1. What you should know….
Holly Ahern MS, BS MT(ASCP)
Associate Professor of Microbiology
SUNY Adirondack, Queensbury, NY

2. I say “LYME DISEASE,”
you say….

6. *Borrelia
burgdorferi
Other
Borrelia
Babesia
Bartonella
Ehrlichia
Anaplasma
Mycoplasma
Viruses

7. University of Rhode Island
Tick Encounter Resource Center
http://www.tickencounter.org/tick_testing

8. Lyme disease is an acute infectious
disease, transmitted by nymph stage
deer ticks, caused by one species of a
specific bacterium named Borrelia
burgdorferi
“Hard to catch and easy to cure”

10. Tick must be attached for a
minimum of 36 hours to
transmit Lyme disease…
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines
 Burgdorfer: transmission
time for Borrelia is
variable.
 Other TBDs transmitted
quickly; viruses in 15 min.
 Borrelia may be sexually
transmitted.
 Borrelia, Babesia,
Anaplasma are
transfusion transmitted.

11. Lyme disease is an acute
infectious disease.
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines
 Lyme disease may
be an acute disease.
 Lyme disease may
also be a chronic
disease.

12. A single “FRONTAL”
pathogen, Borrelia
burgdorferi, is responsible
for Lyme disease symptoms.
 Ticks carry and
transmit multiple
“STEALTH” microbes.
 People infected with
multiple pathogens
have more severe
disease.
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines

13. Diagnostic algorithm (ACP)
includes patient history of tick
bite, “bulls-eye” rash, AND
“laboratory evidence” of
infection (usually this means a
“two-tier” system of antibody
based blood tests for Borrelia
burgdorferi ONLY)
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines
 Current diagnostic criteria
EXCLUDE any form of the
disease that does not meet the
ACP/CDC/IDSA algorithm
 Therefore, you may not be
diagnosed with Lyme disease,
EVEN IF YOU HAVE IT, if:
 No “bulls-eye” at tick bite site
 “First tier” test doesn’t meet a
threshold level
 “Second-tier” test doesn’t have
enough “bands”
 You were infected with more
than one microbe by the tick

14. Most infections resolve after
short-term antibiotic
treatment; 5% of patients
may develop post-tx
sequelae that are
“autoimmune.”
 CDC survey - 61% require
more than recommended
antibiotic treatment.
 30 – 50% have chronic
symptoms persisting after
antibiotics.
 Stealth pathogens are highly
adapted survivors so
persistent infection may be
the cause.
 Reactivation of growth of
spirochetes shown in most
recent study.
Current IDSA/CDC
“Standard of Care”
Peer-reviewed evidence
NOT included in the
IDSA/CDC guidelines

16. EASY to catch and HARD to cure!
Ticks may transmit some pathogens RAPIDLY
Study of Lyme patients: Only 50% developed any type of rash,
of those, only 10% had a “bulls-eye”
Symptoms may occur at ANY TIME of the year
Symptoms are highly variable and may become CHRONIC
Blood tests for Lyme disease are reliably INACCURATE
2-4 weeks of antibiotics MAY NOT cure Lyme disease

17. Disease
New cases
(annual)
NIH funding (FY 2012)
Hepatitis C 1,300 $112 million
West Nile Virus 5,700 $29 million
HIV/AIDS * 56,000 $3 billion (11% total NIH budget)
Influenza * 73,000 $251 million
Lyme disease 312,000 $25 million
Source: http://report.nih.gov/PFSummaryTable.aspx
* Considered “epidemic” by the CDC

18. Financial Burden of Lyme disease,
BEFORE CDC Case Estimate Revision (2012)
New York State 2,590 $10,429 $27,011,110
United States 27,313 $10,429 $284,847,277
Financial Burden of Lyme disease,
AFTER CDC Case Estimate Revision (2012)
New York State 25,900 $10,429 $270 million
United States 312,000 $10,429 $3.25 billion
Financial Burden of Lyme disease,
based on probable number of cases (2012)
New York State 44,030 $10,429 $460 million
United States 445,714 $10,429 $4.65 billion