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Lyme’s disease: a tiring, weary chronical condition

We all know that we can get Lyme’s disease from ticks. If we are not careful, and do not take immediate action, the ticks can fill themselves with our blood, leaving a toxin which is lethal to children or infecting us with bacteria of the Borrelia bergdorferi and Borrelia mayonii type (US) or the Borrelia garinii and Borrelia afzelii type (Europe and Asia). The disease, however, does not occur the first few days; the first symptoms only occur after a week. When we are not cautious enough, we can certainly be infected by this disease, which – in general – commonly appears on the northern hemisphere, in the colder climates as well as the moderate climates. It is estimated to affect 300,000 people a year in the United States and 65,000 people a year in Europe. Infections are most common in the spring and early summer.

Now you may ask yourselves “Why is he writing about this disease?” Well, I have a friend who got this diseases some time ago, and she is trying to make people aware of the dangers. With this blog, I want to contribute to this awareness.

 

How do you get Lyme’s disease?

Whenever it is a good day to go hiking, stroll through meadows, go to a park or any outdoors activity, be very aware of your clothing. The ticks usually nest in the vegetation of meadows, woods or other rural environments. Most commonly, they are carried by small rodents, such as mice, rabbits or similar. All these are merely carriers, not being infected by them. But that does not mean they only stick to these small animals. Only in the larval stage, they attach to the small rodents. In the nymph stage, they can also attach to larger animals, such as cats, dogs, deer and other live stock. These animals are also immune to the disease. Only when the ticks attach to humans, especially in the nymph stage, they become carriers for the disease.

 

Symptoms

Lyme can affect multiple body systems and produce a broad range of symptoms. Not all patients with Lyme disease have all symptoms, and many of the symptoms are not specific to Lyme disease, but can occur with other diseases, as well. Symptoms most often occur from May to September, because the nymphal stage of the tick is responsible for most cases. The classic sign of early local infection with Lyme disease is a circular, outwardly expanding rash called erythema chronicum migrans (EM). This occurs at the site of the tick bite three to 32 days after the tick bite. Within days or weeks, the bacteria may begin to spread through the bloodstream.

Other occurring symptoms may include migrating pain in muscles, joints, and tendons, and dizziness. Also, a number of neurological problems may occur, such as facial palsy, meningitis, neck stiffness, sensitivity to light, inflammation of the spinal cord’s nerve roots, sleep deprivations caused by this inflammation, and mild encephalitis which may lead to memory loss.

After several months, untreated or inadequately treated patients may go on to develop severe and chronic symptoms that affect many parts of the body, including the brain, nerves, eyes, joints, and heart. Many disabling symptoms can occur, including permanent impairment of motor or sensory function of the lower extremities in extreme cases. There are even much more symptoms, but it would take the rest of this blog to mention all of them.

Other symptoms that may occur, depending on the co-infection,  are fatigue (exhaust), severe sweating, high fever and chills, general weakness, weight loss, nausea, abdomenal pains, diarrhea, coughing, short breath, severe headaches, sore neck and back, dizziness, anemia, dark urine or blood in urine, severe neuro-psychiatric symtoms, hart attacks, kidney failure, poor appetite, and an unusual streaked rash that resembles “stretch marks” from pregnancy, swollen glands are typical, especially around the head, neck and arms, blurred vision, numbness in the extremities, memory loss, balance problems, headaches, ataxia (unsteady gait), tremors, encephalitis

Whenever you think you have suffered a tick infection, it is best to see a doctor as soon as possible, in order to get the proper treatment.

 

Co-infections

Along with Lyme disease, a patient can get one or more of the following co-infections:

The above mentioned symptoms may be the result of Lyme itself, or one or more of these co-infections.

 

Diagnosis

Because of the difficulty in culturing Borrelia bacteria in the laboratory, diagnosis of Lyme disease is typically based on the clinical exam findings and a history of exposure to endemic Lyme areas. The EM rash, which does not occur in all cases, is considered sufficient to establish a diagnosis of Lyme disease even when serologic blood tests are negative. Serological testing can be used to support a clinically suspected case, but is not diagnostic by itself.

