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{{Lyme disease}}
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==Overview==
==Overview==
Lyme disease was first described in 1983 by Alfred Buchwald. Later Arvid Afzelius proposed that it was spread by Ixodes tick. The full [[syndrome]] now known as Lyme disease was recognized when uster of cases originally thought to be [[juvenile rheumatoid arthritis]] was identified in three towns in southeastern Connecticut in 1975, including the towns Lyme and Old Lyme, which gave the disease its popular name.<ref>{{cite journal |author=Steere AC |title=Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut |journal=Wien. Klin. Wochenschr. |volume=118 |issue=21-22 |pages=625-33 |year=2006 |pmid=17160599 |doi=10.1007/s00508-006-0687-x}}</ref>
In 1883, Alfred Buchwald was the first to describe a condition associated with [[Lyme disease]] which is now known as [[acrodermatitis chronica atrophicans]]. [[Arvid Afzelius]] first observed ring-like [[lesions]], now known as [[Erythema migrans]], and associated the rash with [[tick]] bites. In the United States, [[Lyme disease]] was not recognized until 1975, when a cluster of cases was identified in three towns in Southeastern Connecticut (including towns Lyme and Old Lyme), which gave [[Lyme disease]] its popular name. In 1981, the [[infectious agent]] (a [[spirochete]]) was isolated by [[Willy Burgdorfer]], a researcher  at the [[National Institutes of Health]], from the [[midgut]] of [[Ixodes|''Ixodes'']] [[ticks]]. The [[Spirochaete|spirochete]] was named ''[[Borrelia burgdorferi]]'' in honor of [[Willy Burgdorfer]].  
 
==Historical Perspective==
==Historical Perspective==
 
{|
===Early History===
|-
*The first record of a condition associated with Lyme disease dates to 1883 in Breslau (formerly in Germany) where physician Alfred Buchwald described a degenerative [[skin disorder]] now known as [[acrodermatitis chronica atrophicans]]. In 1909, [[Arvid Afzelius]] presented research about an expanding, ring-like lesion he had observed. Afzelius published his work 12 years later and speculated that the rash came from the bite of an ''Ixodes'' tick, and that meningitic symptoms and signs occur in a number of cases; this rash is now known as [[erythema migrans]] (EM), the skin rash found in early stage Lyme disease.<ref>{{cite journal | author = Lipschütz B | title = Zur Kenntnis der "Erythema chronicum migrans" | journal = Acta dermato-venereologica | language = German | year = 1931 | volume = 12 | pages = 100–2}}</ref> In 1911, parasitologist Andrew Balfour of the Wellcome Research Laboratory in Khartoum identified "infective granules" or spore-type "cysts" as the cause of persistence of spirochetal infection in the Sudanese Fowl.<ref>{{cite journal | author = Balfour A | title = The Infective Granule in Certain Protozoa Infections, as Illustrated by the Spirochaetosis of Sudanese Fowls | journal = THe British Medical Journal | year = 1911 | pages = 1296}}</ref>
|[[Image:Portrait of Dr Willy Burgdorfer.jpg|thumb|Dr. Willy Burgdorfer, an American-Swiss scientist, discovered the bacterial pathogen responsible for causing Lyme disease
[[Image:Portrait of Dr Willy Burgdorfer.jpg|left|400px|thumb|Dr. Willy Burgdorfer, an American-Swiss scientist, discovered the bacterial pathogen responsible for causing Lyme disease.]]
[http://mtmemory.org/cdm/ref/collection/p16013coll2/id/107 Source - Rocky Mountain Laboratories, National Institutes of Health]]]
* In the 1920s, French physicians Garin and Bujadoux described a patient with meningoencephalitis, painful sensory radiculitis, and erythema migrans following a tick bite, and they postulated the symptoms were due to a spirochetal infection. In the 1940s, German neurologist [[Alfred Bannwarth]] described several cases of chronic lymphocytic [[meningitis]] and [[polyradiculoneuritis]], some of which were accompanied by erythematous [[skin]] lesions.
