Materiały źródłowe

• #1 Lyme disease – Wikipedia

  https://en.wikipedia.org/wiki/Lyme_disease

  Lyme disease is caused by spirochetes, gram-negative bacteria from the genus Borrelia. […] The Lyme-related Borrelia species are collectively known as Borrelia burgdorferi sensu lato, and show a great deal of genetic diversity. […] Eight species are known to cause Lyme disease: B. mayonii (found in North America), B. burgdorferi sensu stricto (found in North America and Europe), B. afzelii, B. garinii, B. spielmanii, and B. lusitaniae (all found in Eurasia). […] Lyme disease is transmitted to humans by the bites of infected ticks of the genus Ixodes. […] In North America, the bacterial species Borrelia burgdorferi and B. mayonii cause Lyme disease. […] In Europe and Asia, Borrelia afzelii, Borrelia garinii, B. spielmanii and four other species also cause the disease. […] Lyme disease is classified as a zoonosis, as it is transmitted to humans from a natural reservoir among small mammals and birds by ticks that feed on both sets of hosts.

• #1 Lyme Disease: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/330178-overview

  Lyme disease is usually caused by infection with the spirochete Borrelia burgdorferi. […] The species Borrelia burgdorferi sensu lato has three well-characterized groups, as follows: B burgdorferi sensu stricto, B garinii, and B afzelii. […] These subspecies are associated with different clinical presentations, probably due to genomic variation. […] Infection with B burgdorferi sensu stricto has a particular predilection to affect joints. […] B garinii has some neurotropism and is the isolate that accounts for most cases of lymphocytic meningoradiculitis (Bannwarth syndrome) and white matter encephalitis, which is rare in North America. […] Other strains, which may be sufficiently different in their genetic structure to be considered separate strains, exist; however, most of these are nonpathogenic to humans.

• #1 Lyme Disease – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/spirochetes/lyme-disease

  Lyme disease is a tick-transmitted infection caused by the spirochete Borrelia species. […] In the United States, Lyme disease is caused primarily by Borrelia burgdorferi and to a lesser extent by B. mayonii, which has recently been found in the upper midwestern states. […] Lyme disease is transmitted primarily by 4 Ixodes species worldwide: I. scapularis (the deer tick) in the northeastern and north central United States, I. pacificus in the western United States, I. ricinus in Europe, and I. persulcatus in Asia. […] In the United States, the white-footed mouse is the primary animal reservoir for Borrelia burgdorferi and the preferred host for nymphal and larval forms of the deer tick. […] B. burgdorferi enters the skin at the site of the tick bite. […] In untreated Lyme disease, the late stage begins months to years after initial infection. […] Some patients have symptoms such as fatigue, headache, joint and muscle aches, and cognitive problems after successful antibiotic treatment. […] There is no evidence linking B. burgdorferi infection to this fibromyalgia-like or chronic fatigue-like syndrome.

• #1 Lyme Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431066/

  Lyme disease, also known as Lyme borreliosis, is an infectious condition transmitted through the bite of infected ticks, primarily caused by the spirochete bacterium Borrelia burgdorferi in the United States and various Borrelia species in Europe and Asia. […] In the US, Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi (and rarely Borrelia mayonii) and is transmitted by the bite of an Ixodes genus black-legged tick. In Europe and Asia, the predominant causes of Lyme disease are B burgdorferi, Borrelia afzelii, and Borrelia garinii. […] The tick lifecycle is significant to understanding when they are infectious. They have a 2- to 3-year life span and cycle through 4 life stages: egg, larva, nymph, and adult. The larva and nymph must take a blood meal to advance to the next life stage, and the female ticks require blood to reproduce.

• #1 What Causes Lyme Disease? – Bay Area Lyme Foundation

  https://www.bayarealyme.org/about-lyme/what-causes-lyme-disease/

  Lyme disease is an infection caused by several strains of the bacteria Borrelia burgdorferi (Bb). The bacteria is transmitted to humans through the bite of an infected tick. […] The tick most often becomes infected during its larval or nymph stage, when it feeds off small animals like squirrels, mice, or birds that carry the bacteria which causes Lyme disease (Borrelia burgdorferi or Bb). […] The tick, now infected, then passes on the bacteria to a human or another animal during its next feeding cycle.

• #1 Lyme Disease: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/330178-overview

  Borrelia miyamotoi, which causes a febrile illness and is transmitted by ixodid ticks, was discovered in 1994 in Japan and has since been reported in North America, Europe, and Asia. […] B burgdorferi is transmitted by ixodid tick species. […] The spirochete Borrelia burgdorferi is introduced into the skin with a bite from an infected Ixodes tick. […] The infectious cycle of B burgdorferi involves colonization, infection of Ixodes ticks, and then transmission to a broad range of mammalian hosts, including humans. […] Variation in environmental and host conditions promotes different gene expression and changes in the composition of the membrane proteins of the spirochete. […] This adaptation is a critical step in the pathogenesis and transmission of Lyme disease.

• #1 How Lyme Disease Spreads | Lyme Disease | CDC

  https://www.cdc.gov/lyme/causes/index.html

  Lyme disease is caused by Borrelia bacteria spread to people by the bite of an infected blacklegged tick. […] The bacteria that cause Lyme disease in the United States, Borrelia burgdorferi and, rarely, B. mayonii, are spread to people through the bites of infected ticks. […] In most cases, a tick must be attached for more than 24 hours before the Lyme disease bacterium can be transmitted. […] Infected ticks must be attached for more than 24 hours to transmit infection; prompt tick removal can prevent transmission.

• #1 Lyme disease – Wikipedia

  https://en.wikipedia.org/wiki/Lyme_disease

  Most infections are caused by ticks in the nymphal stage, because they are very small, thus may feed for long periods of time undetected. […] The younger larval ticks are very rarely infected. […] Although deer are the preferred hosts of adult deer ticks, and tick populations are much lower in the absence of deer, ticks generally do not acquire Borrelia from deer, instead they obtain them from infected small mammals such as the white-footed mouse, and occasionally birds. […] The resistance of a genospecies of Lyme disease spirochetes to the bacteriolytic activities of the alternative complement pathway of various host species may determine its reservoir host association.

