ABSTRACT
We describe a focal epidemic of Lyme disease, which spread from a nature preserve and affected an adjacent community of permanent residents in coastal Massachusetts. The attack rate from 1980 through 1987 was 35 percent among 190 residents living within 5 km of the nature preserve and was greatest (66 percent) among those living closest to the preserve. The risk of infection bore little relation to sex or age. Late Lyme disease, which clustered near the preserve, occurred mainly in residents infected early in the epidemic who did not have a history of erythema migrans and did not receive antibiotic therapy. All the residents with serologic evidence of infection had early or late clinical manifestations of Lyme disease, or both, during the period of study. The seasonal risk of infection was bimodal--greatest in June, with a secondary peak in October--and corresponded to periods of increased transmission. In the nature preserve, the density of the vector tick, Ixodes dammini, exceeded that in other New England sites. The zoonosis rapidly became endemic, and the severity of its impact correlated with the abundance of deer. This epidemic of Lyme disease demonstrated that outbreaks can be focal and can spread rapidly within a community of permanent residents.
Subject(s)
Lyme Disease/epidemiology , Animals , Antibodies, Bacterial/analysis , Borrelia/immunology , Deer/parasitology , Humans , Massachusetts , Muridae/parasitology , Seasons , Ticks , ZoonosesSubject(s)
Dog Diseases/epidemiology , Lyme Disease/veterinary , Animals , Dogs , Humans , Lyme Disease/epidemiology , MassachusettsABSTRACT
The seasonal host-seeking pattern of nymphal Ixodes dammini infected with Babesia microti or Borrelia burgdorferi was determined on Nantucket Island, Massachusetts, during 1985. The peak period of host-seeking by infected nymphal I. dammini occurred in May and June. On a per person-hour basis, the number of infected ticks collected reached a maximum in May (Babesia = 17.3; Borrelia = 16.2). The number of infected ticks remained high in June, but decreased notably in July, August, and September. Transmission risk of the tick-borne etiologic agents of Lyme disease and human babesiosis in Massachusetts is greatest during the late spring-early summer months of May and June.
Subject(s)
Arachnid Vectors , Babesiosis/transmission , Lyme Disease/transmission , Seasons , Ticks , Animals , Babesia , Borrelia , Humans , Massachusetts , Nymph , Risk Factors , Ticks/microbiology , Ticks/parasitologySubject(s)
Arthritis, Infectious/microbiology , Borrelia/isolation & purification , Lyme Disease/microbiology , Adult , Antibodies, Bacterial/analysis , Borrelia/immunology , Fluorescent Antibody Technique , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Male , Synovial Fluid/microbiologyABSTRACT
Although indirect evidence suggests that chronic Lyme arthritis is caused by persistent infection with Borrelia burgdorferi, direct visualization has been lacking. We report the demonstration of B. burgdorferi from synovial fluid aspirated from the right knee of a 31-year-old man with Lyme arthritis for more than 1 year. After 6 days, culture medium inoculated with synovial fluid showed one motile and several nonmotile spirochetes. Direct immunofluorescence staining showed reactivity with anti-B. burgdorferi serum. Spirochetes were not seen in subcultured material. The patient's arthritis improved with high-dose intravenous penicillin. Identification of B. burgdorferi from the joint fluid of a patient with long-standing arthritis supports the concept that the arthritis is due to persistent infection.