|
* In 1948 [[spirochete]]-like structures were observed in skin specimens by Swedish dermatologist Carl Lennhoff.<ref>{{cite journal | author = Lenhoff C | title =Spirochetes in aetiologically obscure diseases | journal = Acta Dermato-Venreol | year = 1948 | volume = 28 | pages = 295-324}}</ref> In the 1950s, relations between tick bite, lymphocytoma, EM and Bannwarth's syndrome are seen throughout Europe leading to the use of [[penicillin]] for treatment.<ref>{{cite journal |author=Bianchi GE |title=Penicillin therapy of lymphocytoma |journal=Dermatologica |volume=100 |issue=4-6 |pages=270-3 |year=1950 |pmid=15421023}}</ref><ref>{{cite journal |author=Hollstrom E |title=Successful treatment of erythema migrans Afzelius |journal=Acta Derm. Venereol. |volume=31 |issue=2 |pages=235-43 |year=1951 |pmid=14829185}}</ref><ref>{{cite journal |author=Paschoud JM |title=Lymphocytoma after tick bite. |language=German |journal=Dermatologica |volume=108 |issue=4-6 |pages=435-7 |year=1954 |pmid=13190934}}</ref>
*In 1883 in Breslau (formerly in Germany, now known as Wrocław, Portland), Alfred Buchwald, a German [[physician]], was the first to describe a condition associated with [[Lyme disease]]. He described the condition as diffuse [[idiopathic]] [[skin]] [[atrophy]]. The condition is a degenerative [[skin disorder]] now known as [[acrodermatitis chronica atrophicans]].<ref>{{cite book | last = Weber | first = Klaus | title = Aspects of Lyme Borreliosis | publisher = Springer Berlin Heidelberg | location = Berlin, Heidelberg | year = 1993 | isbn = 978-3-642-77614-4 }}</ref>
* Interest in [[tick-borne disease|tick-borne infections]] in the U.S. began with the first report of tick-borne [[relapsing fever]] (''Borrelia hermsii'') in 1915, following the recognition of five human patients in Colorado.<ref>{{cite journal | author = Meador CN | title = Five cases of relapsing fever originating in Colorado, with positive blood findings in two | journal = Colorado Medicine | year = 1915 | volume = 12 | pages = 365-9}}</ref>  
*In 1909, [[Arvid Afzelius]], a Swedish [[physician]], presented research about an expanding, ring-like [[lesion]] he had observed. In 1921, [[Arvid Afzelius]] published his work and stated that the rash was due to the bite of an ''[[Ixodes]]'' [[tick]]. He also concluded that [[meningitis]] signs and symptoms occur in a number of cases; this rash is now known as [[erythema migrans]] (EM), the skin rash found in early stage [[Lyme disease]].<ref>{{cite book | last = Forschner | first = Karen | title = Everything you need to know about Lyme disease and other tick-borne disorders | publisher = John Wiley | location = Hoboken, N.J | year = 2003 | isbn = 978-0471473640 }}</ref>
* In 1970 a physician in Wisconsin named Rudolph Scrimenti reports the first case of EM in U.S. and treats it with penicillin based on European literature.<ref>{{cite journal |author=Scrimenti RJ |title=Erythema chronicum migrans |journal=Archives of dermatology |volume=102 |issue=1 |pages=104-5 |year=1970 |pmid=5497158}}</ref>
*In 1911, Andrew Balfour, a Scottish parasitologist of the Wellcome Research Laboratory in Khartoum, identified "infective granules" or spore-type "cysts" as the cause of persistence of spirochetal infection in Sudanese Fowl.<ref name="pmid20765548">{{cite journal |vauthors=Balfour A |title=THE INFECTIVE GRANULE IN CERTAIN PROTOZOAL INFECTIONS, AS ILLUSTRATED BY THE SPIROCHAETOSIS OF SUDANESE FOWLS |journal=Br Med J |volume=1 |issue=2622 |pages=752 |year=1911 |pmid=20765548 |pmc=2333723 |doi= |url=}}</ref>
* The full [[syndrome]] now known as Lyme disease was not recognized until a cluster of cases originally thought to be [[juvenile rheumatoid arthritis]] was identified in three towns in southeastern Connecticut in 1975, including the towns Lyme and Old Lyme, which gave the disease its popular name.<ref>{{cite journal |author=Steere AC |title=Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut |journal=Wien. Klin. Wochenschr. |volume=118 |issue=21-22 |pages=625-33 |year=2006 |pmid=17160599 |doi=10.1007/s00508-006-0687-x}}</ref> This was investigated by Dr. David Snydman and Dr. Allen Steere of the [[Epidemic Intelligence Service]], and by others from Yale University. The recognition that the patients in the United States had EM led to the recognition that "Lyme arthritis" was one manifestation of the same tick-borne condition known in Europe.<ref name=Sternbach>{{cite journal | author = Sternbach G, Dibble C | title = Willy Burgdorfer: Lyme disease. | journal = J Emerg Med | volume = 14 | issue = 5 | pages = 631-4 | year = 1996| pmid = 8933327}}</ref>  
*In 1913, B. Lipschütz, an Austrian [[dermatologist]], described similar [[rash]] as erythema chronicum migrans (ECM).
