Borrelia – Causes, Symptoms and Treatment
Borrelia are spiral-shaped bacteria transmitted through tick bites that can cause Lyme disease. Early diagnosis and treatment are key to a full recovery.
Things worth knowing about "Borrelia"
Borrelia are spiral-shaped bacteria transmitted through tick bites that can cause Lyme disease. Early diagnosis and treatment are key to a full recovery.
What is Borrelia?
Borrelia are gram-negative, spiral-shaped bacteria (spirochetes) belonging to the family Spirochaetaceae. They are found worldwide and can cause serious infections in both humans and animals. The most medically significant species is Borrelia burgdorferi, the causative agent of Lyme disease (also known as Lyme borreliosis). In Europe, Borrelia afzelii and Borrelia garinii are also clinically relevant.
Transmission
Borrelia bacteria are primarily transmitted to humans through the bite of infected hard ticks (Ixodes species). In Central Europe, the common sheep tick (Ixodes ricinus) is the main vector. Transmission generally requires the tick to be attached for at least 12 to 24 hours. Not every tick bite results in infection -- depending on the region, between 5 and 35 percent of ticks in endemic areas carry Borrelia.
Symptoms of Lyme Disease
Early Localized Stage (Stage I)
- A characteristic expanding circular rash: erythema migrans (also called the bull's-eye rash), spreading from the bite site
- Flu-like symptoms including fatigue, fever, headache, and muscle aches
Early Disseminated Stage (Stage II)
- Neurological involvement: Lyme neuroborreliosis with nerve pain, paralysis, or numbness
- Heart rhythm disturbances (Lyme carditis)
- Joint inflammation (Lyme arthritis)
Late Stage (Stage III)
- Chronic joint inflammation, particularly affecting the knees
- Chronic neuroborreliosis with persistent neurological deficits
- Skin condition: acrodermatitis chronica atrophicans (ACA)
Diagnosis
Diagnosis of Lyme disease is based on a combination of clinical presentation and laboratory testing. In the early stage, erythema migrans is a reliable clinical indicator. Laboratory tests include:
- ELISA (screening test): detects IgM and IgG antibodies against Borrelia
- Western blot (confirmatory test): used to verify positive ELISA results
In the early stage, antibody tests may return negative results because the immune system has not yet mounted a sufficient response. If Lyme neuroborreliosis is suspected, analysis of cerebrospinal fluid via lumbar puncture may be required.
Treatment
Lyme disease is treated with antibiotics. The choice of antibiotic and duration of treatment depend on the stage of the disease:
- Early stage: Oral antibiotics such as doxycycline, amoxicillin, or cefuroxime for 14 to 21 days
- Disseminated stage / neuroborreliosis: Intravenous ceftriaxone or penicillin G for 14 to 28 days
- Lyme arthritis: Oral or intravenous antibiotic therapy depending on severity
Early treatment leads to complete recovery in the majority of cases. In later stages, therapy may be more prolonged.
Prevention
As no licensed Lyme disease vaccine is currently available in Europe, prevention focuses on protecting against tick bites:
- Wear light-colored, long-sleeved clothing in wooded and grassy areas
- Apply insect repellents containing DEET or icaridin
- Inspect the body for ticks after spending time outdoors
- Remove ticks as quickly as possible using fine-tipped tweezers or a tick removal tool
- Monitor the bite site for several weeks for signs of redness or rash
References
- Stanek G. et al.: Lyme borreliosis. Lancet. 2012;379(9814):461-473.
- Centers for Disease Control and Prevention (CDC): Lyme Disease. www.cdc.gov (2023).
- European Centre for Disease Prevention and Control (ECDC): Lyme borreliosis in Europe -- Epidemiology, risk factors and prevention. ECDC Technical Report (2022).
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