Lyme disease Classification and external resources
Nymphal and adult deer ticks can be carriers of Lyme disease. Nymphs are about the size of a poppy seed.
ICD-9	088.81
DiseasesDB	1531
MedlinePlus	001319
eMedicine	med/1346

Lyme disease, or borreliosis, is an emerging infectious disease caused by at least three species of bacteria from the genus Borrelia.^[1] Infection is acquired from the bite of hard ticks belonging to several species of the genus Ixodes.^[2] Borrelia burgdorferi is the predominant cause of Lyme disease in the U.S., whereas Borrelia afzelii and Borrelia garinii are implicated in most European cases. Download high resolution version (640x766, 97 KB)Adult deer tick from http://www. ... Binomial name Ixodes scapularis Say, 1821 Ixodes scapularis, known as the deer tick or black-legged tick is a hard-bodied tick (family Ixodidae) of the eastern United States. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... An emerging infectious disease (EID) is an infectious disease whose incidence has increased within the past two decades and which threatens to increase in the near future. ... For other uses, see Species (disambiguation). ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... For other uses, see Genus (disambiguation). ... Species Borrelia anserina Borrelia burgdorferi Borrelia is a genus of bacteria of the spirochete class. ... Species Ixodes holocyclus Ixodes scapularis Ixodes pacificus Ixodes ricinus Ixodes is a genus of hard-bodied ticks (family Ixodidae). ... Binomial name Borrelia burgdorferi Johnson RC et al 1984 Borrelia burgdorferi is a spirochete bacteria and the causative agent of Lyme disease. ...

The disease presentation varies widely, and may include a rash and flu-like symptoms in its initial stage, then musculoskeletal, arthritic, neurologic, psychiatric and cardiac manifestations. In a majority of cases, symptoms can be eliminated with antibiotics, especially if treatment begins early in the course of illness. Late or inadequate treatment can lead to "late stage" Lyme disease that can be disabling and difficult to treat. Controversy over diagnosis, testing and treatment has led to two different standards of care.^[3][4] Respiratory disease properly named influenza(say: in-floo-en-zah ). Some specific varities of influenza with a vaccination available are: A-New Caledonia, A-California, B-Shanghai. ... The human musculoskeletal system is the musculoskeletal system that gives us the ability to move. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... Neurology is the branch of medicine that deals with the nervous system and disorders affecting it. ... Psychiatry is a branch of medicine that studies and treats mental and emotional disorders (see mental illness). ... This page is about the muscular organ, the Heart. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... While there is no doubt that Lyme disease exists, and most clinicians agree on the treatment of early Lyme disease,[1] there is considerable controversy as to the prevalence and historical emergence of the disease, the proper procedure for diagnosis and treatment of later stages, and the likelihood of a... In tort law, the standard of care is the degree of prudence and caution required of an individual who is under a duty of care. ...

Symptoms

Common bullseye rash pattern associated with Lyme Disease.

Characteristic "bulls-eye"-like rash caused by Lyme disease.

The acute phase of Lyme disease infection is a characteristic reddish "bulls-eye" rash, with accompanying fever, malaise, and musculoskeletal pain (arthralgia or myalgia).^[1] The characteristic reddish "bull's-eye" rash (known as erythema migrans) may be seen in about 80% of early stage Lyme disease patients,^[5] appearing anywhere from one day to a month after a tick bite.^[6] The rash does not represent an allergic reaction to the bite, but a skin infection caused by the Lyme bacteria, Borrelia burgdorferi sensu lato. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... Image File history File links Lymebite. ... Image File history File links Lymebite. ... In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... A rash is a change in skin which affects its color, appearance, or texture. ... An analogue medical thermometer showing the temperature of 38. ... Malaise is a feeling of general discomfort or uneasiness, an out of sorts feeling, often the first indication of an infection or other disease. ... This article does not cite any references or sources. ... Myalgia means muscle pain and is a symptom of many diseases and disorders. ... Erythema migrans (EM), formerly called erythema chronicum migrans, refers to the rash often (though not always) seen in the early stage of Lyme disease. ... Pancreatitus can be caused by an Allergic Reaction to a food. ... Borrelia burgdorferi the causative agent of Lyme disease (borreliosis). ...

The incubation period from infection to the onset of symptoms is usually 1–2 weeks, but can be much shorter (days), or much longer (months to years). Symptoms most often occur from May through September because the nymphal stage of the tick is responsible for most cases.^[7] Asymptomatic infection exists but is found in less than 7% of infected individuals in the United States.^[8] Asymptomatic infection may be much more common among those infected in Europe.^[9] Incubation period, also called the latent period or latency period, is the time elapsed between exposure to a pathogenic organism, or chemical or radiation, and when symptoms and signs are first apparent. ...

Other, less common findings in acute Lyme disease include cardiac manifestations (up to 10% of patients may have cardiac manifestations including heart block and palpitations^[10]), and neurologic symptoms (neuroborreliosis may occur in up to 18%^[10]). In addition, simple altered mental status as the sole presenting symptom has been reported in early neuroborreliosis.^[11] Patients have been known to get Baker's cysts. A heart block is a disease in the electrical system of the heart. ... A palpitation is an abnormal, rapid beating of the heart, brought on by overexertion, disease or drugs. ... A Bakers cyst, otherwise known as a popliteal cyst, is a benign swelling found behind the knee joint. ...

Chronic symptoms

Cases may progress to a chronic form most commonly characterized by meningoencephalitis, cardiac inflammation (myocarditis), and frank arthritis.^[1] It should be noted, however, that chronic Lyme disease can have a multitude of symptoms affecting numerous physiological systems: the symptoms appear heterogeneous in the affected population, which may be due to innate immunity or variations in Borrelia bacteria. Late symptoms of Lyme disease can appear months or years after initial infection and often progress in cumulative fashion over time. Neuropsychiatric symptoms often develop much later in the disease progression, much like tertiary neurosyphilis. Meningoencephalitis is a type of infection that simultaneously resembles both meningitis, which is an infection or inflammation of the meninges, and encephalitis, which is an infection or inflammation of the brain. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... Look up Heterogeneous in Wiktionary, the free dictionary. ... Innate immunity is immunity that the body possesses naturally, as opposed to adaptive immunity. ... need information on neurosyphillis infection This page meets Wikipedias criteria for speedy deletion. ...

In addition to the acute symptoms, chronic Lyme disease can be manifested by a wide-range of neurological disorders, either central or peripheral, including encephalitis or encephalomyelitis, muscle twitching, polyneuropathy or paresthesia, and vestibular symptoms or other otolaryngologic symptoms^[12][13], among others. Neuropsychiatric disturbances can occur (possibly from a low-level encephalitis), which may lead to symptoms of memory loss, sleep disturbances, or changes in mood or affect.^[1][14] A diagram showing the CNS: 1. ... The Peripheral nervous system resides or extends outside the CNS central nervous system (the brain and spinal cord) to serve the limbs and organs. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ... Encephalomyelitis is a general term for inflammation of the brain and spinal cord, describing a number of disorders: acute disseminated encephalomyelitis or postinfectious encephalomyelitis, a demyelinating disease of the brain and spinal cord, possibly triggered by vaccination or viral infection; encephalomyelitis disseminata, a synonym for multiple sclerosis; equine encephalomyelitis, a... It has been suggested that this article or section be merged with Twitching. ... Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. ... Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep (but not directly related to the phenomenon of... Balance is the result of a number of body systems working together. ... Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ... Memory loss can be caused by many things. ... A sleep disorder (somnipathy) is a disorder in the sleep patterns of a person or animal. ... A mood is a relatively lasting affective state. ... In psychology, affect is the scientific term used to describe a subjects externally displayed mood. ...

Cause

Main article: Lyme disease microbiology

Borrelia bacteria, the causative agent of Lyme disease. Magnified 400 times.

Lyme disease is caused by Gram-negative spirochetal bacteria from the genus Borrelia. At least 37 Borrelia species have been described, 12 of which are Lyme related. The Borrelia species known to cause Lyme disease are collectively known as Borrelia burgdorferi sensu lato, and have been found to have greater strain diversity than previously estimated.^[15] Borrelia burgdorferi the causative agent of Lyme disease (borreliosis). ... Image File history File linksMetadata Borrelia_image. ... Image File history File linksMetadata Borrelia_image. ... Species Borrelia anserina Borrelia burgdorferi Borrelia is a genus of bacteria of the spirochete class. ... Bacteria that are Gram-negative are not stained dark blue or violet by Gram staining, in contrast to Gram-positive bacteria. ... Families Brachyspiraceae Leptospiraceae Spirochaetaceae The spirochaetes are a phylum of distinctive bacteria, which have long, helically coiled cells. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... For other uses, see Genus (disambiguation). ... Species Borrelia anserina Borrelia burgdorferi Borrelia is a genus of bacteria of the spirochete class. ... For other uses, see Species (disambiguation). ... Sensu is a Latin term meaning in the sense of. It is used in taxonomy to specify which circumscription of a given taxon is meant, where more than one circumscription has been defined. ... Genetic diversity is a characteristic of ecosystems and gene pools that describes an attribute which is commonly held to be advantageous for survival -- that there are many different versions of otherwise similar organisms. ...

Until recently it was thought that only three genospecies caused Lyme disease: B. burgdorferi sensu stricto (predominant in North America, but also in Europe), B. afzelii, and B. garinii (both predominant in Eurasia). However, newly discovered genospecies have also been found to cause disease in humans.^{[citation needed]} "There are over 300 strains of Borrelia world wide"^[16]. It is presently unknown how many of these cause lyme, but some of them may. Sensu stricto is a Latin phrase meaning in the stricter sense [1]. It is used in taxonomy to specify which circumscription of a given taxon is meant, when one includes a greater number of members than another. ... North American redirects here. ... For other uses, see Europe (disambiguation). ... For other uses, see Eurasia (disambiguation). ...

