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- Outer surface proteins: OspA and F- (OspA and OspB in ticks)- The transmission of B.burgdorferi to humans is by injection of the organism in tick saliva or by regurgitation of the tick's midgut contents. Attachment of the tick for 24-48 h is necessary before transmission of B.burgdorferi → B.burgdorferi adheres to proteoglycans on host cells, this is mediated by a borrelial glycosaminoglycan receptor → After injection by the tick, the organism migrates out from the site, producing the characteristic skin lesion → Dissemination occurs by lymphatics or blood to other skin and musculoskeletal sites and many other organs → Lyme disease, like other spirochetal diseases, occurs in stages with early and late manifestations- Lyme disease:1. Erythema chronicum migrans (ECM)a. A unique skin lesion is Erytema chronicum migrans (ECM), which occurs at the tick bite site.2. Neurologic/Cardiologic manifestationa. Occurs weeks to months later and includes arthralgia and arthritis; neurologic manifestations with meningitis; and cardiac disease with conduction defects and myopericarditis.3. Arthritisa. Begins months to years later with chronic skin, nervous system,or joint involvement.

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