Tick Borne Diseases

Though other experts argue about the effect of climate, changes to land use as well, as rodent and deer populations that may influence how many ticks are in your neighborhood, the Centers for Disease Control has issued a report that confirms since 2004, the number of vector-borne diseases spread by ticks and insects such as mosquitoes and fleas has tripled.

Fisher Center Tick-Related Research

The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases is actively researching tick borne diseases.  The following are a selection of our research efforts.

Lyme Disease Clinical Consultations

Our researchers have undertaken a comprehensive, retrospective analysis of persons referred for Lyme disease to the Johns Hopkins Infectious Diseases clinic.  Data will help gain an understanding of reasons why referrals are sought, clinical diagnoses and how both diagnostic and therapeutic decisions are formed.

Geospatial Analysis of Lyme Disease

Lyme disease has been spreading with speed in parts of the South and the Midwest United States.  Using reported case data helps clinicians anticipate areas of the country previously without Lyme disease who are at risk for what would be an emerging infectious disease in their communities.


Geographic Expansion of Lyme Disease in Michigan, 2000-2014. Lantos PM, Tsao J, Nigrovic LE, Auwaerter PG, Fowler VG, Ruffin F, Foster E, Hickling G. Open Forum Infect Dis. 2017 Jan 9;4(1):ofw269. doi: 10.1093/ofid/ofw269. eCollection 2017 Winter. PMID: 28480261

Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014. Lantos PM, Nigrovic LE, Auwaerter PG, Fowler VG Jr, Ruffin F, Brinkerhoff RJ, Reber J, Williams C, Broyhill J, Pan WK, Gaines DN. Open Forum Infect Dis. 2015 Sep 27;2(4):ofv143. doi: 10.1093/ofid/ofv143. eCollection 2015 Dec. PMID: 26550580

Lyme Disease Clinical Management

Novel Diagnostics for Early Lyme Disease

If not accurately diagnosed and treated, Lyme disease infection may progress to affect the cardiac, neurological, and musculoskeletal systems.  Overdiagnosis of Lyme disease may lead to unintended consequences such as vascular catheter complications or bacterial superinfections such as C. diff.  Therefore, accurate, early-stage diagnosis would as current FDA-approved testing for Borrelia burgdorferi is least accurate in the first week or two after acquiring the infection.  The Fisher Center is participating in a clinical research study that may lead to the development of a new diagnostic test for early Lyme disease that may also have implications as corresponding with microbiological cure of the infection.  This research study is sponsored by MicroB-plex, Inc. of Atlanta, GA.


Antibiotics for the neurological complications of Lyme disease. Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H. Cochrane Database Syst Rev. 2016 Dec 8;12:CD006978. doi: 10.1002/14651858.CD006978.pub2. Review. PMID: 27931077

A critical appraisal of the mild axonal peripheral neuropathy of late neurologic Lyme disease. Wormser GP, Strle F, Shapiro ED, Dattwyler RJ, Auwaerter PG. Diagn Microbiol Infect Dis. 2017 Feb;87(2):163-167. doi: 10.1016/j.diagmicrobio.2016.11.003. Epub 2016 Nov 12. Review. PMID: 27914746

Lyme disease serology. Lantos PM, Auwaerter PG, Nelson CA. JAMA. 2016 Apr 26;315(16):1780-1. doi: 10.1001/jama.2016.4882. No abstract available. PMID: 27115380

Time for a different approach to Lyme disease and long-term symptoms. Melia MT, Auwaerter PG. N Engl J Med. 2016 Mar 31;374(13):1277-8. doi: 10.1056/NEJMe1502350. No abstract available. PMID: 27028918

Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence. Lantos PM, Branda JA, Boggan JC, Chudgar SM, Wilson EA, Ruffin F, Fowler V, Auwaerter PG, Nigrovic LE. Clin Infect Dis. 2015 Nov 1;61(9):1374-80. doi: 10.1093/cid/civ584. Epub 2015 Jul 20. PMID: 26195017

Lyme disease: knowing good evidence to help inform practice. Auwaerter PG. Infect Dis Clin North Am. 2015 Jun;29(2):xi-xvi. doi: 10.1016/j.idc.2015.03.001. No abstract available. PMID: 25999231

Editorial commentary: life after Lyme disease. Auwaerter PG. Clin Infect Dis. 2015 Jul 15;61(2):248-50. doi: 10.1093/cid/civ279. Epub 2015 Apr 17. No abstract available. PMID: 25888673