Transmission

Ixodes scapularis, the primary vector of Lyme disease in eastern North America.

Hard-bodied ticks of the genus Ixodes are the primary vectors of Lyme disease.^[1] The majority of infections are caused by ticks in the nymph stage, as adult ticks are more easily detected and removed as a consequence of their relatively large size.^[17] Image File history File links Size of this preview: 757 × 600 pixelsFull resolution (1415 × 1121 pixel, file size: 2. ... Image File history File links Size of this preview: 757 × 600 pixelsFull resolution (1415 × 1121 pixel, file size: 2. ... Binomial name Ixodes scapularis Say, 1821 Ixodes scapularis, known as the deer tick or black-legged tick is a hard-bodied tick (family Ixodidae) of the eastern United States. ... Families Ixodidae - Hard ticks Argasidae - Soft ticks Nuttalliellidae - ????? ticks Wikispecies has information related to: Ixodoidea Tick is the common name for the small arachnids that, along with other mites, constitute the order Acarina. ... Species Ixodes holocyclus Ixodes scapularis Ixodes pacificus Ixodes ricinus Ixodes is a genus of hard-bodied ticks (family Ixodidae). ... In epidemiology, a vector is an organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another. ...

In Europe, the commonly known sheep tick, castor bean tick, or European castor bean tick (Ixodes ricinus) is the transmitter. Binomial name (Linnaeus, 1758) Ixodes ricinus, known as the sheep tick or castor bean tick is a hard-bodied tick (family Ixodidae) of Europe. ...

In North America, the black-legged tick or deer tick (Ixodes scapularis) has been identified as the key to the disease's spread on the east coast. Unfortunately, only about 20% of persons infected with Lyme disease by the deer tick are aware of having had any tick bite,^[18] making early detection difficult in the absence of a rash. Tick bites often go unnoticed due to the small size of the tick in its nymphal stage, as well as tick secretions that prevent the host from feeling any itch or pain from the bite. The lone star tick (Amblyomma americanum), which is found throughout the southeastern U.S. as far west as Texas, has been ruled out as a vector of the Lyme disease spirochete Borrelia burgdorferi[citation needed], though it may be implicated with a clinical syndrome southern tick associated rash illness (STARI), which resembles the skin lesions of Lyme disease^[19]. Binomial name Ixodes scapularis Say, 1821 Ixodes scapularis, known as the deer tick or black-legged tick is a hard-bodied tick (family Ixodidae) of the eastern United States. ... Amblyomma americanum is a species of tick in the genus Amblyomma. ...

On the west coast, the primary vector is the western black-legged tick (Ixodes pacificus).^[20] The preponderance of this tick species to feed on host species that are resistant to Borrelia infection appears to diminish transmission of Lyme disease in the West^[21][22].

While Lyme spirochetes have been found in insects other than ticks,^[23] reports of actual infectious transmission appear to be rare.^[24] Sexual transmission has been anecdotally reported; Lyme spirochetes have been found in semen^[25] and breast milk,^[26] however transmission of the spirochete by these routes is not known to occur.^[27] Sexually-transmitted infections (STIs), also known as sexually-transmitted diseases (STDs), are diseases that are commonly transmitted between partners through some form of sexual activity, most commonly vaginal intercourse, oral sex, or anal sex. ...

Congenital transmission of Lyme disease can occur from an infected mother to fetus through the placenta during pregnancy, however prompt antibiotic treatment appears to prevent fetal harm.^[28] For other uses, see Fetus (disambiguation). ... The placenta (Latin for cake, referencing its appearance in humans) is an ephemeral organ present in placental vertebrates, such as eutherial mammals and sharks during gestation (pregnancy). ...

Diagnosis

Due to the difficulty in culturing Borrelia bacteria in the laboratory, diagnosis of Lyme disease is typically based on the clinical exam findings and a history of exposure to endemic Lyme areas.^[1] The EM rash, which does not occur in all cases, is considered sufficient to establish a diagnosis of Lyme disease even when serologies are negative.^[29][30] Serological testing can be used to support a clinically suspected case but is not diagnostic.^[1] Clinicians who diagnose strictly based on the U.S. Centers for Disease Control (CDC) Case Definition for Lyme may be in error, as the CDC explicitly states that this definition is intended for surveillance purposes only, and is "not intended to be used in clinical diagnosis."^[31][32] A microbiological culture is a way to determine the cause of infectious disease by letting the agent multiply (reproduce) in predetermined media. ... In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. ... Erythema chronicum migrans refers to the rash often (though not always) seen in the early stage of Lyme disease. ... Serology is the scientific study of blood serum. ... The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... Clinical surveillance (or Syndromic Surveillance) refers to the systematic collection, analysis, and interpretation of health data about a clinical syndrome that has a significant impact on public health, which is then used to drive decisions about health policy and health education. ...

Importantly, virtually no controlled studies of late lyme encephalopathy have been performed, and the CDC diagnostic criteria were not formulated for use on this entity. Once lyme disease is well established in the brain, it can occur as a very disabling diffuse encephalopathy which however is difficult to diagnose using standard serological or intrathecal testing for reasons outlined below^{[citation needed]}. Lyme is a deep tissue infection and by the time encephalopathy is established, few if any CSF antibodies can be detected, and PCR is unreliable^{[citation needed]}. Seronegative disease can occur for the same reason that this phenomenon occurs in neurosyphilis, with incomplete or intercurrent antibiotic treatment abrogating the serum antibody response, but not eliminating the infection.^{[citation needed]}

It is in this context that advanced imaging studies like SPECT or PET can provide objective evidence of global brain dysfunction. Resort is often made to neuropsychological testing, but a normal result does not rule out the illness, which can be very subtle and manifest as a disabling mood disorder accompanied by massive and debilitating fatigue, with few objective signs.^{[citation needed]}

Diagnosis of late-stage Lyme disease it is often difficult due to the multi-faceted appearance which can mimic symptoms of many other diseases. For this reason Lyme has often been called the new "great imitator".^[33] Lyme disease may be misdiagnosed as Multiple sclerosis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome (CFS), or other autoimmune and neurodegenerative diseases. Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ... Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other countries, and a smaller fraction of children. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Neurodegenerative disease is a condition which affects brain function. ...

Serology

The serological laboratory tests most widely available and employed are the Western blot and ELISA. A two-tiered protocol is recommended by the CDC: the more sensitive ELISA is performed first, if it is positive or equivocal, the more specific Western blot is run. The reliability of testing in diagnosis remains controversial,^[1] however studies show the Western blot IgM has a specificity of 94–96% for patients with clinical symptoms of early Lyme disease.^[34][35] Serology is the scientific study of blood serum. ... A Western blot. ... Elisa (born Elisa Toffoli on 19 December 1977) is an Italian singer and solo artist, writing and performing within several genres, notably rock, blues, soul and ambient. ... The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... See: Sensitivity (electronics) Sensitivity (human) Sensitivity (tests) For sensitivity in finance, see beta coefficient This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... IGM might be an acronym or abbreviation for: The polymeric immunoglobulin, IgM International Grandmaster, a chess ranking intergalactic medium Intragroup medium - see: Intracluster medium IG Metall - the dominant German metalworkers union IGM is an acronym created by Robinson Technologies for several early BBS door games, including Legend of the Red...

Erroneous test results have been widely reported in both early and late stages of the disease. These errors can be caused by several factors, including antibody cross-reactions from other infections including Epstein-Barr virus and cytomegalovirus,^[36] as well as herpes simplex virus.^[37] Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... The Epstein-Barr virus (EBV), also called Human herpesvirus 4 (HHV-4), is a virus of the herpes family (which includes Herpes simplex virus and Cytomegalovirus), and is one of the most common viruses in humans. ... Species see text Cytomegalovirus (CMV) (from the Greek cyto-, cell, and -mega-, large) is a viral genus of the Herpesviruses group: in humans it is commonly known as human herpesvirus 5 (HHV-5). ... Species Herpes simplex virus 1 (HSV-1) Herpes simplex virus 2 (HSV-2) This article is about the virus. ...

Polymerase chain reaction (PCR) tests for Lyme disease have also been developed to detect the genetic material (DNA) of the Lyme disease spirochete. PCR tests are susceptible to false-positive results from poor laboratory technique.^[38] Even when properly performed, PCR often shows false-negative results with blood and CSF specimens.^[39] Hence PCR is not widely performed for diagnosis of Lyme disease. However PCR may have a role in diagnosis of Lyme arthritis as it is highly sensitive in detecting ospA DNA in synovial fluid.^[40] With the exception of PCR, there is no currently practical means for detection of the presence of the organism, as serologic studies only test for antibodies of Borrelia. High titers of either immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to Borrelia antigens indicate disease, but lower titers can be misleading. The IgM antibodies may remain after the initial infection, and IgG antibodies may remain for years.^[41] “PCR” redirects here. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... Type I errors (or α error, or false positive) and type II errors (β error, or a false negative) are two terms used to describe statistical errors. ... Type I errors (or α error, or false positive) and type II errors (β error, or a false negative) are two terms used to describe statistical errors. ... Wikipedia does not yet have an article with this exact name. ...

Western blot, ELISA and PCR can be performed by either blood test via venipuncture or cerebrospinal fluid (CSF) via lumbar puncture. Though lumbar puncture is more definitive of diagnosis, antigen capture in the CSF is much more elusive; reportedly CSF yields positive results in only 10-30% of patients cultured. The diagnosis of neurologic infection by Borrelia should not be excluded solely on the basis of normal routine CSF or negative CSF antibody analyses.^[42] Venipuncture using a vacutainer. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... A patient undergoes a lumbar puncture at the hands of a neurologist. ...

