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Lyme disease
Other names: Lyme borreliosis
An adult deer tick (most cases of Lyme are caused by nymphal rather than adult ticks)
Specialty Infectious disease
Symptoms Expanding area of redness at the site of a tick bite, fever, headache, tiredness[1]
Complications Facial nerve paralysis, arthritis, meningitis[1]
Usual onset A week after a bite[1]
Causes Borrelia spread by ticks[2]
Diagnostic method Based on symptoms, tick exposure, blood tests[3]
Prevention Prevention of tick bites (clothing the limbs, DEET), doxycycline[2]
Medication Doxycycline, amoxicillin, azithromycin, ceftriaxone, cefuroxime[4]
Frequency 365,000 per year[2][5]

Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by the Borrelia bacterium which is spread by ticks.[2] The most common sign of infection is an expanding area of redness on the skin, known as erythema migrans, that appears at the site of the tick bite about a week after it occurred.[1] The rash is typically neither itchy nor painful.[1] Approximately 70–80% of infected people develop a rash.[1] Other early features may include fever, headache, tiredness and swollen glands.[6] It usually resolves at this stage.[6] If untreated, some people may later develop loss of the ability to move one or both sides of the face, joint pains, severe headaches with neck stiffness, or heart palpitations, among others.[1] Months to years later, repeated episodes of joint pain and swelling may occur.[1][6] Occasionally, people develop shooting pains or tingling in their arms and legs.[1] Despite appropriate treatment, about 10 to 20% of people develop joint pains, memory problems, and tiredness for at least six months.[1][7]

Lyme disease is transmitted to humans by the bites of infected ticks of the genus Ixodes.[8] In the United States, ticks of concern are usually of the Ixodes scapularis type, and must be attached for at least 36 hours before the bacteria can spread.[9][10] In Europe, ticks of the Ixodes ricinus type may spread the bacteria more quickly.[10][11] In North America, the bacteria Borrelia burgdorferi and Borrelia mayonii cause Lyme disease.[2][12] In Europe and Asia, Borrelia afzelii and Borrelia garinii are also causes of the disease.[2] The disease does not appear to be transmissible between people, by other animals, or through food.[9] Diagnosis is based upon a combination of symptoms, history of tick exposure, and possibly testing for specific antibodies in the blood.[3][13] Blood tests are often negative in the early stages of the disease.[2] Testing of individual ticks is not typically useful.[14]

Prevention includes efforts to prevent tick bites such as by wearing clothing to cover the arms and legs, and using DEET-based insect repellents.[2] Using pesticides to reduce tick numbers may also be effective.[2] Ticks can be removed using tweezers.[15] If the removed tick was full of blood, a single dose of doxycycline may be used to prevent development of infection, but is not generally recommended since development of infection is rare.[2] If an infection develops, a number of antibiotics are effective, including doxycycline, amoxicillin, azithromycin, ceftriaxone, and cefuroxime.[4] Standard treatment usually lasts for two or three weeks.[2] Some people develop a fever and muscle and joint pains from treatment which may last for one or two days.[2] In those who develop persistent symptoms, long-term antibiotic therapy has not been found to be useful.[2][16]

Lyme disease is the most common disease spread by ticks in the Northern Hemisphere.[17] It is estimated to affect 300,000 people a year in the United States and 65,000 people a year in Europe.[2][5] Infections are most common in the spring and early summer.[2] Lyme disease was diagnosed as a separate condition for the first time in 1975 in Old Lyme, Connecticut.[18] It was originally mistaken for juvenile rheumatoid arthritis.[18] The bacterium involved was first described in 1981 by Willy Burgdorfer.[19] Chronic symptoms following treatment are well described and are known as "post-treatment Lyme disease syndrome" (PTLDS).[16] PTLDS is different from chronic Lyme disease; a term no longer supported by the scientific community and used in different ways by different groups.[16][20] Some healthcare providers claim that PTLDS 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.[21] A vaccine for Lyme disease was marketed in the United States between 1998 and 2002, but was withdrawn from the market due to poor sales.[2][22][23] Research is ongoing to develop new vaccines.[2]

