Lyme disease and borreliosis: a stealthy infection

The modern pace of life is increasingly bringing people back to nature — walks in parks, countryside getaways, travel, and active tourism. At the same time, medical attention is growing toward infections that were considered relatively rare just a few decades ago. One of these is Lyme disease - a condition that today ranks among the most widespread naturally occurring bacterial infections in the world.

Interest in Lyme disease continues to grow rapidly not only among doctors and scientists but also among the general public. Today, physicians refer to it as the “great imitator”, because the symptoms of borreliosis can resemble dozens of other conditions: from influenza and chronic fatigue to arthritis, neurological disorders, and heart problems.

In recent years, specialists have increasingly highlighted the expansion of the infection’s geographical range, the growing number of cases, and the need for earlier diagnosis.

According to CDC data, approximately 476,000 cases of Lyme disease are diagnosed and treated annually in the United States alone. However, the number of officially reported cases is significantly lower — around 89,000 in 2023, which is related to the specific features of disease diagnosis and reporting. [1]

In Europe, Lyme disease is considered the most common tick-borne disease. Over the past decades, more than 360,000 cases have been reported in European countries, and the spread of ticks continues to increase. [2]

In the Republic of Moldova, Lyme disease also remains one of the most common infections transmitted through tick bites. According to data from the National Public Health Agency (ANSP), 249 cases of the disease were reported in the country in 2024, including 88 cases among children and adolescents under the age of 17. [3]

What is Lyme disease?

Lyme disease is an infectious disease caused by bacteria of the Borrelia genus. Although Borrelia burgdorferi is considered the most well-known causative agent, other Borrelia species are also widely spread in Europe — primarily Borrelia afzelii and Borrelia garinii. These species are often associated with the skin and neurological manifestations of Lyme disease in European patients.

The infection is transmitted through the bite of an infected tick. After entering the body, bacteria can spread through the bloodstream and affect the skin, joints, nervous system, heart, muscles, and sometimes even the eyes.

What contributes to the spread of Lyme disease

Scientists associate the increase in cases with several factors:

• climate change;
• warmer winters;
• growth of tick populations;
• increase in the number of deer and rodents;
• expansion of forest and suburban areas.

The WHO notes that ticks are gradually spreading into more northern regions and to higher altitudes above sea level.

How does infection occur?

Many people believe that a tick transmits the infection instantly, but this is not entirely true. Usually, the bacteria are transmitted 24–36 hours after the tick attaches. This is why rapid removal of the parasite significantly reduces the risk of infection.

Ticks do not jump and do not fall from trees. Most often, they: stay in tall grass, are found in bushes, attach themselves to clothing when it comes into contact with vegetation. The most dangerous areas are: forests, humid parks, areas with tall grass, and locations near bodies of water. Ticks are especially active in spring and summer, although during warm winters they can remain active almost throughout the entire year.

What does a tick look like?

The size of an unfed tick can be as small as 1–3 mm, which is why many people do not even notice the bite. After feeding on blood, the tick can increase in size several times.

The most dangerous are the young forms - nymphs. They are very small and often remain unnoticed, but they are the ones that most frequently transmit the infection to humans.

First symptoms: why the disease is often missed

The incubation period usually lasts from 3 to 30 days. The best-known early feature of Lyme disease is erythema migrans. It is a red patch that gradually expands around the bite site. Typical characteristics include: a ring-shaped or “target-like” appearance, a lighter center, gradual enlargement; the skin is usually not painful and does not itch.

However, it is important to understand that this type of erythema does not appear in all patients. In addition to the rash, fever, body aches, chills, severe fatigue, headache, muscle pain, and enlarged lymph nodes may occur. Very often, at this stage, the disease is mistaken for a common viral infection.

Neurological symptoms: when the nervous system is affected

If the disease is left untreated, bacteria can affect the nervous system. This condition is called neuroborreliosis. [4]

Possible manifestations: numbness of the limbs, tingling sensations, pain along the nerves, memory problems, dizziness, difficulty concentrating, insomnia, increased anxiety, facial nerve paralysis.

One of the best-known complications of Lyme disease is Lyme arthritis. It most often affects large joints, especially the knees, ankles, and elbows. An inflamed joint may become swollen, painful, warm, and lose its normal mobility, significantly limiting movement. It is important to note that such symptoms may not appear immediately but can develop months after the bite of an infected tick.

In some cases, the infection can affect other body systems, including the heart: although this occurs less frequently, Borrelia bacteria can cause inflammation of the heart tissue. This condition is called Lyme carditis and may manifest as irregular heart rhythms, chest pain, shortness of breath, fainting, and pronounced weakness; in rare cases, it can pose a potential threat to life.

Treatment: can it be completely cured?

In most cases, Lyme disease responds well to treatment, especially when detected early. The mainstay of therapy is antibiotics, selected by a physician according to the stage of the disease and the clinical picture.

The duration of treatment depends on the form and severity of the infection. When therapy is started in a timely manner, most patients recover completely without serious consequences. However, with late diagnosis, the recovery process may take significantly longer and may be accompanied by residual symptoms.

What should you do after a tick bite?

The most important step is — remove the tick as quickly as possible.

Correct removal:

1. Use fine-tip tweezers.
2. Grasp the tick as close to the skin as possible.
3. Pull slowly upward.
4. Do not squeeze the tick’s body.
5. Treat the skin with an antiseptic.

If you are unable to do this yourself — contact Invitro Diagnostics clinic for assistance.

Do not: pour oil on the tick, burn it, twist it sharply, or crush it with your fingers.

After removal, it is important to monitor the condition of the skin and your general well-being for about one month.

