Lyme disease and co-infections — the “tick-borne illness”

Borrelia burgdorferi—the pathogen that causes Lyme disease

Lyme borreliosis, also known as Lyme disease, is the most common zoonotic infection worldwide and also the most common tick-borne bacterial disease. The causative agent of the disease is the bacterium Borrelia burgdorferi: a highly motile, corkscrew-shaped bacterium classified in the genus Borrelia, a spirochete that is approximately 15 micrometers long and 0.2 micrometers wide. It is also referred to as a “Teflon parasite” because its surface is coated with a special substance that contains few surface antigens, making it difficult for the body’s antibodies to bind to it. Without treatment, it can remain hidden in the body for years or even decades. This is due not only to its extraordinary adaptability and excellent defensive capabilities but also to its vegetative forms, known as gemmae.

How do ticks transmit disease?

Lyme borreliosis is caused by bacteria transmitted from ticks that enter an open skin wound created by a tick bite. The pathogens can remain dormant in the tick’s midgut for months or even years. A tick bite is painless, so the tick can feed for days, and the infected blood can flow back into the wound, directly into the capillaries.

Lyme borreliosis can affect any organ months, years, or even decades after infection. The pathogen can travel anywhere in the body through the bloodstream and, under suitable conditions — when the immune resistance decreases — can trigger chronic inflammation. Spontaneous recovery has not been proven, but the disease can be effectively treated with medication.

According to current knowledge, the disease does not spread from person to person; it is transmitted from infected animals to humans through ticks. An exception is mother-to-child transmission, which can occur through the placenta and may result in infection of the fetus.

The early skin inflammation, which in itself can be considered diagnostic — the Lyme rash — is usually ring-shaped, resembling a target or a bull’s-eye: inflamed, apparently healthy, and healing skin areas may alternate. However, it can also appear differently, sometimes with a more purplish tone and not always in a circular pattern. In some cases, due to its large size, parts of it may overlap — for example, under the hair — making its shape difficult to determine. The Lyme rash expands day by day.

The Lyme Spot

Despite the infection, the Lyme rash may not appear at all. The skin inflammation develops — or is noticed by the patient — in approximately one-third of all cases.

Lyme disease often causes chronic skin inflammation (atrophic skin degeneration or scarring), but it can also affect the nervous system (neuritis, primarily of the cranial nerves, meningitis, or encephalitis), the joints and muscles (especially large joints, but also small ones), and the heart (pericarditis, arrhythmia). In fact, it can affect any organ, as it is a systemic disease. Therefore, the disappearance of the Lyme rash does not mean that Lyme borreliosis has been cured!

Borrelia burgdorferi, the bacterium that causes Lyme disease, is sensitive to many medications and can be treated with several types of antibiotics available in Hungary. The specialist determines the specific strains (subtypes) of the bacterium and takes their differing antibiotic sensitivities into account when developing the treatment plan. Complete recovery depends on early detection of the disease, the use of effective, adequately dosed, and sufficiently long-lasting combined antibiotic therapy, as well as timely repetition of treatment if needed. According to current knowledge, there is no natural or herbal remedy that can effectively cure Lyme disease on its own.

Co-infections

Lyme borreliosis is the most common zoonosis—that is, a disease transmitted from animals to humans—everywhere in the world, including throughout Hungary. According to our estimates, several hundred thousand, or even as many as one million, people in Hungary may be suffering from Lyme borreliosis. And according to recent statistics, one in five people has already been exposed to the pathogen.

Why is it spreading faster and faster?

In Europe, there are at least 650,000–850,000 new infections each year (some estimates put the number at over 2.5 million), and in Hungary, there are as many as 20,000 each year. Lyme disease is at least five times more common than AIDS and one and a half times more common than breast cancer. It is being diagnosed more and more frequently, due in part to increased awareness of the disease, but also because ticks are spreading to larger areas as a result of climate change. Milder weather and the absence of frost mean that more ticks survive the winter. According to some studies, infected ticks also have a selective advantage in surviving milder winters.

A single tick bite can lead to the development of several infections. Not only Lyme disease but also other bacterial infections transmitted by ticks can spread through the bite. Co-infections associated with Lyme borreliosis and tick bites — such as Bartonella, Babesia, Anaplasma, Ehrlichia, Mycoplasma, and Chlamydia — can cause symptoms similar to those of Lyme disease. It is therefore crucial to determine through testing whether Lyme disease or one of its co-infections is present, so that the patient can receive the appropriate treatment.