Lyme Basics: Short & Sweet
Lyme disease is a growing threat. Some published articles contain some very good information, but are incomplete and have common errors. Busy people need accurate information about this misunderstood disease to avoid the extremes of indifference and panic.
Some articles present Lyme disease as easily prevented and not very common. Yet various agencies report almost 240,000 people catching the disease each year in 49 states and the District of Columbia. The actual number is much larger since some physicians rarely report any case, the labs used to test for Lyme are very poor, and one needs grossly obvious symptoms to even be tested. At least all agree that Lyme disease is America's most prevalent disease spread by insects and ticks, called "vectors."
Humans can be infected with Lyme disease when bitten by a tick infected by a bacterium, Borrelia burgdorferi. The species of tick differs in accordance with the part of the country: the black-legged "deer" tick is common in the Northeast, while the lone star tick is prevalent in Texas and, recently, in areas north of Texas all the way to Maine. In California, most human cases of Lyme disease are transmitted by the nymph of the western black-legged tick. The rate of infection among ticks varies by region, but recent studies indicate that between 4 and 41 percent of ticks are infected, with an average rate of 12 percent.
Some articles and physicians present Lyme disease as easily cured if diagnosed early. In fact, Lyme disease is one of the most challenging diseases seen in a long time in that it is difficult to prevent, diagnose and treat. Medical treatment is often delayed, resulting in a greater chance of chronic infection, which can adversely affect a victim both physically and mentally. More than half of the people responding to a survey in California reported a delay in being diagnosed with Lyme disease by an average of over three years. The delay in treatment is often the result of the patient not seeking medical assistance during the early stages of the disease, and doctors failing to diagnose the disease in a timely manner.
Many patients do not seek medical assistance during the early stages of Lyme disease because they do not realize they are infected until symptoms become obvious. For example, less than a third of all patients diagnosed with Lyme disease recall receiving a tick bite. In addition, most patients do not get the bulls-eye rash widely reported as a classic Lyme symptom. The rash may first appear with central redness rather than in a classic bull's-eye or not at all. Also, the size of the rash is not material; some very small rashes have proven to be caused by Lyme disease. Indeed, Lyme can have about ten different types of body marks, and many look trivial.
Misdiagnosis by physicians is often caused by misunderstanding of the diagnostic guidance prepared by the Centers of Disease Control. Testing is woefully inaccurate; many individuals can test negative, repeatedly, and still have the disease. Lyme disease symptoms can mimic those of other diseases, such as chronic fatigue, multiple sclerosis, Alzheimer's, Parkinson's, and Lou Gehrig's disease. One actress was diagnosed as having Lyme and had positive lab tests, only to be talked out of it, and now believes she has another serious illness. This is a sad and common scenario.
Many doctors continue to base their diagnosis on the existence or nonexistence of the bull's-eye rash, which occurs in less than half of the people with Lyme disease. Despite coming from a very large Lyme county with massive numbers of deer, mice and birds, I have never even seen a bulls eye rash and suspect it may be found in only a minority of patients.
Other doctors give credence to reports that infection can occur only if the tick is attached to the patient for 24 to 48 hours. In fact, the duration of tick attachment has no relationship to the transmission of disease. For example, some ticks may carry some Borrelia burgdorferi in their salivary glands rather than their stomach, which results in an immediate infection. Individuals also may improperly squeeze the tick while removing it, thereby squeezing the Borrelia burgdorferi out of the tick and into the victim.
If not diagnosed early, Lyme disease can be very difficult to cure. The bacteria's long life cycle often thwarts eradication by antibiotics. In addition, it can evade the immune system by entering and exiting a cell cloaked in the cell's own material; it can change into other forms, making it difficult for antibiotics to target; and it can form cysts when its environment becomes hostile to it, only to reemerge years later to infect the victim. If not treated, the bacteria will multiply and spread to various organs. Lyme disease is very hard to cure when the bacteria invade the central nervous system, which it can accomplish within days after a tick bite. In addition, the bacteria might occasionally cross the placenta and cause birth defects or death of the fetus.
There are no studies that can accurately define the percentage of people who relapse after short term antibiotic treatment for early Lyme disease. However, support group leaders around the world have reported that many patients are suffering from chronic Lyme disease, generally resulting from earlier misdiagnosis or past insufficient treatment.
It is difficult to provide significantly accurate information about a very complex issue in a short article. A number of excellent websites contain a wealth of information about tick-borne illnesses, such as the International Lyme and Associated Diseases Society (www.ILADS.org) and The Lyme Disease Association (www.lymediseaseassociation.org).
Dr. Schaller would like to thank the Lyme educator, Bob Dyson, for his work on this brief article. He is a wise journal editor, who sincerely cares for the health of his New England neighbors. While he would never want credit for his service, these articles do not write themselves. Thanks Bob!