Lyme Disease

Lyme borreliosis is an infectious disease caused by the Ixodes tick-transmitted spirochete Borrelia burgdorferi. Yale Rheumatology has been at the forefront of Lyme disease research since the identification and elucidation of Lyme arthritis by our section in the early 1970’s. Lyme disease has emerged as the most common vector-borne disease in North America and is a significant health care concern, with recent CDC estimates of the annual case incidence approaching ~300,000. The infection can present with a localized skin rash at the site of tick bite or with involvement of other organ systems, especially the heart, joints and nervous system. Although the infection is highly responsive to antibiotic therapy when detected early, the time to symptom resolution may be protracted, particularly if infection is prolonged. Arthritis is considered a manifestation of late disseminated infection, occurring months after tick bite. Most patients with Lyme arthritis respond to antimicrobial therapy, but about ~10% of patients evolve an inflammatory arthritis with autoimmune features that similar to those seen in rheumatoid arthritis.

Lyme disease research in the Yale Section of Rheumatology is directed toward understanding disease pathogenesis in mouse models and humans, using genomic, proteomics and state-of-the-art imaging techniques. The Bockenstedt laboratory studies mechanisms of host defense, including innate and adaptive immune mechanisms. The focus has been on the innate defense against this pathogen and use of 2-photon intravital microscopy to evaluate tick-transmitted spirochetal infection and antibiotic responsiveness in mice. The Lyme disease spirochete has a predilection for connective tissue, including the entheses of joints, and on-going studies are evaluating the impact of infection on tendon biology. Clinical translational studies are directed toward using novel panels of B. burgdorferi antigens to improve diagnostic tests for early disease that may also distinguish reinfection from previous infection. For more information, click here.

Ixodes ticks transmit other pathogens, including the red blood cell parasite Babesia microti and a newly emerging relapsing fever spirochete Borrelia miyamotoi, that can cause significant disease in people with compromised immune systems due to age, disease, or use of immunosuppressive medications. Interdisciplinary studies of these pathogens are on-going in mouse models and in humans with investigators in the Yale School of Public Health and the Section of Infectious Diseases.