Lyme disease is the most common vector-borne disease in the US with over 300,000 new cases every year. The geographic range of the tick-borne epidemic is expanding as infected ticks spread into new regions.
Although many with Lyme disease recover, some do not. There can be problems with timely diagnosis and effective treatment. Some previously healthy and productive individuals suffer from ongoing illness that significantly impairs their quality of life.
Lyme disease costs our medical system over a billion dollars per year.
Challenges with Diagnosis and Treatment
- Misdiagnosis and delayed Lyme disease diagnosis can lead to prolonged and debilitating illness.
- The characteristic rash of Lyme disease is not always present or easily recognizable.
- Some people infected by Borrelia burgdorferi, the bacteria that causes Lyme disease, may have mild early symptoms or they may mistake fever and aches for a summer virus.
- Diagnostic tests cannot yet accurately identify the earliest stage of Lyme disease when making the diagnosis is crucial.
- Lyme disease can involve several parts of the body, including joints, connective tissue, heart, brain, and nerves, and produce different symptoms at different times.
- Borrelia burgdorferi can evade our protective immune system and trigger immune system dysfunction.
- No reliable blood test is presently available to measure treatment success, necessitating close clinical follow up and improved physician education.
- There is currently no vaccine to prevent Lyme disease.
The Need for Research
Physicians require enhanced diagnostics and treatments to improve Lyme disease patient care. Human clinical research is urgently needed to expand the knowledge of complex Lyme disease biologic mechanisms. Better understanding of disease pathophysiology will enable the development of improved diagnostic tests and therapies.
Multidisciplinary human clinical research is vital to improving the understanding of Lyme disease and its varied manifestations. This translational research also generates the human biologic specimens that are crucial to driving innovation in Lyme disease diagnostics and treatments.
Our clinical research program has produced the largest biorepository of well-characterized blood and skin tissue samples from patients with all stages of Lyme disease. These valuable samples are the cornerstone to innovative multidisciplinary research collaborations with leading worldwide academic, scientific, and medical investigators. Our landmark SLICE studies (Studies of Lyme disease Immunology and Clinical Events) are providing important insights into disease processes and diagnostic and treatment strategies.
Our mission is to understand and urgently address the varied manifestations of Lyme disease and translate our pioneering multidisciplinary research into improved patient care, education, and health outcomes.
The Center’s patient-based research program applies recent advances in scientific knowledge to address the unanswered questions of Lyme disease. Our goal is to advance the understanding of the complex pathophysiology of Lyme disease and translate findings into improved patient healthcare.
Chronic Lyme disease is a clinical diagnosis that encompasses a range of biologic processes and disease manifestations. Our research establishes well-defined research subgroups within the chronic Lyme disease umbrella as an essential foundation for improving the understanding of the illness’ heterogeneous mechanisms. This enhanced knowledge is the basis for developing improved diagnostic tests and therapies.
The goal of our research is to determine the potential roles of immune dysfunction, inflammation, persistent bacterial infection, neural network alteration, other biologic processes and other tick-borne infections in driving ongoing illness. Improving disease understanding of the biology of the infection, the human immune response, and the symptom illness experience will enable the development of more accurate diagnostics, more effective treatments, as well as tests that can monitor treatment success or failure.
Longer term our goal is to expand our interdisciplinary models to investigate all stages and types of Lyme disease and tick-borne illnesses. We strive for a future where accurate diagnosis and effective treatment will bring better outcomes and new hope to Lyme disease patients and their families.
Currently Recruiting Research Study
- The SLICE II Study – Sex-based differences in the immunobiology and natural history of acute and convalescent Lyme disease
Our Center has published numerous manuscripts in peer-reviewed journals across a range of disciplines, including infectious disease, rheumatology, dermatology, immunology, neuroinflammation, neuropsychology, sex and gender-based medicine, public health, and quality of life research.
- Automated Detection of Erythema Migrans and Other Confounding Skin Lesions via Deep Learning. Burlina PM, Joshi NJ, Ng E, Billings SD, Rebman AW, Aucott JN. Computers in Biology and Medicine. Volume 105, Pages 151-156. February 2019. This study shows that deep machine learning can be utilized to more accurately identify erythema migrans rashes in early Lyme disease from patient photos. Read Entire Article.
- PET Imaging of Glial Activation in Patients with Post Treatment Lyme Disease Symptoms: a pilot study using [11C]DPA-713 PET. Coughlin JM†, Yang T†, Rebman AW, Bechtold, KT, Du Y, Mathews WB, Lesniak WG, Mihm EA, Frey SM, Marshall ES, Rosenthal HB, Reekie, TA, Kassiou M, Dannals, RF, Soloski MJ†, Aucott JN†, Pomper MG†. Journal of Neuroinflammation. December 2018. 15:346. †Contributed equally. This study uses PET imaging to quantify glial activation and results show patients with Post Treatment Lyme Disease have elevated central nervous system immune activation as compared to controls. Read Entire Article.
