Most everyone who is familiar with Lyme disease has heard the story. In November of 1975, 51 people (39 children and 12 adults) mysteriously became ill in Lyme, Connecticut, and a new illness was born (Lloyd 1976).
The event became newsworthy because a cluster of people, all bitten by ticks, suddenly became ill simultaneously. Interestingly, it was a time when people were moving out of cities and into the suburbs built in the tick-filled, wooded countryside.
The illness, typified by arthritis and an unusual rash around the tick bite, was first thought to be viral. By 1981, however, a researcher named Dr. Willy Burgdorfer and his colleagues had isolated the now well-known, corkscrew-like bacteria (called a spirochete) from the blood of victims. The microbe[1] was named in his honor, Borrelia burgdorferi, and the illness was named for the place of origin (Burgdorfer 1984, 1993).
Once people became aware of the new microbe and the illness it caused, cases started popping up all over New England and beyond. Lyme disease seemed to be the newest plague.
An Enigma to Medical Science
From the very beginning, Borrelia burgdorferi frustrated both doctors and scientists. Medical science during that era was focused on snuffing out all the horrible poxes and plagues that threatened the lives of every person on the planet. Great progress was being made with new vaccines and synthetic antibiotics, and optimism was high that someday all threatening infectious diseases would be eradicated from the planet.
Borrelia hindered that optimism.
Borrelia simply didn’t behave like other microbes and other illnesses that medical science was used to dealing with. It made people sick, but not deathly sick. And some people exposed to it didn’t get sick at all.
The microbes were hard to grow in the lab and extremely difficult to isolate from the blood of people who displayed symptoms (making a definitive diagnosis a real challenge, even today). Though the bacteria were sensitive to most antibiotics in the lab, people often ended up chronically and miserably ill despite antibiotic therapy.
Today, Borrelia burgdorferi and Lyme disease are as much of a mystery as ever before. Public awareness about Lyme disease is at an all-time high, but concern from the medical community is at an all-time low. If something is difficult to diagnose, difficult to treat, difficult to understand, and rarely causes life-threatening illness, doctors simply don’t have time in their busy practices to deal with it.
At the heart of this dilemma is a fundamental lack of understanding of the true nature of Borrelia burgdorferi (and possibly microbes in general).
Is Lyme Disease Actually New?
When Lyme disease first debuted, medical science was just beginning to connect the dots between specific microbes and specific illnesses. Doing so was relatively easy with terrible illnesses that had well-defined symptoms, but Lyme disease was anything but well-defined. It took a cluster of similar cases for science (and the media) to take notice at all.
At the time, Lyme disease was labeled as a brand-new illness. It was assumed that new infections with Borrelia spread outward from the point of origin in Lyme, Connecticut. Information that has accumulated in the following years, however, strongly suggests that Borrelia is anything but new.
Even Dr. Burgdorfer and his colleagues suspected they were not dealing with a brand-new illness.[2] Physicians in Europe and North America had been describing a tick-borne illness associated with a bull’s-eye rash (then called erythema migrans, for the rash emanating from the tick bite) for hundreds of years. Because the illness typically resolved without treatment, it had received little notoriety.
Figure 1 - Bull's-eye rash (erythema migrans)
As it turns out, Borrelia is even much older than hundreds of years...Borrelia is truly ancient.
Borrelia species have been found inside ticks trapped inside amber dating back 15-20 million years[3] (and it may be even older). Over that period, Borrelia has developed host-microbe relationships with a huge variety of creatures. In fact, this extremely adaptable microbe can infect most anything with blood. Today, the microbe commonly infects mammals, birds, and even some reptiles.[4]
Because ticks have been biting humans since there have been humans, it would be logical to assume that humans have been on Borrelia’s list of hosts for a very long time as well. Recently, this fact was conclusively confirmed by a bit of evidence found frozen in a glacier for over 5,000 years.
In 1993, the remains of an ancient human were recovered from a glacier in the Italian Alps. Remarkably well-preserved, the 5,300-year-old mummy yielded a wealth of information to forensic scientists and anthropologists. Findings at a formal autopsy in 2011 revealed a surprise: the genetic signature of Borrelia burgdorferi.
At the time of his death, the mummy was in his mid-forties and showed signs of arthritis and degenerative disease, but was murdered with an arrow in the back. He did not die from Lyme disease (Hall 2011).
This is the most intriguing part about the discovery — the 5,300-year-old man wasn’t severely debilitated. He harbored the microbe,[5] but was still mobile and functional. At the time of his murder, the man was actually traversing treacherously high mountain terrain in the European Alps (he apparently carried sacks of goods from one community to another).
This is a fundamental point for understanding Borrelia and tick-borne microbes in general. Making the host deathly sick is not Borrelia’s mission. In fact, a bedridden host works against the microbe’s primary purpose.
