Lyme Disease (for Teens) – Nemours KidsHealth

What Is Lyme Disease?

Lyme disease is the leading tick-borne disease in the United States. It’s most common in the Northeast, the Pacific Northwest, and the northern midwestern states.

Lyme disease is caused by a type of

bacteriafound in animals like mice and deer. Deer ticks (also called black-legged ticks) that feed on these animals can then spread the bacteria to people through tick bites.

You probably won’t see it happening. Deer ticks are tiny, so it’s very hard to see them. Immature ticks (called “nymphs”) are about the size of a poppy seed. Adult ticks are about the size of a sesame seed.

It’s easy to overlook a tick bite. Many people who get Lyme disease don’t remember being bitten. The good news is that most tick bites don’t lead to Lyme disease. But it still helps to know what to watch for.

What Are the Signs & Symptoms of Lyme Disease?

Lyme disease can affect different body systems, such as the nervous system, joints, skin, and heart. The symptoms of Lyme disease are often described as happening in three stages. Not everyone with Lyme has all of these, though:

1. A circular rash at the site of the tick bite, typically within 1–2 weeks of infection, often is the first sign of infection. It’s considered typical of Lyme disease, but many people never get one.

   The rash sometimes has a “bull’s-eye” appearance, with a central red spot surrounded by clear skin that is ringed by an expanding red rash. It also can appear as an growing ring of solid redness. It’s usually flat and painless, but sometimes can be warm to the touch, itchy, scaly, burning, or prickling. The rash may look and feel very different from one person to the next. It can be harder to see on people with darker skin tones, where it can look like a bruise. It gets bigger for a few days to weeks, then goes away on its own. A person also may have flu-like symptoms such as fever, tiredness, headache, and muscle aches.

2. Symptoms of the initial illness may go away on their own. But in some people, the infection spreads to other parts of the body. Symptoms of this stage usually start several weeks after the tick bite, even in those who didn’t have the rash. A person may feel very tired and unwell, or have more areas of rash that aren’t at the site of the bite.

   Lyme disease can affect the heart. This can lead to an irregular heart rhythm, which can cause dizziness or heart palpitations. It can also spread to the nervous system, causing facial paralysis (Bell’s palsy) or meningitis.

3. The last stage of Lyme disease happens if the early stages weren’t found or treated. Symptoms can begin anytime from weeks to years after an infectious tick bite. In kids and teens, this is almost always in the form of arthritis, with swelling and tenderness, particularly in the knees or other large joints.

This wide range of symptoms can make Lyme disease hard for doctors to diagnose. But they can order blood tests to look for signs of the body’s reaction to Lyme disease.

When Should I Call the Doctor?

If a tick bites you, call your doctor. Other conditions can cause similar symptoms, so it’s always a good idea to discuss them with your doctor. That way you can get checked and treated, if needed. Call right away if you get a red-ringed rash, lasting flu-like symptoms, joint pain or a swollen joint, or facial paralysis.

How Is Lyme Disease Treated?

Doctors usually treat Lyme disease with a 2- to 4-week course of antibiotics. People whose Lyme disease is diagnosed quickly and treated with antibiotics almost always have a good outcome. They usually feel back to normal within several weeks of starting treatment.

Is Lyme Disease Contagious?

Lyme disease is not contagious, so you can’t catch it from another person. But you can get it more than once from ticks that live on deer, in the woods, or travel on your pets. So always be cautious, even if you’ve already had Lyme disease.

Can Lyme Disease Be Prevented?

There’s no sure way to avoid getting Lyme disease. But you can minimize your risk. Be aware of ticks when you’re in high-risk areas. If you work outdoors or spend time gardening, fishing, hunting, or camping, take precautions:

• Wear closed shoes or boots, long-sleeved shirts, and long pants. Tuck your pant legs into your shoes or boots to prevent ticks from crawling up your legs.
• Use an insect repellent containing 10% to 30% DEET (N,N-diethyl-meta-toluamide).
• Wear light-colored clothing to help you see ticks more easily.
• Keep long hair pulled back or wear a hat for protection.
• Don’t sit on the ground outside.
• Check yourself for ticks regularly — both indoors and outdoors. Wash your clothes and hair after leaving tick-infested areas.

If you use an insect repellent containing DEET, follow the directions on the product’s label and don’t overapply it. Place DEET on shirt collars and sleeves and pant cuffs, and only use it directly on exposed areas of skin. Be sure to wash it off when you go back indoors.

No vaccine for Lyme disease is currently on the market in the United States.

How Do I Remove a Tick?

You should know how to remove a tick just in case one lands on you or a friend. To be safe, remove the tick as soon as possible.

If you find a tick:

• Call your doctor, who may want you to save the tick after removal so that the tick can later be identified as the type that may carry Lyme disease. You can put the tick in a sealed container to preserve it.
• Use tweezers to grasp the tick firmly at its head or mouth, next to your skin.
• Pull firmly and steadily on the tick until it lets go of the skin. If part of the tick stays in your skin, don’t worry. It will eventually come out. But call your doctor if you notice any irritation in the area or symptoms of Lyme disease.
• Swab the bite site with alcohol.

Note: Don’t use petroleum jelly or a lit match to kill a tick. They won’t get the tick off your skin quickly enough, and may just cause it to burrow deeper into your skin.

Lyme Disease Stories | Lyme Disease

Laura got Lyme disease during a family camping trip. She never saw a tick or a rash and didn’t have symptoms until she suddenly experienced very serious knee and joint pains.

Laura’s Story

Laura is a busy employee of a Colorado non-profit organization. One day in August, while walking up a flight of stairs, she suddenly began to experience pain in both knees and stiffness throughout her entire body. Her friends teased her about being out-of-shape, but as a young and active woman, she was worried. The next day, while riding her bike, her knees began to hurt so badly, she wondered if she’d make it home. On the third day, she didn’t even want to get out of bed. Everything hurt—her knees, ankles, wrists, and shoulders. Just walking to the bathroom was a painful ordeal.

When she saw her doctor a few days later, he asked her a series of questions, including, “Have you taken any vacations?”

Why yes, she had. The previous month, Laura had gone on her family’s annual camping vacation on Assateague Island, Maryland, home of the famous wild ponies. Her doctor decided to test her for Lyme disease and other ailments.

Laura thought back to her vacation and remembered the park ranger in Maryland warning her family about ticks. Could she have Lyme disease? She’d seen ticks crawling near the campsite, but she hadn’t found any ticks on herself. And like nearly a third of Lyme disease patients, she did not recall getting the telltale bull’s-eye rash of Lyme disease.

Two days later, her blood test came back positive for Lyme disease. Laura began taking antibiotics immediately. She started doxycycline on Wednesday and by the next day, she felt slightly better. By Friday, she could navigate steps, slowly and painfully. Progressively her pain subsided, a bit each day. Within a week, she was back to her usual routine.

Laura remains thankful for her doctor’s care. She’s not going to let fear of Lyme disease stop her from attending the next family camping trip; however, she plans to use repellent on her skin and possibly wear permethrin-treated clothing. And now she knows how Lyme disease feels, so if she gets it again, she won’t delay a trip to the doctor. “If you think you have it, go in. Don’t ignore the signs.”

Untreated Lyme disease: If it isn’t caught early, the fallout can be scary

When Nicole Greene’s friend plucked a tick from her head back in 2001 and flushed it away, she thought nothing of it again until six years later when her doctor told her she had Lyme disease and asked if she’d been bitten by a tick.

“I’d never heard of Lyme disease. All I could think was, ‘No, I’m not an outdoor person, there’s no way I have that,”‘ Greene wrote in her blog this week for the U.S. Department of Health and Human Services, where she is deputy director of the Office on Women’s Health.

Driving home from the medical appointment, she remembered the seemingly minor incident from years before.

“My older son used to go to a sleep-away camp and there were parent weekends. I went on a parent weekend and at the time I had long curly hair and I assume that’s when the tick attached itself to me,” Greene told CBS News.

Summer is peak season for ticks and the disea…

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Some time later, she was visiting the friend. “I must have felt something on my head and said, ‘What is this?’ And she called her mom who was a nurse and her mom told her to get the tweezers and get it out and flush it. It was all of two minutes,” Greene said.

“I never even saw it. I did not know about ticks, and I definitely did not know about Lyme disease.”

In the months and years after that, mysterious health issues began cropping up, becoming more serious over time. She experienced achy joints, foggy thinking, depression and shaky hands, to name a few. Despite her efforts to pinpoint a diagnosis, the reason behind the symptoms didn’t become clear until after a flu-like bout in 2007 that left her bedridden for weeks. Her doctor tested her for a slew of conditions – lupus, sickle cell disease, fibromyalgia, chronic fatigue syndrome and Lyme. The Lyme test came back positive.

Greene is one of many people who don’t notice early signs of Lyme disease, brush off the symptoms, or whose medical providers missed the symptoms, which often include fever, headache, fatigue, and a bull’s-eye skin rash called erythema migrans, considered the hallmark of the disease. It appears in about 70 to 80 percent of infected people, according to the U.S. Centers for Disease Control and Prevention, although some doctors believe many more cases lack this obvious sign.

If Lyme is caught early, it can be treated with antibiotics. But if it goes untreated, the infection can spread to the joints, the heart and the nervous system, which explains some of Greene’s symptoms. Patients may suffer with severe headaches and neck aches, heart palpitations, facial palsy, and arthritis with severe joint pain.

A tiny tick, about the size of a mark a felt-tip pen makes, transmits Lyme disease to humans — specifically, a bacterium called Borrelia burgdorferi.

“The tick is so minuscule, the majority of people don’t remember getting bitten by it,” Dr. Neil Spector told CBS News. Spector, a cancer researcher at Duke Medicine, went undiagnosed with Lyme disease himself for four years in the 1990s.

Ticks pick it up from other warm-blooded animals such as deer, mice and foxes, explained Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital and Long Island Jewish Medical Center in New Hyde Park, New York.

There are about 300,000 Lyme infections in the U.S. each year, the CDC estimates, but only about 30,000 cases are confirmed and reported.

People living in New England, the mid-Atlantic states and the upper Midwest are at the biggest risk.

“It’s endemic on Long Island, Cape Cod, Block Island, Shelter Island, and certain parts of Colorado,” Farber told CBS News, highlighting areas where ticks are known to harbor in woods and grassy areas.

Actor/songwriter Kris Kristofferson is among those who suffered from Lyme disease symptoms for years after being misdiagnosed. His wife told Rolling Stone she believes he picked up the infection from a tick in the woods in Vermont while filming the movie “Disappearances” in 2005. His neurological and memory problems were mistakenly blamed on Alzheimer’s, she said.

