Cdc: We Are Not Dismissing Your Pain
Dr. Amesh Adalja, an infectious diseases specialist and an assistant professor at the University of Pittsburgh, says there is no scientific evidence to suggest an ongoing infection in patients with lingering Lyme disease symptoms. He said all infections require a recovery time beyond when the antibiotics run out. He said that continuing antibiotic treatment after a few weeks for people who have Lyme disease carries a lot of risk and no real benefit.
Adalja said the positive test results that some laboratories produce are just a way to support a doctors diagnosis. It is not a valid way of approaching this, he said. The CDC also warns against prolonged antibiotic use because it can drive the growth of bacteria that are resistant to antibiotic medications.
Oral antibiotics can cause gastrointestinal upset, and those who take antibiotics intravenously are subject to line infections. Last year, the CDC issued a call to action to halt unnecessary prescribing of antibiotics.
Yang said Lyme disease is a very well understood condition, with close parallels to another old and well understood disease, syphilis, which is caused by a related bacterium.
The CDCs online information on post-treatment Lyme disease syndrome skirts the controversy by emphasizing that all patients need personalized care.
Who’s At Risk And Where Are Ticks Found
The risk of getting Lyme disease is higher:
- for people who spend time in woodland or moorland areas
- from March to October because more people take part in outdoor activities
Ticks are found throughout the UK and in other parts of Europe and North America. There are a high number of ticks in the Scottish Highlands.
It’s thought only a small proportion of ticks carry the bacteria that cause Lyme disease. Being bitten doesn’t mean you’ll definitely be infected. However, it’s important to be aware of the risk and speak to a GP if you start to feel unwell.
What Are The Side Effects Of Lyme Disease Treatments
Antibiotics, like all medications, have the potential for side effects. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Sometimes symptoms worsen for the first few days on an antibiotic. This is called a Herxheimer reaction and occurs when the antibiotics start to kill the bacteria. In the first 24 to 48 hours, dead bacterial products stimulate the immune system to release inflammatory cytokines and chemokines that can cause increased fever and achiness. This should be transient and last no more than a day or two after the initiation of antibiotics.
The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. This bacterial overgrowth condition occurs because antibiotics kill the good bacteria in our gut. It can be helpful to use probiotics to restore the good bacteria and microbiome balance.
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Chronic Lyme Disease Symptoms
Chronic symptoms of Lyme disease arent always clear cut and manifest similarly to other conditions, which can lead to misdiagnosis. Chronic Lyme disease is often used to describe a range of physical, cognitive, and emotional symptoms that crop up after getting Lyme disease and persist for months to years after infection, Shah says. Common persistent symptoms include:
- Long-lasting, severe fatigue
- Neurological symptoms such as brain fog, cognitive impairment, or facial palsy
- Sensory sensitivity, particularly to lights and sounds
- Anxiety or depression
- Neuropathy
- Gastrointestinal issues, such as abdominal pain, nausea, blood in the stool, or chronic diarrhea
Many tick-borne infections go misdiagnosed for months because these nonspecific symptoms mirror other illnesses, Shah explains, adding that these symptoms can mimic chronic fatigue syndrome, fibromyalgia, ALS, Alzheimers disease, depression, insomnia, and autoimmune disorders such as rheumatoid arthritis and multiple sclerosis .
Chronic Lyme can also trigger an auto-immune response or make a person more susceptible to other infections, systemic inflammations, and imbalances in the gut microbiome, according to Dr. Kellman.
If you suspect you have chronic Lyme, your first step should be to a primary care provider you trust who can help you diagnose by eliminating other potential illnesses.
What If I Dont Feel Better After Treatment
If youre treated for Lyme disease and dont feel better after youve finished your treatment, talk to your healthcare provider. He or she may recommend a longer course of antibiotics or may be able to prescribe another medication to help with symptoms like joint or muscle pain.
You might also want to seek a second opinion, especially if your Lyme disease diagnosis was not initially confirmed via a two-step blood test. If your body has not responded to antibiotics, its possible that something else besides the bacteria that causes Lyme disease is making you sick.
Even if you do recover completely from a Lyme disease diagnosis, your immune system may continue making antibodies to fight Lyme disease bacteria for months or even years after the infection is gone. Those antibodies wont protect you from getting a second Lyme disease infection, however, so be sure to take steps to protect yourself from ticks in the future.
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Four: Prevent Relapse At The End Of A Lyme Disease Treatment
Follow the steps outlined in Finished? And How to Prevent Relapse. Be sure to take Transfer Factor L Plus 1 pill 2 times a day to boost your immune system. Read Transfer Factors: Turn On The Army for more information. Also consider using one prescription antibiotic or the otoba bark extract and cats claw following the recommendations I discuss in Finished? And How to Prevent Relapse. These herbal and prescription antibiotics will police the environment to swat down the Lyme germs and to keep them in remission.
