Analyze Diet
Journal of veterinary internal medicine2018; 32(2); 617-632; doi: 10.1111/jvim.15042

Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement.

Abstract: Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.
Publication Date: 2018-02-22 PubMed ID: 29469222PubMed Central: PMC5866975DOI: 10.1111/jvim.15042Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article discusses the prevalence of Borrelia burgdorferi infection, commonly known as Lyme disease, in North American horses. It delves into potential health issues caused by the infection, the diagnosis of Lyme disease, treatment processes, and the potential for vaccination.

Prevalence of Borrelia burgdorferi Infection in Horses

  • The research indicates that Borrelia burgdorferi infections are frequently found in horses located in regions where Lyme disease is endemic. Furthermore, the likelihood of exposure to this disease is expanding in terms of geographic range.
  • The researchers note that the actual morbidity rate due to B. burgdorferi infection in horses is yet to be determined, suggesting further study in this area is required.

Symptoms and Health Consequences of Infection

  • The study identifies several naturally occurring syndromes in horses that can be attributed to B. burgdorferi infection. These include neuroborreliosis (a neurological condition), uveitis (an inflammatory condition affecting the eye), and cutaneous pseudolymphoma (a skin condition).
  • Aside from these known effects, the researchers mention other clinical signs, such as lameness and stiffness in horses, which have been linked to the disease but have not been sufficiently documented.

Diagnosis and Treatment of Lyme Disease in Horses

  • Lyme disease is diagnosed in horses based on exposure to B. burgdorferi, and confirmed through the examination of cytology or histopathology of the infected fluid or tissue. Additionally, antigen detection is used in diagnosis.
  • In terms of treatment, the researchers indicate that treating Lyme disease in horses is much the same as the treatment given to humans or small animals. However, the success of the treatment may not be equal across species due to differences in antimicrobial bioavailability and the length of infection before treatment is commenced.

Prospects for Vaccination

  • While the article reports that there are no approved Lyme vaccines specifically for horses, the authors suggest that there is strong evidence indicating that proper vaccination could prevent infection in horses, pointing towards a future avenue for preventing the spread of this disease.

Cite This Article

APA
Divers TJ, Gardner RB, Madigan JE, Witonsky SG, Bertone JJ, Swinebroad EL, Schutzer SE, Johnson AL. (2018). Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement. J Vet Intern Med, 32(2), 617-632. https://doi.org/10.1111/jvim.15042

Publication

ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 32
Issue: 2
Pages: 617-632

Researcher Affiliations

Divers, T J
  • Department of Clinical Sciences, Cornell University, Ithaca, NY.
Gardner, R B
  • BW Furlong & Associates, Oldwick, NJ.
Madigan, J E
  • Department of Medicine and Epidemiology, University of California - Davis, CA.
Witonsky, S G
  • Department of Large Animal Clinical Sciences, Virginia-Maryland Region CVM, Blacksburg, VA.
Bertone, J J
  • CVMm Western University of Health Sciences, Pomona, CA.
Swinebroad, E L
  • Newmarket Sporthorse Medicine, Newmarket, NH.
Schutzer, S E
  • Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ.
Johnson, A L
  • Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, PA.

MeSH Terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Borrelia burgdorferi
  • Consensus
  • Horse Diseases / diagnosis
  • Horse Diseases / drug therapy
  • Horse Diseases / epidemiology
  • Horses
  • Lyme Disease / diagnosis
  • Lyme Disease / drug therapy
  • Lyme Disease / epidemiology
  • Lyme Disease / veterinary
  • North America / epidemiology
  • Seroepidemiologic Studies

Conflict of Interest Statement

In the past 5 years Dr Divers has received funds related to Lyme research from Merial and Zoetis. Dr Divers is employed at Cornell University which offers for diagnostic purposes a bead‐based multiple antigen ELISA assay (Multiplex) for detecting B. burgdorferi antibodies. Dr Bertone received financial support from Merial for the purpose of conducting a Lyme vaccine serologic response study.

