Cerebrospinal fluid profiles across clinical manifestations of early European Lyme neuroborreliosis
This study analysed the cerebrospinal fluid (CSF) of 405 patients with confirmed early Lyme neuroborreliosis (LNB) treated at a single centre between 2005 and 2025. Thirteen routine CSF parameters were analysed across three main clinical manifestations – meningoradiculoneuritis (Bannwarth syndrome), cranial neuritis, and erythema migrans-associated meningitis (EM-meningitis).
The extent of CSF inflammation and blood-brain barrier dysfunction differed across the three groups. Bannwarth syndrome was associated with the most pronounced intrathecal inflammatory response, whereas EM-associated meningitis represented a milder phenotype. CSF abnormalities evolve over time, underscoring the importance of early diagnostic evaluation.
(Published September 2026)
Post-Treatment Lyme Disease Syndrome in six European countries using data from the Burden of Lyme Disease (BOLD) study
(Published August 2026)
Single-step immunoblot tests with recombinant protein antigens for detecting IgG and IgM antibodies in Lyme disease
A peer-reviewed US study published in Microbiology Spectrum assessed the effectiveness of FDA-approved Lyme disease antibody tests from IGeneX (#325 and #335) against standard US two-tier testing (STTT) in early-stage patients (up to 30 days post-infection). The data revealed that these tests used together detected antibodies in 58.3% of cases compared to just 30.0% with traditional STTT, nearly doubling accurate detection during the critical early window.
Read IGeniX’s press release for more information.
(Published July 2026)
Antiphospholipid antibodies in acute and post-treatment Lyme disease
This study evaluates antilipid antibodies as biomarkers for both acute and post-treatment Lyme disease, possibly offering a potential breakthrough in diagnosing patients before standard seroconversion occurs. The researchers discovered that antiphosphatidic acid and antiphosphatidylserine levels rise significantly at the time of initial diagnosis, while a distinct subset of patients suffering from chronic, post-treatment symptoms exhibits persistent elevation of antiphosphatidylserine. Crucially, this persistent antibody profile was not present in look-alike autoimmune disorders.
Further research is needed to understand whether dysregulated antilipid immune responses directly drive chronic pathology and whether antilipid antibodies could provide clinicians with a highly specific biomarker to objectively identify and monitor post-treatment Lyme disease.
(Published June 2026)
Results from an enhanced surveillance study of laboratory-confirmed acute Lyme disease cases in England between 1 April 2023 and 31 March 2024
In England, Lyme disease (LD) surveillance is based on laboratory-confirmed cases. However, clinical and epidemiological characteristics of these cases are limited so an enhanced surveillance study of acute LD in England was conducted. An online questionnaire was sent to all laboratory-confirmed acute cases of LD resident in England, with specimen dates between 1 April 2023 and 31 March 2024. The analysis included data from 511/1086 cases. Respondents were representative of age, sex, and region of national LD trends.
A total of 57.3% of the respondents reported that they did not realise that they had been bitten by a tick. Among those who remembered a tick bite, 66.1% reported bites close to their home with 28.5% reporting that the tick bite could have occurred in a garden (only 10.6% happened abroad). Most respondents were residents of areas of higher socioeconomic status. Erythema migrans was noted by 70.5% of the respondents.
(Published June 2026)
Patient roadmap and economic burden of chronic tick-borne illness and post-treatment Lyme disease syndrome in Ireland, and public health issues arising
The research aimed to inform the cost of LD and post-treatment Lyme disease syndrome (PTLDS) in Ireland through results from a patient questionnaire, disease modelling, the construction of a patient roadmap, and attempts to arrive at prevalence calculation estimates based on local data.
(Published June 2026)
Bird-Borrelia Interactions: A Historical Review and Their Significance for Human Disease Ecology
Research increasingly identifies wild birds, particularly long-distance migratory species, as epidemiologically relevant hosts and vectors for tick-borne Borrelia species that pose risks to both avian and human health. T
(Published May 2026)
Infection-Triggered Immune Dysregulation and Immunopathology in Lyme Disease: Mechanisms and Clinical Implications
Lyme disease is classically defined as a tick-borne infection caused by Borrelia burgdorferi sensu lato (Bbsl). However, accumulating evidence indicates that, beyond microbial persistence, Bbsl infection can initiate sustained immune dysregulation and post-infectious inflammatory phenotypes in a subset of patients. This narrative review integrates open-access experimental, translational, and clinical data and discusses Lyme disease within the spectrum of infection-triggered, immune-mediated processes.
