A doença de Lyme é uma doença causada pelas bactérias do complexo Borrelia burgdorferi sensu lato que são transmitidas por carrapatos do complexo Ixodes ricinus. A distribuição geográfica dessas bactérias é confirmada no Hemisfério Norte (America do Norte, Europa e Ásia). Suspeita-se que uma enfermidade, compatível com doença de Lyme no Brasil, esteja provavelmente relacionada a uma espécie de Borrelia diferente das espécies causadoras de doença de Lyme no hemisfério Norte e que o vetor sejam carrapatos do gênero Amblyomma. Por estas razões, a doença brasileira passou a ser chamada de Doença de Lyme-Símile (DLS). A borreliose aviária é causada pela Borrelia anserina, que apresenta distribuição cosmopolita. É transmitida por carrapatos argasideos do gênero Argas. O presente trabalho foi dividido em dois capítulos: o primeiro investigou a presença de Borrelia spp em áreas onde foram relatados casos humanos de DLS no Estado de São Paulo. No segundo capítulo, é relatado o primeiro isolamento em meio BSK e a caracterização molecular de uma cepa de espiroqueta aviária presumidamente identificada como B. anserina, no Brasil. Para o primeiro capítulo, foram processados um total de 349 carrapatos Amblyomm cajennense adultos coletados em áreas com suspeita de DLS, nove amostras de sangue ou tecidos de pacientes humanos com diagnóstico clínico e sorológico de DLS, duas amostras de caldas de meio BSK previamente inoculado com tecidos ou sangue de pacientes com suspeita de DLS, e três amostras de caldas de meio BSK previamente inoculado com carrapatos coletados de áreas com suspeita de DLS. Essas amostras tiveram seu DNA extraído e testado pela nested-PCR com primers específicos para porções do gene flagelina B (flaB), aptos a amplificar porções deste gene de qualquer espécie de Borrelia. Todas as amostras foram negativas pela nested-PCR, não evidenciando a presença de Borrelia sp nas amostras avaliadas. Para o segundo capítulo, foi utilizada uma amostra de espiroqueta aviária originária de carrapatos Argas miniatus, colhidos em um galinheiro no Município de Pedro Leopoldo, MG. O isolamento in vitro e caracterização molecular da espiroqueta aviária foi feito a partir da inoculação de soro infectado, contendo espiroquetas viáveis, em meio BSK. O soro, baço, fígado e o próprio cultivo foram utilizado para amplificação na PCR para os genes rrs e flaB, seguido de seqüenciamento dos mesmos. O isolamento da espiroqueta foi obtido com sucesso, com várias passagens realizadas. A análise genética das seqüências do isolado mostrou 99.8% (483 de 484-bp) e 98.7% (754 de 764-bp) de similaridade às seqüências correspondentes dos genes rrs e flaB de B. anserina, respectivamente, disponíveis no GenBank. Pela análise filogenética inferida pela seqüência parcial do gene flaB, a cepa Brasileira agrupou-se com a seqüência de B. anserina dos EUA. Os resultados indicam a cepa brasileira estudada, designada de cepa PL, pertence à espécie B.anserina. / Lyme disease is caused by bacteria belonging to the complex Borrelia burgdorferi sensu lato, which are transmitted by ticks of the Ixodes ricinus complex. The distribution of these bacteria are restricted to the northern hemisphere (North America, Europe, and Asia). Lyme disease-like cases have been reported in Brazil, but it is possible that another Borrelia species is involved in these cases, and ticks of the genus Amblyomma have been implicated as vectors. Due to these reasons, the disease in Brazil has been referred as Lyme Disease-Simile (LDS). Borrelia anserina, the agent of avian spirochetosis, has a wordwide distribution, where it is transmitted primarily by ticks of the genus Argas. The present study was divided in two chapters: the first one evaluated the presence of Borrelia spp in areas of the state of São Paulo where LDS have been reported. The second chapter reports the first in vitro isolation in BSK medium and molecular characterization of a spirochete strain from Brazil, presumably identified as B. anserina. For the first chapter, a total of 349 adult ticks (Amblyomma cajennense) collected in areas where LDS cases have been reported were processed. In addition, nine human blood or tissue samples from patients with clinical and serological diagnostic of LDS, two samples from BSK medium previously inoculated with samples of skin or blood of LDS patients, and three samples of BSK medium previously inoculated with tick samples were also processed. All these samples were processed for DNA extraction and then tested by nested-PCR employing primers targeting a portion of the flagelin B gene (flaB),which amplify a flaB fragment in all known Borrelia species. All samples were negative by this nested-PCR, showing no evidence of Borrelia sp in the tested samples. The second chapter evaluated an avian spirochete strain originated from Argas miniatus ticks from Pedro Leopoldo municipality, state of Minas Gerais. DNA fragments of the rrs (16S rRNA) and flab genes were amplified by PCR and sequenced to determine phylogenetic similarities. The resulting sequences were 99.8% (483 of 484) and 98.7% (754 of 764) similar to GenBank corresponding sequences of B. anserina rrs and flaB genes, respectively. By neighbor-joining phylogenetic analysis, the flaB sequence of the Brazilian strain clustered in a monophyletic group with the sequence of B. anserina under 100% bootstrap support. The isolate was successfully isolated in BSK medium, with seven passages performed. The spirochete crude antigen, fixed in glass slides, showed strong immunfluorescence reactivity with sera from chickens previously inoculated with the isolate. The spirochete strain isolated in the present study was genetically identified as B. anserina, labeled as strain PL.