• #1 Lyme Disease is On the Rise – An Expert Explains Why | UC San Francisco

  https://www.ucsf.edu/news/2018/05/410401/lyme-disease-rise-expert-explains-why

  Therefore, expansion of the animal reservoir is also another reason for increasing Lyme disease rates. […] Borrelia burgdorferi causes asymptomatic infection in these small mammal reservoirs. […] However, humans are considered a dead-end host because the efficiency of transmitting the bacterium to other humans is extremely low. […] Lyme disease is therefore not considered contagious. […] It does appear that Lyme disease is harder to diagnose, and its because the Borrelia burgdorferi very rapidly leaves the blood and disseminates into the lymph nodes and into tissues. […] Timely and accurate diagnosis of Lyme disease can help prevent potential complications, which include encephalitis, a brain infection; myocarditis, a heart infection; or endocarditis, a heart valve infection. […] The tick typically needs to be on you, basically sucking your blood and attached to you for 36 to 48 hours, during which the Borrelia burgdorferi migrates from the tick gut to its salivary glands, before it can transmit the Lyme pathogen.

• #1 Patient education: Lyme disease symptoms and diagnosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/lyme-disease-symptoms-and-diagnosis-beyond-the-basics/print

  In regions of the United States where Lyme disease is common, individuals who spend a lot of time outdoors are at the greatest risk for Lyme disease, including people who work outdoors, garden, or participate in outdoor activities such as hunting or hiking. […] Symptoms of Lyme disease can vary widely and may include a rash at the site of the tick bite, flu-like symptoms, arthritis, heart symptoms, and neurologic symptoms that can involve facial paralysis, meningitis, or shooting nerve pains. […] Symptoms are caused by the body’s immune response to the bacteria and the inflammation that results; inflammation may continue even after treatment. […] The diagnosis of Lyme disease is based on an individual’s history of possible exposure to ticks, the presence of characteristic signs and symptoms, and the results of blood tests. […] Blood tests for Lyme disease are not recommended in people with nonspecific symptoms since tests may be falsely positive.

• #1 The bulls-eye rash of Lyme disease: Investigating the cutaneous host-pathogen dynamics of erythema migrans.

  https://asm.org/articles/2018/april/going-skin-deep-investigating-the-cutaneous-host-p

  Ixodes scapularis, commonly known as the deer tick, is the primary vector of Borrelia burgdorferi in the United States. According to the CDC, this flagellated spirochete bacterium causes approximately 30,000 cases of Lyme disease in the U.S. each year. […] The key difference is the presence of the microbe. When an insect or arachnid that isnt carrying disease bites a human host, foreign components in the saliva generate an allergic response. […] However, because B. burgdoferi actually causes infection of the skin, the development of erythema migrans depends not only on the innate immune response of the host, but also the pathogenic properties of the bacteria. […] Therefore, this aspect of B. burgdorferis pathogenesis demands further investigation. […] However, researchers discovered evidence that B. burgdorferi can exploit IFN pathways to inhibit T-lymphocyte function and cause localized immunosuppression. […] Overall, these data pointed out some specific strategies that the host uses to fight off infection as well as a number of ways that the microbe attempts to manipulate these immunological processes in order to change the outcome of infection.

• #1

  https://www.jci.org/articles/view/138062

  Lyme disease, which is epidemic in certain communities, primarily in the northeastern United States, is caused by the tick-borne spirochete Borrelia burgdorferi (also called Borreliella burgdorferi). […] The basic pathogenetic feature of postinfectious LA is the development of an excessive, dysregulated proinflammatory immune response during the infection, characterized by exceptionally high IFN- levels, which persists in the postinfectious period. […] The consequences of this excessive proinflammatory response in Lyme synovia include vascular damage, autoimmune and cytotoxic processes, and fibroblast proliferation and fibrosis. […] After oral and IV antibiotics, culture and PCR results for Borrelia burgdorferi have been uniformly negative in postinfectious LA synovial tissue. […] The clinical features and pathogenesis of what is often called posttreatment Lyme disease syndrome (PTLDS) are quite different.

• #1 Lyme Disease | Lyme Disease

  https://www.columbia-lyme.org/lyme-disease

  Lyme disease is an illness caused by a bacterium, Borrelia burgdorferi. […] The „disease” is caused by the inflammatory response to the spirochete. […] If it lands in a joint, it can cause arthritis. […] If it lands in the heart, it can cause disturbances in cardiac conduction arrhythmias or even complete heart block; cardiac Lyme disease can lead to death if not detected and treated early. […] If it lands in the peripheral or central nervous system, it can cause meningitis, confusion, memory loss, burning or stabbing pains, shooting pains, numbness/tingling, and/or weakness. […] Some patients do not experience any symptoms after the bite of a tick that carries the bacterial agent of Lyme disease. […] In most other patients, antibiotic treatment is needed to fight the disease that develops.

• #1 Lyme Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431066/

  The pathophysiology of posttreatment Lyme disease syndrome (PTLDS) is unclear. Several theories have been suggested, though no evidence has been reported to support the existence of chronic Borrelia burgdorferi infection. […] About 10% of patients with Lyme arthritis will experience persistent inflammatory arthritis that does not respond to 1 or more round of antibiotic treatments. If no evidence of persistent infection is identified, this manifestation may be called postinfectious Lyme arthritis.

• #1

  https://www.jci.org/articles/view/138062

  The pathogenesis of PTLDS is not well understood. […] Many studies have been done to address the persistent infection hypothesis. […] The major problem with the persistent infection hypothesis is that 4 double-blind, placebo-controlled trials have not shown a sustained difference between case and control patients. […] With the current lack of evidence of persistent infection or antibiotic efficacy in human patients with PTLDS, the Infectious Diseases Society of America recommends against treatment of such patients with long-term antibiotics. […] Systemic autoimmune or autoinflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis, or peripheral spondyloarthropathy, may develop weeks to months after Lyme disease, most commonly following antibiotic-treated erythema migrans.

