Lyme Disease: A Catch-up Quiz

What would be the ideal direct test for Lyme disease? Which immunogen was identified as a contributor to Lyme arthritis? How prevalent is post-treatment Lyme disease?

Find the answers to these and other key questions by taking this brief quiz on the latest Lyme disease research findings.

1. An ideal direct test for Lyme disease would have which of the following characteristics?

A. High sensitivity and specificity soon after tick bite or infection at or before symptom onset
B. Short turnaround time
C. Nonreactivity when active infection is absent
D. All of the above
E. A and B

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Answer: D. All of the above. Authors of a review published March 5 in Clinical Infectious Diseases state that an ideal direct test for Lyme disease would include high sensitivity and specificity soon after a tick bite or infection at or before symptom onset, a short turnaround time, and nonreactivity when active infection is absent. Authors note that direct tests for early active Lyme disease infection are ready for practical assessment and future tests are likely. As indirect serologic testing improves, direct nucleic acid and protein detections would complement the new techniques for more comprehensive diagnoses.

2. Researchers recently identified which immunogen as a contributor to the development and persistence of Lyme arthritis (LA)?

A. Allergen
B. Peptidoglycan
C. Tolerogen
D. Superantigen

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Answer: B. Peptidoglycan. Persistence of the Borrelia burgdorferi atypical peptidoglycan (PG^Bb) in the joint may contribute to synovitis after antibiotics have eradicated the pathogen, wrote researchers in the June issue of Proceedings of the National Academy of Sciences of the United States of America. B. burgdorferi shedding immunogenic PG^Bb fragments during growth suggests a role for PG^Bb in the immunopathogenesis of other manifestations of Lyme disease. Researchers stated that this discovery could lead to new treatment options.

3. What trend is predicted for the cumulative prevalence of post-treatment Lyme disease (PTLD) in the US?

A. Increase
B. Decrease
C. Stay about the same

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Answer: A. Increase. The cumulative prevalence of PTLD was estimated to be between 69 011 and 1.6 million persons in 2016 and may go as high as 2 million cases in 2020, according to a research article published April 24 in BMC Public Health. Risk factors for PTLD include delayed diagnosis and treatment, more symptoms, and increased severity of acute Lyme disease.

4. A recent study of intra-articular glucocorticoid (IAGC) injection for children with persistent LA had which of the following outcomes?

A. Lower rates of antibiotic-refractory LA
B. Faster rates of clinical resolution
C. Increased need for additional treatment
D. All of the above
E. A and B

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Answer: E. A and B. Along with lower rates of antibiotic-refractory LA and faster rates of clinical resolution, children treated with second-line IAGCs had a reduced need for additional treatment vs those that only received second-line oral antibiotics. The study, published in the March issue of The Journal of Rheumatology, also found that IAGC injection appears to be an effective and safe second-line strategy.

5. What new tick species was recently identified in the US for the first time?

A.Amblyomma americanum (lone star tick)
B.Ixodes pacificus (western black-legged tick)
C.Haemaphysalis longicornis (Asian longhorned tick)
D.Ixodes ricinus (castor bean tick)

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Answer: C. Haemaphysalis longicornis (Asian longhorned tick). According to the Centers for Disease Control, in 2017 the H. longicornis was reported in the US for the first time; as of June 24, 2019 no harmful germs have been found in this tick species in the US. Other disease-causing tickborne germs newly discovered in the US in the past 20 years include Borrelia mayonii, Borrelia miyamotoi, Ehrlichia ewingii, Ehrlichia muris eauclairensis, and Heartland virus.

For more information, please visit 6 Essential Updates in Lyme Disease Research.