Lyme disease is the most common tick-borne disease in North America and Europe. Lyme disease is caused by a bacterial infection and occurs worldwide. The occurrence of Lyme disease in Iowa resembles the national trend reflecting increasing cases of Lyme borreliosis at an alarming rate. Tick-borne illnesses can be serious and disabling.

Since Lyme disease is a multi-systemic illness, there are a wide variety of possible symptoms. These symptoms may vary from mild to severe, and they may come and go. The longer the disease remains undetected, the more difficult it is to treat, and treatment failures do occur. Since early detection and treatment is critical, seek medical advice from a physician experienced with tick-borne illnesses as soon as possible if you think you may have symptoms of Lyme or another tick-borne illness.

Basic Information about Lyme Disease

Source: (International Lyme and Associated Diseases Society, Maryland, U.S.) www.ILADS.org
Updated 4/15/06

1. Lyme disease is transmitted by the bite of a tick, and the disease is prevalent across the United States and throughout the world. Ticks know no borders and respect no boundaries. A patient's county of residence does not accurately reflect his or her Lyme disease risk because people travel, pets travel, and ticks travel. This creates a dynamic situation with many opportunities for exposure to Lyme disease for each individual.

2. Lyme disease is a clinical diagnosis. The disease is caused by a spiral-shaped bacteria (spirochete) called Borrelia burgdorferi. The Lyme spirochete can cause infection of multiple organs and produce a wide range of symptoms. Case reports in the medical literature document the protean manifestations of Lyme disease, and familiarity with its varied presentations is key to recognizing disseminated disease..

3. Fewer than 50% of patients with Lyme disease recall a tick bite. In some studies this number is as low as 15% in culture-proven infection with the Lyme spirochete.

5. The Centers for Disease Control and Prevention (CDC) surveillance criteria for Lyme disease were devised to track a narrow band of cases for epidemiologic purposes. As stated on the CDC website, the surveillance criteria were never intended to be used as diagnostic criteria, nor were they meant to define the entire scope of Lyme disease.

6. The ELISA screening test is unreliable. The test misses 35% of culture proven Lyme disease (only 65% sensitivity) and is unacceptable as the first step of a two-step screening protocol. By definition, a screening test should have at least 95% sensitivity.

7. Of patients with acute culture-proven Lyme disease, 20–30% remain seronegative on serial Western Blot sampling. Antibody titers also appear to decline over time; thus while the Western Blot may remain positive for months, it may not always be sensitive enough to detect chronic infection with the Lyme spirochete. For “epidemiological purposes” the CDC eliminated from the Western Blot analysis the reading of bands 31 and 34. These bands are so specific to Borrelia burgdorferi that they were chosen for vaccine development. Since a vaccine for Lyme disease is currently unavailable, however, a positive 31 or 34 band is highly indicative of Borrelia burgdorferi exposure. Yet these bands are not reported in commercial Lyme tests.

8. When used as part of a diagnostic evaluation for Lyme disease, the Western Blot should be performed by a laboratory that reads and reports all of the bands related to Borrelia burgdorferi. Laboratories that use FDA approved kits (for instance, the Mardx Marblot®) are restricted from reporting all of the bands, as they must abide by the rules of the manufacturer. These rules are set up in accordance with the CDCs surveillance criteria and increase the risk of false-negative results. The commercial kits may be useful for surveillance purposes, but they offer too little information to be useful in patient management.

9. There are 5 subspecies of Borrelia burgdorferi, over 100 strains in the US, and 300 strains worldwide. This diversity is thought to contribute to the antigenic variability of the spirochete and its ability to evade the immune system and antibiotic therapy, leading to chronic infection.

10. Testing for Babesia, Anaplasma, Ehrlichia and Bartonella (other tick-transmitted organisms) should be performed. The presence of co-infection with these organisms points to probable infection with the Lyme spirochete as well. If these coinfections are left untreated, their continued presence increases morbidity and prevents successful treatment of Lyme disease.

11. A preponderance of evidence indicates that active ongoing spirochetal infection with or without other tick-borne coinfections is the cause of the persistent symptoms in chronic Lyme disease.

