Lyme disease (LD) is the most common tick-borne illness in the USA, with an estimated 476,000 cases diagnosed and treated annually. Common signs, symptoms, and manifestations of LD are well described; however, there is limited qualitative understanding of the signs and symptoms patients experience during their illness and the associated impacts patients endure along the way. Thus, we aimed to explore the patient journey and experience with LD, including patient-reported signs and symptoms and impacts to health-related quality of life (HRQOL). No a priori hypotheses were evaluated. In-depth, one-on-one, semi-structured interviews were conducted with US adults aged ≥ 18years who had physician-diagnosed LD in 2023 to explore their experience with LD diagnosis, management, and treatment. The EQ-5D (a standardised HRQOL measure) was administered, and a patient journey map was developed. Interview transcripts were analysed via inductive and deductive coding, using an experiential, realist approach. Twenty-five participants with LD were interviewed (female, 13/25, 52%; male, 12/25, 48%), including those classified as having localised (10/25, 40%), disseminated (10/25, 40%), and indeterminate (5/25, 20%) LD. Participants reported various impacts at diagnosis, such as fear and anxiety, difficulty exercising, needing time off work, and spending increased time indoors. Most participants (19/25, 76%) stated that their symptoms resolved after antibiotic therapy; however, nearly a quarter (6/25, 24%) reported persistent symptoms. Most (15/25, 60%) reported continued emotional impacts after treatment, including fear of future LD infection, fear of the outdoors, and LD-related anxiety. As reported, all EQ-5D domains were worst at diagnosis, but most participants returned to their pre-LD score by the time of the interview. The patient journey with LD is highly varied and individualised, and this study highlights the range of signs, symptoms, physical and emotional impacts that many individuals with LD experience throughout their journey.

Lyme disease is a growing public health concern in the United States. Despite higher rates of infection among children and disseminated disease among racial minorities, few studies have investigated the role of health care inequities on tick-borne disease knowledge among parents. We conducted a single-center, cross-sectional, anonymous survey of tick-borne disease recognition and prevention strategies among English- and Spanish-speaking parents/caregivers in a region of high Lyme disease incidence (Long Island, New York). Survey questions consisted of demographics, knowledge assessment, and tick bite prevention practices. Survey responses were analyzed with descriptive statistics and a multivariable logistic regression model to identify associations between participant characteristics and a calculated knowledge score. In total, 120 participants completed the survey, including 95 (79.2%) English speakers and 25 (20.8%) Spanish speakers. Of these, 72 participants (60%) answered all 4 knowledge questions correctly, and 94 (78.3%) answered 75% of the knowledge questions correctly. English language preference was associated with higher knowledge scores on univariate but not multivariable analysis. Multivariable analysis identified Hispanic or Latino race/ethnicity, lower household income, and fewer years of residence on Long Island as predictors of lower Lyme disease knowledge scores. Our findings highlight the role of adverse social determinants of health on Lyme disease risk, underscoring the need for focused educational interventions on high-risk populations.

Endemic and emerging tick-borne diseases in humans and animals in the US are becoming more frequent and are likely driven by several socioecological factors. Although numerous hard and soft ticks are of medical and veterinary significance, this review focuses on species that are most relevant for the One Health practitioner. This article presents key aspects on significant tick species and tick-borne diseases in the US. Tick biology and ecology of several ticks are discussed, including black-legged ticks (Ixodes scapularis), western black-legged ticks (Ixodes pacificus), American dog ticks (Dermacentor variabilis), Rocky Mountain wood ticks (Dermacentor andersoni), lone star ticks (Amblyomma americanum), Gulf Coast ticks (Amblyomma maculatum), brown dog ticks (Rhipicephalus sanguineus), and the recent invader, Longhorned ticks (Haemaphysalis longicornis). In addition, the epidemiology of several diseases is also discussed, such as Lyme disease, spotted fever rickettsioses, babesiosis, and anaplasmosis/ehrlichiosis. Finally, management recommendations for diagnosis, treatment, and prevention are provided. By integrating knowledge of key tick species, associated pathogens, and evidence-based management recommendations, this review adopts a One Health perspective to inform coordinated veterinary and human health responses to tick-borne diseases in the US. The companion Currents in One Health article by Eleftheriou et al, AJVR, June 2026, addresses research gaps and developments in tick and tick-borne disease research across biological scales.

