Monday, December 4, 2023

Lyme Disease Treatment And Prognosis

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Who’s At Risk Of Lyme Disease

Lyme Disease Prognosis – Johns Hopkins – (5 of 5)

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.

Borrelia Burgdorferi Infectious Cycle

The infectious cycle of B burgdorferi involves colonization, infection of Ixodes ticks, and then transmission to broad a range of mammalian hosts, including humans. Variation in environmental and host conditions promotes different gene expression and changes in the composition of the membrane proteins of the spirochete. This adaptation is a critical step in the pathogenesis and transmission of Lyme disease.

The Ixodes tick progresses through four stages of development: egg, larva, nymph, and adult . Only larvae, nymphs, and adult female ticks require blood meals, and only ticks in the nymphal and adult stages can transmit B burgdorferi.

The life cycle of Ixodes ticks spans 2 years . The adult lays eggs in the spring, and the larvae emerge in the summer. The larvae feed once, in late summer, on any of a wide variety of small animals . The following spring, the larvae emerge as nymphs. Nymphs feed once, in the spring and summer. The white-footed mouse is the preferred feeding source of nymphs, but other animals apparently suffice. Nymphs molt into adults the following fall and feed once on a larger animal, with the white-tailed deer being the preferred host.

Ticks carry B burgdorferi organisms in their midgut. The bacteria are introduced into the skin by a bite from an infected tick, and disease is transmitted to humans as the spirochete is translocated from the gut to the salivary glands and then to the person at the site of the bite.

Early Lyme Disease Treatment

ILADS doctors are likely to recommend more aggressive and longer antibiotic treatment for patients. They may, for instance, treat high risk tick bites where the tick came from an endemic area, was attached a long time, and was removed improperly. They may treat a Lyme rash for a longer period of time than the IDSA recommends, to ensure that the disease does not progress. They are unlikely to withhold treatment pending laboratory test results.

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Ecg Changes And Electrophysiological Findings

As with viral myocarditis, changes in surface ECG are a common finding in Lyme carditis. Diffuse myocardial involvement frequently results in ST segment changes. According to the largest published study of Steere et al. , 60% of the patients showed ST segment depression or T wave inversion, especially in the inferolateral leads. With clinical remission, these changes disappeared completely. Even more common than these unspecific repolarization abnormalities are AV conduction disorders that can be observed in the 12-channel ECG and 24-hour Holter ECG.

Electrophysiological data related to Lyme carditis are only available from case reports. Here, a mainly supra-Hisian/intranodular AV block with corresponding abnormalities of the AH intervals and a small-based AV junctional escape rhythm was identified. Apart from this constellation, which bears a good prognosis, only sporadic reports of infra-Hisian blocks with prolonged HV interval have been documented . Likewise, cases of sinus node dysfunction, more precisely of sinoatrial blocks , temporary bundle blocks , and paroxysmal atrial fibrillations have been described. In three children with Lyme carditis, a prolonged QT interval was reported .

Transmission Of Bb Via Ixodes Spp Vectors

Lyme Disease Testing

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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Study Shows Evidence Of Severe And Lingering Symptoms In Some After Treatment For Lyme Disease

In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue…

In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue, pain, insomnia and depression do indeed persist over long periods of time for some people, despite largely normal physical exams and clinical laboratory testing.

Post-treatment Lyme disease syndrome is a real disorder that causes severe symptoms in the absence of clinically detectable infection, says John N. Aucott, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Lyme Disease Clinical Research Center.

The findings, published in the December issue of Frontiers in Medicine, could spur further investigation into the cause of persistent symptoms, a source of medical controversy. As Lyme disease rates have steadily climbed in the United States since it was first recognized in the mid-1970s, so have reports of a collection of symptoms that patients commonly refer to as chronic Lyme disease. Experts in the field have questioned the validity of this term because of the lack of direct evidence in this group of patients of ongoing infection with Borrelia burgdorferi, the bacterium that causes Lyme disease.

Other Johns Hopkins researchers who participated in this study include Alison W. Rebman, Ting Yang, Erica A. Mihm, Mark J. Soloski and Cheryl Novak.

Late Or Chronic Lyme Disease Treatment

Experts agree that the earlier you are treated the better, since early treatment is often successful. Unfortunately, a substantial portion of patients treated with short-term antibiotics continue to have significant symptoms. The quality of life of patients with chronic Lyme disease is similar to that of patients with congestive heart failure. Doctors dont agree about the cause of these ongoing symptoms. The primary cause of this debate is flawed diagnostic testing. There is currently no test that can determine whether a patient has active infection or whether the infection has been eradicated by treatment.

