Lyme Disease: Realities, Diagnosis, and Treatment
Lyme disease is an infection from a bacteria called borrelia burgdorferi. It is most commonly transmitted through the bite of a tick. Often, patients with Lyme disease do not remember a tick bite. This can be because the ticks carrying Lyme disease can be as small as a poppy seed. Sometimes, patients also think that they need to develop Erythema Migrans (EM), commonly referred to as a bull's eye rash, in order to have Lyme disease. A bull's eye rash is not equired for a diagnosis of Lyme disease. It is possible to contract Lyme disease if you do not remember a tick bite and/or never developed any visible outward signs. Lyme disease can also be transmitted during pregnancy from mother to fetus, resulting in congenital Lyme disease in the child.
Diagnosing Lyme disease can be challenging as testing can be inaccurate. Obtaining a negative Lyme disease test does not rule out the presence and threat of Lyme disease. The Centers for Disease Control estimates 476,000 people (about half the population of Montana) contract Lyme disease each year. For this practice's purpose, a diagnosis is developed after evaluating a medical history, summary of present illness, lab results, and risk factors. Patients may have positive testing for Lyme disease or other infections; however, despite indeterminant testing it is possible and appropriate to make a clinical diagnosis of Lyme disease or other tickborne illnesses without positive testing. Likewise, it is appropriate and advised that treatment be initiated if significant symptoms are present in a patient, and the risks vs the benefits are thoroughly considered.
Symptoms of Lyme disease can be acute or develop over time and become chronic in nature. Acute symptoms of Lyme disease are typically hallmarked as flu like symptoms with fever, headaches, nausea, joint pains, muscle aches, chills/ sweats, or a bull’s eye rash. A bull’s eye rash may have a central clearing, while others are solid throughout. The rash will typically last at least a few days and can expand over those days. In some cases, the rash is very faint, but in others it can be darkly pigmented. Less commonly people can have more than one bulls eye rash on their body with satellite rashes. Some patients present with a neurologic manifestation called Bell’s palsy, where there is a facial droop typically on one side.
The best treatment for Lyme disease is early treatment. Getting treated as soon as possible or prophylactically for tick bites provides the best outcomes. Symptoms of Lyme disease can spread throughout the body and into organs and tissues such as the heart and brain. Despite early treatment about 20% of patients will continue to have symptoms after initial treatment. This could be due to either incomplete treatment, persistent infection, or the presence of other co-infections commonly passed by ticks (it is important to check for these in testing as well).
Symptoms that persist for 6 months or longer become considered chronic Lyme disease. Chronic Lyme disease is serious, and its health risks and impacts require further treatment and management to prevent severe long-term health consequences and disability.
Co-Infections
There are several other infections that can be transmitted by ticks. These need to also be carefully evaluated and assessed. Some of these infections can cause similar symptoms to Lyme disease and can often be treated like Lyme disease. However, there are other infections that require different treatment to recover.
Other potential serious infections to be screened/tested for include:
Bartonella
Babesia
Ehrlichia
Anaplasmosis
Brucella
Rocky Mountain Spotted Fever
Tularemia
Coxiella (Q-fever)
Other Borrelia
Research:
Active Research:
PhD Study: The Relationship of Uncertainty in Illness and PTSD Symptoms in Adult Patients with Chronic Lyme Disease
IRB approved May 25, 2023
Research is completed
Pending publication, stay tuned for future details