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Borrelia miyamotoi: More Lessons on Disease Discovery

TO THE EDITOR: I read Branda and Rosenberg’s (1) editorial with great interest. Readers may be interested to know that my colleagues and I discovered Borrelia miyamotoi in Ixodes scapularis ticks more than 10 years ago and were able to show transmission by infected ticks to mice with subsequent antibody response and persistent infection (2). We also showed that this organism was widespread in I. scapularis, with a mean prevalence of about 2%. We then applied 5 unsuccessful times to the National Institutes of Health and the Centers for Disease Control and Prevention for funding to determine whether this organism infects humans and causes disease. The agencies cited lack of evidence for human infection as their reasoning for not funding our study, which was the objective of the proposal. While attending a zoonoses conference in Cyprus in 2008, I passed by a poster authored by Russian investigator Alexander E. Platonov describing infection with B. miyamotoi in ticks and in patients having not Lyme disease but suspected tickborne encephalitis. My colleague Peter J. Krause and I collaborated with Platonov to publish these cases and compare them with Lyme disease cases in the United States (3). Immediately after publication, we received word that our most recent National Institutes of Health R21 application would be funded. Although I agree that this is a lesson in disease discovery, the real lesson should be that it could have happened a full decade earlier. A similar lesson should have been learned in 1994 when the first cases (some fatal) of human anaplasmosis were reported, even though ticks collected and preserved a decade earlier were found to be infected with the disease agent Anaplasma phagocytophilum (4). We may again learn this lesson with a much more serious tickborne infection, Powassan encephalitis virus, which has recently been found in I. scapularis ticks with prevalence rates of up to 5% (5), exceeding rates reported in areas highly endemic for tickborne encephalitis in Eurasia. How many lessons does it take before it is realized that we are doing disease discovery backward?