Les réservoirs de Borrelia burgdorferi jouent un rôle clé pour assurer sa transmission dans l’environnement. Récemment, de nouveaux acaricides, comme le fluralaner, présentant une efficacité élevée contre les tiques et une longue durée d’action, ont été commercialisés sur le marché des médicaments vétérinaires. Cibler les réservoirs de B. burgdorferi, comme les souris du genre Peromyscus, avec le fluralaner permettrait : d’abord, d’en altérer le cycle endémique; ensuite, de réduire la densité de tiques infectées dans l’environnement ; et, ultimement, de réduire le risque de transmission de la maladie de Lyme (ML). En premier lieu, l’efficacité du fluralaner à tuer des larves de l’espèce Ixodes scapularis infestant des souris du genre Peromyscus a été démontrée en laboratoire. Lors d’infestations expérimentales, des doses de 12,5 et 50 mg/kg ont tué > 90 % des larves d’I. scapularis dans les 4 jours suivant l’administration du traitement. Cependant, cette efficacité a été réduite à moins de 5 % dans les 30 premiers jours. En second lieu, dans le cadre d’une étude controllée non randomisée, des appâts de fluralaner ont été administrés répétitivement à une population de micromammifères sauvages à des densités de 2,1 ou 4,4 appâts/1000 m2 pendant 3 à 4 ans. L’efficacité du traitement à réduire l’infestation des micromammifères a, au préalable, été évaluée. Les densités de 2,1 et 4,4 ont respectivement réduit de 68 % et 86 % le nombre de larves infestant les souris du genre Peromyscus. Seule la densité de 4,4 a réduit significativement le nombre de nymphes de 72 %. Après quoi, l’effet des deux densités d’appâts sur le cycle endémique de B. burgdorferi a été évalué par le biais de 3 paramètres : 1- la prévalence de Peromyscus spp. infectées (PIM), 2- la densité de nymphes en quête (DON), 3- la prévalence de nymphes infectées par B. burgdorferi (NIP). La prévalence d’infection des souris par B. burgdorferi a chuté de 60 à 37 % après deux années de déploiements du traitement. Le traitement a provoqué une réduction de la DON de 45 à 63 % dans les zones traitées. Aucun effet n’a été observé sur le dernier paramètre. En troisième lieu, la pharmacologie du fluralaner a été caractérisée chez des souris du genre Peromycus dans une étude réalisée en laboratoire. Les données recueillies ont été utilisées pour simuler et interpréter différents scénarios de traitement de souris Peromyscus spp. pour une durée équivalente aux pics d’activités des larves et des nymphes d’I. scapularis. Les simulations ont permis d’identifier un jeu de scénarios qui conféreraient une protection contre les tiques pendant toute la saison d’activité des stades immatures d’I. scapularis. L’étude de la pharmacologie des acaricides chez les espèces ciblées et la modélisation de la pharmacocinétique représentent des étapes cruciales pour développer ce type d’intervention. Cette thèse a permis d’entreprendre le développement d’une approche ciblant les réservoirs de B. burgdorferi en utilisant une molécule de la famille des isoxazolines. L’approche décrite a montré le potentiel d’altérer le cycle endémique de B. burgdorferi et de réduire la densité de nymphes infectées dans l’environnement. Plus généralement, en intégrant des études sur la pharmacologie du fluralaner en laboratoire et des études terrains, elle permet d’initier la réflexion quant à l’importance d’avoir un cadre de développement commun pour structurer la recherche autour de ce type d’approches. / Reservoirs of Borrelia burgdorferi play a key role in ensuring its transmission in the environment. Recently, new acaricides, such as fluralaner, with high efficacy against ticks and a long duration of action have been commercialized in the veterinary drug market. Targeting B. burgdorferi reservoirs, such as Peromyscus spp. mice, with fluralaner would yield the following benefits: first, alter its transmission in the environment; second, reduce the density of B. burgdorferi-infected ticks in the environment; and, ultimately, reduce the risk of Lyme disease (LD). Firstly, the efficacy of fluralaner