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 (1-3). 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 (4-5) and Asia (6) and in the northeastern, north central, and Pacific coastal regions of North America. Transmission has not been documented in the tropics.

Risks for Travelers

Travelers to endemic areas who have exposure to tick habitats could 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

Travelers 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 acaricides to clothing can reduce the risk of infection, as can daily tick checks and prompt removal of any attached ticks (see Chapter 2). Remove ticks by grasping them firmly with tweezers as close to the skin as possible and lifting gently.

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 However, the vaccine was withdrawn from the market by the manufacturer in February 2002 because of low sales and is no longer commercially available.

Treatment

Travelers 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 topical medicine. Lyme disease can usually be cured by an appropriate course of antibiotic treatment (7).

References

1. Steere AC. Lyme disease. N Engl J Med. 2001;345:115-25.
2. Stanek G, Strle F. Lyme borreliosis. Lancet. 2003;362:1639-47.
3. Weber K. Aspects of Lyme borreliosis in Europe. Eur J Clin Microbiol Infect Dis. 2001;20:6-13.
4. Gern L, Humair PF. Ecology of Borrelia burgdorferi sensu lato in Europe. In: Gray JS, Kahl O, Lane RS, Stanek G, eds. Lyme borreliosis: biology, epidemiology and control. 1st ed. New York: CABI Publishing, 2002:149–74.
5. Korenberg EI, Gorelova NB, Kovalevskii YV. Ecology of Borrelia burgdorferi sensu lato in Russia. In: Gray JS, Kahl O, Lane RS, Stanek G, eds. Lyme borreliosis: biology, epidemiology and control. 1st ed. New York; CABI Publishing; 2002:175–200.
6. Miyamoto K, Masuzawa T. Ecology of Borrelia burgdorferi sensu lato in Japan and East Asia. In: Gray JS, Kahl O, Lane RS, Stanek G, eds. Lyme borreliosis: biology, epidemiology and control. 1st ed. New York: CABI Publishing, 2002:201–22.
7. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, 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;43:1089-134.