References

This article includes 124 references
  1. Burgdorfer W. Discovery of the Lyme disease spirochete and its relation to tick vectors. Yale J Biol Med 1984;57:515–520.
    pmc: PMC2590008pubmed: 6516454
  2. Parola P, Raoult D. Tick‐borne bacterial diseases emerging in Europe. Clin Microbiol Infect 2001;7:80–83.
    pubmed: 11298147
  3. Appel MJ, Allan S, Jacobson RH. Experimental Lyme disease in dogs produces arthritis and persistent infection. J Infect Dis 1993;167:651–664.
    pubmed: 8440936
  4. Normal GL, Antig JM, Bigaignon G. Serodiagnosis of Lyme borreliosis by Borrelia burgdorferi sensu stricto, B. garinii, and B. afzelii western blots (immunoblots). J Clin Microbiol 1996;34:1732–1738.
    pmc: PMC229104pubmed: 8784579
  5. Schutzer SE, Fraser‐Liggett CM, Casjens SR. Whole‐genome sequences of thirteen isolates of Borrelia burgdorferi. J Bacteriol 2011;193:1018–1020.
    pmc: PMC3028687pubmed: 20935092
  6. Cerar T, Strle F, Stupica D. Differences in genotype, clinical features, and inflammatory potential of Borrelia burgdorferi sensu stricto strains from Europe and the United States. Emerg Infect Dis 2016;22:818–827.
    pmc: PMC4861522pubmed: 27088349
  7. Aguero‐Rosenfeld ME, Wormser GP. Lyme disease: Diagnostic issues and controversies. Expert Rev Mol Diagn 2015;15:1–4.
    pubmed: 25482091
  8. Littman MP, Goldstein RE, Labato MA. ACVIM small animal consensus statement on Lyme disease in dogs: Diagnosis, treatment, and prevention. J Vet Intern Med 2006;20:422–434.
    pubmed: 16594606
  9. Sanchez JL. Clinical manifestations and treatment of Lyme disease. Clin Lab Med 2015;35:765–778.
    pubmed: 26593256
  10. Dambach DM, Smith CA, Lewis RM. Morphologic, immunohistochemical, and ultrastructural characterization of a distinctive renal lesion in dogs putatively associated with Borrelia burgdorferi infection: 49 cases (1987–1992). Vet Pathol 1997;34:85–96.
    pubmed: 9066075
  11. Chang YF, Novosol V, McDonough SP. Experimental infection of ponies with Borrelia burgdorferi by exposure to Ixodid ticks. Vet Pathol 2000;37:68–76.
    pubmed: 10643983
  12. Chang YF, Ku YW, Chang CF. Antibiotic treatment of experimentally Borrelia burgdorferi‐infected ponies. Vet Microbiol 2005;107:285–294.
    pubmed: 15863289
  13. Chang Y, Novosol V, McDonough SP. Vaccination against lyme disease with recombinant Borrelia burgdorferi outer‐surface protein A (rOspA) in horses. Vaccine 1999;18:540–548.
    pubmed: 10519945
  14. Steere AC, Strle F, Wormser GP. Lyme borreliosis. Nat Rev Dis Primers 2016;2:16090.
    pmc: PMC5539539pubmed: 27976670
  15. Pietikäinen A, Maksimow M, Kauko T. Cerebrospinal fluid cytokines in Lyme neuroborreliosis. J Neuroinflammation 2016;13:273–283.
    pmc: PMC5070144pubmed: 27756335
  16. Basile RC, Rivera GG, Del Rio LA. Anaphylactoid reaction caused by sodium ceftriaxone in two horses experimentally infected by Borrelia burgdorferi. BMC Vet Res 2015;11:197–205.
    pmc: PMC4534110pubmed: 26265349
  17. Burgess EC, Gillette D, Pickett JP. Arthritis and panuveitis as manifestations of Borrelia burgdorferi infection in a Wisconsin pony. J Am Vet Med Assoc 1986;189:1340–1342.
    pubmed: 3793582
  18. Burgess EC, Mattison M. Encephalitis associated with Borrelia burgdorferi infection in a horse. J Am Vet Med Assoc 1987;191:1457–1458.
    pubmed: 3692996
  19. Magnarelli LA, Anderson JF, Shaw E. Borreliosis in equids in northeastern United States. Am J Vet Res 1988;49:359–362.