* Before 1976, elements of ''B. burgdorferi'' sensu lato infection were called or known as ''tickborne meningopolyneuritis'', ''Garin-Bujadoux syndrome'', ''Bannworth syndrome'', ''Afzelius syndrome'', ''Montauk Knee'' or ''sheep tick fever''. Since 1976 the disease is most often referred to as Lyme disease,<ref>{{cite journal |author=Mast WE, Burrows WM |title=Erythema chronicum migrans and "Lyme arthritis" |journal=JAMA |volume=236 |issue=21 |pages=2392 |year=1976 |pmid=989847}}</ref><ref>{{cite journal |author=Steere AC, Malawista SE, Snydman DR, ''et al'' |title=Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities |journal=Arthritis Rheum. |volume=20 |issue=1 |pages=7-17 |year=1977 |pmid=836338}}</ref> Lyme borreliosis or simply borreliosis.
* In 1915, tick-borne [[relapsing fever]] (''Borrelia hermsii'') was first reported in the U.S following recognition of five human patients in Colorodo. This led to an increased interest in [[Tick-borne disease|tick-borne infections]] in the U.S.<ref name="DworkinSchwan2008">{{cite journal|last1=Dworkin|first1=Mark S.|last2=Schwan|first2=Tom G.|last3=Anderson|first3=Donald E.|last4=Borchardt|first4=Stephanie M.|title=Tick-Borne Relapsing Fever|journal=Infectious Disease Clinics of North America|volume=22|issue=3|year=2008|pages=449–468|issn=08915520|doi=10.1016/j.idc.2008.03.006}}</ref>
* In 1976, Jay Sanford, a former physician at the [[Walter Reed Army Institute of Research]], published a chapter in the book ''The Biology of Parasitic Spirochetes.'' In it, Dr. Sanford stated:  "the ability of [[borrelia]], especially tick-borne strains, to persist in the brain and in the eye during remission after treatment with arsenic or with penicillin or even after apparent cure, is well known.” <ref name="Sanford">{{cite book | author = Sanford JP | chapter = Relapsing Fever—Treatment and Control | title = Biology of Parasitic [[Spirochetes]] | editor = Johnson RC (ed) | publisher = Academic Press | year = 1976 | isbn = 9780123870506}}</ref> Although the notion of persistent neurological infection was identified early on by military researchers such as Dr. Sanford, later Lyme researchers curiously denied the possibility of persistent ''Borrelia'' infection in the brain, with many researchers ignoring evidence of persistent infection.