• #1 Lyme Disease Treatment | Prognosis for Lyme Patients after Treatment

  https://www.hopkinslyme.org/lyme-disease/treatment-and-prognosis-of-lyme-disease/

  The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. […] The causes of PTLD are not yet well understood but can be multifactorial. Our Center is investigating the potential roles of: infection-induced immune dysfunction or auto-immunity, chronic inflammation, persistent bacterial infection or bacterial debris, neural network alteration, other tick-borne infections, and other biologic mechanisms of disease. […] The persistent symptoms in Lyme disease can have a large negative impact on an individual’s health and quality of life. Patients often call this condition chronic Lyme disease, although an agreed upon clinical case definition for chronic Lyme disease has proven difficult to reach a consensus on. […] In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.

• #1 Taking the bite out of Lyme disease – Northwestern Now

  https://news.northwestern.edu/stories/2025/04/taking-the-bite-out-of-lyme-disease/

  Northwestern scientists believe they now know what causes the treated infection to mimic chronic illness: The body may be responding to remnants of the Borrelia cell wall which breaks down during treatment yet lingers in the liver. […] The unusual chemical properties of Borrelia peptidoglycan promote persistence, but its the individual patient response to the molecule that likely impacts the overall clinical outcome, Jutras said.

• #1 Climate Change Indicators: Lyme Disease | US EPA

  https://www.epa.gov/climate-indicators/climate-change-indicators-lyme-disease

  Lyme disease is a bacterial illness that can cause fever, fatigue, joint pain, and skin rash, as well as more serious joint and nervous system complications. Lyme disease is the most common vector-borne disease (that is, a disease transmitted by mosquitoes, ticks, or fleas) in the United States. Lyme disease is transmitted through the bite of certain species of infected ticks (referred to commonly as deer ticks) that carry the bacteria that cause Lyme disease. These ticks live not only on deer, but also on rodents, birds, and other host animals. Deer do not harbor the bacteria that cause Lyme disease, but certain other hosts such as white-footed mice do, and ticks pick up the bacteria by feeding on these infected hosts. […] Studies provide evidence that climate change has contributed to the expanded range of ticks, increasing the potential risk of Lyme disease, such as in areas of Canada where the ticks were previously unable to survive. The life cycle and prevalence of deer ticks are strongly influenced by temperature. For example, deer ticks are mostly active when temperatures are above 45F, and they thrive in areas with at least 85-percent humidity. Thus, warming temperatures associated with climate change are projected to increase the range of suitable tick habitat and are, therefore, one of multiple factors driving the observed spread of Lyme disease.

• #1 Lyme Disease: Causes, Risk Factors, Treatment

  https://www.health.com/condition/lyme-disease/how-do-you-get-lyme-disease

  Lyme disease is a tick-borne illness. Only infected black-legged ticks can transmit the bacteria that causes Lyme disease. […] Certain inherited genes may increase the risk of complications like Lyme arthritis. Lyme arthritis occurs if the bacteria that causes Lyme disease makes its way into joint tissues. […] The bacteria triggers inflammation and causes swollen and painful joints.

• #1 Lyme borreliosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/nrdp201690

  Lyme borreliosis is a tick-borne disease that predominantly occurs in temperate regions of the northern hemisphere and is primarily caused by the bacterium Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia. […] During infection, the bacteria migrate through the host tissues, adhere to certain cells and can evade immune clearance. […] Except for patients with erythema migrans, Lyme borreliosis is diagnosed based on a characteristic clinical constellation of signs and symptoms with serological confirmation of infection. […] This study demonstrates that the combination of spirochaetal and host genetics, in this case infection with an RST1 strain in patients with a TLR1 polymorphism (1805GG), leads to greater inflammation, more-severe early disease and a greater frequency of antibiotic-refractory Lyme arthritis.

• #1 Ticks and Lyme Disease | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/ticks-and-lyme-disease.html

  Lyme disease is an infection caused by a spiral-shaped bacterium. It’s most commonly spread by a tick bite. […] Lyme disease is caused by bacteria that is spread to humans by tick bites. The ticks that carry the bacteria are: Black-legged deer tick (northeastern, mid-Atlantic, and North Central U.S.) and Western black-legged tick (Pacific coastal U.S.). […] Not all ticks carry the Lyme disease bacteria. Depending on the location, anywhere from less than 1 in 100 to more than half of the ticks are infected with it.

• #1 Lyme Disease: Symptoms, Treatment, Prevention & Recovery

  https://my.clevelandclinic.org/health/diseases/11586-lyme-disease

  Lyme disease is caused by a bacteria, Borrelia burgdorferi, which you can get if an infected deer tick (also called black-legged tick) bites you. […] Researchers found that bites from infected deer ticks were responsible for the outbreak of arthritis. […] Antibiotics, usually doxycycline or amoxicillin, are effective treatments for Lyme disease. […] Most of the people who get Lyme disease and receive treatment early will be fine. Treatment can cure Lyme disease but you might still have some long-term effects. […] This term may be why some people think a Lyme disease infection can occur without being bitten by a tick. There isn’t enough proof that mosquitoes can transmit Lyme disease.

• #1 Lyme Disease (Lyme borreliosis): symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/lyme-disease-lyme-borreliosis

  Lyme disease, also known as Lyme borreliosis, is a tick-borne disease. […] Lyme disease is transmitted by ticks, hematophagous (blood-feeding) arthropods belonging to the order Ixodida (family Ixodidae). The causative agent of Lyme disease was first isolated in a tick of the genus Ixodes in 1982 by Willy Burgdorfer, after whom the agent, Borrelia burgdorferi, is named. It is a gram-negative bacterium (genus Borrelia, family Spirochaetaceae). Many other Borrelia species may be transmitted by ticks. […] Lyme disease cannot be transmitted from person to person. […] Lyme borreliosis is a disease caused by bacteria of the genus Borrelia that are transmitted by a bite from a tick of the genus Ixodes.