for killing Ixodes scapularis larvae infesting Peromyscus mice was demonstrated in a laboratory setting. Doses of 12.5 and 50 mg/kg showed > 90% efficacy at killing I. scapularis larvae infesting Peromyscus spp. mice within 4 days of treatment during experimental infestations. However, efficacy was reduced to less than 5% beyond 30 days. Secondly, in a non-randomized controlled study, fluralaner baits were repeatedly administered to a wild population of small mammals at densities of 2.1 or 4.4 baits/1000m2 over a period of 3 to 4 years. First, the treatment's efficacy at reducing small mammal infestation was evaluated. Densities of 2.1 and 4.4 baits/1000m2 reduced the number of larvae infesting Peromyscus mice by 68% and 86% respectively. Only the density of 4.4 baits/1000m2 significantly reduced the number of nymphs by 72%. Next, the effect of the both bait densities on the B. burgdorferi endemic cycle was evaluated through 3 parameters: i- the prevalence of B. burgdorferi-infected Peromyscus spp. mice (PIM), ii- the density of questing nymphs (DON), and iii- the prevalence of B. burgdorferi in questing nymphs (NIP). Mouse infection by B. burgdorferi decreased from 60 to 37% following two years of treatment deployment. The treatment reduced the DON by 45-63% in the treated areas but no effect was observed on B. burgdorferi prevalence in the NIP. Thirdly, fluralaner pharmacology was characterized in Peromycus mice in a laboratory setting. The data collected were used to simulate and interpret different treatment scenarios for Peromyscus mice over a period corresponding to the peak activities of I. scapularis larvae and nymphs. The simulations identified a set of treatment scenarios that confer protection against ticks for an entire season of I. scapularis activity. The results indicate that investigation of acaricide pharmacology in target species and pharmacokinetic modeling are critical steps in the development of this type of intervention. This thesis initiated the development of an approach targeting B. burgdorferi reservoirs using a molecule of the isoxazoline family. This approach showed potential for disrupting the endemic cycle of B. burgdorferi and reducing the density of B. burgdorferi-infected nymphs in the environment. More broadly, by integrating studies on fluralaner pharmacology in laboratory and field settings, this work has initiated a reflection on the importance of establishing a general development framework to structure research around this type of approach.

Lyme disease is a tick-transmitted illness caused by Borrelia burgdorferi sensu lato (s.l.), a group of spirochetes with at least three human pathogenic species, B. burgdorferi sensu stricto, B. afzelii and B. garinii. These spirochetes cycle between vertebrate reservoirs, mainly rodents, and ixodid ticks. Both terrestrial birds and seabirds can be infected with B. burgdorferi s.l. but the function of birds as reservoirs is largely unknown, even though they are potentially important epidemiologically due to their ability to carry ectoparasites and microorganisms over long distances. This thesis describes the role of birds in Lyme disease Borrelia biology in general and Borrelia ecology and epidemiology in particular. B. burgdorferi s.l. has previously been detected in the seabird tick Ixodes uriae and an enzootic Borrelia cycle distinct from terrestrial Borrelia cycles has been described. In this study B. garinii was isolated from the proposed seabird reservoirs and the tick I. uriae infesting them. The strains isolated did not show evident differences from human pathogenic B. garinii strains, indeed 7/8 strains had an ospC allele associated with Borrelia causing disseminated Lyme disease. Antibodies against B. burgdorferi s.l. were detected in people frequently bitten by I. uriae. Thus the marine enzootic Borrelia cycle may be a risk for humans, either by direct transfer of the spirochete from /. uriae or via introduction of Borrelia into a terrestrial enzootic Borrelia cycle. In order to investigate the role of passerine (Passeriformes) birds as amplification hosts in the terrestrial Borrelia cycle, experimental infections of canary finches (Serinus canaria) and redwing thrushes (Turdus iliacus) were carried out. The result showed that B. burgdorferi s.l. can persist for several months in passerine birds and the infection in redwing thrushes can be reactivated in response to migration. Thus, birds may be more infectious to ticks during their migration and therefore important long-range disseminators of B. burgdorferi s.l. Migration in birds is associated with elevated stress hormones that in turn can cause reactivation of latent infections. Lyme disease in humans could perhaps be activated when the immune response is modulated by stress. Herein I describe a patient with a stress activated latent Borrelia infection, which supports this hypothesis. The seabird tick I. uriae has a circumpolar distribution in both the northern and southern hemispheres and in this study identical B. garinii flagellin gene (flaB) sequences were detected in I. uriae from these hemispheres, indicating a transequatorial transport of B. garinii. Parsimony analysis of I. uriae ITS2 and 16S rDNA sequences suggested that northern and southern I. uriae might be reproductively separated. Therefore passive transport of infected ticks between the polar regions is unlikely and instead seabirds probably carry an active Borrelia infection during their migration. In conclusion, this work shows that migrating seabirds and passerine birds probably are important for the long-range dispersal of B. burgdorferi s.l., and that this mechanism of dispersal could be important for the distribution of human Lyme disease. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 2001, härtill 6 uppsatser</p> / digitalisering@umu

Many zoonotic pathogens of concern to human and veterinary health are maintained in the environment within small mammal reservoirs and vectored to new hosts by ectoparasitic arthropods. While the ecological relationships among small mammals, ectoparasites, and disease-causing symbiotic microorganisms are important to these dynamics, little is known about them across much of North America. The sylvatic cycle of Borrelia burgdorferi, the etiologic agent of Lyme disease, is of particular interest because Lyme disease is the most common vector-borne disease of humans in the United States. However, cases of Lyme disease are primarily confined to the northeastern and Midwestern United States, with only sporadic cases extending into the southeast. As a result, much of what is known of the ecology of Lyme disease comes from studies conducted in those regions. The goal of this study was to examine the ecological dynamics of the B. burgdorferi/vector/reservoir system in south-central Kentucky and gain insight into the relative paucity of Lyme disease in Kentucky. Small mammals were captured using live traps in three 200x50 m trapping grids within Western Kentucky University’s Green River Preserve from November 2014-October 2015. Captured small mammals were identified to species and standard measurements were recorded. Ectoparasites were removed and retained for identification. Collected blood and tissue were examined for B. burgdorferi DNA by polymerase chain reaction with primers specific to the OspA gene. The Bray-Curtis dissimilarity index, Schnabel population estimates, and the Shannon-Wiener diversity index were used to assess the structure of the small mammal communities. Parasite infestation was low but was affected by age and sex of the host, site, and season in different parasite taxa. Infestation by Ixodes scapularis, the primary vector for B. burgdorferi, was uncommon and prevalence of B. burgdorferi in blood was similar to the lowest prevalence previously observed in the Lyme disease endemic regions. We found that life history characteristics of hosts and ectoparasites drive their associations. We also suggest that the lack of an efficient vector for B. burgdorferi is the likely explanation for the few reported cases of Lyme disease in Kentucky.

