Borrelia burgdorferi and autoimmune mechanisms: implications for mimicry, misdiagnosis, and mismanagement in Lyme disease and autoimmune disorders

Abstract

The genus Borrelia encompasses a diverse group of spirochetes transmitted primarily by ticks, with Borrelia burgdorferi causing Lyme disease, which is prevalent in North America and Europe. Borrelia's structural adaptations and ability to persist in diverse host tissues underscore its pathogenic potential. Beyond traditional infectious responses, Borrelia engages in complex interactions with the host immune system, contributing to autoimmune mechanisms such as molecular mimicry and persistent infections. This intricate interplay manifests in symptoms resembling various autoimmune diseases, including systemic lupus erythematosus, dermatomyositis, local scleroderma, and systemic sclerosis. However, these associations lack a precise explanation, emphasizing the need for further investigation. The cases of misdiagnosis between Lyme borreliosis and autoimmune diseases highlight the critical importance of accurate diagnostics and adherence to guidelines. Understanding Borrelia's impact on immune responses is pivotal for advancing diagnostics and targeted therapeutic interventions in Lyme borreliosis and its potential autoimmune implications.

Keywords: Borrelia; Dermatomyositis; Molecular mimicry; Scleroderma; Systemic lupus erythematosus.

Fig. 1

Two isolated, multiform patches of hardened skin on the patient’s chest, who has a medical history of Lyme borreliosis. Patient#1 (The figure is a curtesy of O. Zimba MD)

Fig. 2

Hyperpigmented and indurated round foci on the skin of the arms (A), lower back (B), and legs (C) which appeared after Lyme borreliosis. Patient#2. (The figure is a curtesy of O. Zimba MD)