Lyme disease is caused by Borrelia, a spirochete bacteria. It’s the most common tick-borne infectious disease in the northern hemisphere and there are multiple strains of the bacteria.
Lyme disease is endemic in many parts of the United Kingdom.
Particularly in woodland or heath-land areas but disease carrying ticks can also be found in cities and gardens.
Transmission of Lyme disease can occur when bitten by an infected tick.
Other modes of transmission includ congential transmission from mother to baby.
Although Borrelia has been found in biting insects such as mosquitoesand spiders, there is not yet enough research to prove that the disease can be transmitted via them.
Blood, tissue and organ donation, along with sexual transmission are all cause for concern. But again there is not enough research being done in this area.
The CDC state that, “Although no cases of Lyme disease have been linked to blood transfusion. Scientists have found that the Lyme disease bacteria can live in blood that is stored for donation.”
Until more is known, it would be wise to advise Lyme patients past and present, to avoid donating their blood or tissue.
Signs and symptoms of Lyme disease
Many people with early-stage Lyme disease develop a distinctive circular rash at the site of the tick bite, usually around three to 30 days after being bitten. This is known as erythema migrans.
The rash is often described as looking like a bull’s-eye on a dart board. The affected area of skin will be red and the edges may feel slightly raised.
The size of the rash can vary significantly and it may expand over several days or weeks. Typically it’s around 15cm (6 inches) across. But it can be much larger or smaller than this. Some people may develop several rashes in different parts of their body.
However, around one in three people with Lyme disease won’t develop this rash.
Some people with Lyme disease also experience flu-like symptoms in the early stages, such as tiredness (fatigue), muscle pain, joint pain, headaches, a high temperature (fever), chills and neck stiffness.
More serious symptoms may develop several weeks, months or even years later if Lyme disease is left untreated or is not treated early on. These can include:
- pain and swelling in the joints (inflammatory arthritis)
- problems affecting the nervous system – such as numbness and pain in your limbs, paralysis of your facial muscles, memory problems and difficulty concentrating
- heart problems – such as inflammation of the heart muscle (myocarditis) or sac surrounding the heart (pericarditis), heart block and heart failure
- inflammation of the membranes surrounding the brain and spinal cord (meningitis) – which can cause a severe headache, a stiff neck and increased sensitivity to light
Some of these problems will get better slowly with treatment, although they can persist if treatment is started late.
A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome.
This is known as post-infectious Lyme disease. It’s not clear exactly why this happens, but it’s likely to be related to overactivity of your immune system rather than persistent infection.
When to see your GP
You should see your GP if you develop any of the symptoms described above after being bitten by a tick. Or if you think you may have been bitten.
Make sure you let your GP know if you’ve spent time in woodland or heath areas where ticks are known to live.
Diagnosing Lyme disease is often difficult as many of the symptoms are similar to other conditions. A spreading rash some days after a known tick bite should be treated with appropriate antibiotics without waiting for the results of a blood test.
Blood tests can be carried out to confirm the diagnosis after a few weeks. But these can be negative in the early stages of the infection. You may need to be re-tested if Lyme disease is still suspected after a negative test result.
In the UK, two types of blood test are used to ensure Lyme disease is diagnosed accurately. This is because a single blood test can sometimes produce a positive result even when a person doesn’t have the infection.
If you have post-infectious Lyme disease or long-lasting symptoms, you may see a specialist in microbiology or infectious diseases.
They can arrange for blood samples to be sent to the national reference laboratory run by Public Health England (PHE), where further tests for other tick-borne infections can be carried out.
Treatment of Lyme Disease
If left untreated, Lyme disease can cause significant health issues, including nerve pain, arthritis, and cognitive and neurological problems.
It’s important to get a diagnosis and treatment as soon as possible, before more severe Lyme disease symptoms develop.
Using Antibiotics to Treat Lyme Disease
Lyme disease is typically treated with antibiotics, although the type of antibiotic used depends on what stage of the disease you have.
After you remove a deer tick that has been attached to you for at least 36 hours — the amount of time it takes for the tick to transmit the bacteria Borrelia burgdorferi.
There’s a 72-hour window during which your doctor may give you a single dose of the antibiotic doxycycline to prevent the development of Lyme disease.
Doxycycline is prescribed to patients age 8 and older, except for pregnant women.
If you already have stage 1 (localized) or stage 2 (early disseminated) Lyme disease with the telltale bull’s-eye rash but no other significant symptoms. Your doctor will most likely treat you with oral doxycycline, amoxicillin, or cefuroxime for 14 to 21 days.
But if you have meningitis or nerve issues from early Lyme disease. Your treatment will require taking intravenous ceftriaxone for 14 days.
Stage 3 (late disseminated) Lyme disease is also treated with various antibiotics:
- For Lyme disease that causes arthritis, 28 days of oral doxycycline, amoxicillin, or cefuroxime is prescribed. Additional courses of antibiotics may be necessary, depending on the severity and persistence of your symptoms.
- For Lyme disease affecting the nervous system (late neurologic Lyme disease), two to four weeks of intravenous ceftriaxone or penicillin is prescribed.
Common side effects associated with most antibiotics include gastrointestinal problems, such as nausea, vomiting, and diarrhea.
Allergic reactions can also occur, especially with medications derived from penicillin or sulfa. These reactions can range from a mild rash to anaphylactic shock.
Some drugs can interact with antibiotics, so patients should tell their doctors about any medications they are taking.
Post-Treatment Lyme Disease Syndrome (PTLDS)
After antibiotic treatment for Lyme disease, some people still have lingering symptoms of:
- joint and muscle aches
which can last up to six months or even longer.
This condition is called post-treatment Lyme disease syndrome (PTLDS). It’s also sometimes referred to as chronic Lyme disease.
It isn’t known what exactly causes PTLDS. But scientists think it may be a kind of immune response in which lingering remnants of the bacteria activate the immune system, leading the immune system to attack healthy cells.
The condition may also be the result of residual damage to body tissues from Lyme disease. According to the Centers for Disease Control and Prevention (CDC).
There’s no approved treatment for PTLDS other than relieving specific symptoms. But people with the condition typically get better over time.
Research has found no evidence that extended antibiotic treatment is beneficial for Lyme disease patients in whom symptoms persist after the recommended antibiotic treatment for acute Lyme disease.
Long-term antibiotic or alternative treatments for Lyme disease have also been associated with serious complications.
The CDC recommends that patients who are considering long-term antibiotic treatment for ongoing symptoms associated with a Lyme disease infection should discuss the associated risks with a healthcare provider.