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An Overview of Lyme Disease

Lyme disease (borreliosis) is the most prevalent tick-borne infectious disease in the United States. The disease is caused by spiral-shaped bacteria in the Borrelia genus (commonly B. burgdorferi), carried by a number of species of the Ixodes genus of tick, (commonly the deer tick or black-legged tick). The bacterium is transferred via the tick’s saliva into the bloodstream of its victim. Once infected, symptoms range from neck stiffness and mild fatigue to severe fatigue, arthritis, and neurological problems.

The disease was first reported in the Lyme, Connecticut region in 1975;¹ hence the name. Incidence doubled in the U.S. in 1990s, from just under 8,000 in 1990 to over 16,000 cases in 1999, with the vast majority concentrated in the Northeast and Midwest. More than 90 percent of the 1999 cases came from nine states — Connecticut, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin — where deer ticks are most common. Connecticut accounted for one in every six reported cases in 1999.

In 2003, the U.S. Centers for Disease Control and Prevention (CDC) reported over 21,000 cases of Lyme disease. Although the disease has been reported in nearly every state, more than 95 percent of all cases are concentrated in the coastal Northeast, Mid-Atlantic States, Wisconsin, Minnesota, and northern California. The CDC considers Lyme disease to be an emerging infectious disease because of the rapid spread of infection over the past twenty years.

Health care providers may have difficulty diagnosing Lyme disease because of the complex nature of disease progression and frequent co-infection with other tick-borne diseases. In addition, the only distinctive sign unique to Lyme disease — a red ring-shaped rash known as erythema migrans (EM) — is absent in at least one-fourth of the people who become infected.

Symptoms of Lyme Disease

The presentation and progression of Lyme disease symptoms typically occurs in a series of stages.² The first indication that an individual has contracted Lyme is often — though not always —the circular red rash mentioned above, erythema migrans (EM), sometimes referred to as erythema chronicum migrans (ECM) as it may develop and persist over time. The telltale rash emerges as a small red macule or papule at the site of the bite that expands to form a circular or oval-shaped rash on the skin. The EM is sometimes described as a "bulls-eye," as the central red or purplish lesion may be encircled by a ring of clearing which is itself ringed by a band of reddened rash. This condition occurs in about 80% of those infected with Lyme causing bacteria.

As the infection spreads, a rash may develop at other sites around the body. Additional symptoms that can accompany the early stages of infection include neck stiffness, headaches, body aches and pains, fatigue and depressed mood.

About half of those who go untreated with antibiotics develop recurrent joint swelling and pain within a period of months, most often in the knees. Approximately 1 to 2 out of 10 people with untreated borreliosis develop chronic arthritis. Problems in the nervous system, such as Bell’s palsy and numbness in the legs or arms, can also arise. Less commonly, untreated individuals can develop hepatitis, heart problems, and severe fatigue.

The symptoms can vary between individuals: not all infected parties display all the characteristic symptoms, and Lyme disease symptoms often overlap with those of co-infections or other diseases, such as fibromyalgia, chronic fatigue syndrome, and lupus, as opposed to being exclusive to Lyme disease.

The incubation period from infection to the onset of symptoms varies from person to person, but is usually 1–2 weeks. The incubation period can be much shorter (days) or much longer (months to years). In certain cases where the body’s immune system is strong and its fighting capacity efficient, it can take as long as a year to manifest. Initial symptoms most often occur from May through September, when the nymphal stage of the tick is responsible for most cases. At this stage the tick, and its bite, is very small and not easily noticed. Asymptomatic infection exists but is found in fewer than 7 percent of infected individuals in the U.S.

Lyme disease can significantly affect your life. If you feel that you are not functioning properly or have any of the above-mentioned problems, please call our patient coordinator at 1-212-679-9667, or click to schedule an appointment to see one of our doctors for evaluation and testing. The ELISA (enzyme-linked immunosorbent assay) test for Lyme disease determines titers of IgM and IgG antibodies in the blood against the Borrelia burgdorferi bacteria.

Lyme Disease Progression

There are 3 generalized stages in the progression of Lyme disease. The first stage is the early localization of the infection, which can include the EM rash with redness and irritation combined with itching. It generally occurs at the place of the tick bite and is often painless and goes unnoticed. The early symptoms discussed above appear in nearly all of those infected at this initial stage: muscle stiffness, fatigue, headache. Given that the EM rash often does not develop or goes unnoticed when it does, an opportunity to catch the disease in its initial stages may be limited, and a victim may not seek treatment and the disease has progressed into later stages.