*In the 1920s, Garin and Bujadoux, French [[Physician|physicians]], described a patient with [[meningoencephalitis]], painful [[sensory]] [[radiculitis]], and [[erythema migrans]] following a [[tick]] bite, and postulated that the symptoms were due to a [[Spirochetal Infections|spirochetal infection]].<ref name="pmid6516452">{{cite journal |vauthors=Ryberg B |title=Bannwarth's syndrome (lymphocytic meningoradiculitis) in Sweden |journal=Yale J Biol Med |volume=57 |issue=4 |pages=499–503 |year=1984 |pmid=6516452 |pmc=2590032 |doi= |url=}}</ref>
* In 1980 Steere, et al, began to test [[antibiotics|antibiotic]] regimens in adult patients with Lyme disease.<ref>{{cite journal |author=Steere AC, Hutchinson GJ, Rahn DW, ''et al'' |title=Treatment of the early manifestations of Lyme disease |journal=Ann. Intern. Med. |volume=99 |issue=1 |pages=22-6 |year=1983 |pmid=6407378}}</ref> In 1982 a novel [[spirochete]] was cultured from the mid-gut of ''[[Ixodes]]'' ticks in Shelter Island, New York, and subsequently from patients with Lyme disease. The infecting agent was then identified by [[Jorge Benach]] at the State University of New York at Stony Brook, and soon after isolated by [[Willy Burgdorfer]], a researcher at the [[National Institutes of Health]], who specialized in the study of spirochete microorganisms such as ''Borrelia'' and ''Rickettsia''. The spirochete was named ''Borrelia burgdorferi'' in his honor. Burgdorfer was the partner in the successful effort to culture the spirochete, along with Alan Barbour.
*In the 1940s, [[Alfred Bannwarth]], a German [[neurologist]], described several cases of chronic [[lymphocytic]] [[meningitis]] and polyradiculoneuritis, some of which were accompanied by [[erythematous]] [[skin]] [[lesions]].<ref name="pmid6516452" />
* After identification ''B. burgdorferi'' as the causative agent of Lyme disease, antibiotics were selected for testing, guided by in vitro antibiotic sensitivities, including [[tetracycline antibiotics]], [[amoxicillin]], [[cefuroxime axetil]], intravenous and intramuscular penicillin and intravenous [[ceftriaxone]].<ref>{{cite journal |author=Luft BJ, Volkman DJ, Halperin JJ, Dattwyler RJ |title=New chemotherapeutic approaches in the treatment of Lyme borreliosis |journal=Ann. N. Y. Acad. Sci. |volume=539 |issue= |pages=352-61 |year=1988 |pmid=3056203}}</ref><ref>{{cite journal |author=Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ |title=Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis |journal=Lancet |volume=336 |issue=8728 |pages=1404-6 |year=1990 |pmid=1978873}}</ref> The mechanism of tick transmission was also the subject of much discussion. ''B. burgdorferi'' spirochetes were identified in tick saliva in 1987, confirming the hypothesis that transmission occurred via tick salivary glands.<ref>{{cite journal |author=Ribeiro JM, Mather TN, Piesman J, Spielman A |title=Dissemination and salivary delivery of Lyme disease spirochetes in vector ticks (Acari: Ixodidae) |journal=J. Med. Entomol. |volume=24 |issue=2 |pages=201-5 |year=1987 |pmid=3585913}}</ref>
|}
 
*In 1948, Carl Lennhoff, a Swedish [[dermatologist]], observed [[spirochete]]-like structures in [[skin]] specimens.<ref>{{cite journal | author = Lenhoff C | title =Spirochetes in aetiologically obscure diseases | journal = Acta Dermato-Venreol | year = 1948 | volume = 28 | pages = 295-324}}</ref>
===Recent Developments===
*In the 1950s, relations between [[tick]] bites, lymphocytoma, EM, and Bannwarth's syndrome were seen throughout Europe, leading to the use of [[penicillin]] for treatment.<ref>{{cite journal |author=Bianchi GE |title=Penicillin therapy of lymphocytoma |journal=Dermatologica |volume=100 |issue=4-6 |pages=270-3 |year=1950 |pmid=15421023}}</ref><ref>{{cite journal |author=Hollstrom E |title=Successful treatment of erythema migrans Afzelius |journal=Acta Derm. Venereol. |volume=31 |issue=2 |pages=235-43 |year=1951 |pmid=14829185}}</ref><ref>{{cite journal |author=Paschoud JM |title=Lymphocytoma after tick bite. |language=German |journal=Dermatologica |volume=108 |issue=4-6 |pages=435-7 |year=1954 |pmid=13190934}}</ref>