New techniques for clinical testing of Borrelia infection have been developed, such as LTT-MELISA^[43], which is capable of identifying the active form of Borrelia infection (Lyme disease). Others, such as focus floating microscopy, are under investigation.^[44] New research indicates chemokine CXCL13 may also be a possible marker for neuroborreliosis.^[45] Chemokines are a family of pro-inflammatory activation-inducible cytokines, or small protein signals secreted by cells. ... Chemokine (C-X-C motif) ligand 13 (CXCL13) is a small cytokine belonging to the CXC chemokine family that is also known as B lymphocyte chemoattractant (BLC). ...

Imaging

Single photon emission computed tomography (SPECT) imaging has been used to look for cerebral hypoperfusion indicative of Lyme encephalitis in the patient.^[46] Although SPECT is not a diagnostic tool itself, it may be a useful method of determining brain function. Single photon emission computed tomography (SPECT) is a nuclear medicine tomographic imaging technique using gamma rays. ... Wikipedia does not yet have an article with this exact name. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ...

In Lyme patients cerebral hypoperfusion of frontal subcortical and cortical structures has been reported.^[47] In about 70% of chronic Lyme disease patients with cognitive symptoms, brain SPECT scans typically reveal a pattern of global hypoperfusion in a heterogeneous distribution through the white matter.^[48] This pattern is not specific for Lyme disease, as it can also be seen in other central nervous system (CNS) syndromes such as HIV encephalopathy, viral encephalopathy, chronic cocaine use, and vasculitides. However, most of these syndromes can be ruled out easily through standard serologic testing and careful patient history taking. The basal ganglia (or basal nuclei) are a group of nuclei in the brain interconnected with the cerebral cortex, thalamus and brainstem. ... For other uses, see Cortex. ... White matter is one of the two main solid components of the central nervous system. ... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ... For other uses, see Cocaine (disambiguation). ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels. ...

The presence of global cerebral hypoperfusion deficits on SPECT in the presence of characteristic neuropsychiatric features should dramatically raise suspicion for lyme encephalopathy among patients who inhabit or have traveled to endemic areas, regardless of patient recall of tick bites.^{[citation needed]} Late disease can occur many years after initial infection. The average time from symptom onset to diagnosis in these patients is about 4 years. Because seronegative disease can occur, and because CFS testing is often normal, lyme encephalopathy often becomes a diagnosis of exclusion: once all other possibilities are ruled out, LE becomes ruled in. Although the aberrant SPECT patterns are caused by cerebral vaculitis, a vasculitide, brain biopsy is not commonly performed for these cases as opposed to other types of cerebral vasculitis.

Abnormal magnetic resonance imaging (MRI) findings are often seen in both early and late Lyme disease.^{[citation needed]} MRI scans of patients with neurologic Lyme disease may demonstrate punctuated white matter lesions on T2-weighted images, similar to those seen in demyelinating or inflammatory disorders such as multiple sclerosis, systemic lupus erythematosus (SLE), or cerebrovascular disease.^[49] Cerebral atrophy and brainstem neoplasm has been indicated with Lyme infection as well.^[50] MRI redirects here. ... White matter is one of the two main solid components of the central nervous system. ... A lesion is a non-specific term referring to abnormal tissue in the body. ... In neuroscience, myelin is an electrically insulating phospholipid layer that surrounds the axons of many neurons. ... Cerebral atrophy is a common feature of many of the diseases that affect the brain. ... Neoplasia (literally: new growth) is sudden and abnormal growth in a tissue or organ. ...

Diffuse white matter pathology can disrupt these ubiquitous gray matter connections and could account for deficits in attention, memory, visuospatial ability, complex cognition, and emotional status. White matter disease may have a greater potential for recovery than gray matter disease, perhaps because neuronal loss is less common. Spontaneous remission can occur in multiple sclerosis, and resolution of MRI white matter hyper-intensities, after antibiotic treatment, has been observed in Lyme disease.^[51] Grey matter (or gray matter) is a major component of the central nervous system, consisting of nerve cell bodies, glial cells (astroglia and oligodendrocytes), capillaries, and short nerve cell extensions/processes (axons and dendrites). ... Remission is the state of absence of disease activity in patients with known chronic illness. ...

Prevention

Attached ticks should be removed promptly.^[52] Protective clothing includes a hat and long-sleeved shirts and long pants that are tucked into socks or boots. Also, light-colored clothing makes the tick more easily visible before it attaches itself.

A more effective, community wide method of preventing Lyme disease is to reduce the numbers of primary hosts on which the deer tick depends such as rodents, other small mammals, and deer.

Management of host animals

Lyme and all other deer-tick borne diseases can be prevented on a regional level by reducing the deer population that the ticks depend on for reproductive success. This has been effectively demonstrated in the communities of Monhegan, Maine^[53] and in Mumford Cove, CT.^[54]. The black-legged or deer tick (Ixodes scapularis) depends on the white-tailed deer for successful reproduction. Monhegan is an island located in Lincoln County, Maine about 12 NM off the coast. ...

By reducing the deer population back to healthy levels of 8 to 10 per square mile (from the current levels of 60 or more deer per square mile in the areas of the country with the highest Lyme disease rates) the tick numbers can be brought down to very low levels, too few to spread Lyme and other tick-borne diseases.^[55]

Vaccination

A vaccine, called Lymerix, against a North American strain of the spirochetal bacteria was approved by the United States FDA on December 21, 1998. It was produced by GlaxoSmithKline (GSK) and was based on the outer surface protein A (OspA) of B. burgdorferi. OspA causes the human immune system to create antibodies that attack that protein. A group of patients who took Lymerix developed arthritis, muscle pain and other troubling symptoms after vaccination. A class-action lawsuit against GSK was filed on December 14, 1999. Cassidy v. SmithKline Beecham, No. 99-10423 (Ct. Common Pleas, PA state court) (common settlement case).^[56] On February 26, 2002, GSK, citing poor sales, need for frequent boosters, the high price of the vaccine, and the exclusion of children, decided to withdraw Lymerix from the market. Some people believe that the actual reason was that the vaccine was neither safe nor effective. A vaccine is an antigenic preparation used to establish immunity to a disease. ... GlaxoSmithKline plc (LSE: GSK NYSE: GSK) is a British based pharmaceutical, biological, and healthcare company. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... This article or section does not adequately cite its references or sources. ...

While Lymerix was initially being marketed, it was learned that patients with the genetic allele HLA-DR4 were susceptible to T-cell cross-reactivity between epitopes of OspA and lymphocyte function-associated antigen in these patients causing an autoimmune reaction.^[57] An allele (pronounced , ) (from the Greek αλληλος, meaning each other) is one member of a pair or series of different forms of a gene. ... An epitope is the part of a macromolecule that is recognized by the immune system, specifically by antibodies, B cells, or cytotoxic T cells. ...

New vaccines are being researched using outer surface protein C (OspC) and glycolipoprotein as methods of immunization.^[58][59] Glycolipids are carbohydrate-attached lipids. ...

Removal of ticks

Many urban legends exist about the proper and effective method to remove a tick. Complete removal of the tick head is important; if the head is not completely removed, local infection of bite location may result.^[60] Data have demonstrated that prompt removal of an infected tick, within approximately 36 hours, reduces the risk of transmission to effectively zero percent; however the small size of the tick, especially in nymph stage may make detection difficult.^[61] An urban legend or urban myth is similar to a modern folklore consisting of stories often thought to be factual by those circulating them. ...

Treatment

Antibiotics are the primary treatment for Lyme disease, but the most appropriate antibiotic treatment varies from patient to patient and with the stage of the disease.^[1] The antibiotics of choice are doxycycline (in adults), amoxicillin (in children) and ceftriaxone. Alternative choices are cefuroxime and cefotaxime. ^[1] Macrolide antibiotics have limited efficacy when used alone. Many physicians who treat chronic Lyme disease have noted that combining a macrolide antibiotic such as clarithromycin (biaxin) with hydroxychloroquine (plaquenil) is especially effective in treatment of chronic Lyme disease.^[62] This is suggested as being due to the hydroxychloroquine raising the pH of intracellular acidic vacuoles in which B. burgdorferi may reside; raising the pH is thought to activate the macrolide antibiotic, allowing it to inhibit protein synthesis by the spirochete.^[62] An antibiotic is a drug that kills or slows the growth of bacteria. ... Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... Amoxicillin (INN) or amoxycillin (former BAN) is a moderate-spectrum β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. ... Ceftriaxone (INN) (IPA: ) is a third-generation cephalosporin antibiotic. ... The macrolides are a group of drugs (typically antibiotics) whose activity stems from the presence of a macrolide ring, a large lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, are attached. ... The macrolides are a group of drugs (typically antibiotics) whose activity stems from the presence of a macrolide ring, a large lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, are attached. ... Clarithromycin is a macrolide antibiotic used to treat pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia (especially atypical pneumonias associated with Chlamydia pneumoniae or TWAR), skin and skin structure infections, and, in HIV and AIDS patients to prevent, and to treat, disseminated Mycobacterium avium complex (MAC). ... Hydroxychloroquine is an antimalarial drug, sold under the trade name Plaquenil®, also used to reduce inflammation in the treatment of Rheumatoid arthritis (see Disease-modifying antirheumatic drugs) and lupus. ... Vacuoles are large membrane-bound compartments within some eukaryotic cells where they serve a variety of different functions: capturing food materials or unwanted structural debris surrounding the cell, sequestering materials that might be toxic to the cell, maintaining fluid balance (called turgor) within the cell, exporting unwanted substances from the...

Persons who remove attached ticks should be monitored closely for signs and symptoms of tick-borne diseases for up to 30 days. A three day course of doxycycline therapy may be considered for deer tick bites when the tick has been on the person for at least 12 hours. Patients should report any Erythema migrans over the subsequent two to six weeks. If there should be suspicion of disease, then a course of Doxycycline should be immediately given for ten days without awaiting serology tests which yield positive results only after an interval of one to two months. Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... Erythema migrans (EM), formerly called erythema chronicum migrans, refers to the rash often (though not always) seen in the early stage of Lyme disease. ...

