What Is First Line Treatment For Lyme Disease
Antibiotics. The three first-line oral antibiotics for Lyme disease include doxycycline , amoxicillin , and cefuroxime . Ceftriaxone administered intravenously is the preferred antibiotic for neurologic Lyme disease in the United States.
Can Lyme disease be treated or cured?
Although most cases of Lyme disease can be cured with a 2- to 4-week course of oral antibiotics, patients can sometimes have symptoms of pain, fatigue, or difficulty thinking that lasts for more than 6 months after they finish treatment. This condition is called Post-Treatment Lyme Disease Syndrome .
Where Is Lyme Disease Prevalent
LD is spreading slowly along and inland from the upper east coast, as well as in the upper midwest. The mode of spread is not entirely clear and is probably due to a number of factors such as bird migration, mobility of deer and other large mammals, and infected ticks dropping off of pets as people travel around the country. It is also prevalent in northern California and Oregon coast, but there is little evidence of spread.
In order to assess LD risk you should know whether infected deer ticks are active in your area or in places you may visit. The population density and percentage of infected ticks that may transmit LD vary markedly from one region of the country to another. There is even great variation from county to county within a state and from area to area within a county. For example, less than 5% of adult ticks south of Maryland are infected with B. burgdorferi, while up to 50% are infected in hyperendemic areas of the northeast. The tick infection rate in Pacific coastal states is between 2% and 4%.
What Is Lyme Disease
Several countries around the world, especially in the Northern Hemisphere, and all 50 states in the US have already reported cases of Lyme. The disease is caused by bacteria called Borrelia, and it is spread by ticks. One of the biggest controversies surrounding Lyme is determining whether or not someone has the so-called persistent or chronic Lyme disease. The CDC and most specialists prefer to use a different term, post-treatment Lyme disease .
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What Are The Symptoms Of Post
Doctors have known for years that they cannot rely on a physical exam to diagnose early Lyme disease unless they find an erythema migrans rash, Bells palsy, or heart block. Now, Rebman and colleagues from the Johns Hopkins University School of Medicine acknowledge that doctors also cannot count on a physical exam to diagnose Post-treatment Lyme disease syndrome .
In their article published in the journal Frontiers in Medicine, the authors state, Results from the physical exam and laboratory testing our sample of patients with PTLDS did not show a pattern of significant objective abnormalities. However, the most notable exception was the higher rate of diminished vibratory sensation on physical exam among participants with PTLDS.
Following treatment for Lyme disease, it is uncommon to find objective clinical manifestations in patients with PTLDS, according to the researchers. In fact, a much more likely scenario after treatment is the persistence or development of subjective symptoms without any residual or new objective manifestation.
But the authors did discover a collection of symptoms among the Lyme disease patients which, when looked at as a whole, indicated the presence of problems post-treatment. For example, Although only found in a small subset of our sample , two participants met criteria for postural orthostatic tachycardia syndrome, an autonomic condition that has been previously reported following Lyme disease.
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Looking Forward: The Future Of Ptlds Treatment
Ketamine therapy is not approved for the treatment of Lyme disease or PTLDS, but evidence so far indicates that it may provide crucial symptom relief. The success of ketamine in treating depression, chronic pain, and substance abuse could usher in a bright future for the treatment of chronic illnesses.
Lyme disease was first definitively identified in 1975, which means researchers have had less than 50 years to study the outcomes, effective treatments, and related conditions associated with this disease. While there is no approved treatment for PTLDS today, medical research continuesand ketamine could be the treatment of tomorrow.
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Can You Get Rid Of Lyme Disease Without Antibiotics
Whats the best way to treat Lyme disease?
In addition, this panel believes the goals of medical care in Lyme disease are to prevent the illness whenever possible and to cure the illness when it occurs. When this is not possible, the panel believes the emphasis for treatment should be on reducing patient morbidity.
Why Are Antibiotics The First Line Of Treatment For Lyme Disease
The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. Antibiotics go into the bacteria preferentially and either stop the multiplication of the bacteria or disrupt the cell wall of the bacteria and kill the bacteria . By stopping the growth or killing the bacteria the human host immune response is given a leg up to eradicate the residual infection. Without antibiotics, the infection in Lyme disease can evade the host immune system and more readily persist.
