PreventLymeDisease(Image source) The recent news concerning actor Serban Ionescu who contracted Lyme disease after a tick bite last summer, Romanian medics' questionable understanding regarding the disease and the misguiding and sometimes completely inaccurate articles found in the Romanian press such as THIS just lately, all prompt this post. It is IMPERATIVE that Lyme disease is understood if it is to be avoided and/or treated correctly and efficiently. Rumours that it can be transmitted from person to person for example and that 80% of the Romanian population are possibly infected are completely FALSE, reeking of ignorance and panic-mongering. The tick should NOT be covered with lard to smother it. What a load of rubbish! And Lyme was NOT 'imported' from the USA and neither is it a fatal disease. It is completely treatable. There is NO NEED for people to die of Lyme in 2012.

It may be perfectly true that Lyme disease is 'new' to Romania and hence doctors are not as on the ball as they may be elsewhere. However, Lyme disease is THE most common tick-borne illness in Europe and North America. It was discovered more than twenty years ago and has certainly been on Romanian territory for just as long. Just because it failed to be diagnosed does NOT mean that it didn't exist. I therefore cannot find an excuse for ignorance on the part of doctors and medical staff throughout the country.

I beg you to read the following information carefully and then share it throughout the social networks whether by e-mail or FB. 'Forearmed is forewarned', after all. Perhaps together we can help dispel some of the absurd and uneducated rumours and fears flying around. If you know what causes it, the symptoms it gives, the risk factors and the treatment you ought to receive should you ever suspect you have Lyme disease, you are in control of your body, the care that should be given and the outcome.

All information below is linked to bona fide medical sources so that you can research further if you wish. Further reading in Romanian and a bibliography of references follows the text.

Definition

Lyme disease is caused by the bacterium Borrelia burgdorferi. Deer ticks, which feed on the blood of animals and humans, can harbour the bacteria and spread it when feeding. If you're treated with appropriate antibiotics in the early stages of the disease, you're likely to recover completely. In later stages, response to treatment may be slower, but the majority of people with Lyme disease recover completely with appropriate treatment.

Symptoms

 

  • Rash: A few days to a month before you have other symptoms, a small, red bump may appear at the site of the tick bite. Over the next few days, the redness expands, forming a rash in a bull's-eye pattern, with a red outer ring surrounding a clear area. The rash, called erythema migrans, is one of the hallmarks of Lyme disease. Some people develop several of these rashes, an indication of bacteria multiplying in the blood stream.
  • Flu-like symptoms: Fever, chills, fatigue, body aches and a headache may accompany the rash.
  • Migratory joint pain: If the infection is not treated, you may develop bouts of severe joint pain and swelling several weeks to months after you're infected. Your knees are especially likely to be affected, but the pain can shift from one joint to another.
  • Neurological problems: In some cases, inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement may occur weeks, months or even years after an untreated infection.
  • Less common signs and symptoms: Some people may experience heart problems — such as an irregular heartbeat — several weeks after infection, but this rarely lasts more than a few days or weeks. Eye inflammation, hepatitis and severe fatigue are possible as well.

lyme-disease-stages1There are 3 stages of Lyme disease.

  • Stage 1 is called early localized Lyme disease. The infection is not yet widespread throughout the body.

  • Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.

  • Stage 3 is called late chronic Lyme disease. The bacteria have spread throughout the body.

Causes

 

The Lyme disease bacterium is carried primarily by deer ticks. The ticks are brown and often no bigger than the head of the pin, which can make them nearly impossible to spot. Deer ticks typically feed on the blood of mice, small birds and deer, but they can also feed on the blood of humans, cats, dogs and horses. They live in low bushes and tall grasses of wooded areas, waiting for warm-blooded animals to pass by. Deer ticks are most active in the summer.

To contract Lyme disease, you must be bitten by an infected deer tick. The bacteria enter your skin through the bite and eventually make their way into your bloodstream. Before bacteria can be transmitted, a deer tick must take a blood meal, which can take more than 48 hours of feeding. Only ticks that are attached to your skin and are feeding can transmit the bacteria. An attached tick that has a swollen appearance may indicate that enough time has elapsed to transmit bacteria. Removing the tick as soon as possible may prevent infection.

Risk factors

  • Spendingtime in wooded or grassy areas. Deer ticks are most prevalent in heavily wooded areas where deer ticks thrive. In these regions, children who spend a lot of time outdoors are especially at risk. So are people with outdoor occupations and those who live where mice are common. Deer ticks feed on mice, which are a prime reservoir for Lyme disease bacteria.
  • Having exposed skin. Ticks attach easily to bare flesh. If you're in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants. Don't allow your pets to wander in tall weeds and grasses.
  • Not removing ticks promptly or properly. Bacteria from a tick bite can enter your bloodstream only if the tick stays attached to your skin for 48 hours or longer. If you remove a tick within two days, your risk of acquiring Lyme disease is low.