- Robust B Cell Reponses Predict Rapid Resolution of Lyme Disease. Blum LK, Adamska JZ, Martin DS, Rebman AW, Elliott SE, Cao RRL, Embers ME, Aucott JN, Soloski MJ, Robinson WH. Frontiers of Immunology. July 2018. 9:1634. This study shows that robust B cell plasmablasts predict more rapid resolution of Lyme disease whereas poor plasmablast reponses are associated with a longer duration of symptoms. Read Entire Article.
- Incidence of Lyme Disease Diagnosis in a Maryland Medicaid Population. Rebman AW, Wang L, Yang T, Marsteller JA, Murphy SME, Uriyo M, Mihn EA, Weinstein ER, Fagan P, Aucott JN. American Journal of Epidemiology, Volume 187, Issue 10, Pages 2201-2209, October 2018. This represents the first examination of the epidemiology of Lyme disease using the analysis of health insurance claims data from publicly insured individuals. Read Abstract.
- Cognitive Decline in Post-Treatment Lyme Disease Syndrome. Touradji P, Aucott JN, Yang T, Rebman AW, Bechtold KT. Archives of Clinical Neuropsychology. June 2018. acy051. This study found objective evidence of decline in cognitive functioning in some PTLDS participants, with particular measurable cognitive decline in verbal memory and processing speed. Read Abstract.
- Obstacles to diagnosis and treatment of Lyme disease in the USA. Hirsch AG, Herman RJ, Rebman AW, Moon KA, Aucott JN, Heaney C, Schwartz BS. BMJ Open. 2018. 8:3021367 This study explores factors which may contribute to a delay in diagnosis and treatment of Lyme disease. Read Entire Article.
- Sleep Quality in Well-defined Lyme Disease: A Clinical Cohort Study in Maryland. Weinstein ER, Rebman AW, Aucott JN, Johnson-Greene D, Bechtold KT. Sleep. Volume 41, Issue 5, May 2018, zsy035. This study found poor sleep quality associated with pain among both patients with early Lyme disease and those who develop Post-Treatment Lyme Disease Syndrome. Read Abstract.
- The Clinical, Symptom, and Quality-of-Life Characterization of a Well-Defined Group of Patients with Post Treatment Lyme Disease Syndrome. Rebman AW, Bechtold KT, Yang T, Mihm EA, Soloski MJ, Novak CB and Aucott JN. Frontiers in Medicine.4:224. December 14, 2017. The study demonstrates that patients with well-documented post-treatment Lyme disease syndrome are highly symptomatic, with statistically and clinically significant impacts on quality of life compared to non-Lyme infected healthy controls. Read Entire Article.
- Early Disseminated Lyme Disease with Carditis Complicated by Post Treatment Lyme Disease Syndrome. Cheryl Novak, Andrew Harrison and John Aucott. Case Reports in Infectious Diseases. Article ID 5847156. October 31, 2017. This case study presents the severity of illness that can result from delayed diagnosis and misdiagnosis of Lyme disease, including Lyme carditis and post-treatment Lyme disease syndrome. Read Entire Article.
- Standardized Symptom Measurement of Individuals with Early Lyme Disease Over Time. Kathleen T Bechtold, Alison W. Rebman, Lauren A. Crowder, Doug Johnson-Greene, John N. Aucott. Archives of Clinical Neuropsychology 2017 32(2);129-141. In this longitudinal analysis, ideally treated patients with early Lyme disease recovered well overall however a small subgroup continued to suffer with symptom that lead to functional decline. Read Entire Article.
- CCL19 as a Chemokine Risk Factor for Post-Treatment Lyme Disease Syndrome: A Prospective Clinical Cohort Study. John N. Aucott, Mark J. Soloski, Alison W. Rebman, Lauren A. Crowder, Lauren J. Lahey, Catriona A. Wagner, William H. Robinson, Kathleen T. Bechtold. Clinical and Vaccine Immunology 2016 23(9): 757-66. This study suggests the relevance of the T-cell chemokine CCL19 during both acute infection with Lyme disease and as an immunologic risk factor for PTLDS during the post-treatment phase. Read Entire Article.
- Longitudinal Transcriptome Analysis Reveals a Sustained Differential Gene Expression Signature in Patients Treated for Acute Lyme Disease. Jerome Bouquet, Mark J. Soloski, Andrea Swei, Chris Cheadle, Scot Federman, Jean-Noel Billaud, Alison W. Rebman, Beniwende Kabre, Richard Halpert, Meher Boorgula, John N. Aucott, Charles Y. Chiu. mBio 2016 7(1). This study found a differential gene expression signature in patients with early Lyme disease that persisted to some degree for up to six months following completion of antibiotic therapy. Read Entire Article.
