CONDITIONS

Lyme Disease

What Is Lyme Disease

Lyme disease is the most common tick-borne illness in North America and Europe. Lyme disease is caused by the bacterium Borrelia burgdorferi. Deer ticks, which feed on the blood of animals and humans, can harbor the bacteria and spread it when feeding.

You’re more likely to get Lyme disease if you live or spend time in grassy and heavily wooded areas where ticks carrying the disease thrive. It’s important to take common-sense precautions in areas where Lyme disease is prevalent.

Lyme disease is a bacterial infection that is transmitted mainly through Ixodes ticks, more commonly known as deer ticks, on the East Coast and black-legged ticks on the West Coast of the U.S.A. According to Lymedisease.org, the symptoms of Lyme disease—which include but are not limited to flu-like symptoms, a bull’s-eye shaped rash, and/or Bell’s palsy (drooping of the face)—are often misdiagnosed as other conditions, earning Lyme disease the title of “The Great Imitator.” According the Centers for Disease Control and Prevention (CDC), an estimated 300,000 new cases of Lyme disease are diagnosed across the country each year, more than the annually diagnosed number of breast cancer or HIV/AIDS cases.


The Increasing Threat

In recent years, Lyme disease has appeared to be a growing threat to public health. According to the CDC, there were just over 10,000 confirmed cases of Lyme disease in 1995. In 2013, that number grew to over 25,000, with an additional 10,000 probable (yet unconfirmed) cases. A leading theory behind the increasing prevalence of Lyme disease revolves around forest fragmentation.

Forest fragmentation occurs when larger swaths of forest are broken up into small woodlots (less than one hectare each) in order to make room for agricultural fields or suburban developments. When larger forests are broken up, their ecosystems undergo significant change. Small woodlots cannot sustain large or mid-sized predators and therefore become ideal habitats for small mammals. Mice, especially, thrive in small woodlot areas. Small woodlots cannot sustain the natural predators of mice (long-tailed weasels, red and gray foxes, coyotes). Additionally, mice have proven to be able to adapt to life in small woodlot areas in ways that some other small mammals (chipmunks, squirrels) have not. Therefore, in many small woodlots (which accounts for much of the wooded areas in suburban and rural communities) mice are the most populous mammals.

Though deer and blacklegged tick bites are the main sites of Lyme disease transmission in humans, mice are the main carrier of Borrelia burgdorferi, the bacterium responsible for Lyme disease. Large populations of mice in small woodlot areas attract and sustain large tick populations, which feed on the infected mice. According to the National Science Foundation, small woodlot areas have approximately three times the number of ticks of larger forest fragments, and seven times the number of infected ticks. Though the mice are unaffected by Borrelia burgdorferi, ticks acquire and the bacteria while feeding on the mice and later transmit the bacteria to their human host.

 

What Causes Lyme Disease

Lyme disease is caused by an infection by the bacterium Borrelia burgdorferi, a cork-screw shaped microorganism that is most often transmitted through the bite of an infected Ixodes (deer) tick or black-legged tick. Borrelia burgdorferi does not produce an adverse reaction in all organisms. In fact, mice, the main carriers of B. burgdorferi, are not at all adversely affected by the bacterium. It is the adverse immunopathological response of the human body to B. burgdorferi that causes the symptoms associated with Lyme disease.

According to lymedisease.org, the majority of tick bites occur when the tick is in the nymphal, or immature, form, when the tick is approximately the size of a poppy seed. Lyme disease is not necessarily transmitted immediately after a tick bite. It may take several days or weeks for the transmission to occur. It is therefore crucial to check yourself and your children for ticks after being in an area where there may have been ticks.

Risk Factors For Lyme Disease

Though many potential risk factors for Lyme disease are being researched, there are few factors that draw a conclusive correlation to the risk of developing the disease.

The following factors are known to increase your risk of developing Lyme disease:

  • Location. Certain geographic areas have higher rates of incidence than others. States in the northeast US report the highest number of confirmed Lyme disease cases. Pennsylvania had the highest number of cases in 2013 (4981), followed by New York (3512), New Jersey (2785), and Connecticut (2111).
  • Exposure to tick habitats. Those that spend more time in probable high-tick environments are at a higher risk of developing Lyme disease.