The second stage of Lyme disease is the dissemination of the infection to other parts of the body. If untreated with antibiotics, the spirochete bacteria can spread through the bloodstream, affecting other body systems. The "bulls-eye" rash may appear at other locations on the skin. In certain patients, a purple lump may form on the ear lobe, nipple or scrotum, known as a borrelial lymphocytoma. Limited numbers of untreated patients can develop neurological problems and may experience a change in heartbeat, along with dizziness. Patients may loose muscle tone on one or both sides of the face. They may also become sensitive to light and suffer increased muscle stiffness. Sleep disturbances, memory loss and mood fluctuations in patients may also be manifest.

The third stage of Lyme disease occurs when the disease remains untreated and becomes an established, persistent infection. The patient may develop severe and chronic symptoms that can affect many organs of the body, including the brain, eyes and heart. The patient may suffer from acute numbness and tingling pain in the hands and feet. A feeling of profound fatigue, depression, weakness, and bladder problems may be experienced at this chronic stage. Panic attack and anxiety may occur in patients as well as Lyme arthritis, in which joint erosion is a common feature. Paralytic attacks have occurred in a few critical cases.

There is considerable controversy in the United States among health care professionals, as to whether the symptoms some patients experience in post-treatment Lyme disease are due to recalcitrant infection by spirochetes that either resist the effects of antibiotics or develop immunity to the body’s natural defenses. Patients who have received early antibiotic treatment in most cases are cured of the disease following their course of treatment. But because of the difficulties a person may have recognizing that they have been infected in the first place, many often go untreated and develop moderate to severe disease symptoms before seeking treatment. Once the infection becomes established and symptoms become manifest, the efficacy of antibiotic treatment is not assured. The spirochetes responsible for Lyme disease have developed strategies to sequester themselves from the body’s natural immune defenses, and possibly hide from antibiotic effects within deep tissues. Controversy surrounds post-treatment Lyme symptoms, as to whether their recalcitrance is due to persistent infection or to some other post-treatment Lyme syndrome. (More on this below in the discussion of treatment strategies.)

Lyme Disease Etiology

The causal agent of Lyme disease is Borrelia bacteria in North America, carried by Ixodes scapularis in eastern North America, or Ixodes pacificus in western states. Out of 11 Borrelia species, 3 have been identified to have the capacity to spread Lyme disease. Apart from B. burgdorferi, B. afzelii and B. garinii are common. B. bissetti and B. valaisiana are also thought of as infectious but not as an important cause of disease. In North America, the black-legged tick, better known as the deer tick, has been identified as the key vector for spread of the disease. A different tick species Amblyomma americanum, or, common lone star tick — named for the distinctive white dot on the female’s back — has been found to carry borreliosis spirochetes in 2 percent of its population. The range of Amblyomma americanum includes the Midwest U.S., extending eastward to Maine and into the Southeastern U.S.

Conventional Treatment for Lyme Disease

Conventionally Lyme disease is diagnosed clinically based on the symptoms and objective physical findings; however, confirmation on laboratory testing is recommended before proceeding with treatment. The person’s history of exposure to Lyme disease areas is also a way to determine treatment. Treatment of this disease can be a problem at times in such cases; a doctor will ask details regarding the patient’s medical history and do a physical examination. Lab tests are used to identify antibodies for a few weeks after the infection. The common tests done for suspicion of Lyme disease include:

• Enzyme(5)-linked immunosorbent assay (ELISA) test
• Western blot test
• Polymerase(6) chain reaction (PCR)

According to the Centers for Disease Control ³ Division of Vector-borne illnesses, symptoms of Lyme disease can generally be eliminated with antibiotics if administered at an early stage:

The National Institutes of Health (NIH) has funded several studies on the treatment of Lyme disease. These studies have shown that most patients can be cured with a few weeks of antibiotics taken by mouth. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. Patients with certain neurological or cardiac forms of illness may require intravenous treatment with drugs such as ceftriaxone or penicillin.

At later stages, however, antibiotics may or may not be effective. As mentioned above, some doctors are of the belief that short-term dosing of antibiotics is preferable, while others suggest longer-term dosing, but there is significant controversy in the medical community over this aspect of treatment.

For some patients with difficult cases, specialists in the treatment of this tick-borne illness follow lengthy antibiotic and antifungal protocols. Some of these treatments include IV antibiotics twice per day for up to a year. Some doctors continue well beyond that time period if they deem it necessary. Many doctors incorporate both antibiotic and specialized nutritional supplementation in their treatment plans.

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