Stage : Late Disseminated Lyme Disease
Late disseminated Lyme disease occurs when the infection hasnt been treated in stages 1 and 2. Stage 3 can occur months or years after the tick bite.
This stage is characterized by:
- arthritis of one or more large joints
- brain disorders, such as encephalopathy, which can cause short-term memory loss, difficulty concentrating, mental fogginess, problems with following conversations, and sleep disturbance
- numbness in the arms, legs, hands, or feet
- park or wildlife management
The majority of tick bites happen in the summer when ticks are the most active and people spend more time outside. However, its also possible to get Lyme disease from tick bites in early fall, and even in late winter if the weather is unseasonably warm.
Lyme disease prevention mostly involves decreasing your risk of experiencing a tick bite.
Take the following steps to prevent tick bites:
Contact a doctor if and whenever a tick bites you or your loved ones.
Symptoms Of Post Treatment Lyme Disease
- Include severe fatigue, musculoskeletal pain, & cognitive problems
- Can significantly impact patients health and quality of life
- Can be debilitating and prolonged
Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.
The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.
Genomic Insights From Borreliaceae Lineages
Between 1982 and 2010, the B. burgdorferi species complex, known as B. burgdorferi sensu lato, steadily expanded from 1 to 18 species as isolates from tick vectors, their hosts, and patient samples were characterized . A subset of these species are associated with human disease. B. burgdorferi sensu stricto in the USA, as well as B. afzelii and B. garinii in Eurasia are the most common agents of LD in the Northern hemisphere. Cases of LD in Europe are also caused by Bb and B. bavariensis , but are less common. B. spielmanii , B. bisettiae , and B. lusitaniae have been identified in human specimens but their clinical importance is less clear. B. valaisiana has been identified in human specimens , but others have recently provided compelling reasons why existing evidence does not support it being considered a human pathogen . Additional species have been identified in tick vectors or their hosts, but not in patient samples.
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Azlocillin An Amazing Compound
The study team first tested to see whether different doses of the drugs could kill drug-tolerant borrelia bacteria grown on laboratory plates better than a standard Lyme disease antibiotic .
They carried out each experiment three times in triplicate . The team tested the drugs on different ages of bacteria, colonies that were 3 days old and growing rapidly, and colonies that were 710 days old and had reached a growth plateau.
At high concentrations, both drugs could kill all the drug-resistant borrelia cells and outperformed the standard Lyme disease antibiotic. When the study team tested the drugs at lower doses, azlocillin outperformed the standard antibiotic and cefotaxime, which left 20% of the drug-resistant cells alive.
The researchers tested the drugs in a small number of laboratory-bred mice that they infected with the bacteria. They treated the mice at different stages of the disease at 7, 14, and 21 days after infection.
They gave each mouse a daily dose of either azlocillin, cefotaxime, or the standard treatment for Lyme disease for 5 days. They cultured the mouse organs and checked for live bacteria using microscopy and genetic testing 2 days after the last dose.
The researchers found that both the standard treatment and azlocillin completely cleared the infection in the early stages of the disease, while cefotaxime did not.
We have been screening potential drugs for 6 years, Venkata Raveendra Pothineni, Ph.D., the lead study author says.
Has Niaid Looked At Whether Infection Persists After Antibiotic Therapy
Several recent studies suggest that B. burgdorferi may persist in animals after antibiotic therapy. In one study, NIAID-supported scientists found that remnants of B. burgdorferi remained in mice after antibiotic treatment. Another team of NIAID-supported investigators found that intact B. burgdorferi persist in nonhuman primates after antibiotic treatment. It was not possible to culture these bacteria and it is not clear whether they are infectious. More recent work by Hodzic et al. replicated the earlier finding of persisting DNA but non-cultivatable B. burgdorferi after antibiotic treatment using a mouse model. In 2017, scientists at the Tulane National Primate Research Centers, funded in part by an NIH research resources grant, reported evidence of persistent and metabolically active B. burgdorferi after antibiotic treatment in rhesus macaques.
In a first-of-its-kind study for Lyme disease, NIAID-supported researchers have used live, disease-free ticks to see if Lyme disease bacteria can be detected in people who continue to experience symptoms such as fatigue or arthritis after completing antibiotic therapy). This study remains underway.
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What Is Lyme Arthritis
Lyme arthritis occurs when Lyme disease bacteria enter joint tissue and cause inflammation. If left untreated, permanent damage to the joint can occur. Lyme arthritis accounts for approximately one out of every four Lyme disease cases reported to CDC. Because of reporting practices, this statistic may overstate the frequency of arthritis among patients seen in routine clinical practice.
