What Is Lyme Disease?
According to the US Centers for Disease Control and Prevention, Lyme disease is an illness caused by the bacterium Borrelia burgdorferi. These bacteria may be carried by certain ticks. When an infected tick bites you, it can transfer bacteria, leading potentially to infection. If diagnosed and treated early, many patients recover. However, if not diagnosed or treated early, Lyme disease can, in certain cases, develop into a chronic illness (also called Post Treatment Lyme Disease) that leads to long-term, serious health problems and reduced quality of life.
In other words, the prognosis worsens when diagnosis and treatment are delayed.
A research study published by the Johns Hopkins Medicine Lyme Disease Research Center in 2022 found that even when Lyme disease patients were diagnosed early and promptly treated (a best case scenario), 14% of the patients developed Post Treatment Lyme Disease. These patients have persistent functionally impairing symptoms 6 months or more following the end of the medical treatment, including severe fatigue, body pain, and cognitive challenges. The results confirm that a Lyme disease infection can trigger Post Treatment Lyme Disease despite early treatment with 21 days of the antibiotic (in this case doxycycline).
This rigorously designed prospective controlled study validates that Lyme disease associated chronic illness is real and significant. The study’s Post Treatment Lyme Disease incidence of 14% compares with 4% in a healthy control group. Importantly, the risk of functionally impairing persistent illness would likely be greater than 14% in community (non-study) settings due to the complexity of real-world disease, which includes misdiagnoses and treatment delays.
How Do You Get Lyme Disease?
Lyme disease is mainly transmitted through the bite of an infected tick.
The length of time for a tick to transmit disease can vary based on the type of tick and the stage of the tick (nymph vs. adult, for example). There are many debates and caveats on the exact transmission time and studies have sometimes come up with contradictory results, as such no conclusive answer can be given. Most importantly, it’s important to remove an attached tick as soon as it’s found, and to remove it properly to avoid the spread of pathogens.
Diagnosis
A great deal of confusion surrounds the diagnosis and treatment of Lyme disease. The challenge with Lyme disease is that there isn’t one established set of diagnostic criteria or a surefire treatment protocol that’s universally accepted or successful in the medical community. According to a study published in 2023 and conducted by the Lamar University, patients saw an average of five doctors over a two-year period before being diagnosed.
With over 476,000 new cases each year in the US alone, Lyme disease is the most common disease spread by ticks in the Northern Hemisphere. It is therefore important society as a whole takes note of this disease and recognizes the lake of clear diagnostic criteria.
Furthermore, patients should be aware that there are still a lot of open questions re. the diagnostic and subsequent treatment of Lyme disease. Patients should feel empowered to make informed choices about their care and discuss these in any case with their medical provider.
As published on the website of LymeDisease.org
Lyme Disease Symptoms
In the early stages of Lyme disease, the illness may present as flu-like symptoms: fatigue, fever, enlarged lymph nodes, headaches, muscle aches, and joint pain. If the illness progresses to late-stage Lyme, medical literature (such as Marques, 2008) frequently cites that 10-20% of patients experience ongoing, widespread, multi-systemic symptoms, such as but not limited to e.g fatigue, muscle pain, joint pain, difficulty finding words, difficulty sleeping, difficulty focusing, memory changes, neck pain, paresthesia and depression, because Lyme bacteria seem to continue to spread through the body. This is generally also called Post Treatment Lyme Disease.
Lyme Disease Phases
Early Lyme Disease (3 to 30 days after tick bite)
According to the US Centers for Disease Control and Prevention, early signs and symptoms include inter allia: Fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes and Erythema migrans rash.
Disseminated Lyme Diease (days to months after tick bite)
The bacteria have begun to spread throughout the body and may have spread to distant sites such as the joints and nerves. Signs and symptoms include severe headaches, neck stiffness, additional Erythema migrans rashes on other areas of the body, facial palsy (loss of muscle tone or droop on one or both sides of the face), arthritis with severe joint pain and swelling, particularly the knees and other large joints.
More information regarding the above mentioned stage have been published by the CDC and by the University of Pennsylvannia.
Chronic Lyme Disease (possibly years after the infection)
If the illness progresses to late-stage Lyme (also called Post Treatment Lyme Disease), which occurs in 10-20% of patients, they experience ongoing, widespread, multi-systemic symptoms, such as but not limited to e.g Fatigue, Muscle Pain, Joint Pain, Difficulty Finding Words, Difficulty Sleeping, Difficulty Focusing, Memory Changes , Neck Pain, Paresthesia and Depression, because Lyme bacteria continue to spread through the body.
According to the CDC, there is a critical need to better understand the causes of prolonged symptoms in people who have had Lyme disease and best approaches to treatment and care.
Lyme Disease Treatment
-
I. Treatment of early and dissemintated Lyme Disease
According to the Clinical Practice Guidelines by the Infectious Diseases Society of America, endorsed by the CDC, Lyme Disease can be treated with 10-14 days of antibiotics.
More specifically, recommendation VII of the above mentioned guidelines states that Lyme patients with an erythema migrans should be treated with either a 10-day course of doxycycline or a 14-day course of amoxicillin or cefuroxime axetil.
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely.
-
II. Treatment of chronic Lyme Disease (Post Treatment Lyme Disease)and Controversy over Treatment
According to the International Lyme and Associated Diseases Society (ILADS), Lyme disease is a complex illness with many variables. The severity of the infection and a person’s response to treatment may depend on 1) which species or strains of the bacteria the person has, 2) how long they have been ill, 3) which body systems are involved, 4) whether other tick-borne diseases are present, and 5) the person’s underlying health status.