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Can Chronic Lyme Be Cured Dr Christine Green Answers Your Questions
Christine Green, MD, is a Stanford-trained, board-certified family medicine physician with 30 years of experience treating patients with tick-borne illness.
On the board of LymeDisease.org, Dr. Green is also Co-director of Education for Invisible International,, is on Bay Area Lyme Foundations Scientific Advisory Board and has served on the Education Committee for ILADS.
In this Q& A, she discusses common questions asked by patients about diagnosing and treating Lyme and other tick-borne diseases.
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Is There A Cure Or A Drug Prescribed For People Who Have Not Had Lyme Disease But Are Suffering From The Lymerix Vaccination
The issue of adverse events from the LYMErix vaccine has been under active investigation. If you are suffering from neuropathic pains or arthritic problems after the vaccine, you might consider contacting the Lyme Disease Association for a referral to a physician with a particular clinical and research interest in this question.
Can Lyme Disease Be Prevented
Not all cases of Lyme disease can be prevented. But you can help protect your family from tick bites. If you go into an area where ticks live, be sure to:
- Stay in the middle of the trail, instead of going through high grass or the woods.
- Wear closed shoes or boots, long-sleeved shirts, and long pants. Tuck pant legs into shoes or boots to prevent ticks from crawling up legs.
- Use an insect repellent.
- Consider treating clothing and gear with permethrin to repel ticks. When used properly, permethrin is safe for all ages. But don’t use it on clothing or other material a child may suck on or chew.
- Wear light-colored clothing to help you see ticks more easily.
- Shower and wash hair after being outside to remove ticks before they attach.
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What Criteria Do Doctors Use To Choose Different Antibiotics
Partly, doctors rely on what medicines have been shown in published studies to be effective for Lyme disease. For neurologic Lyme disease, the best tested antibiotic is IV ceftriaxone . For early Lyme disease, the best tested antibiotics include oral doxycycline, cefuroxime and amoxacillin. Physicians however often use other antibiotics well. For example, because one mouse study and several in vitro studies indicate that the agent of Lyme disease can penetrate and lodge inside cells, some doctors prefer to use medications that have good intracellular penetration ). Other factors that go into the decision include whether the patient is allergic to a particular family of antibiotics or whether the patient can tolerate oral medications intolerance might suggest the use of intramuscular penicillin whereas if a person is allergic to penicillins or cephalosporins a doctor would want to avoid long-acting intramuscular penicillin-family medicines.
To our knowledge, having had a Lyme disease infection that has been treated does not have a negative impact on the ability to become pregnant.
Treatment Of Lyme Disease
Early diagnosis and proper antibiotic treatment of Lyme disease is important and can help prevent late Lyme disease. The following treatment regimens reflect CDCs interpretation of the most current data for four important manifestations of Lyme disease. These regimens are consistent with guidanceexternal icon published by the by the Infectious Disease Society of America, American Academy of Neurology, and American College of Rheumatology.
Some patients report persistent symptoms of pain, fatigue, or difficulty thinking even after treatment for Lyme disease. The state of the science relating to persistent symptoms associated with Lyme disease is limited, emerging, and unsettled.
Additional researchexternal icon is needed to better understand how to treat, manage, and support people with persistent symptoms associated with Lyme disease. In light of these research gaps, recommendations for treatment of persistent symptoms in people previously treated for Lyme disease are not provided here.
If you are interested in information on chronic Lyme diseaseexternal icon, see NIHs website.
Links with this icon indicate that you are leaving the CDC website.
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A Reasonable Approach To Post
If you are being treated for PTLD, there is no magic bullet to treat this problem, but here are some important steps to consider:
- Choose a doctor you trust and who can work closely with you.
- If your doctor agrees to start antibiotics for several months, make sure you talk about the risks and cost, as this can be dangerous and expensive.
- Make sure not to rely solely on antibiotics. The evidence for a benefit from antibiotics is weak, and we rely mostly on physicians clinical experience and interest in the disease to design a personalized therapeutic plan. For some, a more holistic approach may be the way to go.
- If you try supplements, ask about their source and purity, as they are not FDA-regulated.
- Consider looking for services in medical school hospitals or clinics where they may have programs with ongoing research on how to diagnose and treat Lyme.
About the Author
How Do I Know Whether I Have Received A Sufficiently Long Course Of Antibiotic Therapy
Taken together, these study results suggest that repeated antibiotic therapy may be beneficial for a subgroup of patients. However all of these studies also reported troubling adverse effects associated with the IV antibiotic therapy. Given these potentially dangerous risks, it is clear that other safer and more durable treatments are needed for patients with persistent symptoms.
