Yes, Lyme disease is widely present across the European continent. Known in Europe as Lyme Borreliosis (LB), the bacterial infection is transmitted by infected ticks and is recognized as the most common tick-borne disease in the Northern Hemisphere. While the disease shares its name and transmission method with the infection found in North America, key differences exist in the specific bacterial strains and the resulting human symptoms. These variations mean that European Lyme Borreliosis often presents with distinct clinical features that differ from the classic North American presentation.
The Specific Borrelia Species in Europe
Lyme Borreliosis is caused by bacteria belonging to the Borrelia burgdorferi sensu lato complex, a group that contains multiple species capable of causing human illness. In Europe, the disease is primarily caused by a diversity of genospecies. The most common species are Borrelia afzelii and Borrelia garinii, though Borrelia burgdorferi sensu stricto, the main strain in the United States, is also present.
This diversity is why European Lyme Borreliosis is often clinically different from the North American form. B. afzelii has a strong association with skin-related symptoms, causing the majority of skin manifestations in European patients. B. garinii, in contrast, exhibits an affinity for the nervous system, leading to a higher incidence of neurological issues.
Geographic Distribution and High-Risk Areas
The primary vector for Lyme Borreliosis across Europe is the sheep tick, Ixodes ricinus, sometimes called the castor bean tick. This species is broadly distributed, meaning the risk of infection extends across most of the continent, from Scandinavia to North Africa and from Ireland to the Ural Mountains. The tick’s habitat is typically woodland, scrubland, and areas with tall grass, but it is also found in urban parks and gardens.
The prevalence of infected ticks is particularly high in Central Europe, making these regions major risk areas. Countries like Germany, Austria, the Czech Republic, Slovenia, and the Baltic states report significant numbers of cases. Furthermore, the geographical range of I. ricinus is expanding northward and to higher altitudes, a shift attributed in part to climate changes. This expansion suggests that previously lower-risk areas are now experiencing increased exposure.
Distinct Clinical Manifestations of European Borreliosis
The symptoms of European Lyme Borreliosis often differ significantly from the typical presentation seen in North America. The most common initial sign is Erythema Migrans (EM), the expanding rash at the site of the tick bite, which occurs in the majority of European cases. However, the classic “bullseye” appearance is less frequent in Europe, with the rash often presenting as a more uniformly red, expanding patch.
The skin manifestations caused by B. afzelii are characteristic of European Borreliosis. One condition is Borrelial Lymphocytoma, which appears as a reddish-blue nodule or plaque, most commonly found on the earlobe in children or the breast in adults. B. afzelii also causes Acrodermatitis Chronica Atrophicans (ACA), a late-stage disease rare in the United States but the most common chronic manifestation in Europe. ACA begins as a reddish-blue discoloration, typically on the hands or feet, and slowly progresses to cause the skin to become thin, wrinkled, and tissue paper-like.
The neurological involvement, or neuroborreliosis, is also more common in Europe, driven primarily by B. garinii. In European adults, the most frequent presentation of early neuroborreliosis is Bannwarth syndrome, a painful condition involving inflammation of the nerve roots, often accompanied by facial nerve palsy. This is distinct from the North American presentation, where isolated facial palsy is the more typical early neurological sign. Symptoms like severe headaches, neck stiffness, and nerve pain indicate the bacteria have invaded the central nervous system.
Prevention and Safe Tick Removal
Minimizing the risk of Lyme Borreliosis starts with taking precautions when spending time in high-risk environments like woodlands and grassy areas. Wearing long-sleeved shirts and long trousers tucked into socks can create a physical barrier against ticks. Using insect repellents that contain DEET on exposed skin, and considering permethrin treatment for clothing, also provides an effective layer of protection.
After any outdoor activity, performing a full-body check is essential, as ticks can be very small and easily missed. Ticks prefer warm, moist areas, so special attention should be paid to the armpits, groin, legs, and hairline. If a tick is found attached, prompt and proper removal is necessary because the infection is unlikely to be transmitted within the first few hours of the tick feeding.
To safely remove a tick, use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible, ideally at the mouthparts. Pull upward with steady, even pressure without twisting or crushing the tick’s body, which could force bacteria into the skin. Once removed, the bite site should be cleaned with soap and water and then disinfected with an antiseptic.