Commonly prescribed antibiotic regimens generally follow a one-size-fits-all approach using 30 or fewer days of antibiotic therapy, but several investigators 1 found that many people remain ill after receiving such care. ILADS maintains that in light of all of the potential variables, antibiotic treatment must be individualized
According to the latest, ILADS’ treatment guidelines, patients with persistent manifestations of Lyme disease may be retreated with antibiotics as one “should not constrain the treating clinician from exercising clinical judgment in the absence of strong compelling evidence to the contrary”.
More specifically the above mentioned guidelines state that clinicians should discuss antibiotic retreatment with all patients who have persistent manifestations of Lyme disease. These discussions should provide patient-specific risk–benefit assessments for each treatment option.
Furthermore, certain recent research publications, such as among others by R.Horowitz, suggest that pulsed biofilm and persister drug regimens, such as dapsone combination therapy, may be an effective solution for the management of chronic Lyme disease along with the treatment of polymicrobial infections and multiple inflammatory triggers. This being said, future studies need to be conducted on persister drugs like dapsone.
Other treatments include certain plants, whose effects on Lyme disease are clinically assessed. Indeed according to a rather recent publication made by Feng J, Leone J, Schweig S, Zhang Y. , certain natural products were found to have good activity against the stationary phase B. burgdorferi culture compared to the control antibiotics doxycycline and cefuroxime. These active botanicals include Cryptolepis sanguinolenta, Juglans nigra (Black walnut), Polygonum cuspidatum (Japanese knotweed), Artemisia annua (Sweet wormwood), Uncaria tomentosa (Cat’s claw), Cistus incanus, and Scutellaria baicalensis (Chinese skullcap).
In addition to the above, another rather recent publication by Zhang and others found that certain herbal product extracts had a high activity against stationary phase B. henselae, these included Cryptolepis sanguinolenta, Juglans nigra, Polygonum cuspidatum. The latter were found to eradicate under certain conditions all stationary phase B. henselae cells within 7 days.
Other popular herbal treatments options include protocols developped by Stephen Buhner in his book Healing Lyme: Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsiosis. This protocol is among others also based on Polygonum cuspidatum.
1 (all the following): Logigian EL, Kaplan RF, Steere AC Successful treatment of Lyme encephalopathy with intravenous ceftriaxone.J Infect Dis. 1999 Aug;180(2):377-83.
Aucott JN, Rebman AW, Crowder LA, Kortte KB. Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here? Qual Life Res (2013) 22:75–84
Shadick NA, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Berardi VP, Duray PH, Larson MG, Wright EA, Ginsburg KS, Katz JN, Liang MH The long-term clinical.Risk of post-treatment Lyme disease in patients with ideally-treated early Lyme disease: A prospective cohort study. Aucott, John N. et al. International Journal of Infectious Diseases, Volume 116, 230 - 237
Lyme Disease Prevention
There’s no foolproof plan to ensure you’ll never come in contact with the types of ticks carrying Lyme disease and other infections. But by staying vigilant, learning tick removal strategies, and practicing good tick prevention, you’ll reduce your risks and still have fun outside.
Practicing good tick bite prevention habits is the best way to prevent Lyme disease and other tick-borne illnesses. Good habits range from what clothing you wear, where you walk, and how often you check for ticks. Simply, it’s important to Be Tick AWARE:
AVOID tick-infested areas. Ticks thrive in wooded areas, leaf litter, tall grass, beach grass, bushy areas, stone walls, and perimeters where the lawn meets the woods.
WEAR light-colored clothing to spot ticks more easily; long-sleeved shirt tucked in at the waist, long pants tucked into high socks, closed-toe shoes, and a hat with your hair tucked in, if possible. Do not walk in the grass barefoot or in open sandals, even if it’s cut short.
APPLY tick repellent, insect repellent, and insecticide (such as permethrin) to skin, clothing, and shoes as directed.
REMOVE clothing upon entering the home; toss into the dryer at high temperature for 10-15 minutes to kill live deer ticks. Putting them in the washer, however, will not.
EXAMINE yourself and your pets for ticks daily. Feel for bumps paying close attention to the back of knees, groin, armpits, in and behind the ears, belly button, and scalp. Check everywhere – ticks love to hide! Shower or bathe as soon as possible to wash away unattached ticks. If you find a tick, remove it quickly! The longer it is attached, the more likely it will transmit a disease.
Lyme Disease Co-infections
Lyme disease may be accompanied by multiple infectious organisms (Co-infections) alongside Lyme disease itself.
There is no unanimity in the medical community on the symptoms associated with Lyme disease Co-infections as well as on how to treat them. Future research may uncover additional Co-infections.
We have taken the liberty to list some of the better known Lyme disease Co-infections. Such as but not limited to:
Bartonella
Bartonella, a bacterial disease, is increasingly recognized as being a possible Co-infection of Lyme disease as it can also be tick-borne. The evidence for ticks as vectors of Bartonella organisms is circumstantial but fairly strong.
Babesiosis
According to the CDC Babesiosis is a disease caused by microscopic parasites that infect red blood cells. A parasite is an organism (living thing) that lives on or inside another organism.
Rickettsia
The Rickettsia bacteria include two different groups: the spotted fever group (which consists of rickettsiae and ehrlichia) and the typhus group. Bacteria from the group of the genus Rickettsia can be tick-borne.