Mental and physical toll

Spector wrote a book about his own medical odyssey of trying to find answers to his constellation of crippling symptoms. He had moved from Boston to Miami at the time, where doctors were less familiar with Lyme disease.

“I think the problem is, one, there’s this dogma that everyone has this perfectly concentric rash that looks like the Target logo or that people should remember getting bitten by a tick. That there’s this very algorithmic set of signs and symptoms and that is actually far from the truth. Depending on which theories you believe, as many as 40 to 50 percent of people don’t have that perfect rash,” he said.

The rash may be hidden in the scalp, which might have happened in Greene’s case. Some may have something like contact dermatitis or hives, said Spector, and “dark complexioned people may not see anything at all. If you only look for rash you’re missing the boat on a lot of people.”

Undiagnosed and untreated, Spector went from running marathons to barely being able to walk down a hallway at work. He suffered joint pain, heart palpitations and what he called “brain fog.” He went to the emergency room and tests were run but they came up normal.

He was told the move to Florida had probably worn him down, caused stress. But he wasn’t convinced. As a physician in training earlier in his life, Spector said, “I had worked 130 hours a week in a very intense environment and had never experienced anything like that. I was 37. I didn’t smoke, was an avid exerciser. No family history of heart disease. There was no reason I had anything going on in my heart or brain.”

A few months after moving to south Florida, he said the fatigue became profound, “to the point where I could barely walk 10 yards without having to stop. I went from running 10 miles a day to barely walking 20 yards.”

He began to suspect Lyme, but he was urged to manage stress, so he tried biofeedback, more time outdoors and mediation, but the symptoms persisted. “The arrhythmias became a bit more complex,” Spector said.

He soon needed a pacemaker/defibrillator. A first Lyme blood test had come back negative for Lyme disease, but when Spector became convinced he had Lyme and read about the inaccuracy of some lab methods for detecting Lyme, he insisted on further testing. Finally, Lyme was confirmed in 1997.

“I was incredibly relieved to know it wasn’t all in my head,” he said. He was given powerful antibiotics through an I.V. every day for three months to rid his body of the Lyme disease bacteria, sitting alongside his cancer patients who were receiving chemotherapy.

He moved to North Carolina in 1998 to work on cancer research at GlaxoSmithKline, but serious damage had already been done to his heart and eventually a heart transplant was required.

Delayed diagnosis has taken a mental and physical toll on Nicole Greene’s health, too. She missed out on some personal and family events, has had to take time off work for a myriad of medical appointments, and had to pay when insurance wouldn’t cover some Lyme specialist appointments. Now, 15 years from when she was bitten, her body is still getting back on track, she said.

“What has helped is a combination of traditional and non-traditional medications. And changing my diet,” Greene explained. “I have blood work done every four weeks. I don’t stay on any one drug for long periods of time. The impact that medication has on your body is tremendous.”

She said working in the health field has been helpful for her.

“Working in this particular office has been a blessing. Because we’re in women’s health, we are the caregivers. I have a lot of caring,” Greene said. Her advice for other patients is to ask questions again and again to get answers that satisfy, and “surround yourself with caregivers, whether it’s your practitioner or loved ones. “

“No one knows your body better than you do”

It’s not clear how many people suffer from what the CDC calls “chronic Lyme disease,” also referred to as “Post-treatment Lyme Disease Syndrome.” Similar complications and autoimmune-type responses can happen following other infections, such as strep and chlamydia. According to CDC experts, research has not shown that patients who go on prolonged courses of antibiotics do better in the long run than patients treated with a placebo.

“Certainly untreated Lyme could do unusual things. It can cause chronic arthritis, encephalopathy [chronic cognitive problems] and heart problems. But I don’t want people to think that this is common. It’s quite unusual,” said Farber, the infectious disease specialist.

“For the overwhelming majority of people who have Lyme disease, it’s been diagnosed and treated, and even when it’s not diagnosed, they don’t go on to develop those symptoms,” he stressed.

Spector, now an associate professor of medicine and of pharmacology and cancer biology at Duke Cancer Institute, has been able to return to a more active lifestyle again. While his chronic health issues did not stop him from working on developing a new class of breast cancer drugs and a new medication for children with leukemia, he is happy to be back to other activities like running.

“I feel great today. I’ve been running again. Last year I ran three half-marathons. My cardiologist said at my seven year [post-transplant] evaluation, ‘I’m hoping you’ll die of something other than heart disease,'” he said.

Spector’s book about his story, “Gone in a Heartbeat: A Physician’s Search for True Healing,” encourages others to take charge of their health.

“I think people have to trust themselves. No one knows your body better than you do. I don’t care if they have a degree from Yale or Harvard. If what you’re hearing from your doctor is not in line with what you are feeling, you’ve got to find somebody else — advocate for yourself or you can easily fall through the cracks. It’s your life,” Spector said.

Trending News

Mary Brophy Marcus

Mary Brophy Marcus covers health and wellness for CBSNews. com

How can Lyme disease last for years?

Category: Health      Published: October 9, 2015

Public Domain Image, source: CDC/James Gathany.

If treated, Lyme disease does not last for years. However, for some people, the after-effects of the disease can linger for months and sometimes even years. Alternative medicine providers call this condition “Chronic Lyme disease,” but this title is simply wrong. For a person who has been infected with Lyme disease and then treated, the bacteria that causes Lyme disease is measurably no longer present in his body, even though he may still feel some symptoms. The correct title for this condition is therefore “Post-treatment Lyme Disease Syndrome.”

Lyme disease is an infection caused by a bacteria known as Borrelia burgdorferi. This bacteria is delivered to humans through tick bites. From the bite site, the bacteria can enter the bloodstream and spread throughout the body. Usually, but not always, an infectious tick bite causes a characteristic red rash at the site of the bite. Other symptoms include fever, muscle soreness, headache, fatigue, and dizziness. In a few cases, symptoms can also include mood swings, memory loss, and sleep disturbance. If left untreated for too long, Lyme disease can lead to nerve damage, thereby causing shooting pain, numbness, and even paralysis.

The good news is that since Lyme disease is caused by bacteria, antibiotics do a good job of eliminating the disease. Taking antibiotics for one to four weeks, as directed by a doctor, successfully kills all the Lyme-disease bacteria in the patient’s body. Unfortunately, a small percentage of people continue to feel symptoms for many months or even years after these bacteria have been eliminated. For such a person, calling his condition Chronic Lyme disease is incorrect since Lyme-disease bacteria are no longer present in his body. Also, since there are no Lyme-disease bacteria in his body, giving such a person more antibiotics over the course of months and years accomplishes nothing.

Researchers do not currently know conclusively what causes Post-treatment Lyme Disease Syndrome. There are two likely culprits: residual tissue damage and auto-immune malfunction. As mentioned earlier, the Lyme-disease bacteria can damage nerves. Depending on the amount of damage, it can simply take months for the nerves to heal, even long after the bacteria are gone. The good news is that they eventually do heal. Almost all people with Post-treatment Lyme Disease Syndrome eventually feel better. The other possible culprit is an auto-immune disorder that is triggered by the Lyme disease. The patient’s own immune system works so hard at killing off the infectious bacteria that it ends up attacking the patient’s own healthy cells long after the bacteria are gone. Again, most people that experience this effect eventually feel better after several months.

Unfortunately, many of the symptoms of Post-treatment Lyme Disease Syndrome; muscle soreness, joint pain, headache, fatigue, malaise, etc. ; are vague symptoms that could be caused by many other conditions. Lupus, Crohn’s disease, HIV, fibromyalgia, CFS, multiple sclerosis, and rheumatoid arthritis are all conditions that could be easily mistaken as Post-treatment Lyme Disease Syndrome. For this reason, the number of people misdiagnosed with Post-treatment Lyme Disease Syndrome or “Chronic Lyme disease” is likely high. Fortunately, a simple blood test for elevated levels of the corresponding antibody can determine whether a person has had Lyme disease, even if the Lyme-disease bacteria are no longer present. Since antibody levels can stay elevated long after the bacteria that triggered them are gone, a positive antibody blood test does not mean that a person currently has Lyme disease, just that he has had Lyme disease in the past.

Some alternative medicine providers use the phrase “Chronic Lyme disease” as a catch-all diagnosis for any person experiencing general fatigue. Such a diagnosis is neither logical nor helpful. If a patient did not receive a tick bite, did not develop a rash, does not have the other symptoms, and does not have positive blood tests, there is no scientific reason to assume that the patient has Lyme disease or has ever had Lyme disease. Misdiagnosing a patient prolongs the time before he is able to find and treat the real cause of his symptoms. Since the concept of Chronic Lyme disease as a diagnosis for general fatigue is not supported by scientific evidence, any website or publication that claims this should be approached with skepticism.

The CDC states,

It is not uncommon for patients treated for Lyme disease with a recommended 2 to 4 week course of antibiotics to have lingering symptoms of fatigue, pain, or joint and muscle aches at the time they finish treatment. In a small percentage of cases, these symptoms can last for more than 6 months. Although sometimes called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme Disease Syndrome” (PTLDS). ..studies have not shown that patients who received prolonged courses of antibiotics do better in the long run than patients treated with placebo.

Topics:
Chronic Lyme disease, Lyme disease, antibiotics, tick

Stages of Lyme Disease | Michigan Medicine

Topic Overview

Lyme disease
can go through several stages. It may cause different symptoms, depending on how long you have been infected and where in your body the infection has spread.

Stage 1: Early localized Lyme disease (1 to 4 weeks)

Early localized Lyme disease develops days to weeks after you become infected. You may have:

• An expanding, circular red rash (erythema migrans).
• Flu-like symptoms, with or without the rash. The symptoms include:
  • Lack of energy.
  • Headache and stiff neck.
  • Fever and chills.
  • Muscle and joint pain.
  • Swollen lymph nodes.

In some cases of Lyme disease, the person doesn’t notice any symptoms during this stage.

Stage 2: Early disseminated infection (1 to 4 months)

If Lyme disease isn’t found and treated while early symptoms are present, or if you don’t have early symptoms that trigger the need for treatment, the infection may affect the skin, joints, nervous system, and heart within weeks to months after the initial infection.

Symptoms may include:

• An expanding, circular rash at the site of the bite. More rashes may appear on other parts of your body as the infection spreads.
• Pain, weakness, or numbness in the arms or legs.
• Not being able to use the muscles of the face.
• Headaches or fainting that continues to happen.
• Poor memory and reduced ability to concentrate.
• Conjunctivitis (pinkeye) or sometimes damage to deep tissue in the eyes.
• Brief episodes of pain, redness, and swelling in one or more large joints—most often the knee. Joint problems are common.
• Occasional rapid heartbeats (palpitations) or, in rare cases, serious heart problems.