    pubmed: 3282461
  20. Hahn CN, Mayhew IG, Whitwell KE. A possible case of Lyme borreliosis in a horse in the UK. Equine Vet J 1996;28:84–88.
    pubmed: 8565961
  21. James FM, Engiles JB, Beech J. Meningitis, cranial neuritis, and radiculoneuritis associated with Borrelia burgdorferi infection in a horse. J Am Vet Med Assoc 2010;237:1180–1185.
    pubmed: 21073390
  22. Imai DM, Barr BC, Daft B. Lyme neuroborreliosis in 2 horses. Vet Pathol 2011;48:1151–1157.
    pubmed: 21285382
  23. Priest HL, Irby NL, Schlafer DH. Diagnosis of Borrelia‐associated uveitis in two horses. Vet Ophthalmol 2012;15:398–405.
    pubmed: 22360730
  24. Sears KP, Divers TJ, Neff RT. A case of Borrelia‐associated cutaneous pseudolymphoma in a horse. Vet Dermatol 2012;23:153–156.
    pubmed: 22029872
  25. Passamonti F, Veronesi F, Cappelli K. Polysynovitis in a horse due to Borrelia burgdorferi sensu lato infection–Case study. Ann Agric Environ Med 2015;22:247–250.
    pubmed: 26094517
  26. Johnstone LK, Engiles JB, Aceto H. Retrospective evaluation of horses diagnosed with neuroborreliosis on postmortem examination: 16 cases (2004–2015). J Vet Intern Med 2016;30:1305–1312.
    pmc: PMC5094551pubmed: 27327172
  27. Wagner B, Glaser A, Bartol J. A new sensitive Lyme multiplex assay to confirm neuroborreliosis in horses: A case report. Proc Am Assoc Equine Pract 2011;57:70–75.
  28. Magnarelli LA, Ijdo JW, Van Andel AE. Serologic confirmation of Ehrlichia equi and Borrelia burgdorferi infections in horses from the northeastern United States. J Am Vet Med Assoc 2000;217:1045–1050.
    pubmed: 11019714
  29. Funk RA, Pleasant RS, Witonsky SG. Seroprevalence of Borrelia burgdorferi in horses presented for coggins testing in southwest Virginia and change in positive test results approximately 1 year later. J Vet Intern Med 2016;30:1300–1304.
    pmc: PMC5089602pubmed: 27214745
  30. Durrani AZ, Goyal SM, Kamal N. Retrospective study on seroprevalence of Borrelia burgdorferi antibodies in horses in Minnesota. J Equine Vet Sci 2011;31:427–429.
  31. Metcalf KB, Lilley CS, Revenaugh MS. The prevalence of antibodies against Borrelia burgdorferi found in horses residing in the northwestern United States. J Equine Vet Sci 2008;28:587–589.
  32. Rosa PA. Microbiology of Borrelia burgdorferi. Semin Neurol 1997;17:5–10.
    pubmed: 9166953
  33. Eisen L, Eisen RJ, Mun J. Transmission cycles of Borrelia burgdorferi and B. bissettii in relation to habitat type in northwestern California. J Vector Ecol 2009;34:81–91.
    pmc: PMC2876337pubmed: 20514140
  34. Barbour AG, Bunikis J, Fish D. Association between body size and reservoir competence of mammals bearing Borrelia burgdorferi at an endemic site in the northeastern United States. Parasit Vectors 2015;30:299–303.
    pmc: PMC4459683pubmed: 26024881
  35. Mather TN, Wilson ML, Moore SI. Comparing the relative potential of rodents as reservoirs of the Lyme disease spirochete (Borrelia burgdorferi). Am J Epidemiol 1989;130:143–150.
    pubmed: 2787105
  36. Radolf JD, Caimano MJ, Stevenson B. Of ticks, mice and men: Understanding the dual‐host lifestyle of Lyme disease spirochaetes. Nat Rev Microbiol 2012;10:87–99.
    pmc: PMC3313462pubmed: 22230951
  37. Cook MJ. Lyme borreliosis: A review of data on transmission time after tick attachment. Int J Gen Med 2015;8:1–8.
    pmc: PMC4278789pubmed: 25565881
