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
The disease was first reported in the Lyme, Connecticut region in 1975;1
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
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
Some Lyme Disease Definitions
- Bacterium — A small unicellular organism that multiplies
by cell division, has a cell wall, can be shaped like a sphere, rod or spiral and
can be found in almost any environment.
- Borrelia — A genus of gram-negative, anaerobic helical bacteria,
various species of which produce relapsing fever in man and other animals.
- Nymphal — Pertaining to the nymph stage of a multistage arthropod
- Spirochete — A microscopic bacterial organism, worm-like
and spiral-shaped in appearance.
- Enzyme — A protein molecule produced by living organisms
that catalyses chemical reactions of other substances but is not destroyed or altered
upon completion of the reactions.
- Polymerase — Enzymes that catalyze the synthesis of nucleic
acids on preexisting nucleic acid templates.
- Sclerosis — A hardening of a body part from inflammation
associated with diseases of the interstitial substance.
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
- 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.
Poor health can significantly affect your life. Improve your life by changing to good health. Call our patient coordinator at 1-212-679-9667 or click on Request an Appointment to schedule an appointment with one of our doctors for evaluation and testing.
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Article Last Updated: 08/26/2015