Several forms of laboratory testing for Lyme disease are available, some of which have not been adequately validated. The most widely used tests are serologies, which measure levels of specific antibodies in a patient’s blood. These tests may be negative in early infection, as the body may not have produced a significant quantity of antibodies, but they are considered a reliable aid in the diagnosis of later stages of Lyme disease. Serologic tests for Lyme disease are of limited use in people lacking objective signs of Lyme disease because of false positive results and cost.

 

Prevention

Protective clothing includes a hat, long-sleeved shirt, and long pants tucked into socks or boots. Light-colored clothing makes the tick more easily visible before it attaches itself. People should use special care in handling and allowing outdoor pets inside homes because they can bring ticks into the house. People who work in areas with woods, bushes, leaf litter, and tall grass are at risk of becoming infected with Lyme at work. Employers can reduce risk for employees by providing education on Lyme transmission and infection risks, and about how to check themselves for ticks on the groin, armpits, and hair. Work clothing used in risky areas should be washed in hot water and dried in a hot dryer to kill any ticks.

 

Vaccination

A recombinant vaccine against Lyme disease, based on the outer surface protein A (ospA) of B. burgdorferi, was developed by SmithKline Beecham. In clinical trials involving more than 10,000 people, the vaccine, called LYMErix, was found to confer protective immunity to Borrelia in 76% of adults and 100% of children with only mild or moderate and transient adverse effects. LYMErix was approved on the basis of these trials by theFDA on December 21, 1998.

New vaccines are being researched using outer surface protein C (OspC) and glycolipoprotein as methods of immunization. Vaccines have been formulated and approved for prevention of Lyme disease in dogs. Currently, three Lyme disease vaccines are available. LymeVax, formulated by Fort Dodge Laboratories, contains intact dead spirochetes which expose the host to the organism. Galaxy Lyme, Intervet-Schering-Plough’s vaccine, targets proteins OspC and OspA. The OspC antibodies kill any of the bacteria that have not been killed by the OspA antibodies. Canine Recombinant Lyme, formulated by Merial, generates antibodies against the OspA protein so a tick feeding on a vaccinated dog draws in blood full of anti-OspA antibodies, which kill the spirochetes in the tick’s gut before they are transmitted to the dog.

 

Preventive antibiotics

The risk of infectious transmission increases with the duration of tick attachment. It requires between 36 and 48 hours of attachment for the bacteria that causes Lyme to travel from within the tick into its saliva. If a deer tick that is sufficiently likely to be carrying Borrelia is found attached to a person and removed, and if the tick has been attached for 36 hours or is engorged, a single dose of doxycycline administered within the 72 hours after removal may reduce the risk of Lyme disease. It is not generally recommended as development of infection is rare: about 50 people would have to be treated this way to prevent one case of infection.

 

Treatment

Antibiotics are the primary treatment. The specific approach to their use is dependent on the individual affected and the stage of the disease. For most people with early localized infection, oral administration of doxycycline is widely recommended as the first choice, as it is effective against not only Borrelia bacteria but also a variety of other illnesses carried by ticks. Doxycycline is contraindicated in children younger than eight years of age and women who are pregnant or breastfeeding; alternatives to doxycycline are amoxicillin, cefuroxime axetil, and azithromycin. Individuals with early disseminated or late infection may have symptomatic cardiac disease, refractory Lyme arthritis, or neurologic symptoms like meningitis or encephalitis. Intravenous administration of ceftriaxone is recommended as the first choice in these cases; cefotaxime and doxycycline are available as alternatives.

These treatment regimens last from one to four weeks. If joint swelling persists or returns, a second round of antibiotics may be considered. Outside of that, a prolonged antibiotic regimen lasting more than 28 days is not recommended as no clinical evidence shows it to be effective. IgM and IgG antibody levels may be elevated for years even after successful treatment with antibiotics. As antibody levels are not indicative of treatment success, testing for them is not recommended.

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