Lyme Disease

Lyme disease has actually been around for over a hundred years. We know this by the literature describing the classic bulls eye rash ( erythema migrant). In the early seventies Yale University studied a cluster of children with arthritic conditions in Old Lyme Connecticut. This arthritis responded to Penicillins and clearly we knew it to be bacterial in origin. It was at this point we had a diagnosis of Lyme disease and then in the early eighties Dr Burgdorferi isolated the actual organism hence, B. Burgdorferi. It is transmitted by Ioxedes scapularis the deer tick. There are actually more than 12 different species that transmit Lyme all being Ioxedes.

Surveillance began in the early eighties and Lyme became reportable to the CDC in 1991. In 2001 there were 17,029 reported cases. In 2014 there were approximately 28,416 reported cases. As you can see this rise is most likely due to education, better reporting and increased knowledge with health care personal.

When ticks hang out on a blade of grass or a leaf waiting for a host this behavior is called questing.

THE TICK HAS TO STAY ATTACHED FOR A MINIMUM OF 24 HOURS BEFORE YOU COULD CONTRACT LYME. This is within reason and common sense. Some ticks can transmit in less time but overall on average 24 hours of attachment increases risk.

Lyme disease in household pets

Should your pet get Lyme disease it is advised that all family members get tested. It is not uncommon for ticks to bite family members and fall off and infect others and/or your pet. Remember Lyme can show little to no symptoms however in pets it is usually always symptomatic. This is a simple case of cost/benefit ratio. The benefit of being tested and treated far out weighs not being tested and the effects of Lyme.

Stages of Tick development

The three stages of the tick

1. Larva stage. At this size it is the size of a numeral of a year on a United States Penny. It is at this stage the tick has six legs. Larva stage does not transit disease.
2. Nymph stage. It is about the size of one letter on a United States dime. Here it has eight legs as it does in adult hood.
3. Adult Tick. About twice the size of a nymph. All stages can transmit disease.

Erythema Migrans ( The Lyme Rash)

The classic Lyme rash is on average about 5 cm in diameter or greater. It has a central clearing area or pale center. Hence the bulls eye appearance. Only about 70-75% of individuals with Lyme have the rash.The rash occurs on average about 7-10 days after the bite however the range is 3-32 days. The rash can appear anywhere on the body but often is near the bite area. Children may have a temperature but not always. I have never had a Lyme patient with a temperature however that is purely anecdotal and does not mean it cannot happen. The rash will fade on average after 3-4 weeks.

Midwest statistics ( Illinois and Wisconsin)

• From the years of 2000 to 2018 there have been 2,968 cases reported in Illinois. With the highest year being 2013 over 300 cases. In 2018 257.
• By comparison Wisconsin had 3,105 cases in 2018 alone. In 2016 they had well over 4,000 cases. Some of this has to do with increased outdoor activity and increased deer population.

The Three Stages of Lyme disease

Early Localized Disease ( Stage 1 )

This is the stage of the rash. One may have some itching or burning at the bite site and even at the rash site. No other symptoms usually present at this stage. Some may have fever although rare.

Early Disseminated Disease (Stage 2 )

• Untreated lyme disease in the second stage can begin to display in a more diffuse skin rash. Small red macule BUT NOT ON THE PALMS OR SOLES OF THE FEET LIKE ROCKY MTN SPOTTED FEVER.
• Lymphadenopthy, swollen lymph nodes can occur
• In about 10-40% of patients in this stage one will see neurologic manifestations. Meninigits or encephalitis. Ones neck may be stiff, dizziness, lethargy, photophobia, and increased sleepiness.
• About 10% will have enlarged liver and can have an enlarged spleen
• About 10% will have some type of cardiac abnormality usually in the form of a conduction delay.
• The classic Lyme arthritis is found in about 60%n of those untreated. It is usually displayed as an arthritic painful joint and usually involves only one joint. This occurs n about 4 weeks to 2 years. It can then rotate to other joints. Most common is the knee but can be seen in shoulder, ankles, hips etc.

Late disease ( Stage 3 )

This stage occurs at least a year or more later. Skin changes are more severe and one may see hyperpigmentation and hair loss. Central nervous system issues of ataxia ( stumbling gait), seizures, and in rare cases strokes. Arthritis is more severe with degenerative arthritis and joint effusions.

Chronic Lyme and Testing for Health care providers

It is here where the controversy starts as well as lab testing. This author has scoured the research from Journal of Infectious Disease, CDC, Australian infectious disease and lab tests that are used in China. The amount of discrepancy is truly amazing.

Chronic Lyme is debated as not being an entity to being a real entity. The controversy has led to many monetizing their work in books. Subsequently when there is this much controversy and people in pan you will find charlatans as well as very real concerned health care providers. Also this extensive controversy on lab testing and formulating a diagnosis tells this author that we clearly have much more to learn.

For example. The progression of testing with high enough suspicion flows like the following in the United States:

1. Suspect Lyme lab draw: CBC, CMP, Rheumatoid Profile, ANA, C-reactive protein and Lyme IgG, IgM antibody.
2. Lyme antibody is positive either IgM or IgG then the lab will do an ELISA looking at specific enzymes if that is positive they will do automatically a Western Blot which is made up of specific bands.
3. In the United States you cannot have a positive test unless you have 5 of 10 bands IgG and 3 of 5 bands on IgM antibody. In China it is one specific band and in Australia it is 3 bands. It should be noted that some of these bands are much more specific for Lyme than others.

This brief global discrepancy is one small area that screams “we are not sure”.

Treatment is fairly straight forward however treatment goes beyond the scope of Survive Outdoors.  See a health care provider well versed in Outdoor Medicine and also a second opinion with an infectious disease specialist would be wise.

Treatment of Lyme disease

Treatment depends on the stage. Survive would like you to refer to your health care provider. It is advised if there is a confirmed tick bite in an endemic area for Lyme, treatment should consist of one dose of 200 mg of Doxycycline.  The benefit far outweighs the risk.