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Lyme disease is an infectious disease caused by spirochetes, bacteria of the genus Borrelia. Over 30 percent of Ixodes ricinus ticks (the common tick; the most common tick species in Central and Northern Europe), as well as dog ticks (including Rhipicephalus sp.) and other blood-sucking species such as fleas, bedbugs, black flies, Anopheles flies, and spiders, are infected with Borrelia and other microbes. These Borrelia bacteria, along with other germs, are found in the salivary glands or midgut of the tick/arthropod and can be transmitted to the host animal/human after a blood meal lasting from a few minutes to hours (6-72 hours), depending on the species of arthropod and the strength of the host's immune system, more or less quickly. Lyme disease is the most common infectious disease in the Northern Hemisphere transmitted by ticks such as Ixodes ricinus, scapularis, or Amblyomma sp., among others. It is particularly common in Central Europe and the Scandinavian countries. Due to global warming, the range of infected ticks is continuously expanding northward. Ixodes ricinus becomes active at ground temperatures above approximately seven degrees Celsius. Approximately three percent of people bitten by Ixodes ricinus ticks develop Lyme disease. In Austria, this equates to an estimated 50,000 to 70,000 Lyme disease patients per year (in the USA, approximately 1 million per year). Due to the change of hosts of ticks and other blood-sucking insects such as fleas, lice, mites, horseflies, mosquitoes, biting flies, and even spider bites, other "co-infections" are possible in addition to Borrelia. Erythema migrans is typically observed in fresh bites or stings. However, this symptom may also be absent! The general symptoms* following an infection with Lyme disease-associated bacteria are extremely diverse and can often persist for years or decades or present a predominantly relapsing clinical picture. Severe, systemic secondary diseases** are also possible, but are rarely associated with the causative mixed Borrelia infection. In neurodegenerative diseases such as MS, ALS, Alzheimer's dementia, and others, active screening for Borrelia and other bacteria should be carried out. Further examples*/** see list (follows) Here are a few special features associated with Borrelia: • Among other things, there are rare but noticeable bite marks on the scalp "scalp eschar" (also called TIBOLA / SENLAT) which are associated with lymphadenopathy in the neck and can be caused by either Rickettsia raoultii or B. afzelii. Accompanying symptoms are fever, fatigue and skin rashes. •Recognizing Alpha-Gal Syndrome! This allergy to the sugar galactose-alpha-1,3-galactose (Alpha-Gal) is caused in some people by the bite of certain tick species (B. lonestarii) and is expressed, among other things, by excruciating itching (urticaria). • Morgellons Disease - MD was first described in more detail in 2011 by Peter Mayne et al. as a skin disease associated with Lyme disease (B. burgdorferi) and is to be understood as a dermal manifestation of the multisystem disease Lyme disease - "Borrelial Dermatitis". Clinically, MD is characterized by general, unexplained itching, nodular inflammation, extremely itchy patches, hypo-hyperpigmentation, crawling and stinging skin sensations, etc. Morgellons appear at 60x magnification as differently colored keratin or collagen-containing filaments that can be found in skin lesions, protrude or can be seen under intact skin at high magnification. How they develop in the skin and the role that Borrelia plays in this has now been investigated by the microbiologist Marianne Middelveen et al. and Dr. Raphael Stricker (physician, researcher and Borrelia specialist) researched it in detail in 2011 and is morphologically very similar to dermatitis digitalis, or DD for short, in cattle and elk. From a professional and ethical perspective, I consider labeling patients with MD as psychotic patients (as "delusional disorders" (ICD-10: F 22.0; DSM-IV 297.1/Dermatozoenwahn (DW)) unacceptable and anti-patient based on the clear study evidence, even though psychiatric comorbidities are clearly more common in patients with Lyme disease/LD and MD due to the high level of suffering. (https://doi.org/10.12688/f1000research.2-118.v1) • Using special laboratory tests, I determine in my patients with more severe clinical courses which Borrelia strains or their numerous subtypes (ssp./strains) such as B. burgdorferi, garinii, afzelii, japonica, vincentii, ( approx. 25 more) ... or which co-infections are present. In addition to the regular antibody test in serum, the relatively new Elispot-LTT is particularly noteworthy. • B. miyamotoi (only known in Austria since 2015), hermsii, duttonii, recurrentis, and others (approximately 15 species) cause, for example, "endemic, recurrent fever/relapsing fever." • Furthermore, co-infections such as Neoehrlichia mikurensis, Ehrlichia/Anaplasma phagocytophilum, Rickettsia ssp., Chlamydiae ssp., Francisella tularensis, Bartonella, Coxiella, Babesia, Leptospira, Mycoplasma, Rabies lyssavirus, Toxoplasma, Wolbachia, Yersinia, and even viruses such as TBE, EBV, Borna virus, Parvo virus, CMV, Herpes simplex types I II, HHV6, HIV, and others, must be detected and treated. to be treated, which requires very in-depth and complex therapy and further follow-up examinations throughout the course of the disease. •Chlamydiasis and Lyme disease: In some cases, it is not the Borrelia bacteria that are responsible for the symptoms, but rather the concurrent Chlamydia (C. pneumoniae, trachomatis). Chlamydia symptoms can resemble Alzheimer's disease, multiple sclerosis, fibromyalgia, CFS, myocardial infarctions, strokes, vascular inflammation, arteriosclerosis, prostate hyperplasia/prostatitis, visual disturbances, migraines, and much more. Dr. Klinghardt refers to this as pseudo-MS, pseudo-fibromyalgia, etc. •And - not everything is a Lyme disease relapse when symptoms persist after what doctors consider a "successful" course of antibiotics! These can either be caused by one or more co-pathogens, or the Borrelia bacteria have had lasting effects before their elimination. Tissue damage can persist for months or even years = Post-Lyme Syndrome/PLDS! (Examples: permanent cognitive impairment after neuroborreliosis due to the formation of persistent antineural antibodies, dilated cardiomyopathy after Lyme carditis, synovitis after Lyme arthritis, etc.)