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Ptlds Vs Chronic Lyme Disease
There is some confusion about the difference between chronic Lyme disease and post-treatment Lyme disease syndrome.
Post-Treatment Lyme Disease Syndrome is the preferred term for many physicians and organizations, including the CDC. It refers specifically to persistent symptoms of Lyme disease in a patient who has already undergone treatment for Lyme disease. Other patients and physicians refer to this same condition as chronic Lyme disease, since the patient is experiencing chronic symptoms.
However, there are cases in which patients and physicians may refer to chronic Lyme disease in the absence of any prior treatment. Remember that many patients go years without ever getting a proper diagnosis of Lyme disease, let alone treatment. Once a diagnosis is made, the symptoms of their late-stage Lyme disease may have become chronic, i.e. leading to chronic Lyme disease. This would not be considered a case of PTLDS since no diagnosis or treatment ever occurred before the disease became chronic.
The important thing to remember is that the earlier a diagnosis is made and treatment is given, the less likely a patient is to develop persistent symptoms.
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
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Why Do Lyme Symptoms Linger
As you know, Lyme disease is caused by the bacterium Borrelia burgdorferi. The conventional approach to eradicating Lyme disease is to eliminate the bacteria, which is why a long series of antibiotics is the standard treatment. But B. burgdorferi is a tricky bugger and one that can continue to wreak havoc long after it has physically been eradicated from your system.
The persistent neurocognitive symptoms that can manifest from PTLDS can include chronic fatigue, musculoskeletal pain, mood or behavioral changes, disrupted sleep patterns, memory loss, dizziness, and headaches. A common consistency among those suffering from PTLDS is that symptoms tend to wax and wane. This, of course, makes PTLDS very frustrating, and as a result, can greatly impact the quality of your life and your ability to shine in all aspects of your life .
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Two Standards Of Care For Lyme Disease Treatment
There is significant controversy in science, medicine, and public policy regarding Lyme disease. Two medical societies hold widely divergent views on the best approach to diagnosing and treating Lyme disease. The conflict makes it difficult for patients to be properly diagnosed and receive treatment.
One medical society, the Infectious Diseases Society of America , regards Lyme disease as hard to catch and easy to cure with a short course of antibiotics. IDSA claims that spirochetal infection cannot persist in the body after a short course of antibiotics. The group also denies the existence of chronic Lyme disease.
In contrast, the International Lyme and Associated Diseases Society , regards Lyme disease as often difficult to diagnose and treat, resulting in persistent infection in many patients. ILADS recommends individualized treatment based on the severity of symptoms, the presence of tick-borne coinfections and patient response to treatment.
LDo believes that patients and their doctors should make Lyme disease treatment decisions together. This requires that patients be given sufficient information about the risks and benefits of different treatment options. Then, patient and health care provider can collaborate to reach an informed decision, based on the patients circumstances, beliefs and preferences.
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Living With Post Treatment Lyme Disease Syndrome
PTLDS can be one of the most frustrating medical issues to navigate. People often have a difficult time receiving a proper diagnosis, let alone treatment that works for them. They may have a difficult time going about their daily life comfortably and deal with impaired mental health as a result of their discomfort and experience.
Although most cases of PTLDS are not preventable, you can take steps to protect yourself and your family from tick bites and long-term symptoms. You can do this by covering your arms and legs while youre in an area where ticks are prevalent, as well as using bug spray, and thoroughly checking yourself, your family, and your pets for ticks after possible exposure.
If you do happen to be bitten by a tick, its important to seek testing as soon as possible, as well as test the tick if youre able to save it. You can do this through services like the tick testing lab at IGeneX.
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.
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What Is The Treatment For Lyme Disease
The first-line standard of care treatment for adults with Lyme disease is doxycycline, a tetracycline antibiotic. Other antibiotics that have activity against borrelia include the penicillin-like antibiotic, amoxicillin, and the second generation cephalosporin, Ceftin. The mainstay of treatment is with oral antibiotics, but intravenous antibiotics are sometimes indicated for more difficult to treat cases of neurologic-Lyme disease, such as meningitis, and cases of late Lyme arthritis.
