Lyme Disease

What is Lyme disease?

Lyme disease is an illness caused by a bacterium, Borrelia burgdorferi. First described in the United States in the 1970s, it was actually reported in Europe long before. When the cause — a spiral shaped microbe transmitted by Ixodes ticks — was identified in the early 1980s by Willy Burgdorferer, it then became clear that certain neurologic diseases in Europe (Bannwarth's Syndrome, Garin-Bujadoux Syndrome) were also caused by a very similar Borrelia organism. The European neurologic diseases might lead to shooting pains, facial palsy and/or meningitis, much like what one sees with Lyme disease in the United States. Lyme disease has now been reported in more than 80 countries.

The spirochete that causes Lyme disease might stay localized to the skin or it might rapidly spread throughout the body after the initial tick bite. The "disease" is caused by the inflammatory response to the spirochete. First, it is lodged in the skin where it may cause a characteristic red round or oval enlarging rash. Next it may travel through the blood stream, landing at different organs. If it lands in a joint, it can cause arthritis. If it lands in the heart, it can cause disturbances in cardiac conduction — arrhythmias or even complete heart block; cardiac Lyme disease can lead to death if not detected and treated early. If it lands in the peripheral or central nervous system, it can cause meningitis, confusion, memory loss, burning or stabbing pains, shooting pains, numbness/tingling, and/or weakness.

Open mouth of tick.
A digitally colored image of a tick's mouth.

Lyme disease may lead to different symptoms at different times. Symptoms may develop quickly or not until many months or years later as the spirochete can evade the immune response and remain dormant in the human host for long periods. Some patients do not experience any symptoms after the bite of a tick that carries the bacterial agent of Lyme disease. In these patients, a healthy immune system may be sufficient to eradicate the spirochete. In most other patients, antibiotic treatment is needed to fight the disease that develops.

When patients are treated shortly after infection, most patients recover fully and do well. For patients whose symptoms return or for those whose initial infection wasn't caught early, the course of illness may be more prolonged and the treatment uncertain. Because we do not yet have a diagnostic test that is a sensitive marker of active infection, patients and doctors are left with tremendous uncertainty regarding whether or not to treat with additional antibiotics. This uncertainty can lead to conflict — with some doctors advocating treatment and others stating further treatment is not indicated. Such conflict can create anxiety in patients as they become uncertain whom to trust — and it can even cause conflict between doctors who hold different perspectives on this illness.

The good news about Lyme disease is that there have been many scientific advances over the last decade that have lead to a new openness in regards to investigating Lyme disease, including the development of better diagnostic tests, better prevention methods, and an identification of biomarkers that can help to predict treatment response and possibly guide the selection of treatments.