Lyme Disease

Lyme disease, named for the small Connecticut town where it was first recognized in 1975, affects multiple body systems. Persons of all ages and both sexes are affected, with onset during the summer months. It occurs in areas where the geographic ranges of certain ixodid ticks are located. It typically begins with the classic skin lesion called erythema chronicum migrans. Weeks or months later, cardiac, neurologic, or joint abnormalities develop, possibly followed by arthritis.

Causes

Lyme disease is caused by bacteria called Borrelia burgdorferi which is found in small animals such as squirrels, mice, and rabbits. Ticks pick up Borrelia burgdorferifrom feeding on an infected host and then carry the bacteria in their guts. Ticks can then transmit the Borrelia burgdorferi bacteria to humans or other animals that they attach to. The tick must generally be attached to the host for 48 hours before enough of the Borrelia burgdorferi bacteria can be transmitted to establish an infection. Not all ticks carry Lyme disease. It is relatively rare to contract Lyme disease from a single tick bite. Checking yourself for ticks daily can help prevent Lyme disease.

Symptoms and Signs

A flu-like and heart condition is the most common sign of Lyme infection and it can occur with or without a rash. Symptoms can last from five to 21 days and may include the following:

• Fatigue.
• Chills and fever.
• Headache.
• Stiff neck.
• Backache.
• Swollen glands.
• Palpitations.
• Shortness of breath.
• Chest pain.
• Dizziness.
• Fainting can occur if the infection affects the heart.
• Less often, widespread muscle and joint aches, nausea, vomiting, and sore throat occur.

Diagnostic tests

Blood tests, including antibody titers to identify B. burgdorferi, are the most practical diagnostic tests. The enzyme-linked immunosorbent assay (ELISA) may be ordered because of its greater sensitivity and specificity. However, serologic test results don't always confirm the diagnosis - especially in Lyme disease's early stages before the body produces antibodies - or seropositivity for B. burgdorferi. Also, the validity of test results depends on laboratory techniques and interpretation.

Mild anemia in addition to elevated erythrocyte sedimentation rate, white blood cell count, serum immunoglobulin M levels, and aspartate aminotransferase levels support the diagnosis.

A lumbar puncture may be ordered if Lyme disease involves the central nervous system. Analysis of cerebrospinal fluid may detect antibodies to B. burgdorferi.

Treatment

A 10- to 20-day course of antibiotics is the treatment of choice. Adults typically receive doxycycline; amoxicillin, cefuroxime axetil, and erythromycin are alter­natives. Children usually receive oral amoxicillin. Administered early in the disease, these medications car minimize later complications. In later stages, high-dose ceftriaxone, cefotaxime, or penicillin G sodium administered I.V. may produce good results.

Prevention

• Try to stay out of woodlands and brush areas where the tick thrives, especially during the peak season of summer and early fall.
• Wear garments that will create barriers to the tick attaching to the skin and biting.

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