Urgent medical consultation is required if you experience:

• the appearance of a red spot;
• fever after a tick bite;
• joint pain;
• facial numbness;
• heart rhythm disturbances;
• severe weakness;
• unusual neurological symptoms.

Prevention in action: how to protect yourself

• wear closed clothing;
• tuck trousers into socks when walking in the forest;
• use repellents;
• carefully examine your body after spending time outdoors;
• check children and pets;
• wash clothes after outdoor activities.

Special attention should be paid to areas where ticks most often remain unnoticed: the neck, armpits, groin area, scalp, and the area behind the ears.

Invitro: accurate diagnosis of Lyme disease

Invitro Diagnostics offers modern laboratory tests for the diagnosis of Lyme disease at different stages after a tick bite.

The choice of method depends on how much time has passed since the bite, whether symptoms are present, and what needs to be determined: assessing the risk of infection, detecting an early infection, or confirming the diagnosis.

Laboratory diagnosis of Lyme disease includes testing of the tick itself, molecular methods (detection of bacterial DNA), and serological tests that identify antibodies produced by the body’s immune system.

It is important to understand: no laboratory test should be evaluated separately. Results must be interpreted by a physician, taking into account symptoms, clinical examination findings, and the time elapsed since the bite.

1. Tick removal

(Immediately after detecting the tick)

If a tick has attached itself to the skin, it is recommended to remove it as soon as possible. At Invitro, the procedure is performed by a medical specialist in compliance with safety rules. After removal, the tick can be sent for laboratory testing to determine the presence of tick-borne infection pathogens. Timely removal of the tick reduces the duration of contact with a possible infectious agent and allows the tick to be preserved for further analysis.

2. Borrelia burgdorferi (DNA, qualitative detection — tick)

(After tick removal)

This test is not performed on a person, but on the tick itself.

Using the PCR method, the presence of Borrelia burgdorferi bacterial DNA — the causative agent of Lyme disease — is determined. The test helps establish whether the tick was a potential carrier of the infection and helps the physician assess the need for further monitoring.

It is important to remember:

• the detection of Borrelia in a tick does not automatically mean that the person has been infected;
• the absence of the bacteria in the tested tick does not completely exclude the risk of infection.

The result is evaluated together with the duration of tick attachment, the time of tick removal, and the patient’s condition.

3. Borrelia burgdorferi (DNA, qualitative detection — blood)

(In specific clinical situations, mainly in the early stages)

This is a molecular PCR-based test that directly detects the genetic material of Borrelia burgdorferi bacteria in the blood.

Unlike antibody tests, this analysis does not evaluate the immune system’s response but is aimed at identifying the pathogen itself. The test may be used by a physician in specific cases, especially during the early stages of the disease.

However, it is important to consider that in Lyme disease, bacteria may be located mainly in tissues and are not always detectable in the blood. Therefore, a negative blood PCR result does not exclude the presence of infection.

4. Antibodies to Borrelia burgdorferi, IgM

(Usually 2–4 weeks after infection)

IgM are the first antibodies produced by the body in response to an infection. The test helps detect an early immune response when a recent infection is suspected. If the test is performed too early - during the first days after a tick bite - the result may be negative because the body has not yet had enough time to produce a sufficient amount of antibodies.

5. Antibodies to Borrelia burgdorferi VlsE, IgG

(Usually 3–6 weeks after infection)

This test detects IgG antibodies against the VlsE protein of Borrelia burgdorferi bacteria. IgG antibodies appear later than IgM but may persist for a long time after exposure to the infection.

The test is used to confirm an active or previously acquired infection. Due to the high specificity of the VlsE antigen, this test is one of the most informative methods for assessing the immune response in Lyme disease.

6. IgM Antibodies to Borrelia spp. (B. afzelii, B. burgdorferi, B. garinii), Western Blot

(Confirmatory test)

Western Blot is a highly specific laboratory method that detects antibodies against individual proteins of different Borrelia species.

It is usually performed after a positive or equivocal IgM antibody test result. This assay helps confirm a recent or ongoing infection and improves the accuracy of Lyme disease diagnosis.

7. IgG Antibodies to Borrelia spp. (B. afzelii, B. burgdorferi, B. garinii), Western Blot

(Confirmatory test for later stages)

This test detects IgG antibodies against specific proteins of Borrelia species.

It is used to confirm a current or past infection, particularly if several weeks or months have passed since infection and the results of other tests require further clarification.

! To learn more about our tests, click on the name of the test you are interested in to access its detailed description and additional information.

Which test should you choose?

• The tick bite occurred today or a few days ago - blood tests are not yet informative, as antibodies have not had enough time to develop. If necessary, the tick itself can be examined.

• 2–4 weeks have passed since the bite or the first symptoms have appeared - testing for IgM antibodies is recommended, and if necessary, together with IgG.

• More than 4–6 weeks have passed - IgG (VlsE) testing is the most informative, and in case of a positive or equivocal result, the doctor may recommend confirmation by the Western Blot method.

Taking care of your health begins with paying attention to your body. After a tick bite, it is important to seek medical advice in a timely manner and choose the appropriate test. This helps assess the risk of infection, obtain reliable information and, if necessary, start further monitoring or treatment in time.
 

Sources of information:

[1] https://www.cdc.gov/lyme/data-research/facts-stats/

[2] https://climate-adapt.eea.europa.eu/en/data-and-downloads

[3] https://tvn.md/ru/ostorozhno-kleshhi-v-moldove-rastyot-chislo-sluchaev-bolezni-lajma/

[4]  https://pubmed.ncbi.nlm.nih.gov/26633786/