  38. Pal U, Montgomery RR, Lusitani D. Inhibition of Borrelia burgdorferi‐tick interactions in vivo by outer surface protein A antibody. J Immunol 2001;166:7398–7403.
    pubmed: 11390491
  39. Tilly K, Rosa PA, Stewart PE. Biology of infection with Borrelia burgdorferi. Infect Dis Clin North Am 2008;22:217–234.
    pmc: PMC2440571pubmed: 18452798
  40. Caine JA, Coburn J. Multifunctional and redundant roles of Borrelia burgdorferi outer surface proteins in tissue adhesion, colonization, and complement evasion. Front Immunol 2016;7:442–452.
    pmc: PMC5073149pubmed: 27818662
  41. Liang FT, Yan J, Mbow ML. Borrelia burgdorferi changes its surface antigenic expression in response to host immune responses. Infect Immun 2004;72:5759–5767.
    pmc: PMC517580pubmed: 15385475
  42. Tilly K, Bestor A, Rosa PA. Lipoprotein succession in Borrelia burgdorferi: Similar but distinct roles for OspC and VIsE at different stages of mammalian infection. Mol Microbiol 2013;89:216–227.
    pmc: PMC3713631pubmed: 23692497
  43. Caine JA, Coburn J, Morrison RP. A short‐term Borrelia burgdorferi infection model identifies tissue tropisms and bloodstream survival conferred by adhesion proteins. Infect Immun 2015;83:3184–3194.
    pmc: PMC4496602pubmed: 26015482
  44. Applegren NC, Kraus CK. Lyme disease: Emergency department considerations. J Emerg Med 2017;52:815–824.
    pubmed: 28291638
  45. Watson SC, Liu Y, Lund RB. A Bayesian spatio‐temporal model for forecasting the prevalence of antibodies to Borrelia burgdorferi, causative agent of Lyme disease, in domestic dogs within the contiguous United States. PLoS One 2017;12:e0174428.
    pmc: PMC5417420pubmed: 28472096
  46. Kugeler KJ, Farley GM, Forrester JD. Geographic distribution and expansion of human Lyme disease, United States. Emerg Infect Dis 2015;21:1455–1457.
    pmc: PMC4517724pubmed: 26196670
  47. Magnarelli E, Fikrig E. Detection of antibodies to B. burgdorferi in naturally infected horses in the USA by enzyme linked immunosorbent assay using whole cell recombinant antigens. Res Vet Sci 2005;79:99–103.
    pubmed: 15924926
  48. Wagner B, Erb H. Dogs and horses with antibodies to outer‐surface protein C as on‐time sentinels for ticks infected with Borrelia burgdorferi in New York State in 2011. Prev Vet Med 2012;107:275–279.
    pubmed: 22841496
  49. Burtis JC, Sullivan P, Levi T. The impact of temperature and precipitation on blacklegged tick activity and Lyme disease incidence in endemic and emerging regions. Parasit Vectors 2016;9:606–615.
    pmc: PMC5124264pubmed: 27887625
  50. Eisen RJ, Eisen L, Beard CB. County‐scale distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the continental United States. J Med Entomol 2016;53:349–386.
    pmc: PMC4844559pubmed: 26783367
  51. Herrin B, Zajac AM, Little SE. Confirmation of Borrelia burgdorferi sensu stricto and Anaplasma phagocytophilum in Ixodes scapularis, Southwestern Virginia. Vector Borne Zoonotic Dis 2014;14:821–823.
    pubmed: 25409274
  52. Nelder MP, Russell CB, Sheehan NJ. Human pathogens associated with blacklegged tick Ixodes scapularis: A systematic review. Parasit Vectors 2016;9:265–278.
    pmc: PMC4857413pubmed: 27151067
  53. Xu G, Mather TN, Hollingsworth CS. Passive surveillance of Ixodes scapularis, their biting activity, and associated pathogens in Massachusetts. Vector Borne Zoonotic Dis 2016;16:520–527.
    pmc: PMC4960492pubmed: 27248292