• #1 Lyme Disease (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/lyme-disease-pro

  B. afzelii from Europe is associated with acrodermatitis chronica atrophicans. […] B. burgdorferi sensu stricto is the only species isolated in the USA with an associated pattern of musculoskeletal and neurological complications. […] There is enormous controversy over chronic Lyme disease and post-Lyme disease syndrome. Neither has universally accepted definitions and both represent a heterogeneous mix of symptoms common to other conditions. In general the scientific community and national guidelines tend to reject the suggestion that these symptoms are due to Lyme disease or previous infection, and emphasise that there is no evidence for the use of long-term or repeated courses of antibiotics for these conditions.

• #1 Large-Scale Study Will Seek to Unearth Causes of Persistent Symptoms of Lyme Disease | Tufts Now

  https://now.tufts.edu/2024/09/17/large-scale-study-will-seek-unearth-causes-persistent-symptoms-lyme-disease

  Tufts University researchers have received a $20.7 million grant from the National Institutes of Health (NIH) to try to answer some of the most vexing questions around chronic Lyme disease. […] Despite decades of research, many of the fundamentals of post-treatment Lyme disease syndrome or chronic Lyme disease remain elusive. […] The teams hypothesis is that chronic Lyme disease is the result of a confluence of events including the genetics of the patient, the infecting bacteria, and prior infections with other organisms that could result in epigenetic changes that alter immune responses. […] Science and medicines understanding of postinfection Lyme disease has been stuck at the same place for more than 30 years.

• #1 Taking the bite out of Lyme disease – Northwestern Now

  https://news.northwestern.edu/stories/2025/04/taking-the-bite-out-of-lyme-disease/

  Lyme disease, a disease transmitted when deer ticks feed on infected animals like deer and rodents, and then bite humans, impacts nearly half a million individuals in the U.S. annually. […] The antibiotic doxycycline is the current gold standard treatment for Lyme. However, doxycycline and other generic antibiotics, wreak havoc on the microbiome, killing beneficial bacteria in the gut and causing troubling side effects even as it kills Borrelia burgdorferi, the bacteria that causes Lyme. […] Northwestern scientists identified that piperacillin, an antibiotic in the same class as penicillin, effectively cured mice of Lyme disease at 100-times less than the effective dose of doxycycline. […] Symptoms that persist long after Lyme disease is treated are not uncommon a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD).

• #2 Lyme Disease: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/330178-overview

  Lyme disease is usually caused by infection with the spirochete Borrelia burgdorferi. […] The species Borrelia burgdorferi sensu lato has three well-characterized groups, as follows: B burgdorferi sensu stricto, B garinii, and B afzelii. […] These subspecies are associated with different clinical presentations, probably due to genomic variation. […] Infection with B burgdorferi sensu stricto has a particular predilection to affect joints. […] B garinii has some neurotropism and is the isolate that accounts for most cases of lymphocytic meningoradiculitis (Bannwarth syndrome) and white matter encephalitis, which is rare in North America. […] Other strains, which may be sufficiently different in their genetic structure to be considered separate strains, exist; however, most of these are nonpathogenic to humans.

• #2 Lyme disease is caused by bacteria – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/lyme-disease-is-caused-by-bacteria/

  Lyme disease is caused by four main species of bacteria. Borrelia burgdorferi and Borrelia mayonii cause Lyme disease in the United States, while Borrelia afzelii and Borrelia garinii are the leading causes in Europe and Asia. […] In the United States, Lyme disease is caused by the bacteria Borrelia burgdorferi and Borrelia mayonii, carried primarily by black-legged or deer ticks. Young brown ticks often are no bigger than a poppy seed, which can make them nearly impossible to spot. […] To contract Lyme disease, an infected deer tick must bite you. The bacteria enter your skin through the bite and eventually make their way into your bloodstream. […] In most cases, to transmit Lyme disease, a deer tick must be attached for 36 to 48 hours. If you find an attached tick that looks swollen, it may have fed long enough to transmit bacteria. Removing the tick as soon as possible might prevent infection.

• #2 Lyme Disease: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/rheumatoid-arthritis/arthritis-lyme-disease

  Lyme disease is a bacterial infection caused by Borrelia burgdorferi and, rarely, Borrelia mayonii bacteria. […] Infected backlegged ticks (also called deer ticks) can transmit the bacteria when they bite. […] The chances you might get Lyme disease from a tick bite depend on the kind of tick, where you were when it bit you, and how long it was attached. […] The tick that causes Lyme disease has been moving from the Northeast and upper Midwest into the Southern and Western U.S., Mexico, and Canada. […] Even though people only report about 30,000 cases of Lyme infection in the U.S. each year, there are actually around 476,000 a year. […] There are several reasons why Lyme is spreading. Some of these are: New trees being planted, especially in the Northeastern U.S.; Climate change and very hot or cold temperatures; People moving away from large cities; More contact with white-tailed deer (the blacklegged tick’s favorite way to travel).

• #2 Lyme Disease (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/lyme-disease-pro

  Lyme disease is caused by the bacterium Borrelia burgdorferi, which is a spirochaete. Recent studies have shown that there are several genospecies and the group as a whole is referred to as B. burgdorferi sensu lato. Humans may contract it when they are bitten by ticks of the Ixodes species which are infected by B. burgdorferi. […] The disease is caused by the infection and the body’s immune response to infection. Different strains of Borrelia spp. cause different clinical manifestations of Lyme disease and this explains differences between the disease in Europe and the disease in the USA. Borrelia burgdorferi is predominant in the USA and is associated with arthritis, whereas B. garinii is found in Eurasia and is linked to neurological problems. […] The spirochaete responsible is transmitted from host to host by Ixodes spp. or deer ticks. Understanding the life cycle of these organisms gives better understanding of the epidemiology, other clinical aspects and prevention of Lyme disease.

