Life After Lyme Disease

Lyme disease is one of the fastest spreading conditions in North America and scientists are constantly working on new treatments and detection procedures.  One of the main problems surrounding Lyme disease it that it can be difficult to detect with the current blood test procedure recommended by the Centers for Disease Control and Prevention.  This is because the Borrelia burgdorferi bacteria that causes the condition can take weeks or even months to develop to a visible level. 

Blood testing

Early detection of Lyme disease is key in the successful treatment of this condition, so scientists are keen to implement a more effective test procedure. Lyme disease is transmitted to humans and animals by the bites of infected blacklegged ticks.  This disease can cause a number of symptoms from fatigue and nausea through to more serious rheumatological, neurological and cardiac complications.

Lyme Symptoms

Lyme disease can be difficult to diagnose on testing alone so it is important that both patients and doctors understand symptoms.  If you have been exposed to ticks and start to feel unwell you should visit your healthcare advisor as soon as possible.  Symptoms can include feelings of tiredness, nausea, muscle weakness and constant headaches.  You should also look out for the characteristic ‘bulls eye’ rash which often appears in conjunction with Lyme disease.  This rash can appear anywhere between three days to four weeks after the initial infection.  Commonly the rash manifests initially around the original infection site.  Lyme disease can remain dormant in the body for some time before any symptoms start to show.  This means that the patient may not remember having been exposed to ticks.  This is why it is so important that healthcare advisors have access to an accurate method of testing to identify this disease for treatment.

Luciferase Immunoprecipitation System (LIPS)

The luciferase immunoprecipitation system (LIPS) test has been around for a few years now and has been used to detect a number of viral and fungal pathogens that can affect the body.  Researchers at the National Institutes of Health have recently announced successful results in the using the LIPS test for Lyme disease.  These results were reported in the recent June 2010 edition of the respected journal ‘Clinical and Vaccine Immunology’. 

In the latest research from the National Institutes of Health the LIPS test was evaluated for its effective at detecting antibody responses to Lyme bacteria.  Blood tests were taken from infected patients and also those that had not been exposed to Lyme disease.  Researchers found that 98 to 100% of patients were correctly diagnosed as having Lyme disease through using the LIPS test in combination with the synthetic protein VOVO.  The report suggested that :

‘…screening by the LIPS test with VOVO and other B. burgdorferi antigens offers an efficient quantitative approach for evaluation of the antibody responses in patients with Lyme disease.’

These results are very impressive and the rollout of screening for Lyme disease through LIPS test with VOVO could offer an effective way to diagnose Lyme Disease quickly and effectively in the future.

The California Lyme Disease Association (CALDA) have reported that at least two poster sessions from the IDSA annual meeting back in the fall revealed some alarming concerns regarding the medical guidelines in place for Lyme disease.  These sessions concluded that only 15% of the current ‘strong recommendations’ by the ISDA for the treatment of Lyme disease were based on ‘strong evidence’.

Further to this an article that recently appeared in the Infectious Diseases in Clinical Practice medical journal also highlighted the lack of scientific evidence available to support many key medical guidelines currently in place, such as those for the treatment of Lyme disease.  The author of this article, IDSA member Thomas File, Jr, MD stated that:

‘Ideally, all recommendations from guidelines would be based on high-level, graded evidence (eg, randomized clinical trials). However, because published level I evidence is not often available, guideline writers are challenged with considering a vast array of different levels of support and creating clinically applicable and clear recommendations from it. Only in the minority instances is there an abundance of evidence available that leads directly to an indisputable recommendation.’

Infectious Diseases in Clinical Practice: May 2010 – Volume 18 – Issue 3 – p 151

May is officially Lyme disease awareness month and this is one of the key times of year when cases of this condition rise, as ticks start feeding voraciously in preparation for the breeding period.  Lyme disease is now one of the most prevalent insect-borne diseases in the Northern Hemisphere, and is passed to humans through the bites of infected ticks.  Although all species of ticks can pass on diseases scientist have identified the genus Ixodes as being the prime carriers of the bacteria which causes Lyme disease, Borrelia burgdorferi.  These ticks are common throughout many parts of the United States and key habitats include woodland and wild land edges, where they can find an abundance of their main prey, deer and small rodents.  Ticks will also feed on any domestic pets and humans they come into contact with, and because they are so small they can be difficult to detect.

