Lyme Basics

Late summer has set in, and the lazy days of sun and sand are numbered. But, before you pack up the pool toys and break out the fall sweaters, you should make sure you’re not ending summer with more than just new tan lines. At Enhanced Medical we encourage our patients to get tested for Lyme disease at the end of summer, even if they have not spent much time outdoors, and whether they remember having been in contact with ticks or not. Experts say this year may be worse than normal for Lyme exposure, as our record snowfall, rather than killing ticks off, actually protected them from freezing over the winter. Lyme is an infection caused by the borellia burgdorferi bacterium, and is spread by certain species of ticks. The disease has been found in all 50 states, and several foreign countries, but is most prevalent in the Northeast, upper Midwest, and some Pacific states.

Lyme disease occurs in stages. The first phase occurs in the days and weeks following exposure to the bacterium. It sometimes, but not always, includes the easily recognizable bullseye rash, as well as flu-like symptoms, including fever, aches, and fatigue. If not treated during this early stage, Lyme can progress and cause a myriad of more serious health problems. As the bacterium spreads and settles throughout the body, it can cause inflammation, especially in the joints, connective tissue, heart and nervous system. This inflammation can result in abnormal heart rhythm, heart failure, facial muscle paralysis, peripheral neuropathy, meningitis, as well as mental issues including confusion, depression, anxiety, and rage. In the latest stages of Lyme, patients may experience chronic joint swelling and pain, most often in the knees. For many patients, symptoms linger even after treatment, often due to residual tissue damage caused by Lyme-related inflammation. Lyme disease also has several common tick borne co-infections, which may persist even after the Lyme disease is treated.

Diagnosing Lyme Disease can sometimes be a tricky endeavor. The CDC standard for testing consists of a two tiered approach. First, an ELISA (enzyme linked imunnosorbent assay), which detects the amount of Lyme antibodies present in the blood, is run. If the ELISA shows antibody levels above a certain threshold a Western blot assay is done, which separates the antibody into its different components, each of which interacts with a different component of the borellia burgdorferi bacterium. According to the CDC criteria, at least two IgM (early infection) or five IgG (late infection) antibody component bands must be present to diagnose Lyme disease. Unfortunately, the ELISA test, relative to screening tests for other conditions, is not very sensitive and therefore results in many false negatives. This means the more sensitive diagnostic Western blot assay is too frequently not run on patients who may actually have Lyme. Additionally, in the later stages of chronic Lyme, or if a patient begins treatment before doing confirmatory lab tests, antibody levels may be lower than the threshold, even if the patient does have clinical Lyme disease.

Lyme, like other bacterial infections, is usually treated with a course of antibiotics. When caught early, a short course of antibiotics is usually effective in clearing the borellia burgdorferi bacteria. However, in later stages, treatment becomes more difficult. A longer course of antibiotics, possibly lasting many months, may be necessary to eradicate the bacteria in the body. Additionally, medications to treat later stage symptoms, such as joint pain and inflammation, cardiac problems, or depression, may be necessary.

There is no vaccine or standard prophylaxis for Lyme disease, but there are steps you can take to help prevent the contraction of the disease. When spending time outdoors, especially in wooded areas, wear a bug repellant with at least 30% DEET, long clothes (even better if they are insecticide coated!), and closed shoes. Stick to trails and cleared areas when hiking, and make sure to check your pets for ticks too as they can transfer them to you. If you do get a tick attached to you, remove it with tweezers as soon as possible; the chance of Lyme transmission increases the longer the tick is attached to you.

If you believe there is a chance you were exposed to Lyme this summer, or have exhibited any symptoms of the disease, please let us know and we can check you for Lyme antibodies with a simple blood draw. However, as we touched on in our discussion of the diagnostic process, antibody testing for Lyme can be inconclusive or misleading. We will go into more detail about this in a post next week. Feel free to get in touch if you have any questions about this, or any other issue.

To your health!
The Enhanced Medical Care Team