Lyme disease pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]


Lyme disease is caused by Borrelia burgdorferi and is transmitted primarily by tick species Ixodes scapularis. Ticks can attach to any part of the human body but are often found in hard-to-see areas such as the groin, armpits, and scalp. In most cases, the tick must be attached for 36 to 48 hours or more before the spirochetes can be transmitted. Very few people affected with Lyme disease recall a tick bite. B. burgdorferi have two morphological forms, a spiral form and a spheroplast form. Survival strategies of B. burgdorferi include: antigenic variation, physical sequestration, intracellular invasion, and immune system supression.



Primary Vector

I. scapularis, the primary vector of Lyme disease in Eastern North America - Source: Gross L (2006) A New View on Lyme Disease: Rodents Hold the Key to Annual Risk. PLoS Biol 4(6): e182.
Relative size of I. scapularis at different life stages - Source:

Other Potential Vectors

Other Modes of Transmission

Reservoir host

  • The primary reservoir host of B. burgdorferi is rodents. These rodents are infested by I. scapularis.
  • The white-footed mouse (Peromyscus leucopus) is the most common rodent infected by B. burgdorferi.[18]
  • Other reservoirs may include voles, chipmunks, squirrels, raccoons, skunks, birds, and reptiles such as lizards.
  • It is predicted that the density of infected nymphal stage of ticks may be lower in areas where predators of primary reservoir hosts, particularly red foxes (Vulpes vulpes), are more active. The reason for this may include:[19]
    • Direct effect: Predation of reservoir hosts.
    • Indirect effect: Decreased movement and increased refuge due to presence of active predator.



Mechanisms of persistence

Role of cytokines

Evidence of a distinct pro-inflammatory immune process has been observed in both acute and antibiotic refractory Lyme disease.

Role of Neurotransmitters

Pathogenesis of Post treatment Lyme disease syndrome

Microscopic pathology

  • Biopsy of erythema migrans shows:
    • Dermal and epidermal involvement in center of lesion
    • Dermal involvement at the periphery


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