For many ODs, Lyme disease (Borrelia burgdoferi) and it’s 22+ variant cousins hit close to home. My father has been bitten by infected ticks with these spirochetes from the genus Ixodes (primarily Ixodes scapularis) over seven times.
This narrative can be repeated with slightly different wrinkles by almost anyone who has been exposed to or knows of a family member or friend in kind. Incidence has more than doubled in the past 13 years with reported cases numbering 30,000 to 43,000 per year.1,2
Admittedly, the Centers for Disease Control (CDC) has said the figure is grossly underestimated by 10 fold coming in at 300,000 cases per year.1 This disease has been a silent epidemic in the United States—and now early stages in Canada—for the last 45 years.
Also by Dr. Cooper: Watch for ocular signs of Lyme disease
Back in 1975, two desperate mothers from Old Lyme, CT, sought help after seeing an outbreak of arthritis and juvenile arthritis around town.3,4
Staring down a litany of unexplainable symptoms and unsatisfying diagnoses, they contacted the Yale School of Medicine and Connecticut State Department of Health. This initial inquiry would spark a widespread investigation that would culminate in the characterization of what is now widely known as Lyme disease.
The initial study focused on the three contiguous towns of Old Lyme, Lyme, and East Haddam where 51 residents were diagnosed with juvenile arthritis or arthritis of unknown cause (39 children and 12 adults) out of a total population of 12,000.5
While early physical examinations and laboratory tests revealed nothing abnormal, the interview painted a different picture.3 A geographic and temporal element to these cases showed multiple family members infected along with a noted appearance in more wooded areas outside of city/town centers with heightened activity from June to September.
Additionally, approximately 25 percent of patients in the study reported a skin lesion with an expanding bull’s-eye pattern four or more weeks preceding the onset of arthritic symptoms.5
Researchers found this to be particularly intriguing because the lesion correlated in description to erythema chronicum migrans (ECM), or erythema migrans (EM), a lesion previously reported in Europe that was thought to be a result of an unknown infectious agent but had never before been associated with arthritis.5,6
1. Kuehn BM. CDC estimates 300000 US cases of Lyme disease annually. JAMA. 2013 Sep 18;310(11):1110.
2. Sancar F. New Indications for Lyme Disease Tests. JAMA. 2019 Sep 17;322(11):1036.
3. Elbaum-Garfinkle S. Close to home: a history of Yale and Lyme disease. Yale J Biol Med. 2011 Jun;84(2):103-8.
4. Edlow JA. Bull’s Eye: Unraveling the Medical Mystery of Lyme Disease. New Haven: Yale University Press; 2003.
5. Steere AC, Malawista SE, Snydman DR, et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum. 1977 Jan-Feb;20(1):7-17.
6. Hellerstrom S. Erythema chronicum migrans Afzelius with meningitis. Acta Derm Venereol. 1951;31(2):227-34.
7. Steere AC, Hardin JA, Malawista SE. Erythema chronicum migrans and Lyme arthritis: cryoimmunoglobulins and clinical activity of skin and joints. Science. 1977 Jun 3;196(4294):1121-2.
8. Steere AC, Malawista SE, Hardin JA, Ruddy S, Askenase W, Andiman WA. Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Ann Intern Med. 1977 Jun;86(6):685-98.
9. Steere AC, Broderick TF, Malawista SE. Erythema chronicum migrans and Lyme Arthritis: epidemiologic evidence for a tick vector. Am J Epidemiol. 1978 Oct;108(4):312-21.
10. Zúñiga CIR, Lozano JC. Powassan virus: a seldom studied flavivirus transmitted by ticks. Rev Latin Infect Pediatr. 2019; 32(1):11-14.
11. Brody T, Yavatkar AS, Park DS, et al. Flavivirus and Filovirus EvoPrinters: New alignment tools for the comparative analysis of viral evolution. PLoS Negl Trop Dis. 2017 Jun 16;11(6):e0005673.
12. Kugeler KJ, Farley GM, Forrester JD, et al. Geographic Distribution and Expansion of Human Lyme Disease, United States. Emerg Infect Dis. 2015 Aug;21(8):1455-7.
13. Littman MP, Gerber B, Goldstein RE, et al ACVIM consensus update on Lyme borreliosis in dogs and cats. J Vet Intern Med. 2018 May;32(3):887-903.
14. Reik L, Steere AC, Bartenhagen NH, et al Neurologic abnormalities of Lyme disease. Medicine (Baltimore). 1979 Jul;58(4):281-94.
15. Steere AC, Batsford WP, Weinberg M, et al. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980 Jul;93(1):8-16.
16. Hardin JA, Walker LC, Steere AC, Trumble TC, Kung KS, Williams RC Jr, Ruddy S, Malawista SE. Circulating immune complexes in Lyme arthritis. Detection by the 125I-C1q binding, C1q solid phase, and Raji cell assays. J Clin Invest. 1979 Mar;63(3):468-77.
17. Malawista SE, Steere AC, Hardin JA. Lyme Disease ― a Unique Human-Model for an Infectious Etiology of Rheumatic Disease. Yale J Biol Med. 1984;57(4):473-477.
18. Steere AC, Hardin JA, Ruddy S, et al. Lyme arthritis: correlation of serum and cryoglobulin IgM with activity, and serum IgG with remission. Arthritis Rheum. 1979;22(5):471-483.
19. Hardin JA, Steere AC, Malawista SE. Immune complexes and the evolution of Lyme arthritis. Dissemination and localization of abnormal C1q binding activity. N Engl J Med. 1979;301(25):1358-1363.
20. Pachner AR, Steere AC. Neurological Findings of Lyme-Disease. Yale J Biol Med. 1984;57(4):481-483.
21. Marques AR. Lyme disease: a review. Curr Allergy Asthma Rep. 2010;10(1): 13–20.
22. Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagen NH. Antibiotic Therapy in Lyme Disease. Ann Intern Med. 1980;93(1):1-8.
23. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.
24. Poland GA. Vaccines against Lyme Disease: what happened and what lessons can we learn? Clin Infect Dis. 2011;52(suppl 3) s253-s258.
25. Nardelli DT, Munson EL, Callister SM, et al. Human Lyme Disease Vaccines: Past and Future Concerns. Future Microbiology. 2009;4(4):457-469.
26. GlaxoSmithKline. Package insert – LYMErix Lyme disease vaccine (Recombinant OspA); 2001. Cited 17July 2019.
27. King LP. The Ongoing 30-Year Lyme Disease War: Case Study of a Failure to Communicate. The Yale Forum on Climate Change & The Media. 2008.
28. Governor Cuomo Announces New Public-Private Research Collaboration to Advance Diagnosis and Treatment of Tick-Borne Diseases [Internet]. 2018 [cited 2019Jul17]. Available from: https://www.governor.ny.gov/news/governor-cuomo-announces-new-public-pri...