This document discusses key issues related to Lyme disease diagnosis and treatment. It summarizes that Lyme disease is caused by the bacterium Borrelia burgdorferi transmitted through deer tick bites, but ticks can transmit multiple pathogens. Contrary to guidelines, infection may cause both acute and chronic symptoms. Additionally, current diagnostic criteria and short-term antibiotic treatment may fail to identify or cure all Lyme disease cases. The document argues that Lyme disease places a high financial burden despite a low level of research funding relative to other infectious diseases.

1. What you should know….
Holly Ahern MS, BS MT(ASCP)
Associate Professor of Microbiology
SUNY Adirondack, Queensbury, NY

2. I say “LYME DISEASE,”
you say….

6. *Borrelia
burgdorferi
Other
Borrelia
Babesia
Bartonella
Ehrlichia
Anaplasma
Mycoplasma
Viruses

7. University of Rhode Island
Tick Encounter Resource Center
http://www.tickencounter.org/tick_testing

8. Lyme disease is an acute infectious
disease, transmitted by nymph stage
deer ticks, caused by one species of a
specific bacterium named Borrelia
burgdorferi
“Hard to catch and easy to cure”

10. Tick must be attached for a
minimum of 36 hours to
transmit Lyme disease…
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines
 Burgdorfer: transmission
time for Borrelia is
variable.
 Other TBDs transmitted
quickly; viruses in 15 min.
 Borrelia may be sexually
transmitted.
 Borrelia, Babesia,
Anaplasma are
transfusion transmitted.

11. Lyme disease is an acute
infectious disease.
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines
 Lyme disease may
be an acute disease.
 Lyme disease may
also be a chronic
disease.

12. A single “FRONTAL”
pathogen, Borrelia
burgdorferi, is responsible
for Lyme disease symptoms.
 Ticks carry and
transmit multiple
“STEALTH” microbes.
 People infected with
multiple pathogens
have more severe
disease.
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines

13. Diagnostic algorithm (ACP)
includes patient history of tick
bite, “bulls-eye” rash, AND
“laboratory evidence” of
infection (usually this means a
“two-tier” system of antibody
based blood tests for Borrelia
burgdorferi ONLY)
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines
 Current diagnostic criteria
EXCLUDE any form of the
disease that does not meet the
ACP/CDC/IDSA algorithm
 Therefore, you may not be
diagnosed with Lyme disease,
EVEN IF YOU HAVE IT, if:
 No “bulls-eye” at tick bite site
 “First tier” test doesn’t meet a
threshold level
 “Second-tier” test doesn’t have
enough “bands”
 You were infected with more
than one microbe by the tick

14. Most infections resolve after
short-term antibiotic
treatment; 5% of patients
may develop post-tx
sequelae that are
“autoimmune.”
 CDC survey - 61% require
more than recommended
antibiotic treatment.
 30 – 50% have chronic
symptoms persisting after
antibiotics.
 Stealth pathogens are highly
adapted survivors so
persistent infection may be
the cause.
 Reactivation of growth of
spirochetes shown in most
recent study.
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines

16. EASY to catch and HARD to cure!
Ticks may transmit some pathogens RAPIDLY
Study of Lyme patients: Only 50% developed any type of rash,
of those, only 10% had a “bulls-eye”
Symptoms may occur at ANY TIME of the year
Symptoms are highly variable and may become CHRONIC
Blood tests for Lyme disease are reliably INACCURATE
2-4 weeks of antibiotics MAY NOT cure Lyme disease

17. Disease
New cases
(annual)
NIH funding (FY 2012)
Hepatitis C 1,300 $112 million
West Nile Virus 5,700 $29 million
HIV/AIDS * 56,000 $3 billion (11% total NIH budget)
Influenza * 73,000 $251 million
Lyme disease 312,000 $25 million
Source: http://report.nih.gov/PFSummaryTable.aspx
* Considered “epidemic” by the CDC

18. Financial Burden of Lyme disease,
BEFORE CDC Case Estimate Revision (2012)
New York State 2,590 $10,429 $27,011,110
United States 27,313 $10,429 $284,847,277
Financial Burden of Lyme disease,
AFTER CDC Case Estimate Revision (2012)
New York State 25,900 $10,429 $270 million
United States 312,000 $10,429 $3.25 billion
Financial Burden of Lyme disease,
based on probable number of cases (2012)
New York State 44,030 $10,429 $460 million
United States 445,714 $10,429 $4.65 billion