Lyme Disease & Co-Infections
What is Lyme Disease?
Lyme disease is an infectious diseases caused by the spirochete (pronounced SPY-ROH-KEET) Borrelia burgdorferi (Bb). Lyme usually results from the bite of an infected tick. This includes infection not only with B. burgdorferi, but the many co-infections that may also result. Lyme is an inflammatory disease characterized at first by a rash, headache, fever, and chills, and later by possible arthritis, neurological, gastro, and cardiac disorders.
The Great Imitator
Called “The Great Imitator,” Lyme disease is often mistaken for illnesses such as fibromyalgia, chronic fatigue syndrome, lupus, multiple sclerosis, rheumatoid arthritis, Lou Gehrig’s disease (ALS), Parkinson’s, ADHD, and even Alzheimer’s.
Signs and Symptoms
The signs and symptoms of Lyme disease depend on the stage of the disease. You may first notice symptoms weeks to months after exposure. During the first stage, symptoms may include fever, headache, and fatigue. There is a chance you may have no symptoms at this stage. A rash often occurs at the site of a tick bite after a delay of 3–30 days (average is about 7 days), and may or may not appear as the well-publicized bull’s-eye (erythema migrans). However, not everyone who has Lyme disease will get a rash.
In the second stage, symptoms may include memory problems and pain and weakness in the arms and legs. In the third stage, symptoms may include swelling and pain in the joints, not being able to control facial muscles, and numbness and tingling in the hands, feet, or back.
Chronic Lyme Disease: A Growing Epidemic
The Centers for Disease Control and Prevention (CDC) consider Lyme disease the fastest growing vector-borne disease in the USA. The CDC reports that Lyme disease infects an estimated 300,000 people a year. That is 10 times more Americans than previously reported.
This new preliminary estimate confirms that Lyme disease is a tremendous public health problem in the United States, and clearly highlights the urgent need for prevention.” said Dr. Paul Mead, chief of epidemiology and surveillance for CDC’s Lyme disease program.
The prevalence of chronic Lyme disease ranges from 34% in a population-based, retrospective cohort study to 62% in a specialty clinic located in an area endemic for Lyme disease.
A widening array of chronic presentations is associated with the Lyme spirochete, Borrelia burgdorferi. There are great challenges in determining optimal cost-effective means for appropriate diagnosis, clinical management and public health control of Lyme disease throughout the world. Additional problems include the identification and management of tick-borne co-infections including Ehrlichia, Babesia and Bartonella species.
Lyme Disease Testing
The diagnosis of Lyme disease is often made by your doctor based on your symptoms. However, testing for Lyme and other tick-borne disease can be helpful in ruling out other possible diagnoses. Lyme disease was initially investigated by CDC epidemiologists focusing on erythema migrans, heart block, meningitis, and arthritis.
The ELISA test and later, the western blot, were introduced for seroepidemiologic studies. Chronic, persistent, recurrent and refractory Lyme disease were not included in these studies. Consequently cases of chronic Lyme disease still remain unrecognized.
Chronic Lyme Disease
For the purpose of the ILADS guidelines, ‘chronic Lyme disease’ is inclusive of persistent symptomatologies including fatigue, cognitive dysfunction, headaches, sleep disturbance and other neurologic features (i.e., Demyelinating disease, peripheral neuropathy, motor neuron disease); such as demyelinating disease, peripheral neuropathy and sometimes motor neuron disease; neuropsychiatric presentations; cardiac presentations including electrical conduction delays and dilated cardiomyopathy; and musculoskeletal problems.
Symptoms may continue despite 30 days of treatment (persistent Lyme disease). The patient may relapse in the absence of another tick bite or erythema migrans rash (recurrent Lyme disease), or be poorly responsive to antibiotic treatment (refractory Lyme disease).
By these definitions, almost two-thirds of 215 Lyme disease patients in a recent retrospective cohort from an endemic region had chronic Lyme disease . Case definitions for Lyme disease have evolved and will continue to develop as a better understanding of chronic Lyme disease emerges to shape a common lexicon.
Standards of Care
It is important to remember that Lyme is not treated the same by all doctors. You will find that the opinion on diagnosing and treating Lyme is deeply divided within the medical community, especially for Lyme that is not cured by short-term treatment. Doctors are divided on how they view Lyme treatment. Some believe that short-term antibiotic therapy cures Lyme: if you are still sick, then you are suffering from an autoimmune response. Other doctors believe that if you still have symptoms after initial treatment than you have an on-going infection or an unknown syndrome. The different views on how to treat Lyme has resulted in two standards of care.