Lyme Disease: Looking Beyond Borrelia
By Tom Moorcroft, DO
cians is that Lyme disease rarely presents with the classic symptoms reported in medical textbooks. Rather, Lyme has been called the new “Great Imitator” because it can look like almost any other disease and commonly looks like several different diseases at the same time. Historically, Syphillis was the first “great imitator.” In this article, we will review some Lyme Basics, including what
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Lyme is, how people get it, how physicians make the diagnosis of Lyme disease and how it is commonly treated. We will also review the less well-known but more common presentations of acute and chronic Lyme disease, symptoms in children (as children act much differently than adults when they are infected with Lyme disease), and individualized approaches to treatment.
Lyme Basics
Lyme disease is the most common vector-borne disease in the United States. It is transmitted to humans by the bite of an infected Ixodes scapularis tick. This tick is better known by its common name the blacklegged or deer tick. Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi. Cases of Lyme have been reported in all 50 states. Summer is the peak time for people to get deer tick bites , but since symptoms may not show themselves for 1-3 months or more after transmission, it’s important to keep Lyme in mind year round.
Deer ticks can be active during all months of the year; however, peak incidence of Lyme transmission occurs during the summer months. Adult deer-tick activity peaks in early spring and again in mid-fall. Adult ticks account for transmission of about 5% of re- ported cases of Lyme disease. The much smaller nymphal tick, that is about the size of a poppy seed, is responsible for about 95% of cases of Lyme and is most active from mid-May through late August in Connecticut. However, I’ve personally seen nymphs active in Con- necticut as late as October. Nymphal ticks feed for 4 days while adult ticks feed for 5-7
days. The rate of transmission of Lyme from the bite of an infected tick increases over time. Transmission over the first 48 hours is about 12%, however it increases dramatically to 75% at 72 hours and 94% at 96 hours. The Centers for Disease Control and Prevention (CDC) has in- dicated that reported cases of Lyme disease are about 10% of actual
12 Natural Nutmeg
Symptoms of Lyme Disease A red rash with central clearing (bull’s eye), called erythema
migrans (EM), is diagnostic of Lyme disease. Studies show that 40- 69% of people have the classic EM rash; however, physicians report that this rate may be as low as 10%. This rash may not occur at the bite site. Patients may present with multiple EM rashes or other types of rashes. fifty to seventy-five percent of those infected with Lyme disease do not remember having had a tick bite. Lyme is a complex, multi-system disease that has the potential to
affect every organ system in the body. The most common symptoms of acute Lyme disease include flu-like symptoms, migratory joint and muscle pains, fatigue, headache, cognitive dysfunction (often called brain fog) and migratory paresthesias (a numb or tingly feeling). Some patients experience sound and light sensitivity as well as eye pain.
Because Lyme can present with many different, seemingly unrelated symptoms, patients may be misdiagnosed with conditions including depression, anxiety, migraine headaches, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome and leaky gut, Parkinson’s disease, and multiple sclerosis. Severe cases of Lyme can cause heart block (a blockage in the
heart’s electrical system), meningitis (inflammation of the covering of the brain and spinal cord) or encephalitis (inflammation of the brain itself), amongst other problems. More than 350 medical conditions have been noted to be caused or associated with Lyme disease in
yme disease and other tick-borne illnesses have reached epi- demic proportions in Connecticut and in much of the United States. one of the greatest difficulties facing patients and physi-
cases that meet their surveillance criteria. This means that up to 90% of cases that meet these criteria are not being reported. Currently, more than 20,000 cases of Lyme disease are being reported each year in the United States. If unreported cases are as prevalent as sus- pected, then there are likely more than 200,000 new cases per year. This would mean that each year 5 times more people would contract Lyme than HIV/AIdS. Lyme disease has reached epidemic proportions in the North- eastern states, including Connecticut. In 2009, the Connecticut state- wide incidence of Lyme disease was 122 cases per 100,000 people, with some counties reaching a rate of 252 cases per 100,000. This is a startling increase when compared to the 2004 statewide incidence of 40 per 100,000. If CDC estimates are correct that would mean that approximately 1 in 100 people in Connecticut become infected with Lyme disease each year. Approximately 25% of the people who become infected with Lyme are children.
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