Borrelia Burgdorferi - The Etiology of Tick Borne Diseases

Borrelia was a subject studied in my epidemiology courses and examined in-depth in some students' research papers in preventive medicine and public health curricula at The Ohio State University College of Medicine. Here, I present as much of the latest findings as possible. As the bank of knowledge fills daily, you can access the reference links through out this article to witness the latest news about this phenomenon of vector borne illness.

Borrelia burgdorferi causes lyme disease (or Lyme disease or borreliosis), and is one of several in the Genus Borrelia bacteria grouping.

Of the family Spirochaetaceae, this bacterium has several siblings or cousins in the form of additional speciesand at least 36 total species to date.

A total of 1/3 of the 36 Borrelia species cause lyme disease; however, with Borrelia afzelii, Borrelia garinii, and Borrelia valaisiana being the three other major players after the Number One culprit B burgdorferi.

VECTOR

Transmitted by animal life to other animals, including humans, from a few lice species and mostly ticks, the Borrelia cause conditions called "vector borne" diseases. This means that some living creature passed it on as an infectious agent to another animal. Vectors can be rats, lice, larvae, mosquitoes, other insects, bacterium, etc. A vector in this sense is a living creature, however big or small.

TARGET

Lyme disease most often affects dogs whose coats hide ticks, but a few cases every year involve human infection in the United States. All cases exhibit symptoms similar to some types of arthritis and rheumatologists study this disease and often treat it. See more on symptomatology below.

Humans at risk are:

• Any age; however, nearly 50% of all reported cases are children and youth as of 2006.
• Female. The male/female ratio is 1:1–2:1, or twice as many girls as boys infected.
• More at risk in the summertime, May - early September, but especially August and early September. For example, Ohio Dept. of Natural Resources broadcasts Tick Alerts in August.
• Most at risk in the Endemic Areas for this disease (areas of concentration): the Northeast US, North Central States, and the Pacific Coast.

PREVALENCE RATE

Lyme disease is an official rare disease as noted by the Office of Rare Diseases of the National Institutes of Health (NIH) in America. This is because its incidence rate is low.

PREVALENCE: Lyme disease in the USA attacks 1 in 2,719 people, or approximately 113,644 total cases on April 22, 2010, calculated by using the US Census perpetual clock's total population at 8:00 PM.

INCIDENCE RATE

The Annual Diagnosis Rate is about 15,000 to 23,000+ cases of lyme disease reported yearly in the USA, but the condition is under-reported. In 2005, we had over 23,000 cases reported; in 2006, we had about 20,000 cases. Because of under-reporting, the true total is unknown. Some victims feel simply that they have Chronic Arthritis.

DISCOVERY

Lyme disease attacks the human immune response to the infection. Arthritis behaves similarly.

In Europe, a rash known as erythema chronicum migrans or ECM was found in the early 1900s. It was attached to neurological symptoms similar to those cause by bites from Ixodes ticks.

In 1975, an outbreak of childhood arthritis was experienced in Lyme, Connecticut and examined by Dr. Allen Steere and the faculty of Yale. They found that these US patients suffered from ECM, which developed into Lyme-area arthritis. This was actually lyme disease.

Dr. Willy Burgdorferdiscovered the Borrelia of Ixodes ticksunder the microscope from patient tissue samples. This B burgdorferi was named after him. Antibody tests for the disease were quickly developed and additional strains of Borrelia were identified. As of today, we have at least 36.

SYMPTOMS

• Not all targets suffer symptoms. Some people test positive, but never show any symptoms.
• Symptom Set One

The bacterium spreads throughout the body; a primary-site organ that may be involved in lyme disease is often unclear. An inflammatory response to B burgdorferi in the skin likely causes multiple lesions (rash) of erythema migrans (ECM).

In ECM, a circular red rashy patch appears 3-30 days after a tick bite and becomes like a target and bullseye. This rash can be confused with the rash of lyme disease. ECM persists for 3-4 weeks.