La thèse vise à comprendre comment une diversité de définitions d'une maladie émergente et complexe, la Borréliose de Lyme, se construisent aujourd'hui dans un grand nombre de lieux. Ces définitions sont parfois concurrentes, parfois étrangères l'une à l'autre ; parfois médiatisées, parfois confinées dans des espaces discrets. Pour comprendre cette diversité, je mobilise le concept de pratique développé par Stengers (2006). J'ai accédé aux processus de connaissance mis en œuvre par les praticiens à travers les deux versants qui définissent une pratique : les obligations, qui renvoient à leur manière spécifique d'interroger l'objet ou l'être dont ils cherchent à apprendre quelque chose ; les exigences qui opèrent des exclusions et tracent des frontières entre pratiques. Cette grille d'analyse s'applique à des groupes de taille variable, professionnels ou non, mandatés ou pas par le politique, de même qu'aux vivants non-humains. La première partie situe la maladie de Lyme dans le champ des maladies et définit sa spécificité en regard des « maladies environnementales » qui ont pour cause les pollutions industrielles. En tant que maladie infectieuse ayant pour vecteur une tique et pour réservoir la faune sauvage, la maladie de Lyme présente davantage les traits d'une « maladie écologique » qui renouvelle l'attribution des responsabilités, les modes de gestion, la nature des entités incriminées ainsi que l'identité des praticiens impliqués. À partir de ce constat, j'ai fait l'hypothèse d'une « écologisation des problèmes sanitaires » : les problématiques environnementales s'immiscent dans d'autres secteurs. J'ai interrogé cette écologisation thématique à la lumière de « l'écologisation des pratiques » que Stengers définit comme un mode de relation entre pratiques qui remplace les exclusions par des coordinations pour produire des savoirs nouveaux, dynamiques et irréductibles à chaque pratique. La deuxième partie expose les pratiques de quatre groupes de praticiens : les malades chroniques qui échangent sur Internet, les infectiologues, les ticologues et les écologues généticiens des populations. L'analyse révèle l'existence de deux espaces de discussions marqués par des relations distinctes : dans le premier, médical, diagnostic et curatif, les définitions de la maladie s'opposent tandis qu'elles se chevauchent dans le second, environnemental, épidémiologique et préventif. Ces deux espaces entretiennent peu de relations entre eux. La troisième partie s'intéresse aux interractions entre praticiens. À travers un groupe de travail, un lieu, un concept et des techniques diagnostiques, j'interroge la rencontre effective entre pratiques environnementales et médicales. L'essentiel des collaborations entre acteurs environnementaux et médicaux portent sur la prévention de la maladie. Les savoirs écologiques, comme ceux des malades, ont pourtant un potentiel pour une autre élaboration du diagnostic de ces maladies. Cette analyse montre que des frictions apparaissent lorsque des praticiens interrogent un même vivant sur des modes différents. À l'inverse, une sympathie se manifeste entre praticiens dès lors qu'ils interrogent sur le même mode des vivants différents. Plus qu'une écologisation du sanitaire, la thèse met en évidence un processus de « sanitarisation de l'écologie ». En effet, ce sont les praticiens rattachés à l'écologie qui s'immiscent dans la thématique des « maladies infectieuses émergentes ». Les savoirs qu'ils produisent tendent à dépeindre un ensemble de maladies variables dans le corps et le milieu, qui rappelle la définition par les malades, sans que ces groupes de praticiens disposent à ce jour d'espace de rencontre. / This thesis aims to understand how a range of definitions of a complex and emerging disease, the Lyme disease, are currently being constructed in many places. These definitions sometimes compete and sometimes develop separately ; they are sometimes widely disseminated and sometimes circumscribed in discrete places. To understand this diversity, I use the concept of « practice » as developed by Stengers (2006). A practice is defined by two sides : obligations, which refer to the specific way in which practitioners relate to the object or being they seek to learn something about ; demands, which generate exclusions and draw boudaries between practices. This framework applies to groups of different sizes and natures, and to non-humans beings. The first part of the thesis situates the Lyme disease among other diseases and clarifies its differences with the « environmental diseases » caused by industrial pollutions. As an infectious disease transmitted by a tick and with a wildlife reservoir, the Lyme disease rather presents the features of an « ecological disease » that renews the attribution of responsibilities, management modes, the nature of entities that are incriminated