NEJM: Example Of Lyme Disease Transmitted by a Biting Fly

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http://cassia.org/library/N_Engl_J_Med_1990_Jun_14,322(24),1752.htm

 

 

Comments from Website author: This article, a letter to the Editor of

the New England Journal of Medicine, is a clear documentation of

other-than-tick transmission of lyme. While I believe it's rare, this

does finally medically document (refuting what some have said) that

lyme can be transmitted by " other-than-tick " .

Comments from Physicians at this article's end: None

 

 

 

Lyme Disease Transmitted by a Biting Fly

 

N Engl J Med 1990 Jun 14;322(24):1752

 

To the Editor:

 

Lyme disese, first described by Steere et al. in 1977,1 was

identified as a disease transmitted by the bite of ixodes ticks.2

Burgdorfer, Barbour, and colleagues then isolated the infectious

agent, a spirochete now known as Borrelia burgdorferi.3 the spirochete

has been shown to be transmitted by a variety of ixodes ticks,

including Ixodes dammini, I. ricinus, I. pacificus, and I.

persulcatus.4 B. burgdorferi has been identified in biting flies, and

there has been anecdotal mention of possible transmission of B.

burgdorferi by such flies. 5,6 This repost describes a case of Lyme

disease transmitted by a fly bite.

 

On July 10, 1989, while jogging with no shirt on, a 42-year-old

man from Old Lyme, Connecticut, an area in which Lyme disease is

endemic, was bothered by a large fly that he believed to be either a

deerfly or a horsefly. After swatting at it unsuccessfully, he was

bitten by the fly several times on the right side of the chest. The

bites were acutely painful. The area around the bites was swollen for

one to two days; the swelling then subsided. The patient was not aware

of any tick bites in teh previous three months. On July 23, he

presented with classic erythema migrans surrounding the bite area,

headache, chills, fever, myalgias, arthralgias, and fatigue.

 

The patient had a temperature of 37.2°C and a pulse of 76 per

minute. Examination disclosed a 16-cm by 11-cm rash (erythema migrans)

on the right side of the chest, with several small papular areas in

it's center consistent with fly bites No regional adenopathy was

present, and no cardiac, joint, or neurologic abnormalities were

found. A diagnosis of Lyme disease was made, and treatment was

initiated with amoxicillin (500 mg three times a day) and probenecid

(500 mg three times a day) for 10 days. On the first night after

treatment the patient had a Jarisch-Herxheimer reaction, with a fever

and worsening of his headache and myalgias. At his 10- and 30- day

follow-up visits he was asymptomatic, and has remained well since.

 

Antibody titres to B. burgdorferi were determined by enzyme-linked

immunosorbent assays in the acute phase and at the 10- and 30- day

follow-up visits. These analyses confirmed a more than four-fold rise

in antibodies to B. burgdorferi (Table 1). Results of other laboratory

tests were within normal limits.

 

Table 1. Antibody Response to B. burgdorferi in the Patient and

According to Diagnostic Criteria.

 

Antibody

 

 

Patient

Negative Indeterminate Positive

Day 1 Day 10 Day 30

IgM <1:100 1:25,600 >1:6400 <1:100 1:100–1:200 >1:200

IgG <1:400 1:400 >1:400 <1:400 1:400 >1:400

 

 

The patient was bitten by a biting fly (an act he both saw and

felt) and subsequently presented with Lyme disease, with erthema

migrans at the site of the bite. Serologic testing confirmed a more

than fourfold rise in antibodies to B. burgdorferi. In contrast to the

painless bite of I. dammini, the bite of flies is painful and not

likely to be overlooked by the patient as a means of transmission of

Lyme disease. I conclude that although in most cases Lyme disease is

transmitted by the bite of ixodes ticks, it may rarely be transmitted

by biting flies.

 

Steven W. Luger, M.D.

8 Davis Rd

 

Old Lyme, CT 06333

 

 

 

1.

 

Steere AC, Malawista SE, Snydman DR, et al. Lyme arthritis: en

epidemic of oligoarticular arthritis in children and adults in three

Connecticut communities, Arthritis Rheum 1977; 20:7-17

2.

 

Steere AC, Malawista SE. Cases of Lyme disease in the United

States: locations correlated with distribution of Ixodes dammini. Ann

Intern Med 1979:91:730-3.

3.

 

Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Brunwaldt E,

Davis JP. Lyme disease -- a tick borne spirochetosis? Science 1982;

216:1317-9.

4.

 

Steere AC, Lyme disease. N Engl J Med 1989; 321:586-96

5.

 

Magnarelli LA, Anderson JF, Barbour AG. The etiologic agent of

lyme disease in deer flies horse flies, and mosquitoes. J Infect Dis

1986; 154:355-8

6.

 

Magnarelli LA, Anderson JF. Ticks and biting insects infected

with the etiologic agent of Lyme disease, Borrelia burgdorferi. J Clin

Microbiol 1988; 26:1482-6