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.
How Is Lyme Disease Diagnosed
A healthcare provider will diagnose Lyme disease based on symptoms, physical findings and whether or not you’ve been in an area populated by infected ticks.
Many people dont remember or know that theyve been bitten by a tick. This is because the tick is tiny, and its bite is usually painless.
Your provider will confirm the diagnosis using a blood test. If your first blood test is negative for Lyme disease, you won’t need another test. If the first test is positive or equivocal, your provider will conduct the test again. You have to have two positive results to be diagnosed with Lyme disease.
Can My Animal Get Infected Despite Being Vaccinated
Yes. Some animals have been infected despite vaccination. The most common reasons are low or short-lasting vaccine antibodies in the individual animal. It is advisable to monitor the vaccine response annually to ensure the animal develops sufficient antibodies in response to vaccination. Vaccine antibodies can be quantified with the Lyme Multiplex assay as early as two weeks following vaccination or anytime afterwards.
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Who Is At Risk
Many occupations may be at risk, including forestry, farming, veterinarians, construction, landscaping, ground keepers, park or wildlife management, and anyone who either works outside or has contact with animals that may carry ticks
Similarly, any person who spends a lot time outdoors , especially in grassy or wooded areas may also be at risk.
Later Symptoms Of Lyme Disease
More serious symptoms may develop if Lyme disease is left untreated or is not treated early. These can include:
- pain and swelling in the joints
- nerve problems such as numbness or pain in your limbs
- memory problems
- difficulty concentrating
Some of these problems will get better slowly with treatment. But they can persist if treatment is started late.
A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome. This is known as post-infectious Lyme disease. It’s not clear exactly why this happens. It’s likely to be related to overactivity of your immune system rather than continued infection.
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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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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.
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Has Niaid Looked At The Potential Benefits Of Long
Yes. NIAID has funded three placebo-controlled clinical trials on the efficacy of prolonged antibiotic therapy for treating PTLDS. The published results were subjected to rigorous statistical, editorial, and scientific peer review.
These trials were designed to ensure that several key parameters were addressed:
- The susceptibility of B.burgdorferi to the antibiotics used
- The ability of the antibiotics to both cross the blood-brain barrier and access the central nervous system and to persist at effective levels throughout the course of therapy
- The ability of the antibiotics to kill bacteria living both outside and inside mammalian cells
- The safety and welfare of patients enrolled in the trials
The first clinical trial, which included two multicenter studies, provided no evidence that extended antibiotic treatment is beneficial. In those studies, physicians examined long-term antibiotic therapy in patients with a well-documented history of previous Lyme disease but who reported persistent pain, fatigue, impaired cognitive function, or unexplained numbness. Those symptoms are common among people reporting PTLDS. Patients were treated with 30 days of an intravenous antibiotic followed by 60 days of an oral antibiotic.
In 2016, a clinical trial conducted in the Netherlands also concluded that in patients with persistent symptoms attributed to Lyme disease, longer term treatment with antibiotics did not provide additional benefits compared with shorter term regimens.
Which Areas Are More Likely To Have It
The tick that causes Lyme disease has been moving from the Northeast and upper Midwest into the Southern and Western U.S., Mexico, and Canada. Cases in California and Florida are on the rise. After a drop between 2017 and 2018, the numbers jumped a little bit in 2019.
But most Lyme cases in 2019 were in 15 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New
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Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin. Washington, DC, is also a hotspot.
In 2019, Pennsylvania had the most Lyme infections, with 6,763. New York was next, with 2,847 cases.
In the Southern U.S., where its hotter, ticks stay under leaves so they dont dry out. This means people dont get Lyme from Southern ticks very often because they dont usually come out to bite.
Even though people only report about 30,000 cases of Lyme infection in the U.S. each year, there are actually around 476,000 a year. The same tick also can spread other diseases, including babesiosis, anaplasmosis, and Powassan virus. Those diseases are also on the rise in the U.S.
Whos likeliest to get Lyme disease?
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Boys up to age 15 and men between the ages of 40 and 60 are the most likely to get Lyme disease. Thats because they tend to play outside and go camping, hunting, and hiking.
Why are there more ticks now than there used to be?
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What To Expect At The Vets Office
If your pet has been diagnosed with uncomplicated Lyme disease, this is what you can expect to happen at your veterinarians office.
- Depending on the type of test used to screen for Lyme disease, a confirmatory test may be necessary.