and identity of practitioners involved. This statement led me to the hypothesis of an « ecologization of health problems » : environmental issues are introduced in other domains. I examined this thematic ecologization through the « ecologization of practices », which Stengers defines as a mode of relation between practices where exclusions are replaced by coordinations in order to produce new, dynamic and transversal knowledge. The second part presents the practices of four groups of practitioners : persons with chronic Lyme disease who exchange on the Internet, infectious disease specialists, tick specialists and specialists of population genetics. The analysis shows the existence of two discussion spaces characterized by distinct relationships : in the first one, which is medical, diagnosis and cure-oriented, definitions of the disease oppose one another while they overlap in the second space, which is environmental, epidemiological and prevention-oriented. There are few relations between these two spaces. The third part focuses on the interactions between practitioners. Through a work group, a place, a concept and diagnosis techniques, I scrutinize how environmental and medical practices actually encounter one another. Most collaborations between environmental and medical practitioners concern the prevention of the disease. Yet, the ecological knowledge of the sick persons has a potential for another elaboration of the diagnosis of these diseases. The analysis shows that frictions appear when practitioners relate differently to a same being. On the contrary, there is sympathy between practitioners who relate similarly to different beings. Rather than an « ecologization of the health sector », this thesis shows a process of « sanitarization of ecology ». Indeed, the practitioners related to ecology are those who become involved in the emerging infectious diseases issues. The knowledge they produce suggests a set of diseases that vary across space and bodies. This reminds how the sick persons define their disease. However, these groups of practitioners do not have (so far) a place to meet and exchange.

Lyme disease (LD) is the most prevalent vector borne disease is North America with 300,000-600,000 human cases each year. Preventative strategies for LD in humans are poorly developed and largely inadequate. While preventive vaccines for LD are widely used in veterinary medicine, there are no vaccines available for use in humans. The goal of this study was to develop a human vaccine that can elicit antibody responses that kill spirochetes in both the tick and mammalian environments. The approach applied in this study centered on the development of chimeric epitope proteins, referred to as chimeritopes. Chimeritopes consist of a series of epitopes derived from one or more proteins or protein variants. Three chimeritope proteins designated as Chv1, Chv2 and Chv3 were designed. These proteins harbor the same set of 18 linear epitopes derived from 9 different OspC type proteins. They differ in epitope arrangement or by the presence or absence of linkers between specific protein segments. The immunogenicity of each protein was assessed in multiple animal models including mice, rats, and purpose bred beagles. Immunoblot, ELISA, and IFA analyses using sera from immunized animals demonstrated that the Chv proteins elicit IgG responses that recognize a diverse array of OspC type proteins. Anti-Chv and anti-OspA antisera displayed complement dependent bactericidal activity. To assess protective efficacy, purpose bred beagles were immunized with each vaccine formulation and then challenged by infestation with infected ticks. Efficacy was assessed by monitoring seroconversion, cultivation of tissue biopsies, clinical presentation and histopathological analysis of joints and tissues. All dogs vaccinated with the Chv2-OspA combination were fully protected. All dogs in this group were seronegative for LD, biopsy culture negative and did not develop LD associated symptoms including lameness or lesions in tissues or joints. In light of market concerns centered on the use of full length OspA in a human vaccine, epitope mapping was performed to identify a linear epitope that could be employed in development of a possible OspC-OspA chimeritope. A linear epitope, designated as OspA221-240was identified. Antisera to KLH-OspA221-240displayed potent and broad bactericidal activity. Interestingly, the OspA221-240epitope has homology to residues 244 to 263 of OspB suggesting that OspB may also be a potential candidate for inclusion in a human vaccine. This study establishes proof of principle for the use of OspC chimeritopes in LD subunit vaccines and highlights the need to employ a multi-valent, multi-antigen vaccine approach in development of a human LD vaccine.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