Transmission Of Bb Via Ixodes Spp Vectors
The black-legged ticks, Ixodes scapularis and Ixodes pacificus on the West Coast, are the primary vectors of Bb in the USA. In endemic areas, the proportion of Ixodes spp. ticks infected with Bb can be remarkably high. One recent survey of the pathogen burden of 197 Ixodes scapularis ticks collected from New York and Connecticut where LD is endemic, revealed 111 ticks were infected with Bb and 37 were co-infected with more than one human pathogen . The high pathogen burden is consistent with previous tick surveys in the same region . In contrast, the percent of infected ticks in other regions of the USA is much lower. In recently published surveys across California, for example, fewer than 5% of Ixodes spp. ticks were infected . Ixodes ticks sometimes carry multiple strains of Bb that may impact the course of disease in people that are co-infected. One tick survey showed that 39% of Ixodes ticks in North America are infected with multiple genotypes of Bb .
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What Should I Do If I Find A Tick On My Child
Don’t panic. First Lyme disease is spread by the black-legged tick, not by the larger and more-common dog tick. The risk of developing Lyme disease after a black-legged tick bite is low, especially if the tick has been attached for a short time.
If you find a tick on your child, remove it using a fine-tipped pair of tweezers. Grasp the body of the tick and pull in an upward motion until the tick comes out. Do not squeeze or twist the ticks body. Take note of the ticks size and color, and how long you think it has been attached to your child.
If your child has been bitten by a black-legged tick that has been attached for more than 24 hours and you are in a Lyme disease endemic area, consult with your pediatrician. In some cases, your child may be prescribed antibiotics to prevent Lyme disease from developing.
What Is Post Treatment Lyme Disease
Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.
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What Is Chronic Lyme Disease
Lyme disease is an infection caused by the bacterium Borrelia burgdorferi. In the majority of cases, it is successfully treated with oral antibiotics. In some patients, symptoms, such as fatigue, pain and joint and muscle aches, persist even after treatment, a condition termed Post Treatment Lyme Disease Syndrome .
The term chronic Lyme disease has been used to describe people with different illnesses. While the term is sometimes used to describe illness in patients with Lyme disease, it has also been used to describe symptoms in people who have no clinical or diagnostic evidence of a current or past infection with B. burgdorferi . Because of the confusion in how the term CLD is employed, and the lack of a clearly defined clinical definition, many experts in this field do not support its use.
Chronic Lyme Dos And Don’ts
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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Full Recommendations For The Prevention Diagnosis And Treatment Of Lyme Disease
I. Which measures should be used to prevent tick bites and tick-borne infections?
Personal Protective Measures
Recommendation
Summary of the Evidence
Rationale for Recommendation
Although there is little systematic evidence supporting some of these measures for the prevention of Lyme disease, they may offer potential benefits with little effort, risk, or cost.
Knowledge Gaps
Properly designed studies performed with human subjects under realistic conditions are required to test the efficacy of personal protection measures. Similarly, research is needed to inform how to motivate the adoption and continued use of best practice personal protection measures.
Repellents to Prevent Tick Bites
Recommendation
Summary of the Evidence
In laboratory and field experiments involving human subjects, the use of DEET, picaridin, IR3535, oil of lemon eucalyptus , p-methane-3,8-diol , 2-undecanone, and permethrin reduced the number of ticks detected crawling on or attached to subjects compared with controls . Other commercially available products, including botanical agents and essential oils cannot be recommended due to insufficient evidence.
Stage : Early Localized Disease
Symptoms of Lyme disease usually start 3 to 30 days after the tick bite. One of the earliest signs of the disease is a bulls-eye rash.
The rash occurs at the site of the tick bite, usually, but not always, as a central red spot surrounded by a clear spot with an area of redness at the edge. It may be warm to the touch, but its not painful and doesnt itch. This rash will gradually fade in most people.
The formal name for this rash is erythema migrans.
Some people with lighter skin have a rash thats solid red. Some people with darker skin may have a rash that resembles a bruise.
The rash can occur with or without systemic viral or flu-like symptoms.
Other symptoms commonly seen in this stage of Lyme disease include:
Youll have a general feeling of being unwell. A rash may appear in areas other than the tick bite.
This stage of the disease is primarily characterized by evidence of systemic infection, which means infection has spread throughout the body, including to other organs.
Symptoms can include:
- disturbances in heart rhythm, which can be caused by Lyme carditis
- neurologic conditions, such as numbness, tingling, facial and cranial nerve palsies, and meningitis
The symptoms of stages 1 and 2 can overlap.
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Who’s At Risk Of Lyme Disease
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
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.
Posttreatment Lyme Disease Syndromes: Distinct Pathogenesis Caused By Maladaptive Host Responses
Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Address correspondence to: Allen C. Steere, Massachusetts General Hospital, CNY 149/8301, 55 Fruit Street, Boston, Massachusetts 02114, USA. Phone: 617.726.1527 Email: .
