Lyme borreliosis has been reported throughout Europe where it is the most common tick-borne infection, as it is in the USA. Studies reported an increasing incidence in several countries over the previous 10-20 years, for example in Germany, the Netherlands and the United Kingdom (Fülöp & Poggensee 2008. Parasitol Res. 103 Suppl 1:117-20; Hofhuis et al. 2006. Euro Surveill. 22:11 E060622.2 E060629.5; Smith et al. 2000. Emerg Infect Dis. 6:404-7 and HPA/Lyme borreliosis website.2008). A large part of this increase can be attributed to heightened awareness of the condition resulting in increased diagnosis and reporting. Although it is known that over diagnosis occurs there has been a genuine increase in transmission rates in some regions (Kampen et al., 2004. Appl Environ Microbiol. 70:1576-82), so Lyme borreliosis should be regarded as a continuing emergent disease.
Public perceptions of the disease in Europe have been distorted by the media and by activist groups, with exaggerated claims of pathogenicity and of difficulties of diagnosis and treatment. While it is true that Lyme borreliosis sometimes presents diagnostic and treatment challenges, many of the misconceptions result from misdiagnosis of Lyme borreliosis in patients who have other conditions. This can occur because clinical presentations are not unique to that infection, and because inadequately standardised and quality-controlled diagnostic methods are used in some laboratories.