Identifying Lyme Disease

In the majority of cases Lyme disease manifests a characteristic circular skin rash known as erythema migrans, but one of the main issues with Lyme disease is that in many cases it only presents generic symptoms such as fatigue, headaches and depression.  This means it can be very difficult to diagnose Lyme disease if the patient is not aware they have been exposed to ticks.  If left untreated Lyme disease can develop into some serious symptoms as the infection spreads throughout the body, and this can cause serious problems in the joints, central nervous system and heart.

Tick crawling on white t-shirt

Treating Lyme Disease

Current Infectious Diseases Society of America (IDSA) regulations regarding the treatment of Lyme disease have recently been reviewed, and no changes were made to longstanding advice for treating this condition which recommends short term use of antibiotics.  In many cases this can clear up infections of Borrelia burgdorferi, but some patients may find that the bacteria is able to linger in the body, and this is known as chronic Lyme disease.  Although chronic Lyme disease is not officially recognized as a condition by the IDSA, many physicians do treat these kinds of cases with long term antibiotics.  Many sufferers have also found that some alternative treatments such as herbal therapies can be effective to help eradicate this bacterium from the body.

Preventing Lyme Disease

Because Lyme disease can be difficult to diagnose and treat it is a good idea to put in place some preventative measures, to reduce the risks of contracting this disease in the first place.  Here are just a few preventative techniques:

• Avoid brush and tall grass – ticks lay in wait for prey on undergrowth and grasses that are around knee to ankle height, so avoid sitting down on the ground and walking through brush and grasses when you are out and about in high risk tick areas.
• Wear Appropriate Clothing – when you are walking through areas with abundant tick populations make sure you cover up and wear trousers tucked into socks and long sleeved tops to reduce the area of skin exposed to ticks.  Also wear light clothing so that you can help spot any ticks that have attached themselves to you.
• Tick Checks – always check your clothes for ticks before you get back in your car or return to your accommodation.  Once in a private place conduct a thorough full body examination if you have been walking in high risk tick areas just to ensure you have not picked up any of these tiny creatures.  Don’t forget to check key areas such as your groin, scalp, and behind your ears and pets will also need a thorough check to ensure they are not bringing ticks into your home.

Tiny adult tick

Domestic animals are prone to a number of insect-borne diseases including Lyme disease, and recent figures show that nearly as many as 30% of all canines in high risk areas will have been exposed to the bacteria which causes Lyme disease, Borellia burgdorferi.  Lyme disease can be a difficult condition to diagnose and treat as many people are not aware of this condition and how it can affect their pets, and after infection the majority of canine patients are never fully cured of the bacteria, despite receiving treatment.  The severity of Lyme disease can vary from mild but persistent symptoms of fatigue and joint pains through to more serious forms of the disease which can cause fatal health breakdowns such as kidney failure.

Prevention

When it comes to Lyme disease in domestic animals prevention is the key, and this means that pet owners will need to understand about the life cycle of ticks, so that they can put effective tick control methods in place.  Ticks follow an annual lifecycle and are not harmful to pets and in all of their development stages.  During the summer ticks are generally in the immature stage and by late summer they actually stop feeding and enter the pupation stage so at this point there is a lower risk of infection, but many pet owners mistakenly believe the summer months are key times to protect against ticks.  In reality the most important stage of the tick’s development occurs in around February to March time, when the adult stage peaks and the ticks begin to feed voraciously in preparation for breeding in early spring.  This is the key time of year when ticks present a high risk of carrying the Lyme bacteria over to pets, and owners should begin using tick control methods when the adults emerge in late fall, and continue right through to early summer.