<p>In Europe, Lyme disease<em> </em>is caused by the species <em>Borrelia (B.) burgdorferi</em> sensu stricto,<em> B. garinii </em>and <em>B. afzelii.</em> The disease is the most common vector-borne infection in Europe and the United States,<em> </em>and the resulting manifestation can involve the skin, nervous system, heart and joints. The symptoms that arise are associated with the <em>Borrelia </em>species causing the infection. The species most associated with neuroborreliosis is <em>B. garinii</em> whilst <em>B. burgdorferi </em>sensu stricto is associated with arthritis and <em>B. afzelii </em>is associated with dermatological symptoms. Lyme disease normally has three phases in untreated patients. The first phase is characterised by erythema migrans, a reddening of the skin around the area of the tick bite. If the disease develops to the second phase the patient will suffer from neuroborreliosis which is characterised by neurological symptoms such as headache and peripheral facial paralysis. Cerebrospinal fluid (CSF) analysis is used to diagnose neuroborreliosis. The diagnosis is complicated by variations between the different <em>Borrelia</em> species and that many healthy individuals have antibodies directed against <em>Borrelia</em>. Antibodies in CSF can be found in different diseases. The antibodies can be produced in the central nervous system or come across the blood-brain barrier and thus derive originally from the blood. By measuring the concentration of total albumin in serum and in CSF it can be determined if the antibodies present in the CSF have been produced in the central nervous system or if they originate from the blood. The typical manifestation in the last phase of Lyme disease is severe arthritis. The aim of this examination project was to compare two ELISAs for detection of antibodies directed to <em>Borrelia</em>. Indirect ELISAs from DAKO and Euroimmun were compared for the diagnosis of neuroborreliosis in 100 individuals. <em>Borrelia </em>specific antibodies of class IgM or IgG were found in 16 of 100 patients by DAKO’s ELISA and in 20 of the same 100 patients by Euroimmun’s ELISA. The reason that Euroimmun’s method detected more cases of neuroborreliosis is probably that this method detects antibodies directed to all three pathological species of <em>Borrelia </em>while DAKO’s method only detects antibodies directed to <em>B. burgdorferi</em>. In conclusion, this study indicates that Euroimmun’s method to detect antibodies of class IgM and IgG directed to <em>Borrelia </em>is superior to DAKO’s method. The obtained results were confirmed by Western blot analysis which gave results in accordance with those of Euroimmun’s ELISA.</p>

The Lyme disease spirochete, B. burgdorferi is atypical in that a large portion of its genome is in the form of plasmids. Many of the plasmid-carried genes form extensive paralogous gene families and encode outer-surface proteins. In this report we have assessed the humoral immune response to proteins belonging to the paralogous protein family, family 163. We have cloned and expressed BBP39, BBO40, BBQ47 and BBN39 and used these recombinant proteins to monitor the temporal nature of the antibody response to these antigens during experimental infection of mice. The immunodominant regions of each protein have also been assessed through immunoblot analyses of a series of truncations of each protein. These analyses have led to the delineation of the targets of the antibody response during infection and of the specificity of the antibody response to family 163 proteins. In addition, we quantified the expression of each gene using real time RT-PCR.

Lyme disease (LD) is the leading arthropod-borne disease in North America with 300-600,000 cases each year. There are currently no approved human LD vaccines. Outer surface protein C (OspC) has emerged as a leading vaccine candidate and an attractive diagnostic marker due to its antigenicity and expression early in infection. Several chimeric, epitope based OspC derived proteins were generated. The constructs were found to be highly immunogenic in mice and vaccination induced complement-dependent bactericidal antibodies. These results suggest that a broadly protective polyvalent OspC epitope based vaccine can be produced. Currently, LD diagnostic approaches are unreliable and unable to differentiate between early and late stage disease. An Ab response to OspE family proteins occurs later in infection. The two-Ag diagnostic assay using chimeric OspC proteins and a site-directed mutant of an OspE paralog, accurately differentiated between early and late infection in experimentally infected canines and humans.