Unorthodox alternative therapies marketed to treat Lyme disease. Lantos PM, Shapiro ED, Auwaerter PG, Baker PJ, Halperin JJ, McSweegan E, Wormser GP. Clin Infect Dis. 2015 Jun 15;60(12):1776-82. doi: 10.1093/cid/civ186. Epub 2015 Apr 6. Review. PMID: 25852124

Lyme disease: authentic imitator or wishful imitation? Melia MT, Lantos PM, Auwaerter PG. JAMA Neurol. 2014 Oct;71(10):1209-10. doi: 10.1001/jamaneurol.2014.1193. No abstract available. PMID: 25090401

A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease. Lantos PM, Auwaerter PG, Wormser GP. Clin Infect Dis. 2014 Mar;58(5):663-71. doi: 10.1093/cid/cit810. Epub 2013 Dec 12. Review. PMID: 24336823

Misdiagnosis of late-onset Lyme arthritis by inappropriate use of Borrelia burgdorferi immunoblot testing with synovial fluid. Barclay SS, Melia MT, Auwaerter PG. Clin Vaccine Immunol. 2012 Nov;19(11):1806-9. doi: 10.1128/CVI.00383-12. Epub 2012 Sep 12. PMID: 22971779

Antiscience and ethical concerns associated with advocacy of Lyme disease. Auwaerter PG, Bakken JS, Dattwyler RJ, Dumler JS, Halperin JJ, McSweegan E, Nadelman RB, O’Connell S, Shapiro ED, Sood SK, Steere AC, Weinstein A, Wormser GP. Lancet Infect Dis. 2011 Sep;11(9):713-9. doi: 10.1016/S1473-3099(11)70034-2. PMID: 21867956

Point: antibiotic therapy is not the answer for patients with persisting symptoms attributable to lyme disease. Auwaerter PG. Clin Infect Dis. 2007 Jul 15;45(2):143-8. Epub 2007 Jun 5. Review. PMID: 17578771

Two year evaluation of Borrelia burgdorferi culture and supplemental tests for definitive diagnosis of Lyme disease. Coulter P, Lema C, Flayhart D, Linhardt AS, Aucott JN, Auwaerter PG, Dumler JS.  J Clin Microbiol. 2005 Oct;43(10):5080-4. Erratum in: J Clin Microbiol. 2007 Jan;45(1):277. PMID: 16207966

Lyme borreliosis (Lyme disease): molecular and cellular pathobiology and prospects for prevention, diagnosis and treatment. Auwaerter PG, Aucott J, Dumler JS. Expert Rev Mol Med. 2004 Jan 19;6(2):1-22. Review. PMID: 14987414

Lyme Disease Treatment

Why some patients fail to improve after antibiotic therapy for Lyme disease is unclear.  Many hypotheses exist including immunological, neurological, mitochondrial or hormonal.  Although there is no convincing data that bacteria persist after appropriate treatment in human infection, the idea that bacteria may not be entirely eradicated is a potential explanation.  Although not meant to indicate what would work in people, in vitro experimental testing of drug combinations may give some insight into potential avenues to explore in clinical studies especially regarding late Lyme arthritis.


A Drug Combination Screen Identifies Drugs Active against Amoxicillin-Induced Round Bodies of In Vitro Borrelia burgdorferi Persisters from an FDA Drug Library. Feng J, Shi W, Zhang S, Sullivan D, Auwaerter PG, Zhang Y. Front Microbiol. 2016 May 23;7:743. doi: 10.3389/fmicb.2016.00743. eCollection 2016. PMID: 27242757

Identification of novel activity against Borrelia burgdorferi persisters using an FDA approved drug library. Feng J, Wang T, Shi W, Zhang S, Sullivan D, Auwaerter PG, Zhang Y. Emerg Microbes Infect. 2014 Jul;3(7):e49. doi: 10.1038/emi.2014.53. Epub 2014 Jul 2. PMID: 26038747

Drug combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone and doxycycline. Feng J, Auwaerter PG, Zhang Y. PLoS One. 2015 Mar 25;10(3):e0117207. doi: 10.1371/journal.pone.0117207. eCollection 2015. PMID: 25806811

Tick-Borne Diseases Other than Lyme Disease

How testing for the tick-borne parasite Babesia is used in routine clinical care is not well described.  Analysis of the yield of positive tests for Babesia and patient outcomes may help clinicians understand how best to use diagnostic tests for this parasite.


Tick Borne Diseases - Additional Information