Lyme disease

Not to be confused with phytophotodermatitis, also known as "lime disease".

Lyme disease
Other namesLyme borreliosis
An adult deer tick (most cases of Lyme are caused by nymphal rather than adult ticks)
SpecialtyInfectious disease
SymptomsExpanding area of redness at the site of a tick bite, fever, headache, tiredness[1]
ComplicationsFacial nerve paralysis, arthritis, meningitis-like symptoms,[2] Heart rhythm irregularities[3]
Usual onsetA week after a bite[1]
CausesBorrelia spread by ticks[4]
Diagnostic methodBased on symptoms, tick exposure, blood tests[5]
PreventionPrevention of tick bites (clothing the limbs, DEET), doxycycline[4]
MedicationDoxycycline, amoxicillin, ceftriaxone, cefuroxime[4]
Frequency~476k/year in U.S. (a likely overestimate), 200k/year in Europe[6][7][8]

Lyme disease, also known as Lyme borreliosis, is a tick-borne disease caused by species of Borrelia bacteria, transmitted by blood-feeding ticks in the genus Ixodes.[4][9][10] The most common sign of infection is an expanding red rash, known as erythema migrans (EM), which appears at the site of the tick bite about a week afterwards.[1] The rash is typically neither itchy nor painful.[1] Approximately 70–80% of infected people develop a rash.[1] Early diagnosis can be difficult.[11] Other early symptoms may include fever, headaches and tiredness.[1] If untreated, symptoms may include loss of the ability to move one or both sides of the face, joint pains, severe headaches with neck stiffness or heart palpitations.[1] Months to years later, repeated episodes of joint pain and swelling may occur.[1] Occasionally, shooting pains or tingling in the arms and legs may develop.[1]

Lyme disease is transmitted to humans by the bites of infected ticks of the genus Ixodes.[12] In the United States, ticks of concern are usually of the Ixodes scapularis type. According to the Centers for Disease Control and Prevention, "In most cases, a tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted. If you remove a tick quickly (within 24 hours), you can greatly reduce your chances of getting Lyme disease."[13][14] In Europe, Ixodes ricinus ticks may spread the bacteria more quickly.[14][15] In North America, the bacterial species Borrelia burgdorferi and B. mayonii cause Lyme disease.[4][16] In Europe and Asia, Borrelia afzelii, Borrelia garinii, B. spielmanii and four other species also cause the disease.[4] The disease does not appear to be transmissible between people, by other animals nor through food.[13] Diagnosis is based on a combination of symptoms, history of tick exposure and possibly testing for specific antibodies in the blood.[5][17] Blood tests are often falsely negative in the early stages of the disease.[4] Testing of individual ticks is not typically useful.[18]

Prevention includes efforts to prevent tick bites by wearing clothing to cover the arms and legs and using DEET or picaridin-based insect repellents.[4][9] Using pesticides to reduce tick numbers may also be effective.[4] Ticks can be removed using tweezers.[19] If the removed tick is full of blood a single dose of doxycycline may be used to prevent the development of infection but is not generally recommended since the development of infection is rare.[4] If an infection develops, a number of antibiotics are effective, including doxycycline, amoxicillin and cefuroxime.[4] Standard treatment usually lasts for two or three weeks.[4] Some people develop a fever and muscle and joint pains from treatment, which may last for one or two days.[4] In those who develop persistent symptoms, long-term antibiotic therapy has not been found to be useful.[4][20]

Lyme disease is the most common disease spread by ticks in the Northern Hemisphere.[21][8] Infections are most common in the spring and early summer.[4] Lyme disease was diagnosed as a separate condition for the first time in 1975 in Lyme, Connecticut. It was originally mistaken for juvenile rheumatoid arthritis.[22] The bacterium involved was first described in 1981 by Willy Burgdorfer.[23] People with persistent symptoms after appropriate treatments are said to have Post-Treatment Lyme Disease Syndrome (PTLDS).[24] PTLDS is different from chronic Lyme disease, a term no longer supported by scientists and used in different ways by different groups.[20][25] Some healthcare providers claim that chronic Lyme is caused by persistent infection, but this is not believed to be true because no evidence of persistent infection can be found after standard treatment.[26]

As of 2023, clinical trials of proposed human vaccines for Lyme disease were being carried out, but no vaccine was available. A vaccine, LYMERix, was produced, but discontinued in 2002 due to insufficient demand.[27] There are several vaccines for the prevention of Lyme disease in dogs.

