Beyond Lyme: aetiology of tick-borne human diseases with emphasis on the south-eastern United States.

Since its emergence in the north-eastern and upper mid-western United States in the 1970s, Lyme disease, caused by Borrelia burgdorferi, has captured the public's attention as the nation's most prevalent vector-borne zoonotic disease. In contrast, recent publications on tick-pathogen systems in the eastern United States, and findings from Department of Defense investigations of ticks found biting military personnel, indicate that residents of the south-eastern United States are primarily at risk from emerging diseases caused by tick-borne pathogens other than B. burgdorferi. The risk of contracting these diseases varies greatly among states as a consequence of regional variation in the abundance of the key vector tick species. Moreover, this risk is changing, because tick distributions are in flux. To improve health outcomes, health providers need better information and awareness regarding which tick species bite humans in each state and which zoonotic pathogens are prevalent in these ticks. Effective diagnosis, treatment, control and reporting of tick-borne disease in the south-eastern United States require that health providers think 'beyond Lyme' and consider the marked regional differences in the tick species that bite humans and in the pathogens that these ticks carry.