{{main|Lyme disease controversy}}
*In 1970, Rudolph Scrimenti, a U.S. physician from Wisconsin, reported the first case of [[erythema migrans]] in U.S. and treated it with [[penicillin]] based on European literature.<ref>{{cite journal |author=Scrimenti RJ |title=Erythema chronicum migrans |journal=Archives of dermatology |volume=102 |issue=1 |pages=104-5 |year=1970 |pmid=5497158}}</ref>  
* Most clinicians agree on the treatment of early Lyme disease infections.<ref name="Murray">{{cite journal | author = Murray T, Feder H | title = Management of tick bites and early Lyme disease: a survey of Connecticut physicians. | journal = Pediatrics | volume = 108 | issue = 6 | pages = 1367-70 | year = 2001 | pmid = 11731662}}</ref> There is, however, considerable disagreement regarding [[prevalence]] of the disease, diagnostic criteria, treatment of late-stage Lyme disease, and the likelihood of a chronic, antibiotic-resistant infections. Some authorities contend that Lyme disease is relatively rare, easily diagnosed with available blood tests, and most often easily treated with two to four weeks of antibiotics,<ref name="Wormser-b">{{cite journal | author = Wormser G | title = Clinical practice. Early Lyme disease. | journal = N Engl J Med | volume = 354 | issue = 26 | pages = 2794-801 | year = 2006 | pmid = 16807416}}</ref> while others propose that the disease is under-diagnosed, available blood tests are unreliable, and that extended antibiotic treatment is often necessary.<ref name="Stricker">{{cite journal | author=Stricker RB, Lautin A, Burrascano JJ | title=Lyme Disease: The Quest for Magic Bullets | journal=Chemotherapy | year=2006 | pages=53-59| volume=52 | issue=2 | pmid= 16498239}}</ref><ref name="Phillips-a">{{cite journal | author=Phillips SE, Harris NS, Horowitz R, Johnson L, Stricker RB | title=Lyme disease: scratching the surface | journal=Lancet | year=2005 | pages=1771 | volume=366 | issue=9499 | pmid= 16298211 | url=http://www.canlyme.com/lyme_scratching_the_surface_05.html}}</ref><ref name="Phillips-b">{{cite web | author=Phillips S, Bransfield R, Sherr V, Brand S, Smith H, Dickson K, and Stricker R | year=2003 | title=Evaluation of antibiotic treatment in patients with persistent symptoms of Lyme disease: an ILADS position paper | format=PDF | work=International Lyme and Associated Diseases Society | url=http://www.ilads.org/files/position2.pdf | accessdate=2006-03-15}}</ref>
*In the United States, [[Lyme disease]] was not recognized until a cluster of cases was identified in three towns in Southeastern Connecticut in 1975. These towns included Lyme and Old Lyme, which gave [[Lyme disease]] its popular name.<ref>{{cite journal|author=Steere AC|title=Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut|journal=Wien. Klin. Wochenschr.|volume=118|issue=21-22|pages=625-33|year=2006|pmid=17160599|doi=10.1007/s00508-006-0687-x}}</ref> The cases were originally thought to be [[juvenile rheumatoid arthritis]]. This was further investigated by Dr. David Snydman and Dr. Allen C. Steere of the [[Epidemic Intelligence Service]], and by others from Yale University. They recognized that the patients in the United States had [[erythema migrans]] and "Lyme arthritis" was one manifestation of the same tick-borne condition known in Europe.<ref name="Sternbach">{{cite journal | author = Sternbach G, Dibble C | title = Willy Burgdorfer: Lyme disease. | journal = J Emerg Med | volume = 14 | issue = 5 | pages = 631-4 | year = 1996| pmid = 8933327}}</ref>  
* The majority of public health agencies such as the U.S. [[Centers for Disease Control]] maintain the former position. While this narrower position is sometimes described as the "mainstream" view of Lyme disease, published studies involving non-randomized surveys of physicians in [[endemic (epidemiology)|endemic]] areas found physicians evenly split in their views, with the majority recognizing [[seronegative]] Lyme disease, and roughly half prescribing extended courses of antibiotics for chronic Lyme disease.<ref name="Ziska">{{cite journal | author=Ziska MH, Donta ST, Demarest FC | title=Physician preferences in the diagnosis and treatment of Lyme disease in the United States | journal=Infection | year=1996 | pages=182-6 | volume=24 | issue=2 | pmid= 8740119}}</ref><ref name="Eppes">{{cite journal | author=Eppes SC, Klein JD, Caputo GM, Rose CD | title=Physician beliefs, attitudes, and approaches toward Lyme disease in an endemic area | journal=Clin Pediatr (Phila) | year=1994 | pages=130-4 | volume=33 | issue=3 | pmid= 8194286}}</ref>