Lyme disease includes any of these symptoms:

• Fatigue
• Chills and fever like the flu
• Headache - worse in the later stages of the disease
• Muscle and joint pain - also worse later on
• Swollen lymph glands - neck, armptits, trunk, etc.
• Primary and secondary rashy skin lesions - can be circular, as in ECM

• Symptom Set Two

A specific immune response can lead to symptoms manifested from a number of organs under attack. Arthritis can also be associated with certain symptoms, some of them similar to lyme disease and/or ECM. [This obfuscation and intrigue is a source of keen interest in TV medical shows like HOUSE - and in real life.]

• Worst Case Symptom Set

After weeks or even several years of apparent healthiness, these symptoms can begin to emerge in lyme disease:

• Joint pain - worsens with time. The skin may become red and painful as well.
• Conjunctivitis - pinkeye. May lead to cellulitis infection, very painful and dangerous.
• Meningitis - very dangerous.
• Bell's palsy (facial paralysis) - However, this can be overcome with treatment of lyme disease.
• Cardiac involvement, sometimes irregular heartbeat (arrythmia can lead to death).
• Expansion of pain to other joints, tendons, muscles, and non-joint bone.
• Arthritis - brief periods of pain and swelling in one or more major joints, usually the knees.
• Neurological involvement - numbness, fever, stiff neck, severe headache, halluciantions, eyesight problems, tingling extremities, other.
• Erosion of cartilage and bone - Similar to some types of arthritis.
• Most severe - depression, sleep changes, fainting, memory lapse, peripheral neuropathy, other.

ANTIBIOTICS

Often, erythromycin, amoxicillin, or doxycycline, a derivative of tetracycline, is administered and a few others are used on occasion. Patients in all disease stages and symptoms seem to respond well to doxycycline. Intravenous (IV) antibiotics are appropriate for late-stage neurological involvement, but oral dosages are appropriate early on. Permanent joint damage requires other treatments.

The Food and Drug Administration licensed LYMErix^TMin 1998 as a vaccine for the prevention of lyme disease in humans. It was taken off the market for "lack of sales." There was not enough call for the vaccine. However, there was a class action suit filed against the makers of this drug, based on side effects of 1) arthritis, 2) actual lyme disease, and 3) other.

PREVENTION

At home and in the woods and fields -

• Take out dead leaves, brush, and tall grass at home. They hide ticks.
• Avoid tick-infested areas in May - September.
• Wear light-colored clothing so you can see ticks.
• Tuck pant-legs into high socks/boots and shirt tails into pants.
• Wear long sleeves and possibly tape the sleeves around your wrists for tight closure in high-risk regions.
• Wear a hat and pin and tuck long hair up into it.
• Walk in the center of trails in high-grass lands.
• After time spent outdoors, undress wash and dry clothes at a high temperature to kill any ticks and bacteria. Examine your body and remove any attached ticks with tweezers, pulling straight back with a slow steady force - don't crush the tick body. Call your doctor. You may receive antibiotics. NOTE: People used to light a match, blow it out, and touch the hot tip the the rear end of the tick to make it let go and back off, but that is not the best method to use for removal; it does not always work.
• Inspect your pets for ticks as well, if they go outside. Remove ticks, and call the vet if bites occurred. Cut pets' hair/fur short, if you can, for summer months. Some forest rangers shave their heads.
• New techniques: some people use certain fungi that kill Ixodes ticks in their lawn and garden areas at home.
• Controversy: Culling deer populations reduces the number of deer ticks in an area. the Ohio DNR oversees annual culling and the meat is given to soup kitchens to help the needy. However, deer are not the primary vectors for the disease, ticks are, and the responsible ticks live in vegetation; still, culling deer reduces the problem of both the disease and the overpopulation of deer - at least in Ohio.

Copyright: © Patty Inglish, MS:Preventive Medicine; April 22, 2010. All rights reserved. Specific written permission is required for quotation or other use.