The IDSA thinks Lyme disease symptoms after treatment represent a possibly autoimmune, post-Lyme syndrome that is not responsive to antibiotics. The IDSA essentially regards Lyme disease as an acute infection like strep throat that can be treated with a short course of antibiotics. The IDSA guidelines are now eight years old and do not reflect recent science.

ILADS physicians believe that ongoing symptoms probably reflect active infection, which should be treated until the symptoms have resolved. These physicians use treatment approaches employed for persistent infections like tuberculosis, including a combination of drugs and longer treatment durations. The ILADS guidelines have just recently been updated using a rigorous review of the medical literature.

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What Is Lyme Disease In Cats

Lyme disease is an infection caused by a spiral-shaped bacteria called Borrelia burgdorferi, which is spread by ticks. If your cat has Lyme disease, it may appear lethargic and lose its appetite.

Even though it is uncommon in cats, Lyme disease is known to be one of the most common tick-transmitted diseases in the world.

Where Are Ticks Found

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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.

They can be found in any areas with deep or overgrown plants where they have access to animals to feed on.

They’re common in woodland and moorland areas, but can also be found in gardens or parks.

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Can Lyme Cause Permanent Damage

Without treatment, Lyme can cause permanent damage. But most people with late-stage Lyme disease can recover if they get treatment with antibiotics. The longer you wait before treating Lyme disease, the longer it can take for symptoms to go away.

A small subset of people may have symptoms that persist after treatment. Some long-term complications people experience include:

  • Synovitis: This is inflammation of the linings of the joints. Up to 10% of people with late-stage Lyme have visible joint inflammation, even after antibiotic treatment. Immunosuppressive medications or surgery can sometimes help to reduce pain.

  • Post-treatment Lyme disease: This is also called chronic Lyme disease or post-lyme syndrome. It happens in around 10% to 20% of people who have had Lyme disease. Its similar to fibromyalgia and chronic fatigue syndrome. Symptoms include fatigue, widespread musculoskeletal pain, and problems with thinking and concentration.

  • Encephalitis, encephalomyelitis, or encephalopathy: These types of brain and spinal cord inflammation can cause long-standing problems with movement and thinking. These symptoms rarely persist after treatment.

  • Neuritis or neuropathy: This is inflammation of nerves outside of the brain, throughout the body. It can cause long-lasting problems with feeling and muscle strength even after treatment. These symptoms rarely persist after treatment.

What Are The Risk Factors For Post Treatment Lyme Disease

Risk factors for Post Treatment Lyme Disease include:

  • Delay in diagnosis
  • Increased severity of initial illness
  • Presence of neurologic symptoms

Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. PTLD is especially common in people that have had neurologic involvement. The rates of Post Treatment Lyme Disease after neurologic involvement may be as high as 20% or even higher. Other risk factors being investigated are genetic predispositions and immunologic variables.

In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.

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Chronic Lyme Disease Symptom Severity

In LDos chronic Lyme disease survey, over 75% of patients reported at least one symptom as severe or very severe and 63% reported two or more such symptoms. Find out more about LDo peer-reviewed published surveys. The chart below shows the severity of ten common chronic Lyme symptoms.

The survey also found that patients with chronic Lyme disease have high disability and unemployment rates. Over 40% of patients with chronic Lyme disease reported that they currently are unable to work because of Lyme disease and 24% report that they have received disability at some point in their illness.

New Findings From The Hu Lab Could Improve Lyme Disease Diagnosis

Pin by Stephanie Marie on CIRS &  genes.

For scientists and clinicians alike, one of the Holy Grails for successfully treating and curing Lyme disease is developing tests that identify the disease sooner, show when people are cured of infection, and can diagnose reinfection.

Now, researchers at GSBS and Tufts University School of Medicine say they have identified just such a testing mechanism. It detects a type of antibody that infected individuals produce against a substance the Lyme bacteria acquires from the host in order to grow. The researchers believe tests to detect these autoantibodies antibodies that mistakenly target and react with a person’s own tissues or organs could provide clinicians with a way to diagnose the disease sooner, know whether treatment with antibiotics is working, and identify patients who have been reinfected.

Lyme disease, which was identified five decades ago along the Connecticut coast and spread across New England and the mid-Atlantic region, affects almost 500,000 people in the U.S. every year. Caused by a bite from an infected tick, it frequently goes undetected unless a person notices the telltale rash that forms around the bite.

Lyme disease can lead to debilitating long-term complications including arthritis, fatigue, mental impairment, and in the most severe cases, attacks on the heart and brain tissue. Caused by the bacterium Borrelia burgdorferi, Lyme disease can often be treated with antibiotics. But in 10 to 20 percent of cases, the diseases effects can persist.