Introduction: Lyme disease is caused by the tick-borne spirochete Borrelia burgdorferi. Research has shown that dogs can be used as sentinels for human infection of Lyme disease. The purpose of this 5-year, retrospective study was to determine if there was any evidence that the incidence of canine Lyme disease has increased between 2000 and 2005 in Accomack and Northampton counties. An increased incidence in Lyme disease in dogs may indicate an increased present or future risk of Lyme disease in humans.Methods: Cases of canine Lyme disease were identified via practice invoicing systems and dogs that received doxycycline were entered into the database. Demographic information and the absence or presence of clinical signs such as fever, lameness, articular swelling, lymphadenomegaly, anorexia, general malaise and improvement after antibiotic use were collected. Testing history also was recorded.Results: Cases of canine Lyme disease that met any definition were identified (n=1048). Over the 5-year period the number of positive ELISA test results increased and the frequency of clinical signs decreased. The incidence of disease meeting the practitioner's definition increased until 2004 when the incidence dropped from 105.33 cases per 1,000 dogs to 56.93 cases per 1,000. The incidence of disease based on the study probable definition remained fairly constant with a high in 2002 of 2.94 cases per 1,000 dogs.Discussion: Trends of canine Lyme disease coincided with the introduction and use of the in-house ELISA test. Practitioners could identify more dogs exposed to Borrelia burgdorferi. The areas with the highest frequency of canine cases of Lyme disease also had the highest frequency of human cases reported to the Virginia Department of Health. Further study could identify animals that tested positive and later developed clinical signs. Using dogs as sentinels for human infection allows public health workers to identify endemic areas regardless of human case reports.

The aim of the study was to obtain and elaborate information focused on metamorphoses of Borrelia burgdorferi sensu lato (s.l.) spirochetes. The research included detection of various stress conditions for production of dormant forms of Borrelia burgdorferi s.l. spirochetes in vitro. Subsequently, metamorphoses from dormant to motile stages was observed under favourable conditions. Proper PCR method for primers aimed to detect dormant forms of Borrelia was delevoped. The infectious potential of dormant spirochetes of Borrelia burgdorferi sensu stricto (s.s.) complex was observed in vivo. Transformations of spirochetes have also been observed in real time and individual stages have been recorded.

An estimated 300,000 people contract Lyme disease in the USA every year, 10-20% of whom will experience long-term symptoms even after antibiotic treatment. These patients are said to have Chronic Lyme Disease (CLD). However, diagnostic guidelines, treatment protocols, and the etiological existence of CLD have been the subject of much controversy in the biomedical field, leading to negative mental and physical health outcomes for of patients with CLD. Patient support networks focused on illness experience, known as biosocialities, have formed in response to this controversy. CLD biosocialities create opportunities for patients to participate in biomedical activism and the scientific research process. A historical precedent for biosocial impact on biomedical knowledge and improved health outcomes has been established from patient activists with HIV/AIDS, breast cancer, and PTSD. The impact of CLD patients’ biosocial activism on a scientific and sociological level is evaluated through an examination of the publications of CLD support networks and biomedical research publications. CLD biosocial activism has resulted in more patient-centered research endeavours, etiological proof of CLD, improved diagnostic technologies, and new treatment protocols. These biomedical results have implications for improved CLD patient health outcomes and credibility for CLD as a legitimate disease on a biological and sociological level.

