How it works and how to deal with it

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By Barry C. Fox, MD, University of Wisconsin

Lyme disease is the most common tick-borne infectious disease in the United States. It is estimated that there are over 300,000 cases of Lyme disease in the United States each year. One patient who suffered from the disease said it felt like a thick steel band had compressed her neck.

Lyme disease is transmitted by ticks and infects people when they are bitten. (Image: KPixMining / Shutterstock)

The bite of the black-legged deer tick

Lyme disease is caused by a spirochete called Borrelia Burgdorferifrom the bite of the black-legged deer tick. The tick must have been in place for more than 24 hours for the spirochetes to begin transmitting. It is therefore worth checking yourself for a wooded area so that the ticks can be removed as soon as possible. If it was less than 24 hours after exposure to ticks, Borrelia Transmission is unlikely.

The acute phase of Lyme disease includes symptoms that usually begin 3 to 14 days after infection, including headache, fatigue, fever, and a tell-tale bullseye rash known as Erythema Chronicum Migrans. This rash occurs in nearly 80 percent of Lyme disease cases and can appear on one or more spots on the skin.

The rash should not be confused with the few inches of redness that often occurs at the site of the actual tick bite. Lyme rash is usually so distinctive that it even makes a clinical diagnosis without the use of blood tests.

Up to 20 percent of people with acute illness can develop a focal neurological deficit, particularly Bell’s facial palsy, which fortunately is reversible. Non-fatal mild forms of meningitis can also occur. Much less often, an unusually slow heart rate can lead to dizziness and fainting before a diagnosis is made.

This is a transcript from the video series An Introduction to Infectious Diseases. Check it out now on The Great Courses Plus.

Are Lyme Disease Tests Reliable?

Some people exposed Borrelia never have any symptoms. Up to five percent of certain Lyme states may have a truly positive blood test, but no memory of an illness. Additionally, up to five percent of patients may also get a false positive test due to the non-specific nature of the IgM immune response applied to an infection, not specifically Lyme disease.

A second confirmatory test, known as the Western blot test, is used to confirm the first true antibody test to be a true positive. But is it possible for someone who was infected with Borrelia have a negative Lyme serological test? Many people who are given antibiotics early in their illness may not develop Lyme antibodies until a few weeks later, but ultimately almost consistently test positive, and this is a common misconception by the public.

It can also be heard that there may be shortcomings in the blood antibody tests for Lyme and that a negative test does not rule out he may have contracted clinical Lyme disease. This can become a point of contention among people who believe they have persistent symptoms of Lyme disease but have no serological evidence of infection.

Learn more about zoonosis – germs that jump from animals to humans.

Diagnosing Lyme disease is complicated

The infectious disease community holds a fairly firm belief that only patients with documented positive Lyme tests have the opportunity to develop late sequelae or aftereffects of Lyme, while other stakeholders disagree.

Lyme-positive test results usually last lifelong, but the size of the test result does not correlate with later symptoms. This makes diagnosing Lyme disease more complicated when people become re-infected.

Direct hit on a human leg.
A rash is a tell-tale sign of Lyme disease. (Image: AnastasiaKopa / Shutterstock)

Note that if a pregnant mother becomes infected with Lyme during pregnancy, the fetus can become infected. If the mother is not treated, the placenta can become infected, which can lead to a possible stillbirth.

However, when the mother is treated with antibiotics, there are usually no serious side effects to the fetus.

Good advice to pregnant women would likely be, if possible, to avoid outdoor areas where ticks are prevalent, especially during the summer months when there are major incidents.

Learn about the history of antibiotic development.

Treatment for Lyme Disease

There are several oral antibiotic treatments for Lyme, which commonly include doxycycline and amoxicillin. Patients with more severe neurological disorders or cardiac forms of the disease may need intravenous therapy.

Doctor removes tick from patient.
Lyme disease can be treated, although it is better to prevent it by taking precautions in high-risk areas. (Image: Alexander Raths / Shutterstock)

In high-risk Lyme areas of the country, single-dose doxycycline prophylaxis has been commonly administered to patients with tick bites that have persisted for more than 24 hours. This 24-hour measure is just as effective as 10-day preventive drugs.

If left untreated, rare patients can develop late manifestations of Lyme, primarily caused by a non-specific, generalized immune overreaction. This may include debilitating arthritis or nerve damage (in rare cases). Because they are immune-mediated antibiotics, long-term, long-term oral or intravenous antibiotics are not effective and are therefore not recommended.

Why is there no vaccine?

Why isn’t there a Lyme vaccine when it’s so common? There is a canine vaccine for Lyme and many dogs are vaccinated every year. But why is there no human vaccine? Two drug companies developed a human vaccine against Lyme disease (which is 50 to 70 percent effective after two doses). Over time, however, the number of vaccinations requested fell from 1.5 million to just 10,000, and vaccines were discontinued due to a lack of public interest.

There have also been some legal battles in which patients actually claimed they developed autoimmune symptoms from the vaccine itself. This created a negative incentive for pharmaceutical development and production ceased. There are a few companies that are currently testing new Lyme vaccines. Maybe this will be beneficial again.

Remember, if someone tests positive for Lyme, they will likely always test positive for Lyme. While it is recognized that the Lyme disease does not “reactivate” months or years later, a new infection with a new tick carrier is possible Borrelia. These cases may be more difficult to diagnose, especially if there is no ECM rash.

Common questions about how Lyme disease works and how to deal with it

Q: What are the symptoms of Lyme disease?

The symptoms of Lyme disease These include headache, fatigue, fever, and a rash. This rash occurs almost 80% of the time. Symptoms begin between 3 and 14 days after the initial infection.

Q: Can Lyme Disease Affect an Unborn Baby?

Yes, if a pregnant woman has Lyme diseaseThen the fetus can also become infected. When the mother is treated with antibiotics, the fetus usually does not experience serious side effects.

Q: Why did the Lyme disease vaccines stop after a while?

After the vaccines for Lyme disease demand slowly decreased, but what also contributed to the dropout were lawsuits filed against drug companies by patients who claimed they had developed autoimmune symptoms.

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