(Published April 2026)
Characterisation of Borrelia-Derived Extracellular Vesicles: Implications for Pathogenesis and Diagnostics
This study supports the idea that bacterial extracellular vesicles (BEVs) released by Borrelia burgdorferi, the causative agent of Lyme disease, exacerbate spirochete-induced damage and serve as a persistent source of antigenic stimulation. It also supports their potential utility as diagnostic and therapeutic targets.
(Published March 2026)
Telomere-to-telomere assembly detects genomic diversity in Canadian strains of Borrelia burgdorferi
A recently reported study in scientific journal Cell Reports examined nine B. burgdorferi strains from ticks from five regions across Northwest Ontario and Manitoba, Canada to better understand the mechanisms that help the bacteria change state. The study also identifies genomic ‘hotspots’ where these changes happen the most – sites which may act as potentially useful future treatment targets.
(Published February 2026)
Sex and menopause-based differences in presentation of early Lyme disease: A prospective cohort study
This American study of 243 adults (118 females and 125 males) examined whether male and female patients, and post menopausal females, with early Lyme disease presented with different symptoms, physical exams, and laboratory test results. Results showed that at diagnosis, males were more likely to have a positive test and more obvious findings of severe disease, with results more comparable to postmenopausal females. A small number of Lyme disease symptoms were reported more frequently among females (heart palpitations, vomiting, eyes sensitive to light, neck pain, nausea) and two symptoms (sleep difficulty and irritability) reported more frequently among males. These findings suggest that sex and menopause status are important to consider in understanding early Lyme disease.
(Published February 2026)
Running into the Lyme-light: a retrospective cross-sectional study of tick bites and Lyme disease prevalence, incidence, and prevention in hill runners, Scotland
Effective prevention of Lyme disease relies on local and individual-level understanding of risk and ecosystem interactions. Despite frequent exposure to tick habitats, little is known about tick bites and Lyme disease risk among hill, trail, and mountain runners. A cross-sectional retrospective survey of Scottish hill runners was conducted in June-July 2024 to help understand more.
A high reported period prevalence of tick bites and incidence of treated suspected cases among surveyed hill runners in Scotland aligned with the low adherence to tick bite prevention behaviours in this population.
(Published January 2026)
Persistent Borrelia Infection in Chronic Lyme Disease: A Review of the Medical Literature
This American study examines the evidence from animal models and human studies that support persistent spirochaetal infection as a cause of ongoing symptoms following antibiotic treatment for Lyme disease. The role of cysts (L-forms) and biofilms in this process is highlighted. Determining the mechanism behind Borrelia persistence may hold the key to the development of targeted treatments for Lyme disease patients.
Mapping ticks (Acari: Argasidae, Ixodidae) and informing local public action: Insights from the United Kingdom Tick Surveillance Scheme (2021-2024)
The Tick Surveillance Scheme (TSS) is a citizen science initiative which relies on public and professional submissions to monitor tick species distribution, seasonal exposure, and host associations across the UK. From 2021–2024, 3182 tick records were received and 27 tick species were detected. The data confirm that Ixodes ricinus, the primary vector for Lyme disease and Tick-borne encephalitis, remains the most common tick in the UK. The TSS continues to detect imported tick species and new evidence of non-endemic species like Hyalomma marginatum being found on hosts without history of foreign travel, although establishment risk is currently considered low.
Species distribution maps have been updated, plus a new tick-bite incidence metric has been developed and translated into a heat map for England and Wales, to help inform public health interventions and awareness campaigns at local authority level.
(Published January 2026)
Babesia and Bartonella Species DNA in Blood and Enrichment Blood Cultures from People with Chronic Fatigue and Concurrent Neurological Symptoms
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a medical condition characterised by extreme fatigue. Based upon case reports, patients infected with Babesia or Bartonella spp. have reported a history of chronic fatigue and concurrent neurological symptoms.
This American study provides documentation supporting a potential role for Babesia and Bartonella infection in patients with presentations consistent with ME/CFS.
It should be noted that the primary vectors of tick-borne disease in the US include the blacklegged tick, followed by the Lone Star tick and the American Dog tick. These ticks are not found in the UK and can carry different species and strains of pathogens.
