# Unmasking Borrelia species: A comprehensive review of their presence in Iran

## TL;DR

This paper reviews the presence and spread of Borrelia species, which cause tick-borne diseases, in Iran, highlighting their public health importance.

## Contribution

The study provides a comprehensive overview of Borrelia species distribution and transmission in Iran, including newly reported cases of Lyme disease.

## Key findings

- Tick-borne relapsing fever is endemic in Iran, and Lyme disease has recently been reported.
- Borrelia species have been documented in 20 Iranian provinces, with the highest diversity in Mazandaran province.
- Hard ticks like I. ricinus and Rh. annulatus are linked to TBRF transmission in Iran.

## Abstract

Borrelia species are the causative agents of Lyme disease (LD) and tick-borne relapsing fever (TBRF) in humans and animals. These pathogens are transmitted through hard and soft ticks. The increasing tick population, influenced by climate change, underscores the urgent need for enhanced research on tick-borne diseases.

Iran, situated in southwestern Asia, boasts a diverse climate that supports a wide range of tick species and their vertebrate hosts. While TBRF is endemic to Iran, recent reports suggest the presence of LD in the country as well. Understanding the various Borrelia species, their tick vectors, human cases, affected reservoirs, and geographical distribution is crucial for assessing the epidemiology of TBRF and LD in Iran.

This comprehensive review examines the epidemiological patterns, geographical distribution, detection methods for these pathogens, providing critical insights into their public health significance.

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•Tick borne relapsing fever (TBRF) is endemic in Iran, and Lyme disease (LD) has recently been reported.•The distribution of Borrelia in Iran has increased, affecting 20 provinces.•Mazandaran province shows the highest diversity of Borrelia species, with six types documented.•Hard ticks (I. ricinus and Rh. annulatus) can also transmit TBRF in Iran, caused by B. miyamotoi and B. theileri.

Tick borne relapsing fever (TBRF) is endemic in Iran, and Lyme disease (LD) has recently been reported.

The distribution of Borrelia in Iran has increased, affecting 20 provinces.

Mazandaran province shows the highest diversity of Borrelia species, with six types documented.

Hard ticks (I. ricinus and Rh. annulatus) can also transmit TBRF in Iran, caused by B. miyamotoi and B. theileri.