In der vorliegenden Arbeit sollten die unterschiedlichen Manifestationsformen der Borreliose anhand verschiedener Parameter verglichen und der Verlauf einer Borrelioseerkrankung analysiert werden. Dabei konnte gezeigt werden, dass es sich um eine ganzjährige Erkrankung handelt, die jedoch - je nach Manifestationsform - verschiedene jahreszeitliche Gipfel aufweist. So kommen die Neuroborreliose und die Frühborreliose gehäuft im Frühling und im Sommer vor, während die Lyme Arthritis durchweg ganzjährig auftritt. Da die Borrelien erst nach ca. 12 Stunden Latenz auf den Wirt übertragen werden, sind es vor allem die unbemerkten Zeckenstiche, die eine Infektion verursachen. Deshalb ist es nicht verwunderlich, dass sich nur rund 55 % der Patienten an einen zurück liegenden Zeckenstich erinnern konnten. Bei der Untersuchung der verschiedenen Laborparameter ergaben sich keine wesentlichen Unterschiede zwischen den Manifestationsformen bezüglich Hämoglobingehalt, Blutsenkungsgeschwindigkeit, Thrombozyten und Leukozyten im Serum. Desweiteren ergaben sich keine Hinweise auf eine Beteiligung des Rheumafaktors oder antinukleärer Antikörper an den immunologischen Prozessen während einer Lyme Arthritis Erkrankung. IL-17 konnte mittels ELISA weder in Serum/Plasma noch in Synovialflüssigkeit signifikant erhöht nachgewiesen werden. Es bleibt jedoch unklar, ob dies aufgrund einer langen Lagerung der Proben der Fall war oder ob IL-17 tatsächlich nicht signifikant erhöht vorlag. Aus der Literatur kann man entnehmen, dass IL-17 bei den Abläufen einer Infektion mit B. burgdorferi eine wichtige Rolle zu spielen scheint. Dies könnte einen Ansatz für neue Behandlungsmethoden der Lyme Arthritis darstellen, weshalb die Durchführung weitere Untersuchungen wichtig ist. Durch die Analyse der initialen Serologie konnte die Antikörperreaktion während einer Infektion mit B. burgdorferi veranschaulicht werden, die mit der Bildung von IgM- Antikörpern beginnt und dann einen Shift zu IgG-Antikörpern vollzieht. Die Antigene p19, p31/34, p39 und p65 scheinen hierbei vor allem bei der Lyme Arthritis im Vordergrund zu stehen. Weiterhin konnte bei dieser Analyse beobachtet werden, dass teilweise zahlreiche serologische Untersuchungen bei ein und demselbem Patienten statt fanden, was darauf schließen lässt, dass diese Untersuchung zur Verlaufskontrolle benutzt wurde. Grundsätzlich ist die Serologie hierzu jedoch nicht geeignet. Vielmehr sollte sie lediglich zur Diagnosestellung dienen. In dieser Funktion ist sie bei korrekter Interpretation ein hervorragendenes diagnostisches Mittel. Leider werden serologische Untersuchungen jedoch häufig falsch interpretiert und angewendet, was dazu führt, dass Patienten häufiger oder auch länger als nötig antibiotisch behandelt werden. So erhielten auch rund 8 % der Lyme Arthritis Patienten mehr als 2 Zyklen antibiotischer Therapie. Die Nebenwirkungen dieser langwierigen antibiotischen Behandlung sind nicht zu vernachlässigen. Die aktuellen Leitlinien sehen im Gegensatz dazu nämlich nach dem zweiten antibiotischen Zyklus den Beginn einer Therapie mit DMARD ́s vor, selten kommen auch intraartikuläre Steroide zum Einsatz. Diese beobachtete „Überdiagnostik und Übertherapie“ der Borrelioseerkrankung spiegelt vermutlich die Angst vor chronischen Verlaufsformen in der Bevölkerung und teilweise auch unter Ärzten wider. Bereits in anderen Studien konnte die Existenz einer therapieresistenten Verlaufsform der Borreliose - insbesondere der Lyme Arthritis – nachgewiesen werden. In der vorliegenden Arbeit litten 24 % der Lyme Arthritis Patienten nach einer adäquaten antibiotischen Behandlung laut eigenen Angaben zum Zeitpunkt der Umfrage noch unter Gelenkbeschwerden. Ob es sich hierbei nun um eine schwerwiegendere Verlaufsform in Europa handelt, bleibt zunächst offen. Zur Objektivierung der Beschwerden, zum Ausschluss einer Zweitinfektion oder aber auch einer Fibromyalgie als mögliche Differentialdiagnose sind prospektive Studien mit klinischer Untersuchung der Patienten im Verlauf nötig. Eindeutig ist jedoch, dass durch eine frühzeitige antibiotische Behandlung nach Infektion das Fortschreiten der Erkrankung effektiv verhindert werden kann. Chronische Beschwerden gaben hingegen auch die Patienten mit zurückliegender Neuroborreliose an. Rund 20% der Patienten litten nach eigener Angabe unter Allgemeinsymptomen, die ihre Lebensqualität subjektiv wesentlich einschränkten. Der spezifische Zusammenhang zwischen diesen