Treatment & Diagnosis of Lyme Disease

Jennifer and Natasha have extensive experience treating Lyme and Tick-Borne Illnesses.  They are ILADS-trained and have been trained under the expertise of Dr. Richard Horowitz.  

Lyme disease is a bacterial infection caused by the bite of an infected tick.  IT IS THE FASTED GROWING vector borne illness in the US.  The CDC estimates that more than 300,000 people are diagnosed with Lyme disease each year in the US. Of these infections, an unknown number will result in a chronic, difficult-to-treat illness.  Lyme disease affects all age groups, with particularly high occurrences among children, especially ages 5-14, and adults 45-64. 

In addition to Lyme disease, ticks are known to transmit other pathogens, often referred to as co-infections.  It is important to consider co-infecting pathogens like Babesia, Anaplasma, Ehrlichia and Bartonella for patients with risk factors for those illnesses and/or persistent symptoms after antibiotic treatment for Lyme disease.  Lab testing for evaluating Lyme and co-infections can be challenging.  Sensitivities of available tests are variable and do not always look at all strains. 

Some of the more common co-infections seen in practice are:

• Anaplasma and Ehrlichia: a white blood cell parasite that causes fever, headaches, and generalized body aches and is associated with a low white blood cell count, low platelets, and elevated liver enzymes.

• Babesia: a malaria-like parasite that invades red blood cells, causing fever, fatigue, chills, drenching sweats, headaches, and shortness of breath often described as air hunger, and may be associated with anemia and elevated liver function testing.

• Bartonella: an intracellular parasite that invades red blood cells, endothelial and other cells; increasing but still inconclusive evidence for tick transmission; associated with fever, swollen lymph nodes, eye disorders, myocarditis, endocarditis, encephalopathy, musculoskeletal involvement, and at times a striated rash.

• Powassan Virus: this can cause severe neurologic symptoms; no known treatment with fatalities documented.

• STARI – a Lyme-like illness, has been associated with bites from the Lonestar tick

Symptoms and Signs of Lyme Disease

Common Symptoms and Signs of Early Lyme Disease

• Erythema Migrans rash (EM) often presents as a “bullseye” rash

• Fatigue, malaise

• Flu-like symptoms, including fever, headache, joint pain and muscle aches 

• Stiff neck

• Painful burning, prickling, or aching sensations in legs or feet or feeling like you are being squeezed around your chest or abdomen

• Swollen lymph nodes

• Facial nerve dysfunction leading to weakness or paralysis of facial muscles (often mislabeled as Bell’s palsy)

Common Symptoms and Signs of Disseminated and Late Lyme Disease

• Fatigue

• Multiple red rashes (EM’s)

• Severe headaches and neck stiffness

• Joint swelling and/or pain

• Neuropathic symptoms – nerve pain, numbness, hot/cold sensations, tingling

• Cognitive dysfunction

• Memory impairment – brain fog

• Unprovoked pain which may interfere with sleep

• Palpitations or chest pain, shortness of breath

• Lightheadedness, fainting

• Gastrointestinal symptoms

• Psychiatric symptoms- including depression, anxiety, and mood changes

Diagnosis of Lyme Disease

Because “classic” indicators of Lyme are not always apparent, and widely available testing procedures are highly insensitive, a diagnosis of Lyme disease must be made on a clinical basis. A provider must consider the patient’s medical history, symptoms, signs, and tick exposure risk.

• Evidence of potential exposure to B. burgdoferi (bacteria that causes Lyme) includes a patient’s recall of a bite.  However,  <30% of US patients with Lyme disease recall a tick bite.

• The presence of erythema migrans (EM) rash is a “classic” indicator of Lyme disease, but the appearance of EM rashes is highly variable. Most EM rashes are solid colored, ranging from faint pink to a deep red. Less than 20% of all EMs have the classic “bull’s-eye” appearance. Given that some patients present with flu-like symptoms without any rash or memory of one, providers should take care to consider Lyme disease in areas where the infection is endemic, even when a patient presents without that hallmark sign.

Widely used tests for Lyme are unreliable

• The commonly recommended testing scheme for evaluating a person suspected of having Lyme disease calls for a first step using a highly sensitive ELISA, with subsequent performance of IgM and IgG Western blots only when the ELISA result is positive or equivocal. In this scheme, samples that are negative by ELISA are not investigated further. This leaves many patients with Lyme disease undiagnosed.  

• The following individual antibody bands on the Western Blot (which we always order if we are working a patient up for Lyme disease, are thought to be significant with regard to providing evidence of Lyme exposure: 23-25, 31, 34, 39, 83-93.

• Stated simply, laboratory results can SUPPORT the diagnosis we suspect clinically but CANNOT, in isolation, rule out the diagnosis of Lyme disease if suspected clinically.

Comprehensive evaluation is required

• Lyme disease has been called the “great imitator.” and its symptoms can mimic those of rheumatologic and neurologic conditions, chronic fatigue syndrome, fibromyalgia, and many difficult-to-diagnose multi-system illnesses. However, in some patients, symptoms attributed to Lyme disease may actually be the result of other illnesses.

• Chronically ill Lyme patients may also have non-tick related infections such as EBV, CMV, HHV6, Mycoplasma, Chlamydia pneumoniae, parvovirus, candida and more.

• We recommend all patients complete Dr. Horowitz’s MSIDS (Multi Systemic Infectious Disease Syndrome) questionnaire prior to their visit:

CLICK HERE FOR THE QUESTIONNAIRE

Diagnosis of Chronic Lyme Disease

For many patients, Lyme disease is strictly an acute infection, but for others, the infection is chronic. Common symptoms include:

• Fatigue

• Cognitive dysfunction

• Headaches

• Sleep disturbances

• Migratory joint and muscle aches 

• Numbness and tingling

• Nerve pain

• Depression and anxiety

• Musculoskeletal problems

The diagnostic issues discussed above also apply to patients with chronic Lyme disease. As a result, patients can exhibit significant symptoms of Lyme disease for years and even decades that are misattributed to other entities.  As in early disease, a COMPREHENSIVE EVALUATION is required.

Prophylaxis and Treatment

Evidence indicates that 20 days of prophylactic antibiotic treatment may be highly effective for preventing the onset of Lyme disease after a known tick bite. Patients with early Lyme disease may be best served by receiving 4-6 weeks of antibiotic therapy. Chronic Lyme and tick-borne infection cases require individualized treatment plans and often prolonged treatment.

• If administered promptly after a tick bite, 20 days of doxycycline may prevent the patient from contracting Lyme disease. Recent mouse studies demonstrate that the effectiveness of this strategy falls off dramatically if administration begins > 48 hours post-tick removal.

• Patients should watch for Lyme disease symptoms.

• Patients should educate themselves about tick bite prevention.

• We ALWAYS recommend saving any tick removed from your person and sending it to a laboratory for testing.  Generally, results are received within a few days, indicating whether or not the tick carried any disease.  This can be very valuable information when determining treatment. 

• Our practice emphasizes patient-centered, person-specific care and the importance of careful assessment and re-assessment of the full clinical picture to guide treatment decisions, initially and if symptoms persist or return.
  Lyme Disease

And remember….prevention is KEY.