- Development of a Multiantigen Panel for Improved Detection of Borrelia burgdorferi Infection in Early Lyme Disease. Lauren J. Lahey, Michael W. Panas, Rong Mao, Michelle Delanoy, John J. Flanagan, Steven R. Binder, Alison W. Rebman, Jose G. Montoya, Mark J. Soloski, Allen C. Steere, Raymond J. Dattwyler, Paul M. Arnaboldi, John N. Aucott, William H. Robinson. Journal of Clinical Microbiology. Volume 53, Issue 12, December 2015. The article shows that a newly developed 10-antigen panel can improve sensitivity of blood testing in early Lyme disease. http://www.ncbi.nlm.nih.gov/pubmed/26447113
- Living in Limbo: Contested Narratives of Patients with Chronic Symptoms Following Lyme Disease. Alison W. Rebman, John N. Aucott, Eric R. Weinstein, Kathleen T. Bechtold, Katherine C. Smith, Lori Leonard. Qualitative Health Research. December 1, 2015. Similar to other contested or medically unexplained syndromes, semi-structured interviews suggest that the social sequelae of PTLDS/CLD can be equally protracted as the physical effects of this illness. http://www.ncbi.nlm.nih.gov/pubmed/26631681
- Quantification of Borrelia burgdorferi Membrane Proteins in Human Serum: A New Concept for Detection of Bacterial Infection. Crystal S. F. Cheung, Kyle W. Anderson, Kenia Y. Villatoro Benitez, Mark J. Soloski, John N. Aucott, Karen W. Phinney, Illarion V. Turko. Analytical Chemistry. Volume 87, Number 22, November 2015. This collaborative proof of concept report shows that a new method can accurately identify a major B. burgdorferi lipoprotein in a small sample of patients with early Lyme disease. http://www.ncbi.nlm.nih.gov/pubmed/26491962
- Posttreatment Lyme disease syndrome. John N Aucott. Infectious Disease Clinics of North America 2015 29(2);309-23. This review article offers an overview of current research into diagnosis, treatment, and proposed mechanisms for post-treatment Lyme disease syndrome. Read Abstract.
- Health Care Costs, Utilization and Patterns of Care following Lyme Disease. Emily R. Adrion, John N. Aucott, Klaus W. Lemke, Jonathan P. Weiner. PLoS ONE. Volume 10, Issue 2. February 4, 2015. Healthcare claims study shows Lyme disease costs upward of $1.3 billion to treat. Read entire article
- Lyme disease and post-treatment Lyme disease syndrome: the neglected disease in our own backyard. Lauren A. Crowder, Victoria A. Yedlin, Eric R. Weinstein, John N. Aucott, Kathleen B. Kortte. Public Health. Volume 128, Issue 9. September 9, 2014. The need for further understanding and communication presents an opportunity for public health research and education in Lyme disease and the sequelae of PTLDS. Read abstract
- Characteristics of seroconversion and implications for diagnosis of post-treatment Lyme disease syndrome: acute and convalescent serology among a prospective cohort of early Lyme disease patients. Alison W. Rebman, Lauren A. Crowder, Allison Kirkpatrick, John N. Aucott. Clinical Rheumatology. June 13, 2014. The lack of seroconversion in a subset of patients, highlights the limitations of using serology alone in identifying early Lyme disease. Read abstract
- Serum Inflammatory Mediators as Markers of Human Lyme Disease Activity. Mark J. Soloski, Lauren A. Crowder, Lauren J. Lahey, Catriona A. Wagner, William H. Robinson, and John N. Aucott. PLOS ONE. (2014) The levels of serum chemokines and the levels of expression of their respective chemokine receptors on T cell subsets may prove to be informative biomarkers for Lyme disease and related to specific disease manifestations. Read entire article.
- Development of a foundation for a case definition of post-treatment Lyme disease syndrome. John N. Aucott, Lauren A.Crowder, and Kathleen B. Kortte. International Journal of Infectious Diseases 17 (2013) This article describes the initial findings of the SLICE Study, showing results from the first prospective controlled study in the United States designed to specifically measure symptom and health related quality of life outcomes after the antibiotic treatment of early Lyme disease. Read entire article.
- Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease. S.E. Schutzer, B.W. Berger, J.G. Krueger, M.W. Eshoo, D.J. Ecker; J.N. Aucott. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 5, May 2013. This report re-emphasizes that the majority of proven cases of erythema migrans do not have the text book “bull’s eye” appearance and therefor may be harder for patients and physicians to recognize as a sign of early Lyme disease. Read entire article.
