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Lyme disease is caused by the bacterium Borrelia burgdorferi
and is transmitted to humans through the bite of an infected
tick. It is one of the fastest growing infectious diseases in the
country. It is underreported, under-researched, and often
debilitating. The number of cases are steadily increasing,
which has led many in the medical/scientific community and
legislative arena to deem the disease a “public health crisis”
and “epidemic.” If diagnosed early most cases of Lyme
disease can be treated successfully with antibiotics. If left
untreated, infection can spread to joints, the heart, and the nervous system making the diagnosis, treatment and recovery time more difficult.
Lyme disease is considered one of the fastest growing infectious diseases in the country as well as one of the most difficult to diagnose.
When bitten by a tick, the bacteria Borrelia burgdorferi can be transmitted into your
blood stream. Typically it is from an infected blacklegged (or deer) tick. As the tick
feeds on its host, being a person or animal, it releases the bacteria into the host's
Once in the host's body, the bacteria can disseminate fairly rapidly and lodge in soft
tissues and organs, including the heart, brain, central nervous system, joints and
muscles. The bacteria is capable of burring deep in the tissue, remaining undetected
by laboratory tests but will cause debilitating symptoms. The longer a tick is attached
the greater the chances are of it transmitting the bacteria causing a disease. Ticks can attach to any part of the human body but are often found in hard-to-see areas such as the groin, armpits, and scalp.
There is no sufficient evidence that Lyme disease is transmitted from person-to-person. There are reports of sexually active couples contracting Lyme disease but insufficient data to determine if it can be sexually transmitted. These couples typically share similar exposure histories.
Since the bacterium travels in the bloodstream, it is possible for it to be transmitted through blood that is stored for transfusions. The American Red Cross does not accept blood donations from patients with Lyme disease or Babesia, another tick-borne disease.
There is insufficient data to determine if the Lyme bacterium can be transmitted through breast-feeding.
Lyme disease acquired during pregnancy can be dangerous to the unborn child. The bacteria can be transmitted to the fetus and cause possible stillbirth or other medical complications. Pregnant woman can be treated with antibiotics that will not negatively impact the fetus. There is insufficient evidence to determine the risk to the child if the mother contracted Lyme disease before pregnancy.
Lyme disease has a wide range of symptoms that mimic many other diseases and ailments, making it difficult to diagnose. This is why it is known as the great imitator, as it can mimic a broad range of other diseases. This also leads to a tremendous amount of misdiagnoses. There are numerous incidents of people being diagnosed with Multiple Sclerosis, Fibromyalgia, Alzheimer's, Arthritis, and other diseases with symptoms such as fatigue, sleep disturbances, paresthesias, neurological issues and joint pains.
The classical rash from Lyme disease is called erythema migrans (EM). It appears like a "bulls-eye. It
is flat in appearance and doesn't itch. It usually appears around 3 to 30 days after a tick bite. There
can also be similar rashes weeks later, an indication the bacteria has spread. Many people never see
a rash. Less than half of the people exposed to Lyme disease get a rash. Although the EM rash is
typical, other types of rashes have also been noted and confused with cellulitis, a bacterial infection
of the skin, or a spider bite.
Some of the symptoms that have been noted with Lyme disease include fatigue, achy, stiff or swollen joints, muscle aches, joint aches that travel to different joints, headaches, dizziness, fevers and/or chills, night sweats, gastrointestinal distress, swollen glands and/or sore throat, stiff neck, back pain, jaw pain, chest pain and palpitations, tingling sensations and numbness to extremities, sleep disturbance, problems with concentration and memory, depression, mood swings, irritability, ringing in the ears, testicular/pelvic pain, Bell's Palsy, regression in a child's performance, speech or motor skills. Because the bacteria invade the body in various places, the symptoms are also vary variable.
It is the bacteria Borrelia that is called Lyme disease. Borrelia has several species (different bacteria) under that heading. Ticks overwhelmingly are infected with multiple bacteria and also some viruses. When a person obtains a tick bite is it more common for them to be infected with multiple organisms (bacteria and/or viruses). This causes an overlapping of signs and symptoms making it more difficult for a physician to diagnose the issue. Of concern is that there are new bacteria/viruses, as well as new ticks, that are continuing to be discovered causing illness.
Some of the more common co-infections include Babesia, Bartonella, Ehrlichia/Anaplasma, Rocky Mountain Spotted Fever / Rickettsia and Southern Tick-Associated Rash Illness (STARI), but there are more.
There are over 30 different species/subspecies of Bartonella, seventeen have been identified as as causing human infections. It used to be thought that Bartonella could only be transmitted to humans by bite or scratch of a cat, fleas, lice, flies or sand fleas. In the late 1990's Bartonella was also identified as being a tick-borne co-infection associated with persistent Lyme disease.
Patients with Lyme disease co-infected with Bartonella are known to have more severe symptoms, particularly neurological issues, meningitis, new onset of seizures, eye problems, infections in the heart, presentations similar to sarcoidosis and inflamed lymph nodes or nodules.
Some patients infected with Bartonella will develop what appears to be stretch marks found on the abdomen, thighs, breasts, sides and upper shoulders, which are mistakenly thought to be from a weight issue.
Babesia is a parasitic infection that is frequently found in patients with persistent Lyme disease. It is transmitted by the same tick that transmits Lyme. Babesia can be transmitted by blood transfusions. Symptoms include day sweats, night sweats (occasional drenching), chills, flushing, fever, cough and air hunger or unexplained shortness of breath. Babesia is a persister parasite and can go on to develop into a chronic carrier state. Because of this, aggressive treatment is necessary if not treated early.