J Clin Invest.
Lyme disease, which is epidemic in certain communities, primarily in the northeastern United States, is caused by the tick-borne spirochete Borrelia burgdorferi . When untreated, the disease usually occurs in stages with different manifestations at each stage . In the northeastern United States, the infection usually begins with a slowly expanding skin lesion, erythema migrans , often accompanied by nonspecific symptoms, including headache, myalgias, arthralgias, fever, malaise, and fatigue. Within weeks , neurologic or cardiac abnormalities may develop. Months later , usually following a latent period, intermittent or persistent monoarticular or oligoarticular arthritis commonly develops, lasting for several years, accompanied by minimal, if any, systemic symptoms. Rarely, patients have late neurologic involvement, characterized by a subtle encephalopathy or sensory polyneuropathy. Thus, in most patients, the natural history of Lyme disease, without treatment, is one of persistent infection for several years, with latent periods and changing system involvement.
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When A Lyme Diagnosis Is Simple
A person who notices a tick bite and gets a bullseye rash will typically get a Lyme disease diagnosis. Treatment can start right away without any testing.
Another straightforward example would be a person who has spent time outdoors in an area where Lyme disease is common. Lets say that person doesnt have a bullseye rash but has other possible symptoms of Lyme disease. Their doctor does a standard two-step blood test, and both are positive. In this case the person gets a Lyme disease diagnosis and starts treatment.
How Does Lyme Disease Affect The Eye
Fortunately, involvement of the eye is uncommon in lyme disease. But when the eyes can be affected in many different ways by the disease.
In the early stage of the disease, many persons have conjunctivitis. In this condition, commonly called pink eye, the eyes are red and uncomfortable, and there is a discharge of pus. Unlike many forms of conjunctivitis, the type that occurs in lyme disease is not contagious.
In later stages of the disease, inflammation of the eye may develop. Parts of the eye that may be affected include the uvea, the middle layer inside the eye, the cornea, part of the outer coat of the eye the iris, the colored circle around the pupil, and the choroid, a layer of blood vessels in the eye. Ocular symptoms can include sensitivity to light and floaters .
Inflammation of the optic nerve also can occur, which results in visual loss. Loss of vision can result from inflammation in the brain as well.
Persons who develop Bells palsy may be unable to blink or close their eyes. This dries the cornea and can result in an infection or even a hole in the cornea, which can endanger vision if not treated promptly.
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What Are The Symptoms Of Lyme Disease
Most children who develop Lyme disease do not recall having been bitten by a tick. Symptoms can appear a few days to many months after the bite, and can include:
- a rash in the form of a bulls-eye
- facial palsy, or weakness of the facial muscles
- headache/meningitis, or swelling of tissues around the brain and spinal cord
Children with a bulls-eye rash may also have systemic symptoms such as fever, fatigue, and joint aches. The rash may not have a classic bull-eye appearance, especially on people with darkly pigmented skin, and can be mistaken for cellulitis, ringworm, or other skin conditions. Children who develop a disseminated infection often have not had a preceding skin rash.
The most common late stage symptom of Lyme disease is arthritis, particularly in the large joints and especially the knee. Typically, the joints will be more swollen and tender than painful, and anti-inflammatory medicine can help.
How Is Lyme Disease Diagnosed
Most tests for Lyme disease look for antibodies the body makes in response to infection. Since it takes time for the immune system to produce these antibodies, an early test may come back negative, but your child could still have Lyme disease. Also, if your child has had Lyme disease in the past, the test may remain positive.
While currently available tests work in most cases, a clinical evaluation should take into account exposure to ticks, as well as the timing and nature of symptoms in making a diagnosis of Lyme disease.
Research is underway to develop and improve methods for diagnosing Lyme disease. Learn more.
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For Depression And Anxiety
Both psychotherapy and pharmacotherapy have proven benefits for improving mood. Psychotherapy has many different types such as supportive, dynamic, cognitive behavioral, dialectical behavior therapy, transference focused psychotherapy each of which offers benefit. Pharmacotherapy also has many different types. For depression the first-line options usually are SSRIs, SNRIs, Tricyclics or other agents with more unique modes of action.
A few noteworthy tips on anti-depressant agents:
- Most anti-depressant agents also help in reducing anxiety. However the opposite isn’t necessarily true. Specific anti-anxiety agents such as clonazepam or diazepam may not necessarily help fight depression.
- Most anti-depressants take three to eight weeks before an effect is seen. Therefore, it is unwise to stop an anti-depressant after only three or four weeks, as staying on it another two to three weeks may lead to a good response.
- Dosage makes a difference. Some anti-depressants work fine at low doses some medications however are effective only at higher doses. Some medications are more effective as the dose is increased. Other antidepressants may have a therapeutic range one has to achieve at least a certain dosage .