- Urine protein screening In general, only dogs who have symptoms of Lyme disease or protein in their urine should be treated with antibiotics.
- Dogs with protein in their urine should have regularly scheduled rechecks to monitor their condition.
Lyme Disease: Signs And Symptoms
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Signs And Symptoms Of Untreated Lyme Disease
Seek medical attention if you observe any of these symptoms and have had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.
Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These include fever, rash, facial paralysis, and arthritis.
The appearance of the erythema migrans rash can vary widely.
- Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash
- Erythema migrans rash :
- Occurs in approximately 70 to 80 percent of infected persons
- Begins at the site of a tick bite after a delay of 3 to 30 days
- Expands gradually over several days reaching up to 12 inches or more across
- May feel warm to the touch but is rarely itchy or painful
- Sometimes clears as it enlarges, resulting in a target or bulls-eye appearance
- May appear on any area of the body
- Does not always appear as a classic erythema migrans rash
Swollen Knee
- Severe headaches and neck stiffness
- Additional EM rashes on other areas of the body
- Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
- Intermittent pain in tendons, muscles, joints, and bones
- Heart palpitations or an irregular heart beat
- Episodes of dizziness or shortness of breath
- Inflammation of the brain and spinal cord
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Can Lyme Disease Be Prevented
Most people with Lyme disease get the infection during the late spring, summer and early fall when immature ticks are out feeding. In warm climates, few tick bites take place during winter months.
Deer ticks are most often found in wooded areas and nearby grasslands. Theyre especially common where the two areas merge, including neighborhood yards where deer occasionally roam. Ticks dont survive long on sunny lawns. They dry out quickly and die.
Although only about 1% of all deer ticks carry Lyme disease-causing bacteria, there are areas in which over 50% of the ticks carry the bacterium. The diseased ticks are often found in the U.S. Northeast and upper Midwest areas. Ticks also live in coastal areas.
Black-legged ticks can get the infection from animals other than deer. Mice, voles and some squirrels can carry the bacteria.
How can I prevent tick bites?
The following tips can help you avoid tick bites:
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Lyme Disease Is Remarkably Difficult To Diagnose
The problem with Lyme disease is that the bacteria can create a hard shell around themselves when inactive so that the blood tests are unable to detect them. This is especially true when the disease has reached the chronic stage. The timing of the symptoms is often used by a medical provider to establish a time line to a tick bite or exposure to a high-risk region where the disease is commonly transmitted.
Because the ticks that can spread Lyme disease are often the size of a pinhead, the ticks might not even be notice. A bulls-eye rash at the bite location is a trademark symptom of Lyme disease, but only about half of the people who are infected with the bacteria develop the rash. Once the disease reaches the chronic stage, chronic arthritis, joint pain, and neurological symptoms begin to appear, sometimes several months after the infection.
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Some Chronic Lyme Disease Symptoms
As mentioned, chronic Lyme disease consists of a broad cluster of physical, cognitive, and psychiatric symptoms. Some of these symptoms are much more common, while others almost never occur, but can be deadly. But even the less severe symptoms, such as chronic fatigue and pain, can lead to drastic changes in quality of life for chronic Lyme patients.
Chronic Lyme survivors have reported experiencing the following symptoms for months to years after infection:
- Intermittent fevers, chills, and sweats
- Chronic inflammation
- Numbness and tingling in the limbs
- Dizziness and shortness of breath
- Heart palpitations and irregular heartbeat
- Anxiety and paranoia
- Multiple-chemical sensitivities
Chronic Lyme disease can be linked to deadly symptoms, such as Lyme carditis .
According to Lymedisease.org, studies consistently show that chronic Lyme disease patients have poorer quality of life than those with other chronic diseases. One of their own studies showed that 75% of surveyed patients reported at least one symptom as severe or very severe.
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How Do I Know If I Am Getting Tested Correctly For Lyme Disease
So we have already established that it is difficult to detect the presence of Lyme disease. But, thankfully, techniques and private testing have been developed to circumvent these complexities .
One technique is PCR which looks at Lyme antigens and the organisms DNA.
While PCR can be effective for detecting Lyme disease, knowing how to give this test is also important. In order to get a good reading, your lymph system needs to be moving. To increase lymphatic movement, here at Neurvana Health, we may use infrared sauna, exercise, or simply therapeutic ultrasound on various areas of the body where we think the infection may be present. To detect its presence, we can review your symptoms and where you experience pain. So we may look at memory problems and use ultrasound on the temporal, upper cervical regions and down the spinal cord. We may also use it on the joints, gallbladder or spleen.
