Xenodiagnosis After Antibiotic Treatment for Lyme Disease

Study Summary

Background: The most common tick-borne illness in the United States, Lyme disease is caused by Borrelia burgdorferi bacteria that are transmitted to people by Ixodes scapularis ticks. Most cases of Lyme disease are cured by antibiotics, but some patients continue to experience symptoms despite the absence of detectable Lyme bacteria. Xenodiagnosis uses a vector to detect the presence of a disease-causing microbe. Researchers will use live, laboratory-bred ticks to see if Lyme disease bacteria can be detected in people after completing antibiotic therapy and if that is more common in people who continue to experience symptoms such as fatigue and joint pain. Objectives: \- To see if ticks can be used to detect B. burgdorferi in people who have had Lyme disease and received antibiotic therapy and if it correlates with persistent symptoms. Eligibility: * Adults at least 18 years old who have: * Untreated erythema migrans (the Lyme disease rash); OR * Untreated Lyme arthritis; OR * Continuing symptoms after treatment for Lyme disease; OR * Had Lyme disease and antibiotic treatment within the past 12 months. * Healthy volunteers Design: * Participants will be screened with medical history, physical exam, and blood tests. * Visit 1: * Blood and urine tests, health questionnaire. * Up to 30 laboratory-bred, pathogen-free, larval ticks (each smaller than a poppy seed) will be placed under a dressing. * Participants may have two small biopsies of skin . * 4 6 days later, Visit 2: * Dressing will be removed and ticks will be collected. * Participants will answer symptom questions. * If many ticks are still attached, participants will have to come back the next day. If not enough ticks feed successfully, the procedure may be repeated. * Participants will keep a diary of symptoms for 30 days. Over 3 months, they will be return to the clinic 3 times to see how they feel and answer questionnaires. Test results will be discussed.

Primary Outcome

Recovered ticks after feeding on research participants were tested for presence of B. burgdorferi using at least one of three procedures: 1. Test ticks by polymerase chain reaction (PCR) and culture - Injection of tick lysate into severe combined immunodeficiency (SCID) mice with subsequent PCR and culture testing 2. Test ticks using isothermal amplification reaction included in the PCR electrospray ionization mass spectroscopy 3. Test ticks by PCR using the Tick-borne disease Capture Sequencin

Interventions

• PROCEDURE Blood draw
• PROCEDURE Skin biopsy
• DEVICE Xenodiagnosis