Lyme disease classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Lyme disease can be classified into three stages. The first stage is localized Lyme disease, the second is disseminated Lyme disease, and the third is late disseminated Lyme disease. During stage 1, the patient can develop erythema migrans rash. Ten to twenty percent of the patients who have Lyme disease can develop post treatment Lyme disease syndrome. There are various genospecies of Borrelia burgdorferi sensu lato complex that can cause Lyme disease. A novel spirochete, Borrelia mayonii, has been recently discovered to be responsible for Lyme disease.

Stage 1 is called early localized Lyme disease. The infection is not yet widespread throughout the body.
Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.
Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

The majority of cases of Lyme disease are caused by Borrelia burgdorferi sensu lato (s.l.) complex. There are 18 genospecies in Borrelia burgdorferi sensu lato (s.l.) complex. Out of these, only 7 infect humans (genotype 3 commonly and 4 occasionally).^[1]

Borrelia burgdorferi sensu lato (s.l.) complex genospecies
Pathogenic		Non-Pathogenic
Commonly infect humans	Rare (no human infection)	Not isolated from humans yet
B. burgdorferi sensu stricto(B. burgdorferi s.s.) B. afzelii B. garinii	B. bavariensis B. bissettii B. kurtenbachii B. lusitaniae B. spielmanii B. valaisiana	B. americana B. andersonii B. californiensis B. carolinensis B. japonica B. tanukii B. turdi B. sinica B. yangtze

However, B. mayonii has recently been discovered to be responsible for development of Lyme disease.^[2]
The following table demonstrates key clinical and epidemiological features that distinguish B. burgdorferi from B. mayonii:

General information	B. burgdorferi	B. mayonii
Transmission	Tick bite	Tick bite
Distribution in the USA	Northeast, Mid-Atlantic, and Midwest regions	Midwest region
Bacteria Concentration in Blood (Spirochetemia)	Lower	Higher
Early Symptoms	Fever, headache, rash, neck pain	Fever, headache, rash, neck pain
Late Symptoms and Complications	Joint pain and arthritis	Joint pain and arthritis
Nausea / Vomiting?	No	Yes
Rash Characteristics	Bullseye target lesion	Diffuse rash
Diagnosis	Serology or PCR	Serology or PCR
Treatment	Doxycycline	Doxycycline

↑ Rudenko N, Golovchenko M, Grubhoffer L, Oliver JH (2011). “Updates on Borrelia burgdorferi sensu lato complex with respect to public health”. Ticks Tick Borne Dis. 2 (3): 123–8. doi:10.1016/j.ttbdis.2011.04.002. PMC 3167092. PMID 21890064.
↑ Pritt, Bobbi S; Mead, Paul S; Johnson, Diep K Hoang; Neitzel, David F; Respicio-Kingry, Laurel B; Davis, Jeffrey P; Schiffman, Elizabeth; Sloan, Lynne M; Schriefer, Martin E; Replogle, Adam J; Paskewitz, Susan M; Ray, Julie A; Bjork, Jenna; Steward, Christopher R; Deedon, Alecia; Lee, Xia; Kingry, Luke C; Miller, Tracy K; Feist, Michelle A; Theel, Elitza S; Patel, Robin; Irish, Cole L; Petersen, Jeannine M (2016). “Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study” (PDF). The Lancet Infectious Diseases. 16 (5): 556–564. doi:10.1016/S1473-3099(15)00464-8. ISSN 1473-3099.