The bacterium that causes Lyme disease, a spirochete identified as Borrelia burgdorferi, rapidly spreads throughout the body after the initial tick bite, producing different symptoms at different times. This bacterium was named after NIH scientist Dr. Willy Burgdorfer who discovered the spiral shaped organism while studying ticks on eastern Long Island (see Dr. Burgdorfer and Dr. Fallon right). Some patients do not experience any symptoms after the bite of a tick that carries the bacterial agent of Lyme disease. In these patients, a healthy immune system may be sufficient to eradicate the spirochete. In most other patients, antibiotic treatment is needed to fight the disease that develops. The initial tick bite marks the beginning of the journey of the spiral shaped bacterium into your body tissues, from its initial location at the skin to its subsequent lodging in the brain, joints, heart, peripheral nerves, muscles, collagen tissue or elsewhere. Symptoms may develop quickly or not until many months or years later as the spirochete can evade the immune response and remain dormant in the human host for long periods.
Because of its initial presentation as a skin rash, its potential involvement of many different organ systems, the difficulty in some cases of even considering Lyme disease given its presentation in the form of other more typical illnesses, and its spirochetal etiology, Lyme disease in the 1980s because known as “the new Great Imitator”, replacing the spirochete syphilis for that dubious distinction. It is wise therefore for clinicians to be aware of the typical and the atypical presentations of Lyme disease.
When starting to evaluate a patient, it is important to obtain a full medical history, including exploring whether or not the person has ever lived or vacationed in a Lyme endemic area. Certain parts of the country such as the northeastern US and mid-western states have the heaviest burden of Bb-infected ticks. Does the person engage in behaviors that might increase the risk of tick-attachment, such as hiking in the woods or walking through high grasses?
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