What does the ultrasound do? Well, the infections have what we call Velcro proteins that allow them to attach to connective tissue. So the ultrasound breaks these proteins and the organisms get dispersed into the circulation where we can detect them. We can detect their DNA in blood or urine.
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Chronic Lyme Arthritis: A Mystery Solved
- By John Ross, MD, FIDSA, Contributor
In 1975, researchers from Yale investigated an epidemic of 51 patients with arthritis who lived near the woodsy town of Lyme, Connecticut. The most common symptom was recurrent attacks of knee swelling. A few had pain in other joints, such as the wrist or ankle. Many had fever, fatigue, and headache. Some remembered a round skin rash before the onset of knee swelling.
We now know that Lyme disease is an infection acquired from tick bites, caused by a spiral bacterium named Borrelia burgdorferi. After a tick bite, Borrelia bacteria wriggle through the skin away from the bite site. This leads to a circular red rash, known as erythema migrans. In its more advanced stages, erythema migrans may take on a bullseye appearance. Many people are unaware of the rash, as it is usually painless, and ticks may bite in less visible locations, such as a buttock or shoulder blade.
Lyme disease is diagnosed with blood tests that detect antibodies to B. burgdorferi. Two-step testing is traditionally performed. A rapid enzyme immunoassay is performed first. If this is positive, a more time-consuming Western blot test is sent for confirmation. The FDA recently approved two rapid tests for Lyme disease that are performed simultaneously, reducing the turnaround time.
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Possible Complications To Watch For With Lyme Disease
Talk to your veterinarian if you have any questions or concerns about your dogs condition.
- Some dogs who take antibiotics can develop loss of appetite, vomiting and diarrhea.
- Once infected, a dog will always have the bacteria that cause Lyme disease in his or her body. Therefore, relapses are possible, and owners should be on the lookout for unexplained fever, swollen lymph nodes, and/or lameness.
- A small percentage of dogs develop kidney failure as a result of Lyme disease. Clinical signs include vomiting, weight loss, poor appetite, lethargy, increased thirst and urination, and abnormal accumulations of fluid within the body.
Regression And Other Symptoms In Children
Children are the largest population of Lyme patients.
The CDC study of reported Lyme cases from 19922006 found that the incidence of new cases was highest among 5- to 14-year-olds . About one quarter of reported Lyme cases in the United States involve children under 14 years old .
Children can have all the signs and symptoms of Lyme that adults have, but they may have trouble telling you exactly what they feel or where it hurts.
You may notice a decline in school performance, or your childs mood swings may become problematic.
Your childs social and speech skills or motor coordination may regress. Or your child may lose their appetite.
Children are more likely than adults to have arthritis as an initial symptom 01267-2/fulltext#sec0040″ rel=”nofollow”> 25).
In a 2012 Nova Scotian study of children with Lyme, 65 percent developed Lyme arthritis . The knee was the most commonly affected joint.
Summary:
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How Can I Prevent Lyme Disease
One of the most important steps you can take is using an insect repellant with Deet outdoors. Check for ticks on yourself, your kid, and your pets and remove them promptly. You can also reduce tick habitats by mowing and clearing brush. Finally, treating outdoor spaces with insecticide can help in many cases. However, this may have environmental downsides, so research the products used.
What Treatment Does Ilads Recommend For Lyme Disease
Many patients with early Lyme have been treated with short courses of antibiotics and recovered. However, both in practice and in the scientific literature, it has been observed that a significant number of patients do not return to their pre-lyme health status.
The ILADS guidelines working group reviewed the available research and developed recommendations, based upon the best-available evidence, clinical expertise, and patient-centered values.
ILADS recommends a 4-6 week course of antibiotics as initial therapy for patients with early Lyme disease presenting with EM. Further treatment is guided by the clinical course and response to treatment. Although the guidelines do not discuss the treatment of non-EM early Lyme disease or disseminated disease, these topics are reviewed in the Fundamentals Course. For non-EM early disease, initial treatment is similar to that for EM. Patients with disseminated disease may need longer courses of antibiotics and antibiotic combinations.
ILADS emphasizes patient-centered, person specific care, and the importance of careful assessment and re-assessment of the full clinical picture to guide treatment decisions, initially and if symptoms persist or return.
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