What is Lyme disease?
Lyme disease (also known as Lyme borelliosis) is an infection caused by a spiral shaped bacterium called borrelia burgdorferi that is transmitted by a bite from a tick carrying the bug. It is named after the town in Connecticut, USA where the first cases of the condition were identified. The infection is generally mild, affecting only the skin, but can sometimes be more severe, leading to more serious illness. Ticks are tiny, spider-like creatures that are commonly found in woodland, moorland and other grassy areas. These areas have the right conditions for maintaining the tick life cycle, ie. high humidity in leaf litter or dead vegetation. They are also found in some animals, such as field mice, voles, sheep, deer and horses. The ticks feed by biting and attaching to the skin and sucking blood from animals such as sheep and deer. If ticks feed on an animal infected with the bacteria B. burgdorferi, the animals will also become infected, and can pass on the bacteria to people and domestic animals. Unlike humans and domestic animals, infected wild animals do not seem to show symptoms of Lyme disease.
In general, the longer the tick has been attached to the skin, the greater the risk of passing on infection. It seems that ticks need to be attached and to have been feeding for quite some time. If a tick is removed as soon as it bites, then the risk of infection is minimal.
What are the symptoms and signs of Lyme disease?
There are three distinct phases of Lyme disease. Each phase involves different parts of the body.
Early localized disease causes skin rashes and redness.
Early disseminated disease affects the nervous system and heart. People in this stage may have palsies that cause paralysis and tremors. A rare but potentially life-threatening bacterial infection called meningitis may occur in this stage. Meningitis affects the tissue surrounding the brain and spinal cord (meninges).
Late disease involves arthritis and neurological issues. During this stage damage to nerves of sensation and movement can occur.
Phase 1: Early localized disease
A characteristic flat, red ring or bull’s-eye rash develops in 75% of those who have been bitten by a tick infected with Lyme disease. The rash appears days to weeks after the bite and spreads outward. The bull’s-eye rash is called “erythema migrans.” Some people don’t notice or remember being bitten by a tick either because the tick was too small or a rash never appeared. Someone with newly acquired Lyme disease may suffer from fatigue, headache, joint and muscle stiffness, and swollen glands. Later stages of the disease affect the heart, joints, and nervous system.
Phase 2: Early disseminated disease
Untreated, skin redness associated with early localized Lyme disease resolves in about one month. The second stage occurs weeks or months after the appearance of the red rash. During this time, bacteria affect other parts of the body including the heart, joints, and nervous system.
Phase 3: Late disease
Late-stage Lyme disease can inflame the heart and lead to heart rhythm disorders and even heart failure. Nervous system problems associated with late disease may include facial paralysis (Bell’s palsy), meningitis, confusion, and abnormal function of the nerves outside of the spinal cord (peripheral neuropathy). Joint inflammation can occur — typically in just one to a few joints (often the knees) — resulting in pain, stiffness, and swelling. Arthritis associated with Lyme disease can become chronic and may mimic other forms of inflammatory arthritis.
Since Lyme disease is a multi-systemic illness there is a multitude of symptoms associated with the illness. Some include;
- Flu-like illness
- Fever
- History of Tick Bite (Not all patients recall a bite)
- Headache
- Extreme Fatigue
- EM Rash, Other Rashes (Only found in 50% of patients)
- Malar Flush, Red Ear Lobes
- TMJ/ Jaw Pain (Temporomandibular Join)
- Neck & Back Pain
- Joint Pain & Swelling, Bone Pain
How is Lyme disease diagnosed?
Doctors use a variety of methods to diagnose Lyme disease. Different approaches may be used depending on the stage of the disease. Early Lyme disease is easily diagnosed if a person has the characteristic red, bull’s-eye rash. The diagnosis is considered when a person has recently been in an area known to have ticks that harbor the bacteria. Sometimes the diagnosis is not as clear-cut. The doctor may perform a physical exam and order tests to exclude other potential problems with the heart, joints, and nervous system.
Antibody tests are available for Lyme disease, but they are not useful in the early stage. They are more helpful in the diagnosis of later stages. A test called the ELISA assay is used to detect Lyme disease antibodies. However, there’s a possibility of a false positive diagnosis because Lyme disease antibodies may be present in the body for years after the illness has resolved. The most reliable test available to confirm the diagnosis of Lyme disease is called the Western Blot assay.
What is the treatment for Lyme disease?
Antibiotics can cure Lyme disease. Different stages of disease may be treated with different antibiotics. Treatment choices also depend on the areas of the body involved. Oral amoxicillin (Amoxil), cefuroxime axetil (Ceftin), and doxycycline (Vibramycin) are often used to treat the early stages of Lyme disease. A bull’s-eye skin rash after a tick bite is a reason to see the doctor urgently for treatment. The rash typically resolves in about 1 or 2 weeks with antibiotic treatment. Intravenous medications such as ceftriaxone (Rocephin) may be necessary to treat later stages of Lyme disease.
What’s the treatment for later-stage joint pain of Lyme disease?
There are a few options to treat the joint pain and swelling associated with Lyme disease. Pain-relievers and anti-inflammatories – such as ibuprofen (Motrin, Nuprin) – can help relieve symptoms. An in-office procedure called arthrocentesis can be used to withdraw fluid from swollen joints. Rarely, arthritis persists after antibiotic treatment. Some scientists believe that chronic joint inflammation can be triggered by the infection even after the successful elimination of Lyme bacteria.
How can Lyme disease be prevented?
The best way to avoid Lyme disease is to prevent it! Take the following measures to reduce the risk of a tick bites and illness.
- Wear shirts with long sleeves and pants to protect the skin.
- Apply bug repellant containing DEET to exposed areas.
- Examine clothing, kids, and pets for ticks after excursions to areas known to harbor ticks.
- If a tick bites, use tweezers to remove it from the skin. Place the tick in a closed container and provide it to health professionals for identification.
- Remove clothes and bathe — washing the entire body and scalp — to help prevent tick bites and the transmission of Lyme disease.
