Lyme Disease
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Lyme disease results from infection with spirochetes belonging to the Borrelia
burgdorferi sensu lato complex. In Europe and Asia, most cases of Lyme
disease are caused by B. burgdorferi sensu stricto, B. afzelii, or B.
garinii; however, in the United States, all cases are caused by B.
burgdorferi sensu stricto. The spirochetes are transmitted to humans
through the bite of infected ticks of the Ixodes ricinus complex.
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Lyme disease occurs in temperate forested regions of Europe and Asia and
in the northeastern, north central, and Pacific coastal regions of North
America. It is not transmitted in the tropics.
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Travelers to endemic areas who have frequent or prolonged exposure to tick
habitats could be at increased risk for Lyme disease.
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Manifestations of Lyme disease include a characteristic expanding rash called
erythema chronicum migrans at the site of tick attachment, fever, arthritis,
and neurologic manifestations, including facial palsy.
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A safe and efficacious vaccine was, until recently, available for protection
from Lyme disease in endemic areas of the United States. However, the vaccine
was withdrawn from the market by the manufacturer in February 2002 because
of low sales and is no longer commercially available.
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Travelers to endemic areas should be advised to avoid tick habitats if possible.
If exposure to tick habitats cannot be avoided, the application of repellents
to skin and acaricides to clothing, as well as regular daily checks for any
attached ticks, can reduce the risk of infection. Because transmission of B.
burgdorferi is unlikely to occur in the first 36 hours of tick attachment,
prompt removal of any attached ticks will help prevent infection.
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Travelers who have erythema chronicum migrans or other manifestations of
Lyme disease should be advised to seek early medical attention. Lyme disease
can usually be cured by an appropriate course of antibiotic treatment.
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