  54. Qurollo BA, Chandrashekar R, Hegarty BC. A serological survey of tick‐borne pathogens in dogs in North America and the Caribbean as assessed by Anaplasma phagocytophilum, A. platys, Ehrlichia canis, E. chaffeensis, E. ewingii, and Borrelia burgdorferi species‐specific peptides. Infect Ecol Epidemiol 2014;4:24699–24712.
    pmc: PMC4212082pubmed: 25405006
  55. Burbelo P, Bren KE, Ching KH. Antibody profiling of Borrelia burgdorferi infection in horses. Clin Vaccine Immunol 2011;18:1562–1567.
    pmc: PMC3165210pubmed: 21775514
  56. Cohen ND, Heck FC, Heim B. Seroprevalence of antibodies to Borrelia burgdorferi in a population of horses in central Texas. J Am Vet Med Assoc 1992;201:1030–1034.
    pubmed: 1429127
  57. Marcus LC, Patterson MM, Gilfillan RE. Antibodies to Borrelia burgdorferi in New England horses: Serologic survey. Am J Vet Res 1985;46:2570–2571.
    pubmed: 4083595
  58. Bosler EM, Cohen DP, Schulze TL. Host responses to Borrelia burgdorferi in dogs and horses. Ann N Y Acad Sci 1988;539:221–234.
    pubmed: 3190094
  59. Magnarelli LA, Anderson JF. Class‐specific and polyvalent enzyme‐linked immunosorbent assays for detection of antibodies to Borrelia burgdorferi in equids. J Am Vet Med Assoc 1989;195:1365–1368.
    pubmed: 2684937
  60. Magnarelli LA, Flavell RA, Padula SJ. Serologic diagnosis of canine and equine borreliosis: Use of recombinant antigens in enzyme‐linked immunosorbent assays. J Clin Microbiol 1997;35:169–173.
    pmc: PMC229532pubmed: 8968901
  61. Carter SD, May C, Barnes A. Borrelia burgdorferi infection in UK horses. Equine Vet J 1994;26:187–190.
    pubmed: 8542836
  62. Dzierzecka M, Kita J. The use of chosen serological diagnostic methods in Lyme disease in horses. Part II. Western blot. Pol J Vet Sci 2002;5:79–84.
    pubmed: 12189953
  63. Wagner B, Freer H, Rollins A. Development of a multiplex assay for the detection of antibodies to Borrelia burgdorferi in horses and its validation using Bayesian and conventional statistical methods. Vet Immunol Immunopathol 2011;144:374–381.
    pubmed: 21890217
  64. Wagner B, Goodman LB, Rollins A. Antibodies to OspC, OspF and C6 antigens as indicators for infection with Borrelia burgdorferi in horses. Equine Vet J 2013;45:533–537.
    pubmed: 23432019
  65. Johnson AL, Divers TJ, Chang YF. Validation of an in‐clinic enzyme‐linked immunosorbent assay kit for diagnosis of Borrelia burgdorferi infection in horses. J Vet Diagn Invest 2008;20:321–324.
    pubmed: 18460618
  66. Grosenbaugh DA, Rissi DR, Krimer PM. Demonstration of the ability of a canine Lyme vaccine to reduce the incidence of histological synovial lesions following experimentally‐induced canine Lyme borreliosis. Vet Immunol Immunopathol 2016;180:29–33.
    pubmed: 27692092
  67. Lindenmayer J, Weber M, Bryant J. Comparison of indirect immunofluorescent‐antibody assay, enzyme‐linked immunosorbent assay, and Western immunoblot for the diagnosis of Lyme disease in dogs. J Clin Microbiol 1990;28:92–96.
    pmc: PMC269543pubmed: 2405018
  68. Shin SJ, Chang YF, Jacobson RH. Cross‐reactivity between B. burgdorferi and other spirochetes affects specificity of serotests for detection of antibodies to the Lyme disease agent in dogs. Vet Microbiol 1993;36:161–174.
    pmc: PMC7117176pubmed: 8236777
  69. Schvartz G, Epp T, Burgess HJ. Comparison between available serologic tests for detecting antibodies against Anaplasma phagocytophilum and Borrelia burgdorferi in horses in Canada. J Vet Diagn Invest 2015;27:540–546.
    pubmed: 26069228
  70. Divers TJ, Grice AL, Mohammed HO. Changes in Borrelia burgdorferi ELISA antibody over time in both antibiotic treated and untreated horses. Acta Vet Hung 2012;60:421–429.
    pubmed: 23160024
  71. Akin E, McHugh GL, Flavell FA. The immunoglobulin (IgG) antibody response to OspA and OspB correlates with severe and prolonged Lyme arthritis and the IgG response to P35 correlates with mild and brief arthritis. Infect Immun 1999;67:173–181.
    pmc: PMC96293pubmed: 9864212
  72. Leeflang MM, Ang CW, Berkhout J. The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: A systematic review and meta‐analysis. BMC Infect Dis 2016;16:140–156.
    pmc: PMC4807538pubmed: 27013465
  73. Ebani VV, Bertelloni F, Pinzauti P. Seroprevalence of Leptospira spp. and Borrelia burgdorferi sensu lato in Italian horses. Ann Agric Environ Med 2012;19:237–240.
    pubmed: 22742794
  74. Wieneke C, Lovrich SD, Callister SM. Evaluation of whole‐cell and OspC enzyme‐linked immunosorbent assays for discrimination of early lyme borreliosis from OspA vaccination. J Clin Microbiol 2000;38:313–317.
    pmc: PMC88715pubmed: 10618107
  75. Pritt BS, Mead PS, Johnson DKH. Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: A descriptive study. Lancet Infect Dis 2016;16:556–564.
    pmc: PMC4975683pubmed: 26856777
  76. Krause PJ, Narasimhan S, Wormser GP. Borrelia miyamotoi sensu lato seroreactivity and seroprevalence in the northeastern United States. Emerg Infect Dis 2014;20:1183–1190.
    pmc: PMC4073859pubmed: 24960072
  77. DeVilbiss BA, Mohammed HO, Divers TJ. Perception of equine practitioners regarding the occurrence of selected equine neurologic diseases in the northeast over a 10‐year period. J Equine Vet Sci 2009;29:237–246.
  78. Bartol J. Is Lyme disease overdiagnosed in horses?. Equine Vet J 2013;45:529–530.
    pubmed: 23909449
  79. Cutler SJ, Rudenko N, Golovchenko M. Diagnosing borreliosis. Vector Borne Zoonotic Dis 2017;17:2–11.
    pubmed: 28055580
  80. Furr M, Howe D, Reed S. Antibody coefficients for the diagnosis of equine protozoal myeloencephalitis. J Vet Intern Med 2011;25:138–142.
    pubmed: 21155894
  81. Djukic M, Schmidt‐Samoa C, Lange P. Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis. J Neurol 2012;259:630–636.
    pmc: PMC3319903pubmed: 21898139
  82. Arvikar SL, Steere AC. Diagnosis and treatment of Lyme arthritis. Infect Dis Clin North Am 2015;29:269–280.
    pmc: PMC4443866pubmed: 25999223
  83. Browning A, Carter SD, Barnes A. Lameness associated with Borrelia burgdorferi infection in the horse. Vet Rec 1993;132:610–611.
    pubmed: 8337810
  84. Schoen A. Equine immune‐mediated myofascial syndrome and its relation to Wei Qi syndromes. Am J Trad Chinese Vet Med 2007;2:75–78.
  85. Maher MC, Schnabel LV, Cross JA. Plasma and synovial fluid concentration of doxycycline following low‐dose, low‐frequency administration, and resultant inhibition of matrix metalloproteinase‐13 from interleukin‐stimulated equine synoviocytes. Equine Vet J 2014;46:198–202.
    pubmed: 23855565
  86. Bernardino AL, Kaushal D, Philipp MT. The antibiotics doxycycline and minocycline inhibit inflammatory responses to the Lyme disease spirochete Borrelia burgdorferi. J Infect Dis 2009;199:1379–1388.
    pmc: PMC3697124pubmed: 19301981
  87. Ates L, Hanssen‐Hubner C, Norris DE. Comparison of in vitro activities of tigecycline, doxycycline, and tetracycline against the spirochete Borrelia burgdorferi. Ticks Tick Borne Dis 2010;1:30–34.
