Lyme Disease (Borreliosis) – Symptoms and Treatment

The incubation period of Lyme disease ranges from a few days to several years. Recent medical research suggests that Lyme disease may be responsible for a number of unexplained health problems in affected people.

Lyme disease is an emerging infectious disease world-wide. According to the Centers for Disease Control and Prevention, almost 29,000 cases of Lyme disease are now reported annually in the United States. The CDC cautions that, because research is limited, and because many cases are misdiagnosed or not reported, the actual prevalence of the disease may be much higher. Lyme disease is currently the leading tick-borne disease in the United States and Europe.

Causes of Lyme Disease

Lyme disease, or Lyme borreliosis, takes its name from the town of Lyme, Connecticut, where the disease broke out in 1975. Entomologist Willy Burgdorfer identified the bacteria causing the disease in 1982.

(above: Borrelia burgdorferi)

At least four different sub-species of B. burgdorferi sensu lato bacteria can cause Lyme disease. The bacteria infect deer as well as squirrels, mice, birds and other small animals. Ticks feed on an infected animals, and can then transmit the bacteria to humans.

Lyme disease bacteria enter the body of a human or animal through a tick bite. It is not possible to get Lyme disease by eating the meat of an infected animal. A person or pet usually picks up a tick by brushing against vegetation.

(above – deer tick, magnified)

Which Ticks Transmit Lyme Disease?

Ticks of the genus Ixodes, known as hard ticks, carry the bacteria causing Lyme disease. In North America, the most common vector of Lyme disease is Ixodes scapularis, also known as the deer tick or black-legged tick. The deer tick is about the size of a grain of black pepper in its nymphal stage, and the size of a sesame seed as an adult. The Western black-legged tick (Ixodes pacificus) can also transmit the disease to humans.

In Europe, the sheep tick or castor bean tick (Ixodes ricinus) is the primary vector. In China, the taiga tick (Ixodes persulcatus) is known to transmit Lyme disease.

Dog ticks, which are easily visible to the naked eye, do not carry Lyme disease. The Lone Star tick (Amblyomma americanum) can transmit STARI, an illness closely resembling Lyme disease.

Geographic Range of Lyme Disease

Lyme disease is most common in the Northern Hemisphere, but incidence of Lyme disease is increasing world-wide. In the United States, Lyme disease occurs in every state except Hawaii. Ninety-nine percent of all reported U.S. cases are in New England, the Mid-Atlantic, South Atlantic, East-North Central and West North-Central regions.

In Europe, the highest incidence of Lyme disease is in Central Europe, especially Slovenia, Austria and the Netherlands, although outbreaks of Lyme disease have been identified throughout Europe. Lyme disease is on the rise in the U.K., Germany and Belgium. Incidence of Lyme disease is also higher in far Eastern Russia, North Africa, Northwest China and Japan.

In Canada, Lyme disease is most common in southwestern British Columbia, Manitoba, southern and eastern Ontario, and parts of Nova Scotia. Ticks carrying Lyme disease are not indigenous to Australia, and the disease does not appear except in people who have traveled abroad.

Migratory birds can bring the bacteria into areas previously unexposed to Lyme disease.

Lyme Disease Symptoms

All Lyme disease symptoms don’t appear in all infected individuals. The incubation period of the disease may  last up to several years before symptoms appear. As Lyme disease progresses in humans, it moves through three stages.

Lyme Disease Symptoms – First Stage

Lyme Disease Rash (Erythema Migrans)

In about 80% of cases, a circular red rash (erythema migrans) forms at the site of the tick bite, three to thirty days after infection. Lyme disease rash is characterized by raised reddish bumps that usually don’t itch. The rash expands outward, and may develop a bulls-eye pattern.

(above – erythema migrans, or Lyme disease rash)

(above – erythema migrans, bulls-eye pattern)

In the United States, individuals bitten an infected Amblyomma americanum tick, also called the Lone Star tick, may experience a rash and similar symptoms, but test negative for Lyme disease. The Lone Star tick carries the disease STARI, or Southern Tick-Associated Rash Illness.

Early symptoms of Lyme disease may include:

• circular red rash

• headache

• chills

• fever

• swollen lymph nodes

• stiff neck

• fatigue

• depression

Lyme Disease Symptoms – Second Stage

Within days to weeks of infection, the bacteria enter the bloodstream. As the disease progresses, Lyme disease rash may appear on other areas of the body, unrelated to the initial bite site.

