Current Problems With Lyme Disease Diagnosis & Patient Care
- Diagnostic tests cannot yet accurately identify the earliest stage of Lyme disease when making the diagnosis is crucial.
- The rash is not always present or easily recognized
- Misdiagnosis and delayed diagnosis can make Lyme disease more difficult to treat and lead to prolonged and debilitating illness
- Early symptoms can be mistaken for a summer flu
- Lyme disease can involve several parts of the body, including joints, connective tissue, heart, brain, and nerves, and produce different symptoms at different times.
- Antibody testing done after early treatment may be negative and never turn positive for some cases
- Borrelia burgdorferi can evade our protective immune system and trigger immune system dysfunction.
- No reliable blood test is presently available to measure treatment success, necessitating close clinical follow up and improved physician education.
- Presently there is no vaccine to prevent Lyme disease available to humans.
At What Point Do I Stop Antibiotics For The Psychological Symptoms Of Lyme Disease And Conclude That These Symptoms Will Not Go Away
The cause of the psychological symptoms in Lyme disease is unclear. It is clear that patients with acute Lyme disease who develop new onset depressive symptoms or irritability or cognitive disturbances often show a remarkable improvement when given antibiotic therapy. If the psychological symptoms persist or if the initial symptoms are severe, it is very important to consult with a psychiatrist to evaluate how best to treat these symptoms apart from the antibiotic therapy. When symptoms continue even after a repeated course of antibiotic therapy, this could be due to the fact that an activated immune system results in a change in neurotransmitter functioning. As a result, the altered neurotransmitter function may contribute to ongoing depressive symptoms, even after the immune system is no longer activated. Treatment of the psychiatric symptoms at that point would require anti-depressant or anti-anxiety medications or psychotherapy.
What Is The Difference Between This Indirect Blood Diagnostic Test And A Direct Test
Direct diagnostic tests measure the presence of the bacteria directly and are much more reliable than tests looking for indirect measurement of antibodies that measure a persons immune response to an infection. Lyme disease diagnoses and disease management would benefit from validated diagnostic tests that directly measure the infection such as a culture, PCR test, or antigen detection tests. Direct tests are vital to the management of other infectious diseases such as HIV, hepatitis C, strep, and COVID-19, but have not yet become widely available for Lyme disease.
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What Is The Best Way To Remove A Tick And What If I Did Not Get The Entire Tick Out
The Centers for Disease Control provides this information about removing a tick: Remove a tick from your skin as soon as you notice it. Use fine-tipped tweezers to firmly grasp the tick very close to your skin. With a steady motion, pull the tick’s body away from your skin. Then clean your skin with soap and warm water. Throw the dead tick away with your household trash. Avoid crushing the tick’s body. Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria. If you accidentally crush the tick, clean your skin with soap and warm water or alcohol. Don’t use petroleum jelly, a hot match, nail polish, or other products to remove a tick. View a diagram of how to remove a tick.
What Can Patients With Chronic Neuropsychiatric Symptoms From Lyme Disease Do To Get Proper Treatment If We Are In A So Called Non
Chronic neuropsychiatric Lyme disease is a confusing entity to treat. That is why it is best to consult with someone who has had considerable experience evaluating these patients. That specialist may then be able to guide you and your doctor regarding the next phase of treatment. For example, while one patient may need additional antibiotics, another may need symptomatic therapies focused more on the residual symptoms. If one lives in an area in which Lyme disease is not common, it can be helpful to ask your doctor whether he or she would consider it useful for you to consult with a doctor from another state who might be more familiar with the latest treatment strategies. Most doctors would appreciate the recommendation of a colleague with more extensive expertise. It helps both the treating doctor and the patient. Your doctor may also wish to call a specialist in another state who has more experience often informal professional to professional consultation is quite helpful. We wish to add however that we have seen many patients who have avoided going to regular doctors or regular psychiatrists because of a fear of being misunderstood. This can be risky because it delays help which that particular doctor may be able to provide. One does not necessarily need to be an expert on neuropsychiatric Lyme disease to treat depression or irritability related to Lyme disease.
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For Chronic Cases Of Lyme Does Iv Igg Hold Hope For Remitting Symptoms And Improving The Quality Of Life
To our knowledge, IV Ig has never been studied in a controlled fashion as a treatment for chronic Lyme disease, although some physicians are using this treatment for patients who are thought to have autoimmune-mediated neurologic sequelae from Lyme disease that persist after antibiotic treatment. There is insufficient data at this point to say whether IVIg treatment will have acute or sustained benefit for patients with persistent symptoms after being treated with antibiotics for Lyme disease. This is an area of research which is worth pursuing. Certainly, given that there is evidence that IV Ig may be beneficial for a variety of inflammatory and autoimmune diseases such as relapsing and remitting multiple sclerosis , myasthenia gravis, pemphigus, polymyositis , dermatomyositis , Wegener’s granulomatosis , and chronic inflammatory demyelinating polyneuropathy, it is reasonable to consider that this treatment may also be beneficial for patients with post-treatment Lyme disease if there is evidence of immunologic dysfunction. This treatment may be especially helpful if there is evidence of autoimmune-mediated neuropathic pain. IV Ig treatment is expensive and not without risks, so such treatment should only be initiated if the potential for benefits significantly outweigh the risks.
