Borreliosis (Lyme/Lyme-like disease) is one the fastest growing infectious diseases in the world – faster than AIDS in some countries.

It is transmitted by a tick bite? In humans it is caused by at least three different strains of the Borrelia bacteria. In the USA, the predominant strain is Borrelia burgdorferi, while in Europe it is B. garinii and B. afzelii. Other strains include B. valarisiana, B. lusitanae, in Asia B. japonica and B. miyamotoi.

Although Lyme disease has been named after the town Lyme in Connecticut, where this disease was first identified in 1975, borreliosis (Lyme/Lyme-like disease) as an infectious disease was identified in Europe back in the early 1920's. The diversity of borreliosis symptoms – skin problems, arthritis, neurological, cardiac, ophthalmological – were already characterised.

Because of the complexity of symptoms Borreliosis has acquired many other names in Europe. Bannwarth’s syndrome for neurological symptoms, chronic lymphocytic meningitis, poly meningoradiculitis, erythema migrans rash etc (see above- this is only present in 20% of people who go on to develop Lyme Disease)

So Lyme is an old disease, not a new disease.

Borrelia – the bacteria that causes Lyme disease – is a very clever pathogen. It has characteristics similar to protozoa. It is the only bacteria with 21 plasmids, 12 straight, and 9 are circular. These plasmids code for active genes, pseudogenes and phages (bacterial virus) which can be used for survive and flourish in the host.

Most hospitals have enough problems trying to keep golden staph infection under control. And Staphylococcus aureus – the bacterium that causes the infection – has only one plasmid. So imagine the plasmid power you are fighting against with Borrelia bacteria.

Borrelia also has the unique ability to release blebs. These are DNA material enclosed in a membrane that is pinched off from the bacterial membrane. The real role of blebs is not clear but it has been postulated that blebs may cause the inflammatory response in the body and tissue damage. Alternatively, blebs are also seen to confuse the immune system so there is no immune response to Borrelia antigens.

Borrelia reproduces very slowly. The common penicillin-based antibiotics kill bacteria with a cell wall, when the bacteria are dividing. However, Borrelia can slow its reproduction time to once a month in vivo or to 48 hourly in vitro. This is unlike strep throat bacteria which reproduce every 20 minutes. Strep bacteria need to be treated for 480 life cycles.

To treat Borrelia bacteria for 480 life cycles you need to take antibiotics for 2.5 years minimum in order to get the infection under control.

The treatment of neuroborreliosis is even more complicated as many antibiotics penetration into the central nervous system (CNS) is limited, so the treatment time for neuroborreliosis would be more than 3 years. This is not unlike mycobacterium tuberculosis infection in the CNS. The treatment regimen for TB in the CNS involves more than 3 years of antibiotics.

Another trick Borrelia have up their sleeve in order to overcome the hostile environment, they encounter in their host, is to change from the spirochete shape to cell wall deficient L form (intracellular form) or to the cyst form.

The existence of the intracellular form of Borrelia explains why blood tests for antibodies for Borrelia in chronic infections are negative even when the bacteria are present.

This ability to change forms means, to kill Borrelia properly three types of antibiotics that target the three different cell forms are needed.

There are similarities between Borreliosis (Lyme/Lyme-like disease) and syphilis. in that they are both caused by spirochete bacterium, are both contagious diseases and can potentially be spread sexually, in utero and via blood transfusions.

Borreliosis is a public health issue.

Furthermore, as the bacteria divide very slowly the development of clinical symptoms are not evident until months or many years later. Because of this latency the symptoms are not attributed to Borrelia infection or to the tick bite.