Survey of tick species and tick-borne pathogens in pet dogs and cats in mainland China.

Lower prevalence of Lyme disease pathogens in mixed deciduous – coniferous forests

Borrelia burgdorferi (Bb), the etiological agent of Lyme disease, lacks the genes for de novo riboflavin biosynthesis and depends on host-derived riboflavin to generate flavin cofactors FMN and FAD. Riboflavin salvage by Bb has demonstrated importance to infection and metabolic homeostasis, though the critical roles of flavin cofactors to central metabolism are not well defined. Here, we demonstrate that riboflavin availability directly controls glycolytic flux through regulation of intracellular redox balance. Disruption of riboflavin uptake by deletion of gene bb0318 encoding the putative ATPase component of the riboflavin transporter resulted in impaired glycolysis as indicated by reduced intracellular pyruvate and a perturbed NADH/NAD+ ratio driven by faulty NAD+ regeneration. We identified coenzyme A disulfide reductase (CoADR) as a key flavin-dependent mediator of glycolytic flux. A Δcdr mutant mimicked the glycolytic dysregulation of the Δbb0318 mutant, but was not rescued by exogenous riboflavin, placing BbCoADR downstream of riboflavin salvage. Biochemical analyses of recombinant BbCoADR demonstrated FAD-dependent NADH oxidase activity. Targeted mutagenesis of predicted FAD-binding residues impaired cofactor binding and NADH oxidase activity, further confirming the dependence of BbCoADR on FAD. Together, this work reveals a direct link between riboflavin acquisition and core metabolic processes driven by BbCoADR-mediated flavin-dependent redox metabolism.

The Lyme disease spirochete Borrelia burgdorferi has a distinctive pattern of growth. Newly born cells elongate by primarily inserting peptidoglycan at mid-cell, while in longer cells, additional insertion sites form at the one-quarter and three-quarter positions along the cell length. It is not known how peptidoglycan insertion is concentrated at these locations in B. burgdorferi. In other bacteria, multi-protein complexes are known to synthesize new peptidoglycan, and are often organized by cytoskeletal proteins. We show here that B. burgdorferi's zonal concentration of peptidoglycan insertion requires BB0538 (BbbF) and BB0245 (BbbG), two members of the bactofilin class of cytoskeletal proteins. Bactofilin depletion redistributed peptidoglycan insertion along the cell length. Prolonged bactofilin depletion arrested growth in culture and induced extensive cell blebbing, indicating that B. burgdorferi bactofilins are essential for viability. Fluorescent protein fusions of BbbF and BbbG localized to new zones of growth before peptidoglycan insertion occurred at these sites, with BbbG localization dependent on BbbF. Our results show that BbbF and BbbG direct the spatial patterning of new peptidoglycan insertion in B. burgdorferi.IMPORTANCEThe spirochetal bacterium Borrelia burgdorferi causes Lyme disease, the most prevalent vector-borne infection in North America and Europe. Cellular replication, which requires growth and division of the peptidoglycan cell wall, facilitates B. burgdorferi transmission to, and dissemination within, new hosts. Cellular replication is therefore essential for pathogenesis. Bactofilins regulate peptidoglycan-related processes in several bacteria but are typically non-essential for cellular replication. Bactofilin-encoding genes can be readily deleted in multiple bacterial species. In contrast, we show that the B. burgdorferi bactofilins BbbF and BbbG are essential for cellular viability and direct zonal peptidoglycan insertion. Our findings broaden the spectrum of known bactofilin functions and advance our understanding of how peptidoglycan insertion is regulated in this unusual, medically important spirochetal bacterium.

Tick-borne diseases in Illinois (USA): A retrospective case analysis.

