Lyme Disease Recent Advances And Perspectives

The interplay between host and pathogen is a complex co-evolutionary battle of surveillance and evasion. The pathogen continuously develops mechanisms to subvert the immune response in order to establish infection while the immune system responds with novel mechanisms of detection. Because the majority of Lyme disease pathology is due to an over-exuberant immune response, much research in Borrelia burgdorferi pathogenesis has been devoted to understanding the mammalian host response to the bacterium. Immunological studies continue to be an active area of research employing emerging techniques, such as intra-vital imaging. These studies have furthered our understanding of inflammatory processes during long-term infection and provided some surprising insights, such as the continued presence of bacterial products after clearance. The field of Lyme disease has long debated the etiology of long-term inflammation and recent studies in the murine host have shed light on relevant cell types and inflammatory mediators that participate in the pathology of Lyme arthritis. Live imaging and bioluminescent studies have allowed for a novel view of the bacterial life cycle, including the tick mid-gut, tick-to-mammal transmission and dissemination throughout a mouse. A number of tick and bacterial proteins have been shown to participate in the completion of the enzootic cycle. Novel mechanisms of gene regulation are continuously being identified. However, B. burgdorferi lacks many traditional virulence factors, such as toxins or specialized secretion systems. Many genes in the B. burgdorferi genome have no known homolog in other bacteria. Therefore, studies focusing on host-pathogen interactions have therefore been limited by an incomplete understanding of the repertoire of bacterial virulence factors. Questions such as how the pathogen causes disease, colonizes the tick and evades host immune-surveillance have been difficult to address. Genetic studies involving single gene deletions have identified a number of important bacterial proteins, but a large-scale genomics approach to identify virulence factors has not been attempted until recently. The generation of a site-directed mutagenesis library is an important step towards a detailed analysis of the B. burgdorferi genome and pathogenome. Using this library, high-throughput genomic studies, utilizing techniques such as massively parallel sequencing have been promising and could be used to identify novel virulence determinants of disease in the mammalian host or persistence in the tick vector. Continued research on this unique pathogen and its specific interaction with host and vector may have far reaching consequences and provide insights for diverse disciplines including ecology, infectious disease, and immunology. Here, several reviews will discuss the most recent advances and future studies to be undertaken in the field of B. burgdorferi biology.

A single tick bite can have debilitating consequences. Lyme disease is the most common disease carried by ticks in the United States, and the number of those afflicted is growing steadily. If left untreated, the diseases carried by ticks-known as tick-borne diseases-can cause severe pain, fatigue, neurological problems, and other serious health problems. The Institute of Medicine held a workshop October 11-12, 2010, to examine the state of the science in Lyme disease and other tick-borne diseases.

Lyme disease is the most common tick-borne illness in the United States, with more than 300,000 cases diagnosed each year. However, doctors are deeply divided on how to diagnose and treat it, giving rise to the controversy known as the “Lyme Wars.” Firmly entrenched camps have emerged, causing physicians, patient communities, and insurance providers to be pitted against one another in a struggle to define Lyme disease and its clinical challenges. Health care providers may not be aware of its diverse manifestations or the limitations of diagnostic tests. Meanwhile, patients have felt dismissed by their doctors and confused by the conflicting opinions and dubious self-help information found online. In this authoritative book, the Columbia University Medical Center physicians Brian A. Fallon and Jennifer Sotsky explain that, despite the vexing “Lyme Wars,” there is cause for both doctors and patients to be optimistic. The past decade’s advances in precision medicine and biotechnology are reshaping our understanding of Lyme disease and accelerating the discovery of new tools to diagnose and treat it, such that the great divide previously separating medical communities is now being bridged. Drawing on both extensive clinical experience and cutting-edge research, Fallon, Sotsky, and their colleagues present these paradigm-shifting breakthroughs in language accessible to both sides. They clearly explain the immunologic, infectious, and neurologic basis of chronic symptoms, the cognitive and psychological impact of the disease, as well as current and emerging diagnostic tests, treatments, and prevention strategies. Written for the educated patient and health care provider seeking to learn more, Conquering Lyme Disease gives an up-to-the-minute overview of the science that is transforming the way we address this complex illness. It argues forcefully that the expanding plague of Lyme and other tick-borne diseases can be confronted successfully and may soon even be reversed.

This new edition of Lyme Disease provides up-to-date evidence-based research and covers the significant advances in our understanding of the disorders referred to as Lyme disease or Lyme borreliosis. This book explores the causative organism, its requisite ecosystem, disease epidemiology, host-Borrelia interactions, diagnostic testing, clinical manifestations, therapeutic options, the role of host immunity on pathogenesis and long term prognosis. The authors provide balanced perspectives on all aspects of Lyme disease and explicitly review both the basic biology of the infection and practical clinical aspects. This new edition includes new borrelial pathogens that have been identified (B. miyamotoi, B. mayonii and B. bavariensis among others). Provides updated information on the molecular biology of the organism, neuroborreliosis, and the role of the C6 peptide in diagnosis. Discusses the controversies about 'chronic Lyme disease', post Lyme disease syndrome and other ongoing but non-specific symptoms that have been attributed to this infection. As the endemic footprint of Lyme disease continues to grow, this book provides a broad and detailed guide for clinicians and researchers involved with the diagnosis and treatment of the condition. Covering biology, epidemiology and therapeutics, it is also essential reading for students of global health and infectious disease.