Results of a recent double blind, randomized, placebo-controlled multicenter clinical study, done in Finland, indicated that oral adjunct antibiotics were not justified in the treatment of patients with disseminated Lyme borreliosis who initially received intravenous antibiotics for 3 weeks. The researchers noted the clinical outcome of said patients should not be evaluated at the completion of intravenous antibiotic treatment but rather 6-12 months afterwards. In patients with chronic post-treatment symptoms, persistent positive levels of antibodies did not seem to provide any useful information for further care of the patient.^[63]. However, this study has been criticized by ILADS, on the grounds that 1) treatment over years is often necessary to produce noticeable improvement in chronic Lyme patients and 2) the antibiotics used were cell wall antibiotics which may act relatively slowly against Lyme disease. For other uses, see Placebo (disambiguation). ...

In later stages, the bacteria disseminate throughout the body and may cross the blood-brain barrier, making the infection more difficult to treat. Late diagnosed Lyme is treated with oral or IV antibiotics, frequently ceftriaxone, 2 grams per day, for a minimum of four weeks. Minocycline is also indicated for neuroborreliosis for its ability to cross the blood-brain barrier.^{[citation needed]} The blood-brain barrier (BBB) is a membranic structure that acts primarily to protect the brain from chemicals in the blood, while still allowing essential metabolic function. ... Ceftriaxone (INN) (IPA: ) is a third-generation cephalosporin antibiotic. ... Minocycline hydrochloride, also known as minocycline, is a member of the broad spectrum tetracycline antibiotics, and has a broader spectrum than the other members. ...

Therapies for "post-Lyme syndrome"/"chronic Lyme disease"

Further information: Lyme disease controversy

Some Lyme disease patients who have completed a course of antibiotic treatment continue to have symptoms such as severe fatigue, sleep disturbance, and cognitive difficulties. It is currently unclear whether persisting symptoms following antibiotic treatment result from continuing low-level B. burgdorferi infection or from residual effects of the infection prior to treatment. Currently there are two sets of peer-reviewed published guidelines in the United States. The International Lyme and Associated Diseases Society (ILADS)^[64] advocates extended courses of antibiotics for chronic Lyme patients in light of evidence of persistent infection following "standard" antibiotic treatment of some Lyme disease patients. In contrast, the Infectious Diseases Society of America^[65], which favors the term "post-Lyme syndrome" to describe the condition in these patients, does not believe persisting symptoms following standard antibiotic treatment results from chronic infection and does not recommend additional antibiotic treatment. While there is no doubt that Lyme disease exists, and most clinicians agree on the treatment of early Lyme disease,[1] there is considerable controversy as to the prevalence and historical emergence of the disease, the proper procedure for diagnosis and treatment of later stages, and the likelihood of a... Borrelia burgdorferi the causative agent of Lyme disease (borreliosis). ...

Three double-blind, placebo-controlled trials of long-term antibiotics for chronic Lyme have produced mixed results. In all three studies, the subjects had persisting symptoms despite being treated with a standard course of antibiotics for Lyme disease. The first published study failed to detect any benefit of a 90-day course of antibiotics.^[66] However, the patients enrolled in the study may have been unusually difficult to treat as suggested by their previous multiple antibiotic treatment failures and their lengthy illness prior to the study; hence the results may not be generalizable to others with post-Lyme syndrome.^[67] Further, the study has been criticized for failing to run the antibiotic treatment over a long enough period to take into account the very gradual improvement of chronic Lyme patients seen over many months or even years on antibiotics.^[67] The second clinical trial, which used slightly different enrollment criteria and outcome measures, noted improvement in disabling fatigue that was sustained for six months following antibiotic therapy.^[68] The most recent trial was published by a group known to favor prolonged treatment with antibiotics.^[69] They found that subjects with post-treatment cognitive impairment exhibited some improvement following intravenous cefriaxone treatment for 10 weeks. However, the cognitive gains were lost when the subjects were examined 14 weeks following treatment.^[70] There is disagreement with the interpretation of the data. ILADS believes that the relapse observed following the termination of antibiotic therapy is consistent with persistent infection with B. burgdorferi, whereas the lack of lasting improvement is cited in the editorial accompanying the article as evidence that prolonged antibiotic treatment is not helpful.^[69] The double blind is ray charles is ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesis ray charlesof the scientific method, used to prevent research... For other uses, see Placebo (disambiguation). ...

A controversial new guideline developed by the American Academy of Neurology, finds conventionally recommended courses of antibiotics are highly effective for treating nervous system Lyme disease.^[71] They find no compelling evidence that prolonged treatment with antibiotics has any benefit in treating symptoms that persist following previous standard antibiotic therapy. The new guideline was touted as independent corroboration of the IDSA guideline and was quickly endorsed by the IDSA. However ILADS has accused AAN of simply repackaging the IDSA guidelines as three coauthors of the new guideline, including the lead author, were also coauthors of the IDSA Lyme guideline. There is significant disagreement with this guideline (www.ilads.org). The American Academy of Neurology (AAN) is a professional society for neurologists and neuroscientists. ...

Antibiotic-resistant therapies

Antibiotic treatment is the central pillar in the management of Lyme disease. In the late stages of borreliosis, symptoms may persist despite extensive and repeated antibiotic treatment.^[72][73] Lyme arthritis which is antibiotic resistant may be treated with hydroxychloroquine or methotrexate.^[74] Experimental data are consensual on the deleterious consequences of systemic corticosteroid therapy. Corticosteroids are not indicated in Lyme disease.^[75] Hydroxychloroquine is an antimalarial drug, sold under the trade name Plaquenil®, also used to reduce inflammation in the treatment of Rheumatoid arthritis (see Disease-modifying antirheumatic drugs) and lupus. ... Amethopterin redirects here. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ...

Antibiotic refractory patients with neuropathic pain responded well to gabapentin monotherapy with residual pain after intravenous ceftriaxone treatment in a pilot study.^[76] The immunomodulating, neuroprotective and anti-inflammatory potential of minocycline may be helpful in late/chronic Lyme disease with neurological or other inflammatory manifestations. Minocycline is used in other neurodegenerative and inflammatory disorders such as multiple sclerosis, Parkinsons, Huntington's disease, rheumatoid arthritis (RA) and ALS.^[77] Gabapentin (brand name Neurontin) is a medication originally developed for the treatment of epilepsy. ... Minocycline hydrochloride, also known as minocycline, is a member of the broad spectrum tetracycline antibiotics, and has a broader spectrum than the other members. ... Neurodegenerative disease is a condition which affects brain function. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... Parkinsons disease (PD; paralysis agitans) is a neurodegenerative disease of the substantia nigra (an area in the basal ganglia of the brain). ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... For other uses, see Als (disambiguation). ...

Alternative therapies

A number of other alternative therapies have been suggested, though clinical trials have not been conducted. For example, the use of hyperbaric oxygen therapy (which is used conventionally to treat a number of other conditions), as an adjunct to antibiotics for Lyme has been discussed.^[78] Though there are no published data from clinical trials to support its use, preliminary results using a mouse model suggest its effectiveness against B. burgdorferi both in vitro and in vivo.^[79] Anecdotal clinical research has shown potential for the antifungal azole medications such as diflucan in the treatment of Lyme, but has yet to be repeated in a controlled study or postulated a developed hypothetical model for its use.^[80] This article does not cite any references or sources. ... Species 50 species; see text *Several subfamilies of Muroids include animals called rats. ... In vitro (Latin: within the glass) refers to the technique of performing a given experiment in a test tube, or, generally, in a controlled environment outside a living organism. ... In vivo (Latin for (with)in the living). ... An azole is a class of five-membered nitrogen heterocyclic ring compounds containing at least one other noncarbon atom, nitrogen, sulfur or oxygen. ... Fluconazole (INN) (IPA: ) is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. ...

Alternative medicine approaches include bee venom because it contains the peptide melittin, which has been shown to exert inhibitory effects on Lyme bacteria in vitro;^[81] no clinical trials of this treatment have been carried out, however. Alternative medicine has been described as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Alternative medicine practices are often based in belief systems not derived from modern science. ... Families Andrenidae Anthophoridae Apidae Colletidae Ctenoplectridae Halictidae Heterogynaidae Megachilidae Melittidae Oxaeidae Sphecidae Stenotritidae This article is about the insect. ... Melittin is the principal active component of bee venom, and is a powerful anti-inflammatory substance said to be 100 times more potent than hydrocortisone. ... In vitro (Latin: within the glass) refers to the technique of performing a given experiment in a test tube, or, generally, in a controlled environment outside a living organism. ...

Prognosis

For early cases, prompt treatment is usually curative.^[82] However, the severity and treatment of Lyme disease may be complicated due to late diagnosis, failure of antibiotic treatment, simultaneous infection with other tick-borne diseases including ehrlichiosis, babesiosis, and bartonella, and immune suppression in the patient. It has been suggested that Ehrlickiosis be merged into this article or section. ... Babesiosis is a parasitic disease caused by protozoan parasites of the genus Babesia, which belongs to the phylum Apicomplexa. ... Bartonella is a genus of bacterium. ...

A meta-analysis published in 2005 found that some patients with Lyme disease have fatigue, joint and/or muscle pain, and neurocognitive symptoms persisting for years despite antibiotic treatment.^[83] Patients with late stage Lyme disease have been shown to experience a level of physical disability equivalent to that seen in congestive heart failure.^[84] Neurocognitive is a term used to describe cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain. ... Disabled redirects here. ... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ...