*Before 1976, elements of ''[[Borrelia burgdorferi|B. burgdorferi]]'' sensu lato complex [[infection]] were known as "tickborne meningopolyneuritis," "Garin-Bujadoux syndrome," "Bannworth syndrome," "Lymphocytic meningoradiculitis," "Afzelius syndrome," "Montauk Knee" or "sheep tick fever." Since 1976, the disease has been most often referred to as [[Lyme disease]], [[Lyme borreliosis]], or simply [[borreliosis]].<ref>{{cite journal |author=Mast WE, Burrows WM |title=Erythema chronicum migrans and "Lyme arthritis" |journal=JAMA |volume=236 |issue=21 |pages=2392 |year=1976 |pmid=989847}}</ref><ref>{{cite journal |author=Steere AC, Malawista SE, Snydman DR, ''et al'' |title=Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities |journal=Arthritis Rheum. |volume=20 |issue=1 |pages=7-17 |year=1977 |pmid=836338}}</ref>  
* In recent years a few prominent American Lyme researchers have received funding for the study of organisms that may have previously been used as [[bioweapons]] that could be used in bioterrorism attacks. The funding has been granted by various U.S. Government agencies including the [[National Institute of Health]] (NIH), and the [[National Institute of Allergy and Infectious Diseases]] (NIAID).  
*In 1976, Jay Sanford, a former [[physician]] at the [[Walter Reed Army Institute of Research]], published a chapter in the book ''The Biology of Parasitic Spirochetes.'' In it, Dr. Sanford stated:  "The ability of [[borrelia]], especially tick-borne strains, to persist in the brain and in the eye during remission after treatment with arsenic or with penicillin or even after apparent cure, is well known.” <ref name="Sanford">{{cite book | author = Sanford JP | chapter = Relapsing Fever—Treatment and Control | title = Biology of Parasitic [[Spirochetes]] | editor = Johnson RC (ed) | publisher = Academic Press | year = 1976 | isbn = 9780123870506}}</ref>  
* For some, these grants have become a source of controversy. They argue that these researchers have a conflict of interest in receiving these U.S. Government funds due to the politicization of Lyme disease and their roles in the history of the controversy, others point out that the grants are warranted as the infectious agents that the researchers are studying for bioterror defense are similar in genetic makeup and [[pathogenesis]] of ''Borrelia'', such as [[tularemia]], [[brucellosis]] and [[Q fever]]. Nonetheless, although confusion exists, federal grants such as these comprise the main mechanism whereby infectious disease research is funded in the U.S.
*In 1980, Allen C. Steere, a [[rheumatologist]] at Yale University, and his colleagues began to test [[antibiotics|antibiotic]] regimens in adult patients with [[Lyme disease]].<ref>{{cite journal |author=Steere AC, Hutchinson GJ, Rahn DW, ''et al'' |title=Treatment of the early manifestations of Lyme disease |journal=Ann. Intern. Med. |volume=99 |issue=1 |pages=22-6 |year=1983 |pmid=6407378}}</ref>  
* In October 2006, further controversy erupted with the release of updated diagnosis and treatment guidelines from the [[Infectious Diseases Society of America]] (IDSA).<ref name=Showdown>{{cite news | title = New Lyme Disease Guidelines Spark Showdown | publisher = U.S. Department of Health and Human Services | date = 2006-11-09 | url = http://www.4woman.gov/news/english/535816.htm | accessdate = 2007-08-21}}</ref> The new IDSA recommendations are more restrictive than prior IDSA treatment guidelines for Lyme,<ref name="IDSA">{{cite journal | author = Wormser G, Dattwyler R, Shapiro E, ''et al'' | title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 43 | issue = 9 | pages = 1089-134 | year = 2006 | pmid = 17029130 | url=http://www.journals.uchicago.edu/CID/journal/issues/v43n9/40897/40897.html}}</ref> and now require either an EM rash or positive laboratory tests for diagnosis; seronegative Lyme disease is no longer acknowledged (except incidentally in early Lyme disease). The authors of the guidelines maintain that chronic Lyme disease does not result from persistent infection, and therefore treatment beyond 2-4 weeks is not recommended, even in late stage cases. An opposing viewpoint has been expressed by the International Lyme and Associated Disease Society (ILADS), which proposes extended antibiotic treatment beyond four weeks for both early and late Lyme disease.