Frequently Asked Questions About Lyme Disease The following answers are based on clinical Practice Guidelines on Lyme Disease developed for the Infectious Diseases Society of America (IDSA) by a panel of researchers and medical doctors who treat patients for Lyme disease.
What is Lyme disease?
Lyme disease is caused by an infection with a type of bacterium called Borrelia burgdorferi, which is principally transmitted by the deer tick (Ixodes scapularis). The tick typically feeds on small mammals, birds and deer but may also feed on cats, dogs and humans.
Research suggests the tick has to be attached to the skin for at least two days to transmit the Lyme bacteria.
How many people get Lyme disease every year?
About 20,000 Americans are reported with Lyme disease every year.
Are there are other illnesses transmitted by deer ticks?
Yes. Although less common than Lyme disease, HGA (human granulocytic anaplasmosis, formerly known as human granulocytic ehrlichiosis) and babesiosis are associated with deer ticks. However, as with Lyme disease, not all ticks carry these diseases. HGA is an acute illness caused by a bacterium called Anaplasma phagocytophilum and the most common symptoms are headache, fever, chills and muscle pain.
Babesiosis is a parasitic infection that affects the red blood cells and also can cause viral-like symptoms. Babesiosis usually does not cause significant symptoms in healthy people. Severe babesiosis may occur in people who are elderly or have compromised immune symptoms. Treatment for HGA or babesiosis typically includes a short course of antibiotic therapy.
However, most tick bites do not cause infection and babesiosis is only found in limited areas. While it is important to take measures to avoid getting bitten by a tick, many thousands of people are bitten every year and do not acquire any disease.
Is Lyme disease found everywhere in the United States?
Lyme disease has been reported in nearly all states, but more than 98 percent of all cases are found in Coastal New England and the Mid-Atlantic states, as well as Wisconsin, Minnesota and Northern California.
What are the symptoms of Lyme disease?
The great majority of people who are infected with Lyme disease develop a large (three inches or more) circular, red rash surrounding the site where a tick attached. They may also develop non-specific symptoms such as muscle and joint aches. Infection occurs from three to 30 (average 10) days after a tick bite, but most people do not recall the bite because the ticks are small and the bite usually is not itchy or painful.
Less commonly, Lyme disease can cause arthritis, facial paralysis and other neurological problems or an abnormally slow heart rate. While patients with Lyme disease may have muscle and joint aches, these symptoms usually accompany objective signs like the rash or arthritis and virtually never are the only symptoms in persons with Lyme disease who have longer-term complaints.
Not everybody who gets Lyme disease will notice the characteristic circular red rash Also, many diseases and conditions other than Lyme disease can cause similar symptoms.
How is Lyme disease diagnosed? When the characteristic skin rash is present, Lyme disease is diagnosed clinically based on visual inspection of the patient by the doctor. For all other manifestations, Lyme disease is diagnosed based on the patient's history and the doctor's examination of the patient in conjunction with a positive laboratory test result. The most commonly used laboratory test is a blood test which determines whether the patient has developed antibodies to the Borrelia burgdorferi bacteria.
How is Lyme disease treated?
Treatment usually involves 10-28 days of oral antibiotics and is highly effective.
When Lyme disease is diagnosed and treated quickly, 95 percent of people are cured within a few weeks of treatment.
What about the other 5 percent?
The number of people who continue to have problems is very small. Most likely, their symptoms are related to one of the following:
They never had Lyme disease at all and received the wrong treatment for their illness They had Lyme disease and another infection simultaneously and were only treated for Lyme disease.
They contracted a new illness unrelated to Lyme disease but with similar symptoms They have again been bitten by the tick that causes Lyme disease.
What if patients with Lyme disease who have the characteristic rash are not diagnosed and treated?
In that circumstance the rash will resolve within about one month. However, over the course of the next months slightly more than half of such individuals will go on to develop a type of arthritis affecting the knee or other large joint, and about 10 percent to 20 percent will develop neurological problems or an abnormally slow heart rate. These patients may require up to 28 days of antibiotic therapy.