(Published December 2025)
An update on Borrelia burgdorferi s.l. prevalence and hazard in ticks at recreational areas in England and Wales between 2021 and 2023
This study aimed to measure Lyme disease hazard to the public across a range of recreational areas. From 2021 to 2023, 84 sites were sampled within 36 recreational areas across England and Wales. The density of questing I. ricinus nymphs was significantly higher in woodlands than in grasslands and significantly increased in the presence of deer. Tick density was significantly higher in the north and south of England compared to central England.
Nymphs are responsible for the majority of Lyme disease cases, due to their small size and ability to go unnoticed. The overall prevalence of B. burgdorferi s.l. in I. ricinus nymphs was 5.8 % with site-level prevalences ranging from 0 % to 30.4 %. The dominant genospecies was B. garinii (39 % of positive samples), followed by B. valaisiana (21.9 %), B. afzelii (15.4 %) and B. burgdorferi s.s. (3.1 %), which sets England and Wales apart from other European countries where B. afzelii typically dominates. The highest densities of infected nymphs were identified in Kielder Forest, Yorkshire Dales, Exmoor, Blackdown Hills and South Devon.
(Published September 2025)
Lyme Disease Biobank: 10 years of 3 month follow-up visits from 2014 to 2023 (USA)
This 10 year study of 253 participants in Lyme disease endemic areas in the US confirmed that the CDC’s standard two-tier testing (STTT) is insensitive in early Lyme disease and that IgG seroconversion is rare following antibiotic treatment.
The study also confirmed that although the majority of people who receive antibiotics early in their disease do not report ongoing symptoms, a significant number do (21% ~ 3 months after antibiotics). In conclusion, it is recommended that healthcare professionals treating Lyme disease patients should follow-up to assess for ongoing symptoms, and consider antibiotic re-treatment as appropriate.
(Published July 2025)
Experimental evidence rules out mosquitoes as vectors of Lyme disease
Ixodes ticks are the primary vectors of Lyme disease, caused by Borrelia burgdorferi sensu lato (s.l.). However, many patients do not recall tick bites, fuelling speculation about alternative transmission routes, particularly via mosquito bites. This belief is reinforced by studies reporting Borrelia presence in mosquitoes.
This study demonstrated that mosquitoes lack the biological capacity to efficiently acquire and maintain B. burgdorferi s.l. spirochetes and are unable to transmit them through natural or mechanical means. It provides compelling evidence against mosquito-borne transmission of Lyme disease and reinforces Ixodes ticks as the sole competent vectors.
(Published June 2025)
Lyme disease as a differential diagnosis in a child with lower motor neuron facial palsy
Lower motor neuron (LMN) palsy is an uncommon condition in children under the age of five, with Bell’s palsy being the most prevalent cause of isolated facial paralysis. Nevertheless, Lyme disease should be considered as a differential diagnosis in cases of isolated facial palsy, given the significance of early diagnosis and treatment.
Timely intervention and appropriate antibiotic therapy can lead to favourable outcomes, highlighting the need for increased awareness among healthcare providers regarding Lyme disease in children. Multidisciplinary collaboration is essential for optimizing patient management and recovery.
(Published May 2025)
Lyme disease treated with antibiotic that doesn’t harm gut microbiome
Bay Area Lyme Foundation, a leading sponsor of Lyme disease research in the US, has announced two pre-clinical studies published in the peer-reviewed journal Science Translational Medicine. The studies demonstrate promising implications for understanding and treating Lyme disease through peptidoglycan, a molecule found in the cell wall of the bacterium, Borrelia burgdorferi, which causes the illness.
The first study finds that the antibiotic piperacillin inhibits peptidoglycan production, and may be a more useful treatment for Lyme disease than the current “gold standard” treatment, doxycycline, which does not appear to be effective for a proportion of patients. The second study uncovers how lingering peptidoglycan builds up in the joint fluid and liver and can contribute to chronic symptoms.
(Published April 2025)
The release of non-native gamebirds is associated with amplified zoonotic disease risk
Releasing pheasants into the countryside may boost the risk of humans catching Lyme disease, according to new research from Cardiff and Exeter Universities, and the UK Health Security Agency.
The study, published in the journal Ecology Letters, found the bacteria that can cause Lyme disease was almost 2.5 times more common in ticks located in areas where the gamebirds were released. Some 35 to 48 million pheasants are released into the UK countryside each year to be shot for sport. Pheasants are ‘competent’ hosts of Borrelia – meaning they have a relatively high likelihood of contracting and retransmitting the bacteria.
Climate change contributes further to the problem as tick populations more easily survive winter months.