It is also important that pet owners use the right tick control methods, and for those living in high risk areas it is best to stick to veterinary-quality products as these offer a much higher level of effectiveness against ticks (90% or above) than the equivalent over-the-counter versions, so although this will cost more and will have to be sourced from your vet you will be able to provide more protection for your pet against Lyme disease. 

Adult tick feeding on a dog

Diagnosis

One of the problems with diagnosing Lyme disease is that ticks are very tiny, even in the adult stages, and so it can be difficult to tell whether your pet has been bitten or not.  If you live in a high risk area for ticks and your pet is regularly exposed to thick vegetation, wild areas and woodland edges then the likelihood of them being bitten is very high, so if your pet displays any unusual symptoms it is worth asking your vet about the possibility of Lyme disease.

Lyme Vaccinations for Pets

Bacterial vaccinations have evolved in recent years but there is still of lot of hesitancy from both vets and pet owners in using these methods to prevent against insect-borne conditions such as Lyme disease.  This is because there is a lot of misinformation about how effective these vaccinations can be, but recent studies have shown the new vaccine technologies can provide safe, effective ways to reduce the risks of pets contracting Lyme disease.

The panel put in place to review the 2006 Infectious Diseases Society of America (IDSA) guidelines which detail the treatment of Lyme disease have voted unanimously to make ‘no changes’, and to continue recommending short-term antibiotic treatment for the infectious condition Lyme disease (spread by infected tick bites), and advising against long-term antibiotic therapy for patients with ongoing problems.  This news has dismayed many doctors, patients and activists throughout America who have long campaigned for changes to be made to the 2006 IDSA Lyme treatment guidelines.

Report Findings

The ISDA stated that the controversial guidelines as published in 2006 still remained the most effective clinical protocols for the treatment of Lyme disease, despite heavy criticism from sufferers of this condition who believe that Lyme disease should be re-classed as a chronic condition that could require long-term antibiotic treatment.  The report issued by the panel on 22 April 2010 stated that “Reports purporting to show the persistence of viable B. burgdorferi organisms after treatment with recommended regimens for Lyme disease have not been conclusive or corroborated by controlled studies.” In short the panel did not believe the clinical evidence gathered on Lyme disease supported the theory that this was a chronic condition and believed that there was no “benefit to prolonging antibiotic therapy beyond one month”.

Infected ticks can spread Lyme disease

Reactions

These findings have angered the hundreds of patients around America that suffer prolonged and often debilitating symptoms following the recommended treatment schedule of short-term antibiotics for Lyme disease, and Dr Daniel Cameron (a past president of the International Lyme and Associated Diseases Society) has responded to this report with some resignation, stating that he was not at all surprised by the ‘no change’ verdict.  Dr Cameron is just one of the many healthcare advisers around America that have been disappointed by the failure of the ISDA to offer leadership on the difficult and growing problem of Lyme disease, and is keen to reassure patients that doctors will continue to support those that suffer from chronic Lyme related problems and offer ongoing treatment.  Dr Cameron also pointed out that the report from the panel would be just another excuse for health insurers to refuse to pay out for those patients that needed ongoing medical support for Lyme disease.

Challenges to the 2006 Guidelines

Many critics of the 2006 Lyme treatment guidelines have long raised concerns over the initial development of these guidelines, and Connecticut Attorney General Richard Blumenthal challenged the society to answer the point that a number authors were said to have “undisclosed conflicts of interest” (thought to include financial stakes in Lyme disease related commercial industries), which could have influenced their findings.  The report released on 22 April 2010 sought to address some of these concerns and Blumenthal issued a statement assuring those concerned that his office was reviewing the findings in detail and would determine if the IDSA had ‘fulfilled the requirements of our settlement’.

Lyme Disease Association have reported that an estimated 15-20% of all Lyme victims will go on to develop a chronic form of the disease, and although the review panel chairwoman Dr. Carol J. Baker assured patients that the panel members had “tremendous compassion” those victims who said they had chronic cases, all of the members were concerned about the safety and cost issues of prescribing extended antibiotic therapy, and stated that “We don’t want our patients to be exposed to those kinds of risks when there was no credible medical or scientific evidence that these kinds of therapies improved their illness”.