In rare cases, Lyme disease can be fatal.^{[85][86][87][88]}The first CDC recognized death from Lyme disease was Amanda Schmidt, age 11.^[89]

Ecology

Urbanization and other anthropogenic factors can be implicated in the spread of the Lyme disease into the human population. In many areas, expansion of suburban neighborhoods has led to the gradual deforestation of surrounding wooded areas and increasing "border" contact between humans and tick-dense areas. Human expansion has also resulted in a gradual reduction of the predators that normally hunt deer as well as mice, chipmunks and other small rodents -- the primary reservoirs for Lyme disease. As a consequence of increased human contact with host and vector, the likelihood of transmission to Lyme residents has greatly increased.^[90][91] Researchers are also investigating possible links between global warming and the spread of vector-borne diseases including Lyme disease.^[92] Global warming refers to the increase in the average temperature of the Earths near-surface air and oceans in recent decades and its projected continuation. ...

The deer tick (Ixodes scapularis, the primary vector in the northeastern U.S.) has a two-year life cycle, first progressing from larva to nymph, and then from nymph to adult. The tick feeds only once at each stage. In the fall, large acorn forests attract deer as well as mice, chipmunks and other small rodents infected with B. burgdorferi. During the following spring, the ticks lay their eggs. The rodent population then "booms." Tick eggs hatch into larvae, which feed on the rodents; thus the larvae acquire infection from the rodents. (Note: At this stage, it is proposed that tick infestation may be controlled using acaricides (miticide)). Miticides are pesticides that kill mites. ...

Adult ticks may also transmit disease to humans. After feeding, female adult ticks lay their eggs on the ground, and the cycle is complete. On the west coast, Lyme disease is spread by the western black-legged tick (Ixodes pacificus), which has a different life cycle.

The risk of acquiring Lyme disease does not depend on the existence of a local deer population, as is commonly assumed. New research suggests that eliminating deer from smaller areas (less than 2.5 ha or 6.2 acres) may in fact lead to an increase in tick density and the rise of "tick-borne disease hotspots".^[93] A hectare (symbol ha) is a metric unit of surface area, equal to 100 ares (the name is a contraction of the SI prefix hecto + are). ... This article is about the unit of measure known as the acre. ...

Epidemiology

Lyme disease is the most common tick-borne disease in North America and Europe, and one of the fastest-growing infectious diseases in the United States. Of cases reported to the United States Center for Disease Control (CDC), the ratio of Lyme disease infection is 7.9 cases for every 100,000 persons. In the ten states where Lyme disease is most common, the average was 31.6 cases for every 100,000 persons for the year 2005.^[94] Tick-borne diseases are diseases or illnesses transmitted by ticks. ... North American redirects here. ... For other uses, see Europe (disambiguation). ... In medicine, infectious disease or communicable disease is disease caused by a biological agent (e. ... The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ...

Although Lyme disease has now been reported in 49 of 50 states in the U.S, about 99% of all reported cases are confined to just five geographic areas (New England, Mid-Atlantic, East-North Central, South Atlantic, and West North-Central). Charts and tables for Lyme disease statistics in the U.S. can be found at the CDC website. New 2008 CDC (Center for Disease Control) Lyme case definition guidelines are used to determine confirmed CDC surveillance cases. (online, http://www.cdc.gov/ncphi/disss/nndss/casedef/lyme_disease_2008.htm.) Effective January 2008, the CDC gives equal weight to laboratory evidence from 1) a positive culture for B. burgdorferi; 2) two-tier testing (ELISA screening and Western Blot confirming); or 3) single-tier IgG (old infection) Western Blot. Previously, the CDC only included laboratory evidence based on (1) and (2) in their surveillance case definition. The case definition now includes the use of Western Blot without prior ELISA screen.

The number of reported cases of the disease have been increasing, as are endemic regions in North America. For example, it had previously been thought that B. burgdorferi sensu lato was hindered in its ability to be maintained in an enzootic cycle in California because it was assumed the large lizard population would dilute the prevalence of B. burgdorferi in local tick populations, but this has since been brought into question as some evidence has suggested that lizards can become infected. ^[95] Except for one study in Europe ^[96], much of the data implicating lizards is based on DNA detection of the spirochete and has not demonstrated that lizards are able to infect naive ticks feeding upon them ^{[97][98][99][100]}. As some experiments suggest lizards are refractory to infection with Borrelia, it appears likely their involvement in the enzootic cycle is more complex and species-specific ^[22]. This article is about the U.S. state. ...

While B. burgdorferi is most associated with deer tick and the white tailed mouse, Borrelia afzelii is most frequently detected in rodent-feeding vector ticks, Borrelia garinii and Borrelia valaisiana appear to be associated with birds. Both rodents and birds are competent reservoir hosts for B. burgdorferi sensu stricto. The resistance of a genospecies of Lyme disease spirochetes to the bacteriolytic activities of the alternative complement pathway of various host species may determine its reservoir host association.

In Europe, cases of B. burgdorferi sensu lato infected ticks are found predominantly in Norway, Netherlands, Germany, France, Italy, Slovenia and Poland, but have been isolated in almost every country on the continent. Lyme disease statistics for Europe can be found at Eurosurveillance website. For other uses, see Europe (disambiguation). ...

B. burgdorferi sensu lato infested ticks are being found more frequently in Japan, as well as in Northwest China and far eastern Russia.^[101][102] Borrelia has been isolated in Mongolia as well.^[103]

In South America tick-borne disease recognition and occurrence is rising. Ticks carrying B. burgdorferi sensu lato, as well as canine and human tick-borne disease, have been reported widely in Brazil, but the subspecies of Borrelia has not yet been defined.^[104] The first reported case of Lyme disease in Brazil was made in 1993 in Sao Paulo.^[105] B. burgdorferi sensu stricto antigens in patients have been identified in Colombia and in Bolivia. South America South America is a continent crossed by the equator, with most of its area in the Southern Hemisphere. ... This article is about the Brazilian state, São Paulo. ...

In Northern Africa B. burgdorferi sensu lato has been identified in Morocco, Algeria, Egypt and Tunisia.^{[106][107][108]}

Lyme disease in sub-Saharan is presently unknown but evidence indicates that Lyme disease may occur in humans in this region. The abundance of hosts and tick vectors would favor the establishment of Lyme infection in Africa.^[109] In East Africa, two cases of Lyme disease have been reported in Kenya.^[110]

In Australia there is no definitive evidence for the existence of B. burgdorferi or for any other tick-borne spirochete that may be responsible for a local syndrome being reported as Lyme disease.^[111] Cases of neuroborreliosis have been documented in Australia but are often ascribed to travel to other continents. The existence of Lyme disease in Australia is controversial.

To date, data shows that Northern hemisphere temperate regions are most endemic for Lyme disease.^[112][113] Northern hemisphere highlighted in yellow. ...

Controversy

Main article: Lyme disease controversy

Most clinicians agree on the treatment of early Lyme disease infections.^[114] There is, however, considerable disagreement regarding prevalence of the disease, diagnostic criteria, treatment of late-stage Lyme disease, and the likelihood of chronic, antibiotic-resistant infections. Some authorities contend that Lyme disease is relatively rare, easily diagnosed with available blood tests, and most often easily treated with two to four weeks of antibiotics,^[115] while others propose that the disease is under-diagnosed, available blood tests are unreliable, and that extended antibiotic treatment is often necessary.^{[116][117][118]} While there is no doubt that Lyme disease exists, and most clinicians agree on the treatment of early Lyme disease,[1] there is considerable controversy as to the prevalence and historical emergence of the disease, the proper procedure for diagnosis and treatment of later stages, and the likelihood of a... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ...

The majority of public health agencies such as the U.S. Centers for Disease Control maintain the former position. Published studies involving non-randomized surveys of physicians in endemic areas found physicians evenly split in their views, with the majority recognizing seronegative Lyme disease, and roughly half prescribing extended courses of antibiotics for chronic Lyme disease, suggesting that there is much disagreement and confusion on this topic.^[119][120] The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. ... Seronegative is a general term that means absent from the blood. More specifically, it almost always is used to refer to antibodies being absent from the blood. ...

Some of the scientists involved in formulating what have become controversial Lyme diagnostic tests and treatment guidelines have been involved in both commercial vaccine and diagnostic test development, which some view as a conflict of interest.^[121] In response to these and other concerns expressed by the expanding national community of patients, Richard Blumenthal, the Attorney General of Connecticut has launched an investigation exploring possible conflicts of interest.

To date, federal research aimed at developing treatments for chronic Lyme disease is roughly $30 million, as contrasted to a $22 billion budget for military biodefense. Some scientists involved in Lyme treatment and diagnostic testing policy in the United States have a well publicized history in biodefense research. Several Lyme disease investigators, including Mark Klempner of Boston University,^[122][123] Jorge Benach of the State University of New York,^[124] and Alan Barbour of UC Irvine^[125] have recently received biodefense grants for BSL-3 and BSL-4 Labs where, critics contend, Lyme treatment research lacks transparency, accountability and focus on treatment research^[126][127], though, it should be pointed out, that labs obtaining such grants are required to make their research findings publicly available via publication and focus their studies on issues pertinent to human health ^[128]. Most people familiar with the field contend that the new grants and centers stimulate research by bringing together experts in the field and providing a stable source of funding.^[129] For the similarly named institution in Chestnut Hill, see Boston College. ... Jorge Benach is a medical researcher at the State University of New York (SUNY) at Stonybrook in New York state. ... Not to be confused with University of the State of New York. ... The University of California, Irvine is a public, coeducational university situated in suburban Irvine, California. ...

The selection of leading Lyme researchers for such senior posts in biodefense and emerging infectious disease research has fueled conspiracy theories that suggest Lyme disease is clandestinely connected with biological warfare. Such lines of thought overlook the fact that the majority of infectious disease research is supported by the U.S. government via National Institutes of Health grants^[130], and therefore the funding of Lyme disease research does not appear to be unusual. National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ...

