Lyme Disease

Description

Lyme disease results from infection with spirochetes belonging to the Borrelia burgdorferi sensu lato complex. In Europe and Asia, most cases of Lyme disease are caused by B. burgdorferi sensu stricto, B. afzelii, or B. garinii; however, in the United States, all cases are caused by B. burgdorferi sensu stricto. The spirochetes are transmitted to humans through the bite of infected ticks of the Ixodes ricinus complex.

Occurrence

Lyme disease occurs in temperate forested regions of Europe and Asia and in the northeastern, north central, and Pacific coastal regions of North America. It is not transmitted in the tropics.

Risk for Travellers

Travellers to endemic areas who have exposure to tick habitats may be at risk for Lyme disease.

Clinical Presentation

Manifestations of Lyme disease include a characteristic expanding rash called erythema chronicum migrans at the site of tick attachment, fever, arthritis, and neurologic manifestations, including facial palsy.

Prevention

Vaccine

A safe and efficacious vaccine was, until recently, available for protection from Lyme disease in endemic areas of the United States. However, the vaccine was withdrawn from the market by the manufacturer in February 2002 because of low sales and is no longer commercially available.

Other

Travellers to endemic areas should be advised to avoid tick habitats if possible. If exposure to tick habitats cannot be avoided, the application of repellents to skin and Permethrin to clothing (See Protection Against Mosquitoes and Other Arthropods) can reduce the risk of infection, as can daily tick checks and prompt removal of any attached ticks. Remove ticks by grasping them firmly with tweezers as close to the skin as possible and lifting gently.

Treatment

Travellers who have erythema chronicum migrans or other manifestations of Lyme disease should be advised to seek early medical attention. In general, it should not be necessary to seek care from a specialist in travel or tropical medicine. Lyme disease can usually be cured by a course of antibiotic treatment.

Bibliography
  • Gern L, Humair PF. Ecology of Borrelia burgdorferi sensu lato in Europe. In: Gray JS, Kahl O, Lane RS, Stanek G, editors. Lyme borreliosis: biology, epidemiology and control. 1st ed. New York: CABI Publishing; 2002. p. 149-74.
  • Korenberg EI, Gorelova NB, Kovalevskii YV. Ecology of Borrelia burgdorferi sensu lato in Russia. In: Gray JS, Kahl O, Lane RS, Stanek G, editors. Lyme borreliosis: biology, epidemiology and control. 1st ed. New York: CABI Publishing; 2002. p. 175-200.
  • Miyamoto K, Masuzawa T. Ecology of Borrelia burgdorferi sensu lato in Japan and East Asia. In: Gray JS, Kahl O, Lane RS, Stanek G, editors. Lyme borreliosis: biology, epidemiology and control. 1st ed. New York: CABI Publishing; 2002. p. 201-22.
  • Stanek G, Strle F. Lyme borreliosis. Lancet. 2003;362:1639-47.
  • Steere AC. Lyme disease. N Eng J Med. 2001;345:115-25.
  • Weber K. Aspects of Lyme borreliosis in Europe. Eur J Clin Microbiol Infect Dis. 2001;20:6-13.
  • Wormser GP, Nadelman RB, Dattwyler RJ, et al. Practice guidelines for the treatment of Lyme disease. The Infectious Diseases Society of America. Clin Infec Dis. 2000;31 Suppl 1:S1-14.

- Edward B. Hayes and Paul Mead

© Medic8 ® All Rights Reserved.