• #2 Lyme Disease (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/lyme-disease-pro

  B. afzelii from Europe is associated with acrodermatitis chronica atrophicans. […] B. burgdorferi sensu stricto is the only species isolated in the USA with an associated pattern of musculoskeletal and neurological complications. […] There is enormous controversy over chronic Lyme disease and post-Lyme disease syndrome. Neither has universally accepted definitions and both represent a heterogeneous mix of symptoms common to other conditions. In general the scientific community and national guidelines tend to reject the suggestion that these symptoms are due to Lyme disease or previous infection, and emphasise that there is no evidence for the use of long-term or repeated courses of antibiotics for these conditions.

• #2 Lyme Disease: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/330178-overview

  Borrelia miyamotoi, which causes a febrile illness and is transmitted by ixodid ticks, was discovered in 1994 in Japan and has since been reported in North America, Europe, and Asia. […] B burgdorferi is transmitted by ixodid tick species. […] The spirochete Borrelia burgdorferi is introduced into the skin with a bite from an infected Ixodes tick. […] The infectious cycle of B burgdorferi involves colonization, infection of Ixodes ticks, and then transmission to a broad range of mammalian hosts, including humans. […] Variation in environmental and host conditions promotes different gene expression and changes in the composition of the membrane proteins of the spirochete. […] This adaptation is a critical step in the pathogenesis and transmission of Lyme disease.

• #2 Borreliosis (Lyme disease)

  https://www.ecdc.europa.eu/en/borreliosis-lyme-disease

  Lyme disease is a bacterial illness transmitted to humans through the bite of infected ticks. The disease is caused by bacteria in the family Borreliaceae, particularly Borrelia (Borreliella) burgdorferi s.l. […] The bacteria are only transmitted by the bites of the ticks Ixodes ricinus and I. persulcatus (the former is common in most of Europe, the later in the Baltic countries and Finland). […] Transmission of Lyme disease to humans occurs through the bite of an infected tick.

• #2 Lyme Disease: Symptoms, Causes & Treatment

  https://resources.healthgrades.com/right-care/lyme-disease/lyme-disease

  Lyme disease is an infectious disease caused by the bacterium Borrelia burgdorferi, which is transmitted through tick bites. […] Lyme disease is an infectious disease caused by the bite of a tick infected with Borrelia burgdorferi bacteria. These are in the spirochete class of bacteria, which includes the T. pallidum bacterium that causes syphilis. […] Lyme disease bacteria usually live in rodents and other small animals and are transmitted when a tick bites an infected animal. The bacteria live in the gut of the tick. When the tick bites a human, bacteria from an infected tick can pass from the tick into the person’s bloodstream. […] For an infected deer tick to transmit the bacteria, it typically needs to feed for more than 36 hours. The longer the tick is attached and feeding, the greater the likelihood of the person developing Lyme disease.

• #2

  https://www.insectshield.com/blogs/blog/how-ticks-spread-lyme-disease

  Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted to humans through the bite of infected blacklegged ticks, commonly known as deer ticks. These ticks acquire the bacteria by feeding on small mammals, such as mice and chipmunks, which serve as reservoir hosts for the germ. […] The bacterium Borrelia burgdorferi, which causes Lyme disease, primarily affects the joints, skin, heart, and nervous system. […] The bacterium has evolved mechanisms to evade the immune response, leading to persistent infections in some cases. […] Ticks are not born with Lyme disease. Instead, they acquire the bacterium Borrelia burgdorferi, which causes Lyme disease, by feeding on infected hosts during their life cycle. […] Lyme disease is primarily transmitted to humans through the bite of infected ticks, with blacklegged ticks, also known as deer ticks, being the primary vectors for the causative bacterium Borrelia burgdorferi.

• #2 Lyme Disease: Causes, Risk Factors, Treatment

  https://www.health.com/condition/lyme-disease/how-do-you-get-lyme-disease

  You can get Lyme disease twice, as it’s possible any time you get a bite from an infected tick. […] Lyme disease is a tick-borne illness that causes a „bulls-eye” rash, fever, headache, and fatigue. Infected black-legged ticks, which typically live in grassy and wooded areas, spread bacteria through their bites. […] The bacteria Borrelia burgdorferi causes Lyme disease. The bacteria spread through the bites of infected black-legged ticks, also known as deer ticks. „Lyme disease transmission happens when an infected tick bites you and remains attached for long enough to have a blood meal and become fully engorged,” said Dr. Kuritzkes. […] Usually, ticks must attach to the skin for 36-48 hours to transmit Lyme disease. „In the process of sucking the blood from the person, [the tick is] also releasing the bacteria from its salivary glands into the person’s body,” said Dr. Kuritzkes.

• #2 Lyme disease – Wikipedia

  https://en.wikipedia.org/wiki/Lyme_disease

  Most infections are caused by ticks in the nymphal stage, because they are very small, thus may feed for long periods of time undetected. […] The younger larval ticks are very rarely infected. […] Although deer are the preferred hosts of adult deer ticks, and tick populations are much lower in the absence of deer, ticks generally do not acquire Borrelia from deer, instead they obtain them from infected small mammals such as the white-footed mouse, and occasionally birds. […] The resistance of a genospecies of Lyme disease spirochetes to the bacteriolytic activities of the alternative complement pathway of various host species may determine its reservoir host association.

• #2 Lyme Disease: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/rheumatoid-arthritis/arthritis-lyme-disease

  Deer and white-footed mice give Lyme disease to ticks that bite them. […] Experts aren’t sure why Lyme symptoms don’t always go away. One theory is that your body keeps fighting the infection even after the bacteria are gone, like an autoimmune disorder. […] You get Lyme disease from bacteria transmitted through the bite of infected ticks, mostly deer ticks.

• #2 Why Lyme and other tick-borne diseases are on the rise | PBS News

  https://www.pbs.org/newshour/science/why-lyme-and-other-tick-borne-diseases-are-on-the-rise

  As mouse numbers rise, the odds that a hungry tick will feed on a disease-harboring rodent go up in turn, increasing the odds that a person gardening in their yard or going for a walk in the forest will get infected with Borrelia burgdorferi from a tick bite. […] The ability of ticks to survive, reproduce and spread disease depends on what hosts are around for them to bite. Some small mammals, like the white-footed mouse, can harbor pathogens.

