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Developmental stages of Ixodes ricinus From left to right: larva, nymph, adult female, adult male. Reproduced with permission from the European Concerted Action on Lyme Borreliosis.

Developmental stages of Ixodes ricinus From left to right: larva, nymph, adult female, adult male. Reproduced with permission from the European Concerted Action on Lyme Borreliosis.

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Lyme borreliosis (Lyme disease) is caused by spirochaetes of the Borrelia burgdorferi sensu lato species complex, which are transmitted by ticks. The most common clinical manifestation is erythema migrans, which eventually resolves, even without antibiotic treatment. However, the infecting pathogen can spread to other tissues and organs, causing mo...

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This study aimed at finding epidemiological and clinical features of autochthonous Lyme borreliosis in humans through epidemiological investigations and identifying its vectors and pathogens through analysis of ticks. Epidemiological investigations, including review of the retrospective medical records and patient interviews, were conducted in two...
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Erythema migrans (EM) is the most common and recognized clinical manifestation of early Lyme Borreliosis (LB) in Europe. Purpose: to evaluate clinically and serologically all the patients with EM and to correlate the serology with clinical approach. Material and method: A prospective analyses of all patients that came with EM in our University Hosp...
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Comparison of clinical efficacy and adverse effects of treatment with azithromycin and amoxicillin in children with solitary erythema migrans (EM). Consecutive patients < 15 years with untreated solitary EM referred to our institution 2002 - 2003 were included in thisunblinded prospective clinical study in which patients were alternatively treated...
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Background. Lyme borreliosis disease results from infection by members of the Borrelia burgdorferi sensu lato complex. The most common clinical presentation of Lyme borreliosis is erythema migrans (EM). To gain knowledge of the epidemiological parameters and the risk factors of EM in Slovenia, a survey has been carried out in 2010. Methods. A short...
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Public health statistics recorded an increasing trend in the incidence of tick bites and erythema migrans in the Netherlands. We investigated whether the disease incidence could be predicted by a spatially explicit categorization model, based on environmental factors and a training set of tick absence-presence data. Presence and absence of Ixodes r...

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... Systemic borreliosis is considered the most common vector-borne illness caused by spirochetes of the Borrelia burgdorferi species [48,49]. Multiple organ systems may be involved, including the heart, joints, skin, eyes and the CNS, in which case it is referred to as neuro-Lyme disease [48]. ...
... Systemic borreliosis is considered the most common vector-borne illness caused by spirochetes of the Borrelia burgdorferi species [48,49]. Multiple organ systems may be involved, including the heart, joints, skin, eyes and the CNS, in which case it is referred to as neuro-Lyme disease [48]. Three stages of Lyme disease are identified. ...
... Facial nerve palsy is common in neuro-Lyme disease, with bilateral involvement in 50% of cases, and it is considered a rather disease-specific finding (Fig. 4c) [49]. CSF analysis shows reduced glucose levels, increased protein concentration and pleiocytosis, and it is therefore non-specific [48]. Treatment of choice is based on antibiotics [48]. ...
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Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.
... The agents responsible for Lyme borreliosis are a diverse group of spirochetal bacteria within the Borrelia genus. Borrelia burgdorferi sensu lato complex comprises at least 20 named species (Margos et al. 2019), with most human Lyme cases being caused by B. burgdorferi sensu stricto, B. afzelii, B. garinii, and B. bavariensis (Stanek et al. 2012). ...
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Lyme borreliosis is a bacterial infection that can be spread to humans by infected ticks and may severely affect many organs and tissues. Nearly four decades have elapsed since the discovery of the disease agent called Borrelia burgdorferi. Although there is a plethora of knowledge on the infectious agent and thousands of scientific publications, an effective way on how to combat and prevent Lyme borreliosis has not been found yet. There is no vaccine for humans available, and only one active vaccine program in clinical development is currently running. A spirited search for possible disease interventions is of high public interest as surveillance data indicates that the number of cases of Lyme borreliosis is steadily increasing in Europe and North America. This review provides a condensed digest of the history of vaccine development up to new promising vaccine candidates and strategies that are targeted against Lyme borreliosis, including elements of the tick vector, the reservoir hosts, and the Borrelia pathogen itself.
... The first line treatment of borreliosis is based on antibiotics such as doxycycline used for adults and amoxicillin or cefuroxime acetyl for adults and children. These antibiotics work sufficiently well when administrated at the early stages of borrelia infection but not at its late stages [13][14][15][16][17][18] However, some patients experience adverse effects with chemical antibiotics which may range from undesired to life threatening. Furthermore, in course of the treatment regimen resistances may rise. ...
