Diagnosis And Treatment Of Lyme Disease
It is very important to diagnose and treat Lyme disease as early as possible. Use precautions to prevent tick bites by covering exposed skin when working or hiking in the outdoors during the warmer months. Check your skin for ticks after being outside and remove them, including the head with tweezers only. If you do receive a tick bite and think you have Lyme, see a doctor right away.
Diagnosis
Lyme disease can be very difficult to diagnose. Ticks on humans not only transmit Lyme disease, but other infections too. If you get bit and develop a Lyme disease rash, this is singlehandedly the best and most accurate way to diagnose Lyme. If you have the rash, the doctor will start treatment right away. If you receive a bite, but do not develop the rash the doctor can run the following tests:
- ELISA This is the most common test for Lyme disease and checks for antibodies to the bacteria, B. burgdorferi. It takes a while to become positive so the test cannot be performed for a few weeks after a bite.
- Western Blot This is usually a secondary test if the ELISA comes back positive. This test also checks for antibodies to the bacteria and needs to be done a few weeks after the bite.
- PCR If you have joint pain after a tick bite, the doctor can withdraw a sample of joint fluid and test it for the bacteria. It wont check for the infection in the bloodstream, but can also be used to check for infection in the spinal fluid.
Treatment
Complications Of Untreated Lyme Disease
If unchecked, the Lyme disease infection can spread to other bodily systems, causing significant damage. Untreated, complications of this condition can be very severe:
- Arthritis:Prolonged infection with Lyme disease leads to chronic joint inflammation and swelling, usually in the knees . These symptoms tend to arise within two years of infection, with periods of flare-ups and remissions. This arthritis is relatively difficult to manage, though antibiotics and steroids may be attempted.
- Lyme carditis:If the bacteria reach the heart tissues, they can cause inflammation and lead to heart block. The electrical signals being sent between the upper and lower chambers of the heart are interrupted, impairing the coordination of the heartbeat. Though disruptive, this is rarely fatal.
- Lyme neuroborreliosis:Inflammation of multiple nerves, including those in the spine and brain, is the chief characteristic of this condition. This can also affect the meningesthe layer of tissue surrounding the brain and spineleading to meningitis, among other conditions. Antibiotic therapy, if applied promptly, tends to be effective as a treatment.
Even in cases where Lyme disease has progressed, antibiotic regimensespecially drugs like doxycyclineare generally successful in resolving problems.
Exhaustion Fuzzy Thinking And Other Cognitive Problems
Borrelia burgdorferi is one of the few bacteria that can cross the blood-brain barrier and infect the central nervous system, explains Timothy J. Sellati, Ph.D., Chief Scientific Officer for the Global Lyme Alliance. That can lead to inflammation of the brain, which can affect your central nervous system function in a few different ways.
One of those is extreme fatigue, which affects as many as 76% of people with advanced Lyme disease, according to research. Trouble concentrating, loss of coordination, and short-term memory loss are other possible problems, occurring in up to 24% of people. In extreme cases where the disease is left untreated for extended periods, you might even develop facial weakness and behavioral changes, Sellati says.
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Chronic Lyme Disease Vs Acute And Late Stage Lyme
One reason chronic Lyme disease is harder to detect and treat than Lyme at earlier stages is that chronic Lyme disease symptoms are more wide-ranging and varied. Chronic Lyme disease can cause symptoms of early Lyme disease such as fatigue and muscle aches to recur, but it can also cause new symptoms that affect different parts of the body.
Common Causes Of Chronic Illness Flare
When youre in the middle of a chronic illness flare-up, it can be difficult to pinpoint what might have triggered your reaction. But understanding your triggers is an important step in healing your body: It helps ensure youre not contributing to the problem, and that you can prevent flare-ups in the future.
If you feel like youve tried everything to manage or avoid flare-ups with no luck, keep reading to learn about 10 of the most common causes that you might not know about. By understanding what causes flare-ups, youll be able to gather the tools you need to avoid them in the future and feel better longer.
1. Herxheimer Reactions
Herxheimer reactions are common among Lyme disease patients using antimicrobials. When bacteria start to die off, they shed body parts called endotoxins that can circulate through the body and trigger a whole-body inflammatory reaction. The result: Lyme symptoms temporarily intensify.
Usual Herxheimer reactions include fatigue or generally feeling terrible all over. Generally, they start with the introduction of a new therapy, and ramp up as the serving size of the treatment is increased. Ordinarily, herxing is much more intense with conventional antibiotics than with herbal therapy the latter causes more gradual die-off and thus a less intense immune response.
2. Bacterial or Viral Flare-up
3. Acute Viral Infections
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A Leading Cause Of Misdiagnosis Is The Failure To Recognize The Lyme Disease Rash When Present
Available blood tests are antibody-based for Lyme disease and do not accurately diagnose Lyme disease in the first few weeks of infection. False negative tests are a problem in acute Lyme disease. Therefore, early Lyme disease is a clinical diagnosis. Recognizing signs and symptoms can be vital to receiving appropriate early treatment and patient care, especially in the COVID-19 era.
