In the two previous articles on Lyme disease we explained the importance of prevention and prompt treatment of early Lyme disease. What happens if an individual is not treated promptly?
Lyme disease is a bacterial infection transmitted by mostly the Deer tick. When a tick bites, it injects the individual with the Lyme disease bacteria. The bacteria travel through the skin and enter veins to circulate throughout the body and deposit it in specific target organs. These may include muscles, tendons and ligaments and joints, leading to the flu-like symptoms many individuals describe. If not treated or not cured at this early stage the final target organ of this germ is the Brain.
Unfortunately, there is no oral antibiotic that can cross the blood-brain effectively to kill this bacterium in the brain. This is the reason that oral antibiotic therapy for Lyme disease is not universally effective in treating early disease. If even a few bacteria get to the brain before oral antibiotic therapy is started, the individual will not be cured of Lyme disease and will develop a different presentation of Lyme disease called Late stage Lyme disease.
These individuals may in fact appear to get well from the initial oral antibiotic treatment, but somewhere within three months to a year after treatment may begin to develop new signs and symptoms. This may include more classic signs and symptoms such as swollen joints, but many will begin to experience more slowly progressive issues that may come and go. These may include fatigue, headaches, muscle and joint pains, Bell’s palsy, dizziness, memory problems, confusion, shooting pains, behavioral changes such as depression to name just a few. In fact Lyme disease has mimicked many other diseases.
Late stage Lyme disease, treatment requires the use of intravenous antibiotics as these are the only agents which can cross the brains’ blood-brain barrier at dosages which are adequate to kill the Lyme disease bacteria. Prior to embarking on this treatment the Physician should confirm that the individual is really infected with the Lyme disease bacterium. What we consider sound medical practice to achieve this goal will be described in next week’s installment.
Ticks prefer wooded and bushy areas with high grass and a lot of leaf litter. These are very common in the Wilmington, Delaware area. These are areas to avoid.
Take extra precautions in May, June, and July. This is when ticks that transmit Lyme disease are most active.
If you do enter a tick area, walk in the center of the trail to avoid contact with overgrown grass, brush, and leaf litter.
Ask your local health department and park or extension service about tick infested areas to avoid.
Keep ticks off your skin
Use insect repellent with Permethrin to prevent tick bites. It can be purchased at outdoor equipment stores that carry camping or hunting gear. Permethrin kills ticks on contact! One application to pants, socks, and shoes typically stays effective through several washings. Permethrin should not be applied directly to skin.
Wear long pants, long sleeves, and long socks to keep ticks off your skin. Light-colored clothing will help you spot ticks more easily. Tucking pant legs into socks or boots and tucking shirts into pants help keep ticks on the outside of clothing. If you’ll be outside for an extended period of time, tape the area where your pants and socks meet to prevent ticks from crawling under your clothes.
Check your skin and clothes for ticks every day
Remove ticks from your clothes before going indoors. To kill ticks that you may have missed, wash your clothes with hot water and dry them using high heat for at least one hour.
Perform daily tick checks after being outdoors, even in your own yard. Inspect all parts of your body carefully including your armpits, scalp, and groin. Remove ticks immediately using fine-tipped tweezers.
If a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small. But just to be safe, monitor your health closely after a tick bite and be alert for any signs and symptoms of tick-borne illness.
If you suspect Lyme disease it’s important to get an accurate diagnosis and Lyme treatment started right away.
1. Recent infection before immune response
2. Antibodies are in immune complexes
3. Spirochete encapsulated by host tissue (i.e.: lymphocytic cell walls)
4. Spirochete is deep in host tissue (i.e.: fibroblasts, neurons, etc.)
5. Blebs in body fluid, no whole organisms available for PCR
6. No spirochetes in body fluid on day of test
7. Genetic heterogeneity (300 strains, 100 in U.S.)
8. Antigenic variability
9. Surface antigens change with temperature
10. Utilization of host protease instead of microbial protease
11. Spirochete in dormancy phase (L-form) with no cell walls Additional Reasons for False Lyme test
12. Recent antibiotic treatment
13. Recent anti-inflammatory treatment
14. Concomitant infection with babesia may cause immunosuppression
15. Other causes of immunosuppression
16. Lab with poor technical capability for Lyme disease
17. Lab tests not standardized for late stage disease
18. CDC criteria is epidemiological not a diagnostic criteria
19. Lack of standardized control
20. Most controls use only a few strains as reference point
21. Few organisms are sometimes present
22. Encapsulated by glycoprotein “S-layer” which impairs immune recognition
23. “S”- layer binds to IgM
24. Immune deficiency
25. Possible down regulation of immune system by cytokines
26. Revised Western Blot test criteria fails to include most significant antigens