Late persistent Lyme disease

If Lyme disease isn’t promptly or effectively treated, damage to the joints, nerves, and brain may develop months or years after you become infected. It is the last and often the most serious stage of the disease.

Symptoms at this stage may include:

• Arthritis that most often affects the knee. A small number of people eventually get chronic Lyme arthritis, which causes recurring episodes of swelling, redness, and fluid buildup in one or more joints that last up to 6 months at a time.
• Numbness and tingling in the hands, feet, or back.
• Feeling very tired.
• Not being able to control the muscles of the face.
• Problems with memory, mood, or sleep, and sometimes problems speaking.
• Heart problems, which are rare but can occur months to even years after you are bitten by an infected tick. The most serious heart problems—such as inflammation of the structures surrounding the heart (pericarditis)—usually resolve without any lifelong damage. Unfortunately, heart problems can be the first sign of Lyme disease in a small number of people who didn’t have early symptoms.

Stage 2 and stage 3 symptoms may be the first signs of Lyme disease in people who didn’t have a rash or other symptoms of early infection.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Christine Hahn MD – Epidemiology
W. David Colby IV MSc, MD, FRCPC – Infectious Disease

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Christine Hahn MD – Epidemiology & W. David Colby IV MSc, MD, FRCPC – Infectious Disease

Lyme disease: MedlinePlus Medical Encyclopedia

Lyme disease is caused by bacteria called Borrelia burgdorferi (B burgdorferi). Blacklegged ticks (also called deer ticks) can carry these bacteria. Not all species of ticks can carry these bacteria. Immature ticks are called nymphs, and they are about the size of a pinhead. Nymphs pick up bacteria when they feed on small rodents, such as mice, infected with B burgdorferi. You can only get the disease if you are bitten by an infected tick.

Lyme disease was first reported in the United States in 1977 in the town of Old Lyme, Connecticut. The same disease occurs in many parts of Europe and Asia. In the United States, most Lyme disease infections occur in the following areas:

• Northeastern states, from Virginia to Maine
• North-central states, mostly in Wisconsin and Minnesota
• West Coast, mainly in the northwest

There are three stages of Lyme disease.

• Stage 1 is called early localized Lyme disease. The bacteria have not yet spread throughout the body.
• Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.
• Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

Risk factors for Lyme disease include:

• Doing outside activities that increase tick exposure (for example, gardening, hunting, or hiking) in an area where Lyme disease occurs
• Having a pet that may carry infected ticks home
• Walking in high grasses in areas where Lyme disease occurs

Important facts about tick bites and Lyme disease:

• A tick must be attached to your body for 24 to 36 hours in order to spread the bacteria to your blood.
• Blacklegged ticks can be so small that they are almost impossible to see. Many people with Lyme disease never even see or feel a tick on their body.
• Most people who are bitten by a tick do not get Lyme disease.

Why Is Lyme Disease So Hard to Understand?

In the fall of 1997, after I graduated from college, I began experiencing what I called “electric shocks”—tiny stabbing sensations that flickered over my legs and arms every morning. They were so extreme that as I walked to work from my East Village basement apartment, I often had to stop on Ninth Street and rub my legs against a parking meter, or else my muscles would begin twitching and spasming. My doctor couldn’t figure out what was wrong—dry skin, he proposed—and eventually the shocks went away. A year later, they returned for a few months, only to go away again just when I couldn’t bear it anymore.

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Over the years, the shocks and other strange symptoms—vertigo, fatigue, joint pain, memory problems, tremors—came and went. In 2002, I began waking up every night drenched in sweat, with hives covering my legs. A doctor I consulted thought, based on a test result, that I might have lupus, but I had few other markers of the autoimmune disease. In 2008, when I was 32, doctors identified arthritis in my hips and neck, for which I had surgery and physical therapy. I was also bizarrely exhausted. Nothing was really wrong, the doctors I visited told me; my tests looked fine.

In 2012, I was diagnosed with a relatively mild autoimmune disease, Hashimoto’s thyroiditis. Yet despite eating carefully and sleeping well, I was having difficulty functioning, which didn’t make sense to my doctor—or to me. Recalling basic words was often challenging. Teaching a poetry class at Princeton, I found myself talking to the students about “the season that comes after winter, when flowers grow.” I was in near-constant pain, as I wrote in an essay for The New Yorker at the time about living with chronic illness. Yet some part of me thought that perhaps this was what everyone in her mid-30s felt. Pain, exhaustion, a leaden mind.

I looked over at the man sitting next to me—a novelist I’d known for years—and realized I had no idea who he was.

One chilly December night in 2012, I drove a few colleagues back to Brooklyn after our department holiday party in New Jersey. I looked over at the man sitting next to me—a novelist I’d known for years—and realized that I had no idea who he was. I pondered the problem. I knew I knew him, but who was he? It took an hour to recover the information that he was a friend. At home, I asked my partner, Jim, whether he had ever experienced anything like this. He shook his head. Something was wrong.

By the following fall, any outing—to teach my class, or to attend a friend’s birthday dinner—could mean days in bed afterward. I hid matters as best I could. Debt piled up as I sought out top-tier physicians (many of whom didn’t take insurance)—a neurologist who diagnosed neuropathy of unclear origin, a rheumatologist who diagnosed “unspecified connective-tissue disease” and gave me steroids and intravenous immunoglobulin infusions. I visited acupuncturists and nutritionists. I saw expensive out-of-network “integrative” doctors (M.D.s who take a holistic approach to health) and was diagnosed with overexhaustion and given IV vitamin drips. Many doctors, I could tell, weren’t sure what to think. Is this all in her head? I felt them wondering. One suggested I see a therapist. “We’re all tired,” another chided me.

I was a patient of relative privilege who had access to excellent medical care. Even so, I felt terrifyingly alone—until, in the fall of 2013, I found my way to yet another doctor, who had an interest in infectious diseases, and tested me for Lyme. I had grown up on the East Coast, camping and hiking. Over the years, I had pulled many engorged deer ticks off myself. I’d never gotten the classic bull’s-eye rash, but this doctor ordered several Lyme-disease tests anyway; though indeterminate, the results led her to think I might have the infection.

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I began to do research, and discovered other patients like me, with troubling joint pain and neurological problems. To keep symptoms at bay, some of them had been taking oral and intravenous antibiotics for years, which can be dangerous; one acquaintance of mine was on her fifth or sixth course of IV drugs, because that was the only treatment she’d found that kept her cognitive faculties functioning. I read posts by people who experienced debilitating exhaustion and memory impairment. Some were so disoriented that they had trouble finding their own home. Others were severely depressed. Along the way, nearly all had navigated a medical system that had discredited their testimony and struggled to give them a diagnosis. Many had been shunted by internists to psychiatrists. The stories were not encouraging.

After a decade and a half in the dark, I at last had a possible name for my problems. Yet instead of feeling relief, I felt I had woken into a nightmare. I wasn’t sure whether the disease I had really was untreated Lyme. Even if I did have Lyme, there was little agreement about how to treat a patient like me—whose test results were equivocal and who had been diagnosed very late in the course of the disease—and no guarantee that I would get better if I tried antibiotics.

It was a scary path to walk down. My own doctor cautioned that the label Lyme disease was easy to pin on one’s symptoms, because the tests can be inaccurate. I understood. I’d gotten my hopes up before. My experience of medicine had led me to conclude that specialists often saw my troubles through their particular lens—an autoimmune disease! a viral issue! your mind! And I worried that if I were to go see a Lyme specialist—an internist with a focus on the disease—he would say I had it no matter what.

Scott W. Baker / Getty

In the absence of medical clarity, I had to decide what to do. Was I going to become a Lyme patient? If so, whom was I to trust, and how far would I go? Then one night, in my rabbit-hole searching, I stumbled on a thread of Lyme patients describing the same electric shocks that had bedeviled me for years. The back of my neck went cold. For nearly 20 years I had tried to find a doctor who would think the problem was something other than dry skin. I had asked friends if they had any idea what I was talking about. No one ever did. I had thought I was imagining it, or being oversensitive—or was somehow at fault. To see my ordeal described in familiar, torturous detail jolted me to attention.

I knew then that I needed to learn more about the complex reality of Lyme disease and tackle the near-impossible task of sorting out what was understood and what wasn’t. I didn’t yet know that simply by exploring whether untreated Lyme disease could be the cause of my illness, I risked being labeled one of the “Lyme loonies”—patients who believed that a long-ago bite from a tick was the cause of their years of suffering. They’d been called that in a 2007 email sent by the program officer overseeing Lyme grants at the National Institutes of Health. The now-infamous phrase betrayed just how fiercely contested the disease is—“one of the biggest controversies that medicine has seen,” as John Aucott, a physician and the director of the Johns Hopkins Lyme Disease Clinical Research Center, later described it to me.

Lyme Disease was discovered in Connecticut in the mid-1970s. Today it is a major, and growing, health threat, whose reach extends well beyond its initial East Coast locus. Reported cases increased almost fivefold from 1992 to 2017, and the Centers for Disease Control and Prevention estimates that annual incidences have risen to more than 300,000, and may even range above 400,000. Step into parks in coastal Maine or Paris, and you’ll see ominous signs in black and red type warning of the presence of ticks causing Lyme disease. In the summer in the eastern United States, many parents I know cover their children from head to toe—never mind the heat—for a hike in the woods or a jaunt to a grassy playground. On a recent trip to my brother’s new country house in Vermont, a few weeks before his partner woke up one morning with a dramatic bull’s-eye rash, I chased my toddler sons around, spraying them so often with tick repellent that they thought we were playing a special outdoor game.

Read: What tick saliva does to the human body

By now, just about everyone knows someone who’s been diagnosed with Lyme disease, and most of us know to look for the telltale rash (often described as a bull’s-eye, many Lyme rashes are solid-colored lesions) and to ask for a prompt dose of antibiotics. For most of those who get swiftly diagnosed and treated, that will be the end of the story. But lots of Americans have also heard secondhand reports of people who stayed sick after that course of antibiotics. And lots know of cases in which no rash appeared and a diagnosis came late, when damage had already been wrought. Plenty of others, upon discovering an attached deer tick, have encountered doctors who balk at prescribing antibiotics to treat a possible Lyme infection, wary of overdiagnosis.

(CDC data for Massachusetts are not available for 2016 and 2017.)

The degree of alarm and confusion about such a long-standing public-health issue is extraordinary. The consequences can’t be overestimated, now that Lyme disease has become an almost “unparalleled threat to regular American life,” as Bennett Nemser, a former Columbia University epidemiologist who manages the Cohen Lyme and Tickborne Disease Initiative at the Steven & Alexandra Cohen Foundation, characterized it to me. “Really anyone—regardless of age, gender, political interest, affluence—can touch a piece of grass and get a tick on them.”

