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Lyme Summary

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Lyme Disease Summary 

Lyme disease is an infection acquired by a tick bite.  It is caused by the bacterium, Borrelia burgdorferi. Treatment with antibiotics is the standard for care. Some people continue to have generalized symptoms years after treatment is complete but most fully recover. Sometimes serious complications occur; early recognition is critical in achieving a good outcome.

 

Cause 

A tick bite is the cause of Lyme disease. Specifically a tick carrying the bacterium Borrelia burgdorferi. Not all ticks carry the bacterium so it is important not to panic if a patient reports a tick bite. If a person finds a tick on their body they should remove it immediately; never wait for the tick to release and fall off on its own. The goal when removing the tick is to not leave the head and mouth buried in the skin. Using tweezers, grab a hold of the tick as close to the skin as possible. Use a gentle, steady motion to pull the tick out. Don’t twist while pulling as this will often times break the head off the body. After removal put the tick in alcohol, flush it down the toilet, or bag it in plastic. Never try to crush the tick with your fingers, as this will not always kill the bug.

 

Signs and Symptoms 

Signs and symptoms can be broken down into early and later signs and symptoms:

Early Signs and Symptoms (72 hours – 4 weeks after tick bite):

  • Fever
  • Chills
  • Headache
  • Fatigue
  • Muscle and joint aches
  • Swollen lymph nodes
  • Erythema migrans (EM) rash:
    • ​70-80% of all persons infected develop this type of rash. Rash begins at the site of the tick bite after a 3-30 day period of time, although the average time is 1 week. Circumference of rash continues to expand over a period of days. Rash will often clear as the circumference grows larger. This cleared area gives it the appearance of a “target” or a “bullseye.” The rash may appear on whatever part of the body was bitten by the tick.

 

Later Signs and Symptoms (days to months later):

  • Severe headache
  • Stiffness in the neck
  • Multiple EM rashes on other area of the body
  • Arthritis with severe joint pain
  • Intermittent pain and tenderness in tendons, joints, muscles and bones
  • Irregular heartbeat and palpitations (lyme carditis)
  • Shortness of breath
  • Dizziness
  • Nerve pain
  • Encephalitis
  • Meningitis
  • Nerve pain
  • Numbness in hands and feet
  • Shooting pains
  • Short term memory loss

If a person has had a known tick bite and experiences any of these symptoms, they should seek medical attention immediately and request testing.

 

Testing 

The CDC recommends a two-tier testing procedure. Only one blood sample is required to do both tests. The first test is the “EIA” test; if this test result is negative the second test is not necessary. If the “EIA” test is positive or inconclusive then the second test, the “Western blot” is run. This two-tiered system helps to eliminate unnecessary treatment.

 

Post-Treatment Lyme Disease Syndrome 

Previously referred to as Chronic Lyme disease, this is a condition in which symptoms persist for weeks or months after treatment is completed. The CDC recommends a 2-4 week course of antibiotics once Lyme disease is confirmed by testing.

Patients frequently experience fatigue, pain, and muscle aches for several weeks post treatment. It is much less frequent for the symptoms to linger for months. The recommended plan of care is to treat the patient’s symptoms until they resolve.  This may include pain medication, muscle relaxants and other medications.

 

Complications 

Lyme carditis is one of the most serious complications. It occurs when the Lyme disease bacteria enters the heart and colonizes in the heart tissue. This bacteria growth interferes with the electrical impulses of the heart resulting in a heart block. This condition can occur very quickly, and can be deadly if not recognized early. It is important for the patient to be educated on the signs and symptoms of a heart block. Light headedness, fatigue, irregular heartbeat, and palpitations may be felt. Other symptoms that may occur are fainting, shortness of breath, chest pain, fever, and body aches.

 

Prevention and Prevalence 

Two companies have patents for vaccines to prevent Lyme disease. Both vaccines are 60% effective after one injection, 75% after the 2nd injection and 90% after the third. An antibody titer is recommended to demonstrate immunity.

Although Lyme disease is on the rise, particularly in the Northeastern states, vaccine sales dropped dramatically in the early 2000s. 1.5 million doses were sold in 1999, dropping to 10,000 doses in 2002. The two companies making the vaccine stopped manufacturing it that same year. That being said, in 2013 there was an announcement of a new vaccine underway and in clinical trials.

 

 

References:

Lyme Disease. Retrieved from https://www.cdc.gov/lyme/index.html. 

Lyme Disease. Retrieved from https://www.niaid.nih.gov/diseases-conditions/lyme-disease. 

Post-Treatment Lyme Disease Syndrome. Retrieved from https://www.cdc.gov/lyme/postlds/index.html. 

 

Hyperlink:

https://www.cdc.gov/lyme/index.html

Hyperlink:

https://www.niaid.nih.gov/diseases-conditions/lyme-disease

Hyperlink:

https://www.cdc.gov/lyme/postlds/index.html