Diagnosing Lyme Disease

Lyme disease is what is known as a clinical diagnosis, meaning that the diagnosis is made based on a patient’s medical history, symptoms, physical exam (which may demonstrate the characteristic bulls-eye rash), and a history of exposure to ticks or travel to a known region where there is a high occurrence of Lyme disease. There is no conclusive testing available to confirm a Lyme disease diagnosis. Most doctors choose to use a Lyme disease antibody test, which checks the blood for the presence of antibodies against the bacterium that causes Lyme disease. However, antibody tests cannot detect every strain of Lyme disease, they will not detect cases where the patient has the disease but is lacking the corresponding antibodies, and they will not detect the disease during the first four to six weeks of infection. Despite the tests’ limitations, the CDC still recommends the use of the two following tests:

  • Enzyme-linked immunosorbent assay (ELISA)
  • Western blot

Due to the wide-range of Lyme disease symptoms and the sometimes hard-to-detect factor of the tick bite, Lyme disease is often initially misdiagnosed as chronic fatigue syndrome, fibromyalgia, multiple sclerosis, or depression.

Symptoms of Lyme Disease

The symptoms of Lyme disease change with the stage of the disease. According to the Centers for Disease Control and Prevention, the stage-specific symptoms of Lyme disease are as follows:

**Later-stage patients may show symptoms of their current stage or any earlier stage

Stage 1: Early localized stage (3-30 days following tick bite)

  • A red, expanding rash in a “bull’s eye” formation, known as Erythema migraines (EM),
  • Fatigue
  • Chills
  • Fever
  • Headache
  • Muscle/joint aches
  • Swollen lymph nodes

Stage 2: Early disseminated stage (days to weeks following tick bite—usually one to four months)

  • Multiple EM rashes on multiple places of the body
  • Facial/Bell’s palsy (drooping face)
  • Severe headaches
  • Neck Stiffness
  • Pain and swelling in joints
  • General sensations of sharp pain (especially pain that disrupts sleep patterns)
  • Irregular heartbeat

Late disseminated stage (months to years following tick bite)

  • Arthritis that most often affects the knee.  A small number of people eventually get chronic Lyme arthritis, which causes recurring episodes of swelling, redness, and fluid buildup in one or more joints that last up to 6 months at a time.
  • Numbness and tingling in the hands, feet, or back.
  • Feeling very tired.
  • Not being able to control the muscles of the face.
  • Problems with memory, mood, or sleep, and sometimes problems speaking.
  • Heart problems, which are rare, can occur months to even years after being bitten by an infected tick. The most serious heart problems—such as inflammation of the structures surrounding the heart (pericarditis)—usually resolve without any lifelong damage. Unfortunately, heart problems can be the first sign of Lyme disease in a small number of people who didn’t have early symptoms.

Stage 2 and stage 3 symptoms may be the first signs of Lyme disease in people who didn’t have a rash or other symptoms of early infection.

Late disseminated Lyme disease occurs when the infection hasn’t been treated in stage 1 and 2. Stage 3 can occur weeks, months or years after the tick bite. This stage is characterized by:

  • Severe headaches
  • Arthritis of one or more large joints
  • Disturbances in heart rhythm
  • Brain disorders (encephalopathy) involving memory, mood and sleep.
  • Short term memory loss
  • Difficulty concentrating
  • Mental fogginess
  • Problems following conversations
  • Numbness in the arms, legs, hands, or feet
  • Contact your doctor immediately if you have any of these symptoms.

According to the CDC, 10-20% of Lyme disease patients will experience post-treatment Lyme disease syndrome, in which symptoms linger after treatment.