In recent years, of a number of documents referring to the study of Lyme disease at facilities that also have BSL-4 (Biosafety Level 4) labs, the highest level of biocontainment which is reserved for highly infectious and deadly disease agents, has only served to stoke suspicion further. An example of one such document, which leads to this confusion, is a section on biocontainment in a 2003 letter from the director of a California Health Department concerning a bid for a biodefense grant, where possible research at a new lab is discussed.^[131] The mixture of infectious disease work from BSL-1 to BSL-4 level agents at such facilities appears to be the source of confusion on this issue - the biosafety level that research on a pathogen is conducted at remains relatively constant. Laws and practice of several countries specify four levels of biocontainment precautions for biological agents, Biosafety Levels 1 through 4. ... A pathogen (from Greek pathos, suffering/emotion, and gene, to give birth to), infectious agent, or more commonly germ, is a biological agent that causes disease or illness to its host. ...

Consistently, disagreement on the exact guidelines for diagnosis and treatment of Lyme disease has been a source of controversy and high emotions. In October 2006, further controversy erupted with the release of updated diagnosis and treatment guidelines from the Infectious Diseases Society of America (IDSA).^[132] The new IDSA recommendations are more restrictive than prior IDSA treatment guidelines for Lyme,^[133] and now require either an EM rash or positive laboratory tests for diagnosis; seronegative Lyme disease is no longer acknowledged (except incidentally in early Lyme disease). The authors of the guidelines maintain that chronic Lyme disease does not result from persistent infection, and therefore treatment beyond 2-4 weeks is not recommended, even in late stage cases. An opposing viewpoint has been expressed by the International Lyme and Associated Disease Society (ILADS), which proposes extended antibiotic treatment beyond four weeks for both early and late Lyme disease.^[134] Hopefully future research will provide clarity on this issue. The Infectious Diseases Society of America (IDSA) is a medical association representing physicians, scientists and other health care professionals who specialize in infectious diseases. ...

On May 1st 2008, Connecticut Attorney General Blumenthal announced news of a settlement in a landmark antitrust investigation into the Lyme treatment guidelines of the Infectious Diseases Society of America (IDSA). "My office uncovered undisclosed financial interests held by several of the most powerful IDSA panelists," said Blumenthal. "The IDSA's guideline panel improperly ignored, or minimized, consideration of alternative medical opinion and evidence regarding chronic Lyme disease, potentially raising serious questions about whether the recommendations reflected all relevant science."

This finding forces a complete review of the IDSA guidelines by a new panel free from conflicts of interest, specifically excluding previous panel members. This panel will consider a range of scientific evidence in a public forum broadcast live over the internet and will be overseen by a specialist in financial conflicts of interest in medicine.

Advancing immunology research

Long term persistence of T cell lymphocyte responses to B. burgdorferi as an "immunological scar syndrome" was hypothesized in 1990.^[135] The role of Th1 and interferon-gamma (IFN-gamma) in borrelia was first described in 1995.^[136] The cytokine pattern of Lyme disease, and the role of Th1 with down regulation of interleukin-10 (IL-10) was first proposed in 1997.^[137] A scanning electron microscope (SEM) image of a single human lymphocyte. ... T helper cells (also known as effector T cells or Th cells) are a sub-group of lymphocytes (a type of white blood cell or leukocyte) that play an important role in establishing and maximising the capabilities of the immune system. ... Interferon-gamma or IFN-g is a dimerized soluble cytokine which is a Type II Interferon. ... Cytokines are a category of less-widely-known signalling proteins and glycoproteins that, like hormones and neurotransmitters, are used extensively in cellular communication. ... Interleukin-10 (IL-10 or IL10), also known as human cytokine synthesis inhibitory factor (CSIF), is an anti-inflammatory cytokine, capable of inhibiting synthesis of pro-inflammatory cytokines like IFN-gamma, IL-2, IL-3, TNFα and GM-CSF by cells such as macrophages and Th1 cells. ...

Inflammation

Further information: Innate immune system and Cell signaling networks

Recent studies in both acute and antibiotic refractory, or chronic, Lyme disease have shown a distinct pro-inflammatory immune process. This pro-inflammatory process is a cell-mediated immunity and results in Th1 upregulation. These studies have shown a significant decrease in cytokine output of (IL-10), an upregulation of Interleukin-6 (IL-6), Interleukin-12 (IL-12) and IFN-gamma and disregulation in TNF-alpha predominantly.^[138] The innate immune system comprises the cells and mechanisms that defend the host from infection by other organisms, in a non-specific manner. ... Cell signaling pathways interact with one another to form networks in natural systems. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... Cell-mediated immunity is an immune response that does not involve antibodies but rather involves the activation of macrophages and NK-cells, the production of antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen. ... Cytokines are a category of less-widely-known signalling proteins and glycoproteins that, like hormones and neurotransmitters, are used extensively in cellular communication. ... Interleukin-6 (IL-6) is a pro-inflammatory cytokine secreted by T cells and macrophages to stimulate immune response to trauma, especially burns or other tissue damage leading to inflammation. ... Interleukin 12 (IL-12) is an interleukin that are naturally produced by macrophages and human B-lymphoblastoid cells (NC-37)in response to antigenic stimulation. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ...

These studies suggest that the host immune response to infection results in increased levels of IFN-gamma in the serum and lesions of Lyme disease patients that correlate with greater severity of disease. IFN-gamma alters gene expression by endothelia exposed to B. burgdorferi in a manner that promotes recruitment of T cells and suppresses that of neutrophils. The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. ... T cells are a subset of lymphocytes that play a large role in the immune response. ... Neutrophil granulocytes (commonly referred to as neutrophils) are a class of white blood cells and are part of the immune system. ...

Studies also suggest suppressors of cytokine signaling (SOCS) proteins are induced by cytokines, and T cell receptor can down-regulate cytokine and T cell signaling in macrophages. It is hypothesized that SOCS are induced by IL-10 and B. burgdorferi and its lipoproteins in macrophages, and that SOCS may mediate the inhibition of IL-10 by concomitantly elicited cytokines. IL-10 is generally regarded as an anti-inflammatory cytokine, since it acts on a variety of cell types to suppress production of proinflammatory mediators. A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Macrophages (Greek: big eaters) are cells found in tissues that are responsible for phagocytosis of pathogens, dead cells and cellular debris. ... A lipoprotein is a biochemical assembly that contains both proteins and lipids and may be structural or catalytic in function. ...

Researchers are also beginning to identify microglia as a previously unappreciated source of inflammatory mediator production following infection with B. burgdorferi. Such production may play an important role during the development of cognitive disorders in Lyme neuroborreliosis. This effect is associated with induction of nuclear factor-kappa B (NF-KB) by Borrelia.^[139][140] Microglia cells positive for lectins Microglia are a type of glial cell that act as the immune cells of the Central nervous system (CNS). ... NF-κB, or Nuclear Factor kappa B, is a nuclear transcription factor found in all cell types and is involved in cellular responses to stimuli such as stress, cytokines, free radicals, ultraviolet irradiation, and bacterial or viral antigens. ...

Disregulated production of pro-inflammatory cytokines such as IL-6 and TNF-alpha can lead to neuronal damage in Borrelia infected patients.^[141] IL-6 and TNF-Alpha cytokines produce fatigue and malaise, two of the more prominent symptoms experienced by patients with chronic Lyme disease.^[142][143]IL-6 is also significantly indicated in cognitive impairment.^[144]

Neuroendocrine

Further information: Signal transduction

A developing hypothesis is that the chronic secretion of stress hormones as a result of Borrelia infection may reduce the effect of neurotransmitters, or other receptors in the brain by cell-mediated pro-inflammatory pathways, thereby leading to the dysregulation of neurohormones, specifically glucocorticoids and catecholamines, the major stress hormones. ^[145][146]This process is mediated via the Hypothalamic-pituitary-adrenal axis. Additionally Tryptophan, a precursor to serotonin appears to be reduced within the CNS in a number of infectious diseases that affect the brain, including Lyme.^[147] Researchers are investigating if this neurohormone secretion is the cause of neuro-psychiatric disorders developing in some patients with borreliosis.^[148] In biology, signal transduction refers to any process by which a cell converts one kind of signal or stimulus into another, most often involving ordered sequences of biochemical reactions inside the cell, that are carried out by enzymes and linked through second messengers resulting in what is thought of as... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... Hormone is also the NATO reporting name for the Soviet/Russian Kamov Ka-25 military helicopter. ... Neurotransmitters are chemicals that are used to relay, amplify and modulate electrical signals between a presynaptic and a postsynaptic neuron. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... Catecholamines are chemical compounds derived from the amino acid tyrosine that act as hormones or neurotransmitters. ... It has been suggested that HTPA be merged into this article or section. ... Tryptophan (abbreviated as Trp or W)[1] is one of the 20 standard amino acids, which are the building blocks of proteins, and an essential amino acid in the human diet. ... For the professional wrestling stable, see Ravens Nest#Serotonin. ...

Antidepressants acting on serotonin, norepinephrine and dopamine receptors have been shown to be immunomodulatory and anti-inflammatory against pro-inflammatory cytokine processes, specifically on the regulation of IFN-gamma and IL-10, as well as TNF-alpha and IL-6 through a psycho-neuroimmunological process.^[149] Antidepressants have also been shown to suppress Th1 upregulation.^[150]These studies warrant investigation for antidepressants for use in a psycho-neuroimmunological approach for optimal pharmacotherapy of antibiotic refractory Lyme patients.^{[citation needed]} An antidepressant is a medication used primarily in the treatment of clinical depression. ... Norepinephrine (INN)(abbr. ... For other uses, see Dopamine (disambiguation). ... Psychoneuroimmunology (PNI) investigates the relations between the psychophysiological and immunophysiological dimensions of living beings. ... Pharmacotherapy is the practice of treating diseases with medication. ...

