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MEDICAL CONDITIONS

• What is Lyme disease?
• What are symptoms and signs of Lyme disease?
• How is Lyme disease diagnosed?
• How is Lyme disease treated?
• How can Lyme disease be prevented?
• Lyme Disease At A Glance

What is Lyme disease?

Lyme disease is a bacterial illness caused by a bacterium called a "spirochete." The actual name of the bacterium is Borrelia burgdorferi. Lyme disease is spread by ticks when they bite the skin permitting the bacterium to infect the body. Lyme disease can cause abnormalities in the skin, joints, heart and nervous system.

Interestingly, the disease only became apparent in 1975 when mothers of a group of children who lived near each other in Lyme, Connecticut made researchers aware that their children all were diagnosed with rheumatoid arthritis. This unusual grouping of illness that appeared "rheumatoid" eventually led researchers to the identification of the baterial cause of Lyme disease in 1982. The number of cases of the disease in an area depends on the amount of ticks in an area and how often the ticks are infected with the bacteria. In certain areas of New York, where Lyme disease is common, over half of the ticks are infected. Lyme disease has been reported most often in the Northeastern United States, but has been reported in all 50 states as well as China, Europe, Japan, Australia and the parts of the former Soviet Union. In the United States, it is primarily contracted in the Northeast from the state of Maine to Maryland, in the Midwest in Minnesota and Wisconsin, and in the West in Oregon and Northern California.

What are symptoms and signs of Lyme disease?

Lyme disease affects different areas of the body in varying degrees as it progresses. The site where the tick attaches to the body is where the bacteria enter through the skin. Initially, the disease affects the skin and also causes "flu-like" symptoms. Later, it produces abnormalities in the joints, heart and nervous system.

Lyme disease is medically described in three phases as: (a) Early localized disease with skin inflammation (b) Early disseminated disease with heart and nervous system involvement, including palsies and meningitis (c) Late disease featuring motor and sensory nerve damage and brain inflammation and arthritis.

In the early phase of the illness, within hours to weeks of the tick bite, the local skin develops an expanding ring of unraised redness. There may be an outer ring of brighter redness and a central area of clearing, leading to a "bulls-eye" appearance. This classic initial rash is called "erythema migrans" (formerly called erythema chronicum migrans). Patients often can't recall the tick bite (the ticks can be as small as the periods in this paragraph). Also, they may not have the identifying rash to signal the doctor. More than one in four patients never get a rash. The redness of the skin is often accompanied by generalized fatigue, muscle and joint stiffness, swollen glands and headache.

Weeks to months after the initial redness of the skin the bacterium and its effects spread throughout the body. It is then that disease in the joints, heart and nervous system occurs.

The later phases of Lyme disease can affect the heart, causing inflammation of the heart muscle. This can result in abnormal heart rhythm and heart failure. The nervous system can develop facial muscle paralysis (Bell's palsy), abnormal sensation due to disease of peripheral nerves (peripheral neuropathy), meningitis and confusion. Arthritis, or inflammation in the joints, begins with swelling, stiffness, and pain. Usually, only one or a few joints become affected, most commonly the knees. The arthritis of Lyme disease can look like many other types of arthritis and can become chronic.

How is Lyme disease diagnosed?

In early Lyme disease doctors can sometimes make a diagnosis simply by finding the classic red rash (described above). The doctor might review the patient's history and examine the patient in order to exclude diseases with similar findings in the joints, heart and nervous system. Blood testing for antibodies to Lyme bacteria also can help in diagnosis. (Antibodies are produced by the body to attack the bacteria and can be evidence of exposure to the bacteria. This antibodies can be detected using a laboratory method called an Elisa assay.) Antibodies, however, can be false indicators of disease, since they can remain for years after the disease is cured. Currently, the confirmatory test that is most reliable is the Western Blot assay antibody test. More accurate tests are being developed.

How is Lyme disease treated?

Most Lyme disease is curable with antibiotics. This is so true that some authors of Lyme disease research have stated that the most common cause of lack of response of Lyme disease to antibiotics is a lack of Lyme disease to begin with! The type of antibiotic depends on the stage of the disease (early or late) and what areas of the body are affected. Early illness is usually treated with oral medicines, for example, doxycycline (Vibramycin). Therefore, if a person finds a typical "bulls-eye" skin rash (described above) developing in an area of a tick bite, they should seek medical attention as soon as possible. Later illness such as nervous system disease might require intravenous drugs, for example, ceftriaxone (Rocephin).

For the relief of symptoms, pain relieving medicines might be added. Swollen joints can be reduced by the doctor removing fluid from them (arthrocentesis). An arthrocentesis is a procedure whereby fluid is removed from a joint using a needle and syringe under sterile conditions. It is usually performed in a doctor's office. Rarely, even with appropriate antibiotics arthritis persists. The doctor also can inject cortisone into swollen joints or use oral medications, such as ibuprofen (Motrin, Nuprin), to reduce inflammation and improve function.

How can Lyme disease be prevented?

Because Lyme disease is transmitted by ticks attaching to the body, it is important to use tick bite avoidance techniques when visiting known tick areas. Wearing long clothing can protect the skin. Clothing, children and pets should be examined for ticks. Ticks can be removed gently with tweezers and saved in a jar for later identification. Bathing the skin and scalp, and washing clothing upon returning home might prevent the bite and transmission of the disease.

Vaccines were on the market, however, as of February 25, 2002 the manufacturer announced that the LYMErix™ Lyme disease vaccine will no longer be commercially available. Further studies of vaccines are needed. For now, ideal prevention focuses on the recommendations of the preceding paragraph.

Lyme Disease At A Glance

• Lyme disease is a bacterial illness that is spread by tick bites.
• Lyme disease can affect the skin, joints, heart, and the nervous system.
• Lyme disease occurs in phases, the early phase beginning at the site of the tick bite with an expanding ring of redness.
• Lyme disease is diagnosed based on the patient's clinical signs of illness and the detection of Lyme antibodies in the blood.
• Lyme disease is treated with antibiotics.

For more information about Lyme disease, please visit the following site:

American Lyme Disease Foundation (http://www.aldf.com)
American Lyme Disease Foundation, Inc.
Mill Pond Offices
293 Route 100, Suite 204
Somers, New York 10589
800-876-LYME

or contact:

Center for Disease Control and Prevention (CDC)
404-332-4555

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