{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:45:14Z","timestamp":1788839114490,"version":"build-2803163510"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Erythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than <jats:italic>Borrelia<\/jats:italic>, and the impact of co-infection on the clinical manifestations and disease duration.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Skin biopsies from 139\/188 EM patients were analyzed using PCR for <jats:italic>Neoehrlichia mikurensis<\/jats:italic>, <jats:italic>Rickettsia<\/jats:italic> spp., <jats:italic>Anaplasma phagocytophilum<\/jats:italic> and <jats:italic>Babesia<\/jats:italic> spp. Follow-up sera from 135\/188 patients were analyzed for spotted fever group (SFG) <jats:italic>Rickettsia, A. phagocytophilum<\/jats:italic> and <jats:italic>Babesia microti<\/jats:italic> antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8\/188) or EM duration of\u2009\u2265\u200921\u00a0days (69\/188) were analyzed, using PCR, for <jats:italic>A. phagocytophilum<\/jats:italic>, <jats:italic>Rickettsia<\/jats:italic> spp., <jats:italic>Babesia<\/jats:italic> spp. and <jats:italic>N<\/jats:italic>. <jats:italic>mikurensis<\/jats:italic>. Day 14 sera were tested for TBEV IgG.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG <jats:italic>Rickettsia<\/jats:italic> and <jats:italic>A<\/jats:italic>. <jats:italic>phagocytophilum<\/jats:italic> were detected in 11\/135 and 8\/135, respectively<jats:italic>.<\/jats:italic> Three patients exhibited both SFG <jats:italic>Rickettsia<\/jats:italic> and <jats:italic>A<\/jats:italic>. <jats:italic>phagocytophilum<\/jats:italic> antibodies, albeit negative PCR. No antibodies were detected against <jats:italic>B<\/jats:italic>. <jats:italic>microti<\/jats:italic>. 2\/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Co-infection with <jats:italic>N<\/jats:italic>. <jats:italic>mikurensis<\/jats:italic>, <jats:italic>A<\/jats:italic>. <jats:italic>phagocytophilum<\/jats:italic>, SFG <jats:italic>Rickettsia<\/jats:italic>, <jats:italic>Babesia<\/jats:italic> spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG <jats:italic>Rickettsia<\/jats:italic> and <jats:italic>A<\/jats:italic>. <jats:italic>phagocytophilum<\/jats:italic> in some patients, no clinical implications could be demonstrated.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06755-8","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T14:51:02Z","timestamp":1633877462000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Tick-transmitted co-infections among erythema migrans patients in a general practice setting in Norway: a clinical and laboratory follow-up study"],"prefix":"10.1186","volume":"21","author":[{"given":"Knut Eirik","family":"Eliassen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas Frans","family":"Ocias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen A.","family":"Krogfelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wilhelmsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne Gjeruldsen","family":"Dudman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c5shild","family":"Andreassen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Lindbak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per-Eric","family":"Lindgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,8]]},"reference":[{"issue":"9814","key":"6755_CR1","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/S0140-6736(11)60103-7","volume":"379","author":"G Stanek","year":"2012","unstructured":"Stanek G, Wormser GP, Gray J, Strle F. 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All EM-patients signed an informed consent to participate in the original trial [], including having their skin biopsies and serum samples analyzed abroad.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1044"}}