Information about Lyme Disease
- Lyme disease is transmitted
by the bite of a tick, and the disease is prevalent across the United
States and throughout the world. Ticks know no borders and respect no
boundaries. A patient's county of residence does not accurately reflect his or
her Lyme disease risk because people travel, pets travel, and ticks travel.
This creates a dynamic situation with many opportunities for exposure to Lyme
disease for each individual.
- Lyme disease is a
clinical diagnosis. The disease is caused by a spiral-shaped bacteria
(spirochete) called Borrelia burgdorferi. The Lyme spirochete can cause
infection of multiple organs and produce a wide range of symptoms. Case
reports in the medical literature document the protean manifestations of Lyme
disease, and familiarity with its varied presentations is key to recognizing
- Fewer than 50% of
patients with Lyme disease recall a tick bite. In some studies this
number is as low as 15% in culture-proven infection with the Lyme spirochete.
- Fewer than 50% of
patients with Lyme disease recall any rash. Although the erythema migrans (EM)
or “bull’s-eye” rash is considered classic, it is not the most common
dermatologic manifestation of early-localized Lyme infection. Atypical forms
of this rash are seen far more commonly. It is important to know that the EM
rash is pathognomonic of Lyme disease and requires no further verification
prior to starting an appropriate course of antibiotic therapy.
- The Centers for Disease
Control and Prevention (CDC) surveillance criteria for Lyme disease
were devised to track a narrow band of cases for epidemiologic purposes. As
stated on the CDC website, the surveillance criteria were never
intended to be used as diagnostic criteria, nor were they meant to define the
entire scope of Lyme disease.
- The ELISA screening
test is unreliable. The test misses 35% of culture proven Lyme disease
(only 65% sensitivity) and is unacceptable as the first step of a two-step
screening protocol. By definition, a screening test should have at least 95%
- Of patients with acute
culture-proven Lyme disease, 20–30% remain seronegative on serial
Western Blot sampling. Antibody titers also appear to decline over time;
thus while the Western Blot may remain positive for months, it may not always
be sensitive enough to detect chronic infection with the Lyme spirochete. For
“epidemiological purposes” the CDC eliminated from the Western Blot analysis
the reading of bands 31 and 34. These bands are so specific to
Borrelia burgdorferi that they were chosen for vaccine development. Since
a vaccine for Lyme disease is currently unavailable, however, a positive 31 or
34 band is highly indicative of Borrelia burgdorferi exposure. Yet
these bands are not reported in commercial Lyme tests.
- When used as part of a
diagnostic evaluation for Lyme disease, the Western Blot should be performed
by a laboratory
that reads and reports all of the bands
related to Borrelia burgdorferi. Laboratories that use FDA approved
kits (for instance, the Mardx Marblot®) are restricted from reporting all of
the bands, as they must abide by the rules of the manufacturer. These rules
are set up in accordance with the CDCs surveillance criteria and increase the
risk of false-negative results. The commercial kits may be useful for
surveillance purposes, but they offer too little information to be useful in
- There are 5 subspecies of
Borrelia burgdorferi, over 100 strains in the US, and 300 strains
worldwide. This diversity is thought to contribute to the antigenic
variability of the spirochete and its ability to evade the immune system and
antibiotic therapy, leading to chronic infection.
- Testing for Babesia,
Anaplasma, Ehrlichia and Bartonella (other
tick-transmitted organisms) should be performed. The presence of
co-infection with these organisms points to probable infection with the
Lyme spirochete as well. If these coinfections are left untreated, their
continued presence increases morbidity and prevents successful
treatment of Lyme disease.
- A preponderance of evidence
indicates that active ongoing spirochetal infection with or without
other tick-borne coinfections is the cause of the persistent symptoms in
chronic Lyme disease.
- There has never been a
study demonstrating that 30 days of antibiotic treatment cures chronic Lyme
disease. However there is a plethora of documentation in the US and
European medical literature demonstrating by histology and culture techniques
that short courses of antibiotic treatment fail to eradicate the Lyme
spirochete. Short treatment courses have resulted in upwards of a 40% relapse
rate, especially if treatment is delayed.
- Most cases of chronic Lyme
disease require an extended course of antibiotic therapy to achieve
symptomatic relief. The return of symptoms and evidence of the continued
presence of Borrelia burgdorferi indicates the need for further
treatment. The very real consequences of untreated chronic persistent Lyme
infection far outweigh the potential consequences of long-term antibiotic
- Many patients with chronic
Lyme disease require treatment for 1–4 years, or until the patient is
symptom-free. Relapses occur and maintenance antibiotics may be required.
There are no tests currently available to prove that the organism is
eradicated or that the patient with chronic Lyme disease is cured.
- Like syphilis in the 19th
century, Lyme disease has been called the great imitator and should be
considered in the differential diagnosis of rheumatologic and neurologic
conditions, as well as chronic fatigue syndrome, fibromyalgia, somatization
disorder and any difficult-to-diagnose multi-system illness.
foregoing information is for educational purposes only. It is not
intended to replace or supersede patient care by a healthcare provider. If an
individual suspects the presence of a tick-borne illness, that individual should
consult a healthcare provider who is familiar with the diagnosis and treatment
of tick-borne diseases.