(Published April 2025)
Identifying hotspots and risk factors for tick-borne encephalitis virus emergence and its range margins to guide interventions
Tick-borne encephalitis virus (TBEV) is expanding its range in Europe, with increasing human cases reported. Since the first detection of TBEV in ticks in the United Kingdom in 2019, one possible, two probable and two confirmed indigenous cases in humans have been reported.
This study showed probable exposure to TBEV was more likely in sites with a greater percentage cover of coniferous woodland, with multiple deer species, higher winter temperatures and rates of spring warming. The resulting TBEV suitability maps offer public health bodies opportunity to tailor surveillance and identify probable high-risk areas for human exposure, to guide awareness raising and vaccination policy.
(Published April 2025)
Lyme disease in UK primary care: a knowledge, attitude, and practice survey
This study aimed to describe baseline primary care clinician knowledge, attitude and practice (KAP) on Lyme disease in Scotland and England, based on responses to an online KAP questionnaire.
Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses.
(Published March 2025)
Researchers discover Achilles’ heel of Lyme pathogen
Researchers have discovered that an enzyme can serve as an ideal target for developing new therapeutics against Lyme disease and, likely, other tick-borne diseases.
(Published March 2025)
Putting the breaks on bacterial mobility: a new approach to fighting disease
Researchers have identified a possible new way to fight infections like Lyme disease and syphilis by disrupting the bacteria’s movement system and ability to spread between and within hosts.
These bacteria accelerate using long strands called flagella, joined by hooks to the organisms’ motion-generating machinery. Built from self-assembled protein subunits called FlgE, the hooks are tightly held together by molecular bridges known as lysinoalanine (LAL) cross-links. When LAL formation is disrupted, a spirochete’s flagella, hook and motor are unable to work together to move effectively.
After testing a collection of existing, clinically approved drug compounds, researchers identified three (hexachlorophene, triclosan, and dichlorophene) that could interfere with the connections between LAL molecules and the flagella hook.
The findings could have wide-ranging impacts on the treatment of infections in the future as concern about antibiotic-resistant strains grows.
(Published February 2025)
Neuroborreliosis with encephalitis: a broad spectrum of clinical manifestations
Neuroborreliosis can present with symptoms that mimic various neurological disorders, such as dementia, movement disorders, and epilepsy. Radiculitis, peripheral facial palsy or meningitis are an additional hint for this infectious disease. Analysis of CSF, which includes testing for intrathecally produced Borrelia burgdorferi antibodies, is crucial for the diagnosis.
(Published February 2025)
Lyme arthritis: It’s never too late for joint decision making
A 25-year-old male presented with acute swelling of the left knee consistent with an inflammatory arthritis. Symptoms escalated despite multiple joint aspirations, steroid injections and anti-rheumatic drugs. He later tested positive for Lyme disease despite no memory of any tick bites or an erythema migrans rash.
The response to 28 days of oral doxycycline followed by 30 days of intravenous ceftriaxone was unsatisfactory. Following this, anti-TNF treatment (etanercept) achieved an excellent response within 6 weeks. However, this did not completely resolve his synovitis.
(Published January 2025)
Tick hazard in the South Downs National Park
South Downs National Park (SDNP) is the UK’s most visited National Park, and a focus of tick-borne Lyme disease. The first presumed UK autochthonous cases of tick-borne encephalitis and babesiosis were recorded here in 2019–20. Mapping showed tick hazard broadly distributed across SDNP. I. ricinus was most common, but H. punctata’s range expansion was concerning.
Recommendations resulting from this study: management of small, heavily visited high hazard plots; post-visit precaution signage (all sites); repellent impregnated clothing for deerstalkers; flock trials to control H. punctata.
Further research may help clarify ecological dynamics underlying infection density and predator re-introduction/protection as public health interventions. Ecological research on H. punctata would aid control.
(Published June 2024)
A longitudinal study of a large clinical cohort of patients with Lyme disease and tick-borne co-infections treated with combination antibiotics
The rising prevalence of tick-borne infections (TBIs) necessitates further attention. This study retrospectively investigated various types of TBIs and symptoms, and showed that combination antibiotics were helpful for a patient cohort at an infectious disease clinic in Ireland.
(Published August 2023)
Ixodes ricinus and Borrelia burgdorferi sensu lato in the Royal Parks of London, UK
Assessing the risk of tick-borne disease in areas with high visitor numbers is important from a public health perspective. This study assessed nymph density, Borrelia prevalence and the density of infected nymphs across a range of habitat types in nine parks in London which receive millions of visitors each year.
(Published June 2021)