Lyme Disease

Inflammatory and Immune System

Lyme disease received its name from the town in Connecticut where many cases were found in 1977. It is a bacterial infection transmitted by ticks that are infected with Borrelia burgdorferi (or rarely Borrelia mayonii) who then bite a human and spread the bacteria. This infection is the most common vector-borne (bitten by a mosquito, tick, or flea) disease in the United States and is usually carried by deer who are infested with ticks. It is most often found in heavily wooded areas including the Northeast, North Central, and the Pacific Coast. A small number of cases are found in other areas due to migrating animals and people. Infestations are most prevalent in the spring and summer months and less common in fall and winter. The disease affects many of the body systems and tissues with a wide variety of symptoms. Lyme disease is often misdiagnosed as other illnesses due to the wide range of symptoms it causes. Testing is not always positive, and the disease can be mistaken for multiple sclerosis, seizures, chronic fatigue syndrome, fibromyalgia, hypochondria, and/or arthritis.

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Symptoms

The onset of symptoms for Lyme disease usually occurs within 3 to 30 days after the bite. Early symptoms include fatigue, fever, headache, body aches, joint pain, and sometimes a round rash that looks like a “bullseye” at the site of the bite. This rash is known as erythema migrans and occurs in at least thirty and up to eighty percent of people with Lyme disease. The rash will usually appear within seven days of a tick bite and expands over several days reaching up to 12 inches or more in diameter.  The rash is rarely itchy or painful and may feel warm to the touch. Other symptoms of Lyme include a wide range of full-body symptoms and are explained below:

Active/Early Lyme Disease

  • Fatigue
  • Fever
  • Chills
  • Headache
  • Sweats
  • Joint pain
  • Body aches
  • Sleep issues
  • Brain swelling (encephalitis)

Late-Stage Lyme Disease

  • Nerve pain
  • Lyme carditis (heart palpitations or arrhythmia)
  • Inflammation of the brain and spinal cord
  • Shooting pains, tingling, or numbness in the hands or feet
  • Arthritis and severe joint pain
  • Bell’s palsy (facial drooping)
  • Dizziness
  • Shortness of breath
  • Erythema migrans rashes in other areas of the body
  • Swollen knee

Chronic Lyme Disease (occurs after treatment)

  • Fatigue
  • Joint and/or muscle pain
  • Neuropathy
  • Depression
  • Cognitive dysfunction (concentration and memory difficulties)
  • Headaches
  • Heart murmur/palpitations
  • Sleep issues
  • Speech problems

Autoimmune disorders

Risk Factors

Lyme disease is found all over the United States. However, it primarily occurs in the United States in three geographic locations:

  • Pacific Northwest (especially northwestern California and Oregon)
  • North Central (Minnesota and Wisconsin)
  • Northeast and mid-Atlantic (Maine to Maryland)

If you live or travel in any of the above-mentioned regions you are at an increased risk of encountering the vector (tick) that carries the bacteria that causes Lyme disease. These ticks are most active in warmer temperatures so any woody or grassy area of the United States that has warm temperatures increase your risk of exposure. If you work, hike, camp, hunt, or picnic in this type of environment, know you are at an increased risk of coming in contact with the ticks that carry the Lyme disease bacteria. Ticks prefer wet, green, brushy, and wooded areas, so wear protective clothing in these areas to reduce your risk of infection.

 

Diagnosis

Here is the tricky part about Lyme disease. Diagnosis can be hard if you have been bitten by a tick and do not have symptoms right away or the characteristic “bullseye rash.” Not everyone gets the “bullseye rash” or it can disappear quickly. Lab tests for Lyme disease have a high rate of false-negative results. The most recommended way to diagnose Lyme is by clinical symptoms and/or the appearance of the bullseye rash and a history of a known tick bite. If you suspect a tick bite, here are the steps to take:

See a doctor right away. If you think you have been bitten by a tick and see any rashes on your body, see your doctor right away.

If you start having symptoms, keep a journal. Keep track of your symptoms and if your doctor starts you on treatment, write down the dates and dosages of the medications.

Ask for testing. Testing may take a few weeks to be positive. The tests include ELISA and western blot testing. These check for antibodies to the Lyme bacteria and need time for results as the lab technicians wait for the antibodies to build up.

Be persistent. If you have symptoms of Lyme and your tests come back negative, get a second opinion preferably from a doctor that works with Lyme disease patients. Educate yourself about the symptoms of the stages of Lyme disease and chronic Lyme disease to avoid misdiagnosis with something else and receive prompt treatment.

Lyme disease has commonly been misdiagnosed as:

  • Alzheimer’s disease
  • Arthritis
  • ADHD
  • Chronic fatigue
  • Fibromyalgia
  • Guillain-Barre
  • Mononucleosis
  • Lupus
  • Lou Gehrig’s disease
  • Multiple sclerosis
  • Parkinson’s disease

Treatments

There are a few ways to treat Lyme disease depending on the doctor and school of thought. The Infectious Diseases Society of America (IDSA) believes that Lyme disease is “hard to catch and easy to cure” as long as the patient takes a short course of antibiotics early in the disease. This school of thought believes the spirochete is eradicated with antibiotics and does not persist beyond treatment.

