Am J Trop Med Hyg. 2012 Feb; 86(2): 320-327
Diuk-Wasser MA, Hoen AG, Cislo P, Brinkerhoff R, Hamer SA, Rowland M, Cortinas R, Vourc'h G, Melton F, Hickling GJ, Tsao JI, Bunikis J, Barbour AG, Kitron U, Piesman J, Fish D

Abstract. The geographic pattern of human risk for infection with Borrelia burgdorferi sensu stricto, the tick-borne pathogen that causes Lyme disease, was mapped for the eastern United States. The map is based on standardized field sampling in 304 sites of the density of Ixodes scapularis host-seeking nymphs infected with B. burgdorferi, which is closely associated with human infection risk. Risk factors for the presence and density of infected nymphs were used to model a continuous 8 km×8 km resolution predictive surface of human risk, including confidence intervals for each pixel. Discontinuous Lyme disease risk foci were identified in the Northeast and upper Midwest, with a transitional zone including sites with uninfected I. scapularis populations. Given frequent under- and over-diagnoses of Lyme disease, this map could act as a tool to guide surveillance, control, and prevention efforts and act as a baseline for studies tracking the spread of infection.

QJM. 2012 Feb 1;
Cottle LE, Mekonnen E, Beadsworth MB, Miller AR, Beeching NJ

BACKGROUND: Concerns about over-diagnosis and inappropriate management of Lyme disease (LD) are well documented in North America and supported by clinical data. There are few parallel data on the situation in the UK. AIM: To describe the patterns of referral, investigation, diagnosis and treatment of patients with suspected LD referred to an infectious disease unit in Liverpool, UK. Previous management by National Health Service (NHS) and non-NHS practitioners was reviewed. DESIGN: Descriptive study conducted by retrospective casenotes review. METHODS: Retrospective casenotes review of adults referred with possible LD to an infectious disease unit in Liverpool, UK, over 5 years (2006-2010). RESULTS: Of 115 patients, 27 (23%) were diagnosed with LD, 38 (33%) with chronic fatigue syndrome (CFS) and 13 (11%) with other medical conditions. No specific diagnosis could be made in 38 (33%). At least 53 unnecessary antibiotic courses had been given by non-NHS practitioners; 21 unnecessary courses had been prescribed by NHS practitioners. Among 38 patients, 17 (45%) with CFS had been misdiagnosed as having LD by non-NHS practitioners. CONCLUSION: A minority of referred patients had LD, while a third had CFS. LD is over-diagnosed by non-specialists, reflecting the complexities of clinical and/or laboratory diagnosis. Patients with CFS were susceptible to misdiagnosis in non-NHS settings, reinforcing concerns about missed opportunities for appropriate treatment for this group and about the use of inappropriate diagnostic modalities and anti-microbials in non-NHS settings.

Drug Discov Today. 2012 Jan 24;
Bradley M

Int J Infect Dis. 2012 Jan 31;
Czupryna P, Moniuszko A, Czeczuga A, Pancewicz S, Zajkowska J

OBJECTIVE: The aim of this study was to evaluate the ultrasonographic images of patients with chronic knee pain and serologic features of Lyme disease. METHODS: Seventy-six patients hospitalized in The Department of Infectious Diseases and Neuroinfections of the Medical University in Białystok, Poland were included in the study. Patients were divided into two groups: (1) the Lyme disease group included patients with pain in one or both knees and anti-Borrelia burgdorferi antibodies with symptoms lasting for over 6 months; (2) the control group included patients suffering from pain in one or both knees for over 6 months, but for whom B. burgdorferi infection was excluded. RESULTS: The most frequent ultrasonographic finding in the Lyme disease group was effusion, and its frequency was significantly higher than in the control group. No patient in the control group presented with synovitis or cartilage damage, while these were quite frequent findings in the Lyme disease group. Baker's cysts were more frequent in the Lyme disease group, but this was statistically non-significant. CONCLUSIONS: Ultrasonography may be useful in following the sequelae of Lyme disease. The abnormalities found in Lyme disease patients are non-specific and ultrasonography is not useful in the differential diagnosis.

Ticks Tick Borne Dis. 2012 Jan 30;
Hamer SA, Hickling GJ, Sidge JL, Walker ED, Tsao JI

To elucidate features of enzootic maintenance of the Lyme disease bacterium that affect human risk of infection, we conducted a longitudinal study of the phenology of the vector tick, Ixodes scapularis, at a newly invaded site in the north-central United States. Surveys for questing ticks and ticks parasitizing white-footed mice and eastern chipmunks revealed that I. scapularis nymphal and larval activity peaked synchronously in June and exhibited an atypical, unimodal seasonality. Adult seasonal activity was bimodal and distributed evenly in spring and fall. We discuss implications of these phenology data for the duration of the I. scapularis life cycle. Densities of Borrelia burgdorferi-infected, questing nymphs were comparable to those found in endemic areas elsewhere in the midwestern and northeastern U.S. Molecular genetic diversity of B. burgdorferi infecting these ticks and rodents was assessed by analysis of the ribosomal spacer types (RSTs). RST 1, a clade that includes strains with highly pathogenic properties, was relatively uncommon (3.4%) in contrast to the northeastern U.S., whereas less pathogenic ribotypes of the RST 2 and 3 clades were more common. These features of the ecology of this midwestern Lyme disease system likely contribute to the lower incidence of Lyme disease in humans in the Upper Midwest compared with that of the Northeast owing to reduced exposure to pathogenic strains of B. burgdorferi.