Do Dogs Recover From Lyme Disease
Lyme disease in dogs is curable, however, this may depend on each case and at what stage of the disease the dog receives treatment during.
In most cases, symptoms will begin to lessen after 3 days of treatment.
When treating Lyme disease, its important to know that this illness is not always curable.
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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, âIâm not cured. I have symptoms now that I never had before Lyme disease. Iâm fatigued 90% of the day. My muscles ache. My brain is in a fog. I canât think clearly any more. Iâm super sensitive to light and sound. What is going on? Chronic Lyme disease does exist â Iâm a living example of it!â
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 oneâs identity as a provider, caretaker, or friend. Sometimes patients find themselves identifying with Job â 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.
Lyme Disease Rash Vs Other Rashes
Lyme disease diagnoses have been steadily increasing in the United States at alarming rates, especially the Maryland, DC, and Virginia area.
Below is a map from the Centers for Disease Control which shows reported cases of Lyme Disease in 2001 and 2014.
The trademark rash of Lyme disease is often described as a bull’s-eye with a round red rash that is dark in the center, and has dark outer edges.
It is formally called Erythema Chronicum Migrans or Erythema Migrans. This rash indicates the early stage of Lyme disease. Because of its growing awareness, many rashes are often mistaken for Lyme disease. Below are a few examples of Lyme disease rashes compared to other common rashes.
1. Erythema Migrans vs. Ringworm
To the left is how a Lyme disease rash, Erythema Migrans, usually appears with the trademark circular bull’s-eye center.
Ringworm is described as a circular rash that often has raised edges. Ringworm is caused by a fungus while Lyme disease is caused by the bacteria Borrelia burgdorferi.
2. Erythema Migrans vs. an Insect Bite Allergic Reaction
This version of Erythema Migrans on the left is slightly different than the characterized bull’s-eye rash.
It is a spread out rash with a scab in the center.
The insect bite allergic reaction on the right does look similar, but it was described as itchy. Erythema Migrans is mostly described as not itchy or painful, but warm to the touch.
3. Erythema Migrans vs. a Drug Allergic Reaction
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Lyme Disease And The Cdc
In order for the Centers for Disease Control to recognize a Lyme case for surveillance purposes, there must be objective findings, such as positive blood tests, Bells palsy or joint swelling . The chart below reflects the CDC-reviewed surveillance case manifestations from 2001 to 2010.
This situation contributes to what many experts view as severe undercounting of Lyme disease by the CDC.
Ongoing Symptoms Of Lyme Disease
A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years.
These symptoms are often compared to fibromyalgia and chronic fatigue syndrome.
It’s not clear why this happens to some people and not others. This means there’s also no agreed treatment.
Speak to a doctor if your symptoms come back, or do not improve, after treatment with antibiotics.
The doctor may be able to offer you further support if needed, such as:
- referral for a care needs assessment
- telling your employer, school or higher education institution that you require a gradual return to activities
- communicating with children and families’ social care
Page last reviewed: 05 July 2021 Next review due: 05 July 2024
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Lyme Disease Rashes And Look
Circular, expanding rash with target-like appearance.
Expanding rash with central crust
Expanding lesion with central crust on chest.
Expanding erythema migrans
Photo Credit: Reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectivesexternal icon. J Am Acad Dermatol 2011 64:619-36, with permission from Elsevier.
Description:Early, expanding erythema migrans with nodule.
Multiple rashes, disseminated infection
Early disseminated Lyme disease multiple lesions with dusky centers.
Red, oval plaque
Red, expanding oval-shaped plaque on trunk.
Expanding rash with central clearing
Circular, expanding rash with central clearing.
Bluish hued rash, no central clearing
Bluish hued without central clearing.
Expanding lesion, no central clearing
Expanding lesion without central clearing on back of knee.
Red-blue lesion with central clearing
Red-blue lesion with some central clearing on back of knee.
Insect bite hyper-sensitivity
Large itchy rash caused by an allergic reaction to an insect bite.
Fixed drug reaction
Description:A skin condition that occurs up to two weeks after a person takes a medication. The skin condition reappears at the same location every time a person takes that particular medication.
Ringworm
Description:Ringworm is a common skin infection that is caused by a fungus. Its called ringworm because it can cause a ring-shaped rash that is usually red and itchy with raised edges.
Pityriasis rosea rash
Granuloma annulare rash
Lyme Disease Signs & Symptoms
Lyme disease is medically described as occurring in three phases, each with distinctive symptoms. The first phase is early localized disease, which occurs three to 30 days after the tick bite that transmitted the infection. This stage is characterized by skin inflammation. The rash that occurs is referred to as erythema migrans. It develops in about 70% of people who get Lyme disease. It starts at the site of the tick bite and expands over the next several days. It can eventually cover an area up to about 12 inches across. Some of the area may clear, giving the rash at times a bull’s-eye appearance.
