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May is Lyme Disease Awareness Month. It is a month to share information, stories, and preventative care about a disease that affects so many around the world. Let’s take a moment and look at the big picture of what we know about Lyme disease.
Lyme disease was identified in 1975 in Lyme, Connecticut after multiple unexplained cases of pediatric arthritis were diagnosed in the community. The primary causal agent for Lyme disease in the US is Borrelia burgdorferi, a bacterium transmitted through ticks. B. burgdorferi is a slow-growing bacterium that hides in its hosts. Alongside B. burgdorferi, B. miyamotoi is an emerging cause of hard tick relapsing fever in the US. In Europe and Asia, several other Borrelia species are also implicated in Lyme borreliosis.
If left undiagnosed, Lyme disease can wreak havoc on the immune system. A lot of Lyme disease symptoms are non-specific and common ailments like fatigue, headaches, joint pain, etc. Symptoms can be severe, including arthritis, heart problems, and neurological issues. Since it can take a while for symptoms to develop, people may have forgotten about the initial tick exposure, making it even harder to diagnose.
Geography
The highest concentration of Lyme disease cases in the US is in the Northeast and North-Midwest. The CDC estimates there are about 300,000 thousand new cases a year. While not as prevalent in warmer states, Lyme disease can be found across the country. There are a few theories that explore the geographical nature of the disease, and why the number of cases becomes less dense below the Mason Dixon line.
One of these theories explores the best living conditions for Borrelia burgdorferi’s vector, ticks. Ticks need to live in areas that are cooler and humid. During the summer months in warm areas, they seem to hide in piles of leaves on the ground as opposed to the trees. Hiding closer to the ground limits the tick’s ability to find a host. A person hiking on a trail in a warmer location is more likely to walk over a tick and not pass it.
Another consideration is the underdiagnosis of Lyme disease in warmer areas. There can be a lack of education for people and health care providers alike. Symptoms of the disease can go unnoticed for years. It is important to keep in mind that having sensitive testing methods play a role in the diagnosis of Lyme disease.
Recent scientific advances
Lyme disease has been researched for almost 50 years. In that time, there have been many advances in the study of Borrelia burgdorferi. For a long time, researchers have speculated that B. burgdorferi hid in their hosts in a way that wasn’t fully understood. It has a limited number of genes, which means it relies on its host for nutrients. The genes it does have play a role in antigenic variation or immune evasion. In 2019, Christa Winslow and Jenifer Coburn of the Medical College of Wisconsin published a review (free to read on the internet) of what was known about the genetics of Borrelia burgdorferi at that time.
Research suggests B. burgdorferi’s ability to hide in its host may occur because of antigenic variation. Antigenic variation is the mechanism by which an infectious agent such as B. burgdorferi alters the protein or carbohydrate on its surface to avoid a host immune response. Research to study this process continues to make progress, with many discoveries since 2019.
Understanding how and why a pathogen operates helps advance research, as well as the continued development of research methods that allow a pathogen to be studied as it responds to its natural environment. This is especially important for stealth pathogens like Borrelia species.
This kind of research advances the development of new technology, such as that used at Galaxy Diagnostics to develop new testing methods including our Lyme Borrelia Nanotrap Antigen test. This assay concentrates and detects the outer surface protein A, specific to Borrelia species, through an innovative urine testing method.
Prevention
Research on prevention has also advanced since 50 years ago. This research focuses on the entire lifecycle of the bacteria, from animal reservoirs to vectors and finally to human transmission. The concept of One Health – that human, animal and environmental health are all related – has helped advance this research as forestry and wildlife professionals have become a part of the research.
Despite that research, preventing Lyme disease is still primary the task of each individual. The CDC’s recommended tips for prevention remain:
- Stay aware – knowing where ticks reside can help you stay vigilant and on the lookout for these vectors. They live in grassy, brushy, or wooded areas. It is common to encounter them in the woods, in yards, in fields with tall grass, etc.
- Be proactive – Using bug spray and keeping yards well managed can help repel ticks. Wearing clothing that covers the body leaves less room for a tick to easily attach to a host.
- Check yourself – After spending prolonged time outside, it is helpful to check for ticks. Look closely at clothes and different parts of the body where ticks may hide. See the image below for places to check for ticks.
Conclusion
Lyme disease imposes a burden on the health of people around the world. In just a little over 50 years, a great deal of scientific progress has been made in studying the genetics of the bacteria that cause Lyme disease and in understanding the ecology that brings the disease into contact with people. At Galaxy Diagnostics, we have been able to turn this research into innovative new testing. As we look to future steps in translating science into improvement in people’s lives, we look forward to further advances in testing and treatment as well as better ways to protect people from becoming infected.
Referecnces
Winslow, C., & Coburn, J. (2019). Recent discoveries and advancements in research on the Lyme disease spirochete Borrelia burgdorferi. F1000Research, 8, 763. https://doi.org/10.12688/f1000research.18379.1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545822/pdf/f1000research-8-20108.pdf
Oppler, Z. J. et al. (2021). Evolutionary genetics of Borrelia. Current Issues in Molecular Biology, 42, 97-112. 10.2177/cimb.042.097 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330495/pdf/nihms-1727371.pdf
Kitsou, C., & Pal, U. (2018). Ixodes immune responses against Lyme disease pathogens. Froniers in Cellular and Infection Microbiology, 8, Article 176. 10.3389/fcimb.2018.00176 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986905/pdf/fcimb-08-00176.pdf
USGS. (2017, January 11). News release. https://www.usgs.gov/news/national-news-release/its-heat-and-humidity-new-study-finds-why-lyme-disease-common-north-rare
Stöppler, M. C. (2021, March 29). Definition of enzootic. https://www.rxlist.com/enzootic/definition.htm
Antigenic variation. (2021, February 26). Biology Online. https://www.biologyonline.com/dictionary/antigenic-variation
Mineo, L. (2022, January 25). Wrenching 5-year battle with Lyme disease. The Harvard Gazette. https://news.harvard.edu/gazette/story/2022/01/ross-douthats-wrenching-lyme-disease-battle/
Centers for Disease Control and Prevention. (2019, September 30). Lyme disease on people. https://www.cdc.gov/lyme/prev/on_people.html
Fraser, C. M. et al. (1997). Genomic sequence of a Lyme disease spirochaete, Borrelia burgdorferi. Nature, 390(6660), 580-586. 10.1038/37551 https://pubmed.ncbi.nlm.nih.gov/9403685/#:~:text=The%20chromosome%20contains%20853%20genes,Because%20B