Symptoms of Lyme disease in the second stage may include:

• rash on multiple sites on the body

• purplish lumps on the earlobe, nipple or scrotum (borrelial lymphocytoma)

• joint pain

• heart palpitations

• central and peripheral nervous system disorders

• general weakness

• extreme fatigue

Lyme Disease Symptoms – Third Stage

The third stage of Lyme disease can last for several months to several years. Symptoms may include:

• chronic arthritis

• shooting pains

• numbness

• tingling in hands and feet

• neurological disorders

• panic attacks and anxiety

• delusional behavior; detachment from reality

• memory loss

• paraplegia (in extreme cases)

Usually, Lyme disease is not fatal. Complications arise when the disease is not properly treated, leading to chronic health problems in infected individuals.

Diagnosis of Lyme Disease

The circular, radiating red rash is the most obvious sign of early stage infection of Lyme disease. Diagnosis also includes the history of exposure to ticks carrying Lyme disease, such as outdoor activity in areas of high tick populations.

Symptoms of Lyme disease can imitate those of other diseases and conditions such as rheumatoid arthritis, fibromyalgia, multiple sclerosis, lupus, chronic fatigue syndrome (CFS) and schizophrenia. Misdiagnosis is common, and experts disagree on effective testing methods for Lyme disease.

Laboratory diagnosis of Lyme disease includes tests to measure levels of antibodies in a patient’s blood. In the early stages, blood tests may appear negative. In the later stages, when the body has produced more antibodies, the tests are more reliable. Other test procedures include:

• Leukapheresis - examination of white blood cells

• Lumbar puncture or spinal tap – collection and testing of cerebrospinal fluid (CSF) below the spinal cord

• Magnetic resonance imaging (MRI) – brain imaging, using a strong magnetic field and radio waves.

Treatment of Lyme Disease

When U.S. President George Bush contracted Lyme disease, doctors recognized the early stages of the disease by the tell-tale circular rash. Bush underwent a schedule of antibiotic treatments to cure the infection. Antibiotics are the common course of treatment for Lyme disease. If the disease is diagnosed and treated in the early stages, it has no lasting effects on the patient.

The further the disease progresses, the more difficult it is to treat.

Most cases of Lyme disease require two to four weeks of treatment, with antibiotics doxycycline, amoxicillin, or ceftriaxone. Patients with cardiac or neurological symptoms may receive intravenous treatment with ceftriaxone or penicillin. In the later stages of the disease, a patient may have persistent or recurrent symptoms, and may need a longer course of antibiotic treatment.

Although scientists developed a Lyme disease vaccine, its use was discontinued in 2002. The vaccine was not effective over the long term. Anyone previously vaccinated against Lyme disease is currently still at risk for the disease.

Prevention of Lyme Disease

Only about ten percent of Lyme disease patients recall being bitten by a tick. Because the tick may be barely visible to the human eye, it may be difficult to spot. A person bitten by a tick usually feels a brief pricking sensation.

Hunters, outdoor enthusiasts and people in high-risk regions should check regularly for ticks.

Immediately remove an attached tick. If the tick is not engorged, there is no risk of Lyme disease. To transmit the disease, a tick needs to attach to its host for 36 to 48 hours. To remove a tick, grasp the head with tweezers, and pull gently but firmly. Do not pull the body of the tick, as it will tear away, leaving the head and mouth parts in the patient’s skin.

(above: an attached tick)

Ticks cling to foliage, tall grass or underbrush. Wear protective clothing outdoors. Tie hair back. Wear a hat, long-sleeved shirts, and long trousers tucked into boots or socks. Wear light-colored clothing, to make the tick easier to spot before it can attach itself to the body.

Do not sit directly on the ground, or on stone walls or wood piles.

Domestic guinea fowl have been shown to control tick populations. Guinea fowl feed on ticks, beetles and mosquitoes, and many guinea fowl owners have reported a significant decrease in ticks and insects without using chemicals.

Pets can bring ticks into the house. Check outdoor pets thoroughly before allowing them indoors. Dogs and cats can also get Lyme disease, but cannot tranfer the disease to humans.

Around the home, keep leaf litter and underbrush cleared. Clean beneath bird feeders. Keep lawn and garden free of prolonged moisture or humid conditions.

Pest repellents with 20 to 30% DEET (N,N-diethyl-meta-toluamide) are effective in reducing risk of tick contact in adults and children. Despite some earlier health concerns, recent research finds that DEET is not as harmful to children as previously suspected. .

Permethrin is a long-lasting and effective repellent, and can be applied to shoes and clothing, but not directly to skin.

Pesticides, or acaricides, can reduce local tick populations by 68 to 100%. Regulations for the use of pesticides vary by region Check with local authorities before using any chemical or pesticide product.

Communities can help lower the risk of Lyme disease by keeping populations of deer, as well as rodents and other small animals, under control.

Further Reading

1. Lyme Disease (Centers for Disease Control and Prevention)

2. Safe use of DEET and other Insect Repellents (Health Canada 2009)

3. Guinea fowl and tick control

4. An interview with Willy Burgdorfer, about Lyme disease controversy