Lyme disease epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Epidemiology and Demographics

Lyme disease is the most common tick-borne disease in North America and Europe, and one of the fastest-growing infectious diseases in the United States. Of cases reported to the United States Center for Disease Control (CDC), the ratio of Lyme disease infection is 7.9 cases for every 100,000 persons. In the ten states where Lyme disease is most common, the average was 31.6 cases for every 100,000 persons for the year 2005.[1]

Although Lyme disease has now been reported in 49 of 50 states in the U.S, about 99% of all reported cases are confined to just five geographic areas (New England, Mid-Atlantic, East-North Central, South Atlantic, and West North-Central). Charts and tables for Lyme disease statistics in the U.S. can be found at the CDC website.

The number of reported cases of the disease have been increasing, as are endemic regions in North America. For example, it had previously been thought that B. burgdorferi sensu lato couldn't be maintained in an enzootic cycle in California because it was assumed the large lizard population would dilute the prevalence of B. burgdorferi in local tick populations, but this has since been proven false as lizards are now known carriers of ticks in North America, Europe and North Africa. Indeed, the DNA of Borrelia has been detected in lizards, indicating that they can be infected.[2]

While B. burgdorferi is most associated with deer tick and the white tailed mouse, Borrelia afzelii is most frequently detected in rodent-feeding vector ticks, Borrelia garinii and Borrelia valaisiana appear to be associated with birds. Both rodents and birds are competent reservoir hosts for B. burgdorferi sensu stricto. The resistance of a genospecies of Lyme disease spirochetes to the bacteriolytic activities of the alternative complement pathway of various host species may determine its reservoir host association.

In Europe, cases of B. burgdorferi sensu lato infected ticks are found predominantly in Norway, Netherlands, Germany, France, Italy, Slovenia and Poland, but have been isolated in almost every country on the continent. Lyme disease statistics for Europe can be found at Eurosurveillance website.

B. burgdorferi sensu lato infested ticks are being found more frequently in Japan, as well as in Northwest China and far eastern Russia.[3][4] Borrelia has been isolated in Mongolia as well.[5]

In South America tick-borne disease recognition and occurrence is rising. Ticks carrying B. burgdorferi sensu lato, as well as canine and human tick-borne disease, have been reported widely in Brazil, but the subspecies of Borrelia has not yet been defined.[6] The first reported case of Lyme disease in Brazil was made in 1993 in Sao Paulo.[7] B. burgdorferi sensu stricto antigens in patients have been identified in Colombia and in Bolivia.

In Northern Africa B. burgdorferi sensu lato has been identified in Morocco, Algeria, Egypt and Tunisia.[8][9][10]

In Western and sub-Saharan Africa, tick-borne relapsing fever was first identified by the British physicians Joseph Dutton and John Todd in 1905. Borrelia in the manifestation of Lyme disease in this region is presently unknown but evidence indicates that Lyme disease may occur in humans in sub-Saharan Africa. The abundance of hosts and tick vectors would favor the establishment of Lyme infection in Africa.[11] In East Africa, two cases of Lyme disease have been reported in Kenya.[12]

In Australia there is no definitive evidence for the existence of B. burgdorferi or for any other tick-borne spirochete that may be responsible for a local syndrome being reported as Lyme disease.[13] Cases of neuroborreliosis have been documented in Australia but are often ascribed to travel to other continents. The existence of Lyme disease in Australia is controversial.

To date, data shows that Northern hemisphere temperate regions are most endemic for Lyme disease.[14][15]

Sudden Deaths Associated with Lyme Carditis

During November 2012 to July 2013, one woman and two men from high-incidence Lyme disease regions experienced sudden cardiac death and, on postmortem examination, were found to have evidence of Lyme carditis. Whether the preexisting heart conditions found in two patients increased their risk for death is unclear.

