It’s summertime! Everyone is outside walking, hiking, camping and doing yardwork. Every year at this time we start getting calls and appointments because people find ticks on themselves, their children, their family/friends/acquaintances/perfect strangers and their pets. Finding a tick immediately makes people think of Lyme disease. What is Lyme disease?
Lyme disease is an infection that causes pretty significant symptoms. There has been a lot of buzz lately about so-called Chronic Lyme Disease and many people with chronic joint pain and fatigue (VERY common symptoms) are concerned they may have Chronic Lyme Disease.
Lyme disease is caused by infection with a bacteria called Borrelia burgdorferi. The deer tick, Ixodes scapularis, transmits the infection when it bites a human and takes a blood meal. Most of the time the tick must be attached to the host for 36-48 hours in order to spread the infection.
Lyme disease can also be transmitted by the bites of immature ticks called nymphs. Nymphs are less than 2 mm in size, much smaller than the adult tick pictured above, and difficult to see. Just because you haven’t found a tick attached to your body doesn’t mean you can’t have Lyme disease!
Lyme disease causes flulike symptoms and a rash. Symptoms include fever, chills, headache, muscle and joint pain, and swollen lymph nodes. 70-80% of patients will have the typical bulls-eye rash. A small percentage of patients may have brain or nerve symptoms, like weakness of the face, burning nerve pain, severe headaches, stiff neck and problems with short-term memory. Lyme disease can also affect the heart and cause irregular heartbeat, palpitations, shortness of breath and dizziness.
Lyme disease is treated with antibiotics like doxycycline, amoxicillin and cefuroxime. If caught and treated early, most patients will have a prompt and complete recovery. Those who have brain or heart involvement may need to be hospitalized for IV antibiotics. A small percentage of patients do not respond and develop long-term symptoms. Also, those who are not diagnosed early may go on to have persistent symptoms.
Chronic Lyme Disease
Some patients who are treated appropriately with antibiotics for Lyme disease have symptoms that persist for more than 6 months. This is commonly called chronic Lyme disease but it is more properly called “Post-treatment Lyme Disease Syndrome” (PTLDS).
The cause of PTLDS is not known. There is some evidence that it may be a post-infectious autoimmune reaction similar to Guillain-Barrre after a viral or gastrointestinal infection, Reiter’s syndrome after Chlamydia infection, or rheumatic heart disease after strep throat.
PTLDS may also be due to persistent infection with Borrelia bacteria. The research is ongoing to determine the cause and the best treatment. Studies have NOT shown that long-term treatment with antibiotics results in better results than placebo, and long-term antibiotic therapy can have very serious adverse effects.
Most patients with PTLDS have gradual improvement of their symptoms over time. It can take a VERY long time for symptoms to resolve completely, and sometimes they don’t go away altogether. If this is the case, patients often get relief with treatments designed for chronic fatigue syndrome and fibromyalgia.
If you see the rash shown above at ANY time of year, not just in the summer, see the doctor right away. If you develop a flu-like illness with fever, headache, body aches and joint pain and swelling, ask your doctor to test you for Lyme disease. If you had Lyme disease and were treated, but your symptoms seem to be hanging around for longer than they should, talk to your doctor about it. He or she may be able to help, or to refer you to a rheumatologist or infectious disease specialist who can help you feel better.
QUESTION: Do you know anyone who has had Lyme disease?