RECURRENT LYME DISEASE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 莱姆病是美国报告的最常见的扁虱传播感染。居住在莱姆病流行地区的人经常反复接触未感染和受感染的硬蜱的叮咬，并报告了这种感染的反复发作。我们发现，在罗德岛布洛克岛上经历莱姆病的人中，约有14%的人反复感染，随后感染的症状比最初感染的症状更少。目前尚不清楚在大陆流行的地点是否会出现类似的复发率和较温和的复发发作期间的临床结果。目前也不清楚是什么阻止了大多数人在反复接触感染了伯氏疏螺旋体的扁虱时经历初次感染或复发感染。虽然对病原体的免疫可能有助于限制复发，但针对扁虱媒介的免疫反应也可能有助于防止首次和重复感染。我们的前两个目标是比较布洛克岛和新英格兰南部和纽约的大陆地区莱姆病复发的频率和临床结果。我们的第三个目标是检查对我肩周炎唾液腺蛋白的免疫反应与预防原发和复发伯氏杆菌感染之间的关系。特别是，我们提出了三个具体目标。 1.确定原发和复发莱姆病的频率在RI布洛克岛和新英格兰南部和纽约的居民中是否有所不同。 2.确定反复发作的莱姆病的急性症状是否没有最初发作的莱姆病严重。 3.确定针对肩部硬蜱的免疫因素是否对伯氏硬蜱的传播具有保护作用，以及它们是否与原发和复发的莱姆病的发病率呈负相关。 这项拟议的工作将为了解复发性莱姆病的频率和临床结果，以及针对扁虱媒介的免疫因素如何限制复发性莱姆病和其他经由扁虱传播的感染的发生率提供基础。

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.