Complications

Left untreated, Lyme disease can cause:

  • Chronic joint inflammation (Lyme arthritis), particularly of the knee
  • Neurological symptoms, such as facial palsy and neuropathy
  • Cognitive defects, such as impaired memory
  • Heart rhythm irregularities

Tests and diagnosis

  • Enzyme-linked immunosorbent assay (ELISA) test: The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis. See further info HERE and HERE (Romanian)
  • Western blot test: If the ELISA test is positive, another test — the Western blot — is usually done to confirm the diagnosis. The Western blot detects antibodies to several proteins of B. burgdorferi. See more info HERE and HERE (Romanian).
  • Polymerase chain reaction (PCR): This test helps detect bacterial DNA in fluid drawn from an infected joint. It's not as effective at detecting infection of blood or urine. It's used for people who may have chronic Lyme arthritis. It may also be used to detect persistent infection in the cerebrospinal fluid of people who have nervous system symptoms. See further info HERE (Romanian).

Other tests that may be done, when the infection has become more widespread, include:

  • Electrocardiogram

  • Echocardiogram to look at the heart

  • Lumbar puncture to examine spinal fluid

  • MRI of the brain

Treatments and drugs

Antibiotics are used to treat Lyme disease.

Medications:

Oral antibiotics
Oral antibiotics are the standard treatment for early-stage Lyme disease. These usually include doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women. These drugs often clear the infection and prevent complications. A 14- to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective. Patients allergic to penicillin are given erythromycin or related antibiotics.

Intravenous antibiotics
If the disease has progressed, your doctor may recommend treatment with an intravenous antibiotic for 14 to 28 days. This is effective in eliminating infection, although it may take some time to recover symptomatically. Intravenous antibiotics can cause various side effects, including a lower white blood cell count, mild to severe diarrhea, or colonisation or infection with other antibiotic-resistant organisms unrelated to Lyme.

Following treatment for Lyme disease, some people still have persistent fatigue and achiness. This general malaise can take months to slowly disappear, although it generally does so spontaneously without the use of additional antibiotic therapy. There is no evidence that the Borrelia infection causes chronic fatigue syndrome or fibromyalgia. Although some patients with Lyme disease may develop these problems, as with other patients who get chronic fatigue or fibromyalgia, long-term antibiotics will not hasten recovery.

Pain medications, such as ibuprofen, are sometimes prescribed to relieve joint stiffness.

IMPORTANT NOTE: In the first few weeks following infection (when the rash first appears), antibody tests are not reliable because a patient's immune system has not produced enough antibodies to be detected. Antibiotics given to a patient early during infection may also prevent antibodies from reaching detectable levels, even though the Lyme disease bacterium is the cause of the patient's symptoms.

Prevention

You can decrease your risk of getting Lyme disease with some simple precautions:

  • Wear long trousers and sleeves. When walking in wooded or grassy areas, wear shoes, long pants tucked into your socks, a long-sleeved shirt, a hat and gloves. Try to stick to trails and avoid walking through low bushes and long grass. Keep your dog on a lead.
  • Use insect repellents. Apply an insect repellent with a 10-30% concentration of DEET to your skin and clothing. Choose the concentration based on the hours of protection you need - the higher the concentration of DEET, the longer you are protected. A 10% concentration protects you for about two hours. Keep in mind that chemical repellents can be toxic, and use only the amount needed for the time you'll be outdoors. Don't use DEET on the hands of young children or on infants younger than 2 months. According to the Centres for Disease Control and Prevention, oil of lemon eucalyptus, a more natural product, offers the same protection as DEET when used in similar concentrations. Don't use this product on children younger than 3 years.
  • Do your best to tick-proof your garden, if you have one. Clear brush and leaves where ticks live. Keep woodpiles in sunny areas.
  • Check yourself, your children and your pets for ticks. Be especially vigilant after spending time in wooded or grassy areas. Deer ticks are often no bigger than the head of a pin, so you may not discover them unless you search carefully. It's helpful to shower as soon as you come indoors. Ticks often remain on your skin for hours before attaching themselves. Showering and using a washcloth may be enough to remove any unattached ticks.
  • Don't assume you're immune. Even if you've had Lyme disease before, you can get it again
  • If you are bitten by a tick:

    lyme_disease_alert









See advice for prevention also HERE in Romanian.

Avoid Bismacine
The Food and Drug Administration (FDA) warns consumers and health care providers to avoid Bismacine, an injectable compound prescribed by some alternative medicine practitioners to treat Lyme disease. Bismacine, also known as Chromacine, contains high levels of the metal bismuth. Although bismuth is safely used in some oral medications for digestive conditions, it's not approved for use in injectable form or as a treatment for Lyme disease. Bismacine can cause bismuth poisoning, which may lead to heart and kidney failure.

Is There a Vaccine for Lyme Disease?

In 1998, the FDA approved a vaccine for Lyme disease called LYMErix. Although some people reported becoming ill from the vaccine, the FDA found no evidence that it was dangerous. However, in February 2002, the makers of the vaccine pulled it off the market due to poor sales. Currently, there is no available vaccine on the market for Lyme disease.

Further reading in Romanian:

  1. Wikipedia
  2. Lyme.ro
  3. i-medic.ro
  4. Terapiamedicala.ro: Boala Lyme


References

  1. Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91-102.
  2. Lyme disease. CDC. Page last updated April 12, 2011. Viewed August 24, 2011.
  3. Steere AC. Borrelia burgdorferi (lyme disease, lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 242.
  4. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.
  5. Mayo Clinic website
  6. PubMedHealth website on Lyme Disease
  7. WebMD website: Lyme Disease