Two adult ticks waiting for prey

Despite many advances in modern medicine there are still a number of age old diseases that are on the rise, including the insect-borne condition Lyme disease. 

Lyme disease is prevalent in mainland USA, particularly in the mid and eastern states and is passed to humans and domestic animals by the bites of infected ticks.  The Maine Center for Disease Control and Prevention reported recently that Lyme disease cases in January and February 2010 has risen by as much as two thirds over figures recorded 5 years ago, and this pattern seems to be in evidence in high risk Lyme disease areas across the United States.

Why is Lyme Risk on the Rise?

One of the main reasons experts believe Lyme disease is growing more prevalent is the increasing demands on ecological systems, which are creating ideal environments for ticks to breed and spread, bringing them into closer contact with humans.  Commercial forest management causes the balance of natural wild ecological systems to be significantly altered, resulting in woodland clearing which provides ideal habitats for the prey of ticks to flourish, such as mice, rabbits, deer and other small mammals and so in turn the tick populations also increase.  This combined with the fact that wild land and urban areas are growing ever closer together means that there are more ticks patrolling woodland edges for prey, and more and more humans living and working in tick habitats, which increases the likelihood that people are going to be infected with tick-borne disease such as Lyme disease.

Treating Lyme Disease

The main problem with Lyme disease is although it can be treated with antibiotics quickly if caught in the early stages, if left untreated it can develop into some serious and potentially debilitating diseases such as Lyme arthritis.  Lyme disease is caused by the infection of bacteria known as B.burgdorferi and this can spread quickly throughout the body through the blood and lymph systems and can be carried to key organs which can result in serious problems with the heart and nervous system.  Lyme disease is difficult to detect, as it can take anywhere from 3-30 days (or even longer) to manifest any physical symptoms, and by this time the sufferer may not realize their symptoms are connected to a tick bite, or in some cases may not have even realized they had been bitten in the first place.  Compounding this problem is the fact that there are no reliable tests as yet easily available to test for B.burgdorferi in the early stages, and it is not until the bacteria has become more widely spread in the system that blood tests can be effective at identifying the infection, at which point it is much more difficult to treat and may have already caused a number of unpleasant symptoms such as joint pain, fatigue and skin problems.

Close up of adult tick

Residents in Maine and other areas in the US which are plagued with tick-borne diseases are well aware of the risks of contracting Lyme disease from coming into contact with ticks, and this can make campers, hikers and hunters very nervous about visiting the forest and wild land areas, as even when the disease is caught early on it can still leave debilitating symptoms for months and even years after the initial infection has passed.  Preventive measures such as wearing boots and full leg and arm coverings, avoiding long grass and undergrowth and checking for ticks before you return to your car and home can help to reduce the risks of tick bites, but there is still no really effective way to really prevent ticks from passing on the Lyme disease infection.

PORTLAND, Maine — State health officials say that they are seeing a rise in the number of Lyme disease cases in Maine.

Reports of confirmed Lyme disease cases have been pouring into the Maine Center for Disease Control and Prevention this year at a rate three times above normal. Dr. Dora Anne Mills of the Maine Center of Disease Control says that 50 cases were reported in the state in January and February. That’s up from a five-year average of 15 for those two months.

Dr. Mills added that “Lyme disease has tripled in just the first two months of the year. I’ve never heard of ticks in February and March in Maine.”  This represents a large and disturbing raise in Lyme disease cases.

Additionally, veterinarians in southern Maine say many dogs were diagnosed with Lyme disease this winter, this is something that normally does not happen until spring.

Officials have speculated that this disturbing increase in Lyme disease cases is due to the warm temperatures in recent months, setting the stage for a possible increase in ticks for the upcoming summer.

Maine Medical Center biologist Chuck Lubelczyk said ticks normally come out in the middle of April, when the snow is gone and the ground thaws. But with the warm winter, ticks have been active most of the past several months. Studies conducted in York County by Maine Medical Center biologists have shown that anywhere from 50 to 70 percent of ticks carry the Lyme disease bacteria.

