Lyme Disease

Lyme Disease, Lyme borreliosis is an infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu strict is the main cause of Lyme disease in North America, whereas Borrelia afzelii and Borrelia garinii cause most European cases. The disease is named after the towns of Lyme and Old Lyme, Connecticut, USA, where a number of cases were identified in 1975. Although Allen Steere realized that Lyme disease was a tick-borne disease in 1978, the cause of the disease remained a mystery until 1981, when B. Burgdorferi was identified by Willy Burgdorfer.

Lyme disease is the most common tick-borne disease in the Northern Hemisphere. Borrelia is transmitted to humans by the bite of infected ticks belonging to a few species of the genus Ixodes (“hard ticks”). Early symptoms may include fever, headache, fatigue, depression, and a characteristic circular skin rash called erythema migrans (EM). Left untreated, later symptoms may involve the joints, heart, and central nervous system. In most cases, the infection and its symptoms are eliminated by antibiotics, especially if the illness is treated early. Delayed or inadequate treatment can lead to more serious symptoms, which can be disabling and difficult to treat.

Symptoms

  • shooting pains, numbness, and tingling
  • difficulties with concentration and short-term memory
  • cognitive impairment
  • weakness in the legs
  • awkward gait
  • facial palsy
  • bladder problems
  • vertigo
  • back pain
  • After several months, untreated or inadequately treated patients may go on to develop severe and chronic symptoms that affect many parts of the body, including the brain, nerves, eyes, joints and heart. Many disabling symptoms can occur, including permanent paraparesis in extreme cases. The associated nerve pain radiating out from the spine is termed Bannwarth syndrome.
  • The late disseminated stage is where the infection has fully spread throughout the body. Chronic neurologic symptoms occur in up to 5% of untreated patients. A polyneuropathy that involves shooting pains, numbness, and tingling in the hands or feet may develop. A neurologic syndrome called Lyme encephalopathy is associated with subtle cognitive problems, such as difficulties with concentration and short-term memory. These patients may also experience profound fatigue. However, other problems, such as depression and fibromyalgia, are no more common in people who have been infected with Lyme than in the general population.
  • Chronic encephalomyelitis, which may be progressive, can involve cognitive impairment, weakness in the legs, awkward gait, facial palsy, bladder problems, vertigo, and back pain. In rare cases untreated Lyme disease may cause frank psychosis, which has been mis-diagnosed as schizophrenia or bipolar disorder. Panic attacks and anxiety can occur; there may also be delusional behavior, including somatoform delusions, sometimes accompanied by a depersonalization or derealization syndrome, where the patients begin to feel detached from themselves or from reality.
  • Lyme arthritis usually affects the knees. In a minority of patients, arthritis can occur in other joints, including the ankles, elbows, wrist, hips, and shoulders. Pain is often mild or moderate, usually with swelling at the involved joint. Baker’s cysts may form and rupture. In some cases, joint erosion occurs.
  • Acrodermatitis chronica atrophicans (ACA) is a chronic skin disorder observed primarily in Europe among the elderly. ACA begins as a reddish-blue patch of discolored skin, often on the backs of the hands or feet. The lesion slowly atrophies over several weeks or months, with the skin becoming first thin and wrinkled and then, if untreated, completely dry and hairless.

Resources

  • Aguero-Rosenfeld ME, Wang G, Schwartz I, Wormser GP (July 2005). “Diagnosis of lyme borreliosis”. Clin. Microbiol. Rev. 18 (3): 484–509. doi:10.1128/CMR.18.3.484-509.2005. PMC 1195970. PMID 16020686.
  • Goossens HA, Nohlmans MK, van den Bogaard AE (1999). “Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis”. Infection 27 (3): 231. doi:10.1007/BF02561539. PMID 10378140.
  • Molloy PJ, Persing DH, Berardi VP (August 2001). “False-positive results of PCR testing for Lyme disease”. Clin. Infect. Dis. 33 (3): 412–3. doi:10.1086/321911. PMID 11438915.
  • Nocton JJ, Dressler F, Rutledge BJ, Rys PN, Persing DH, Steere AC (January 1994). “Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis”. N. Engl. J. Med. 330 (4): 229–34. doi:10.1056/NEJM199401273300401. PMID 8272083.
  • Strasfeld L, Romanzi L, Seder RH, Berardi VP (December 2005). “False-positive serological test results for Lyme disease in a patient with acute herpes simplex virus type 2 infection”. Clin. Infect. Dis. 41 (12): 1826–7. doi:10.1086/498319. PMID 16288417.

Treatments

  • Antibiotics are the primary treatment for Lyme disease; the most appropriate antibiotic treatment depends upon the patient and the stage of the disease. According to the Infectious Diseases Society of America (IDSA) guidelines, the antibiotics of choice are doxycycline (in adults), amoxicillin (in children), erythromycin (for pregnant women) and ceftriaxone, with treatment lasting 10 to 28 days. If Lyme arthritis symptoms fail to respond to a 30-day antibiotic regimen, some recommend an additional 30 days of antibiotics. Alternative choices are cefuroxime and cefotaxime. Treatment of pregnant women is similar, but doxycycline should not be used.
  • A double blind, randomized, placebo-controlled multicenter clinical study indicated three weeks of treatment with intravenous ceftriaxone, followed by 100 days of treatment with oral amoxicillin did not improve symptoms any more than just three weeks of treatment with ceftriaxone. The researchers noted the outcome should not be evaluated after the initial antibiotic treatment, but rather 6–12 months afterwards. In patients with chronic post treatment symptoms, persistent positive levels of antibodies did not seem to provide any useful information for further care of the patient.
  • In later stages, the bacteria disseminate throughout the body and may cross the blood–brain barrier, making the infection more difficult to treat. Late diagnosed Lyme is treated with oral or intravenous antibiotics, frequently ceftriaxone for a minimum of four weeks. Minocycline is also indicated for neuroborreliosis for its ability to cross the blood–brain barrier

With the announcement of Avril Lavigne having Lyme disease from a tick bite, the world is getting a glimpse of the world of long term chronic pain sufferers.

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