New developments

New research has also found that chronic Lyme patients have higher amounts of Borrelia-specific forkhead box P3 (FoxP3) than healthy controls, indicating that regulatory T cells might also play a role, by immunosuppression, in the development of chronic Lyme disease. FoxP3 are a specific marker of regulatory T cells.^[151] The signaling pathway P38 mitogen-activated protein kinases (p38 MAP kinase) has also been identified as promoting expression of pro-inflammatory cytokines from Borrelia.^[152] Foxp3 is a member of the forkhead/winged-helix family of transcriptional regulators and functions as the master regulator in the development and function of regulatory T cells. ... Regulatory T cells (also known as suppressor T cells) are a specialized subpopulation of T cells that act to suppress activation of the immune system and thereby maintain immune system homeostasis and tolerance to self. ... Immunosuppression is the medical suppression of the immune system. ... P38 mitogen-activated protein kinases are a class of mitogen-activated protein kinases which are responsive to stress stimuli, such as cytokines, ultraviolet irradiation, heat shock, and osmotic shock, and are involved in cell differentiation and apoptosis. ...

The culmination of these new and ongoing immunological studies suggest this cell-mediated immune disruption in the Lyme patient amplifies the inflammatory process, often rendering it chronic and self-perpetuating, regardless of whether the Borrelia bacterium is still present in the host, or in the absence of the inciting pathogen in an autoimmune pattern.^[153]. This interpretation must however be considered against the evidence (above) for persistence of the 'spore' form of Borrellia in human and animal hosts, and the tendency for relapses to occur after antibiotics are continued. It is possible that whereas some chronic Lyme patients retain actual populations of live spirochaetes, others have symptoms brought on only by an inflammatory or auto-immune reaction. Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ...

Researchers hope that this new developing understanding of the biomolecular basis and pathology of cell-mediated signaling events caused by B. burgdorferi infection will lead to a greater understanding of immune response and inflammation caused by Lyme disease and, hopefully, new treatment strategies for chronic antibiotic-resistant disease. A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ...

History

The first record of a condition associated with Lyme disease dates to 1883 in Wrocław, Poland (then known as Breslau, Germany) where physician Alfred Buchwald described a degenerative skin disorder now known as acrodermatitis chronica atrophicans. In 1909, Arvid Afzelius presented research about an expanding, ring-like lesion he had observed. Afzelius published his work 12 years later and speculated that the rash came from the bite of an Ixodes tick, and that meningitic symptoms and signs occur in a number of cases; this rash is now known as erythema migrans (EM), the skin rash found in early stage Lyme disease.^[154] Motto: Miasto spotkaÅ„ (the meeting place) Coordinates: , Country Poland Voivodeship Lower Silesian Powiat city county Gmina WrocÅ‚aw Established 10th century City Rights 1262 Government  - Mayor RafaÅ‚ Dutkiewicz Area  - City 292. ... Wrocław. ... Dermatology (from Greek derma, skin) is a branch of medicine dealing with the skin and its appendages (hair, nails, sweat glands etc). ... Acrodermatitis chronica atrophicans (ACA) also known as Pick-Herxheimer disease, is a skin rash indicative of the third or late stage of European Lyme borreliosis. ... Arvid August Afzelius Arvid August Afzelius (October 8, 1785–September 25, 1871), Swedish pastor, poet, historian and mythologist. ... Erythema migrans (EM), formerly called erythema chronicum migrans, refers to the rash often (though not always) seen in the early stage of Lyme disease. ...

In the 1920s, French physicians Garin and Bujadoux described a patient with meningoencephalitis, painful sensory radiculitis, and erythema migrans following a tick bite, and they postulated the symptoms were due to a spirochetal infection. In the 1940s, German neurologist Alfred Bannwarth described several cases of chronic lymphocytic meningitis and polyradiculoneuritis, some of which were accompanied by erythematous skin lesions. German neurologist, 1903-1970. ...

In 1948 spirochete-like structures were observed in skin specimens by Swedish dermatologist Carl Lennhoff.^[155] In the 1950s, relations between tick bite, lymphocytoma, EM and Bannwarth's syndrome are seen throughout Europe leading to the use of penicillin for treatment.^{[156][157][158]} Families Brachyspiraceae Leptospiraceae Spirochaetaceae The spirochaetes are a phylum of distinctive bacteria, which have long, helically coiled cells. ... Penicillin core structure Penicillin (abbreviated PCN) is a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ...

Interest in tick-borne infections in the U.S. began with the first report of tick-borne relapsing fever (Borrelia hermsii) in 1915, following the recognition of five human patients in Colorado.^[159] Tick-borne diseases are diseases or illnesses transmitted by ticks. ...

In 1970 a physician in Wisconsin named Rudolph Scrimenti reports the first case of EM in U.S. and treats it with penicillin based on European literature.^[160]

The full syndrome now known as Lyme disease was not recognized until a cluster of cases originally thought to be juvenile rheumatoid arthritis was identified in three towns in southeastern Connecticut in 1975, including the towns Lyme and Old Lyme, which gave the disease its popular name.^[161] This was investigated by Dr. David Snydman and Dr. Allen Steere of the Epidemic Intelligence Service, and by others from Yale University. The recognition that the patients in the United States had EM led to the recognition that "Lyme arthritis" was one manifestation of the same tick-borne condition known in Europe.^[162] In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... Juvenile arthritis is a type of arthritis typically affects children before the age of sixteen. ... Official language(s) none (de facto English) Capital Hartford Largest city Bridgeport[2] Largest metro area Hartford Metro Area[3] Area  Ranked 48th in the US  - Total 5,543[4] sq mi (14,356 km²)  - Width 70 miles (113 km)  - Length 110 miles (177 km)  - % water 12. ... Lyme is a town located in New London County, Connecticut. ... Old Lyme is a town located in New London County, Connecticut. ... Allen Steere is a professor of rheumatology at Harvard University and previously Yale University. ... The Epidemic Intelligence Service (EIS) was established in 1951 following the start of the Korean War as an early warning system against biological warfare and man-made epidemics. ... Yale redirects here. ...

Before 1976, elements of B. burgdorferi sensu lato infection were called or known as tickborne meningopolyneuritis, Garin-Bujadoux syndrome, Bannworth syndrome, Afzelius syndrome, Montauk Knee or sheep tick fever. Since 1976 the disease is most often referred to as Lyme disease,^[163][164] Lyme borreliosis or simply borreliosis. Montauk is a hamlet (and census-designated place) in Suffolk County, New York on the South Shore of Long Island. ...

In 1980 Steere, et al, began to test antibiotic regimens in adult patients with Lyme disease^[165] In 1982 a novel spirochete was cultured from the mid-gut of Ixodes ticks in Shelter Island, New York, and subsequently from patients with Lyme disease. The infecting agent was then identified by Jorge Benach at the State University of New York at Stony Brook, and soon after isolated by Willy Burgdorfer, a researcher at the National Institutes of Health, who specialized in the study of spirochete microorganisms such as Borrelia and Rickettsia. The spirochete was named Borrelia burgdorferi in his honor. Burgdorfer was the partner in the successful effort to culture the spirochete, along with Alan Barbour. An antibiotic is a drug that kills or slows the growth of bacteria. ... Families Brachyspiraceae Leptospiraceae Spirochaetaceae The spirochaetes are a phylum of distinctive bacteria, which have long, helically coiled cells. ... Species Ixodes holocyclus Ixodes scapularis Ixodes pacificus Ixodes ricinus Ixodes is a genus of hard-bodied ticks (family Ixodidae). ... Shelter Island may refer to: Shelter Island (town), New York Shelter Island (CDP), New York Shelter Island, Hong Kong This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Jorge Benach is a medical researcher at the State University of New York (SUNY) at Stonybrook in New York state. ... The State University of New York at Stony Brook (SUNYSB), also known as Stony Brook University (SBU) is a public research university located in Stony Brook, New York (on the north side of Long Island, about 55 miles east of Manhattan, New York). ... Willy Burgdorfer, an American scientist born and educated in Basel, Switzerland, is an international leader in the field of medical entomology. ... National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ...

After identification B. burgdorferi as the causative agent of Lyme disease, antibiotics were selected for testing, guided by in vitro antibiotic sensitivities, including tetracycline antibiotics, amoxicillin, cefuroxime axetil, intravenous and intramuscular penicillin and intravenous ceftriaxone.^[166][167] The mechanism of tick transmission was also the subject of much discussion. B. burgdorferi spirochetes were identified in tick saliva in 1987, confirming the hypothesis that transmission occurred via tick salivary glands.^[168] This article deals with the group of antibiotics known as the Tetracyclines . ... Amoxicillin (INN) or amoxycillin (former BAN) is a moderate-spectrum β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. ... Cefuroxime is an cephalosporin antibiotic that has been widely available in the USA since 1977. ... Ceftriaxone (INN) (IPA: ) is a third-generation cephalosporin antibiotic. ...