12. There has never been a study demonstrating that 30 days of antibiotic treatment cures chronic Lyme disease. However there is a plethora of documentation in the US and European medical literature demonstrating by histology and culture techniques that short courses of antibiotic treatment fail to eradicate the Lyme spirochete. Short treatment courses have resulted in upwards of a 40% relapse rate, especially if treatment is delayed.

13. Most cases of chronic Lyme disease require an extended course of antibiotic therapy to achieve symptomatic relief. The return of symptoms and evidence of the continued presence of Borrelia burgdorferi indicates the need for further treatment. The very real consequences of untreated chronic persistent Lyme infection far outweigh the potential consequences of long-term antibiotic therapy.

14. Many patients with chronic Lyme disease require treatment for 1–4 years, or until the patient is symptom-free. Relapses occur and maintenance antibiotics may be required. There are no tests currently available to prove that the organism is eradicated or that the patient with chronic Lyme disease is cured.

15. Like syphilis in the 19th century, Lyme disease has been called the great imitator and should be considered in the differential diagnosis of rheumatologic and neurologic conditions, as well as chronic fatigue syndrome, fibromyalgia, somatization disorder and any difficult-to-diagnose multi-system illness.

Disclaimer: The foregoing information is for educational purposes only. It is not intended to replace or supersede patient care by a healthcare provider. If an individual suspects the presence of a tick-borne illness, that individual should consult a healthcare provider who is familiar with the diagnosis and treatment of tick-borne diseases.

How do people get Lyme disease?

Lyme disease (LD) or Lyme borreliosis is an infection caused by the species complex Borrelia burgdorferi sensu lato, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried most commonly by ticks. An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are very severe or life threatening.
Who can get Lyme disease?

Persons of all ages and both sexes are equally susceptible, although the highest rates are in children up to 15 years of age and in adults 30 years and older. The body does not maintain a natural immunity to the disease. Thus, a person can be re-infected with the disease on subsequent tick bites.
What does Lyme do to the body in the early stages?

LD manifests itself as a multi-system inflammatory disease that infects the skin in its early, localized stage, and quickly spreads to the joints, nervous system and, many other organ systems in its disseminated stages. If diagnosed and treated early with the proper antibiotics, LD prognosis is improved. However, early detection is difficult when the characteristic rash is not present, and even those who are diagnosed and treated early may remain symptomatic and need long term treatment.
What happens if misdiagnosed or not treated properly?

Late, disseminated Lyme borreliosis is comprised of many debilitating symptoms and is considered difficult to treat by the medical community. Late, disseminated borreliosis results from delayed or inadequate treatment. The rate of disease progression and individual response to treatment varies from one patient to the next and can be disabling. Some patients may experience persistent late stage Lyme disease and have symptoms for many months or even years, even with treatment. Typically these are patients in whom Lyme disease was unrecognized in the early stages or for whom the initial treatment was inadequate. In some patients, late stage LD causes varying degrees of permanent arthritic joint or neurological damage or even death.
What makes treating tick infections so difficult?

Lyme disease is complicated by the fact that one tick bite can transmit many different tick borne illnesses, and testing can be inaccurate. Due to the vast range of symptoms present in Lyme, often times patients are misdiagnosed with fibromyalgia, chronic fatigue syndrome, multiple sclerosis, depression, rheumatoid arthritis, ALS, Parkinson's, and other autoimmune conditions or neurological disorders.
Is Lyme disease a new disease?
Manifestations of what we now call Lyme disease were first reported in medical literature in Europe in 1883. Over the years, various clinical signs of this illness have been noted as separate medical conditions: acrodermatitis, chronica atrophicans (ACA), lymphadenosis benigna cutis (LABC), erythema migrans (EM), and lymphocytic meningradiculitis (Bannwarth's syndrome). However, these diverse manifestations were not recognized as indicators of a single infectious illness caused by Borrelia bacteria until 1975, when LD was described following an outbreak of apparent juvenile arthritis, preceded by a rash, among residents of Lyme, Connecticut.
How is Lyme disease treated?

Antibiotic therapy is the treatment of choice for Lyme disease. The antibiotic used, route of administration and duration of antibiotic therapy is determined by stage of infection. See the treatment guidelines section for details.

Treating late stage Lyme disease is very challenging, and some are never cured. While scientific knowledge of the bacterium and disease continues to grow, there is much that is still unknown.