What is Lyme disease?
Lyme disease, also called borreliosis, is a zoonosis caused by the bacterium Borrelia burgdorferi , which is transmitted by the tick Ixodes ricinus . Its main features are like symptoms of the flu that can progress to more serious complications such as arthritis .
In Brazil, the bacterium responsible for the disease has undergone adaptations and resides in the star tick ( Amblyomma cajennense ). The disease, in this case, is known as Brazilian human borreliosis, and causes more cases of recurrence of symptoms, neurological and autoimmune complications.
The condition is also called “the great imitator”, because it mimics several symptoms of common illnesses. Among them are common flu symptoms, which progress to symptoms of arthritis and some neurological conditions.
Because it is a zoonosis, it can also affect animals and, therefore, it is necessary to pay extra attention to pets, which can bring ticks into the home.
Lyme disease got its name after an outbreak in the city of Lyme, Connecticut, in the United States, in 1975. During that time, several mothers were concerned that their children were being diagnosed with rheumatoid arthritis, a disease that typically affects older people. old.
This outbreak of rheumatoid symptoms (related to the joints) eventually caused researchers to find the cause of the disease: a bacterium. The disease was then called “Lyme disease”, as it was the place of origin of the first known outbreak.
Lyme disease usually progresses progressively, with very characteristic phases, which demonstrate how much the bacteria has spread throughout the body.
Localized early stage
At first, the disease is in the early localized stage , in which a large red spot (called migratory erythema) appears on the skin, at the site of the tick bite. This spot can reach up to 15cm in diameter, with a clear area in the center. It is often described as a target-shaped spot.
The incubation period of the bacteria lasts between 3 to 32 days, in which the disease may or may not manifest its initial symptoms.
Premature dissemination stage
After that, the bacteria spreads throughout the body, initiating the stage of premature dissemination . At that time, several symptoms can manifest, being very similar to common symptoms of a cold or flu . Therefore, many people end up not going to the doctor and allow the disease to continue to evolve. After this stage, the symptoms disappear for a period of time, which can be weeks, months or years.
After this silent period, the late stage begins , in which more severe symptoms appear and which can become chronic complications for patients. It is at this stage that most people seek medical help, and often suffer a wrong diagnosis, due to the manifestations common to other diseases. In some cases, this step starts what is known as chronic Lyme disease .
Borreliosis is caused by the bacterium Borrelia burgdorferi , transmitted through the bite of some species of ticks that feed on human blood. However, the tick can only transmit the bacteria if it stays on the person for more than 24 hours .
In the United States and Europe, the main transmitting species of Lyme disease is Ixodes ricinus , popularly known as the “deer tick”, for its predilection for these animals. In Brazil, the species that transmit the disease are Amblyomma cajennense and Rhipicephalus sanguineus .
How does transmission occur?
Originally, the tick does not carry Borrelia burgdorferi , but it acquires it by biting and feeding on the blood of an animal that carries the bacterium. Thus, it becomes a guest, which transmits the bacteria to the other animals (and humans) on which it feeds.
There is no evidence that transmission can occur from human to human, except in cases of pregnant women who may end up passing the bacteria on to their babies. However, there is no evidence that the bacterium is transmitted through breast milk.
Risk factors and groups
Because the disease is transmitted by ticks, the biggest risk factor is contact with nature or animals , especially with inappropriate clothes and shoes. With that, it can be said that the main risk groups are:
- Children: Because they are closer to the ground (where the ticks meet) due to their short stature and they like to be close to pets, which can bring the hosts inside the house;
- Trailers: Because they always live outdoors;
- Gardeners and people who work outdoors: Due to their constant contact with nature.
Symptoms of Lyme disease are divided over the 3 stages of the disease. Understand:
Localized early stage
The main symptom of this phase is migratory erythema (red spot), although it is not always present. Many people do not notice the stain, while others suffer from huge stains that do not necessarily itch or hurt, but can be hot to the touch.
Erythema can manifest itself at the location of the bite, as well as migrate to other parts of the body, in addition to the possibility of having more than one spot at a time.
Its appearance resembles a target, with a red center and reddish rings around it. Sometimes it may just look like a big red spot. Others have an irregular shape. There are cases where it looks like a scabbed wound. In addition, the erythema may also appear as a spider bite or lesions of dermatophytosis.