<ref>{{cite web | title = Treatment guidelines | year = 2007 | publisher = International Lyme and Associated Disease Society | url = http://www.ilads.org/guidelines.html | accessdate = 2007-08-21}}</ref>
*In 1981, [[Jorge Benach|Jorge L. Benach]], a [[Pathologists|pathologist]] at the State University of New York at Stony Brook  identified  a novel [[spirochete]] which was cultured from the [[midgut]] of ''[[Ixodes]]'' ticks in Shelter Island, New York, and subsequently from patients with [[Lyme disease]]. Soon after, the [[infectious agent]] was isolated by [[Willy Burgdorfer]], a researcher at the [[National Institutes of Health]], who specialized in the study of  [[Microorganism|microorganisms]] such as ''[[Borrelia]]'' and ''[[Rickettsiae|Rickettsia]]''. The [[Spirochaete|spirochete]] was named ''[[Borrelia burgdorferi]]'' in his honor. [[Willy Burgdorfer]] and Alan Barbour were partners in the successful effort to culture the [[Spirochaete|spirochete]].<ref name="pmid8221514">{{cite journal| author=Burgdorfer W| title=How the discovery of Borrelia burgdorferi came about. | journal=Clin Dermatol | year= 1993 | volume= 11 | issue= 3 | pages= 335-8 | pmid=8221514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8221514  }} </ref>
*After identification of ''[[B. burgdorferi]]'' as the causative agent of [[Lyme disease]], [[antibiotics]] were selected for testing, guided by [[in vitro]] [[antibiotic]] sensitivities, including [[tetracycline antibiotics]], [[amoxicillin]], [[cefuroxime axetil]], [[intravenous]] and [[intramuscular]] [[penicillin]], and [[intravenous]] [[ceftriaxone]].<ref>{{cite journal |author=Luft BJ, Volkman DJ, Halperin JJ, Dattwyler RJ |title=New chemotherapeutic approaches in the treatment of Lyme borreliosis |journal=Ann. N. Y. Acad. Sci. |volume=539 |issue= |pages=352-61 |year=1988 |pmid=3056203}}</ref><ref>{{cite journal |author=Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ |title=Amoxycillin plus probenecid versus doxycycline for treatment of [[erythema migrans]] borreliosis |journal=Lancet |volume=336 |issue=8728 |pages=1404-6 |year=1990 |pmid=1978873}}</ref>  
*In 1987, ''[[B. burgdorferi]]'' [[Spirochaete|spirochetes]] were identified in [[tick]] [[saliva]], confirming the hypothesis that [[Transmission (medicine)|transmission]] occurred via [[tick]] [[salivary glands]].<ref>{{cite journal |author=Ribeiro JM, Mather TN, Piesman J, Spielman A |title=Dissemination and salivary delivery of Lyme disease spirochetes in vector ticks (Acari: Ixodidae) |journal=J. Med. Entomol. |volume=24 |issue=2 |pages=201-5 |year=1987 |pmid=3585913}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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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], Ilan Dock, B.S.

Overview

In 1883, Alfred Buchwald was the first to describe a condition associated with Lyme disease which is now known as acrodermatitis chronica atrophicans. Arvid Afzelius first observed ring-like lesions, now known as Erythema migrans, and associated the rash with tick bites. In the United States, Lyme disease was not recognized until 1975, when a cluster of cases was identified in three towns in Southeastern Connecticut (including towns Lyme and Old Lyme), which gave Lyme disease its popular name. In 1981, the infectious agent (a spirochete) was isolated by Willy Burgdorfer, a researcher at the National Institutes of Health, from the midgut of Ixodes ticks. The spirochete was named Borrelia burgdorferi in honor of Willy Burgdorfer.