Lyme Disease Is A Growing Problem
Lyme disease has become much more of a concern since 2002. According to the CDC, about 30,000 cases are reported each year, though the agency says this is probably lower than the true number of cases because of undercounting. This is compared with about 24,000 cases that were reported in 2002. A study using private insurance-claims data estimated that about 476,000 patients were diagnosed with and treated for Lyme disease between 2010 and 2018.
In 2022, a study estimated that 15% of the global population had contracted Lyme disease at some point in their lifetimes.
One theory for increasing Lyme prevalence in the American Northeast involves the rise of patchy forests, which leads to more of a particular kind of mouse that’s a great reservoir for Lyme-causing bacteria. Additionally, the climate crisis is expanding the range of disease-carrying ticks because warmer temperatures can speed up the life cycle of ticks and make winters more survivable.
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Impact On Life Functioning
In order to capture the impact of health status on life functioning, the 36-item Short Form Health Survey, Version 2 , was administered at each study visit. It has been designed to study eight health attributes and has been shown to have high reliability and validity across a range of populations . Each of the 36 items in the measure loads onto one of eight subscales: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Raw scores of 0100 are generated for each subscale, and then scores are adjusted using a linear transformation to a mean of 50 and a standard deviation of 10 using 1998 general population norms . Lower scores reflect more negative impact of health status on life functioning. In our sample, we found Cronbachs of > 0.70 for all subscales, with 5/8 subscales > 0.90.
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A Reasonable Approach To Post
If you are being treated for PTLD, there is no magic bullet to treat this problem, but here are some important steps to consider:
- Choose a doctor you trust and who can work closely with you.
- If your doctor agrees to start antibiotics for several months, make sure you talk about the risks and cost, as this can be dangerous and expensive.
- Make sure not to rely solely on antibiotics. The evidence for a benefit from antibiotics is weak, and we rely mostly on physicians clinical experience and interest in the disease to design a personalized therapeutic plan. For some, a more holistic approach may be the way to go.
- If you try supplements, ask about their source and purity, as they are not FDA-regulated.
- Consider looking for services in medical school hospitals or clinics where they may have programs with ongoing research on how to diagnose and treat Lyme.
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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.
What Is The Outlook For Someone With Lyme Disease
Most of the people who get Lyme disease and receive treatment early will be fine. Treatment can cure Lyme disease but you might still have some long-term effects. Untreated Lyme disease may contribute to other serious problems but its rarely fatal.
Post-treatment Lyme disease syndrome
Even after proper treatment, some people may experience lingering fatigue, achiness or headaches. This is known as post-treatment Lyme disease syndrome or PTLDS. The symptoms dont mean that you still have an infection. PTLDS probably wont respond to additional antibiotics. The majority of people in this group will have symptoms that resolve at some point over the next six months.
Chronic Lyme disease
Chronic Lyme disease is a term used by some for a condition in a person who had Lyme disease and the symptoms of PTLDS. Some people consider chronic Lyme disease to be the same as PTLDS. However, some people receive a chronic Lyme disease diagnosis without a Lyme disease diagnosis. Sometimes, extended treatment with antibiotics helps.
This term may be why some people think a Lyme disease infection can occur without being bitten by a tick. There isn’t enough proof that mosquitoes can transmit Lyme disease. Many researchers dislike using the term chronic Lyme disease.
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What Are The Side Effects Of Lyme Disease Treatments
Antibiotics, like all medications, have the potential for side effects. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Sometimes symptoms worsen for the first few days on an antibiotic. This is called a Herxheimer reaction and occurs when the antibiotics start to kill the bacteria. In the first 24 to 48 hours, dead bacterial products stimulate the immune system to release inflammatory cytokines and chemokines that can cause increased fever and achiness. This should be transient and last no more than a day or two after the initiation of antibiotics.
The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. This bacterial overgrowth condition occurs because antibiotics kill the good bacteria in our gut. It can be helpful to use probiotics to restore the good bacteria and microbiome balance.
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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