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Also known as tick-borne borreliosis or Lyme arthritis, Lyme disease is caused by the bacteria Borrelia burgdorferi, which is transmitted by the Ixodes tick. Lyme disease may cause symptoms affecting the skin, nervous system, heart and/or joints. Lyme disease is most common in the Northeast and mid-Atlantic states.
Causes & Development; Risk Factors
Not all deer ticks are infected with the bacteria that causes Lyme disease. Ticks can become infected if they feed on small animals that are infected. The disease can be spread when a tick infected with the bacteria bites a person and stays attached for a period of time. Person-to-person spread of Lyme disease does not occur.
Lyme disease can affect people of any age. People who spend time in grassy and wooded environments are at an increased risk of exposure. The chances of being bitten by a deer tick are greater during times of the year when ticks are most active. Deer ticks in the nymphal stage are active from mid-May to mid-August, and are about the size of poppy seeds. Adult ticks, which are approximately the size of sesame seeds, are most active in mid to late fall. The risk of exposure to infected deer ticks may be statewide.
Signs & Symptoms
Early symptoms may develop within a week to a few months of the tick bite. In about half of these cases a large, reddish rash about 2 inches in diameter appears and expands around or near the site of the bite. Sometimes multiple rash sites appear. Other symptoms, such as fever, headache, fatigue, stiff neck, muscle and/or joint pain, may develop. If left untreated, within a few weeks to months, complications, such as meningitis, facial palsy, or heart abnormalities may occur. Later symptoms may develop in people who did not have early symptoms or did not recognize them. Swelling and pain in the large joints may recur over many years. It is believed that re-infection is possible i.e. having it once does not provide full immunity.
Diagnosis & Tests
Laboratory testing for Lyme disease is under continuing development, but is still the best method to confirm the diagnosis. The Lyme Disease Foundation (LDF), in their brochure entitled "LDF Frequently Asked Questions About Lyme Disease" (1999), lists nine reasons for false negative Lyme disease tests results. This means that even though tests indicate you don't have the disease, you still could.
Nine reasons for false negative Lyme disease tests results:
A. Antibodies against Borrelia burgdorferi (Bb) are present, but the laboratory is unable to detect them.
B. Antibodies against Bb may not be present in detectable levels in patients with Lyme disease. Possible reasons for this are listed below.- The patient is currently on, or has recently taken, antibiotics. The antibacterial effect of antibiotics can reduce the body's production of antibodies.
- The patient is currently on or has previously taken anti-inflammatory steroidal drugs (such as those taken to treat
rheumatoid arthritis) or certain anticancer drugs. These can suppress a person's immune system, thus reducing or preventing an antibody response. - The patient's antibodies may be bound with the bacteria with not enough free antibodies available for testing. This reason is very important and prevalent. Some of the worst cases of Lyme disease test negative - too much bacteria for the immune system to handle.
- The patient could be immunosuppressed for a number of other reasons and the immune system is not reacting to the bacterium.
- The bacterium has changed its makeup (antigenic shift) limiting recognition by the patient's immune system.
- The patient's immune response has not been stimulated to produce antibodies, i.e., the blood test is taken too soon after the tick-bite (2-6 weeks). Please do not interpret this statement as implying that you should wait for a positive test to begin treatment.
- The laboratory has raised its cutoff so high that a patient's previously positive test is now borderline or negative.
- The patient is reacting to the Lyme bacterium, but is not producing the "right" bands to be considered positive.
Treatment & Prevention
What can be done to prevent it? When in tick-infested areas (i.e. tall grass, overgrown brush, etc.), special precautions should be taken. Wear light-colored clothing, tuck pants legs into socks, and wear closed toe shoes. Use commercial insect repellents (particularly those containing DEET) sparingly and with care, as they may cause side-effects, especially in young children. Avoid application to damaged skin. When returning from outdoors it is important to check yourself, your children and your pets for ticks. Look for ticks in all joint areas, the navel, behind ears, in the hairline, and in other skin folds. Wash all skin treated with insect repellent thoroughly. Keep your lawn mowed and cut overgrown brush.
Prognosis
Prognosis is improved with prompt diagnosis and appropriate, early treatment.