Historical Perspective

Dr. Willy Burgdorfer, an American-Swiss scientist, discovered the bacterial pathogen responsible for causing Lyme disease Source - Rocky Mountain Laboratories, National Institutes of Health

References

  1. ↑ Weber, Klaus (1993). Aspects of Lyme Borreliosis. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 978-3-642-77614-4.
  2. ↑ Forschner, Karen (2003). Everything you need to know about Lyme disease and other tick-borne disorders. Hoboken, N.J: John Wiley. ISBN 978-0471473640.
  3. ↑ Balfour A (1911). "THE INFECTIVE GRANULE IN CERTAIN PROTOZOAL INFECTIONS, AS ILLUSTRATED BY THE SPIROCHAETOSIS OF SUDANESE FOWLS". Br Med J. 1 (2622): 752. PMC 2333723. PMID 20765548.
  4. ↑ Dworkin, Mark S.; Schwan, Tom G.; Anderson, Donald E.; Borchardt, Stephanie M. (2008). "Tick-Borne Relapsing Fever". Infectious Disease Clinics of North America. 22 (3): 449–468. doi:10.1016/j.idc.2008.03.006. ISSN 0891-5520.
  5. ↑ 5.0 5.1 Ryberg B (1984). "Bannwarth's syndrome (lymphocytic meningoradiculitis) in Sweden". Yale J Biol Med. 57 (4): 499–503. PMC 2590032. PMID 6516452.
  6. ↑ Lenhoff C (1948). "Spirochetes in aetiologically obscure diseases". Acta Dermato-Venreol. 28: 295–324.
  7. ↑ Bianchi GE (1950). "Penicillin therapy of lymphocytoma". Dermatologica. 100 (4–6): 270–3. PMID 15421023.
  8. ↑ Hollstrom E (1951). "Successful treatment of erythema migrans Afzelius". Acta Derm. Venereol. 31 (2): 235–43. PMID 14829185.
  9. ↑ Paschoud JM (1954). "Lymphocytoma after tick bite". Dermatologica (in German). 108 (4–6): 435–7. PMID 13190934.
  10. ↑ Scrimenti RJ (1970). "Erythema chronicum migrans". Archives of dermatology. 102 (1): 104–5. PMID 5497158.
  11. ↑ Steere AC (2006). "Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut". Wien. Klin. Wochenschr. 118 (21–22): 625–33. doi:10.1007/s00508-006-0687-x. PMID 17160599.
  12. ↑ Sternbach G, Dibble C (1996). "Willy Burgdorfer: Lyme disease". J Emerg Med. 14 (5): 631–4. PMID 8933327.
  13. ↑ Mast WE, Burrows WM (1976). "Erythema chronicum migrans and "Lyme arthritis"". JAMA. 236 (21): 2392. PMID 989847.
  14. ↑ Steere AC, Malawista SE, Snydman DR; et al. (1977). "Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities". Arthritis Rheum. 20 (1): 7–17. PMID 836338.
  15. ↑ Sanford JP (1976). "Relapsing Fever—Treatment and Control". In Johnson RC (ed). Biology of Parasitic Spirochetes. Academic Press. ISBN 9780123870506.
  16. ↑ Steere AC, Hutchinson GJ, Rahn DW; et al. (1983). "Treatment of the early manifestations of Lyme disease". Ann. Intern. Med. 99 (1): 22–6. PMID 6407378.
  17. ↑ Burgdorfer W (1993). "How the discovery of Borrelia burgdorferi came about". Clin Dermatol. 11 (3): 335–8. PMID 8221514.
  18. ↑ Luft BJ, Volkman DJ, Halperin JJ, Dattwyler RJ (1988). "New chemotherapeutic approaches in the treatment of Lyme borreliosis". Ann. N. Y. Acad. Sci. 539: 352–61. PMID 3056203.
  19. ↑ Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ (1990). "Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis". Lancet. 336 (8728): 1404–6. PMID 1978873.
  20. ↑ Ribeiro JM, Mather TN, Piesman J, Spielman A (1987). "Dissemination and salivary delivery of Lyme disease spirochetes in vector ticks (Acari: Ixodidae)". J. Med. Entomol. 24 (2): 201–5. PMID 3585913.


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