A sixty-six-year-old woman with a strong family history of breast cancer noted gradual onset of axillary lymph node enlargement in 2019. Axillary lymph node biopsies disclosed Lymph node involvement by Chronic Lymphocytic Leukemia (CLL/SLL). Immunophenotype analysis of nodal tissue and of bloodstream leukemic cells in immunohistochemistry and flow cytometry and next generation molecular diagnostics confirmed CLL/SLL. Replicate absolute peripheral blood lymphocyte counts in excess of 5.0 x 10e3/microliter confirmed the numerical threshold for diagnosis of Chronic Lymphocytic Leukemia in the bloodstream. FISH studies disclosed an immunoglobulin “mutation negative” CLL/SLL genotype without a light chain restriction pattern. No translocations or germline mutations were present. Borrelia spirochetes in the bloodstream were detected with simultaneous high spirochetemia of both borrelia miyamotoi and borrelia burgdorferi. FISH hybridization of leukemic lymphocytes disclosed extensive borrelia invasion of the cytoplasm and of the nucleus compartments of CLL/SLL tumor cells. Retrospective studies of the patient’s archival stored blood smears obtained three years prior in 2016 at age 63 disclosed no evidence of CLL/SLL but confirmed asymptomatic bloodstream borrelia miyamotoi and borrelia burgdorferi borrelia infection. Lyme serology had been reported as negative in 2016. Additionally, retrospective FISH DNA hybridizations focused on preleukemic bloodstream Lymphocytes disclosed rare borrelia spirochetal adherence to benign blood lymphocytes in the year 2016 in the preleukemic blood smears. This case report is the very first to describe precursor chronic asymptomatic Lyme borreliosis and Miyamotoi borrelia bloodstream infections three years prior to the diagnosis of Rai Stage 1 Chronic Lymphocytic leukemia.

Borrelia miyamotoi is an emerging tick-borne pathogen in the Northern hemisphere and is the causative agent of Borrelia miyamotoi disease (BMD). B. miyamotoi is vectored by the same hard-bodied ticks as Lyme disease Borrelia, yet phylogenetically groups with relapsing fever Borrelia, and thus has been uniquely labeled a hard tick-borne relapsing fever Borrelia. Burgeoning research has uncovered new aspects of B. miyamotoi in human patients, nature, and the lab. Of particular interest are novel findings on disease pathology, prevalence, diagnostic methods, ecological maintenance, transmission, and genetic characteristics. Herein we review recent literature on B. miyamotoi, discuss how findings adapt to current Borrelia doctrines, and briefly consider what remains unknown about B. miyamotoi.

Green spaces localized in cities create favourable environmental conditions for Ixodes ricinus, the most widespread and important vector of tick-borne pathogens in Central Europe. In this study, we described the prevalence of Borrelia burgdorferi s.l. and Babesia species found in mono- and double infections among I. ricinus ticks occurring in urban areas of the city of Poznań, west-central Poland. Two tick groups were examined: (i) a group of 1,029 host-seeking ticks (460 nymphs, 289 females, and 280 males and (ii) a group of 1,268 engorged female ticks removed from 1,115 tick-infested animals, dogs and cats. The overall prevalence of B. burgdorferi s.l. found in host-seeking ticks was almost two-fold higher in comparison to ticks derived from pets (8.7 vs. 4.7%, respectively, χ2 test, P = 0.001). Borrelia afzelii and B. garinii were the most prevalent species both in ticks from vegetation (3.7% and 3.7%, respectively) and from pets (3.7% and 0.6%, respectively). Babesia infections were slightly more common in feeding ticks compared to those from vegetation (6.0 vs. 4.7%, respectively), however, the difference was not significant. Three Babesia species including Ba. microti, Ba. venatorum and Ba. canis were identified. Babesia canis and Ba. microti were the most prevalent in host-seeking (2.6% and 1.4%, respectively) and feeding ticks (2.8% and 2.2%, respectively), whereas Ba. venatorum was the rarest piroplasm. All Ba microti obtained sequences (n=42) were identical to Ba. microti genotype "Jena/Germany" that is considered as pathogenic to humans. Furthermore, the sequences of Ba. venatorum (n=17) were identical with those isolated from patients in Italy, Austria and Poland. Altogether, out of 121 Babesia-positive ticks, 19.8% were simultaneously infected with B. burgdorferi s.l. spirochetes. We found similar prevalences of co-infections in host-seeking (1.1%) as well as in feeding ticks (1.0%). In the first group, Ba. canis prevailed in coinfections (73%), mostly with B. afzelii and B. garinii, in the second group, Babesia microti dominated with B. afzelii (92.7%). This is the first finding documenting the co-occurrence of both pathogens in ticks from companion animals. The detection of Ba. microti and Ba. venatorum sequences identical to strains pathogenic to humans as well as predominance of LB spirochetes, B. afzelii and B. garinii in I. ricinus from vegetation and animals indicates that there is a potential risk of acquiring human babesiosis and/or Lyme borreliosis in urban areas of the city of Poznań. Although, the overall risk of encountering a Ba. microti and B. burgdorferi s.l. co-infected tick was low (1.0%), the potential for more severe clinical symptoms and complications deserves notice. A relatively high infection rates of Ba. canis in dog-derived ticks (3.2%) and in host-seeking ticks (2.6%), suggests that I. ricinus could potentially be involved in the circulation of this piroplasm in areas, where the competent vector, Dermacentor reticulatus is absent or rare.