References

Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 187th day of the year (188th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 25th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... For other uses, see Psychosis (disambiguation). ... For other uses, see Bipolar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 341st day of the year (342nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... is the 32nd day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 81st day of the year (82nd in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... {| style=float:right; |- | |- | |} is the 235th day of the year (236th in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... is the 24th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... {| style=float:right; |- | |- | |} is the 235th day of the year (236th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... This article is about the year. ... is the 269th day of the year (270th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 275th day of the year (276th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 232nd day of the year (233rd in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 74th day of the year (75th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 313th day of the year (314th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 233rd day of the year (234th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... {| style=float:right; |- | |- | |} is the 235th day of the year (236th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

Wikispecies has information related to:

Borrelia

General

• Compilation of academic literature and electron micrographs on the existence and basis of chronic Lyme infection
• Lyme disease at the Open Directory Project
• CDC Lyme disease page
• Columbia University - Overview of Neuropsychiatric Lyme Disease
• Eurosurveillance: Lyme disease in Europe
• Lyme Disease The Merck Manual
• US Army Factsheet on Lyme Disease (CHPPM's Entomological Sciences Program)
• National Institute for Occupational Safety and Health - Lyme Disease Page

Images

• Collection of micrographs and academic literature on the 'spore' form of Lyme
• Factsheet on Lyme Disease (Hardin MD/Univ of Iowa)
• Interactive Image of Ixodes scapularis, Deer Tick or Blacklegged Tick (CHPPM's Entomological Sciences Program)

Professional societies, foundations, advocacy

• Lyme disease organizations at the Open Directory Project
• National Research Fund of Tick-Borne Diseases
• Lyme Disease Research Foundation of Maryland

Other

• Lyme.startpagina.nl: Professional link-site with 100+ links to Lyme-sites
• Lyme Disease Medical Literature Summaries
• Lyme Disease Research Database
• Prehistoric Lyme - (The History of Lyme Disease) Lymenet Newsletter Volume: 1 Issue: 24 25-Oct-93

Image File history File links Wikispecies-logo. ... Wikispecies is a wiki-based online project supported by the Wikimedia Foundation that aims to create a comprehensive free content catalogue of all species (including animalia, plantae, fungi, bacteria, archaea, and protista). ... The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ... The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria is also the fictional name of a warring nation under Benzino Napaloni as dictator, in the 1940 film The Great Dictator... Gram-positive bacteria are those that are stained dark blue or violet by gram staining, in contrast to gram-negative bacteria, which are not affected by the stain. ... Classes Bacilli Clostridia Mollicutes The Firmicutes are a division of bacteria, most of which have Gram-positive cell wall structure. ... Species Clostridium acetobutylicum Clostridium aerotolerans Clostridium botulinum Clostridium colicanis Clostridium difficile Clostridium formicaceticum Clostridium novyi Clostridium perfringens Clostridium sordelli Clostridium tetani Clostridium piliforme Clostridium tyrobutyricum etc. ... Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. ... Botulism (Latin, botulus, sausage) is a rare, but serious paralytic illness caused by a nerve toxin, botulin, that is produced by the bacterium Clostridium botulinum. ... Tetanus is a medical condition that is characterized by a prolonged contraction of skeletal muscle fibers. ... Gas gangrene is a bacterial infection that produces gas within tissues in gangrene. ... The group A streptococcus bacterium (Streptococcus pyogenes, or GAS) is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. ... It has been suggested that Perinatal Group B Streptococcal Disease be merged into this article or section. ... Staphylococcus (in Greek staphyle means bunch of grapes and coccos means granule) is a genus of Gram-positive bacteria. ... Toxic shock syndrome (TSS) is a rare but potentially fatal disease caused by a bacterial toxin. ... This page is about the bacterial class. ... Gram-positive bacteria are those that are stained dark blue or violet by gram staining, in contrast to gram-negative bacteria, which are not affected by the stain. ... Subclasses Acidimicrobidae Actinobacteridae Coriobacteridae Rubrobacteridae Sphaerobacteridae The Actinobacteria or Actinomycetes are a group of Gram-positive bacteria. ... Species See text. ... Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... Visible cavities in later stage tuberculosis; Ghon focuses are smaller. ... Ghons complex is a pathological entity caused by the the progression of tuberculosis, an infectious respiratory disease. ... Tuberculous meningitis is also called TB meningitis. Tuberculous meningitis is Mycobacterium tuberculosis infection of the meninges. ... Tuberculosis of the spine in an Egyptian mummy Potts disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints. ... King Henry IV of France touching a number of sufferers of scrofula who are gathered about him in a circle. ... Bazin disease is a skin ulceration on the back of the calves. ... Lupus vulgaris are cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around nose and ears. ... For the malady found in the Hebrew Bible, see the article Tzaraath. ... This article is in need of attention. ... Buruli ulcer is an infectious disease caused by the Mycobacterium ulcerans, from the same family of bacteria which causes tuberculosis and leprosy. ... Suborders Actinomycineae Corynebacterineae Frankineae Glycomycineae Micrococcineae Micromonosporineae Propionibacterineae Pseudonocardineae Streptomycineae Streptosporangineae Actinomycetales is an order of Actinobacteria. ... Erythrasma is a skin disease that can result in pink patches, which can turn into brown scales. ... Bacteria that are Gram-negative are not stained dark blue or violet by Gram staining, in contrast to Gram-positive bacteria. ... Families Spirochaetaceae Brachyspiraceae    Brachyspira    Serpulina Leptospiraceae    Leptospira    Leptonema Spirochaetes is a phylum of distinctive Gram-negative bacteria, which have long, helically coiled cells. ... Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. ... Bejel, or endemic syphilis, is a chronic skin and tissue disease caused by infection by a subspecies of the spirochete Treponema pallidum. ... Yaws (also Frambesia tropica, thymosis, polypapilloma tropicum or pian) is a tropical infection of the skin, bones and joints caused by the spirochete bacterium Treponema pertenue. ... Pinta is a human skin disease endemic to Mexico, Central America, and South America. ... Noma (from Greek numein: to devour) also known as cancrum oris or gangrenous stomatitis, is a gangrenous disease leading to tissue destruction of the face, especially the mouth and cheek. ... Trench mouth is a polymicrobial infection of the gums leading to inflammation, bleeding, deep ulceration and necrotic gum tissue, there may also be fever. ... Sodoku is a bacterial zoonotic disease. ... Bacteria that are Gram-negative are not stained dark blue or violet by Gram staining, in contrast to Gram-positive bacteria. ... Genera Chlamydia Chlamydophila Parachlamydia Simkania Waddlia The Chlamydiae are a group of bacteria, all of which are intracellular parasites of eukaryotic cells. ... Species See text. ... In medicine (pulmonology), psittacosis -- also known as parrot disease, parrot fever, and ornithosis -- is a zoonotic infectious disease caused by a bacterium called Mycoplasma psittaci and contracted from parrots, macaws, cockatiels, and parakeets. ... Species Chlamydia muridarum Chlamydia suis Chlamydia trachomatis For the disease in humans, see Chlamydia infection. ... The term Chlamydia refers to an infection by any one of the species in the bacterial genus, Chlamydia—Chlamydia trachomatis, Chlamydia suis or Chlamydia muridarum—but of these, only C. trachomatis is found in humans. ... Lymphogranuloma venereum (LGV), also known as lymphopathia venerea, tropical bubo, climatic bubo, strumous bubo, poradenitis inguinales, Durand-Nicolas-Favre disease and lymphogranuloma inguinale, is a sexually transmitted disease caused by the invasive serovars L1, L2, or L3 of Chlamydia trachomatis. ... Bacteria that are Gram-negative are not stained dark blue or violet by Gram staining, in contrast to Gram-positive bacteria. ... Orders Alpha Proteobacteria    Caulobacterales - e. ... A rickettsiosis is a disease casused by Rickettsiales. ... For the unrelated disease caused by Salmonella typhi, see Typhoid fever. ... Scrub typhus is a form of typhus caused by Orientia tsutsugamushi and transmitted by chiggers, which are found in areas of heavy scrub vegetation. ... Binomial name Wolbach, 1919 Rocky Mountain spotted fever is the most severe and most frequently reported rickettsial illness in the United States, and has been diagnosed throughout the Americas. ... Boutonneuse fever (also called Mediterranean Fever) is a fever as a result of a Rickettsial infection. ... Trench Fever is a moderately serious disease, transmitted by body lice. ... Rickettsialpox is caused by bacteria found in the Rickettsia family (Rickettsia akari) but humans contract the disease through a much less direct route. ... For other uses, see Catscratch and Cat Scratch Fever. ... Bacillary angiomatosis (BA) is a bacterial infection caused by either Bartonella henselae or Bartonella quintana. ... Bacteria that are Gram-negative are not stained dark blue or violet by Gram staining, in contrast to Gram-positive bacteria. ... Orders Alpha Proteobacteria    Caulobacterales - e. ... Species S. bongori S. enterica This article is about the bacteria. ... For a similar disease with a similar name, see typhus. ... Species S. enterica Salmonella is a genus of rod-shaped Gram-negative enterobacteria that causes typhoid fever, paratyphoid and foodborne illness. ... Salmonellosis is an infection with Salmonella bacteria. ... Distribution of cholera Cholera, sometimes known as Asiatic cholera or epidemic cholera, is an infectious gastroenteritis caused by the bacterium Vibrio cholerae. ... Zoonosis (pronounced ) is any infectious disease that may be transmitted from other animals, both wild and domestic, to humans or from humans to animals (the latter is sometimes called reverse zoonosis). ... Bubonic plague is the best-known manifestation of the bacterial disease plague, caused by the bacterium Yersinia pestis. ... Tularemia (also known as rabbit fever) is an infectious disease caused by the bacterium Francisella tularensis. ... Glanders is an infectious disease that occurs primarily in horses, mules, and donkeys. ... Melioidosis, also known as pseudoglanders and Whitmores disease (after Capt Alfred Whitmore) is an uncommon infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water. ... Pasteurellosis is an infection with a species of the bacteria genus Pasteurella, which is found in humans and animals. ... Pertussis, also known as whooping cough, a highly contagious disease caused by the bacterium, Bordetella pertussis; it derived its name from a characteristic severe hacking cough followed by a high-pitched intake of breath that sounds like whoop; a similar, milder disease is caused by B. parapertussis. ... Binomial name Neisseria meningitidis Albrecht & Ghon, 1901 Neisseria meningitidis, also simply known as meningococcus is a gram-negative bacterium best known for its role in meningitis. ... Meningitis is inflammation of the membranes (meninges) covering the brain and the spinal cord. ... Waterhouse-Friderichsen syndrome is massive, usually bilateral, hemorrhage into the adrenal glands caused by fulminant meningococcemia. ... Legionellosis is an infectious disease caused by bacteria belonging to the genus Legionella. ... Brazilian purpuric fever (BPF) is a fulminant sceptacaemic illness of children caused by the gram negative bacteria Haemophilus influenzae biogroup aegyptius Category: ... Chancroid is a sexually transmitted disease characterized by painful sores on the genitalia. ... Granuloma inguinale or Donovanosis is a bacterial disease caused by the organism Calymmatobacterium granulomatis. ... The clap redirects here. ...