Lyme disease (LD) is an infection caused by Borreliaburgdorferi, a type of bacterium called a spirochete that is carried by deer ticks. An infected tick can transmit the spirochete to the humans and animals it bites. If left untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe. LD acts as a multisystem inflammatory disease and affects the skin in its early stage, and later, spreads onto the joints, nervous system and in severe cases, it also affects other organs of the body.
What are ticks?
Ticks are closely related to spiders. They are typically small when unfed, (1 to 5 mm in length), and all active stages feed on blood. They are small and can be hard to see. Immature ticks, or nymphs, are about the size of a poppy seed; adult ticks are about the size of a sesame seed. They cannot fly and they move quite slowly. Ticks usually come in contact with people or animals by positioning themselves on tall grass and bushes. They may take several hours to find a suitable place on the host to attach to feed. Most tick bites are painless. The majority of bites will not result in disease because most ticks are not infected with the agent of Lyme disease.
LD is the most common illness in the U.S., more than 150,000 cases have been reported till date since the year 1982.
Causes
Infected blacklegged ticks can spread Lyme disease to humans through their bite. Ticks are very small and as their bites are usually painless, you may not know you have been bitten.
Blacklegged ticks are most often found in forests and the overgrown areas between woods and open spaces. Current locations where populations of ticks and Lyme disease can be found, and where surveillance and research studies suggest ticks and possible Lyme disease risk have begun to become established are detailed on this map. But remember, it is possible to acquire Lyme disease outside of these areas as tick populations are expanding.
There is no agreed upon scientific evidence that people can spread Lyme disease to each other. Pets, particularly dogs, can get Lyme disease, but there is no evidence that they can spread the infection to humans. Pets can carry infected ticks into your home and your yard.
Symptoms
The early symptoms of LD can be mild and easily overlooked. People who are aware of the risk of LD in their communities and who do not ignore the sometimes subtle early symptoms are most likely to seek medical attention and treatment early enough to be assured of a full recovery.
The first symptom is usually an expanding rash (called erythema migrans, or EM, in medical terms) which is thought to occur in 80% to 90% of all LD cases. An EM rash generally has the following characteristics:
- Usually (but not always) radiates from the site of the tickbite
- Appears either as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that is in turn ringed by an expanding red rash (looks like a bull’s-eye)
- Appears an average of 1 to 2 weeks (range = 3 to 30 days) after disease transmission
- Has an average diameter of 5 to 6 inches
- (range = 2 inches to 2 feet)
- Persists for about 3 to 5 weeks
- May or may not be warm to the touch
- Is usually not painful or itchy
EM rashes appearing on brown-skinned or sun-tanned patients may be more difficult to identify because of decreased contrast between light-skinned tones and the red rash. A dark, bruise-like appearance is more common on dark-skinned patients.
Other symptoms such as joint pains, chills, fever, and fatigue are common, but they may not seem serious enough. As the LD spirochete continues spreading through the body, a number of other symptoms including severe fatigue, a stiff, aching neck, and peripheral nervous system (PNS) involvement such as tingling or numbness in the extremities or facial palsy (paralysis) can occur.
LD has 3 stages. Following are the symptoms according to the stages of LD-
Localized Early (Acute) Stage:
- Solid red or bull’s-eye rash, usually at site of bite
- Swelling of lymph glands near tick bite
- Generalized achiness
- Headache
Early Disseminated Stage:
- Two or more rashes not at site of bite
- Migrating pains in joints/tendons
- Headache
- Stiff, aching neck
- Facial palsy (facial paralysis similar to Bell’s palsy)
- Tingling or numbness in extremities
- Multiple enlarged lymph glands
- Abnormal pulse
- Sore throat
- Changes in vision
- Fever of 100 to 102 F
- Severe fatigue
Late Stage:
- Arthritis (pain/swelling) of one or two large joints
- Disabling neurological disorders (disorientation; confusion; dizziness; short-term memory loss; inability to concentrate, finish sentences or follow conversations; mental “fog”)
- Numbness in arms/hands or legs/feet
Complications associated with Lyme disease
- Meningitis is characterized by headaches that fluctuate in intensity from mild to severe with or without associated nausea, vomiting, light sensitivity, neck stiffness, or pain on eye motion.
- Encephalitis is commonly accompanied sleepiness, mood swings and irritiability, atypical spontaneous tearfulness or personality change, cognitive problems (typically with word finding problems, memory loss, slowed mental speed), balance problems, and sensory hyperarousal (e.g., vision, hearing).