DNA sequencing test results

Diagnosing Lyme disease has always been a problem, as many of the symptoms are similar to a whole host of other conditions and traditional serological testing methods are unreliable in the early stages. Doctors have to rely on combining a list of symptoms with identifying the risks of patient exposure to ticks (which carry the bacteria responsible for Lyme disease), and as this condition can incubate in the body for months or even years before it manifests this can make diagnosis even more difficult.

A recent report published in the latest April 2010 edition of the American Journal of Clinical Pathology may bring some hope to medical staff dealing with Lyme disease around the world, as a team at the Milford Hospital, CT (headed by Connecticut physician Sin Hang Lee, MD) have now revealed a new way of diagnosing  this disease by using DNA testing to identify whether or not the patient has any of the bacteria which cause Lyme disease present in their blood. In clinical testing this DNA procedure proved to be highly successful at identifying low levels of the Lyme bacteria, which were often missed by the previous methods of serological testing.

Early Lyme Diagnosis

Lyme disease can easily be treated in the early stages by using standard antibiotics, but if left untreated this bacteria can spread through the body causing a whole host of painful and potentially debilitating conditions such as Lyme arthritis, chronic fatigue and even serious problems with the central nervous system and heart such as neuro borrelia and arrhythmia.  This is why it is so important to diagnose Lyme disease as quickly as possible, as it can save months of unnecessary pain and discomfort for patients and can prevent any serious complications from developing.

Model of DNA Strand

The DNA test discovered by the Connecticut research team is highly sensitive and specifically aimed at identifying Lyme disease, and is most effective in the early stages of the condition when the bacteria are circulating freely in the blood system. Several leading medical insurance companies have already recognized the potential of this new testing method and have provisionally agreed to cover the costs of this procedure for their members.

What Causes Lyme Disease?

Lyme disease is spread by the bite of infected black legged ticks, which are common in many areas of Europe and throughout the mid and eastern United States. Lyme disease is caused by the Borrelia burgdorferi bacteria which is transmitted through tick saliva into the body of the host, where it typically has an incubation period of around 3 to 30 days (although it has been known to remain undetected for years before manifesting symptoms in the host). The Lyme bacteria infection can spread through the body via the blood stream and also lymph nodes, and can be carried to major organs and other areas of the skin.

As well as preventing under-diagnosis of Lyme disease and ensuring that sufferers are treated as quickly as possible this new DNA technique could also help to prevent over-diagnosis of this condition, and this can reduce the unnecessary use of strong antibiotics in patients who have been misdiagnosed with Lyme disease.

Actor, Ben Stiller

Hollywood funnyman Ben Stiller may be among one of the thousands of people around the world who have contracted the chronic condition Lyme disease. Like many other sufferers Stiller, 44, discovered he may have this potentially harmful disease after seeking treatment for another ailment, in this case an inflamed knee which never healed after he injured it whilst on a charity related trip to Mozambique. Stiller explained that "I was in Africa about three and half weeks ago and I stepped in a ditch in Mozambique", but after a few weeks his knee was still very painful and inflamed, causing Stiller to walk with a limp at times and so he sought further medical assistance. Despite numerous tests doctors could not identify the cause of the inflammation and infection and this painful condition was exacerbated by some arthritic elements that were revealed on MRI scans.

Lyme Disease Suspected

Stiller’s knee injury grew steadily worse over the following weeks and was so painful at one point he almost had to pull out of a high profile interview with one of America’s premier TV talk show hosts David Letterman, which had been scheduled for March 23. However recently a breakthrough in Stiller’s mystery knee complaint came through when one of his doctors queried whether or not he had ever had Lyme disease. Stiller had been on the East Coast during the height of the tick season the previous year (ticks are prime carriers of Lyme disease) and that at this time his son had actually contracted the disease. Lyme disease is well known for causing severe joint pain and arthritic conditions, and Stiller’s doctors finally diagnosed Lyme disease as the most likely cause of his painful knee condition. As Stiller explained to Letterman in his interview this breakthrough came just at the right time, as the next stage of his treatment would have been orthoscopic procedures followed by possible invasive surgery, and as he said “…if it is Lyme disease, I won’t have to have the procedure done, which is great", as this treatment could have seriously restricted his mobility for months and prevented him from working on any new movies or other projects.