Donated corneas from two decedents had been transplanted to three recipients before the diagnosis of Lyme disease was established, but no evidence of disease transmission was found. Although no cases of Lyme disease transmission through organ or tissue transplantation have been reported, the identification of spirochetes in tissue suggests the risk for transmission could exist. Ophthalmologic manifestations of Lyme disease are rare but can involve any of the ocular structures and occur during any stage of Lyme disease.[16]

References

  1. CDC (2006-10-02). "Reported Cases of Lyme Disease by Year, United States, 1991-2005". Retrieved 2007-08-20.
  2. Swanson KI, Norris DE (2007). "Detection of Borrelia burgdorferi DNA in lizards from Southern Maryland". Vector Borne Zoonotic Dis. 7 (1): 42–9. doi:10.1089/vbz.2006.0548. PMID 17417956.
  3. Li M, Masuzawa T, Takada N; et al. (1998). "Lyme disease Borrelia species in northeastern China resemble those isolated from far eastern Russia and Japan". Appl. Environ. Microbiol. 64 (7): 2705–9. PMID 9647853.
  4. Masuzawa T (2004). "Terrestrial distribution of the Lyme borreliosis agent Borrelia burgdorferi sensu lato in East Asia". Jpn. J. Infect. Dis. 57 (6): 229–35. PMID 15623946.
  5. Walder G, Lkhamsuren E, Shagdar A; et al. (2006). "Serological evidence for tick-borne encephalitis, borreliosis, and human granulocytic anaplasmosis in Mongolia". Int. J. Med. Microbiol. 296 Suppl 40: 69–75. doi:10.1016/j.ijmm.2006.01.031. PMID 16524782.
  6. Mantovani E, Costa IP, Gauditano G, Bonoldi VL, Higuchi ML, Yoshinari NH (2007). "Description of Lyme disease-like syndrome in Brazil. Is it a new tick borne disease or Lyme disease variation?". Braz. J. Med. Biol. Res. 40 (4): 443–56. PMID 17401487.
  7. Yoshinari NH, Oyafuso LK, Monteiro FG; et al. (1993). "Lyme disease. Report of a case observed in Brazil". Revista do Hospital das Clínicas (in Portuguese). 48 (4): 170–4. PMID 8284588.
  8. Bouattour A, Ghorbel A, Chabchoub A, Postic D (2004). "Lyme borreliosis situation in North Africa". Archives de l'Institut Pasteur de Tunis (in French). 81 (1–4): 13–20. PMID 16929760.
  9. Dsouli N, Younsi-Kabachii H, Postic D; et al. (2006). "Reservoir role of lizard Psammodromus algirus in transmission cycle of Borrelia burgdorferi sensu lato (Spirochaetaceae) in Tunisia". J. Med. Entomol. 43 (4): 737–42. PMID 16892633.
  10. Helmy N (2000). "Seasonal abundance of Ornithodoros (O.) savignyi and prevalence of infection with Borrelia spirochetes in Egypt". Journal of the Egyptian Society of Parasitology. 30 (2): 607–19. PMID 10946521.
  11. Fivaz BH, Petney TN (1989). "Lyme disease--a new disease in southern Africa?". Journal of the South African Veterinary Association. 60 (3): 155–8. PMID 2699499.
  12. Jowi JO, Gathua SN (2005). "Lyme disease: report of two cases". East African medical journal. 82 (5): 267–9. PMID 16119758.
  13. Piesman J, Stone BF (1991). "Vector competence of the Australian paralysis tick, Ixodes holocyclus, for the Lyme disease spirochete Borrelia burgdorferi". Int. J. Parasitol. 21 (1): 109–11. PMID 2040556.
  14. Grubhoffer L, Golovchenko M, Vancová M, Zacharovová-Slavícková K, Rudenko N, Oliver JH (2005). "Lyme borreliosis: insights into tick-/host-borrelia relations". Folia Parasitol. 52 (4): 279–94. PMID 16405291.
  15. Higgins R (2004). "Emerging or re-emerging bacterial zoonotic diseases: bartonellosis, leptospirosis, Lyme borreliosis, plague". Rev. - Off. Int. Epizoot. 23 (2): 569–81. PMID 15702720.
  16. "Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013". Retrieved 13 December 2013.


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