Even as changes in the climate and in land use are causing a dramatic rise in Lyme and other tick-borne diseases, the American medical establishment remains entrenched in a struggle over who can be said to have Lyme disease and whether it can become chronic—and if so, why. The standoff has impeded research that could help break the logjam and clarify how a wily bacterium, and the co-infections that can come with it, can affect human bodies. After 40 years in the public-health spotlight, Lyme disease still can’t be prevented by a vaccine; eludes reliable testing; and continues to pit patients against doctors, and researchers against one another. When I got my inconclusive diagnosis, I knew better than to dream of a quick cure. But I didn’t know how extreme the roller coaster of uncertainty would be.

Lyme Disease came into public view when an epidemic of what appeared to be rheumatoid arthritis began afflicting children in Lyme, Connecticut. A young rheumatologist at Yale named Allen Steere, who now conducts research at Massachusetts General Hospital, in Boston, studied the children. In 1976 he named the mysterious illness after its locale and described its main symptoms more fully: a bull’s-eye rash; fevers and aches; Bell’s palsy, or partial paralysis of the face, and other neurological issues; and rheumatological manifestations such as swelling of the knees. After much study, Steere realized that the black-legged ticks that live on mice and deer (among other mammals) might be harboring a pathogen responsible for the outbreak. In 1981, the medical entomologist Willy Burgdorfer finally identified the bacterium that causes Lyme, and it was named after him: Borrelia burgdorferi.

B. burgdorferi is a corkscrew-shaped bacterium known as a spirochete that can burrow deep into its host’s tissue, causing damage as it goes and, in laboratory conditions at least, morphing as needed from corkscrew to cystlike blob to, potentially, slimy “biofilm” forms. Because of this ability, researchers describe it as an “immune evader.” Once it hits the human bloodstream, it changes its outer surface to elude an immune response, and then quickly moves from the blood into tissue, which poses problems for early detection. (Hard to find in the bloodstream and other body fluids, the B. burgdorferi spirochete is hard to culture, which is how bacterial infections are definitively diagnosed.) If it goes untreated, B. burgdorferi can make its way into fluid in the joints, into the spinal cord, and even into the brain and the heart, where it can cause the sometimes deadly Lyme carditis.

Chronic Lyme disease, in the view of the infectious-disease establishment, was a pseudoscientific diagnosis—an ideology rather than a biological reality.

By the mid-’90s, a mainstream consensus emerged that Lyme disease was relatively easy to diagnose—thanks to the telltale rash and flulike symptoms—and to treat. Infectious diseases are the kind of clear-cut illness that our medical system generally excels at handling. Evidence indicated that the prescribed treatment protocol—a few weeks of oral antibiotics, typically doxycycline—would take care of most cases that were caught early, while late-stage cases of Lyme disease might require intravenous antibiotics for up to a month. That assessment, made by the Infectious Diseases Society of America, formed the basis of the IDSA’s treatment guidelines from 2006 until recently. (In late June, a revised draft called for, among other things, a shorter course—10 days—of doxycycline for patients with early Lyme.)

Yet the picture on the ground looked far murkier. A significant percentage of people who had Lyme symptoms and later tested positive for the disease had never gotten the rash. Others had many characteristic symptoms but tested negative for the infection, and entered treatment anyway. Most startling, a portion of patients who had been promptly and conclusively diagnosed with Lyme disease and treated with the standard course of doxycycline didn’t really get better. When people from each of these groups failed to recover fully, they began referring to their condition as “chronic Lyme disease,” believing in some cases that the bacterium was still lurking deep in their bodies.

Frustrated with the medical system’s seeming inability to help them, patients emerged as an activist force, arguing that Lyme disease was harder to cure than the establishment acknowledged. Family physicians in Lyme-endemic areas, confronted with patients who weren’t getting better, tried out other treatment protocols, including long-term oral and intravenous antibiotics, sometimes administered for months or years. They also started testing assiduously for tick-borne co-infections, which were appearing in some of the sickest patients. Many of these doctors rotated drugs in the hope of finding a more effective regimen. Some patients responded well. Others didn’t get better. In 1999, these doctors banded together to form the International Lyme and Associated Diseases Society. Highlighting the problems with Lyme-disease tests and citing early evidence that bacteria could persist in animals and humans with Lyme disease even after they’d been treated, ILADS proposed an alternative standard of care that defined the illness more broadly and allowed for more extensive treatment.

Jon Lovette / Getty

But some prominent Lyme-disease researchers were skeptical that the infection could persist after treatment—that bacteria could remain in the body. They argued that many chronic Lyme-disease patients were being treated for an infection they no longer had, while others had never had Lyme disease in the first place but had appropriated the diagnosis for symptoms that could easily have other causes. Chronic Lyme disease, in the Infectious Diseases Society of America’s view, was a pseudoscientific diagnosis—an ideology rather than a biological reality. Under the sway of that ideology, it contended, credulous patients were needlessly being treated with dangerous IV antibiotics by irresponsible physicians. (It didn’t help when a Lyme patient in her 30s died from an IV-related infection.)

To make its case, the IDSA cited a handful of studies indicating that long-term antibiotic treatment of patients with ongoing symptoms was no more effective than a placebo—proof, in its view, that the bacterium wasn’t causing the symptoms. The IDSA also highlighted statistics suggesting that the commonly cited chronic Lyme symptoms—ongoing fatigue, brain fog, joint pain—occurred no more frequently in Lyme patients than in the general population. In the press, experts in this camp implied that patients who believed they had been sick with Lyme disease for years were deluded or mentally ill.

The antagonism was “fierce and alienating for the patients,” Brian Fallon, the director of the Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center, told me. Hostilities continued to intensify, not just between patients and experts, but between community doctors and academic doctors. In 2006, the IDSA guidelines for patients and physicians argued that “in many patients, posttreatment symptoms appear to be more related to the aches and pains of daily living rather than to either Lyme disease or a tick-borne co-infection.” This message rang hollow for many. “Researchers were saying, ‘Your symptoms have nothing to do with Lyme. You have chronic fatigue syndrome, or fibromyalgia, or depression,’ ” Fallon told me. “And that didn’t make sense to these patients, who were well until they got Lyme, and then were sick.”

By the time the doctor first floated the possibility, in 2013, that I might have Lyme, my headaches, brain fog, and joint pain had gotten much worse, and tiny bruises had bloomed all over my legs and arms. I was so dizzy that I began fainting. A black ocean, it seemed, kept crashing over me, so that I couldn’t catch my breath. I could no more touch the old delights of my life than a firefly could touch the world beyond the jar in which it had been caught.

When I returned to the doctor’s office two weeks later to go over the test results, I didn’t know what I was in for. Imperfect diagnostics lie at the core of the whole debate over Lyme disease. Standard Lyme tests—structured in two tiers, to minimize false positives—can’t reliably identify an infection early on or determine whether an infection has been eradicated. That’s because the tests are not looking for the “immune evader” itself—the B. burgdorferi spirochete—in your blood. Instead, they assess indirectly: They look for the antibodies (the small proteins our bodies create to fight infection) produced in response to the bacteria. But antibody production takes time, which means early detection can be hard. And once produced, antibodies can last for years, which makes it difficult to see whether an infection is resolved, or even whether a new one has occurred. What’s more, antibodies to autoimmune and viral diseases can look like the ones the body makes in response to Lyme.

For a thorough interpretive reading, some doctors will send blood to several different labs, which can deliver results that don’t always agree with one another. And the CDC—which recommends that only a specific pattern of antibodies, agreed on by experts in 1994, be considered indicative of a positive test—suggests that, when needed, doctors should use their judgment to make what’s called a “clinical diagnosis,” based on symptoms and likelihood of exposure, along with the lab tests.

I was confused. My doctor showed me mixed results from three labs. Two had a positive response on one part of the test but not the other, while the third had a negative response on both parts. Because of my medical history as well as particular findings on my tests, she concluded that I probably did have Lyme disease. But she also noted that I had a few nasty viruses, including Epstein-Barr. In addition, the test may have been picking up on autoimmune antibodies, given my earlier diagnosis.

At the recommendation of a science-writer friend, I finally went to see Richard Horowitz, a doctor in upstate New York who specializes in Lyme disease and had earned a reputation as a brilliant diagnostician. Horowitz, who goes by “Dr. H” with many of his patients, is a practicing Buddhist, with bright-blue eyes and an air of brimming eagerness. He recently served as a member of the Tick-Borne Disease Working Group convened by the Department of Health and Human Services, which in 2018 issued a report to Congress outlining problems with the diagnosis and treatment of Lyme patients.

I told him that I wasn’t sure I had Lyme disease. I had brought along a stack of lab results nearly half a foot tall—a paper trail that would scare off many doctors. He perused every page, asking questions and making notes. Finally, he looked up.

“Based on your labs, your symptoms, and your various results over the years, I highly suspect you have Lyme,” he said. “See these?”—he bent over a set of results from Stony Brook laboratory—“these bands are specific for Lyme.”

In his waiting room, I had completed an elaborate questionnaire designed to single out Lyme patients from a pool of patients with other illnesses that affect multiple biological systems. (It has since been empirically validated as a screening tool.) Now Dr. H did a physical exam and ordered a range of tests to rule out further thyroid problems, diabetes, and other possible causes of my symptoms. Because I had night sweats and the sensation that I couldn’t get enough air into my lungs—a symptom known as “air hunger”—he proposed that I might have a co-infection of babesia, a malaria-like parasite also transmitted by ticks. Curious, I told him that I had always thought of Lyme as a primarily arthritic disease, whereas I had many neurological and cognitive symptoms. He explained that B. burgdorferi is now known to come in different strains, which are thought to produce different kinds of disease.

“The funny thing is, I think you’re actually a very strong and healthy person, and that’s why you did okay for so long,” he continued. “Now your body needs help.”

Douglas Sacha / Getty

Dr. H prescribed a month of doxycycline, and warned me about something I’d read online. When I began the antibiotic, I might at first feel worse: As the bacteria die, they release toxins that create what’s known as a Jarisch-Herxheimer reaction—a flulike response that Lyme patients commonly refer to as “herxing.” But over time, he said, I should feel better. If not, we were on the wrong track.

Over dinner that night, back in Brooklyn, I told Jim that despite what Horowitz had urged, I wasn’t sure I wanted to take the antibiotics. I didn’t have a cut-and-dried positive test for Lyme, and I knew how damaging antibiotics are to the microbiome. “What do you really have to lose?” he asked, in disbelief. “You’re sick, you’re suffering, and you’ve tried everything else.”

The next morning, I took a dose of the doxycycline, along with Plaquenil, which is thought to help the antibiotics penetrate cells better. I took another dose that night with dinner. I went to bed and woke up feeling like hell. My throat was sore and my head was foggy. My neck was a fiery rebar.