Is treatment ever prescribed for someone who has been bitten by a tick, but does not have symptoms?
Routine antibiotic administration is not recommended for people who have been bitten by a tick and have no symptoms. However, one dose of an antibiotic is recommended in cases in which all four of the following are true:
the tick can be identified as an Ixodes scapularis deer tick and has been attached for 36 hours or more;
preventive treatment can be started within 72 hours of removal of the tick;
the local rate of infection of these ticks with Borrelia burgdorferi bacteria is 20 percent or more; and there are no contraindications to the use of the antibiotic.
Can't Lyme disease sometimes become on ongoing problem?
In rare cases, people who have been diagnosed with Lyme disease and properly treated have lingering symptoms, typically generalized pain, joint pain and fatigue. These symptoms have been interpreted by some to suggest the presence of chronic Borrelia burgdorferi infection.
However, an extensive review of scientifically rigorous studies and papers available to date, has determined that there is no convincing biologic evidence to support a diagnosis of chronic Lyme disease after completion of the recommended treatment.
There is no doubt that patients with persistent symptoms are suffering, but many report non-specific symptoms that also are associated with a number of other medical conditions. To be certain they receive the proper medical care, people who continue to have symptoms that persist after appropriate antibiotic treatment for Lyme disease should talk to their physicians about whether the original diagnosis of Lyme disease was accurate or if they may have a different or new illness.
But some people are receiving long-term therapy for Lyme disease and say it's helping. Couldn't this be true?
Long-term therapy for so-called chronic Lyme disease can involve weeks, months and even years of intravenous antibiotics. Although some people may feel better, it doesn't prove that the antibiotic cured or suppressed infection.
Sometimes, the belief that a treatment is helping can be enough to make people feel better. This is called the placebo effect and it is a well-documented medical phenomenon. Antibiotics also have anti-inflammatory effects that may help alleviate certain symptoms. Or, in some cases, patients may have another infectious disease that is responsive to antibiotics.
In more than 20 years there has not been one scientifically valid study published in the peer-reviewed medical literature that proves that the benefit of long-term antibiotic treatment outweighs the risk.
What's the harm in trying the therapy?
Long-term antibiotic therapy for so-called chronic Lyme disease is not only unproven, it may in fact be dangerous. For instance, it may lead to complications related to delivery of the medicine, such as infections of the blood stream as a result of long-term intravenous administration of antibiotics.
Also, use of certain antibiotics can lead to a potentially severe and sometimes deadly infection of the bowel caused by a type of bacteria called Clostridium difficile. Further, long-term antibiotic therapy may foster the development of drug-resistant superbugs that are difficult to treat.
What are the Clinical Practice Guidelines on Lyme disease?
The Clinical Practice Guidelines were developed by an expert panel according to widely accepted criteria for evidence-based medicine and contain updated information on the epidemiology, clinical features, diagnosis, prevention and treatment of Lyme disease in the United States.
The Infectious Diseases Society of America (IDSA) believes that no guidelines can replace a doctor's judgment, but these guidelines are the best information science can provide to the wide range of physicians who might treat a patient with Lyme disease - from the family doctor or pediatrician to the specialist.
Nearly 400 references of papers and studies are cited in the guidelines and many, many more that did not meet the scientific standard were reviewed.
Now available online, the 2006 Guidelines were published in the Nov. 1, 2006 edition of the journal, Clinical Infectious Diseases.
Who served on the IDSA guidelines committee?
The singular mission of the IDSA guidelines panel is to provide the highest quality standards for treating patients. IDSA has criteria for its guidelines panel membership: This panel included both researchers and physicians who treat patients with Lyme disease. In addition, input from a variety of sources was welcomed and evaluated.
[ 04. April 2007, 11:24 PM: Message edited by: Neil M Martin ]
-------------------- Neil Posts: 697 | From Tucson, AZ USA | Registered: Apr 2002
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