References

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  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 "Signs and Symptoms of Lyme Disease". cdc.gov. 11 January 2013. Archived from the original on 16 January 2013. Retrieved 2 March 2015.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 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.
  3. ↑ 3.0 3.1 "Lyme Disease Diagnosis and Testing". cdc.gov. 10 January 2013. Archived from the original on 2 March 2015. Retrieved 2 March 2015.
  4. ↑ 4.0 4.1 "5. Infection: 2.3. Lyme disease". British National Formulary (BNF) (82 ed.). London: BMJ Group and the Pharmaceutical Press. September 2021 – March 2022. pp. 620–621. ISBN 978-0-85711-413-6.CS1 maint: date format (link)
  5. ↑ 5.0 5.1 Berger, Stephen (2014). Lyme disease: Global Status 2014 Edition. GIDEON Informatics Inc. p. 7. ISBN 9781498803434. Archived from the original on 8 September 2017.
  6. ↑ 6.0 6.1 6.2 Barlow, Gavin; Irving, William L.; Moss, Peter J. (2020). "20. Infectious disease". In Feather, Adam; Randall, David; Waterhouse, Mona (eds.). Kumar and Clark's Clinical Medicine (in Turanci) (10th ed.). Elsevier. p. 549. ISBN 978-0-7020-7870-5. Archived from the original on 15 January 2023. Retrieved 14 January 2023.
  7. ↑ Aucott JN (June 2015). "Posttreatment Lyme disease syndrome". Infectious Disease Clinics of North America. 29 (2): 309–323. doi:10.1016/j.idc.2015.02.012. PMID 25999226.
  8. ↑ 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.
  9. ↑ 9.0 9.1 "Lyme disease transmission". cdc.gov. 11 January 2013. Archived from the original on 3 March 2015. Retrieved 2 March 2015.
  10. ↑ 10.0 10.1 Steere, AC; Strle, F; Wormser, GP; Hu, LT; Branda, JA; Hovius, JW; Li, X; Mead, PS (15 December 2016). "Lyme borreliosis". Nature Reviews. Disease Primers. 2: 16090. doi:10.1038/nrdp.2016.90. PMC 5539539. PMID 27976670.
  11. ↑ "Lyme borreliosis" (PDF). ECDC. Archived (PDF) from the original on 29 September 2018. Retrieved 29 September 2018.
  12. ↑ Pritt BS, Mead PS, Johnson DK, Neitzel DF, Respicio-Kingry LB, Davis JP, Schiffman E, Sloan LM, Schriefer ME, Replogle AJ, Paskewitz SM, Ray JA, Bjork J, Steward CR, Deedon A, Lee X, Kingry LC, Miller TK, Feist MA, Theel ES, Patel R, Irish CL, Petersen JM (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.
  13. ↑ "Two-step Laboratory Testing Process". cdc.gov. 15 November 2011. Archived from the original on 12 March 2015. Retrieved 2 March 2015.
  14. ↑ "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 this is not recommended
  15. ↑ "Tick Removal". cdc.gov. 23 June 2014. Archived from the original on 10 March 2015. Retrieved 2 March 2015.
  16. ↑ 16.0 16.1 16.2 "Post-Treatment Lyme Disease Syndrome". cdc.gov. 1 December 2017. Archived from the original on 27 February 2015. Retrieved 20 June 2018.
  17. ↑ Regional Disease Vector Ecology Profile: Central Europe. DIANE Publishing. April 2001. p. 136. ISBN 9781428911437. Archived from the original on 8 September 2017.
  18. ↑ 18.0 18.1 Williams, Carolyn (2007). Infectious disease epidemiology : theory and practice (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers. p. 447. ISBN 9780763728793. Archived from the original on 8 September 2017.
  19. ↑ "Willy Burgdorfer – obituary". Daily Telegraph. 1 December 2014. Archived from the original on 1 December 2014. Retrieved 1 December 2014.
  20. ↑ Baker, PJ (November 2010). "Chronic Lyme disease: in defense of the scientific enterprise". FASEB Journal. 24 (11): 4175–7. doi:10.1096/fj.10-167247. PMID 20631327. Archived from the original on 28 August 2021. Retrieved 21 July 2020.
  21. ↑ Lantos PM (June 2015). "Chronic Lyme disease". Infectious Disease Clinics of North America. 29 (2): 325–40. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.
  22. ↑ "When a vaccine is safe". Nature. 439 (7076): 509. February 2006. Bibcode:2006Natur.439Q.509.. doi:10.1038/439509a. PMID 16452935.
  23. ↑ Aronowitz, Robert A (June 2016). "The Rise and Fall of the Lyme Disease Vaccines: A Cautionary Tale for Risk Interventions in American Medicine and Public Health". The Milbank Quarterly. 90 (2): 250–277. doi:10.1111/j.1468-0009.2012.00663.x. ISSN 0887-378X. PMC 3460208. PMID 22709388.
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