• #2 The bulls-eye rash of Lyme disease: Investigating the cutaneous host-pathogen dynamics of erythema migrans.

  https://asm.org/articles/2018/april/going-skin-deep-investigating-the-cutaneous-host-p

  Ixodes scapularis, commonly known as the deer tick, is the primary vector of Borrelia burgdorferi in the United States. According to the CDC, this flagellated spirochete bacterium causes approximately 30,000 cases of Lyme disease in the U.S. each year. […] The key difference is the presence of the microbe. When an insect or arachnid that isnt carrying disease bites a human host, foreign components in the saliva generate an allergic response. […] However, because B. burgdoferi actually causes infection of the skin, the development of erythema migrans depends not only on the innate immune response of the host, but also the pathogenic properties of the bacteria. […] Therefore, this aspect of B. burgdorferis pathogenesis demands further investigation. […] However, researchers discovered evidence that B. burgdorferi can exploit IFN pathways to inhibit T-lymphocyte function and cause localized immunosuppression. […] Overall, these data pointed out some specific strategies that the host uses to fight off infection as well as a number of ways that the microbe attempts to manipulate these immunological processes in order to change the outcome of infection.

• #2 Lyme borreliosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/nrdp201690

  Lyme borreliosis is a tick-borne disease that predominantly occurs in temperate regions of the northern hemisphere and is primarily caused by the bacterium Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia. […] During infection, the bacteria migrate through the host tissues, adhere to certain cells and can evade immune clearance. […] Except for patients with erythema migrans, Lyme borreliosis is diagnosed based on a characteristic clinical constellation of signs and symptoms with serological confirmation of infection. […] This study demonstrates that the combination of spirochaetal and host genetics, in this case infection with an RST1 strain in patients with a TLR1 polymorphism (1805GG), leads to greater inflammation, more-severe early disease and a greater frequency of antibiotic-refractory Lyme arthritis.

• #2

  https://www.jci.org/articles/view/138062

  Lyme disease, which is epidemic in certain communities, primarily in the northeastern United States, is caused by the tick-borne spirochete Borrelia burgdorferi (also called Borreliella burgdorferi). […] The basic pathogenetic feature of postinfectious LA is the development of an excessive, dysregulated proinflammatory immune response during the infection, characterized by exceptionally high IFN- levels, which persists in the postinfectious period. […] The consequences of this excessive proinflammatory response in Lyme synovia include vascular damage, autoimmune and cytotoxic processes, and fibroblast proliferation and fibrosis. […] After oral and IV antibiotics, culture and PCR results for Borrelia burgdorferi have been uniformly negative in postinfectious LA synovial tissue. […] The clinical features and pathogenesis of what is often called posttreatment Lyme disease syndrome (PTLDS) are quite different.

• #2 Untreated Lyme Disease: Signs, Symptoms, and Complications

  https://www.verywellhealth.com/untreated-lyme-disease-5181045

  Lyme disease is a bacterial infection spread by black-legged ticks, commonly known as deer ticks. It is the most frequently seen vector-borne disease in the United States. […] Lyme disease is carried by the blacklegged tick, also known as the deer tick. This tick is found in the northeastern and upper midwestern United States. On the Pacific coast, Lyme disease is spread by the western blacklegged tick (also called the deer tick). […] When an infected tick bites you, a bacteria called Borrelia burgdorferi passes from the tick into your bloodstream. […] Lyme disease causes a range of symptoms that change and intensify as the Borrelia burgdorferi bacteria spreads to the rest of the body. Untreated cases can cause serious problems or lead to a fatal condition. […] If unchecked, the Lyme disease infection can spread to other bodily systems, causing significant damage. Untreated, complications of this condition can be very severe: […] Left untreated, Lyme disease can spread to joints and organs, causing significant damage. Arthritis, heart disease, and nervous system problems are common complications of untreated Lyme disease.

• #2 Lyme Disease: Causes, Risk Factors, Treatment

  https://www.health.com/condition/lyme-disease/how-do-you-get-lyme-disease

  Lyme disease is a tick-borne illness. Only infected black-legged ticks can transmit the bacteria that causes Lyme disease. […] Certain inherited genes may increase the risk of complications like Lyme arthritis. Lyme arthritis occurs if the bacteria that causes Lyme disease makes its way into joint tissues. […] The bacteria triggers inflammation and causes swollen and painful joints.

• #2 Chronic (Persistent) Lyme Disease: Symptoms and Diagnosis

  https://www.healthline.com/health/lyme-disease-chronic-persistent

  Chronic Lyme disease occurs when a person whos treated with antibiotic therapy for the disease continues to experience symptoms. […] Its not known why some people develop post-treatment Lyme disease syndrome and others dont. Its also unclear what exactly causes the chronic symptoms. […] Lyme disease is a bacterial infection thats caused by the bacteria Borrelia burgdorferi. […] Experts are unclear as to why some people dont fully recover after treatment. Some experts think that the symptoms are caused by persistent bacteria that werent destroyed by the antibiotics, though there is no evidence to support this conclusion. Others believe that the disease damages your immune system and tissues. Your damaged immune system continues to respond to the infection even after the bacteria are destroyed, causing symptoms. […] The exact cause of post-treatment Lyme disease syndrome is not known, so theres some debate regarding appropriate treatment.

• #2 Taking the bite out of Lyme disease – Northwestern Now

  https://news.northwestern.edu/stories/2025/04/taking-the-bite-out-of-lyme-disease/

  Northwestern scientists believe they now know what causes the treated infection to mimic chronic illness: The body may be responding to remnants of the Borrelia cell wall which breaks down during treatment yet lingers in the liver. […] The unusual chemical properties of Borrelia peptidoglycan promote persistence, but its the individual patient response to the molecule that likely impacts the overall clinical outcome, Jutras said.

