- Eugene D. Shapiro, MD*
- *Departments of Pediatrics, Epidemiology of Microbial Diseases, and Investigative Medicine, Yale University Schools of Medicine and of Public Health and Graduate School of Arts and Sciences, New Haven, CT.
Dr. Shapiro has disclosed that this article was made possible, in part, by support from Clinical and Translational Science Award grants UL1 TR000142 and KL2 TR000140 from the National Center for Research Resources and the National Center for Advancing Translational Science, components of the National Institutes of Health, and National Institutes of Health Roadmap for Medical Research. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.
- enzyme-linked immunosorbent assay
- erythema migrans
- southern tick–associated rash illness
Although Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne disease in the United States, there is considerable misunderstanding about the clinical manifestations and consequences of this infection. (1)(2)
When to perform diagnostic tests and how to interpret the results for antibodies against B burgdorferi are common sources of confusion for physicians and patients. (3)(4)(5)
Misinformation about chronic Lyme disease on the Internet and in popular media has led to publicity and anxiety about Lyme disease that is out of proportion to the actual morbidity that it causes. (6)(7)(8)
After completing this article, readers should be able to:
Understand the ecology and the epidemiology of Lyme disease.
Know when to order and how to interpret serologic tests for the diagnosis of Lyme disease.
Understand the clinical manifestations of Lyme disease and appropriate treatment
Epidemiology and Ecology
Lyme disease is the most common vector-borne disease in the United States. In the United States, the spirochete Borrelia burgdorferi sensu stricto (hereafter termed B burgdorferi) is the only pathogen that causes Lyme disease. However, in Europe and Asia, Borrelia afzelii, Borrelia garinii, and other related species, in addition to B burgdorferi, cause Lyme disease. In the United States, these bacteria are transmitted by hard-bodied ticks, including Ixodes scapularis (the black-legged tick, commonly called a deer …