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Signs, symptoms & indicators of Lyme Disease:
Conditions that suggest Lyme Disease:
Risk factors for Lyme Disease:
Lyme Disease suggests the following may be present:
Lyme Disease could instead be: | | | | | Aging |  Alzheimer's Disease | Spirochetes, such as those found in Lyme disease, may be one of the causes of Alzheimer's disease and may also be the source of beta amyloid deposited in the brains of such infected patients. |
 Parkinson's Disease| | Differentiating neuropsychiatric Lyme disease from a primary psychiatric disorder can be a daunting task. Functional brain imaging and neuropsychological testing can be particularly valuable in helping to make diagnostic distinctions. |
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Autoimmune |
Lupus, SLE (Systemic Lupus Erythromatosis)| | Lyme arthritis is often mistaken clinically for systemic lupus erythematosus. |
Amyotrophic Lateral Sclerosis| | Many different neurological conditions may be seen in the later stages of Lyme's Disease, such as blindness, epileptic crises, CVA, extrapyramidal disorders, amyotrophic lateral sclerosis, and dementia. |
Multiple Sclerosis| | Lyme Disease has been called "The New Great Imitator", a replacement for that old "great imitator" neurosyphilis. The two diseases share so many symptoms that Lyme disease should be ruled out if multiple sclerosis diagnosis is in question. |
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Immunity |
Chronic Fatigue / Fibromyalgia Syndrome| | Lyme disease should be a differential diagnosis for all fibromyalgia patients who could have been exposed to a tick bite. |
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Musculo-Skeletal |
Juvenile Rheumatoid Arthritis| | Lyme disease was "discovered" in Lyme, Connecticut in 1975 because of the perseverance of Polly Murray, a homemaker who thought that too much Juvenile Rheumatoid Arthritis (JRA) was being diagnosed in her community. Putting aside the issue of whether Lyme disease does or does not cause some cases of JRA, the two diseases share so many symptoms that Lyme disease is often mistaken for JRA. |
Gout / Hyperuricemia| | Lyme disease is similar to gout and is sometimes misdiagnosed as such. |
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Nervous System |
Guillain-Barre Syndrome| | Putting aside the issue of whether Lyme disease does or does not cause some cases of Guillain-Barre syndrome, the two diseases share so many symptoms that Lyme disease can be mistaken for Guillain-Barre syndrome. |
Trigeminal Neuralgia / Facial Pain| | The rheumatoid-related condition, Lyme disease, can cause head and neck pain which could be mistaken for trigeminal neuralgia. |
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Recommendations and treatments for Lyme Disease:
KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link |  | | May do some good |  | | Likely to help |  | | Highly recommended |
GLOSSARY
AIDS
Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Alzheimer's Disease (Alzheimer's)
A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Antigen (Antigenic, Antigens)
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bell's Palsy
One-sided facial paralysis of sudden onset and unknown cause. The mechanism is presumed to involve swelling of the nerve due to immune or viral disease, with ischemia and compression of the facial nerve in the narrow confines of its course through the temporal bone.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Dementia (Senile Dementia)
An acquired progressive impairment of intellectual function. Marked compromise exists in at least three of the following mental activity spheres: memory, language, personality, visuospatial skills, and cognition (i.e. abstraction and calculation).
Extrapyramidal
Referring to brain structures other than those needed for motor activities.
Fibromyalgia (FMS)
Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Gout
A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mineral (Minerals)
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Multiple Sclerosis (MS)
Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g. muscle weakness, loss of vision, and mood alterations.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Prognosis
A prediction (estimate) of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Trigeminal Neuralgia (Facial Neuralgia, Tic Douloureux)
This condition involves pain in the trigeminal nerve - chief sensory nerve of the face and the motor nerve enabling chewing. It is a disorder of the trigeminal nerve producing bouts of severe, lancinating pain lasting seconds to minutes in the distribution of one or more of its sensory divisions, most often the mandibular and/or maxillary. The cause is uncertain. Recently, at surgery or autopsy, arterial and - less often - venous loops have been found compressing the trigeminal nerve root at its entry point into the brainstem, which suggests that this is essentially a compressive neuropathy. Adults usually are affected, especially later in life. The pain is often set off by touching a trigger point or by activity (e.g. chewing or brushing the teeth). Although each bout of intense pain is brief, successive bouts may incapacitate the patient.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Last updated: May 11, 2008
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