Qual Life Res. 2012 Feb 1;
Aucott JN, Rebman AW, Crowder LA, Kortte KB

PURPOSE: A subset of patients treated for Lyme disease report persistent or recurrent symptoms of unknown etiology named post-treatment Lyme disease syndrome (PTLDS). This study aims to describe a cohort of participants with early, untreated Lyme disease, and characterize post-treatment symptomatology and functional impact of PTLDS over time. METHODS: Sixty-three participants with erythema migrans and systemic symptoms were enrolled in a prospective cohort study. Participants underwent physical exams and clinical assessments, and completed the SF-36 (daily life functioning) and the Beck Depression Inventory, Second Edition (BDI-II) (depression), at each of five visits over a period of 6 months. RESULTS: Signs of Lyme disease disappeared post-treatment; however, new-onset patient-reported symptoms increased or plateaued over time. At 6 months, 36% of patients reported new-onset fatigue, 20% widespread pain, and 45% neurocognitive difficulties. However, less than 10% reported greater than "minimal" depression across the entire period. Those with PTLDS (36%) did not differ significantly from those without with respect to demographics, pre-treatment SF-36, and BDI-II scores. Statistically significant differences were found over time on the Role Physical, Vitality, Social Functioning, Role Emotional, and Mental Health subscales (with a trend toward significance for the remaining three subscales of Physical Functioning, Bodily Pain, and General Health) of the SF-36 between those with an eventual PTLDS diagnosis and those without when measured at 6 months. CONCLUSIONS: Unlike clinical signs of Lyme disease, new-onset symptoms are reported by a subset of participants without evidence of depressive symptomatology. Patients who developed PTLDS had significantly lower life functioning compared to those without PTLDS. We propose future avenues for researching infection-triggered symptoms resulting from multiple mechanisms.

Clin Infect Dis. 2012 Jan 30;
Schmitz L

Infect Immun. 2012 Jan 30;
Chan K, Casjens S, Parveen N

Borrelia burgdorferi sensu stricto is the major causative agent of Lyme disease in the United States while B. garinii and B. afzelii are more prevalent in the Europe. The highly complex genome of B. burgdorferi is comprised of a linear chromosome and a large number of variably sized linear and circular plasmids. Many plasmids of this spirochete are unstable during its culture in vitro. Given that many of the B. burgdorferi virulence factors identified to date are plasmid-encoded, spirochetal plasmid content determination is essential for genetic analysis of Lyme pathogenesis. Although Polymerase Chain Reaction (PCR)-based assays facilitate plasmid profiling of sequenced B. burgdorferi strains, the rapid genetic content determination strategy for non-sequenced strains has not been described yet. In this study, we combined pulse field gel electrophoresis and Southern hybridization for detection of genes encoding known virulence factors, ribosomal DNA spacer restriction fragment length polymorphism types (RST), ospC group determination, and sequencing of the variable dbpA and ospC genes. We show that two strains isolated from the same tick and both originally named N40, are in fact very distinct. Furthermore, we failed to detect bbk32, which encodes a fibronectin-binding adhesin in one "N40" strain. Thus, two distinct strains were isolated from the same tick that show different plasmid profile as determined by PFGE and PCR and vary in their ospC and dbpA sequence. However, both belong to RST3B group.

Vet Rec. 2012 Jan 28; 170(4): 88

Arthritis Rheum. 2012 Jan 24;
Levy E, Morruzzi C, Barbarini A, Sordet C, Cribier B, Jaulhac B, Lipsker D

Neth J Med. 2012 Jan; 70(1): 3-5
Klempner MS, Halperin JJ, Baker PJ, Shapiro ED, O'Connell S, Fingerle V, Wormser GP

No abstract available.

Clin Exp Obstet Gynecol. 2011; 38(4): 412-3
Check JH, Cohen R

To show that chronic fatigue syndrome can be mistakenly attributed to Lyme disease rather than considering sympathetic neural hyperalgesia edema syndrome. This common disorder of women, frequently, but not always causing pelvic pain, can present simply as chronic fatigue.A water load test was performed in a woman reactive for B-Burgdorferi with chronic fatigue whose symptoms did not improve despite three months of treatment with doxycycline. A water load test was performed.She failed the water load test by excreting only 50% ingested load standing for four hours. She showed marked improvement following treatment with dextroamphetamine sulfate.This very treatable disorder of the sympathetic nervous system should be considered in women with an unknown cause of chronic fatigue or if the symptoms persist despite treatment of another potential cause.