Introduction: Tick-borne-disease (TBD) risk is high along the Appalachian Trail (AT), yet little is known about how long-distance hikers practice recommended prevention behaviors. Because their prolonged outdoor exposure limits the feasibility of standard guidelines, understanding their behaviors and the beliefs shaping them is essential. This study examines TBD prevalence and prevention behaviors using the health belief model (HBM). Methods: A self-administered Qualtrics survey, pilot-tested for clarity, assessed demographics, AT hiking experience, diagnosis of TBD, prevention behaviors, and HBM constructs. Participants were ≥18 years old with AT experience. Recruitment occurred through in-person sampling, online forums, and snowball sampling. Prevention behaviors and HBM variables were analyzed using descriptive statistics and multiple regression models. Results: A total of 202 responses were analyzed. Over one-fifth of participants reported a previous TBD, most commonly Lyme disease. Prevention behaviors varied, with carrying tick removal devices, conducting daily tick checks, and using permethrin being the most frequently practiced. Regression models indicated that perceived barriers consistently predicted all prevention behaviors, while perceived benefits, susceptibility, and cues to action were significant in select models. Conclusions: Long-distance hikers demonstrated high TBD prevalence and inconsistent prevention practices. Tick checks, removal tools, and permethrin use were common prevention behaviors. Perceived barriers and perceived benefits were the strongest behavioral predictors, underscoring the need for interventions that reduce barriers and strengthen perceptions of effectiveness. Findings highlight opportunities to improve prevention strategies for hikers in high-risk environments.

Borrelia burgdorferi sensu lato, a spirochete bacterium responsible for Lyme borreliosis-the most common tick-borne infection in North America and Europe-can trigger the production of antiphospholipid antibodies. These antibodies target host lipids such as cardiolipin (CL), phosphatidic acid (PA), phosphatidylcholine (PC), and phosphatidylserine (PS), which the spirochete incorporates into its membrane from the surrounding environment. Although antiphospholipid antibodies are typically associated with antiphospholipid syndrome (APS), they may also arise during infections, including Lyme borreliosis. This study aimed to develop and optimize several enzyme-linked immunosorbent assays (ELISAs) for measuring various antiphospholipid antibodies in patients with Lyme borreliosis. Thirty patients diagnosed with Lyme borreliosis were enrolled: ten with solitary erythema migrans (EM), ten with multiple EM (MEM), and ten with late manifestations known as acrodermatitis chronica atrophicans (ACA). Forty healthy blood donors served as controls. Four distinct antiphospholipid antibody ELISAs were developed, each using a different phospholipid coating: CL, PA, PC, and PS. Serum of APS patient was used as a positive control and for standard curve generation. All four ELISAs were successfully established and demonstrated good measurement precision. Significant differences in antiphospholipid antibody levels and positivity rates were observed between Lyme borreliosis patients and healthy blood donors. Notably, levels of antibodies directed against PA (aPA), PC (aPC), and PS (aPS), both IgG and IgM, were significantly higher in patients with late Lyme borreliosis, manifested as ACA, compared to healthy blood donors. In contrast, anti-CL (aCL) levels did not differ significantly between groups. Patients with ACA also showed the highest frequency of multiple antiphospholipid antibody positivity, with 7 out of 10 patients testing positive for three or more antiphospholipid antibodies. Accurate and precise in-house ELISAs for the detection of aCL, aPA, aPC, and aPS using APS sera as standard material were developed and validated for the analysis of samples of patients with Lyme borreliosis. Our data suggest that antiphospholipid antibody levels-specifically aPA, aPC, and aPS-differ across clinical manifestations of Lyme borreliosis, with the greatest increases observed in patients with ACA.

