Current risk of Borrelia burgdorferi infection

In 1977, arthritis and skin lesions were described in Lyme and Old Lyme in the state of Connecticut in the USA, which was associated with tick bites. Currently, Lyme disease (borreliosis) is the most common tick-borne disease in the world. In Poland, most cases of Lyme disease occur between May and November, and over 80% of cases are found in June and July due to foraging nymphs ticks. The reservoir of bacteria is about 300 different species of mammals. Borrelia burgdorferi is characterised by morphological and immunological variability in particular stages of development. The bacterium has the ability to morphologically transform into cell wall-deficient forms (CWD) in the form of spheroplasts, L-form, bleb-like spirochetes, and in the form of cysts (round body/form). It also has the ability to create a biofilm. The above conditions affect the reliability of diagnostic tests, which may lead to incorrect therapeutic decisions. In the initial procedure, it is important to implement effective treatment to prevent further progression of infection. A particular difficulty in the procedure is caused by re-reflux syndrome, when severe states of organ failure occur. Symptoms of the syndrome appear months or years after antibiotic therapy in 10–20% of those treated as an autoimmune response, which was created after active infection and effective treatment that could eliminate the causative agent. The discrepancy in therapeutic recommendations concerns mainly the choice of antibiotics, its dose, and time of administration. The proposed doxycycline is included in all the recommendations, although its MIC90 is 2.0 mg/l. Other antibiotics have better parameters, especially azithromycin, which can be fully effective when administered topically in the first stage of infection..