Lyme disease – Symptoms, Causes, Diagnosis, and Treatments

Lyme disease is a tick-borne infection characterised by multi-systemic involvement of the skin, joints, nervous system and the heart, either individually or as a combination of all the organs.  

History  

Lyme disease was named after the town of Old Lyme, located near Connecticut, United States of America, where it was first identified in 1975.

Lyme disease was recognised as an individual and specific disease in 1976 due to the close clustering of symptoms in the children at Lyme, Connecticut, who were thought to have juvenile rheumatoid arthritis.

Lyme Disease has also been identified in Europe and has been named differently as erythema chronicum migrans, Bannwarth’s syndrome or acrodermatitis chronica atrophicans.

These syndromes were linked to Lyme disease twice in the year 1982 and later in 1983 after the isolation of the pathogenic spirochete from the tick vector and also from infected patients.

The basic symptoms of the disease are similar worldwide, but there are some variations in symptoms and severity, mainly between the illness found in America and that found in Europe and Asia.  

Causes of Lyme disease

Lyme disease is caused by a group of organisms called Borellia. Three pathogenic species of Borellia are implicated in causing Lyme disease.

The Bacteria are mostly transmitted to humans through the bite of an infected tick known as a deer tick. The deer tick, Ixodes scapularis, is the only vector of Lyme disease in the United States.  

Symptoms and Stages of Lyme disease  

The disease occurs in three stages  

Stage 1

Lyme disease usually begins with the bite of an infected deer tick which releases the bacteria into the human being to cause a characteristic expanding skin lesion called bull’s eye rash of Lyme disease.

Lyme rash is also called erythema migrans (EM), which occurs at the site of the tick bite and is the most common symptom of this stage.

Stage 2

Within several days to weeks, the bacteria may spread to other areas, specifically to the skin, nervous system, heart and joints. Headache, fever and joint pains are symptoms of this stage.  

Stage 3

After months to years following periods of latent infection, the bacteria may cause persistent disease that commonly affects the joints, nervous system or skin.   

All stages of the disease are potentially curable by early diagnosis and appropriate antibiotic therapy. The chances of death in patients treated for Lyme disease are very less.

Despite the fact that Lyme disease is categorised into three stages, the symptoms can often overlap with each other and sometimes individuals may have only late symptoms and not have any early symptoms.  

The common symptoms are a circular or oval-shaped rash with a red spot in the middle of the rash, which is often the site of the bite of the deer tick.

The other symptoms are fatigue, joint pain, headache and fever. There may also be enlarged lymph nodes.

Diagnosis

Diagnosis is guided by specific clinical findings and a positive result for IgG serologic test, using a two-test approach of enzyme-linked immunosorbent assay and Western blot.   

Treatment   

For early infection, oral antibiotic therapy with amoxicillin, 500 mg three times daily for 14 to 21 days or doxycycline, 100 mg twice daily, is considered appropriate resulting in reversal of clinical symptoms.

Some patients with neurological symptoms, joint pains or arthritis may require intravenous therapy with ceftriaxone, 2 g a day for 28 days.   

Post Lyme Syndrome   

This unique condition is noted in some patients with Lyme disease who have been treated for the infection but continue to experience symptoms. The cause and mechanism are not well explained.  

Prevention  

Currently, there is no evidence that Lyme disease is contagious and does not spread via personal contact.  

The use of full pants and full sleeve shirts while trekking through woods greatly helps to protect against tick bites.  

A vaccine for Lyme disease consisting of recombinant OspA with adjuvant was shown to be safe and effective, but the vaccine is available only in selected countries.  

Conclusion

Lyme disease is a localised or systemic infection that typically presents with skin and musculoskeletal signs and symptoms, but it can also affect other organ systems, including the neurological system and, less frequently, the heart.

Some people develop Post Treatment Lyme Disease Syndrome (PTLDS) that includes tiredness, headaches, minor memory loss and musculoskeletal pain.

A vaccine for Lyme disease was shown to be safe and effective.

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