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Treatment Within 30 Days Of Initial Tick Bite
Studies show that 80 to 90% of people, who take a two to three week course of antibiotics within 30 days after a known acute tick bite, do not develop chronic Lyme disease. Based on my experience, these people are cured of Lyme disease – they will not have further problems with Lyme disease, unless they get a new tick bite.
For the best chance of cure in acute Lyme, I found doxycycline to works best in my Seattle practice. But if a person cannot take doxycycline, cefuroxime or amoxicillin is an option. These are the three antibiotics recommended by the United States Centers for Disease Control and the Infectious Diseases Society of America. In my experience, I find these work better in an acute setting than herbal antibiotics at getting a cure.
Chronic Lyme Dos And Donts
Chronic Lyme disease is an ongoing Borrelia burgdorferi infection that can involve any body system or tissue. The infection produces a wide range of symptoms and signs, which can be debilitating for some patients. Common symptoms include severe fatigue, migratory musculoskeletal pain, headaches, and impaired memory. Unfortunately, chronic Lyme disease is complex and often misunderstood, which means that many patients will struggle to obtain the care they need to regain their health. Every patient concerned about Lyme disease and tick-borne illness should know the following.
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Chronic Lyme Disease Vs Post
Patients typically use the term chronic Lyme disease to describe the cluster of symptoms that started after getting Lyme disease and that persist despite having received a course of antibiotic treatment which has been deemed curative by the Infectious Diseases Society of America. Patients say, “I’m not cured. I have symptoms now that I never had before Lyme disease. I’m fatigued 90% of the day. My muscles ache. My brain is in a fog. I can’t think clearly any more. I’m super sensitive to light and sound. What is going on? Chronic Lyme disease does exist – I’m a living example of it!”
Whatever one calls it, the experience is the same. Most often these patients experience profound fatigue, pain, and/or cognitive impairment. Mild to moderate levels of depression and anxiety may also accompany these symptoms, as the functional limitations can lead to social isolation, inability to work, and loss of sense of one’s identity as a provider, caretaker, or friend. Sometimes patients find themselves identifying with Job – the just and good man in the Bible whose life was wrecked by illness, death of loved ones, and economic disaster he felt tormented by God.
Who Gets Lyme Disease
Anyone bitten by an infected deer tick can get Lyme disease. Most U.S. cases of Lyme disease happen in Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin. But Lyme disease is also found in other parts of the U.S., Europe, and Asia.
Other things that might increase a person’s risk include:
- spending a lot of time outdoors in tall grass, brush, shrubs, or wooded areas
- having pets that may carry ticks indoors
- activities such as yardwork, hiking, camping, fishing, or hunting in tick-infested areas
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Lyme Disease Frequently Asked Questions
If you have not done so already, remove the tick with fine-tipped tweezers.
The chances that you might get Lyme disease from a single tick bite depend on the type of tick, where you acquired it, and how long it was attached to you. Many types of ticks bite people in the U.S., but only blacklegged ticks transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in the highly endemic areas of the northeastern and north central U.S. are commonly infected. Finally, blacklegged ticks need to be attached for at least 24 hours before they can transmit Lyme disease. This is why its so important to remove them promptly and to check your body daily for ticks if you live in an endemic area.
If you develop illness within a few weeks of a tick bite, see your health care provider right away. Common symptoms of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so its important to be alert for any illness that follows a tick bite.
References:
Moody KD, Barthold SW, 1991. Relative infectivity of Borrelia burgdorferi in Lewis rats by various routes of inoculation.Am J Trop Med Hyg 44: 135-9.
There are no reports of Lyme disease being spread to infants through breast milk. If you are diagnosed with Lyme disease and are also breastfeeding, make sure that your doctor knows this so that he or she can prescribe an antibiotic thats safe for use when breastfeeding.
How Long Does Lyme Disease Last
Lyme disease symptoms can begin anywhere from three to 30 days after transmission of the infection from a tick. If treated early on with antibiotics, most people feel better within a few weeks, said Dr. Zemel.
According to the CDC, it’s not uncommon for people to experience lingering symptoms like fatigue and joint or muscle pain for a few weeks or months after treatment. Additional antibiotics won’t help these symptoms, however, and most people improve on their own over time.
In a small percentage of cases, people continue to experience symptoms for more than six months after their recommended course of antibiotics is completed. This is sometimes referred to as chronic Lyme disease, according to the National Institute of Allergy and Infectious Diseases but that name is misleading, said Dr. Kuritzkes, because there is no evidence that the bacteria that causes Lyme disease is still present in the body. Instead, the CDC refers to this condition as post-treatment Lyme disease syndrome .
“As with many other kinds of infectious diseases, some people are left with some debilitating symptoms that don’t go away,” said Dr. Kuritzkes. “I like to compare it to polio: Some people who had polio are left paralyzed, but that doesn’t mean they have chronic polio they have permanent damage from the infection, even after it’s gone away.”
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