The International Lyme and Associated Diseases Society (ILADS) school of thought believe that Lyme disease is hard to diagnose and eradicate. They believe treatment needs to be initiated based on symptoms and patient response. In the early stages of Lyme, these doctors believe Lyme needs high doses of antibiotics for a long period of time. They also treat any tick bite prophylactically if the person lives in a “high-risk” area. In the later stages, they may choose to continue antibiotic treatment until all symptoms subside and this could go on for years.
The antibiotics used for Lyme disease:

  • Doxycycline
  • Amoxicillin
  • Cefuroxime axetil

In the past, some doctors have tried combination therapy with clindamycin and azithromycin but these have not shown to be more effective than the three listed above. Antibiotics are generally given from 3 to 6 weeks in early Lyme disease and 6 months to a year in late-stage Lyme disease.

Alternative Treatments and Home Remedies

It is strongly recommended that you not treat Lyme disease with alternative medicine alone. Antibiotics are the only proven way to eradicate Lyme disease without severe complications. However, many alternative medicine treatments may complement antibiotic therapy if your doctor gives the okay.

Alternative medicine is said to help stop and prevent long-term symptoms that may stem from Lyme disease, although controversial. See a doctor that knows about Lyme disease and that agrees to work with you on the best treatment plan for you. Always let your doctor know if you are already using herbal remedies. Some alternative medicine treatments for Lyme include:

Probiotics. If you are on antibiotics for Lyme, probiotics can help put the helpful bacteria back in your body that antibiotics kill off. This is especially helpful if you have a yeast co-infection or get yeast from taking the antibiotics. Make sure you use a probiotic that contains active cultures, at least 5 to 10 billion units daily.

Beta-glucan. This helpful fiber may help boost your immune system to fight off Lyme. If you have an autoimmune disorder or use immunosuppressant medication, this supplement is not advised.

Garlic. Garlic is a natural antibacterial and may help ward off ticks. Use caution with garlic if you are on blood-thinning medication because it is also a natural blood thinner.

Burdock Root. Naturopaths may suggest burdock root preparations to help Lyme disease. It can have powerful side-effects and must be monitored by a doctor who knows how to use it.

Prevention

Cover your skin. If you spend time outdoors, make sure to cover your skin as much as possible. Try not to brush against foliage when hiking and use trails if possible. Wear your pants tucked into socks and wear long-sleeved shirts when walking in grassy or wooded areas.

Tick proof your surroundings. Cut back any long brush, mow the grass, and use an insecticide on your lawn. Spray the inside of your house where your pets sleep and treat them regularly for fleas and ticks.

Use EPA-registered insect repellents. Use insect repellents that contain at least 20 percent DEET but use sparingly due to toxic effects. Only spray on exposed parts of your body. A safer alternative is insect sprays containing permethrin and oil of lemon and eucalyptus. The EPA has a webpage devoted to finding the right insect repellant for you here.

Check for ticks. After spending time outdoors or hiking, check each other for any ticks that may have hitched a ride home with you. They like to hide so check behind the knees, the back area, under the arms, and in your hair.

Remove ticks promptly. If you find a tick, use a pair of tweezers to firmly pull out the entire body and head. Make sure the head does not stay under the skin and do not squeeze the abdomen. Make sure you are wearing gloves and use a fine-tipped pair of tweezers. Do not twist, burn, or use petroleum jelly to remove the tick. After you remove the tick, place it in alcohol to kill it. Clean the bite site with antiseptic soap and water and apply antibiotic ointment. Monitor the site closely for any infection, rash, or changes and see a healthcare provider immediately if you develop any symptoms.

Stay out from under trees. Ticks can congregate on the branches and leaves of trees. They can sense the oxygen and carbon dioxide from your breath and drop on you as you walk under them. This is a very common way for ticks to find their next meal.

Hike carefully. Walk in the center of the trails and avoid long grassy areas and heavily wooded trails.

References

Centers for Disease Control and Prevention. (2020, November 05). Lyme disease. Retrieved from: https://www.lymedisease.org/lyme-basics/lyme-disease/about-lyme/

Horn, D. L. (2020). Risk factors for Lyme disease. Retrieved from: https://www.winchesterhospital.org/health-library/article?id=19794

Johnson, L., Wilcox, S., Mankoff, J., & Stricker, R. B. (2014, March 27). Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. Peer J. Retrieved from:  https://peerj.com/articles/322/

Medical Leadership Board. (2020). About Lyme disease. Retrieved from: https://www.lymedisease.org/lyme-basics/lyme-disease/about-lyme/

National Institute of Neurological Disorders and Stroke. (2019, March 27). Neurological complication of Lyme disease information page. Retrieved from: https://www.ninds.nih.gov/Disorders/All-Disorders/Neurological-Complications-Lyme-Disease-Information-Page

Schmid, G. P., et al.  (1984, August). DNA characterization of the spirochete that causes Lyme disease. Journal of Clinical Microbiology, 20(2), 155-158. Retrieved from: https://jcm.asm.org/content/jcm/20/2/155.full.pdf

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