To complete its life cycle, Borrelia microbes must infect a new host via a tick bite, reproduce within that host (which only requires maintaining a simple presence of the microbe in the host’s tissues, not an overwhelming infection), and then get on board a new tick when the host is bitten again. That last step, re-boarding a new tick, is crucial. If the host is never bitten by another tick, the microbe reaches a dead end. It can’t spread to new hosts.
In other words, the microbes need a mobile host to fulfill their purpose. The more mobile the host is and the more tick bites the host receives, the better it is for the microbes.
A severely debilitated host is the sign of an imbalanced host-microbe relationship. It suggests that the host’s immune system has been unnaturally compromised.
Borrelia, a Newly Emerging Microbe?
Borrelia is often compared to HIV as a “newly emerging microbe.” Newly emerging implies that such microbial infection is new to the scene and rapidly expanding.
Human immunodeficiency virus (HIV), the cause of acquired immune deficiency syndrome (AIDS), fits the definition of “newly emerging” perfectly. HIV first crossed over into human populations from monkeys in the early mid-twentieth century. It was first recognized in the United States in 1981. Over a very short period, HIV rapidly spread across the entire globe.
Most people infected with HIV become severely ill and often die (before drug therapies, most died). Symptoms of HIV are very recognizable; it’s easy to tell who’s sick and who isn’t. Because the virus causes overwhelming infection in the host, testing for HIV is very reliable. The incidence of infection within any population of people has always been easy to define.
Infection with Borrelia is the exact opposite. We now know that Borrelia isn’t at all new to humans, and that it’s been infecting humans for many thousands of years. Symptoms related to infection are highly variable, and many people infected with Borrelia never get sick. People carrying the microbe without having symptoms are unlikely to be tested.
Testing for Borrelia burgdorferi wasn’t done before 1981, so we have no idea how common it was for people to be infected prior to that date. Testing that has been done over the past 40 years has generally been poor and sporadically performed, certainly not enough to establish a reliable estimate of the true rate of infection.
Though more Borrelia diagnoses are made every year (especially over the past five to ten years), it may be a factor of improved testing (though testing is still far from being ideal) and the fact that more people with symptoms are being tested. Increased awareness artificially skews the data, making it appear that the rate of infection has increased, though it may or may not have.
No doubt, tick populations and the microbes they transmit are being affected by environmental changes, global warming, loss of large animal species, reforestation of farmland, and mobility of human populations, but how this affects the actual rate of Borrelia infection in humans is truly unknown.
Maybe there are a lot more ticks, but are people getting bitten more often? A hundred years ago, before industrialization, many people spent a good portion of their lives working outside in fields and woodlands. Tick bites were an everyday fact of life. Today, most people spend most of their time indoors. Tick bites are much less common for the average person.
Now that researchers are finally getting around to looking for Borrelia in tick populations, they are finding that the microbe is quite prevalent. Borrelia has been found in tick populations from the Arctic to the tropics and everywhere in between; it’s present wherever there are ticks (Hvidsten 2015 and Masuzawa 2004). Because the relationship between Borrelia and ticks is so ancient, it can be assumed that Borrelia has had a widespread presence in tick populations worldwide for a very long time.
All of this leaves a very cloudy picture for Borrelia. At this moment, no institution or individual in the world has any idea of how many people are infected with Borrelia, past or present (no matter what they might say) — the rate of people harboring Borrelia without having symptoms may be much higher than presently estimated. Without knowing how many people are presently infected with Borrelia or have been in the past, it is impossible to classify Borrelia as a newly emerging microbe.
An overriding question, one that’s more important than knowing the actual rate of Borrelia infection, is: Are people getting sicker from Borrelia today than they did in the past?
If the iceman of the Italian Alps provides any sort of example, Borrelia wasn’t causing severely debilitating illness 5,000 years ago.
And before 1975, Borrelia wasn’t making people sick enough to even get noticed.
Today, however, almost everyone knows someone who has been touched by the chronic, debilitating side of Lyme disease. It’s in the headlines almost every day.
It does appear that debilitating chronic illness associated with Borrelia infection is becoming much more prevalent (or at least much more noticed), even though the rate of infection with Borrelia within human populations may or may not have changed much throughout history.
This is potential cause for concern. For an ancient bacterium that has been causing low grade infection in humans for thousands of years to suddenly start causing widespread, debilitating illness suggests an imbalance in nature. It suggests that factors unique to the modern world are making people more vulnerable to becoming chronically ill.
This concern, and how it affects our relationship with Borrelia burgdorferi and microbes with similar characteristics, will be thoroughly explored in upcoming chapters. It’s the key to understanding Lyme disease and similar chronic illnesses that have become the plagues of modern times.
ESSENTIAL LYME DISEASE FACTS