Prognosis

The prognosis for Lyme disease depends largely on the stage in which it is diagnosed. If Lyme disease is diagnosed in its early stages, antibiotic therapy can most likely cure the patient. However if it is caught at a progressed stage, when the infection has spread throughout the body, it is possible that antibiotic therapy would not be able to reverse damage done to bodily tissues and the patient would suffer from chronic symptoms. According to the CDC, an estimated 10-20% of Lyme disease patients experience lingering symptoms after their treatment is over, a condition known as post-treatment Lyme disease (PTLD). These symptoms may persist for up to 6 months after treatment and often include fatigue, pain, and muscle aches. Although the exact cause of PTLD is not known, it is believed that residual damages to the body and immune system may contribute to the symptoms. Similar chronic conditions follow treatment for Guillain-Barre syndrome, Reiter’s syndrome, and Strep throat. Although those receiving long-term antibiotics may not recover any faster than those who do not, symptoms will improve and resolve with time (up to 6 months).

Living With Lyme Disease

The following tips can help making living with Lyme disease a little bit easier:

  • Educate yourself. Lyme disease is a complex disease with much ongoing research. Educate yourself about the basics of the disease and read up on the latest news and research. This will help you to make informed decisions throughout your treatment process.
  • Consider all treatment options, especially if you are not responding to traditional treatments. There are many alternative therapies that may be successful. (These methods are not backed by clinical research data but by anecdotal evidence.)
  • Get plenty of rest. Recognize that your body is fighting an infection and that it needs time to rest and recover. Don’t try to push yourself to hard or you may worsen your condition.
  • Eat a balanced diet with plenty of fresh fruits and vegetables if available. Stay away from inflammatory foods like coffee, refined sugars, and large quantities of meat.
  • Exercise to your best ability. Be conscious of your physical limitations while still allowing yourself to get a rewarding workout.

Screening

There is no universally accepted screening test for Lyme disease largely because there is no definitive diagnosis for Lyme disease. Patients who have been exposed to ticks and who show any number of the symptoms of Lyme disease may be recommended for diagnostic testing.

Prevention

There is no way of knowing whether or not a tick is infected with Lyme disease. Your best chance at preventing Lyme disease is to prevent tick bites when in tick environments.

According to lymedisease.org, the following tips can decrease your risk of getting a tick bite:

  • Avoid tick habitat when possible, but don’t trade away all of your outdoor time. Stay on the center of the trail path while hiking and avoid walking in high grasses/shrub areas when possible.
  • Dress appropriately. When you know that you will be entering a tick habitat, do your best to defend yourself with your wardrobe. Boots, long socks, long pants, long sleeves, and a hat can help decrease the surface area of exposed skin. Tying loose hair back can help prevent ticks from latching on to hair. Light colored clothing will help to provide a contrast against the tick for easy spotting. In cases of high tick exposure, clothing treated with the insecticide permethrin (either pre-treated or treated at home) can help to prevent tick bites.
  • Use repellent. DEET is an effective chemical method, and eucalyptus oil is a solid natural alternative.
  • Remove your clothes, shower, and check for ticks. Especially if you spotted a tick on your clothing, run your outfit in a hot dryer for at least 10 minutes. This will kill any remaining ticks on your clothing. Showering will help to remove loose ticks and removing dirt will help you to better check yourself for ticks.
  • Get tick-protection for your pet. Even if they do not spend that much time outdoors, pets can attract ticks. Talk to your vet about available tick-prevention methods for your pet.

Medication And Treatment

Choosing a treatment plan for Lyme disease can be very difficult, especially with the conflicting opinions within the medical and scientific communities. Lymedisease.org reports that central to the divide in opinion are the Infectious Diseases Society of America (IDSA) and he International Lyme and Associated Diseases Society (ILADS). The IDSA claims that antibiotic treatment is capable of treating all cases of Lyme disease, but the challenge lays in detecting the disease. The ILADS recognizes the complexity of Lyme disease and contends that treatment for Lyme disease is more complicated than a simple antibiotic regimen.

Each case of Lyme disease should be treated with special attention to the case’s details, such as the stage of the disease upon diagnosis, the patient’s location (and subsequent risk of exposure to infected ticks), and the patient’s symptoms. Cases of Lyme disease that are caught early on will most likely be curable with antibiotic therapy. However, in cases that were diagnosed at later stages, treatment may need to include the management of post-Lyme syndrome symptoms. Because standard treatment available for post-Lyme syndrome symptoms does not address the cause of the symptoms, many patients choose to turn to alternative modes of treatment.

