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Disease manifestations in the United States and Europe vary as a result of geographic distribution of different species within the genospecies<jats:italic>Borrelia burgdorferi<\/jats:italic>sensu lato, which in turn are host\u2010specific. Certain toxigenic<jats:italic>B. burgdorferi<\/jats:italic>strains cause early disseminated disease. The ability of Borrelial organisms to break down the extracellular matrix also promotes dissemination.<jats:italic>B. burgdorferi<\/jats:italic>are eliminated by complement\u2010mediated lysis and by T and B cell activity of the specific immune response. Yet,<jats:italic>B. burgdorferi<\/jats:italic>can evade humoral immunity by means of type of protective mechanism by which it adheres to the proteoglycan decorin in the joints and skin. A further factor in the persistence of the pathogen is altered antigen expression. Re\u2010infection usually occurs with a different strain, although repeated infection with the same strain is also possible after a certain period of latency. New developments in serologic testing include the use of recombinant native antigen as well as antigens produced in vivo such as VlsE (variable major protein\u2010like sequence, expressed) or decorin\u2010binding protein A. Diagnosis continues to be complicated by seropositivity of healthy individuals, the persistence of antibodies after therapy, and a lacking humoral immune response in patients with erythema migrans.<\/jats:p>","DOI":"10.1111\/j.1610-0387.2007.06285.x","type":"journal-article","created":{"date-parts":[[2007,6,21]],"date-time":"2007-06-21T15:43:53Z","timestamp":1182440633000},"page":"406-414","source":"Crossref","is-referenced-by-count":23,"title":["Lyme borreliosis \u2013 an update"],"prefix":"10.1111","volume":"5","author":[{"given":"Elisabeth","family":"Aberer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,4,20]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1021286528058"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00393-003-0428-8"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00105-005-0995-5"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14798-8"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00722-9"},{"issue":"6","key":"e_1_2_10_7_2","doi-asserted-by":"crossref","first-page":"229","DOI":"10.7883\/yoken.JJID.2004.229","article-title":"Terrestrial distribution of the Lyme borreliosis agent Borrelia burgdorferi sensu lato in East Asia","volume":"57","author":"Masuzawa T","year":"2004","journal-title":"Jpn J Infect Dis"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0966-842X(01)02298-3"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.92.7.2909"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/37551"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.73.9.5547-5553.2005"},{"issue":"7","key":"e_1_2_10_12_2","doi-asserted-by":"crossref","first-page":"3518","DOI":"10.1128\/IAI.67.7.3518-3524.1999","article-title":"Four clones of Borrelia burgdorferi sensu stricto cause invasive infection in humans","volume":"67","author":"Seinost G","year":"1999","journal-title":"Infect Immun"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.72.9.5262-5266.2004"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0306845101"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-142-9-200505030-00011"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/iai.64.10.4307-4312.1996"},{"issue":"8","key":"e_1_2_10_17_2","doi-asserted-by":"crossref","first-page":"3929","DOI":"10.1128\/IAI.67.8.3929-3936.1999","article-title":"Plasmin\u2010coated Borrelia burgdorferi degrades soluble and insoluble components of the mammalian extracellular matrix","volume":"67","author":"Coleman JL","year":"1999","journal-title":"Infect Immun"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-6968.1996.tb08506.x"},{"issue":"11","key":"e_1_2_10_19_2","doi-asserted-by":"crossref","first-page":"3964","DOI":"10.4049\/jimmunol.146.11.3964","article-title":"Complement\u2010mediated killing of the Lyme disease spirochete Borrelia burgdorferi. 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