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Making Sense of ... Lyme disease

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Lyme Disease

What is Lyme disease?

Lyme disease is a bacterial infection, caused by spirochetes from the Borrelia burgdorferi group. The infection is transmitted to humans via bites of infected ticks.

Where is Lyme disease usually found?

Lyme disease mostly occurs in temperate forest regions of Europe, Asia and the Americas. June and July are the seasonal peak of host-seeking activities of infective nymphal-stage ticks in northern hemisphere areas where the diseaseis endemic.

How common is Lyme disease?

In the United states, 20-25,000 cases are reported annually; in the ten states where the disease is found most often, the rate is over 30 cases per 100,000 population.

Underreporting is still an issue, partly as statistics include only people who present with a classic erythema migrans rash - the hallmark symptom of Lyme disease.

How is Lyme disease transmitted?

Ticks infected with Borrelia burgdorferi transmit Lyme disease. The tick most commonly associated with the disease in the Northeast US is the blacklegged tick, Ixodes scapularis, but other ticks have been identified as transmiission vectors elsewhere.

The larval and nymphal stages of the tick are less than 2 mm; adult ticks are slightly larger. Ticks usually transmit the disease to during the nymphal stage. This may be because nymphs are so small that they can pass unnoticed on a person's body for days, rather than hours; this gives them ample time to feed and transmit the infection. research suggests that 24 to 36 hours is needed for the infection to be transmitted).

Can Lyme disease be spread from person-to-person?

It is theoretically possible that the disease could be transmitted via blood transfusion or other contact with infected blood or urine: no such incidents have been recorded. There is no evidence of transission by air, food or water, or from sexual contact or even directly from animals. There is little evidence that insects transmit Lyme disease.

Who is most at risk from Lyme disease?

Ticks find their way to the tips of grasses and shrubs, and transfer to animals or persons who brush against the vegetation; so those who live, work or hunt in endemic areas are at risk.

What are the symptoms of Lyme disease?

Lyme disease is an inflammatory disease characterized by a skin rash, joint inflammation, and flu-like symptoms. Many people presenting with Lyme disease are unaware of the tick bite; they are more likely to develop symptoms, as the tick may have been feeding for a longer period.

A characteristic red lesion usually appears at the site of the tick bite. This may be over three inches in diameter, often with a clear area in the middle.

Other symptoms may include:

  • Fever
  • Headache
  • Muscle pain
  • Inflammation of the large joints
  • Lethargy
  • Neck stiffness

Additional symptoms occasionally seen:

  • Overall itching
  • Unusual behavior

What are the long term effects of Lyme disease?

Physical examination of people with advanced Lyme disease may reveal joint, heart, or brain abnormalities.

What is the mortality rate for Lyme disease?

Negligable.

How is Lyme disease diagnosed?

Diagnosis is primarily on the basis of clinical examination, but this is difficult in the early stages of the disease1. However, as many clinicians rely on the initial local lesion, false negatives are common in early disease. If advanced or disseminated disease is suspected, laboratory confirmation is vital - and useful.

Is there a treatment for Lyme disease?

Early and / or localized disease is effectively treated with oral antibiotics - doxycycline (for adults) or amoxycillin are the first line choices.

Late diagnosed or disseminated disease will require extended therapy (14-28 days), and symptoms may indicate parenteral therapy. Ceftriaxone is the first line antibiotic by the parenteral route.

Is there a way to prevent infection?

Current advice to people moving in high risk areas is to be "Tick Aware"; this includes learning about tick-borne diseases, such as Lyme disease.

  1. Use insect repellants over clothing and on exposed skin
  2. Wear long sleeved clothes, fasted at the cuff
  3. wear trousers, not shorts, tucked into socks
  4. Wear shoes or boots - not sandals
  5. Examine self and companions every 2-3 hours
  6. Perform a thorough skin search at the end of the day.
  7. Pay special attention to skin fold areas and scalp
  8. Remove outdoor clothing outdoors and check carefully.
  9. Ensure pets do not bring ticks into the home.
  10. remove any ticks - but don't panic!

Ticks should be removed carefully without twisting, jerking or squeezing; do not use chemicals or heat - this may cause the tick to regurgitate infected blood back into the wound, increasing the disease risk. Sometimes the ticks head or mouthparts may become separated, with parts remaining in the wound - this is unlikely to increase the risk of Lyme disease, but may lead to local skin infection. Tick extractors are easily and cheaply available, and should be carried by those who visit high-risk areas frequently.

Is there a Lyme disease vaccine?

Lymerix was developed as a vaccine to protect against Lyme Disease. Lymerix (Lyme Disease Vaccine [Recombinant OspA]) received FDA approval in 1998, but was the subject of many reports of severe arthritis and the contraction of Lyme Disease itself. Federal health authorities investigated whether some people who received the Lymerix vaccine later developed severe cases of arthritis or Lyme disease as a result.

There were many law suits, including class action, and not all the legal battles are over.

In 2002, the maker withdrew it from the market, citing poor sales, despite Federal health officials finding no evidence that the vaccine was dangerous. Centers for Disease Control and Prevention had advised that only those at high risk should be vaccinated, largely because the vaccine did not offer complete protection. research suggests it was 80 percent effective after a full course of three injections.

The vaccine to prevent the illness is no longer available.

Can Lyme disease be controlled environmentally?

Ticks are endemic; there is no realistic expectation of the risk of tick-borne diseases being eradicated.

Is there legal protection for workers and others?

Employers have a duty of care, and should ensure their employees who ned to move in high risk areas have appropriate education, warnings and skin protection. There is legal recourse for employees who are not forwarned and prepared for entering high risk areas.

Similarly, visitors to high-risk areas that are open to the public are entitled to warnings of the risk.

See the section on vaccine for more on legal issues.

What can be learned from history?

In 1975, Lyme Disease was classified as disease in following the diagnsis of almost fifty cases of pediatric arthritis in Lyme, Connecticut. The disease was originally called 'Lyme Arthritis', until more was known and understood.

But Lyme disease was not new; Alfred Buchwald described a case of degenerative skin disorder now known as acrodermatitis chronica atorphicans, in 1883.

In 1909, Arvid Afzelius described an expanding ring-like lesion (erythema migrans), and in 1921, he speculated on the origin of the disease as the Ixodes ccapularis tick and linked the disease with joint problems.

Over the next fifty years, further symptoms were linked with the disease, culminating with Allen C. Steere's investigation of a group of rashes and swollen joints in Lyme, Connecticut in 1975. In the same year, Scrimenti published details of successful treatment of the rash with penicillin.

Despite all the history, however, Steere's team misdiagnosed Lyme Disease as "Lyme Arthritis" (juvenile rheumatoid arthritis) in 1977.

Most doubt was removed in 1982, with Dr. Willy Burgdorfer's identification of the etiological agent of the disease, Borrelia burgdorferi.

Bibliography and Further Information Sources

References

  1. Aucott, J., at al (2009) Diagnostic challenges of early Lyme disease: Lessons from a community case series BMC Infectious Diseases 2009, 9:79 [PDF]

If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

First Published: 07 June 2007
Last updated: 18 March 2012
© Andrew Heenan 2007 et seq
 

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This site is not - and is not intended to be - a substitute for medical advice.

The information provided here is accurate, to the very best of our knowledge, but it is general facts, never, ever, specific to your circumstances.

If you need medical advice, you need a doctor.

If you need legal advice, you need a lawyer.

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