RECURRENT LYME DISEASE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Lyme disease is the most frequently reported tick-borne infection in the United States. People who live in areas that are endemic for Lyme disease are often repeatedly exposed to bites of uninfected as well as infected Ixodes ticks and recurrent episodes of this infection have been reported. We found that about 14% of people experiencing Lyme disease on Block Island, Rhode Island suffered recurrent infection and that subsequent episodes of infection were associated with fewer symptoms than the initial infection. It is unclear whether a similar rate of recurrence and a milder clinical outcome during recurrent episodes occur at endemic mainland sites. It is also unclear what prevents the majority of people from experiencing either initial infection or recurrent infection when they are repeatedly exposed to Borrelia burgdorferi-infected ticks. Although immunity against the causative pathogen probably helps limit recurrence, immune responses directed against the tick vector also may help prevent initial and repeated infections. Our first two objectives are to compare frequency and clinical outcomes of recurrent Lyme disease on Block Island and at mainland sites in southern New England and New York. Our third objective is to examine relationships among immune responses to I. scapularis salivary gland proteins and protection against the development of primary and recurrent B. burgdorferi infections. In particular, we propose three specific aims. 1. Determine whether the frequencies of primary and recurrent Lyme disease differ among residents of Block Island, RI and of southern New England and New York. 2. Determine whether the acute symptoms of repeated episodes of Lyme disease are less severe than the initial episode of Lyme disease. 3. Determine whether immune factors directed against the tick Ixodes scapularis are protective against B. burgdorferi transmission and whether they correlate inversely with the incidence of primary and recurrent Lyme disease. This proposed body of work will provide a basis for understanding the frequency and clinical outcome of recurrent Lyme disease and how immune factors directed against the tick vector may limit the incidence of recurrent Lyme disease and other tick-borne infections.