This stain tends to increase in size over time, until it disappears after about 4 weeks. In some cases, it may reappear, even after it is completely gone.
Premature dissemination stage
In this phase, after the incubation of the bacteria, the main symptoms begin. Are they:
- Neck stiffness;
- Muscle aches;
- Joint pain;
- Migratory erythema in other parts of the body;
- Back pain;
- Sore throat;
- Swollen lymph nodes.
Some of these symptoms may disappear and reappear, but feelings of malaise and tiredness persist. In some people, more serious complications can develop, which can affect the nervous system and the heart.
Late stage (chronic)
When left untreated, the infection can lead to a late stage, in which symptoms become serious complications. More than half of people develop arthritis as a result of the disease and the swelling and pain are repeated in the large joints, especially the knee. There may be the development of cysts behind the knee that, when ruptured, cause even more pain.
Other people may develop symptoms of cognitive malfunction, with memory, sleep patterns, mood and speech affected. There is a risk of facial nerve palsy (Bell’s palsy), as well as meningitis (inflammation of the meninges, tissue that lines and protects the brain). Arrhythmias and other heart problems are also common.
This stage can last for years and, therefore, it is also known as chronic.
Symptoms in children
There are two factors that make Lyme disease barely recognizable in children: the fact that they do not know how to express exactly what they feel and the nonspecific symptoms that the disease causes.
Because of these symptoms, parents may be confused and not realize that the child is actually sick, thinking it is just a common discomfort of age. They may feel that the child is wanting attention or does not want to go to school, and the fact that some cognitive functions may be affected helps parents to think that this is the fault of poor school performance.
Often, the only way to realize that your child may be unwell is to observe changes in his behavior. Some signs that parents should watch for are:
- Problems related to fatigue: Severe tiredness that is not relieved after rest, insomnia and irritability;
- Malaise: Headache (headache), nausea, abdominal pain, fever, chills, joint pain and dizziness;
- Impairment in cognitive processes: Impaired concentration, problems with short-term memory, difficulty maintaining attention, making decisions, thinking and expressing yourself, reading and writing, confusion, sudden changes in mood and increased sensitivity to sounds and lights.
In the case of mothers affected with the disease, signs that the bacteria may have been passed on to the child are:
- Frequent fevers;
- Higher incidence of throat and ear infections;
- Higher incidence of pneumonia;
- Pain in muscles and joints;
- Bad muscle development;
- Gastroesophageal reflux;
- Tracheomalacia (flaccidity in the cartilage of the trachea);
- Cataracts and other eye problems;
- Delay in cognitive development;
- Learning difficulties;
- Psychiatric manifestations.
Symptoms in animals
Animals can also suffer from Lyme disease, so pet owners like dogs and cats should take the animal to a veterinarian when they:
- He hesitates to climb on high places such as beds, sofas, chairs and stairs – a sign of pain and muscle weakness;
- He remains lying and sleeping for much longer than normal and shows no excitement when being called for a walk – a sign that he may be suffering from fatigue;
- Walks limping or without precision, due to pain;
- Presents vomiting, fever, lack of appetite and swelling in the lymph nodes.
These symptoms tend to appear cyclically, that is, the animal may present them and improve suddenly, until, after a while, it worsens again. If the owner does not take him to be treated by a veterinarian, the symptoms gradually worsen, leading to death from paralysis and asphyxiation.
The diagnosis of Lyme disease is made mainly based on the symptoms and history of exposure to areas and animals that could have ticks. This is because the main tests used to try to diagnose the disease are inaccurate and, therefore, a negative result does not necessarily mean that the possibility of the disease must be ruled out.
In general, exams are done in pairs, because when one fails, the other confirms. Even so, there are many people with a wrong diagnosis, since the disease has symptoms very similar to others.
The main tests for the diagnosis of Lyme disease are:
This test allows the detection of specific antibodies, that is, it lets the doctor know that the patient’s immune system is producing antibodies against Borrelia burgdorferi . In general, this test is done with a blood sample from the patient, which is sent to the laboratory for analysis.
The disadvantages of this test are that patients who have had Lyme disease and have already been cured still have antibodies, which can give a false positive result.