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Chronic Lyme: What Happens When Lyme Goes Untreated
The Lyme community typically uses the term chronic Lyme disease 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.
The risk of chronic Lyme increases the longer a Lyme infection goes untreated or undertreated. In other words, patients are more likely to recover fully if their Lyme infection is detected and treated as early as possible after the discovery of a tick bite. This stage is usually marked by symptoms such as fevers, chills, muscle aches, and sometimes rashes.
When left untreated or undertreated, however, Lyme disease can spread throughout the body and affect:
- The central nervous system
As Lymedisease.org points out, these symptoms can evolve, disappear, and reappear at different times.
Does Heat Make Lyme Disease Worse
Some patients bodies have trouble regulating blood pressure and heart rate, and extreme temperatures can send those processes into distress. Common Lyme symptoms of dizziness, fatigue, and joint acheshard enough to deal with on a moderate dayare intensified in the heat of summer or the bitterness of winter.
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Heart Palpitations Dizziness Or Shortness Of Breath
In addition to invading the central nervous system, Borrelia burgdorferi can make its way into heart tissue. That can cause the tissue to become inflamed, leading to heart palpitations, Sellati explains. It might feel like your heart is pounding, fluttering, or beating faster than usual.
Usually, it becomes more noticeable with vigorous exercise or stress. The problem isnt all that common, affecting only around 11% of patients. Still, it can be serious. If occur frequently, seem to get worse, or are accompanied by chest pain, fainting, severe shortness of breath, or dizziness, you should seek immediate medical attention, Sellati says.
One thing to note: Generally, shortness of breath is most likely to strike when youre exerting yourself, but with Lyme that isnt always the case. A Lyme disease patient can experience shortness of breath during normal activity that in the past might not have resulted in this response, Sellati explains.
Can Lyme Disease Be Dormant For Years
Lyme disease can remain dormant for weeks, months or even years. When symptoms do eventually develop, they can be severe and patients often need aggressive treatment. Intravenous treatment is often required to treat late-stage infection. Late-stage treatment can last many months as seen in other infections as well.
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When Should I Go See My Doctor
Anyone who has been bitten by a black-legged deer tick is at risk for Lyme disease. The highest risk groups include those living in or visiting endemic areas, especially people who spend significant time outdoors such as gardeners, hikers, or outdoor workers.
Patients should seek advice from their doctor if they have a suspicious round expanding red skin lesion, and/or show signs of summer-flu, particularly during Lyme disease season, which is highest-risk late spring through July/August. If those circumstances apply or symptoms persist it is very important to go to a physician.
For the west coast and other more temperate regions Lyme disease can be a year-round concern.
In the later disseminated stages, Lyme disease can be a much more insidious and complex illness. An individual should seek medical care if experiencing symptoms such as prolonged fevers, unexplained fatigue, painful joints, new or unusual headache, or heart or neurologic symptoms. If unexplained viral-like symptoms last for more than 1-2 weeks, please seek the advice of a physician.
Using Erythema Migrans To Diagnose Lyme Disease
Many cases of Lyme disease are initially misdiagnosed. The early symptoms of Lyme disease are common symptoms that occur with many illnesses. Although not all people with Lyme disease have erythema migrans, recognizing it when it is present is an important part of early diagnosis and treatment.
When erythema migrans is present, it can be the basis of a diagnosis by itself since early blood tests are not always reliable. You should understand that the bullseye pattern is only present in a minority of cases. Most often, the lesion is a solid red or blue-red oval or circle. The lesion expands over several days and may have blisters in the center, though this is not common.
If no rash is present or it goes unnoticed, and you don’t remember being bitten by a tick, it can be difficult to diagnose Lyme disease. Testing early in the disease process will likely show a false negative, as your body hasn’t had time to develop a response that can be measured. Once your body does develop a response, you may get a positive test for years, even after Lyme disease has been properly treated.
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What Can Be Done To Prevent Lyme Disease
The best prevention of Lyme disease is through awareness. Generally, ticks cannot jump or fly onto a person. They wait in vegetation and cling to animals and humans when they brush by. When in a potentially tick-infested habitat take special care to prevent tick bites, such as wearing light-colored clothing and tucking pants into socks and shirt into pants. Check after every 2 to 3 hours of outdoor activity for ticks on clothing or skin. Brush off any ticks on clothing or skin before skin attachment occurs. A thorough check of body surfaces for attached ticks should be done at the end of the day. If removal of attached ticks occurs within 36 hours, the risk of tick-borne infection is minimal. For proper tick removal, please watch the video at Tick removal. A vaccine for Lyme disease is not currently available.
Insect repellents can be effective at reducing bites from ticks that can spread disease. If you decide to use a repellent, use only what and how much you need for your situation. More information on repellents can be found at Environmental Protection Agency â insect-repellents.
In addition:
Domestic animals can carry ticks into areas where you live so it is important to check pets for ticks before they enter the home.