Two days later, we went out to get lunch. I was still groggy and unwell. It was a heavy, gray day, with low clouds. Returning home, I felt rain all over my bare arms. I told Jim we should hurry.

“Why?” he said.

“It’s raining!”

“It’s not raining,” he said. “It’s just cloudy.” I raised my hands to show him the raindrops. A dozen pips of cold popped along my arm. But there was no rain. As we walked home, cold drops rushed all over my body, my skin crawling as if a strange, violent water were cleansing it.

Several days later, though, I felt excited to fly to a conference in Chicago, rather than exhausted by the prospect. For three more weeks, I took the drugs and supplements Dr. H had prescribed. The doxycycline made me allergic to the sun. One late-spring morning, I forgot to put sunblock on my right hand before taking a walk with a friend, holding a coffee cup. It was 9 o’clock and cloudy. By the time I got home, my hand felt tender. Over the next few days a second-degree burn developed, blistering into an open wound.

After a month of antibiotic treatment, I took the train back up to Dr. H’s office. On his questionnaire, I rated my symptoms as less severe than I had a month earlier, but my total score still fell in the high range. Dr. H changed the protocol, adding an antimalarial drug. He was concerned about my continued night sweats and air hunger.

When I started taking the new drugs, in June 2014, I was nearly as sick as I had ever been. I flew to Paris to teach at NYU’s summer writing program. Within two days of arriving, I could barely walk down the street. Violent electric shocks lacerated my skin, and patches of burning pain and numbness spread up my neck. I shook and shivered. The reaction lasted five days, during which panic mixed with the pain. How was I to know whether this was herxing and a positive reaction to the drugs as they killed bacteria and parasites, or a manifestation of the disease itself? Or were weeks of antibiotics themselves causing problems for me?

“I know you think you’re doing the right thing,” a concerned colleague said, “but aren’t you just making yourself sicker?”

On the sixth day, I was sitting on the couch in my rented apartment and the shocks were so violent, racing across my forearms and thighs and calves, that when I looked up at the tall open windows, the sun streaming through them, it occurred to me that I could jump out of them and find relief.

The next morning I woke up to the same bright sun, feeling better than I had in ages. Stunned by my energy, I went out for a run. I wasn’t exactly racing down the sidewalk, but 40 minutes later, for the first time in years, I had run three miles. As the weeks passed, I felt better and better. My drenching night sweats vanished. The air hunger was gone. I had loads of energy. I took antibiotics for several more months, and each month I had fewer symptoms. After eight months of treatment, Dr. H decided that I could stop. It was the spring of 2015.

That fall I got pregnant, at the age of 39. At Dr. H’s urging, I took antibiotics on and off during my pregnancy. In the summer of 2016, I delivered a healthy baby boy.

By the time I started treatment, the fact that Lyme disease causes ongoing symptoms in some patients could no longer be viewed as the product of their imaginations. A well-designed longitudinal study by John Aucott at Johns Hopkins showed the presence of persistent brain fog, joint pain, and related issues in approximately 10 percent of even an ideally treated population—patients who got the Lyme rash and took the recommended antibiotics. Other studies found these symptoms in up to 20 percent of patients. The condition, christened “post-treatment Lyme disease syndrome,” or PTLDS, is now recognized by the CDC. (Of course, the term doesn’t apply to patients like me, who never had a rash or a clearly positive test.) Even so, the condition is hotly contested, and plenty of high-level people in the field—as well as the Infectious Diseases Society of America itself—still don’t recognize it as an official diagnosis. Perhaps most important, crucial questions about the cause of ongoing symptoms remain unanswered, due in part to the decades-long standoff over whether and how the disease can become chronic. As Sue Visser, the CDC’s associate director for policy in the Division of Vector-Borne Diseases, acknowledges, “Many are very rightfully frustrated that it’s been decades and we still don’t have answers for some patients.”

Recently, though, a host of new studies has freshly tackled a lot of those questions: Why do Lyme symptoms persist in only some patients? What don’t we know about the behavior of the B. burgdorferi bacteria that might help explain the variation in patients’ responses to it?

There isn’t much federal funding to study Lyme disease, and what there is often goes to research on prevention and transmission. (The NIH spends only $768 on each new confirmed case of Lyme, compared with $36,063 on each new case of hepatitis C.) Much of the money to investigate PTLDS has come from private foundations, including the Steven & Alexandra Cohen Foundation, the Global Lyme Alliance, and the Bay Area Lyme Foundation. The CDC and the NIH recently reached out to these groups, officials told me, spurred on in part by the 2018 Tick-Borne Disease Working Group report to Congress outlining major holes in the scientific understanding of Lyme disease.

Read: When evidence says no, but doctors say yes

In a conversation I had with him, Bennett Nemser of the Cohen Foundation laid out some of the hypotheses that are currently being explored. The complexity is daunting. A patient with ongoing symptoms may actually still have a Lyme infection, and/or a lingering infection from some other tick-borne disease. Or the original infection might have caused systemic damage, leaving a patient with recurring symptoms such as nerve pain and chronic inflammation. Or the Lyme infection might have triggered an autoimmune response, in which the immune system starts attacking the body’s own tissues and organs. Or a patient might be suffering from some combination of all three, complicated by triggers that researchers have not yet identified.

One way or another, an intricate interplay of the infection and the immune system, new research suggests, is at work in patients who don’t get better. The immune response to the Lyme infection, it turns out, is “highly variable,” John Aucott told me. For example, some research has suggested that ongoing symptoms are a result of an overactive immune response triggered by Lyme disease. Recently, though, a study co-authored by Aucott with scientists at Stanford found that, in patients who developed PTLDS, the Lyme bacteria had actually inhibited the immune response.

By now, accumulating evidence suggests that in many mammals, Lyme bacteria can persist after treatment with antibiotics—leading more scientists to wonder if the bacteria can do the same in humans. In 2012, a team led by the microbiologist Monica Embers of the Tulane National Primate Research Center found intact B. burgdorferi lingering for months in rhesus macaques after treatment. Embers also reported that the macaques had varying immune responses to the infection, possibly explaining why active bacteria remained in some. The study drew criticism from figures in the IDSA establishment; in their view it failed to prove that the bacteria remained biologically active. But Embers told me that this year, in their work with mice, she and her team have managed the feat of culturing B. burgdorferi, showing that it was viable after a course of doxycycline. New studies looking into possible bacterial persistence in humans—conducted by the National Institute of Allergy and Infectious Diseases, part of the NIH—are under way.

Markus Spiske / Unsplash

Meanwhile, several researchers, including Ying Zhang at the Johns Hopkins Bloomberg School of Public Health, have proposed another explanation for how B. burgdorferi can remain after treatment: the presence of what are called “persister bacteria,” similar to those found in certain hard-to-treat staph infections but long thought not to exist in Lyme. In the case of Lyme disease, persister bacteria are a subpopulation that enters a dormant state, allowing them to survive a normally lethal siege of antibiotics. These persister bacteria, Zhang’s team found, caused severe symptoms in mice, and the current single-antibiotic Lyme protocols didn’t eradicate them—which makes sense: Doxycycline functions not by directly killing bacteria, but by inhibiting their replication. Thus it affects only actively dividing bacteria, not dormant ones, relying on a healthy immune system to dispatch any B. burgdorferi that remain.

The big outcome, though, was that when Zhang’s team treated the mice with a three-antibiotic cocktail, including a drug known to work on persistent staph infections, the mice cleared the persistent B. burgdorferi infection. “We now have not only a plausible explanation but also a potential solution for patients who suffer from persistent Lyme-disease symptoms despite standard single-antibiotic treatment,” Zhang said. Taking the next step, Kim Lewis at Northeastern University, who has had a distinguished career studying persister bacteria, is about to conduct a study, in collaboration with Brian Fallon, looking at whether a compound that specifically targets persister cells can help patients with PTLDS.

Of course, even if active bacteria do remain in some Lyme patients, they may well not be the cause of the symptoms, as many in the IDSA have long contended. Paul Auwaerter, the clinical director of infectious diseases at Johns Hopkins School of Medicine and a former president of the IDSA, points out that Lyme bacteria can leave behind DNA “debris” that may trigger ongoing “low-grade inflammatory responses.” Lewis told me that the overarching question—“whether the pathogen is there and is slowly causing damage, or has already left the body and has wrecked the immune system”—has yet to be settled, in his view. But, he said, “I’m optimistic that we and others are going to find a cure for PTLDS.”

When my son was seven months old, my interlude of feeling energetic and mostly symptom-free abruptly ended. He was not a good sleeper, and months of waking at night had worn me down. In early April 2017, we both got sick, and I didn’t recover. My body ached. My brain got foggy. My primary-care doctor noted that the Epstein-Barr virus was active in my system again. Dr. H suggested that the Lyme infection had recurred, and that I needed another course of antibiotics, but I hesitated. I wasn’t sure whether to believe that the Lyme infection could persist, and I attributed my ill health to an autoimmune flare or postviral fatigue. For months I stalled, but soon the electric shocks were back, zapping my arms and legs, and life became a slog. I started antibiotics. Within five days, my energy returned and I felt almost completely well again. A month later, feeling better than I had in almost 20 years, I got pregnant with my second son.

Could this recovery be attributed to the placebo effect?, I wondered. If so, it was the only placebo that had ever worked for me.

Meanwhile, my father, who lived in Connecticut, had begun to suffer drenching night sweats, fatigue, and aches and pains. His tests were negative for Lyme but suggestive of ehrlichiosis, another tick-borne infection, and his doctor—in the heart of Lyme country—decided to treat what seemed like a plausible culprit and its co-infection. My father was put on doxycycline for five months. He didn’t improve, which surprised me, given that I had seen immediate results. Then one day my brother found him at home, on the verge of collapse, and took him to an ER, where batteries of tests revealed that he had a different problem. He was suffering from Stage 4 Hodgkin’s lymphoma.

In 2018, my father died of complications from pneumonia, after recovering from the cancer. I couldn’t help wondering how much those lost months had perhaps cost him, as the cancer advanced and weakened him—all because Lyme had seemed like an obvious enough explanation, and the testing was sufficiently murky, that his doctor did not pursue other diagnoses. Though promising new diagnostic technologies are on the horizon, we still can’t reliably sort out who has a tick-borne disease and who doesn’t.

On a brisk March day this year, the kind of day that can’t decide whether it’s warm or cold, I visited a research laboratory at Massachusetts General Hospital directed by Allen Steere, the rheumatologist who discovered Lyme disease and helped establish the testing parameters for it. A slim, gray-haired man with an intense gaze, he has become, in the eyes of many Lyme patients, an embodiment of the medical system’s indifference, because he has long suggested that some chronic Lyme patients were incorrectly diagnosed in the first place. He has been shouted down at conferences and ambushed by people purporting to be journalistic interviewers. Scientists who disagree with him had nonetheless singled him out to me for his commitment to studying Lyme. I wanted to hear his perspective on the disease and on the debate after four decades of immersion in both.