... Each therapy should therefore be controlled regularly until its successful end is confirmed. The The actual absence of Borreliella in blood does not necessarily indicate complete bacteria eradication because they may change into inactive round bodies (stationary phase, cysts, L-forms ( Figure 2) and enter other parts of the human body such as skin or cartilage, where up to now they cannot be detected neither by the described GC-method nor with the standard serological tests, but may be treated by the garlic therapy [18]. From these hidden places the bacteria may change back to the motile helical form and can migrate into blood where they can be recognized and combated again. ...
... One of the clearest impacts of climate change on human health is the spread of vector-borne diseases (McMichael et al., 2006;Medlock and Leach, 2015;Semenza, 2009). While the spread of malaria through mosquitos has received much attention, the costs associated with the spread of infectious diseases transmitted by ticks, such as tick-borne encephalitis (TBE) and Lyme borreliosis (LB), are poorly covered in the literature (Lindquist and Vapalahti, 2008;Stanek et al., 2012). With a warmer and moister climate, the regions with tick infestation have expanded to higher latitudes and altitudes, and this development is expected to continue (Gray et al., 2009;T. ...
... While symptoms can be mild or absent for some individuals, they can be severe for others, especially if not treated early. There is no vaccine available on the market, but LB infections can be treated with antibiotics (Stanek et al., 2012). ...
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Understanding how changes in baseline risk influence preferences for risk reduction isimportant when valuing the welfare effects of environmental change, including the spreadof disease. We conduct a survey-based choice experiment among respondents residing inareas with different prevalence of ticks and incidence of Lyme borreliosis (LB) and tick-borne encephalitis (TBE) in Sweden. Respondents face a trade-off between risk and travelcost when choosing between visiting recreational areas differing in prevalence of ticks anddisease incidence. Our study indicates that the presence of ticks and the associated risk oftick-borne diseases significantly influence the choice of recreational area and have substan-tial welfare effects. The mean willingness to pay (WTP) per trip to avoid areas with differentlevels of ticks, LB risk and TBE risk ranges from 12 to 78 EUR. The WTP for risk reduction issignificantly lower among respondents residing in risk areas compared to respondents inemerging risk areas. Explanations for these differences in WTP for risk reduction betweengroups with different baseline risks include differences in reference point utility, knowledgeand learning, leading to adaptation of behaviour and preferences.
... Lyme borreliosis is a vector-borne bacterial zoonosis [1]. The vector is a tick of the family Ixodes and the reservoirs for the bacteria are mainly small animals such as birds or rodents that the ticks feed on [2]. ...
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Background In a study from 2013 that prioritised communicable diseases for surveillance in Sweden, we identified Lyme borreliosis as one of the diseases with highest priority. In 2014, when the present study was designed, there were also plans to make neuroborreliosis notifiable within the European Union.AimWe compared possibilities of surveillance of neuroborreliosis in Sweden through two different sources: the hospital discharge register and reporting from the clinical microbiology laboratories.Methods We examined the validity of ICD-10 codes in the hospital discharge register by extracting personal identification numbers for all cases of neuroborreliosis, defined by a positive cerebrospinal fluid-serum anti-Borrelia antibody index, who were diagnosed at the largest clinical microbiology laboratory in Sweden during 2014. We conducted a retrospective observational study with a questionnaire sent to all clinical microbiology laboratories in Sweden requesting information on yearly number of cases, age group and sex for the period 2010 to 2014.ResultsAmong 150 neuroborreliosis cases, 67 (45%) had received the ICD-10 code A69.2 (Lyme borreliosis) in combination with G01.9 (meningitis in bacterial diseases classified elsewhere), the combination that the Swedish National Board of Health and Welfare recommends for neuroborreliosis. All 22 clinical laboratories replied to our questionnaire. Based on laboratory reporting, the annual incidence of neuroborreliosis in Sweden was 6.3 cases per 100,000 in 2014.Conclusion The hospital discharge register was unsuitable for surveillance of neuroborreliosis, whereas laboratory-based reporting was a feasible alternative. In 2018, the European Commission included Lyme neuroborreliosis on the list of diseases under epidemiological surveillance.
... Lyme borreliosis (LB) is caused by spirochaetes of the Borrelia burgdorferi sensu lato species complex, which are transmitted by different Ixodes spp. ticks [1]. The most common clinical manifestation is erythema migrans (EM). ...
