Abstract
BackgroundUnderstanding and quantification of the risk of Lyme borreliosis after a tick bite can aid development of prevention strategies against Lyme borreliosis.MethodsWe used 3,525 single tick bite reports from three large prospective studies on the transmission risk of tick-borne pathogens to humans, with 50 reports of Lyme borreliosis during the follow-up period, among 1,973 reports with known outcome. A structural equation model was applied to estimate the risk of Lyme borreliosis after a tick bite, and quantify the influence of: developmental stage of the tick, detection of Borrelia burgdorferi s.l. DNA in the tick by PCR, tick engorgement, patient-estimated duration of tick attachment, and patient age.ResultsThe overall risk of developing Lyme borreliosis after a tick bite was 2.6% (95%CI 1.4–5.1).The risk increased with:- Tick engorgement: 1.4% (95%CI 0.7%-2.3%) for low engorgement to 5.5% (95%CI 2.8%-9.2%) for substantially engorged ticks;- Rising patient-estimated tick attachment duration: 2.0% (95%CI 1.3%-2.8%) after <12 hours, to 5.2% (95%CI 3.0%-8.9%) after ≥4 days;- Detection of Borrelia burgdorferi s.l. DNA in ticks: 6.7% (95%CI 3.6%-13.5%), versus 1.4% (95%CI 0.7%-2.9%) when ticks tested negative.The highest observed risk of Lyme borreliosis was 14.4% (95%CI 6.8%-24.6%) after one tick bite of a substantially engorged tick that tested positive for Borrelia burgdorferi s.l. DNA, which corresponds to one new case of Lyme borreliosis per 7 (95%CI 4–15) of such tick bites.ConclusionsAn individual's risk of Lyme borreliosis after a tick bite can be predicted with tick engorgement, patient-estimated duration of tick attachment, and detection of Borrelia burgdorferi s.l. DNA in the tick.
Highlights
Lyme borreliosis is a tick-borne disease caused by bacteria of the Borrelia burgdorferi sensu lato group
The highest observed risk of Lyme borreliosis was 14.4% (95%CI 6.8%-24.6%) after one tick bite of a substantially engorged tick that tested positive for Borrelia burgdorferi s.l
In the current article we model the risk of Lyme borreliosis after a tick bite, and we investigate the effect of possible predictors such as the developmental stage of the tick, tick engorgement, detection of Borrelia DNA in the tick, patient-estimated duration of tick attachment, and patient age
Summary
Lyme borreliosis is a tick-borne disease caused by bacteria of the Borrelia burgdorferi sensu lato group (hereafter referred to as Borrelia). To aid development of prevention strategies against Lyme borreliosis, understanding and quantification of the risk of developing Lyme borreliosis after a tick bite are required. Among field collected host-seeking ticks, less than 1% of larvae are infected, about 10% to 30% of the nymph, and 15% to 40% of adults[4,5,6]. Another factor is the transmission of Borrelia from ticks to humans, which increases with the duration of the tick’s blood meal, and can be quantified as patient-estimated duration of the tick bite or as degree of engorgement of the tick. Understanding and quantification of the risk of Lyme borreliosis after a tick bite can aid development of prevention strategies against Lyme borreliosis
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