A doença de Lyme é uma doença causada pelas bactérias do complexo Borrelia burgdorferi sensu lato que são transmitidas por carrapatos do complexo Ixodes ricinus. A distribuição geográfica dessas bactérias é confirmada no Hemisfério Norte (America do Norte, Europa e Ásia). Suspeita-se que uma enfermidade, compatível com doença de Lyme no Brasil, esteja provavelmente relacionada a uma espécie de Borrelia diferente das espécies causadoras de doença de Lyme no hemisfério Norte e que o vetor sejam carrapatos do gênero Amblyomma. Por estas razões, a doença brasileira passou a ser chamada de Doença de Lyme-Símile (DLS). A borreliose aviária é causada pela Borrelia anserina, que apresenta distribuição cosmopolita. É transmitida por carrapatos argasideos do gênero Argas. O presente trabalho foi dividido em dois capítulos: o primeiro investigou a presença de Borrelia spp em áreas onde foram relatados casos humanos de DLS no Estado de São Paulo. No segundo capítulo, é relatado o primeiro isolamento em meio BSK e a caracterização molecular de uma cepa de espiroqueta aviária presumidamente identificada como B. anserina, no Brasil. Para o primeiro capítulo, foram processados um total de 349 carrapatos Amblyomm cajennense adultos coletados em áreas com suspeita de DLS, nove amostras de sangue ou tecidos de pacientes humanos com diagnóstico clínico e sorológico de DLS, duas amostras de caldas de meio BSK previamente inoculado com tecidos ou sangue de pacientes com suspeita de DLS, e três amostras de caldas de meio BSK previamente inoculado com carrapatos coletados de áreas com suspeita de DLS. Essas amostras tiveram seu DNA extraído e testado pela nested-PCR com primers específicos para porções do gene flagelina B (flaB), aptos a amplificar porções deste gene de qualquer espécie de Borrelia. Todas as amostras foram negativas pela nested-PCR, não evidenciando a presença de Borrelia sp nas amostras avaliadas. Para o segundo capítulo, foi utilizada uma amostra de espiroqueta aviária originária de carrapatos Argas miniatus, colhidos em um galinheiro no Município de Pedro Leopoldo, MG. O isolamento in vitro e caracterização molecular da espiroqueta aviária foi feito a partir da inoculação de soro infectado, contendo espiroquetas viáveis, em meio BSK. O soro, baço, fígado e o próprio cultivo foram utilizado para amplificação na PCR para os genes rrs e flaB, seguido de seqüenciamento dos mesmos. O isolamento da espiroqueta foi obtido com sucesso, com várias passagens realizadas. A análise genética das seqüências do isolado mostrou 99.8% (483 de 484-bp) e 98.7% (754 de 764-bp) de similaridade às seqüências correspondentes dos genes rrs e flaB de B. anserina, respectivamente, disponíveis no GenBank. Pela análise filogenética inferida pela seqüência parcial do gene flaB, a cepa Brasileira agrupou-se com a seqüência de B. anserina dos EUA. Os resultados indicam a cepa brasileira estudada, designada de cepa PL, pertence à espécie B.anserina. / Lyme disease is caused by bacteria belonging to the complex Borrelia burgdorferi sensu lato, which are transmitted by ticks of the Ixodes ricinus complex. The distribution of these bacteria are restricted to the northern hemisphere (North America, Europe, and Asia). Lyme disease-like cases have been reported in Brazil, but it is possible that another Borrelia species is involved in these cases, and ticks of the genus Amblyomma have been implicated as vectors. Due to these reasons, the disease in Brazil has been referred as Lyme Disease-Simile (LDS). Borrelia anserina, the agent of avian spirochetosis, has a wordwide distribution, where it is transmitted primarily by ticks of the genus Argas. The present study was divided in two chapters: the first one evaluated the presence of Borrelia spp in areas of the state of São Paulo where LDS have been reported. The second chapter reports the first in vitro isolation in BSK medium and molecular characterization of a spirochete strain from Brazil, presumably identified as B. anserina. For the first chapter, a total of 349 adult ticks (Amblyomma cajennense) collected in areas where LDS cases have been reported were processed. In addition, nine human blood or tissue samples from patients with clinical and serological diagnostic of LDS, two samples from BSK medium previously inoculated with samples of skin or blood of LDS patients, and three samples of BSK medium previously inoculated with tick samples were also processed. All these samples were processed for DNA extraction and then tested by nested-PCR employing primers targeting a portion of the flagelin B gene (flaB),which amplify a flaB fragment in all known Borrelia species. All samples were negative by this nested-PCR, showing no evidence of Borrelia sp in the tested samples. The second chapter evaluated an avian spirochete strain originated from Argas miniatus ticks from