While underscoring that medicine can be humbling, and that Lyme disease is complex, Steere spoke with the calm air of someone setting a child straight. Emphasizing that in many people Lyme disease can resolve on its own without antibiotics, he carefully described a disease that in the United States frequently follows a specific progression of stages if untreated, beginning with an early rash and fever, then neurological symptoms, and culminating later in inflammatory arthritis. The joint inflammation can continue for months or even years after antibiotic treatment, but not, he believes, because the bacteria persist. His research on patients who have these continuing arthritis symptoms has revealed one cause to be a genetic susceptibility to an ongoing inflammatory response. This discovery has led to effective treatment for the longer-term challenges of Lyme arthritis, using what are called disease-modifying anti-rheumatic agents.

After I told him a little about my case, he struck a note of similarly solicitous firmness. He told me that in his view, late-stage Lyme (which is what I had been diagnosed with) usually does not cause a lot of “systemic symptoms,” such as the fatigue and brain fog I had experienced. “I want you to free yourself from the Lyme ideology,” he said. “You clearly were helped by antibiotic therapy. But I don’t favor the idea that it was spirochetal infection. Of course, there are other infectious agents,” he continued, noting that some of them trigger complex immune responses.

Jon Tyson / Unsplash

I left Steere’s office unnerved, thinking that if I had met a doctor with some version of this view in 2014, I would never have started doxycycline and gotten better. Could it really be that I had some condition other than Lyme that turned out to respond to antibiotics? He was an expert who had devoted his entire career to studying the mechanics of the disease; I was a patient who happens to be temperamentally both exacting and excitable, and scientifically curious—a layperson craving evidence.

That night I curled up with my computer in my hotel room and reread a 1976 New York Times article about the discovery of Lyme. New things struck me, in particular Steere’s growing suspicion back then that bacteria couldn’t be the cause, because this microorganism wasn’t acting like a bacterium:

The bacterial infections that are known to cause arthritis leave permanent joint damage, and bacteria are easy to see in body fluids and easy to grow in test tubes. Every effort to culture bacteria from fluids and tissues from the patients has failed.

Steere had moved on to a new possibility: “A virus is the most likely candidate,” he told the Times. “Just because we haven’t found one yet doesn’t mean it isn’t there. We’ll keep looking.” When I recently wrote to ask him if he had been “fooled” by Lyme disease back in the 1970s, he reminded me of how much he and others had learned, in just a few years, about this then-new infection. He went on to remind me that science can “lead to one ‘dead end’ after another. One needs to learn from these dead ends and continue trying.”

“Anyone who says they really understand the pathophysiology of what’s going on is oversimplifying to some degree,” said Ramzi Asfour, a physician and member of the Infectious Diseases Society of America with notably open views on Lyme disease, when I reached him on the phone in his Bay Area office. Asfour has found that a one-size-fits-all approach to Lyme diagnosis and treatment is inadequate for most patients in his medical practice. We don’t know enough yet about diseases that are characterized by abnormal activity of the immune system, he emphasized. But, alongside the usual standardized protocols, they clearly call for the tactics of personalized medicine, because the immune system is so complex—and so individualized. For example, autoimmune diseases can be triggered by stressors that include trauma or infection. And standard lab reports don’t always capture early stages of disease. Listening to patients is crucial.

“Being an infectious-disease doctor is usually pretty rewarding in the conventional sense,” Asfour said. “The patient is in the ICU; you grow a bacteria, and you see it; then you give them a magic pill. They get better and walk home. It’s very satisfying.” The experience of Lyme patients challenges that model. As the surgeon Atul Gawande once wrote of the medical profession, “Nothing is more threatening to who you think you are than a patient with a problem you cannot solve.”

The less we understand about a disease, as Susan Sontag argued years ago in Illness as Metaphor, the more we tend to psychologize or stigmatize it. In the midst of the current debate over Lyme, I can’t help thinking about other illnesses that modern medicine misunderstood for years. Multiple sclerosis was once called hysterical paralysis, and ulcers were considered “a disease of tense, nervous persons who live a strenuous and worrisome life,” as one mid-century medical manual put it, outlining a notion that remained common until the 1980s. In fact, ulcers are caused by bacteria—though when a researcher proposed as much in 1983, he was almost literally laughed out of a room of experts, who swore by the medical tenet that the stomach was a sterile environment. Doctors now also know that not everyone with the bacteria gets an ulcer—it’s caused by a complex interplay of pathogen and host, of soil and seed, perhaps like post-treatment Lyme disease syndrome.

In a week, or a month, or six months, I will start feeling less well. Sharp electric shocks will start running along my legs and arms, for minutes, then hours, then days.

It is true that Lyme disease has become a term that stands for more than itself. If not an ideology, it is a metonym for all tick-borne illness, for embattled suffering, for the ways that medicine has fallen short of its promised goal of doing no harm—in this case by dismissing and mocking suffering patients. As Wendy Adams of the Bay Area Lyme Foundation put it to me, “We now have incontrovertible data that says these people are legitimately sick. ” Just because a symptom is common and subjective—as fatigue is—doesn’t mean that a patient can’t tell the difference between a normal version of it and a pathological one. After all, we’re able to distinguish between the common cold and a case of the flu. When I was very ill, I felt like a zombie—more important, I felt categorically different from myself. By contrast, today I have aches and pains, and I’m tired, but I am more or less “me.”

Recently, I called Richard Horowitz and several other Lyme experts to ask them, once again, if they really thought it was likely that I had Lyme. “Meghan. You have Lyme disease,” Dr. H said. “You have had multiple Lyme-specific antibodies show up on your tests. You had all the symptoms that led to a clinical diagnosis. And you got better when you took antibiotics.” Others echoed his conclusion.

I live in uncertainties, as the poet John Keats put it while he was dying of an infection then thought to be a disease of sensitive souls, which we now know is tuberculosis. But I am fairly sure of one thing. In a week, or a month, or six months, I will start feeling less well. My head will get foggier, my energy level will sink. When I wake in the morning, I will have a severe headache. Sharp electric shocks will start running along my legs and arms, for minutes, then hours, then days. My older son will stop eating his breakfast as I twitch in pain, and say, “What’s wrong, Mommy?” And once again I will ask Dr. H for antibiotics.

While writing this article, it happened. I took the antibiotics. I felt worse, and then I felt dramatically better. In a few months, when I have stopped nursing my younger son, I will try Dr. H’s new anti-persister regimen. Consisting of three different drugs, including antibiotics used to treat persister bacteria found in diseases like TB and leprosy, it has put some of his most challenging patients into remission for nearly two years now.

I can’t know for sure that I have Lyme disease. But to imagine that I might never have found the treatment that has saved my life in every sense—restoring its joy—terrifies me. I think often about patients who are less fortunate, whose disease, whatever it may be, has gone unrecognized. One of the bitterest aspects of my illness has been this: Not only did I suffer from a disease, but I suffered at the hands of a medical establishment that discredited my testimony and—simply because of my search for answers, and my own lived experiences—wrote me off as a loon. In the throes of illness, cut off from the life you once lived, fearing that your future has been filched, what do you have but the act of witness? This is what it is like. Please listen, so that one day you might be able to help.

This article appears in the September 2019 print edition with the headline “Life With Lyme.”

Lyme Disease | Zecken.de

According to the current state of knowledge, Lyme disease can only be contracted through a tick bite. Individuals with Lyme disease are not contagious. Since Borrelia bacteria are first found in the midgut of the tick, it takes some time for them to enter the bloodstream. Presumably, after the tick is sucked, many hours must pass before it enters the host’s blood. That is, the faster the tick is removed, the lower the risk of developing Lyme disease.

There is currently no vaccine against Lyme disease. In addition, it is possible to become infected several times and have Lyme disease in several stages at the same time.
Lyme disease occurs worldwide where ticks live. Various types of ticks are known to carry Lyme disease. In Europe, the dog tick (Ixodes ricinus) is the main vector. The pathogen is spread in different ways, according to the Robert Koch Institute, depending on the region, from 5 to 35 percent of ticks carry Borrelia bacteria.The chances of becoming infected with Lyme disease after a tick bite are on average 1.5 to 6 percent. The longer the tick drinks blood, the higher the chance of infection.

However, not everyone who comes into contact with Borrelia as a result of a tick bite will get sick. In many cases, the body manages to control the disease – the infection does not cause any complaints and is cured without consequences. Therefore, in many healthy people, protective bodies against the causative agent of borreliosis are found in the blood.Up to 25 percent of people have these antibodies in their blood, having never had Lyme disease before. Only 0.5 to 1.5 percent of those bitten by a tick really get sick.

Diagnosis of Lyme disease

Lyme disease is most easily identified by a physician as erythema migrans, a circular, extensive reddening. It often occurs in the area of ​​a tick bite, however, it can also occur in other parts of the body. It may take about 28 days for migratory redness to appear.Therefore, it is important to observe the bite site.

If migratory redness develops and the patient remembers that he was bitten by a tick, the doctor will start treating Lyme disease with antibiotics. An additional laboratory blood test is not required, since antibodies to the causative agent of borreliosis at an early stage of infection are often not yet confirmed. Conversely, the presence of antibodies in the blood is not a confirmation of overt Lyme disease, since the corresponding substances can be found in the blood of even healthy people.

It is more difficult to diagnose Lyme disease at a later stage. The migratory redness disappears by this time. Patients also can no longer remember whether a tick has bitten them, since many years may have passed since then. Therefore, the doctor should take a closer look at the symptoms of his patient – such as changes in the condition of the skin, complaints of joint pain or paralysis of the facial nerve, as well as take into account another clinical picture with similar signs. Positive laboratory results are not reliable diagnostics and, moreover, hide the danger that the real cause of complaints will go unnoticed.If, as a result of a laboratory blood test, no protective bodies for the causative agent of borreliosis are found, the doctor with a probability bordering on certainty can exclude Lyme disease at a late stage.

Lyme disease treatment

Since Lyme disease is a bacterial disease, antibiotics can be treated very well, especially at an early stage. Late onset or chronic symptoms often require intravenous antibiotics over several weeks.

Protection against Lyme disease

How dangerous is borreliosis

Most of the Urals already know that tick-borne encephalitis is dangerous both for its health consequences and deaths. But ticks carry not only tick-borne encephalitis, but also other infections, for example, Lyme borreliosis .

How dangerous it is and what to do if bitten by a tick, said neurologist Anastasia Yakupova.

We publish an interview from the E1 portal.