Western Blot is a method of molecular biology that detects antibodies to the proteins of the disease-causing bacteria. It is usually requested after a positive ELISA result, which, because it is highly sensitive, can be a false positive. When both tests confirm the presence of antibodies, a diagnosis can be made.
Examination of C-reactive protein detects the bacterium’s DNA in the patient’s blood, proving the presence of infection by the microorganism. The biggest disadvantage of this test is that the bacteria is scarce in the blood and is not always present in the sample collected, characterizing a false negative.
Culture tests, in which the bacterium is grown in the laboratory, are not very useful in the case of Borrelia burgdorferi , as it cannot maintain itself in the environment in vitro .
Because it is a disease that mimics many symptoms, it is common for the patient to be misdiagnosed with the following conditions:
- Rheumatoid arthritis;
- Multiple sclerosis;
- Rheumatic fever;
Fortunately, Lyme disease is curable , but it can leave lifelong consequences, especially if the treatment is not followed correctly or if it started too late.
The treatment is based on the use of antibiotics to eliminate the bacteria, as well as non-steroidal anti-inflammatory drugs to control inflammation in the joints (arthritis).
When a patient is diagnosed with borreliosis, there are two ways to think about treatment: while the Infectious Diseases Society of America (IDSA) recommends using antibiotics for a short period of time, the International Lyme and Associated Diseases Society (ILADS) advises an analysis of individual issues, such as the severity of symptoms, the presence of co-infections (infections that occur simultaneously) and the patient’s response to treatment.
Although there is no consensus on the ideal treatment, often the duration of antibiotic medication varies between 2 and 4 weeks. There is a suspicion that the chronic symptoms of the disease occur because this treatment time is insufficient and, therefore, some doctors may recommend more extensive treatments, similar to those for persistent diseases, such as tuberculosis . Either way, the medication should not be stopped as soon as the patient feels better, as this can cause the bacteria to gain resistance and the disease to come back even stronger.
Regarding the medications available, it must be kept in mind that, although it is not a rare disease, the pharmaceutical industry is still in an emerging state in relation to Lyme disease.
It is important to note that, if there is no consensus on treatment, the patient should inform himself about the disease and analyze the options available with a doctor, in order to find the best approach for each case. There is no antibiotic or combination of specific medications to treat Lyme disease and there are cases of recurrence of symptoms (chronic phase) with all types of treatment.
Medications can be administered orally and, in specific cases, hospitalization may be necessary for the patient to take the medication intravenously.
When a tick bite is reported before the patient even has symptoms, some doctors may recommend a dose of doxycycline to prevent the bacteria from proliferating. In some cases, doctors may extend this prophylactic treatment by prescribing doses of the antibiotic for about 20 days.
Treatment of migratory erythema
When a migratory erythema is found, some doctors may prescribe antibiotics such as azithromycin , cefuroxime , doxycycline and amoxicillin for 20 days. However, this method is not always effective and it is up to the patient, together with the doctor, to evaluate this option. This is because this treatment, if successful, can prevent the prolonged use of antibiotics afterwards – which could lead to several adverse reactions -, however, there are patients who prefer to take this risk rather than failing the treatment.
If the 20-day treatment did not work – or the patient chose not to undergo this treatment -, some doctors recommend continuing the treatment, with the prolonged use of antibiotics. In this case, the doses can be adjusted and, taking into account all possible factors (co-infections, severity of symptoms, age, etc.), the treatment can be redesigned to suit the patient’s condition. In long-term treatment, the use of tetracycline is considered .
Prolonged treatment can also be done in patients who have shown improvement with the treatment of a few days, as this would avoid the possibility of recurrence of symptoms. While some patients choose this option, others may prefer not to use antibiotics “unnecessarily”, since their symptoms have already been resolved with short-term treatment. For this reason, there are those who reject prolonged treatment.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
When the patient shows symptoms after treatment (featuring chronic Lyme disease), some healthcare professionals may advise the patient to resume treatment. This repetition can bring significant improvements to the patient’s quality of life, although it is not always able to prevent new recurrences.
In order for the doctor to be able to recommend the treatment again, he must assess factors such as the severity of symptoms, duration of time and impact on the patient’s quality of life.
When left untreated, Lyme disease can become chronic, that is, its symptoms may reoccur on a recurring basis. This condition is called “Lyme disease post-treatment syndrome”.