Pedro Leopoldo municipality, state of Minas Gerais. DNA fragments of the rrs (16S rRNA) and flab genes were amplified by PCR and sequenced to determine phylogenetic similarities. The resulting sequences were 99.8% (483 of 484) and 98.7% (754 of 764) similar to GenBank corresponding sequences of B. anserina rrs and flaB genes, respectively. By neighbor-joining phylogenetic analysis, the flaB sequence of the Brazilian strain clustered in a monophyletic group with the sequence of B. anserina under 100% bootstrap support. The isolate was successfully isolated in BSK medium, with seven passages performed. The spirochete crude antigen, fixed in glass slides, showed strong immunfluorescence reactivity with sera from chickens previously inoculated with the isolate. The spirochete strain isolated in the present study was genetically identified as B. anserina, labeled as strain PL.

Host cell attachment by pathogenic bacteria can play very different roles in the course of infection. The pathogenic spirochetes Borrelia hermsii and Borrelia burgdorferi sensu lato which cause relapsing fever and Lyme disease, respectively, are transmitted by the bite of infected ticks. After transmission, these spirochetes can cause systemic infection. Relapsing fever spirochetes remain largely in the bloodstream causing febrile episodes, while Lyme disease will often colonize a variety of tissues, such as the heart, joint and nervous system, resulting in a chronic multisystemic disorder. Borrelia species have the ability to bind to various cell types, a process which plays a crucial role in pathogenesis and may influence spirochetal clearance from the bloodstream. Colonization of multiple tissues and cell types is likely promoted by the ability to bind to components found in target tissues, and many B. burgdorferi adhesins have been shown to promote attachment to a wide variety of cells and extracellular matrix components. Different Lyme disease strains have been shown to preferentially colonize certain tissues, although the basis of this tissue tropism is not well understood. In this study we found that among different Lyme disease strains, allelic variation of the adhesin DbpA contributes to variation in its in vitro binding activities raising the possibility that this variation contributes to tissue tropism in vivo. In studying B. hermsii infection, we found evidence by both histological and fluorescence in situ hybridization (FISH) analysis of tissues that indicated that red blood cells were removed by tissue resident macrophages in infected mice. Spirochetes in the spleen and liver were often visualized associated with RBCs, lending support to the hypothesis that direct interaction of B. hermsii spirochetes with RBCs leads to clearance of bacteria from the bloodstream. Our findings indicate that host cell attachment play a key role in the establishment of Lyme disease infection, and in contrast contributes to the clearance of relapsing fever infection.

Host cell binding is an essential step in colonization by many bacterial pathogens, and the Lyme disease agent, Borrelia burgdorferi, which colonizes multiple tissues, is capable of attachment to diverse cell types. Glycosaminoglycans (GAGs) are ubiquitously expressed on mammalian cells and are recognized by multiple B. burgdorferi surface proteins. We previously showed that B. burgdorferi strains differ in the particular spectrum of GAGs that they recognize, leading to differences in the cultured mammalian cell types that they efficiently bind. The molecular basis of these binding specificities remains undefined, due to the difficulty of analyzing multiple, potentially redundant cell attachment pathways and to the paucity of genetic tools for this pathogen. Complementation of a high-passage non-adherent B. burgdorferi strain reveals that the expression of DbpA, DbpB, or BBK32, is sufficient to confer efficient spirochete attachment to 293 epithelial cells. Epithelial cell attachment by DbpA and B was mediated by dermatan sulfate, while BBK32 recognized dermatan and heparan sulfate. The GAG binding properties of bacteria expressing DbpB or DbpA were distinguishable in that DbpB, but not DbpA, promoted spirochetal attachment to C6 glial cells. Furthermore, DbpA alleles from diverse Lyme disease spirochetes exhibit allelic variation with respect to binding decorin, dermatan sulfate, and epithelial cells. Targeted disruption of bbk32 resulted in decreased spirochete binding to fibronectin, GAGs, and mammalian cells. Thus, DbpA, DbpB, and BBK32 may play central but distinct roles in cell type-specific binding by Lyme disease spirochetes. This study illustrates that transformation of high-passage B. burgdorferi strains and targeted gene disruption provide a comprehensive genetic approach to analyze virulence-associated phenotypes conferred by multiple bacterial factors.