In Yekaterinburg, the news that it is possible to contract a fatal infection in a popular vacation spot excited many.

We turned to the specialists of the city center for the prevention and treatment of natural focal infections of the City Clinical Hospital No. 33. They did not comment on this case, since the girl did not come to them and they did not know what actually happened.

We just wanted to find out how dangerous borreliosis is (by the way, there is no vaccine against this infection), whether there are often deaths and how to protect yourself from it.

“Yes, unlike tick-borne encephalitis, there are no vaccinations against borreliosis,” said Anastasia Yakupova, a neurologist at the center, to E1.RU . – But with encephalitis, there are deaths in unvaccinated people. But I have not heard about deaths from infection with borreliosis, and this has not happened in our practice.

– How does the disease manifest itself?

– Symptoms: erythema at the site of the bite or other areas of the skin (spot with clear contours, size from 2-3 to 20 cm), aching joints, muscles, nausea, severe headache.There may be no aches and fever, only erythema. However, erythema is not always the case. You need to carefully monitor your well-being.

The incubation period for borreliosis is from six to seven days to three weeks, sometimes the incubation period can be long, up to three months.

If a tick bites you, you must immediately contact the emergency room, remove it, and take it for analysis. And then (regardless of the test results, even if the study showed that the tick is not infected), you need to monitor the condition for one to one and a half months.

At this time, you need to protect yourself from overheating: it is better not to take a steam bath, not to sunbathe on the beach. If you experience an atypical headache, aching muscles or joints, erythema (symptoms of a tick-borne infection may resemble ARVI), consult a doctor. Additional blood tests for tick-borne infections need to be done.

– Is this infection difficult to treat?

– Prescribe antibiotics. Usually, treatment is outpatient, that is, at home.But you cannot engage in self-medication. Treatment is with antibiotics, but only as directed by a doctor. If borreliosis is not treated, bacteria multiply in the body and can affect joints, internal organs: liver, heart. But if the patient is undergoing treatment, the disease goes away without complications.

– Can borreliosis provoke an exacerbation of chronic diseases?

– Usually borreliosis itself cannot provoke an exacerbation of diseases.Although the course of the disease depends on the individual characteristics of the organism: on age, on the immune status.

In the Sverdlovsk region, ticks have become more active since the beginning of June. You can read how to protect yourself from ticks in the forest here. We talked about the consequences of a tick bite on the example of the stories of several people.

Source: https://www.e1.ru/news/spool/news_id-66153418.html

It’s safe at the New Hospital .We have taken unprecedented measures of epidemiological safety in order for our patients to calmly resolve health issues

90,000 Erythema migrans – Medical Center “Liko-Med”

Publication date
3 October 2018

What is it?

Erythema migrans is the name for the ring-shaped rash that occurs in Lyme disease. The rash looks like a ring with an outer bright red edge and a diameter of up to 15 centimeters or more, there may be several such rings.The disease can develop as a result of a tick bite that is infected with the bacteria that cause Lyme disease. In some cases, Lyme disease may not be accompanied by a rash, but is characterized by the presence of fever, headache, joint pain, and fatigue. Sometimes very serious complications develop with Lyme disease.

What to expect?

Erythema migrans usually appears within a month from the time of the tick bite. In some cases, it occurs in multiple locations.The rash can last from several days to a month or longer. At the site of the rash, there is soreness, itching, the rash is hot to the touch. Although no specific treatment is required for erythema migrans, Lyme disease itself requires antibiotic therapy. The earlier treatment is started, the higher the chances of a complete cure.

Prevalence

The average incidence of Lyme disease is approximately 5-6 episodes per 100,000 people.

Treatment

Erythema migrans usually resolves on its own without treatment, but Lyme disease requires antibiotics.In some cases, anti-inflammatory drugs for fever and joint pain may also be used.

When to see a doctor?

See a doctor if you see erythema migrans or any other symptom of Lyme disease.

What to ask the doctor about?

• Are the observed symptoms due to Lyme disease or are there other causes?
• Are any studies required to confirm the diagnosis?
• If the test is positive for Lyme disease, what are the next steps?
• What treatment is needed?
• Will symptoms improve?

Diagnosis

When diagnosing erythema migrans and Lyme disease, the doctor takes a history of the disease and performs a physical examination.You will also need a blood test.

Risk factors

• Activities such as hiking or gardening in tick-infested areas.

90,000 Vampires attack: Ixodid tick infestation

Myths and legends

No, ticks are not insects, they are arachnids. Insects have six legs, arachnids have eight.

No, they do not fall from trees – they climb onto us from the grass or from low bushes (the maximum height to which the tick rises is one and a half meters), and then for a long time – from 30 minutes to several hours – they crawl over us in search of the optimal places for a bite.

No, they do not need to be watered with oil, kerosene, gasoline, vodka, cologne, paint thinner or any other liquid. If you harm someone with this, then definitely not a tick.

No, if you or your friend was bitten by a tick, and then nothing terrible happened, this does not mean that any tick bite is safe. This is tantamount to the statement “And I once ran across the motorway, and the car did not hit me, which means that pedestrian crossings are not needed.”Or something like this: “But I had unprotected sex with a stranger, and I did not get sick, so it is not worth spending money on condoms.” If someone is lucky once, this does not mean that everyone will always be lucky. Alas.

No, if you have not found either encephalitis or borreliosis, this does not mean that you are the lucky one. Not every laboratory is tested for all tick-borne infections. If for the second month they are trying to treat you for a mysterious acute respiratory disease, but your temperature does not go away and everything hurts, and even diarrhea in addition, your task is to find a competent infectious disease specialist.

There is good news: if you have been diagnosed with encephalitis or borreliosis, you are not contagious to others – these infections are not transmitted by airborne droplets or by contact. But if you are a nursing mother, breastfeeding, unfortunately, will have to be interrupted – there is a risk of transmitting the pathogen to the baby through breast milk.

How to prevent tick-borne borreliosis from ruining your life

Ticks are most active in late spring and early summer.It is during this period that it is easiest to pick up borreliosis (aka Lyme disease). In 2017, 90,151 almost 7 thousand cases of the disease were registered in Russia.

What is tick-borne borreliosis and how is it dangerous

Lyme disease is a bacterial infection. Bacteria – Borrelia – enter the human body from the salivary glands of a tick that has stuck into the skin. Fortunately, not everyone, but only the ixod.

This family of bloodsuckers is generally extremely unpleasant. In addition to Lyme disease, tick-borne encephalitis and some other diseases, such as babesiosis, tick-borne fever, are transmitted by ixodids.Therefore, it is advisable to take the tick pulled out of the body to the laboratory in order to find out if it belongs to a dangerous family.

But even if it belongs, the chance to stay healthy remains.

Not every ixodid tick is contagious.

But if it is contagious, the prospects are unpleasant. Tick-borne borreliosis is dangerous due to complications of ^{, which appear several weeks, or even months after the bite. These include:}

• Joint problems.Bacteria that enter the body cause joint inflammation. At first, this is manifested by pain and swelling. Over time, the situation worsens up to the development of arthritis and forced limitation of mobility.
• Neurological problems. Numbness and weakness in the extremities, movement disorders, temporary paralysis of one side of the face, inflammation of the meninges (meningitis) are just a short list of complications associated with neurology.
• Cardiovascular problems, in particular severe arrhythmia.
• Inflammation of the liver (hepatitis).
• Inflammation of the eyes.
• Severe fatigue.

These complications can be fatal. Therefore, it is very important not to overlook Lyme disease and not refuse treatment.

How to understand that you have tick-borne borreliosis

The first sign of a possible infection is the tick bite itself. If you are lucky enough to remove the arthropod and take it to the laboratory, great: it will dispel or, on the contrary, strengthen your suspicions.But if the laboratory failed to dissect the bloodsucker, begin to closely monitor the skin and well-being.

1. Watch the bite site

A red bump and swelling like a mosquito bite is normal. Such a skin reaction, even if the edema is large, disappears in a few days and is not a sign of borreliosis.

An obvious symptom appears at the site of the bite after 3–30 days.

Photo: AnastasiaKopa / Shutterstock

This is the so-called erythema – a red spot surrounded by white and red rims.If you find it on the skin, urgently contact a therapist: you have tick-borne borreliosis.

However, not everyone infected with Lyme disease marks such a target. So other signs are also important.

2. Watch your well-being

With Lyme disease, a few days after the bite appear:

• fever and chills, seemingly unreasonable, because there are no traditional signs of ARVI like a runny nose, cough, sore throat;
• weakness, increased fatigue;
• headaches;
• pain, body aches;
• slight difficulty with neck movements;
• swollen lymph nodes.

The presence of these symptoms does not speak for sure about borreliosis. Fever and aches may be due to other causes. But if you observe in yourself two or more signs and at the same time remember that you have recently been bitten by a tick, be sure to consult a doctor.

See a doctor even if symptoms come and go.

This also happens with borreliosis. The disease continues to spread quietly, only to seriously ruin your life one day.

How to treat tick-borne borreliosis

First, you need a doctor to make a diagnosis. Unfortunately, this can take time. If there is no obvious sign of erythema, Lyme disease is confirmed with a blood test. But you will have to wait with him, because antibodies to the disease are produced only a few weeks after the bite.

If the diagnosis is confirmed, your doctor will prescribe antibiotics. Which one depends on your age and the duration of the bite, as well as on the severity of the symptoms.Typically, doxycycline, amoxicillin, cefuroxime are used, but other options are possible. In difficult cases, when the disease has already affected the nervous system, antibiotics are prescribed intravenously.

Most often, borreliosis is completely curable. To do this, you just need to start treatment on time.

But even after successful therapy, the so-called post-treatment Lyme disease syndrome can develop. It includes weakness, increased fatigue, and regular muscle and joint pain.Scientists don’t know why this is happening.

Why it is impossible not to treat tick-borne borreliosis

At first glance, the question sounds strange. This is if you do not know how insidious Lyme disease is.

It happens that after the detection of erythema, a person cannot immediately get to a therapist. In the meantime, the erythema disappears, and the remaining symptoms appear so implicitly that the bitten one decides: “I recovered myself!” And already deliberately does not go to the doctor. This is a huge mistake.

Borrelia, without even making themselves felt, continue to multiply in the body, slowly affecting various organs and systems.

Problems with joints, heart, nervous system are gradually increasing. A patient who has already forgotten about the bite is running around uselessly between a therapist, a cardiologist, a neurologist, a rheumatologist, who also do not understand what is happening. And if one day some particularly attentive doctor nevertheless establishes the main cause of the disease, it may be too late: Borrelia will corrode the body so much that it will be impossible to cure a person.

Hence an important rule: if there is the slightest suspicion of borreliosis, a check is necessary.And if the fears are confirmed, treatment is required.