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Do All Ticks Transmit Lyme Disease

In Wisconsin, there are at least 16 species of tick, but not all of them transmit disease to humans. Only one type of tick, Ixodes scapularis , carries and transmits Lyme disease. Contrary to what the ticks name might imply, deer do not transmit Lyme disease bacteria to ticks. Deer are simply a common food source for the ticks. Also, not all of the Ixodes scapularis ticks are capable of transmitting Lyme disease. Only those that carry the bacteria can transmit it.

What Is Neurologic Lyme Disease

Neurologic symptoms of Lyme disease occur when the Lyme disease bacteria affect the peripheral or central nervous systems.

  • Cranial nerve involvement: When the cranial nerves are affected, facial palsy can occur on one or both sides of the face.
  • Peripheral nerve involvement: When the peripheral nerves are affected, patients can develop radiculoneuropathy which can cause numbness, tingling, shooting pain, or weakness in the arms or legs.
  • Central nervous system involvement: When the central nervous system is affected, Lyme meningitis can cause fever, headache, sensitivity to light, and stiff neck.

Out of every 100 patients whose cases are reported to CDC, 9 have facial palsy, 4 have radiculopathy, and 3 have meningitis or encephalitis. Because of reporting practices, this statistic may overestimate how often these manifestations are seen by clinicians.

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The Experience Of Lyme Disease

In our book, Conquering Lyme Disease: Science Bridges the Great Divide, we review several of the key features of Lyme disease that can make the experience of this illness so challenging, including:

  • The politically charged climate
  • The protean nature of manifestations of the illness
  • The waxing and waning course of symptoms
  • The psychological ramifications of having an “invisible” chronic illness and the experience of invalidation
  • The challenge of having a disease that affects the brain and sensory system
  • The impact of uncertainty surrounding diagnosis, treatment, and prognosis

Lyme Disease Treatment And Management

Lyme Disease: Diagnosis and Treatment for People and Pets

How to manage a tick bite

  • If the tick is still attached, remove it. Grip the tick with fine-tipped or precision tweezers and pull upwards without twisting.
  • Clean the skin afterwards with soap and water or an antiseptic preparation.
  • The tick may be disposed of in normal household rubbish.
  • Do NOT use petroleum jelly, alcohol, or nail varnish remover, or burn the tick off.
  • For those regularly exposed to ticks, removal devices are available from veterinary surgeries or pet shops.
  • Antibiotic prophylaxis is NOT recommended routinely in the UK following a tick bite.

How to manage a patient with erythema migrans and a history of tick bite or likely exposureBlood tests are NOT necessary the diagnosis can be made clinically.

Treat with an oral antibiotic for 2-3 weeks:

  • Doxycycline 100 mg bd or amoxicillin 500 mg tds.
  • Cefuroxime 500 mg bd if both are contra-indicated and there is no history of anaphylaxis with penicillins.
  • For children aged under 12, use amoxicillin in age-dependent doses as per the British National Formulary or cefuroxime 5 mg/kg twice per day .
  • For breast-feeding women, use amoxicillin or cefuroxime.
  • For pregnant women, use amoxicillin or cefuroxime and inform an obstetrician. Lyme disease carries little direct risk to the pregnancy however, there is a possible risk of uterine contraction following a reaction to treatment.

How to manage a patient with an isolated facial nerve palsy and a history of recent erythema migrans or exposure to tick bites

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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.

Can Lyme Disease Completely Be Cured

Taking oral antibiotics typically cures Lyme disease after two to four weeks. You may need to get antibiotics through the vein for four more weeks. However, theres no reason to think that Lyme disease stays in you forever after treatment.

A note from Cleveland Clinic

If youre going to spend time in an area that might have ticks, take measures to avoid being bitten. This includes wearing long-sleeved shirts and pants to make it harder for ticks to bite. If you feel sick after being in an area that probably has ticks, make an appointment with your healthcare provider. If your provider prescribes antibiotics, make sure you take all of them as instructed.

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Like Humans The Bacteria That Causes Lyme Disease Can Infect Cats However Lyme Disease Is Much More Common In Dogs And Humans And The Illness Is Rarely Seen In Our Feline Friends

Add to this the fact that cats do not always develop symptoms and this can make reaching a diagnosis quite difficult.

So how is Lyme disease in cats transmitted? The bacteria that cause Lyme disease is spread by ticks. Cat ticks are very good at passing on infections from one animal to another. Ticks feed by biting an animal and feeding on its blood. They may stay on the skin for a few days and then once theyve had enough, they drop off. The ticks can transmit microbes that cause diseases, such as Lyme disease or babesiosis but its unusual for cats to catch either disease.

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