Lyme borreliosis (Lyme disease): interactions of Borrelia burgdorferi sensu lato with human (and other mammalian) hosts

In the twenty years since its description, Lyme disease has evolved from being a curiosity in three small communities on the east bank of the Connecticut River to the most common vector-borne disease in the U.S. and Germany, and a worldwide concern. In this short time, the aetiologic agent has been identified and grown, the clinical syndromes due to this agent have been delineated, seroconfirmatory tests developed, effective therapeutic regimens determined, a vaccine found safe and effective, and the epidemiology and ecology understood sufficiently to establish avoidance and prevention strategies. However, the mechanisms whereby the aetiologic agent, Borrelia burgdorferi sensu lato actually causes tissue damage/dysfunction remain to be defined. The following represents a review of some proposed immunopathogenic mechanisms with a focus on possible autoimmunity.