... The most common clinical manifestation is erythema migrans (EM). However, in the absence of antibiotic treatment the infection can spread and cause severe manifestations affecting a patient's skin, nervous system, joints, or heart [1]. ...
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Background: Lyme borreliosis (LB) is the most frequent vector-borne disease in France. Since 2009, surveillance of LB is conducted by a sentinel network of general practitioners (GPs). This system, in conjunction with the national hospitalisation database was used to estimate the incidence and describe the characteristics of LB in France. Aim: To describe the estimated incidence and trends in GP consultations and hospital admissions for LB in France and identify risk groups and high-incidence regions. Results: From 2011 to 2016, the mean yearly incidence rate of LB cases was 53 per 100,000 inhabitants (95% CI: 41-65) ranging from 41 in 2011 to 84 per 100 000 in 2016. A mean of 799 cases per year were hospitalised with LB associated diagnoses 2005-16. The hospitalisation incidence rate (HIR) ranged from 1.1 cases per 100,000 inhabitants in 2005 to 1.5 in 2011 with no statistically significant trend. We observed seasonality with a peak during the summer, important inter-regional variations and a bimodal age distribution in LB incidence and HIR with higher incidence between 5 and 9 year olds and those aged 60 years. Erythema migrans affected 633/667 (95%) of the patients at primary care level. Among hospitalised cases, the most common manifestation was neuroborreliosis 4,906/9,594 (51%). Conclusion: Public health strategies should focus on high-incidence age groups and regions during the months with the highest incidences and should emphasise prevention measures such as regular tick checks after exposure and prompt removal to avoid infection.
... Among pathogens transmitted by ticks, bacteria are responsible for a number of major diseases, including rickettsioses, that are present worldwide (Balraj et al. 2009;Blanton 2013), as well as the Borrelia species responsible for Lyme borreliosis in the Northern Hemisphere, and relapsing fever in tropical and temperate areas (Stanek et al. 2012;Steere et al. 2016;Talagrand-Reboul et al. 2018). The identity of the Dermacentor species found harbouring this virus remains uncertain. ...
Article
Knowledge of the tick fauna of continental Southeast Asia is either patchy or, in some cases, for example Cambodia and Myanmar, poor. Nevertheless, 97 species have been recorded from this region, making it one of the most diverse for ticks worldwide. Throughout Southeast Asia, work on tick-borne diseases of stock and companion animals, as well as of humans, is in its infancy, and the medical, veterinary and socio-economic importance of these diseases is largely unknown. Here we review current knowledge of Southeast Asian ticks and tick-borne diseases, with the aim of stimulating further research on this subject.
... The late symptoms of LB may as well appear after many months or years [1,7]. Apart from the skin symptoms, musculoskeletal manifestations, Lyme neuroborreliosis (LNB) and less frequently cardiac and ocular impairments [8,9,10], borrelial infection may also lead to hearing deterioration. It is supposed that in Europe alone, such pathologies may affect even 44-75% of patients [11,12]. ...
Article
Wstęp Borelioza z Lyme (Lyme borreliosis – LB) jest najczęstszą chorobą odkleszczową u ludzi. Celem pracy było przeprowadzenie wstępnej analizy występowania zaburzeń słuchu u chorych na LB. Materiał i metody Testy audiometryczne objęły 66 chorych z rozpoznaną LB, w wieku od 18 do 45 lat. Wszyscy badani (kobiety i mężczyźni) zostali podzieleni na dwie główne grupy: 1 – wczesnej, rozsianej LB i 2 – późnej LB; wśród nich zostały wyodrębnione podgrupy pacjentów z rozpoznaniem neuroboreliozy (Lyme neuroborreliosis – LNB). Diagnostykę narządu słuchu przeprowadzono na podstawie badań audiometrii tonalnej, audiometrii tonalnej rozszerzonej (o wysokiej częstotliwości do 18 kHz), audiometrii impedancyjnej i audiometrii mowy. Wyniki Nieprawidłowe wyniki testów audiometrycznych stwierdzono u 66,7% badanych, a analiza statystyczna wskazała na istotny związek z zakażeniem Borrelia burgdorferi (p = 0,017). Większość stanowiły osoby z późną LB, zarówno bez, jak i z LNB. Wnioski Zaburzenia słuchu różnego stopnia występują u ponad połowy chorych na LB, zwłaszcza w późnych stadiach procesu chorobowego. Uzyskane wyniki wskazują na konieczność prowadzenia dalszych wszechstronnych badań uwzględniających uszkodzenie narządu słuchu i równowagi w przebiegu LB, obejmujących większe grupy chorych.