• #2 Lyme Disease is On the Rise – An Expert Explains Why | UC San Francisco

  https://www.ucsf.edu/news/2018/05/410401/lyme-disease-rise-expert-explains-why

  May marks the beginning of the summer season when black-legged ticks that spread Lyme disease are more prevalent even in California. […] Earlier this month, the U.S. Centers for Disease Control and Prevention (CDC) reported that cases of tickborne diseases had more than doubled from 2004 to 2016, from 22,000 to 48,000, and that Lyme disease accounted for 82 percent of tickborne diseases. […] Moreover, due to underreporting, the actual number of Lyme disease cases is estimated to be significantly higher likely more than 350,000 in 2016. […] There are several potential reasons why rates have increased in California and nationwide. One is globalization. […] Another reason is climate change, in that the geographic range of the tick vector, which is the Ixodes or black-legged tick, has expanded westward from the northeast United States as well as southward year after year.

• #2 Climate Change Indicators: Lyme Disease | US EPA

  https://www.epa.gov/climate-indicators/climate-change-indicators-lyme-disease

  Climate is just one of many important factors that influence the transmission, distribution, and incidence of Lyme disease. Other factors that affect the number of Lyme disease cases include changes in the populations of host species (particularly deer), which affect tick population size. The percentage of ticks that are infected depends on the prevalence and infection rates of white-footed mice and certain other hosts. Host species populations and habitats can be affected by climate change and other ecosystem disturbances. Human exposure to infected ticks is also influenced by factors such as changes in the proximity of human populations to ticks and other hosts, increased awareness of Lyme disease, and modified behaviors, such as spending less time outdoors, taking precautions against being bitten, and checking more carefully for ticks.

• #2 Lyme disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001319.htm

  Lyme disease is a bacterial infection that is spread through the bite of one of several types of ticks. […] Lyme disease is caused by bacteria called Borrelia burgdorferi (B burgdorferi). Blacklegged ticks (also called deer ticks) can carry these bacteria. Not all species of ticks can carry these bacteria. Immature ticks are called nymphs, and they are about the size of a pinhead. Nymphs pick up bacteria when they feed on small rodents, such as mice, infected with B burgdorferi. You can only get the disease if you are bitten by an infected tick. […] There are three stages of Lyme disease. […] Risk factors for Lyme disease include: Doing outside activities that increase tick exposure (for example, gardening, hunting, or hiking) in an area where Lyme disease occurs.

• #2 Lyme Disease Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/infectious-disease/lyme-disease/causes-and-diagnoses

  Lyme disease is caused by the spiral-shaped bacterium Borrelia burgdorferi, which is carried by black-legged ticks that travel on deer and other animals. […] Tick bites spread the bacteria that cause Lyme disease. Spending time in areas where the tick is found increases your risk for the disease. […] Wearing protective clothes, using insect repellent and avoiding tick-infested areas are all ways to prevent Lyme disease.

• #2 In the Northeast, 50% of Adult Ticks Carry Lyme Disease | Dartmouth

  https://home.dartmouth.edu/news/2025/01/northeast-50-adult-ticks-carry-lyme-disease

  In the Northeast, 50% of adult blacklegged ticks carry the bacteria that causes Lyme disease while up to 25% of the younger (nymph) blacklegged ticks carry the bacteria. […] Lyme disease is caused by a bacteria called Borrelia burgdorferi. Some but not all, white-footed mice, chipmunks, birds, squirrels, and other small animals carry the bacteria in their blood, making them competent hosts. […] Blacklegged ticks are not born infected with the Lyme disease bacteria. But when a blacklegged tick feeds on an infected host, the tick can get the bacteria that causes Lyme disease and then potentially spread it to humans through its bite. […] However, we did find an increase in the percentage of blacklegged ticks that carry the Lyme disease bacteria.

• #2 Lyme disease: Prevention and risks – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/lyme-disease/prevention-lyme-disease.html

  Lyme disease is caused by a bacterium called Borrelia burgdorferi, which is spread through the bite of infected blacklegged ticks (deer ticks) and western blacklegged ticks. […] In most cases, infected ticks need to be attached for at least 24 hours to transmit the bacteria that causes Lyme disease. […] While transmission of Lyme disease during pregnancy is possible, the risk of passing Lyme disease to a baby during pregnancy is considered very low.

• #2

  https://bodybio.com/blogs/blog/lyme-disease?srsltid=AfmBOoocVziDQAinSlM5eVFA0_lOpXZ0dKrsNb1M7d4Clvc0hfzbvUyC

  Lyme disease is traditionally caused by the bacterium Borrelia burgdorferi, which is transmitted via tick bite, specifically the blacklegged tick (Ixodes). […] However, we now know that other vectors such as mosquitoes, louse, and even possibly horse flies or other insects carry the Lyme bacteria. […] Many physicians that specialize and treat Lyme have also noted that people with preexisting conditions or exposure to environmental toxins or pollutants are more susceptible to the Lyme pathogen as well as more difficult to treat. […] What we do know is that cases of Lyme are rising, and the illness has been identified in people from all 50 states. […] Lyme disease is not contagious in the same way that a cold is contagious, but unfortunately, pregnant mothers can pass the Lyme bacteria to their children.

• #2 Lyme Disease: Causes, Symptoms, and Treatments | LifeMD

  https://lifemd.com/learn/lyme-disease-causes-symptoms-and-treatment-options

  Lyme disease is primarily caused by tick bites from those infected with Borrelia burgdorferi bacteria. […] Before transmitting bacteria, a tick must be attached to its host for 36 to 48 hours. […] If the tick is removed from the skin before then, your chances of getting infected decrease. […] This disease is not contagious and cannot be transmitted from person to person through any form of touching, kissing, or sexual contact. […] Lyme disease also cant be transmitted through air, food, water, or contact with infected surfaces. […] The only known method of transmission is through tick bites.