Aspects of Lyme Borreliosis is a comprehensive scientific presentation of virtually all aspects of lyme borreliosis. It starts with a concise history of lyme borreliosis and its causative agent, Borrelia burgdorferi. The morphological and biological characteristics of B. burgdorferi are presented, followed by outlines on the ecology and histopathology of LB.The various aspects of the clinical manifestations of LB are systematically dealt with, starting with a clinical overview. A special chapter covers the microbiological diagnosis. After a presentation on the susceptibility of B. burgdorferi in vitro and in animals against a great variety of antibiotics, a thorough discussion on the treatment of LB including criticalremarks follows. The book closes with a chapter on the epidemiology of LB.

NEW YORK TIMES EDITORS’ CHOICE • In this vulnerable, insightful memoir, the New York Times columnist tells the story of his five-year struggle with a disease that officially doesn’t exist, exploring the limits of modern medicine, the stories that we unexpectedly fall into, and the secrets that only suffering reveals. “A powerful memoir about our fragile hopes in the face of chronic illness.”—Kate Bowler, bestselling author of Everything Happens for a Reason In the summer of 2015, Ross Douthat was moving his family, with two young daughters and a pregnant wife, from Washington, D.C., to a sprawling farmhouse in a picturesque Connecticut town when he acquired a mysterious and devastating sickness. It left him sleepless, crippled, wracked with pain--a shell of himself. After months of seeing doctors and descending deeper into a physical inferno, he discovered that he had a disease which according to CDC definitions does not actually exist: the chronic form of Lyme disease, a hotly contested condition that devastates the lives of tens of thousands of people but has no official recognition--and no medically approved cure. From a rural dream house that now felt like a prison, Douthat's search for help takes him off the map of official medicine, into territory where cranks and conspiracies abound and patients are forced to take control of their own treatment and experiment on themselves. Slowly, against his instincts and assumptions, he realizes that many of the cranks and weirdos are right, that many supposed "hypochondriacs" are victims of an indifferent medical establishment, and that all kinds of unexpected experiences and revelations lurk beneath the surface of normal existence, in the places underneath. The Deep Places is a story about what happens when you are terribly sick and realize that even the doctors who are willing to treat you can only do so much. Along the way, Douthat describes his struggle back toward health with wit and candor, portraying sickness as the most terrible of gifts. It teaches you to appreciate the grace of ordinary life by taking that life away from you. It reveals the deep strangeness of the world, the possibility that the reasonable people might be wrong, and the necessity of figuring out things for yourself. And it proves, day by dreadful day, that you are stronger than you ever imagined, and that even in the depths there is always hope.

Pathogens transmitted among humans, animals, or plants by insects and arthropod vectors have been responsible for significant morbidity and mortality throughout recorded history. Such vector-borne diseases â€" including malaria, dengue, yellow fever, and plague â€" together accounted for more human disease and death in the 17th through early 20th centuries than all other causes combined. Over the past three decades, previously controlled vector-borne diseases have resurged or reemerged in new geographic locations, and several newly identified pathogens and vectors have triggered disease outbreaks in plants and animals, including humans. Domestic and international capabilities to detect, identify, and effectively respond to vector-borne diseases are limited. Few vaccines have been developed against vector-borne pathogens. At the same time, drug resistance has developed in vector-borne pathogens while their vectors are increasingly resistant to insecticide controls. Furthermore, the ranks of scientists trained to conduct research in key fields including medical entomology, vector ecology, and tropical medicine have dwindled, threatening prospects for addressing vector-borne diseases now and in the future. In June 2007, as these circumstances became alarmingly apparent, the Forum on Microbial Threats hosted a workshop to explore the dynamic relationships among host, pathogen(s), vector(s), and ecosystems that characterize vector-borne diseases. Revisiting this topic in September 2014, the Forum organized a workshop to examine trends and patterns in the incidence and prevalence of vector-borne diseases in an increasingly interconnected and ecologically disturbed world, as well as recent developments to meet these dynamic threats. Participants examined the emergence and global movement of vector-borne diseases, research priorities for understanding their biology and ecology, and global preparedness for and progress toward their prevention, control, and mitigation. This report summarizes the presentations and discussions from the workshop.

"Superbly written and researched." --Booklist "Builds a strong case." --Kirkus Lyme disease is spreading rapidly around the globe as ticks move into places they could not survive before. Mary Beth Pfeiffer argues it is the first epidemic to emerge in the era of climate change, infecting millions around the globe. She tells the heart-rending stories of its victims, families whose lives have been destroyed by a single, often unseen, tick bite. Pfeiffer also warns of the emergence of other tick-borne illnesses that make Lyme more difficult to treat and pose their own grave risks. Lyme is an impeccably researched account of an enigmatic disease, making a powerful case for action to fight ticks, heal patients, and recognize humanity's role in a modern scourge.