Confirming Lyme Disease

Lyme disease is a difficult condition to properly diagnose, as it can in some cases take months or even years for the symptoms to appear, and standard testing can not always identify positively whether or not the bacteria that causes Lyme disease, Borrelia burgdorferi, is actually present in the system. Although there are still more tests to go ahead before Stiller can be confirmed with Lyme disease, he could be among thousands of patients around the world suffering from this potentially debilitating condition who are initially misdiagnosed, and undergo months of futile tests. Lyme disease is easy to treat in the early stages with antibiotics, but if left to develop it can cause a number of painful symptoms such as inflammation and swelling of the joints, and it can also be much more difficult to treat once the bacteria has spread throughout the body’s system.

Image of adult blacklegged tick

Lyme disease is a tick-borne infection, and is primarily spread to humans through bites from deer ticks, Western blacklegged ticks and possibly lone star ticks.  These tick species carry the Borrelia burgdorferi bacterium which causes Lyme disease, and feed on a number of small to medium size mammals and birds including small rodents, deer and household pets.

Birds

Birds play a major role in the spread of Lyme disease as they can pick up a tick carrying the Borrelia burgdorferi bacterium in one location, and because it takes a long time for ticks to feed they could be hundreds or even thousands of miles away before the tick finally drops off.  The seasonal migration of birds in Northern America is key to the spread of Lyme disease and over 650 species of bird migrate to different parts of the world annually, either taking part in long distance migration to places such as Africa, Eastern Europe and South America, or short distance migration of just a few hundred miles.  Many birds such as White-throated Sparrows and robins spend the winter in Northern America before moving on to summer feeding grounds in Canada, and there are also a number of transitory birds that pass through Canada as a stop over on the way to other feeding grounds, and many of these could potentially be carrying infected ticks or the Borrelia burgdorferi bacterium itself, which they could pass on to uninfected ticks in the areas they feed in.

The spread of ticks carrying Borrelia burgdorferi bacterium into Southern Canada

Reforestation

A number of factors can influence the spread of any insect species, but the main culprit for the spread of ticks is thought to be reforestation.  Ticks are hardy creatures, but they do require the right habitats to live in. For example the blacklegged tick thrives in cool, moist conditions and the majority can be found in forested areas with dense shrub layers to provide shade and moisture, and tend to condense along the forest and woodland edges, where food is most abundant.  They can also survive in denser underground planting in some landscaped residential areas.

In recent years many areas that were previous cleared for farmland in northern America have been reverted back to small patches of woodland and forest, creating ideal environments not just for ticks, but for the animals they feed on such as deer and small rodents.  This increase in wild tick populations would not normally be a major problem but as urbanization is also increasing, with residential developments encroaching on wild areas, more and more infected ticks are coming into contact with humans, and these woodland border areas in which ticks are prevalent are now coexisting alongside residential areas, creating high risk zones for Lyme disease crossing to humans.

Reforestation is thought to be having a significant impact on the increasing spread of Lyme disease from North America into Canada, and studies by the Public Health Agency of Canada have so far tracked new infected tick emergence in Ontario, Nova Scotia, New Brunswick, Quebec and Manitoba. 

Steps to Prevent the Spread

The Public Health Agency of Canada and other organizations are calling for national surveillance to be put in place to monitor the changing patterns of tick behavior, to identify new endemic areas quickly and effectively in order to notify the public and local health authorities and ensure education is put in place to minimize the impact of Lyme disease.  Doctors are now required to report any suspected and confirmed cases of Lyme disease to the Public Health Agency, and this enhanced surveillance combined with greater physician and public awareness are crucial steps to help mimize the impact of the disease as it spreads into Canada.