Lyme Disease

What is Lyme Disease?

Lyme Disease is an infectious disease caused by at least three species of bacteria of the genusBorrelia, B. burgdorferi (sometimes abbreviated “Bb”) is most common in the United States, and Borrelia afzelii and Borrelia garinii are more common in Europe.  The bacteria is transmitted via a tick bite from the deer tick, Lone Star tick, or Western black-legged tick.

There are three recognized stages of infection with Lyme disease.  Stage 1 is early localized infection, which is classically characterized by a “bullseye” rash. ILADS (the International Lyme and Associated Diseases Society) estimates that only 35-60% of patients experience a rash, and it may not appear in the classic bullseye pattern. Some patients also experience flu-like symptoms. Lyme disease is easiest to treat in this stage, so early detection and treatment is critical.

In the second stage, early disseminated infection, the bacteria spread throughout the bloodstream. The rash may appear in areas distant from the original tick bite.  Symptoms may also include neurological problems, meningitis, shooting pains, or altered mental status.

If untreated, Lyme disease may progress to a persistent infection, the third stage. In this stage, the bacteria spreads to the joints, heart, brain, nerves, and eyes. Joint pain, nerve pains, cognitive difficulties, and fatigue are all common symptoms of persistent infection.

Prevalence

Lyme disease has become more common over the last few decades. It was first recognized in Lyme, Connecticut, where a cluster of the disease was recognized.

Not all ticks carry Lyme Disease.  The deer tick (also called black-legged tick), Ixodes scapularis,  is primarily responsible for transmitting the bacteria, however, the Lone Star tick and the Western black-legged tick also carry it. Dog ticks, which are also very common, are not carriers. Dog ticks are significantly larger than deer ticks, and are distinguishable by their brown legs and body. If you can easily see the tick from more than a few feet away, it’s most likely not a black legged tick.  Lone Star ticks are also larger than black legged ticks, and look similar to dog ticks but can be distinguished by a white dot on the back.

Diagnosis

Early diagnosis is the most effective weapon we have against Lyme disease. That being said, it’s sometimes difficult to diagnose Lyme disease, especially in the later stages, because the symptoms are non-specific.  Lyme has been called “the great imitator” because the symptoms can mimic other diseases.  Lyme disease is commonly misdiagnosed as arthritis, Lupus, Multiple Sclerosis, ALS, and even psychiatric disorders.

Diagnosis is done through clinical history, possibility of exposure, as well as diagnostic testing. Although many labs can test for Lyme disease, the world’s leading lab is Igenex, Inc. in California. Because they specialize in Lyme and associated diseases, their lab is the one we prefer. Samples from blood, serum, and urine can be tested for the presence of antibodies (the body’s immune response to the bacteria), as well as for DNA from the bacteria themselves. There is no definitive test for Lyme, and a negative test does not necessarily rule out Lyme disease. If initial tests are negative, the doctor may decide to do an antibiotic challenge to increase the sensitivity of the test.

Treatment

The only effective treatment for killing the bacteria that cause Lyme disease is antibiotics. When an infection is caught early, a single course of antibiotics is usually effective.  Unfortunately, if months or even years have passed, it often takes several prolonged courses of antibiotics.  The bacterial spirochetes like to “hide out” in various tissues of the body that antibiotics can’t easily reach – like the space inside joints.  This makes treatment much more difficult. In Washington state, naturopathic doctors are licensed to prescribe antibiotics.

Naturopathic treatment of Lyme disease also includes nutrition and dietary recommendations and supplements designed to support the immune system, and to make the body less hospitable to the bacteria. Sugar is the preferred food for bacteria, so the diet should low in sugar and simple carbohydrates. Supplements are selected that will support the immune system, and that have direct antibiotic effect.  Antibacterial herbs are used that work with the prescription antibiotics for a synergistic effect.

The presence of Borrelia spirochetes in the body drains the immune system.  When the immune system is “preoccupied” with Lyme, it can’t fight other diseases as effectively – which is why other infections, such as Candida, Staph, Strep, Epstein Barr, and herpes are more common in patients with Lyme disease.  There are also a number of “co-infections” that be transmitted from a tick bite, further taxing the immune system.  This is why naturopathic treatment of Lyme involves a heavy emphasis on immune system support.

Prevention

The first step to prevention is recognizing that all 50 states – as well as Europe and Asia – have Lyme disease.  One of the myths of Lyme disease is that it is only present on the East coast, but it is all too common on the West coast as well.  Ticks are most common in wooded areas and grassy fields, but can be present in urban areas.  Wearing long pants and long sleeves, tucking pant legs into socks, and spraying clothes with a 0.5% permethrin containing bug repellant is the most effective way to prevent ticks from attaching. DEET is not nearly as effective at repelling ticks as permethrin, but permethrin must be applied to clothes, not skin – make sure to follow the manufacturer’s directions. Once home, it is essential to do a full body check to make sure there aren’t any “hitchhikers.” Remember that the tick that carries Lyme disease is very small – it can be the size of the head of a pin. The tick bite is often not felt, so a close visual inspection is a must; it helps to have a partner to check hard to see areas.

If you find a tick, remove it immediately.  Use small tweezers to grasp the tick as close to the skin as possible.  Carefully, holding firmly but without squeezing the tick, pull the tick straight out andsave it in a glass jar so it can be tested. Infected nymphs begin to transmit Borrelia burgdorferi 36 hours after attachment.  At this point the tick has begun to fill with blood.  If the tick has been attached for less than 36 hours, there is very low risk of infection.  In fact, several state testing laboratories won’t test ticks that are not yet engorged with blood because the risk of contracting Lyme disease is negligible. If you are unsure, call your doctor.  And of course, if you experience any of the symptoms described above – a rash of any sort, flu-like symptoms or joint pain – call your doctor right away.