Complementary and Alternative Treatment

The following alternative treatments are available for patients with Lyme disease:

  • Acupunture. Acupuncture is a form of traditional Chinese medicine in which small needles are inserted at points throughout the body to help restore the flow of bodily energy. Acupuncture can help decrease pain and inflammation, and increase the body’s ability to fight infection.
  • Herbal therapies. There are many herbs that are thought to have Lyme-fighting potential. However, due to the severity of the disease, it is recommended that you seek herbal therapies from a qualified herbalist. Do not try to cure Lyme disease with herbal therapy without first seeking the advice of a trained and trusted herbalist.
  • Probiotic therapy. The potent antibiotics used to fight Lyme-disease diminish the body’s micro biota, which can cause a host of health problems including indigestion, diarrhea, frequent infections, reoccurring colds/flus, and acne.
  • Mind/body therapy. These techniques help the mind and body to work together in fighting the Lyme disease infection. These include:
    • Tai-Chai
    • Yoga
    • Guided meditation
    • Reiki

Care Guide

If you are caring for a loved one with Lyme disease, consider the following:

  • Educate yourself. Lyme disease is a complex disease with much ongoing research. Educate yourself about the basics of the disease and read up on the latest news and research. This will help you to make informed decisions for your loved one throughout the treatment process.
  • Consider all treatment options, especially if your loved one is not responding to traditional treatments. There are many alternative therapies that may be successful. (Many of these methods are not backed by clinical research data but by anecdotal evidence.)
  • Respect your loved one’s limitations. Know that they may not be able to do all that they used to.
  • Listen to your loved one and be diligent about their reported symptoms. Do your best to report all of these symptoms back to the doctor.
  • Help them find support in your community or online. For more information, visit The Lyme Disease Network

When To Contact A Doctor

If you experience any of the following, contact a doctor immediately:

  • Erythema migraines (EM), a red, expanding rash in a “bull’s eye” formation
  • Fatigue
  • Chills
  • Fever
  • Headache
  • Muscle/joint aches
  • Swollen lymph nodes
  • Facial/Bell’s palsy (drooping face)
  • Severe headaches**
  • Neck Stiffness**
  • Pain and swelling in joints
  • General sensations of sharp pain (especially pain that disrupts sleep patterns)
  • Irregular heartbeat****If you experience these symptoms, call emergency services. They may be signs of serious infection or heart attack.

 

Find a Doctor

To find a general practitioner in your area, click here

To find a physician that is a member of the International Lyme and Associated Diseases Society, visit The International Lyme and Associated Diseases Society

 

Resources

For more information on Lyme disease, visit:

For more information on the effect of forest fragmentation on Lyme disease, visit:

For more statistics on Lyme disease, visit:

For more information on Borrelia burgdorferi, the bacterium responsible for Lyme disease, visit:

 

For more information on alternative therapies for Lyme disease treatment, visit:

Questions For Your Doctor

To find a physician that is a member of the International Lyme and Associated Diseases Society, visit The International Lyme and Associated Diseases Society

Questions For A Doctor

You may want to ask your doctor the following questions:

  • What is the cause of my symptoms?
  • Are there other possible causes of my symptoms?
  • What are the available treatments for Lyme disease?
  • What are the side effects?
  • In what stage is my disease?
  • Will be condition worsen/will my disease progress?
  • Will my disease be able to be cured?
  • Will I experience lasting symptoms?
  • What can I do to hasten my recovery?
  • Are there any alternative treatments that you could recommend?

What lifestyle changes should I make to accommodate my illness?

Resources

For more information on Lyme disease, visit:

For more information on the effect of forest fragmentation on Lyme disease, visit:

For more statistics on Lyme disease, visit:

For more information on Borrelia burgdorferi, the bacterium responsible for Lyme disease, visit:

For more information on alternative therapies for Lyme disease treatment, visit: