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
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.
Steven W. Luger, M.D.
Old Lyme, CT 06333