Evaluation of a novel multiplex PCR amplicon sequencing assay for detection of human pathogens in Ixodes ticks

Tickborne diseases are an increasing public health concern in the United States, where the majority of notifiable cases are caused by pathogens vectored by Ixodes ticks. To better monitor changes in acarological risk of human encounters with these ticks and their associated pathogens, the Centers for Disease Control and Prevention (CDC) recently established a national tick and tickborne pathogen surveillance program. Here, we describe and evaluate a new Multiplex PCR Amplicon Sequencing (MPAS) assay for potential use in surveillance programs targeting two common human-biting vector ticks, Ixodes scapularis and Ixodes pacificus. The ability of the MPAS assay to detect five Ixodes-associated human pathogens (Borrelia burgdorferi sensu stricto, Borrelia mayonii, Borrelia miyamotoi, Anaplasma phagocytophilum and Babesia microti) was compared to that of a previously published and routinely used probe-based (TaqMan) PCR testing algorithm for pathogen detection in Ixodes ticks. Assay performance comparisons included a set of 175 host-seeking Ixodes nymphs collected in Connecticut as well as DNA from our pathogen reference collection. The MPAS assay and the CDC standard TaqMan PCR pathogen testing algorithm were found to have equivalent detection sensitivity for Ixodes-associated human pathogens. However, the MPAS assay was able to detect a broader range of tick-associated microorganisms, more effectively detected co-infections of multiple pathogens in a single tick (including different species within the Borrelia burgdorferi sensu lato complex), and required a smaller volume of test sample (thus preserving more sample for future testing).