{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:58:16Z","timestamp":1769158696541,"version":"3.49.0"},"reference-count":59,"publisher":"Microbiology Society","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,5,1]]},"abstract":"<jats:p>The present study investigated the cause of illness in human patients primarily in the southern USA with suspected Lyme disease based on erythema migrans-like skin lesions and\/or symptoms consistent with early localized or late disseminated Lyme borreliosis. The study also included some patients from other states throughout the USA. Several PCR assays specific for either members of the genus <jats:italic>Borrelia<\/jats:italic> or only for Lyme group <jats:italic>Borrelia<\/jats:italic> spp. (<jats:italic>Borrelia burgdorferi<\/jats:italic> \n                  <jats:italic>sensu lato<\/jats:italic>), and DNA sequence analysis, were used to identify <jats:italic>Borrelia<\/jats:italic> spp. DNA in blood and skin biopsy samples from human patients. <jats:italic>B. burgdorferi<\/jats:italic> \n                  <jats:italic>sensu lato<\/jats:italic> DNA was found in both blood and skin biopsy samples from patients residing in the southern states and elsewhere in the USA, but no evidence of DNA from other <jats:italic>Borrelia<\/jats:italic> spp. was detected. Based on phylogenetic analysis of partial flagellin (<jats:italic>flaB<\/jats:italic>) gene sequences, strains that clustered separately with <jats:italic>B. burgdorferi<\/jats:italic> \n                  <jats:italic>sensu stricto<\/jats:italic>, <jats:italic>Borrelia americana<\/jats:italic> or <jats:italic>Borrelia andersonii<\/jats:italic> were associated with Lyme disease-like signs and symptoms in patients from the southern states, as well as from some other areas of the country. Strains most similar to <jats:italic>B. burgdorferi<\/jats:italic> \n                  <jats:italic>sensu stricto<\/jats:italic> and <jats:italic>B. americana<\/jats:italic> were found most commonly and appeared to be widely distributed among patients residing throughout the USA. The study findings suggest that human cases of Lyme disease in the southern USA may be more common than previously recognized and may also be caused by more than one species of <jats:italic>B. burgdorferi<\/jats:italic> \n                  <jats:italic>sensu lato<\/jats:italic>. This study provides further evidence that <jats:italic>B. burgdorferi<\/jats:italic> \n                  <jats:italic>sensu stricto<\/jats:italic> is not the only species associated with signs and\/or symptoms consistent with Lyme borreliosis in the USA.<\/jats:p>","DOI":"10.1099\/jmm.0.073122-0","type":"journal-article","created":{"date-parts":[[2014,2,26]],"date-time":"2014-02-26T03:27:26Z","timestamp":1393385246000},"page":"674-684","source":"Crossref","is-referenced-by-count":31,"title":["Geographical and genospecies distribution of Borrelia burgdorferi\n            sensu lato DNA detected in humans in the USA"],"prefix":"10.1099","volume":"63","author":[{"given":"Kerry L.","family":"Clark","sequence":"first","affiliation":[{"name":"Department of Public Health, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian F.","family":"Leydet","sequence":"additional","affiliation":[{"name":"Department of 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