• #2 What is Lyme disease and why do we need to be tick-aware? – UK Health Security Agency

  https://ukhsa.blog.gov.uk/2024/03/21/what-is-lyme-disease-and-why-do-we-need-to-be-tick-aware/

  The rise in total cases may be due to a combination of increased awareness of Lyme disease as well as improved surveillance, better access to diagnostics, increased potential for encounters with ticks due to changes in wildlife populations and habitat modification that may have resulted in changes in tick distribution across the country, and human behaviour changes.

• #2

  https://www.jci.org/articles/view/138062

  The pathogenesis of PTLDS is not well understood. […] Many studies have been done to address the persistent infection hypothesis. […] The major problem with the persistent infection hypothesis is that 4 double-blind, placebo-controlled trials have not shown a sustained difference between case and control patients. […] With the current lack of evidence of persistent infection or antibiotic efficacy in human patients with PTLDS, the Infectious Diseases Society of America recommends against treatment of such patients with long-term antibiotics. […] Systemic autoimmune or autoinflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis, or peripheral spondyloarthropathy, may develop weeks to months after Lyme disease, most commonly following antibiotic-treated erythema migrans.

• #2 Uncovering the Causes of Persistent Symptoms in Lyme Disease | Graduate School of Biomedical Sciences

  https://gsbs.tufts.edu/news-events/news/uncovering-causes-persistent-symptoms-lyme-disease

  Tufts University researchers have received a $20.7 million grant from the National Institutes of Health (NIH) to try to answer some of the most vexing questions around chronic Lyme disease. […] Despite decades of research, many of the fundamentals of post-treatment Lyme disease syndrome or chronic Lyme disease remain elusive. There is no diagnostic test, clear definition, or specific treatment. There is no agreement on the mechanisms causing the condition or how frequently it occurs. […] The team’s hypothesis is that chronic Lyme disease is the result of a confluence of events including the genetics of the patient, the infecting bacteria, and prior infections with other organisms that could result in epigenetic changes that alter immune responses. This complexity may contribute to why chronic Lyme disease has been so difficult to understand. […] Science and medicine’s understanding of postinfection Lyme disease has been stuck at the same place for more than 30 years.

• #3 Lyme Disease: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/330178-overview

  Lyme disease is usually caused by infection with the spirochete Borrelia burgdorferi. […] The species Borrelia burgdorferi sensu lato has three well-characterized groups, as follows: B burgdorferi sensu stricto, B garinii, and B afzelii. […] These subspecies are associated with different clinical presentations, probably due to genomic variation. […] Infection with B burgdorferi sensu stricto has a particular predilection to affect joints. […] B garinii has some neurotropism and is the isolate that accounts for most cases of lymphocytic meningoradiculitis (Bannwarth syndrome) and white matter encephalitis, which is rare in North America. […] Other strains, which may be sufficiently different in their genetic structure to be considered separate strains, exist; however, most of these are nonpathogenic to humans.

• #3 Patient education: Lyme disease symptoms and diagnosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/lyme-disease-symptoms-and-diagnosis-beyond-the-basics/print

  Lyme disease is caused by an infection with the bacteria, Borrelia burgdorferi, which is carried by deer ticks. The bacteria are transmitted when a tick bites a person. […] Lyme disease was first described after an outbreak of what was thought to be „juvenile rheumatoid arthritis” in Lyme, Connecticut and surrounding communities. […] It became clear that Lyme disease affects different organs during different stages of the infection. […] Ticks take up to 24 hours from the time of first contact with the skin before they actually start to feed on the host’s blood. The tick must remain firmly attached to the skin for 48 to 72 hours to pass the bacteria that causes Lyme disease to humans. […] An individual who is bitten by a tick has a very low risk (about 1 in 100 chance) of acquiring Lyme disease if the tick is removed before it is engorged.

• #3 Lyme Disease Treatment | Prognosis for Lyme Patients after Treatment

  https://www.hopkinslyme.org/lyme-disease/treatment-and-prognosis-of-lyme-disease/

  The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. […] The causes of PTLD are not yet well understood but can be multifactorial. Our Center is investigating the potential roles of: infection-induced immune dysfunction or auto-immunity, chronic inflammation, persistent bacterial infection or bacterial debris, neural network alteration, other tick-borne infections, and other biologic mechanisms of disease. […] The persistent symptoms in Lyme disease can have a large negative impact on an individual’s health and quality of life. Patients often call this condition chronic Lyme disease, although an agreed upon clinical case definition for chronic Lyme disease has proven difficult to reach a consensus on. […] In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.

• #3 Lyme disease | Definition, Cause, Rash, & Treatment | Britannica

  https://www.britannica.com/science/Lyme-disease

  Lyme disease is caused by several closely related spirochetes (corkscrew-shaped bacteria), including primarily Borrelia burgdorferi in the United States, which B. mayonii being a much less frequent cause of the disease there. B. afzelii and B. garinii are the primary causes of infection in Europe and Asia. The spirochetes are transmitted to the human bloodstream by the bite of various species of ticks. […] The growing incidence of Lyme disease is attributed to multiple factors. Lyme disease is considered an indicator of climate change, owing to the fact that warming temperatures are associated with an expansion in the geographic range and increased activity of the Ixodes ticks that transmit the disease. Populations of white-footed mice have also increased, potentially leading to more ticks carrying the causative bacteria. […] These factors are suspected to have contributed to a rise in Lyme disease cases particularly in areas where it was previously uncommon.

• #3 Lyme Disease is On the Rise – An Expert Explains Why | UC San Francisco

  https://www.ucsf.edu/news/2018/05/410401/lyme-disease-rise-expert-explains-why

  Some hypotheses are that the Borrelia burgdorferi bacterium causes persistent infection somewhere in the body or that the symptoms are due to an aberrant immune response to Lyme infection, such as autoimmune disease. […] Part of the reason why we havent been seeing, clinical trials, vaccines, or drugs for Lyme disease is that we dont have an accurate diagnostic test, and we would have no way of monitoring, for instance, effectiveness of a prospective vaccine or drug therapy in a clinical trial. […] A second critical next step is identifying why is it that a proportion of patients with Lyme disease exhibit persistent symptoms that can last for months to years.

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