    pubmed: 21771509
  88. Bryant JE, Brown MP, Gronwall RR. Study of intragastric administration of doxycycline: Pharmacokinetics including body fluid, endometrial and minimum inhibitory concentrations. Equine Vet J 2000;32:233–238.
    pubmed: 10836479
  89. Dowling PM, Russell AM. Pharmacokinetics of a long‐acting oxytetracycline‐polyethylene glycol formulation in horses. J Vet Pharmacol Ther 2000;23:107–110.
    pubmed: 10849256
  90. Gardner SY, Aucoin DP. Pharmacokinetics of ceftriaxone in mares. J Vet Pharmacol Ther 1994;17:155–156.
    pubmed: 8040935
  91. Schnabel LV, Papich MG, Divers TJ. Pharmacokinetics and distribution of minocycline in mature horses after oral administration of multiple doses and comparison with minimum inhibitory concentrations. Equine Vet J 2012;44:453–458.
    pubmed: 21950341
  92. Kim D, Kordick D, Divers T. In vitro susceptibilities of Leptospira spp. and Borrelia burgdorferi isolates to amoxicillin, tilmicosin, and enrofloxacin. J Vet Sci 2006;7:355–359.
    pmc: PMC3242144pubmed: 17106227
  93. Caol S, Divers T, Crisman M. In vitro susceptibility of Borrelia burgdorferi isolates to three antibiotics commonly used for treating equine Lyme disease. BMC Vet Res 2017;13:293–298.
    pmc: PMC5622483pubmed: 28962614
  94. Wormser GP, Dattwyler RJ, Shapiro ED. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43:1089–1134.
    pubmed: 17029130
  95. Berende A, ter Hofstede HJ, Vos FJ. Randomized trial of longer‐term therapy for symptoms attributed to Lyme disease. New Engl J Med 2016;374:1209–1220.
    pubmed: 27028911
  96. Halperin JJ. Chronic Lyme disease: Misconceptions and challenges for patient management. Infect Drug Resist 2015;8:119–128.
    pmc: PMC4440423pubmed: 26028977
  97. Cadavid D, Auwaerter PG, Rumbaugh J. Antibiotics for the neurological complications of Lyme disease. Cochrane Database Syst Rev 2016;12:CD006978.
    pmc: PMC6463975pubmed: 27931077
  98. Ogrinc K, Logar M, Lotric‐Furlan S. Doxycycline versus ceftriaxone for the treatment of patients with chronic Lyme borreliosis. Wien Klin Wochenschr 2006;118:696–701.
    pubmed: 17160610
  99. Agwuh KN, MacGowan A. Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. J Antimicrob Chemother 2006;58:256–265.
    pubmed: 16816396
  100. Stricker RB. Counterpoint: Long‐term antibiotic therapy improves persistent symptoms associated with lyme disease. Clin Infect Dis 2007;45:149–157.
    pubmed: 17578772
  101. Girschick HJ, Morbach H, Tappe D. Treatment of Lyme borreliosis. Arthritis Res Ther 2009;11:258–267.
    pmc: PMC3003502pubmed: 20067594
  102. Grace PM, Hutchinson MR, Maier SF. Pathological pain and the neuroimmune interface. Nat Rev Immunol 2014;14:217–231.
    pmc: PMC5525062pubmed: 24577438
  103. Gegelashvili G, Bjerrum OJ. High‐affinity glutamate transporters in chronic pain: An emerging therapeutic target. J Neurochem 2014;131:712–730.
    pubmed: 25270665
  104. Brorson O, Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to metronidazole. Acta Path Micro Im Scand 1999;107:566–576.
    pubmed: 10379684
  105. Sapi E, Kaur N, Anyanwu S. Evaluation of in‐vitro antibiotic susceptibility of different morphological forms of Borrelia burgdoferi. Infect Drug Resist 2011;4:97–113.
    pmc: PMC3132871pubmed: 21753890