Lyme disease, the most common tick borne disease in United States, is caused by the bacterial pathogen Borrelia burgdorferi. In nature, B. burgdorferi exists in an enzootic infectious cycle between an arthropod vector and mammalian hosts. Identification and characterization of the genes essential for B. burgdorferi survival throughout its infectious cycle is an important step toward understanding the molecular mechanisms involved in B. burgdorferi pathogenesis. B. burgdorferi contains a small genome, which lacks the genes encoding for the enzymes required for de novo synthesis of amino acids, fatty acids and nucleic acid precursors. Therefore, the spirochete is dependent upon the host environment for the uptake of these essential nutrients. Purines are required for the synthesis of nucleotides for the biosynthesis of DNA and RNA. Due to the lack of de novo purine synthesis, the ability of B. burgdorferi to salvage purines from its host environments is essential to its survival. While the enzymes critical for the B. burgdorferi purine salvage pathway are known, the transporters involved in the uptake of purines from the host environments are not. The work in this thesis is focused on identification of the genes encoding purine permeases in B. burgdorferi and genetic and biochemical characterization of their functions in the infectious cycle of B. burgdorferi. Here, we demonstrate that homologous genes bbb22 and bbb23 present on circular plasmid 26 encode for purine permeases, which are important for transport of hypoxanthine, adenine and guanine. Furthermore, genes bbb22-23 together were essential for B. burgdorferi infection in mice. BBB22 and BBB23 share 78% amino acid identify. And although, individually both BBB22 and BBB23 were found to be capable of purine transport, BBB22 has higher affinity for hypoxanthine and adenine compared to BBB23. Moreover, the bbb22 gene alone was sufficient to restore mouse infectivity to spirochetes lacking both bbb22 and bbb23, whereas, bbb23 was not. Nonetheless, the spirochete loads in the tissues of mice infected with B. burgdorferi carrying bbb22 alone were significantly reduced compared to B. burgdorferi carrying both bbb22 and bbb23, demonstrating the importance of the two genes together for the spirochetes to achieve wild type levels of infection. In ticks, genes bbb22 and bbb23 were dispensable for spirochete survival but contributed to spirochete replication in fed larvae. The replication of spirochetes lacking bbb22-23 in larval ticks was restored to wild type levels by the reintroduction of the low affinity purine transporter encoded by bbb23 alone. Overall, we have identified a purine transport system in B. burgdorferi, which is essential for spirochete survival in the mammalian host and contributes to spirochete replication in the tick vector. As B. burgdorferi lacks typical virulence factors and toxins, these studies highlight the critical role of physiological functions in the virulence of this pathogen. Moreover, the BBB22-23 in vivo essential transport system may represent a novel therapeutic target to deliver antimicrobial drugs to treat Lyme disease.

Lyme disease, caused by the bite of a deer tick infected with Borrelia burdorferi, has been increasing in distribution and prevalence annually throughout Maine. Worker’s compensation claims for Lyme disease have also been increasing steadily since the initial claim made in 1999. This research reviewed Maine worker’s compensation claims for Lyme disease from 1999-2011 to determine trends in state distribution and occupation type. Descriptive statistics were calculated to analyze different distributions of occupational Lyme disease. Occupations with the highest distribution of Lyme disease claims were those requiring workers to spend the majority of their time outdoors. A clear trend of claim distribution was seen, which mirrored that of the State of Maine Lyme disease case surveillance data. With the apparent increase in worker’s compensation claims due to Lyme disease and an increased geographic distribution annually, additional prevention and education efforts should be focused toward the higher risk occupations.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010. / Härtill 5 uppsatser.