Some other complications that may arise as a result of the disease are:
- Fatigue: The fatigue (extreme tiredness) caused by borreliosis can last for years after the resolution of the condition;
- Arthritis: In some people, arthritis (inflammation of the joints) reappears even after healing;
- Cognitive problems: Some people continue to have problems with memory and other cognitive processes, in addition to headaches;
- Bell’s palsy: When the bacteria reaches the nerve of the face, the patient may have part of the face paralyzed. This condition causes numbness on one side of the face and the patient may have impaired vision and hearing;
- Heart problems: In rare cases, Lyme disease damages the heart, which can suffer from arrhythmia and even a slow heartbeat;
- Depression, anxiety and stress: Due to the limitations and chronic pain caused by the disease, it is common for patients with borreliosis to develop psychological problems, such as depression, anxiety and stress.
The quality of life of patients who had Lyme disease, especially those who ended up developing the chronic form of the disease, can be as bad as that of a patient with chronic limiting diseases. Therefore, living with borreliosis is not simple.
Some measures to be taken to improve this period are:
- Do the treatment correctly: Taking the medications at the right times and following the schedule that the doctor has prescribed is extremely important, so that the treatment has the expected effectiveness;
- Seek help: When affected by feelings of sadness or anxiety, seek professional help. Having a limiting illness can be devastating, but you need to stay motivated to battle the condition and get better;
- Join a support group: Remember that you are not alone and that other people are also dealing with the same disease. Participating in a support group helps to exchange ideas, information and solutions for a better day to day even with the disease;
- Don’t try too hard: If you feel pain, don’t force yourself to do more than you can. Ask people nearby to help you perform everyday tasks.
Because it is a tick-borne disease, to prevent it, just avoid exposure to hosts. So, some tips are:
- Wear long clothes, which do not leave anything exposed, during walks in parks, woods and other places in contact with nature;
- To improve the visualization of ticks, wear light clothes;
- Make use of repellent with DEET, a substance that, in addition to scaring away insects and mosquitoes, also repels ticks;
- After nature walks, check all your clothes and examine your body thoroughly for ticks. This helps because the tick needs to spend more than 24 hours clinging to transmit the disease-causing bacteria;
- Check for the presence of ticks in domestic animals;
- When you find a tick, remove it correctly, without crushing or pulling it awkwardly;
- Control the entry of animals considered pests at home, such as rats. In addition to borreliosis, they can help in the transmission of other diseases.
Prevention in animals
For some animals, it is more difficult to prevent the disease, since they live in contact with nature and can easily contract ticks. Therefore, some tips that owners can follow are:
- Put an anti-tick collar on the animal;
- Pass repellents suitable for animals when taking him for a walk;
- Bathing with ticks after walks and other outdoor activities.
In 1998, a vaccine for humans called LYMErix, formulated by the GSK laboratory ( GlaxoSmithKline ) was approved by the FDA ( Food and Drug Administration ) in the United States. Clinically, the vaccine was able to prevent Lyme disease in 76% of adults and 100% of children, with few adverse reactions.
The vaccine was not very well introduced in the market due to its high initial cost and the fact that the covenants would not pay for them. In addition, several patients who used the vaccine developed autoimmune reactions and filed lawsuits against the laboratory. The FDA and other government agencies investigated the complaints, but found no scientific evidence that such reactions were caused by LYMErix.
Due to pressure from the media and the population, the vaccine was withdrawn from the market in 2002, even without evidence that it was the cause of the reported reactions.
Despite all this, the development of vaccines for dogs has not stopped and, today, in the United States, there are three types of vaccines that can be given to the animal at risk of being infected. These vaccines are:
- LymeVax, por Fort Dodge Laboratories;
- Galaxy Lyme, por Intervet-Schering-Plow ;
- Canine Recombinant Lyme, por Merial.
It does not take much effort to remove the tick correctly. For that, you only need fine-tipped tweezers.
- With the tweezers, grab the tick as close to the skin as possible;
- Pull the tick out at a right angle, without twisting the clamp, firmly;
- Asepsis (disinfect) the bite site and wash your hands;
- If you prefer, save the tick for exams, in a pot or plastic bag.
Lyme disease is painful and limiting, but it can be cured with proper treatment. For more people to have this information in hand, share this text with your friends! If there is any doubt, ask that we respond.