  1. ^ a b c d e f g h i "Signs and Symptoms of Lyme Disease". cdc.gov. 11 January 2013. Archived from the original on 16 January 2013. Retrieved 2 March 2015.
  2. ^ "Clinical Care and Treatment of Neurologic Lyme Disease". Lyme Disease. 20 May 2024. Retrieved 27 May 2024.
  3. ^ "Lyme disease - Symptoms and causes". Mayo Clinic. Retrieved 7 June 2022.
  4. ^ a b c d e f g h i j k l m n o Shapiro ED (May 2014). "Clinical practice. Lyme disease" (PDF). The New England Journal of Medicine. 370 (18): 1724–1731. doi:10.1056/NEJMcp1314325. PMC 4487875. PMID 24785207. Archived from the original (PDF) on 21 August 2016. Retrieved 5 July 2016.
  5. ^ a b "Lyme Disease Diagnosis and Testing". cdc.gov. 10 January 2013. Archived from the original on 2 March 2015. Retrieved 2 March 2015.
  6. ^ "Lyme Disease Surveillance and Data". Centers for Disease Control and Prevention. 15 May 2024. Retrieved 16 August 2024.
  7. ^ Kugeler KJ, Schwartz AM, Delorey MJ, Mead PS, Hinckley AF (February 2021). "Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010-2018". Emerging Infectious Diseases. 27 (2): 616–619. doi:10.3201/eid2702.202731. PMC 7853543. PMID 33496229.
  8. ^ a b Marques AR, Strle F, Wormser GP (August 2021). "Comparison of Lyme Disease in the United States and Europe". Emerging Infectious Diseases. 27 (8): 2017–2024. doi:10.3201/eid2708.204763. PMC 8314816. PMID 34286689.
  9. ^ a b Wenner M (11 June 2021). "Let's Do a Tick Check - These pervasive bloodsuckers can give you more than just Lyme disease. Here's how to protect yourself. (Interactive)". The New York Times. Retrieved 19 June 2021.
  10. ^ Wolcott KA, Margos G, Fingerle V, Becker NS (September 2021). "Host association of Borrelia burgdorferi sensu lato: A review". Ticks and Tick-Borne Diseases. 12 (5): 101766. doi:10.1016/j.ttbdis.2021.101766. PMID 34161868.
  11. ^ Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK (June 2009). "Diagnostic challenges of early Lyme disease: lessons from a community case series". BMC Infectious Diseases. 9: 79. doi:10.1186/1471-2334-9-79. PMC 2698836. PMID 19486523.
  12. ^ Johnson RC (1996). "Borrelia". In Baron S, et al. (eds.). Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. PMID 21413339. Archived from the original on 7 February 2009.
  13. ^ a b "Lyme disease transmission". cdc.gov. 11 January 2013. Archived from the original on 3 March 2015. Retrieved 2 March 2015.
  14. ^ a b Steere AC, Strle F, Wormser GP, Hu LT, Branda JA, Hovius JW, et al. (December 2016). "Lyme borreliosis". Nature Reviews. Disease Primers. 2: 16090. doi:10.1038/nrdp.2016.90. PMC 5539539. PMID 27976670.
  15. ^ "Lyme borreliosis" (PDF). ECDC. Archived (PDF) from the original on 29 September 2018. Retrieved 29 September 2018.
  16. ^ Pritt BS, Mead PS, Johnson DK, Neitzel DF, Respicio-Kingry LB, Davis JP, et al. (May 2016). "Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study". The Lancet. Infectious Diseases. 16 (5): 556–564. doi:10.1016/S1473-3099(15)00464-8. PMC 4975683. PMID 26856777.
  17. ^ "Two-step Laboratory Testing Process". cdc.gov. 15 November 2011. Archived from the original on 12 March 2015. Retrieved 2 March 2015.
  18. ^ "Testing of Ticks". cdc.gov. 4 June 2013. Archived from the original on 19 February 2015. Retrieved 2 March 2015. Although some commercial groups offer testing, in general it is not recommended
  19. ^ "Tick Removal". cdc.gov. 23 June 2014. Archived from the original on 10 March 2015. Retrieved 2 March 2015.
  20. ^ a b "Post-Treatment Lyme Disease Syndrome". cdc.gov. 1 December 2017. Archived from the original on 27 February 2015. Retrieved 20 June 2018.
  21. ^ Regional Disease Vector Ecology Profile: Central Europe. DIANE Publishing. April 2001. p. 136. ISBN 978-1-4289-1143-7. Archived from the original on 8 September 2017.
  22. ^ Williams C (2007). Infectious disease epidemiology : theory and practice (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers. p. 447. ISBN 978-0-7637-2879-3. Archived from the original on 8 September 2017.
  23. ^ "Willy Burgdorfer – obituary". Daily Telegraph. 1 December 2014. Archived from the original on 1 December 2014. Retrieved 1 December 2014.
  24. ^ CDC (11 June 2024). "Chronic Symptoms and Lyme Disease". Lyme Disease. Retrieved 27 July 2024.
  25. ^ Baker PJ (November 2010). "Chronic Lyme disease: in defense of the scientific enterprise". FASEB Journal. 24 (11): 4175–4177. doi:10.1096/fj.10-167247. PMID 20631327. S2CID 36141950.
  26. ^ Lantos PM (June 2015). "Chronic Lyme disease". Infectious Disease Clinics of North America. 29 (2): 325–340. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.
  27. ^ Cite error: The named reference cdc-vaccine was invoked but never defined (see the help page).