Most Lyme groups agree that “the duration of tick attachment is among the most important predictors of subsequent Lyme Disease (LD)” but the situation is more complex than portrayed in the draft guidelines. To date, there is no study that has established the minimum tick attachment time for transmission of LD in humans. The draft guidelines imply that if the attachment is less than 36 hours the risk of bacterial transmission is low. Dr. Willy Burgdorfer the microbiologist who identified the bacteria that causes  Lyme disease acknowledged in a 2001 interview that “there are about 5 to 10 percent of infected ticks that have a generalized infection,” including it being present in their salivary glands and saliva at the time of attachment. “In such cases, transmission of spirochetes would and does occur immediately at time of attachment.” Unfortunately, many physicians are unaware that instantaneous transmission is possible.   A bite by an infected tick can have a 1/20-1/10 chance of rapidly passing on the illness, so that by the 36-hour mark, the bacteria can be spreading to multiple body sites.   There should be some mention that this rapid transmission can occur in the guidelines.

Rosalie Greenberg, MD

Psychiatrist

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