- Direct Molecular Detection and Genotyping of Borrelia burgdorferi from Whole Blood of Patients with Early Lyme Disease. Mark W. Eshoo, Christopher C. Crowder, Alison W. Rebman, Megan A. Rounds, Heather E. Matthews, John M. Picuri, Mark J. Soloski, David J. Ecker, Steven E. Schutzer, John N. Aucott. Published: PLoS ONE | www.plosone.org — May 2012 | Volume 7 | Issue 5 | e36825. This research collaboration shows that new state of the art methods can accurately detect the minute amount of DNA of the bacteria Borrelia burgdorferi in the blood stream of patients with early untreated Lyme disease. Read entire article.
- Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans. John N. Aucott, Lauren A.Crowder, Victoria Yedlin, and Kathleen B. Kortte. Dermatology Research and Practice, Volume 20. The results of this survey demonstrate that individuals are unfamiliar with the atypical skin manifestations of early Lyme disease. Read entire article.
- Probable late lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection. John N. Aucott, Ari Seifter, and Alison W Rebman. BMC Infectious Diseases 2012, 12:173. This review of patients seen in the community practice of medicine shows that some patients with untreated late Lyme disease may have only chronic symptoms and do not have the classic objective findings of Lyme arthritis or nerve damage. Read entire article.
- Post-treatment Lyme Disease syndrome symptomatology and the impact on life functioning: is there something here? John N. Aucott, Alison W. Rebman, Lauren A. Crowder, & Kathleen B. Kortte. Quality of Life Research. Published online: February 1, 2012. This study aims to describe a cohort of participants with early, untreated Lyme disease, and characterize post-antibiotic treatment symptoms and functional impact of post-treatment Lyme disease syndrome over time. Read entire article.
- Misdiagnosis of early Lyme disease as the summer flu. John N. Aucott, Ari Seifter. Orthopedic Reviews 2011 3:2. This case report provides an example of how Lyme disease can present with viral-like symptoms that may remain unrecognized. Read Entire Article.
- Sex Differences in the Clinical and Serologic Presentation of Early Lyme Disease: Results From a Retrospective Review Alison Schwarzwalder, MPH; Michael F. Schneider, MS; Alison Lydecker, MPH; and John N. Aucott, MD. Gender Medicine. Volume 7, Issue 4, 2010. This paper shows for the first time that women’s antibody responses used to diagnose Lyme disease may not be equivalent to those seen in men. Read entire article
- The Utility of “Google Trends for Epidemiological Research: Lyme Disease as an Example. Ari Seifter, Alison Schwarzwalder, Kate Geis, John Aucott. Geospatial Health 4(2), 2010, pp. 135-137. Article examines the potential of the Internet for monitoring epidemics of disease such as Lyme. Read entire article.
- Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology Candis Morrison, PhD, CRNP, Ari Seifter, and John N. Aucott, MD. J Am Board Fam Med 2009;22:219 –222. This article highlights an unusual presentation that most physicians would not consider to be a result of Lyme disease. Read entire article.
- Diagnostic Challenges of Early Lyme Disease: Lessons from a Community Case Series John Aucott, Candis Morrison, Beatriz Munoz, Peter C Rowe, Alison Schwarzwalder and Sheila K West. BMC Infectious Diseases 2009, 9:79 Accepted: 1 June 2009. This manuscript describes the variability in the presenting symptoms of Lyme disease and difficulty with its diagnosis in the community-based practice of medicine. It shows physicians’ current, widespread difficulty in making accurate diagnosis and treatment decisions in early Lyme. Read entire article
Abstracts Presented at National Meetings about the Slice Study
- Temporal patterns of early cytokine immune response to infection with B burgdorferi. Aucott J, Schwarzwalder A, Miagkov A, Soloski M. Presented at the American Society for Tropical Medicine and Hygiene meetings, November 19-22, 2009. Read abstract
- Post-Lyme syndrome, an emerging complication of acute infection with Borrelia burgdorferi. Schwarzwalder A, Johnson-Greene D, Aucott J. Presented at the International Conference on Emerging Infectious Diseases, July 11-15, 2010. See chart
- Another Difference between Boys and Girls: Sex-Based Differences in Lyme Disease. L. A. Crowder, V. A. Yedlin, M. Soloski, J. N. Aucott See chart
- T-cell Immunophenotyping in Early Lyme Disease. L. A. Crowder, J. N. Aucott, M. Soloski See chart
Note: These abstracts describe the SLICE Study, a five-year prospective cohort study conducted through Johns Hopkins Green Spring/Johns Hopkins Bayview examining symptom prevalence, risk factors, natural history, and biomarkers associated with the development of persistent symptoms following exposure to Lyme disease.