Healthy Control Subjects From Areas Of Endemicity And Areas Of Nonendemicity
Among the 86 healthy individuals from areas in which Lyme disease is endemic who did not have a history of the infection, 1 each had IgM or IgG reactivity with B. burgdorferi by 2-tier testing . The person with a positive IgG response also had reactivity with the VlsE C6 peptide, and 3 other individuals had responses to the VlsE peptide alone. Among the 50 healthy blood donors from an area in which Lyme disease was not endemic, none had positive results by 2-tier testing, but 1 had reactivity with the VlsE peptide alone.
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Does The Time Of Year Matter In The Diagnosis Of Lyme Disease
Since Lyme disease is a tick-borne infection, the seasonality of the disease is linked tightly to the life cycle and behavior of ticks. May, June, July, and early August are the biggest risk months for acquiring first stage Lyme disease in the US. This is the feeding time for nymph and adolescent ticks which are difficult to see. A viral-like illness in those early summer months might be Lyme disease. There is also some transmission of Lyme disease via adult ticks in the fall and winter and throughout the year anytime the temperature is above 40 degrees, but to a lesser degree.
The risk of acute Lyme disease is more of a year-round risk in more temperate regions such as northern California and the pacific northwest. Later stage Lyme disease, however, can manifest at any time.
Sensitivity And Specificity Of Tests
Among the 76 patients with EM, the sensitivity of both IgM and IgG 2-tier tests and the IgG VlsE C6 peptide ELISA was low in acute-phase samples, but it was higher in convalescent-phase samples obtained 34 weeks later . Among the 44 patients with neurologic, heart, or joint abnormalities, all had positive IgM or IgG responses to B. burgdorferi with 2-tier testing, and all 44 had IgG reactivity with the VlsE C6 peptide. Thus, in patients with later manifestations of the infection, 2-tier testing had a sensitivity of 100% and a specificity of 99%. Similarly, the VlsE C6 peptide ELISA had a sensitivity of 100% but a specificity of 96%. These differences in sensitivity and specificity were not statistically significant.
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My Child Had Lyme Disease Got Treated And Is Now Depressed Could This Be A Sign Of A Relapse
Depression is a word that encompasses physical, cognitive, and emotional components. The physical would be poor sleep, fatigue, low energy, lack of sex drive. The cognitive would include poor concentration and trouble making decisions. The emotional would include feeling guilty, hopeless, suicidal, and being unable to enjoy life in any aspect. Chronic symptoms triggered by Lyme disease are most often associated with insomnia or hypersomnia, fatigue, headaches, pain, and, not uncommonly, problems with cognition as well. In other words, chronic Lyme symptoms are most often associated with the physical and cognitive parts of the depressive picture and less often with the emotionally despairing part. When a person presents with the emotional part that is sustained for at least 2 weeks, it may be that a full syndrome depression has emerged related to the Lyme disease or that it is a concurrent but unrelated illness. The emotional aspects of depression might occur secondarily to being sick with a physical illness or directly from an infection affecting the brain or from chemicals affecting the brain that were released by infection outside of the brain. When a person has Lyme encephalitis , the emotional part of depression can be very dramatic. The person might be suddenly tearful for no apparent reason, have very poor frustration tolerance, become paranoid or angered at the least provocation, and appear to have a personality change.
Inclusion Criteria For Patients With Em
Patients were required to meet the criteria of the CDC for Lyme disease . In patients with EM, a 1.5-mm punch skin biopsy was performed for culture of B. burgdorferi , and an EDTA-anti-coagulated blood sample was obtained for PCR detection of B. burgdorferi, Anaplasma phagocytophilum, and Babesia microti DNA . In addition, an acute-phase blood sample was obtained, and 34 weeks later, at the conclusion of antibiotic therapy, a convalescent-phase serum sample was obtained for serologic testing for these 3 organisms. Of the 97 patients with EM who were initially evaluated, 79 had a culture positive for B. burgdorferi, and 3 patients had a PCR result positive for a coinfecting agent or IgM or IgG seroconversion to a coinfecting agent . Thus, for this analysis, only the 76 culture-positive patients who did not have evidence of coinfection were included. In these patients, disseminated disease was defined by a PCR result positive for B. burgdorferi DNA in blood or by multiple EM skin lesions.