  106. Lantos PM, Wormser GP. Chronic coinfections in patients diagnosed with chronic lyme disease: A systematic review. Am J Med 2014;127:1105–1110.
    pmc: PMC4252587pubmed: 24929022
  107. Bockenstedt LK, Mao J, Hodzic E. Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi‐infected mice after antibiotic treatment. J Infect Dis 2002;186:1430–1437.
    pubmed: 12404158
  108. Kowalski TJ, Tata S, Berth W. Antibiotic treatment duration and long‐term outcomes of patients with early lyme disease from a lyme disease‐hyperendemic area. Clin Infect Dis 2010;50:512–520.
    pubmed: 20070237
  109. Ramesh G, Meisner OC, Philipp MT. Anti‐inflammatory effects of dexamethasone and meloxicam on Borrelia burgdorferi‐induced inflammation in neuronal cultures of dorsal root ganglia and myelinating cells of the peripheral nervous system. J Neuroinflammation 2015;12:240–251.
    pmc: PMC4690425pubmed: 26700298
  110. Ramesh G, Martinez AN, Martin DS. Effects of dexamethasone and meloxicam on Borrelia burgdorferi‐induced inflammation in glial and neuronal cells of the central nervous system. J Neuroinflammation 2017;14:28–37.
    pmc: PMC5290621pubmed: 28153013
  111. Jowett N, Gaudin RA, Banks CA. Steroid use in Lyme disease‐associated facial palsy is associated with worse long‐term outcomes. Laryngoscope 2017;127:1451–1458.
    pubmed: 27598389
  112. Shapiro ED. Lyme disease. New Engl J Med 2014;371:684.
    pmc: PMC4492124pubmed: 25119621
  113. Lantos PM. Chronic Lyme disease. Infect Dis Clin North Am 2015;29:325–340.
    pmc: PMC4477530pubmed: 25999227
  114. Hammers‐Berggren S, Lebech AM, Karlsson M. Serological follow‐up after treatment of patients with erythema migrans and neuroborreliosis. J Clin Microbiol 1994;32:1519–1525.
    pmc: PMC264030pubmed: 8077398
  115. Butler CM, Sloet van Oldruitenborgh‐Oosterbaan MM, Werners AH. Borrelia burgdorferi and Anaplasma phagocytophilum in ticks and their equine hosts: A prospective clinical and diagnostic study of 47 horses following removal of a feeding tick. Pferdeheilkunde 2016;32:335–345.
  116. Stafford KC III. Tick Management Handbook. New Haven, CT: Connecticut Agricultural Experiment Station; 2004.
  117. Deblinger RD, Wilson ML, Rimmer DW. Reduced abundance of immature Ixodes dammini (Acari: Ixodidae) following incremental removal of deer. J Med Entomol 1993;30:144–150.
    pubmed: 8433321
  118. Herrmann C, Gern L. Survival of Ixodes ricinus (Acari:Ixodidae) nymphs under cold conditions is negatively influenced by frequent temperature variations. Ticks Tick Borne Dis 2013;4:445–451.
    pubmed: 23850119
  119. Slaughter KM, Halland SK, Schur LA. Humoral response of Borrelia burgdorferi outer surface protein A (OspA) vaccination in equids. Equine Vet Educ 2017;29:572–576.
  120. Guarino C, Asbie S, Rohde J. Vaccination of horses with Lyme vaccines for dogs induces short‐lasting antibody responses. Vaccine 2017;35:4140–4147.
    pubmed: 28668566
  121. Halperin JJ, Baker P, Wormser GP. Common misconceptions about Lyme disease. Am J Med 2013;126:264.e1–264.e7.
    pubmed: 23321431
  122. Lantos PM. Chronic Lyme disease: The controversies and the science. Expert Rev anti Infect Ther 2011;9:787–797.
    pubmed: 21810051
  123. Plotkin SA. Need for a new Lyme disease vaccine. New. Engl J Med 2016;375:911–913.
    pubmed: 27602662
  124. Šmit R, Postma MJ. Lyme borreliosis: Reviewing potential vaccines, clinical aspects and health economics. Expert Rev Vaccines 2015;14:1549–1561.
    pubmed: 26414102