- Cranial neuritis– CN VII Palsy (facial nerve weakness) is a form of cranial neuritis that is thought by many physicians to be common, however studies suggest that it may be seen in as few as 10% of patients with neurologic Lyme disease. However, in a patient from a Lyme endemic area or in an individual who has previously visited a Lyme endemic area, a presentation of a facial nerve palsy should lead the physician to test for Lyme disease.
- Radiculoneuritis – When the infection in Lyme disease affects the nerve roots, it is called radiculoneuropathy.
- Encephalopathy – Patients may develop cognitive problems from Lyme disease either early or many months or years after the initial infection. The cognitive problems most commonly include problems with short-term memory, problems with verbal fluency such as in name or word retrieval, and problems with slower speed of thinking.
- Neuropsychiatric Lyme Disease – Neuropsychiatric symptoms can emerge either early or late in the disseminated phase of infection. These symptoms commonly appear as cognitive symptoms and as irritability, easy tearfulness, anxiety, and depression. Rarely, patients with undetected Lyme disease may present with obsessive compulsive disorder, paranoia, auditory/visual hallucinations, or full blown mania.
Treatment
Medications
There are accepted pharmaceutical treatments that have been found to be effective for LD, but with possible side effects.
- Doxycycline (Vibramycin, Avidoxy, Monodox, Doxy 100, Doryx, Oracea, Adoxa)
Doxycycline inhibits protein synthesis and thus bacterial growth by binding to the 30S and possibly the 50S ribosomal subunits of susceptible bacteria. This agent interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria.
- Tetracycline – Tetracycline is used to treat gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. This agent inhibits bacterial protein synthesis.
- Penicillinsprovide effective treatment of Lyme disease. These agents are used in patients who are intolerant of doxycycline and in pregnant women and children under the age of 8 years, in whom doxycycline is contraindicated.
- Intravenous antibiotics. If the disease involves the central nervous system, your doctor might recommend treatment with an intravenous antibiotic for 14 to 28 days. This is effective in eliminating infection, although it may take you some time to recover from your symptoms. Intravenous antibiotics can cause various side effects, including a lower white blood cell count, mild to severe diarrhea, or colonization or infection with other antibiotic-resistant organisms unrelated to Lyme.
- NSAIDS – Like ibuprofen (Advil, Motrin), naproxen (Aleve), to relieve pain and inflammation.
Alternative Treatment
Nutrition and Supplements
- Probiotic supplement (containing Lactobacillus acidophilus – Probiotics, or “friendly” bacteria, help maintain intestinal health. If the patient takes antibiotics to treat Lyme disease, the antibiotics will kill the “good” bacteria along with the bad. That can cause diarrhea or yeast infections. Taking probiotics may reduce these side effects. People with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking probiotics.
- Beta-glucan – This is a kind of fiber, is sometimes used to help fight Lyme disease. Beta-glucan is thought to stimulate the immune system, so people with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking it.
Herbs
- Garlic (Allium sativum) – This has antibacterial effects, and one study suggested it may help prevent tick bites. In that study, people who took garlic reported fewer bites than those who took a placebo. Garlic may increase the risk of bleeding, especially if the person also takes blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Garlic can potentially interfere with several medications, including drugs used to treat HIV/AIDS, and even some birth control medications. Speak to your doctor.
- Essaic – Burdock root (Arctiumlappa), sheep sorrel (Rumexacetosella), slippery elm (Ulmusfulva), rhubarb (Rheum palmate). It helps to treat Lyme disease. Essaic is a formula that contains several different herbs, and may interact with many medications and potentially cause some dangerous side effects.
Reference
http://www.ilads.org/lyme/about-lyme.php
http://www.medicinenet.com/lyme_disease/article.htm
http://www.medicinenet.com/lyme_disease/article.htm
http://www.lymediseaseassociation.org/
http://www.aldf.com/pdf/Halperin_Book_Chapter_17.pdf
http://www.mayoclinic.org/diseases-conditions/lyme-disease/basics/definition/con-20019701
http://www.nhs.uk/Conditions/Lyme-disease/Pages/Introduction.aspx#treatment
http://emedicine.medscape.com/article/330178-medication#4
http://www.borrelia-tbe.se/filer/Vortrag%20Schweden%202_10_10_200910.pdf