Beschwerden und einer Neuroborreliose bzw. einer Borrelioseerkrankung im Allgemeinen ließ sich jedoch nicht endgültig klären. Es wäre hierfür der Vergleich mit einer gesunden Kohorte und die Anwendung spezieller neuropsychologischer Untersuchungen nötig. / This paper should compare different manifestations of borreliosis based on various parameters as well as analyze the development of a borreliosis infection. It could be shown that it is a year-round disease reaching different seasonal peaks depending on its manifestation. As an example, neuro borreliosis and early borreliosis occur frequently in spring and summer, whereas lyme arthritis infections occur during the whole year. As borrelia are transmitted to the host only after 12 hours of latency, especially tick bites that go unnoticed cause infections. That is why it does not come as a surprise that only 55% of the patients were able to remember a tick bite in the past. Examining the different laboratory parameters, no substantial differences between the different types of manifestation regarding haemoglobin content, erythrocyte sedimentation rate, thrombocytes and leucocytes in the serum were discovered. In addition, there were no hints as to a contribution of the rheumatic factor or antinuclear antibodies to immunologic processes during a lyme arthritis infection. Using ELISA, IL-17 could neither be detected in serum/plasma nor in synovial liquid in significantly increased concentrations. However, it remains unclear whether this was due to the long storage of the samples or whether IL-17 was actually not significantly increased. According to literature on this topic, IL-17 seems to play a major role during the course of an infection with B. burgdorferi. This could be a starting point for new ways of treating lyme arthritis and makes further research necessary. By analyzing initial serology, the antibody reaction during an infection with B. burgdorferi could be shown. It starts with the creation of IgM antibodies and then shifts to IgG antibodies. The antigenes p19, p31/34, p39 and p65 seem to be especially important when it comes to lyme arthritis. The analysis also made it clear that in some cases a single patient was exposed to numerous serological examinations what makes it probable that this examination was used to control the course of the infection. Basically, serology is not a suitable instrument to do so. It should rather be used to diagnose. Interpreting it correctly, it is in that function an excellent means of diagnosing. Unfortunately, serological examinations are often interpreted and applied in the wrong way, what leads to a more frequent or unnecessarily long antibiotics treatment of patients. Around 8% of lyme arthritis patients received more than two cycles of antibiotics treatment. The side effects of this longsome antibiotics treatment are not to be neglected. In contrast, current guidelines recommend a DMARDs therapy after the second cycle of antibiotics treatment, in rare cases intraarticular steroids are used. This observed “overdiagnostics and overtherapy” of borreliosis infections presumably reflects the fear of chronic infections among the population and partly among doctors. There have already been other studies proving the existence of a form of borreliosis infection resistant to therapy – especially regarding lyme arthritis. According to this paper, 24% of lyme arthritis patients said, when they were interrogated, that they were still suffering from arthralgia after an adequate antibiotics treatment. It remains open whether this is just a more serious progression in Europe. To come to an objective judgement of the pains, to exclude a second infection or a fibromyalgia as a potential differential diagnosis, prospective studies invoving clinical examinations of the patients are necessary. However, it is beyond any doubt that an early antibiotics treatment after the infection can effectively prevent the progress of the infection. Nevertheless, also patients with an overcome neuroborreliosis reported chronic pains. About 20% of the patients reported that they were suffering from general syndromes limiting their quality of life subjectively essentially. The specific connection between these pains and a neuroborreliosis respectively a borreliosis infection in general could, however, not be proven in the end. For this, it would be necessary to make a comparison with a healthy cohort and to apply special neuropsychological studies.