apply insect repellent, such as DEET
- Cover skin while outdoors
- Limit exposure, stay indoors during the dusk-dawn period of the day
- Avoid contact with dead animals