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Microbiology of Lyme disease

Alan G Barbour, MD
Section Editor
Allen C Steere, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Lyme disease is the most common tick-borne disease in the United States, Canada, and Europe [1,2]. It is a bacterial infection caused by members of the Borrelia species, Borrelia burgdorferi in North America, and primarily by Borrelia afzelii and Borrelia garinii in Europe and Asia. The reservoirs in nature are several species of small mammals and birds. Humans acquire the infection not from direct contact with these vertebrates, but from the bite of an infected tick of the genus Ixodes. The infection begins in the skin at the site of the tick bite. From there, the spirochetes may disseminate in the blood to other tissues and organs. The usual manifestations of Lyme disease involve the skin, joints, heart, and nervous system.

In the early 20th century, erythema migrans and Bannwarth’s syndrome, which are now known to be skin and neurologic manifestations of Lyme borreliosis, were described in Europe [3]. Lyme disease was first described in North America in 1977 as "Lyme arthritis" [4], and the etiologic agent was identified in 1982 [5].

The microbiology of Lyme disease will be reviewed here. Issues related to immunopathogenesis, epidemiology, prevention, clinical manifestations, diagnosis, and therapy of Lyme disease are discussed separately. (See "Epidemiology of Lyme disease" and "Immunopathogenesis of Lyme disease" and "Prevention of Lyme disease" and "Evaluation of a tick bite for possible Lyme disease" and "Clinical manifestations of Lyme disease in adults" and "Lyme disease: Clinical manifestations in children" and "Treatment of Lyme disease".)


The members of Borrelia species are spirochetes, which are motile, spiral, or wavy bacteria that are only distantly related to gram-negative and gram-positive pathogens. The genomes of B. burgdorferi, B. afzelii, and B. garinii comprise small linear chromosomes of approximately 1000 kb, and 17 to 21 linear and circular plasmids totaling another 400 to 500 kb [6-8].

Spirochetes have two cellular membranes like gram-negative bacteria, but their flagella, the organelles of motility, are uniquely located between in the inner and outer membrane rather than on the surface. B. burgdorferi is 8 to 30 microns in length and about 0.2 microns in width. Their narrowness accounts for the inability to see unstained or Gram stained cells by standard light microscopy.


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Literature review current through: Feb 2017. | This topic last updated: Thu Sep 11 00:00:00 GMT 2014.
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