These bacteria are some of the most common co-infections. There are several species. Common symptoms include high fever, headaches,muscle aches, and fatigue that resemble a flu-like illness in the spring, summer or fall. Can be transmitted by blood transfusions.
These bacteria live within the host cells with the most common rickettsial infection being Rocky Mountain Spotted Fever. The symptoms of infection can be nonspecific and include fever, nausea, vomiting, severe headaches, and muscle pain, which is frequently mistaken for a flu-like illness. There is a classic red-spotted rash, but it is not present all the time. This makes the rash unreliable as a means for the diagnosis.
The bacteria that causes STARI, also known as Master's disease, can cause a rash that is indistinguishable from the ones seen in Lyme disease. The bacteria that causes STARI was first noted in the southeastern and south-central United States. Similar symptoms to Lyme disease can occur and include fevers, headaches, stiff neck, joint pain and fatigue.
The above are a sample of the tick-borne diseases that can occur. There are also other bacteria as well as viruses that are know causes of disease.
Diagnosing Lyme or an associated tick-borne illness is the most challenging part. About 50% of people with Lyme test negative. Lyme is essentially a clinical diagnosis due to the challenges of the testing available. One of the tools used is the Multiple Systemic Infectious Disease Syndrome questionnaire developed by Dr. Richard Horowitz, M.D. Using this questionnaire along with an adequate and full history and examination a clinical diagnosis can be made. The laboratory testing aids in the diagnosis.
Being less than 50% of people ever notice the typical bull's-eye rash or a tick bite, diagnosing Lyme disease can be very difficult. Plus, many people have co-infections with other organisms that display various other symptoms. Add all this to the fact that these organisms invade the immune system making detection of them very difficult, one can see how diagnosing Lyme can be a task. And lets not forget the testing is also a major issue.
If one goes by the current CDC guidelines and definition of Lyme, a lot of cases will be missed or delayed for treatment. There is a two tiered testing system. The first test is to see if you have any antibodies against Borrelia burgdorferi bacteria. If this is negative, no further testing is done and you are considered not to have Lyme disease. If this test is positive,
depending how long you have had symptoms a Western Blot test is obtained for IgG and/or IgM antibodies against Borrelia burgdorferi. This test produces results that look like a bar code with several lines called bands. Each band represents antibodies to a different component of the bacteria. It is considered positive if you have 2 out of 3 IgM bands; 24 kDa, 39 kDa and 41 kDa. It is also considered positive if you have 5 out of 10 IgG bands; 18 kDa, 21 kDa, 28 kDa, 30 kDa, 39 kDa, 41 kDa, 45 kDa, 58 kDa, 66 kDa and 93 kDa. This two tiered testing will miss approximately half of those affected, due to the insensitivity of the tests.
As of 2016, the only standard of care for the diagnosis and treatment
of Lyme disease in the United States is the International Lyme and
Associated Diseases Society (ILADS) guidelines. The Infectious
Disease Society of America (IDSA) guidelines were removed because
they contained outdated science. The IDSA guidelines follow the CDC
guidelines which are so narrow that only a minority of cases would
actually meet its strict criteria. ILADS guidelines stress the importance
of a doctor's clinical judgment in making the diagnosis, because the scientific literature has found that existing testing is unreliable.
The ILADS guidelines state that Lyme disease is a clinical diagnosis. Positive two-tiered testing is not required due to the current testing being unreliable, due to lack of sensitivity and specificity. CDC guidelines only test for one strain of bacteria, Borrelia burgdorferi, but there are other strains. It has also been shown that in clinical practice patients with persistent Lyme
disease symptoms rarely have a positive IgG Western Blot, and more often, they have a positive IgM, in both early and late stage Lyme disease. This is in contrast to how the CDC wants you to test based on their idea that testing for IgM in people with greater than 1 month of illness is not appropriate . The discrepancy is because in clinical practice we know the organisms invade the immune system and will cause the body to not produce the IgM and/or IgG antibodies normally. Because of this a person may not exhibit the antibodies that one would think would be present, and in some cases they may not show up at all initially.
The Western Blot testing (second of the two-tiered testing) can still be useful, but there are definite limitations. There are other laboratory companies , such as IGeneX, that test for multiple strains of Borrelia burgdorferi, as well as co-infections.
Dr. Richard Horowitz, M.D. developed an approach to chronically ill patients along with a questionnaire to identify a persons risk of having Lyme or an associated disease. His system is called Multiple Systemic Infectious Disease Syndrome (MSIDS). This addresses many factors involved with a chronic illness. The main one being inflammation. Initial inflammation may be from Lyme or an associated co-infection, or from an overstimulated immune system, environmental toxins, food allergies, mineral/vitamin deficiencies, gut microbiome imbalance, or even a sleep disorder. Understanding the complexities involved in chronic illness as well as obtaining a full Functional Medicine history and diagnostic tests can help one to start reversing the underlying issues involved in causing the illness.
ILADS guidelines take a patient-centered approach to treatment where there is no fixed duration or combination of antibiotics. Instead, the guidelines suggest to tailor the treatment to the patient's response, and adjusting treatment accordingly to reduce the risk of chronic complications due to inadequate treatment.
Treatment typically involves the use of multiple antibiotics along with anti-fungal medication and high-dose probiotics. The types of antibiotics used are individualized according to the history, signs,symptoms and how long they have been present. The length of treatment is also variable according to how one responds to the treatment. Typically, the longer one has had the issue(s) and if the issue(s) involve the peripheral and/or central nervous system, the treatment is longer due to the various forms of the bacteria, its invasiveness and what is called persister/biofilm forms.