... The disease affects multiple organs and manifests itself by various clinical symptoms, from non-specific flu-like symptoms and the most common skin manifestation, erythema migrans, to late skin lesions (lymphocytoma, lymphadenosis benigna cutis, or acrodermatitis chronica atrophicans), large joint inflammation, neurological symptoms (neuroborreliosis), meningopolyneuritis, and cardiac and/or eye involvement (Basta et al. 1999;Denis et Hayes. 2002;Grubhoffer et al. 2005;Danielova et al. 2004;Hubálek 2009;Stanek et al. 2011;Stanek et al. 2012). ...
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Sera collected from healthy individuals from the general population in the Czech Republic during repeated cross-sectional surveys were analyzed. Samples collected in the same six districts in two time periods, 1978-1989 and 2001, were compared. The study subjects were divided into six age categories between 10 and 59 years. Overall, 434 samples from 1978-1989 and 270 samples from 2001 were screened for Anaplasma phagocytophilum (AP) and Borrelia burgdorferi sensu lato (BB). The anti-AP positivity rates were 13.1% and 11.5% in the first and second period, respectively, and did not differ significantly between the periods (P = 0.559). The anti-BB antibodies were detected in 33.9% and 14.8% of study subjects, respectively. The positivity rates were significantly lower in the second period (P<0.001). No considerable changes were observed in the sex distribution of positive findings between the two periods. The highest positivity rates of anti-AP antibodies were found in the 10–14 year age group: 16.0% in 1978-1989 and 16.7% in 2001. The age distribution of the anti-AP antibody positivity rates did not change substantially (P = 0.872). In 1978-1989, the lowest anti-BB antibody positivity rate (26.7%) was found in the 10–14 year age group, with a gradual increase with age to 41.1% in 50–59 year-olds. In 2001, the positivity rate in the 10–14 year age group was 26.2% and was not significantly different from that in the first period (P = 0.955). However, the positivity rates in the older age groups 15–59 years decreased significantly (P<0.001) and varied between 8.3% and 15.1%.
... The risk of tick-borne diseases (TBDs) has markedly increased due to the modifications of the ecosystem by humans, the intensification of human and animal mobility, and socioeconomic changes (Kilpatrick and Randolph, 2012;Léger et al., 2013;Lindgren et al., 2012;Madder et al., 2011;Rizzoli et al., 2014). Among pathogens transmitted by ticks, bacteria are responsible of the most prevalent diseases, such as Lyme borreliosis in the northern hemisphere (Stanek et al., 2012;Steere et al., 2016) or the worldwide present rickettsioses (Balraj et al., 2009;Blanton, 2013 cidence is 300,000 cases per annum in the United States (Mead, 2015) and 65,500 cases in Europe (Rizzoli et al., 2011). Borrelia afzelii, Borrelia garinii, Borrelia burgdorferi sensu stricto (ss), Borrelia bavariensis, and Borrelia spielmanii are the major species involved in human pathogenesis. ...
... The first local clinical manifestation is the so-called EM, which corresponds to a skin inflammation expanding from the site of the tick bite. In the absence of an efficient immune response, the bacteria can disseminate via the blood and the skin to distant organs: heart, joints, central nervous system, and distant skin (Stanek et al., 2012;Steere et al., 2016). Lyme borreliosis is transmitted by hard ticks belonging to the Ixodes genus, including mostly Ixodes scapularis/pacificus in North America, Ixodes ricinus in Europe, and Ixodes persulcatus in Asia. ...
Chapter
Ticks are obligate hematophagous acari transmitting a high variety of pathogens that affects both humans and animals worldwide. Bacteria constitute a major group of pathogens transmitted by ticks such as Borrelia, the causative agent of Lyme borreliosis and relapsing fever, Rickettsia responsible of rickettsioses, and Anaplasma, the bacterium causing anaplasmosis. Most of these diseases are zoonoses, which explain their large geographic distribution and the difficulties to control them. Ticks are more than just living syringes since many components of their saliva facilitate pathogen transmission by modulating the pharmacology and the immune system of the vertebrate host. Tick saliva assures optimal feeding for the tick and creates a favorable environment for bacteria transmission, facilitating their multiplication and persistence. These phenomena occur at the skin interface that constitutes the first line of defense against the transmitted pathogens. Lyme borreliosis is the most studied tick-borne disease (TBD) in terms of transmission analysis and effect of Ixodes saliva on pathogen virulence. A better understanding of these processes and of the role the skin plays in pathogen persistence may advance the development of efficient diagnostic tools and eventually vaccines to control these TBDs.