Lyme borreliosis is a multisystemic tick-borne infection caused by Borrelia burgdorferi sensu lato complex. Renal involvement is well documented in dogs with Lyme nephritis, whereas human renal manifestations have been reported only rarely, mainly as isolated case reports of glomerular disease. Because a proportion of chronic kidney disease (CKD) cases remain unexplained, we aimed to determine the possible contribution of previous exposure to idiopathic CKD. The study included 45 patients and 45 age and sex matched controls. Serum samples were tested for anti-Borrelia IgG using enzyme-linked immunosorbent assay (ELISA). Positive or borderline ELISA results were further evaluated by Western blot (WB) analysis. Overall, anti-Borrelia IgG seropositivity was 5.55% with WB. In the CKD group, ELISA positivity was 11.1% and WB-confirmed positivity was 8.9%. In the control group, ELISA positivity was 4.4% and WB-confirmed positivity was 2.2%. (p > 0.05). All confirmed patients were living in rural areas, engaged in farming and/or animal husbandry, and reported repeated tick exposure. IgG seropositivity was numerically higher among patients with CKD of unknown etiology than among healthy controls; however, this difference was not statistically significant. Larger, risk-factor-adjusted studies are needed to clarify whether Borrelia exposure may be associated with unexplained CKD.

Evaluation of EcoCRM, virus-like particles, and mRNA as vaccine platforms against Borrelia burgdorferi.

Structural architecture of a hybrid β-barrel assembly machinery BAM-TAM complex in Borrelia burgdorferi.

Human granulocytic anaplasmosis (HGA) is caused by Anaplasma phagocytophilum. In the Netherlands, the bacterium is present in a few percent of Ixodes ricinus ticks, but only a specific subvariant is associated with human disease. Although the infection is often asymptomatic, the clinical course can be severe and unpredictable. Here, we describe three recent Dutch cases: two autochthonous cases with a severe course and one case acquired in the United States. All patients recovered rapidly after initiation of doxycycline following the final diagnosis. Awareness of tick-borne diseases other than Lyme disease is important for healthcare professionals in primary, secondary, and tertiary care, as well as for supporting (laboratory) specialties such as clinical chemistry and medical microbiology.

In England, Lyme disease (LD) surveillance is based on laboratory-confirmed cases. However, clinical and epidemiological characteristics of these cases are limited; therefore, we conducted an enhanced surveillance study of acute LD in England. Enhanced data were collected through an online questionnaire sent to all laboratory-confirmed acute cases of LD resident in England, with specimen dates between 1 April 2023 and 31 March 2024. The analysis included data from 511/1086 cases. Respondents were representative of age, sex, and region of national LD trends. A total of 57.3% of the respondents reported that they did not realize that they had been bitten by a tick. Among those who remembered a tick bite, 66.1% reported bites close to their home and only 10.6% happened abroad, and 28.5% reported that the tick bite could have occurred in a garden. Most respondents were residents of areas of higher socioeconomic status. Erythema migrans was noted by 70.5% of the respondents. It is important to raise awareness among both patients and clinicians that ticks can be found in urban and suburban parks and gardens, as well as ensuring that wildlife initiatives to increase biodiversity include information on tick prevention and tick checks.

EU-wide external quality assessment study on the sensitivity and specificity of different DNA amplification protocols for the detection of Borrelia burgdorferi sensu lato.

The prevalence of tick-borne disease continues to rise in the United States. Lyme disease is the most prevalent, classically presenting as monoarthralgia or polyarthralgia and effusions. Although most cases of Lyme arthritis are well managed with antibiotics, in some cases, refractory symptoms and arthritis persist. In addition, the tick-borne disease, alpha-gal syndrome (AGS), can have long-term sequelae, including immunoglobulin E-mediated hypersensitivity to mammalian products. Classically, AGS presents as a new onset of food allergy or intolerance to bovine products. As interest in biologics and xenografts for medical devices grows, AGS raises concerns about implant complications and perioperative anesthesia risks. It is imperative that the orthopaedic surgeon be aware of Lyme disease and AGS, and this review provides a concise overview of the pathogenesis, epidemiology, clinical presentation, diagnostic evaluation, and management of joint effusions as they pertain to tick-borne disease. We highlight the management pathway for AGS and tools for streamlining the preoperative pathway.

Infection with multiple strains of the Lyme disease bacterium in female mice can affect the strain-specific maternal antibody response in their offspring.

Clinical challenges and delayed diagnosis of Lyme borreliosis in non-endemic regions: A case series.

A diagnostic gap in rising Lyme borreliosis endemicity: Lyme testing patterns among facial palsy patients in Ohio, 2022-2024.