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Can Autism Be Misdiagnosed As Lyme Disease What Research Is There To Prove This Can A Child With Autism Be Successfully Treated For Lyme Disease
It would be extremely unusual to misdiagnose a child with autism as having Lyme disease. Lyme disease typically gets diagnosed when a child has joint and muscle pains, along with fatigue, positive blood tests, and central or peripheral nervous system involvement. Certainly a child with autism may also get Lyme disease and thus have two disorders. In that situation, treatment of Lyme disease should result in a resolution of the Lyme disease but it would not likely result in a change in the autism symptoms. The question of interest to us is whether there are cases of “regressive autism” that occur in older pre-school age children for example that has been induced by a central nervous system infection, such as with Borrelia burgdorferi. In such a situation, treatment with antibiotics may well result in an improvement in the developmental regression. This area however has not been adequately studied.
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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Algorithms Using Igg Blots Without Igm Blots As A Secondtier Test
The first alternative considered was an IgG blot , without an IgM blot, as the second test in a 2-tiered algorithm for use in all stages of the illness . ROC curves showed that inclusion of the VlsE band in the IgG blot resulted in greater area under the curve for IgG testing in all stages of LD, compared with CDC-recommended criteria . With a requirement of 99% specificity, the greatest sensitivity was achieved using a cutoff of 3 of 11 specific IgG bands . However, compared with standard 2-tiered IgM and IgG testing, there was still considerable loss of sensitivity in stage 1 LD.
Performance of Standard 2-Tiered Testing Using Centers for Disease Control and Prevention Criteria, Compared with 2-Tiered Testing Using Only Immunoglobulin G Algorithms
Receiver operating characteristic curves to determine whether incorporation of the VlsE band result into immunoglobulin G Western blot criteria would improve performance. Area under the curve is indicated for each ROC curve.
With this hybrid approach, 34% of patients with acute EM, 96% of those with acute neuroborreliosis or carditis, and 100% of those with Lyme arthritis or late neurologic involvement had positive responses . Compared with standard 2-tiered IgM and IgG testing, the hybrid approach allowed slightly better sensitivity in stage 1 , significantly greater sensitivity in stage 2 , comparable sensitivity in stage 3 , and equivalent specificity among the control groups.
I Am Wondering If Columbia University Uses Xenodiagnosis For Detection Of Infectious Diseases
This is an interesting question. Xenodiagnosis in this case refers to allowing an uninfected tick to feed on an individual with suspected infection to see whether the tick is able to suck up spirochetes when the spirochetes might not have been detectable otherwise. As strange as this concept appears, it has been used successfully recently by Dr. Steven Barthold at UC Davis. After being unable to identify persistent infection in a treated infected mouse using the standard PCR and culture techniques, he was then able to identify the spirochetes in these mice after treatment using the xenodiagnosis method. We at Columbia are not using this method on humans. This is a very intriguing scientific question that should be studied in humans.
The Centers for Disease Control publishes national statistics and identifies those counties with the highest rates of Lyme disease in the United States. The web sites of many state health departments provide data on Lyme disease by town of residence.
Support groups can be found by calling the Lyme clinics or Lyme disease organizations in your state. You might also call a national organization, such as the Lyme Disease Association for the names of support groups in your area.
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What Does It Mean If Your 23 Kd Band Result Is Too High
Two types of antibodies are detected in the Western blot test.
This particular marker is called 23 KD and hence is a IgM antibody marker. IgM antibodies reflect a relatively recent infection. IgG antibodies in contrast are a sign of an older infection.
IgM antibodies usually disappear after eight weeks post-exposure. IgG remains in the serum for a very long time.
In the Western blot test there are three bands for IgM and 10 bands for IgG.
Here is the important part:
– You need to have 2 out of 3 for the positive IgM result
– Or you need to have 5 out of 10 for the positive IgG result.
Either one confirms the diagnosis.
Here is the 2nd important part when it comes to a diagnosis:
If a person doesn’t have signs or symptoms of Lyme disease, then the person does not have Lyme disease as the definition of disease requires symptoms.
What could some of those symptoms be?
What are the symptoms of Lyme disease?
Lyme disease symptoms are wide-ranging, with more than a hundred different symptoms recorded. Symptoms can also change over time, as the bacteria spreads throughout the body. To make things more confusing, Lyme disease symptoms will also vary from patient-to-patient. Lyme disease can mimic hundreds of other conditions since its symptoms mirror many medical problems such as multiple sclerosis, arthritis, chronic fatigue syndrome or lupus, and is sometimes known as The Great Imitator because of this.
Symptoms in acute Lyme disease:
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.
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