How to protect yourself from tick-borne borreliosis

Lyme disease is easier to prevent than to cure. Therefore, remember the important safety rules.

1. Dress appropriately when going outdoors. You should be wearing a long-sleeved jacket, loose pants and high shoes. Tuck your legs into shoes or socks if you are wearing sneakers. T-shirts and shirts into trousers. It is good if the clothes are light and monochromatic: it is easier to notice a tick against such a background.A headdress is required.
2. Use repellents. Those that contain permethrin and the chemical compound diethyltoluamide (DEET) are most effective against ticks. Just spray them on your clothing, not your skin.
3. Get in the habit of looking at yourself and those around you. At least once every half hour, carefully examine clothes and exposed areas of the body for ticks.
4. Avoid bushes or tall grass. These are the places that ticks prefer.
5. Back home, wash your clothes at a temperature not lower than 60 ° C.Tick ​​larvae can remain on it, which are difficult to notice.
6. Immediately after your visit to nature, take a shower and bathe the children. During the procedure, carefully examine and feel the body, especially the scalp under the hair and the area under the knees. If the tick has sucked in, you need to remove it as soon as possible. The longer it stays on the skin, the higher the risk of getting sick. Lyme infection is unlikely if the tick is attached for less than 36 to 48 hours.

Read also ☀️🧐🌲

symptoms, diagnosis and treatment “- Yandex.Kew

Lyme disease is a vector-borne pathology caused by pathogenic bacteria of the genus Borrelia.

It is very difficult to talk about the prevalence of pathology, which in many sources is called the “great imitator.” This name is due to the polymorphism of the clinical manifestations of Lyme disease, in connection with which patients develop symptoms that force them to turn to neuropathologists, dermatologists or rheumatologists, and not to infectious disease specialists.

Lyme disease is very common in Europe, North America, Australia and Asia.In recent years, the number of patients with this diagnosis has been increasing in Russia and Ukraine. This is due to the high sensitivity of the human body to Borrelia. Many famous personalities have had this disease – Avril Lavigne, Ashley Olsen, Richard Gere and others.

Causes

The causative agent of the disease is bacteria of the genus Borrelia from the Spirochaetaceae family. The vectors of pathogens are ixodid ticks (I.ricinus, I. pacificus, I. damini). An infected tick is contagious at any stage of its development. This means that larvae, nymphs, and adults of arthropods are quite capable of leading to human infection with Borrelia with the further development of Lyme disease.

Human infection occurs when tick saliva enters the damaged skin areas. Another route of infection is also possible – contamination, when the contents of a crushed tick is rubbed into the skin while scratching its itchy areas.In addition, there are cases of transmission of pathology by the placental pathway. A surge of pathology is observed in the spring-autumn period.

Stages of the disease

Conventionally, Lyme disease is divided into 3 stages:

1. The first stage lasts 30 days after the tick bite. At this time, the patient has a general malaise, flu-like symptoms are observed. Over the course of a crescent, the patient’s body temperature may rise up to 40 degrees.Sometimes there may be signs of intoxication of the body. During this period, you can notice an increase in the spot at the site of the tick bite. Timely started treatment helps get rid of the stain in a few days. If therapy has not been carried out, it can remain on the body for up to 2 months.
2. The disease progresses to the second stage of development in the absence of treatment. After a few weeks or months, the nervous system is damaged, the patient develops a skin rash (like hives), and heart pains.At this stage, angina often occurs, renal, hepatic and ocular pathologies develop. Relapses of bronchitis may occur.
3. The third stage of Lyme disease develops approximately 2-3 (or 5-6) months after the end of phases 1 and 2. At this time, the pathology passes into the phase of chronicity. The patient complains of constant fatigue and loss of strength, sleep disturbance and depression. At this stage, the process of damage to various internal organs and systems continues.

Lyme disease symptoms

The incubation period of the disease is 1-2 weeks.The first symptoms of Lyme disease do not have specific features, and they are expressed:

• increase in body temperature;
• cephalalgia;
• chills;
• joint aches;
• muscle weakness;
• general malaise and weakness.

Stiffness in the neck is one of the most common symptoms of Lyme disease. An annular erythema forms at the site of the bite, which is the main manifestation of erythema annular migrans. During the first days, a small macula or papule forms, and then erythema begins to spread, affecting large areas of the skin.At the edges, redness has a bright shade, it rises slightly above the epidermis. The ring is paler in the middle.

Round erythema can reach 10-2 cm in diameter. It is often localized on the legs, less often in the lumbar region, neck, abdomen, armpits or groin area.

In the acute period of the course of the disease, the appearance of:

• headaches;
• nausea with vomiting;
• photophobia;
• hyperesthesia;
• muscle and joint pain;
• meningeal symptoms.

After 1-3 months, the disease can go to the 2nd stage of development. At this time, neuralgic and cardiac symptoms appear.

Systemic tick-borne borreliosis is accompanied by the development of meningitis in combination with neuritis of the cranial nerves and radiculoneuritis. Among the most common cardiac symptoms is atrioventricular block. Myocarditis and pericarditis may develop.

Over time, the occurrence and increase of shortness of breath, increased heart rate, chest pains.Lyme disease rarely goes to the last, 3, stage of development. It comes in about 6 months, or 1-2 years. With its development, the joints are damaged (chronic Lyme arthritis), the skin (atrophic acrodermatitis), the nervous system (chronic neurological syndrome).

Signs of a chronic form

One of the most common symptoms of borreliosis is the development of arthritis, which can be accompanied by other chronic processes in the patient’s body.In particular, this concerns the development of osteoporosis, thinning of cartilage, and sometimes their complete loss, less often (in more severe cases) – degenerative changes.

Often, skin lesions occur, accompanied by the formation of a benign nodule – lymphocytoma, which has a raspberry tint and a convex, rounded shape. When pressed on its surface, the tumor-like growth can become painful.

The most common sites for this infiltrate are the nipple of the breast and the earlobe.Lymphocytoma can persist on the human body for months, or even years.

Atrophic acrodermatitis is characterized by the appearance of cyanotic red spots in the extensor areas of the arms and legs. They are prone to peripheral enlargement and fusion. This, in turn, can lead to the development of systemic inflammation.

Over time, the skin in the area of ​​the spots atrophies and becomes similar to papyrus. The development of such a pathological process can continue for several months or years.

Lyme disease – photo

The photos below show what Lyme disease looks like.

Diagnostics

The diagnosis is made on the basis of a carefully collected history and analysis of the clinical picture observed in the patient. Since the tick is the carrier of pathology, the patient must remember whether in the recent past there has been a visit to a forest, forest belt, parks. However, not all people notice a tick bite, so a timely visit to a doctor is rare.

To confirm or refute the diagnosis of Lyme disease, a specific diagnosis is carried out, which consists in the use of serological methods of blood tests – ELISA and ELISA. Performing such diagnostic manipulations helps to identify immunoglobulins (antibodies) of the IgG and IgM classes in the patient’s biomaterial.

However, in the first phase of the development of the disease, serological research methods turn out to be uninformative in 50% of cases. For this reason, a repeated study of blood serum is carried out after 20-30 days.

Through PCR, it is possible to accurately identify the DNA of Borrelia in a sample of skin tissue, cerebrospinal fluid, or blood.

Differential diagnosis

It is very important to differentiate Lyme disease from diseases with similar symptoms. This list includes:

Borreliosis at the 1st stage of development must be distinguished from these diseases. In the second phase, differential diagnosis must be carried out in order to exclude various forms of tick-borne encephalitis, rheumatic heart disease or cardiopathy.At 3 stages of progression, pathology should be differentiated from rheumatoid arthritis, rheumatism, Reiter’s disease and reactive arthritis. To carry out such a diagnosis, synovial fluid is used for further morphological studies.

Lyme disease treatment

Patients with this diagnosis are hospitalized without fail in the hospital of the infectious diseases department. Pharmacological drugs are prescribed taking into account the phase of the pathology.

Patients with mild borreliosis are usually prescribed antibiotics of the tetracycline series (Tetracycline, Doxycillin). Medication is taken for 14 days. If necessary, the drug Amoxicillin can be prescribed.

The transition of Lyme disease to stages 2 and 3, accompanied by damage to the joints, nervous system and heart, requires the use of cephalosporin or penicillin antibiotics. The course of therapy lasts from 3 to 4 weeks.

During antibiotic therapy, the patient may experience or worsen symptoms of spirochetosis.This is due to the process of death and elimination of borrelia from the body, as a result of which endotoxins are actively released into the blood. Under such circumstances, antibiotics are temporarily stopped and then resumed.

Treatment of Lyme disease depends largely on the accompanying symptoms. So, in case of joint damage,

NSAIDs

, analgesics, as well as courses of physiotherapy. When general infectious signs occur, detoxification therapy is carried out, and with meningitis, dehydration treatment is resorted to.If severe systemic inflammation develops, the patient is prescribed oral corticosteroids, or intra-articular injections are given (with the development of synovitis).

Complications

Lyme disease can cause:

1. Brain complications. The most severe course is characterized by pathological processes that have affected the central nervous system. Inflammation of the meninges, peripheral or cranial nerve fibers may develop.
2. Cardiac complications.Untreated borreliosis is fraught with the development of endocarditis or pericarditis.
3. Articular complications, in particular their inflammation.

Prophylaxis

To date, there are no specific measures for the prevention of Lyme disease. Therefore, it is important to exercise caution in areas where a person is most susceptible to tick bites.

When driving into forest park zones, forest belts or forests, you must carefully protect the body. The easiest way is to wear a long-sleeved, high-collar shirt and long trousers.If a tick has been found on the body, it must be carefully removed. This should be done with gloves, using pre-disinfected tweezers. If the manipulation was successful, the tick must be clamped by the head and removed with twisting movements.

It is not necessary to crush the tick – this can lead to the ingress of its pathological contents on healthy areas of the skin. After the procedure, the wound must be rinsed with an antiseptic, and then hands must be thoroughly washed.

If there are pets in the house, they should be examined after each walk, as ticks often attach to animals.

Forecast

A favorable prognosis is possible only with timely detection and treatment of the disease. There are cases when systemic tick-borne borreliosis stopped at an early stage of development, leaving behind the so-called “serological tail”.

The prognosis is unfavorable in patients who have abnormally high titers of IgG immunoglobulin for a long time. In this case, repeated antibiotic therapy is indicated along with symptomatic treatment.Patients who have undergone pathology should be under dispensary observation in the conditions of KIZ for a year. During this time, clinical and diagnostic studies are required every 14-21 days, 3, 6 and 12 months.

If skin, neurological or rheumatic symptoms persist, the patient is referred to specialized medical specialists. Further studies are carried out taking into account the patient’s history.

Material provided

simptomy-lechenie.net

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