Introduction
Many patients will suffer for years with non-specific symptoms. This might include aching bones and muscles and tingling nerves that cannot be explained. One often missed cause is a rare infection called Lyme disease. It comes from a tick bite and can cause mysterious symptoms like fatigue. It is good to be aware of it for those who cannot explain their symptoms.
What is Lyme Disease?
Lyme disease is a complex, multisystem disease that can present sneakily over a great length of time and present a great diagnostic challenge. Lyme is a disease caused by a spirochaete, a kind of bacteria, and is transmitted via the bite of a tick. Often the tick bite cannot be remembered but when it does occur, it can cause a large bulls eye red rash at the site.
This disease affects multiple parts of the body…
- The nervous system
- Skin
- Heart
- Muscles
Lyme is relatively easy to treat if identified in the first 6 weeks after a bite. However, it can persist for years after this with non specific symptoms that do not resolve with antibiotic treatment.
How does Lyme Disease start?
Borrelia Burgderfori is a spirochaete bacteria transmitted by the bite of a tick called Ixodes ricinus. It is common in parts of the Northern hemishphere including Asia, North America and Europe. Bites are more common in Spring and Summer and in wooded environments.
The tick has to attach for 24 hours before infection is likely. After this, about 50% of patients will get a characteristic ‘bulls eye’ rash (called Erythema Migrans) that is more or less a slam dunk confirmation of Lyme disease. The rash usually occurs within 3-30 days and grows to 5cm with central clearing.
It is critical to treat Lyme disease at this stage of the disease as it is 99% effective; beyond this, the late term complications are much harder to treat.
What are the longer term manifestations of Lyme disease?
Musculoskeletal symptoms
After about 6 months, it is typical for musculoskeletal symptoms to begin. This involves muscle, joint and bone pain which migrates and is non specific. They are usually one sided and will either resolve or progress to full arthritis; the typical story is a big red knee effusion on one side.
Neurological Symptoms
About 60% of patients go on to have neurological symptoms. This includes meningitis (inflammation of the brain lining causing headaches, confusion, neck pain), shooting pain down the nerves, failure of the nerves that control eye or facial muscle movement. People can even have stroke-like attacks as well as areas of numbness and sensory change over the body. Dementia and speech problems are possible.
Heart
A smaller percentage, <10%, of people may have issues with the heart ranging from conduction issues to full-blown heart inflammation.
How is Lyme disease diagnosed?
If a patient presents with the bullseye rash, then the diagnosis is clear. Later down the track, diagnosis is much more difficult.
It is important to ask if there has been a tick bite as this is helpful. This will be followed by a series of antigen tests however these are not always reliable.
How is Lyme disease treated?
Lyme disease is treated with antibiotics.
References
Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T. Lyme disease: review. Arch Med Sci. 2012;8(6):978-982. doi:10.5114/aoms.2012.30948
