Lyme Disease

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What is Lyme disease?

Lyme disease is caused by an infection with Borrelia burgdorferi, a bacteria carried by deer ticks. The bacteria are transmitted when a tick bites a person. The tick must usually be attached for 36–48 hours or more before the bacteria can be transmitted. Most infections occur during the summer months because of the life cycle of the tick.

What are the symptoms of Lyme Disease?

Symptoms can start days or weeks after a tick bite and include:

  • A rash at the site of the tick bite that may appear within 4 weeks of getting bitten. To some, it may look like a “bull’s eye.”
  • Fever, feeling tired, body aches and pains
  • Headache and stiff neck, weakness, or numbness
  • Pain and swelling of joints (this occurs several weeks to months later)
  • Trouble with memory and thinking

How do we test for Lyme Disease?

Lyme disease is diagnosed based on signs and symptoms and a possible exposure to the ticks that transmit Lyme disease. Laboratory testing can be useful if it is interpreted correctly.

The tests for Lyme disease detect antibodies made by the immune system to fight off the infection.

The laboratory tests for two types of antibodies. The IgM appears early in the infection and IgG appears 4-6 weeks later. Both antibodies usually take a few weeks to develop, so tests performed early may be negative even if the person is infected. Sometimes, patients may have a positive IgM even if they don’t have the infection. In both cases, a person should have a positive IgG test a few weeks later if they have Lyme disease. For an IgG test to be considered positive, at least five of ten bands must be present on the Western blot.

Once infected, the immune system continues to make these antibodies for months or years even after the infection is gone. This means that once a blood tests positive for Lyme disease, it will continue to test positive for months to years even though the bacteria are no longer present. There is no evidence to suggest that following immunoglobulin titers is helpful.

Post-Lyme disease syndromes

In some people, symptoms such as headache, fatigue, and joint pain do not resolve immediately after treatment is completed. In some cases, patients develop these symptoms after a gap of several weeks to months after antibiotic treatment of Lyme disease. These symptoms usually resolve gradually over time and taking more antibiotics does not improve symptoms or shorten the course of post-Lyme disease treatment symptoms.

“Chronic Lyme disease” is another term that is used to describe a wide array of symptoms that occur after antibiotic treatment of Lyme disease. Currently, there are no strict criteria for defining “chronic Lyme disease”, and no scientific evidence that antibiotics beyond the currently recommended duration improve symptoms.

Patients without evidence of Lyme disease and those who have completed adequate therapy for the infection should not be given additional therapy. Because the symptoms are often non-specific and can overlap with many other diseases, it is important to ensure that there are no other possible causes of the symptoms that may be more amenable to therapy.