Lyme disease

Definition:
Lyme disease is an infection caused by bacteria called Borrelia burgdorferi, which is transmitted to humans by ticks that feed on the blood of animals such as deer or sheep, mice, hedgehogs, pheasants, hamsters and squirrels. It was first recognized in the United States in 1975 after a mysterious outbreak of arthritis near Old Lyme, Connecticut. Since then, reports of Lyme disease have increased dramatically, and the disease has become an important public health problem.

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It is an inflammatory disease and is the most common tick-borne disease in North America, Europe, and Asia. Connecticut has the highest annual rate of new cases of Lyme disease each year. The name Lyme disease was used because of the number of children in Lyme, Connecticut who first developed this problem back in the late 1970s.

More than 90 percent of the Lyme disease cases in the United States continue to occur in Connecticut and nine other states including New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Wisconsin, Delaware, Maryland, and Minnesota.

However, the link between tick bites and a condition affecting the nervous system has been recognised for much longer and was known as tick-borne meningoencephalitis

Ticks can be tiny, just one or two mm across and their saliva contains painkillers, anticoagulants and immune suppressants. Many bites, therefore, go unnoticed. If undetected, the tick will typically remain in place for several days, and will drop off when finished feeding.

The bacteria are carried in the tick’s gut, and can take some time to move into its mouthparts and then into your body. The risk of infection increases the longer the tick is left in position. Normally, the risk is minimal if the tick is removed or falls off within 24 hours. However, it’s possible to be infected at any time after a bite. A partially fed tick, for example, can pass on the infection relatively quickly. In any given tick population, it’s thought that about 15 to 20 per cent carry Lyme disease. Only a small percentage of tick bites will lead to the condition.

Once the person is infected with Borrelia burgdorferi bacteria, there are several possible outcomes. The infection may be cleared without problems (some people have no symptoms but develop antibodies showing they have been exposed to the bacteria).

Alternatively the bacteria may spread through the body causing symptoms of infection, or in some cases it may trigger an immune response that leads to symptoms such as arthritis.

Symptoms:
The initial tick bite may be so small that more than half of those bitten don’t even notice or remember a bite. Between two days and four weeks later, an expanding, circular red rash appears in about 40 per cent of cases, usually at or near the site of the bite.

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Sometimes several of these rashes appear, which usually don’t itch or burn. Tiredness, headache, joint pains and flu-like symptoms may also occur. If no treatment is given, the rash will typically persist for two to three weeks. After that about one in three people have no further problems.

If no treatment is received, more than 60 per cent of those with Lyme disease will go on to stage 2 of the condition within six months. A wide range of symptoms have been recorded including:

•Fatigue
•Symptoms similar to meningitis
•Peripheral nervous symptoms such as numbness or tingling sensations
•In some cases psychiatric symptoms
These episodes may go on for many years. There may also be problems with nerve palsies (for example, weakness of the nerves to the muscles of the face), inflammation or damage of the nerves, abnormal heart rhythms, and severe malaise.

For some people Lyme disease then persists in a chronic form or Stage 3, where arthritis, neurological damage and fibromyalgia (severe aching and weak muscles) continue to affect them long term.

The symptoms of Lyme disease are partly determined by the particular strain of B burgdorferi bacteria. The strain most often seen in Europe tends to lead to neurological or nerve disease.

Causes:
It’s not just visitors to rural North America who might be exposed to these tick-borne infections. Infected ticks can be found across the UK, and anyone who enjoys exploring UK’s woodlands and uplands may also be at risk. People like gamekeepers, farmers and hunters are also at risk.

Cases have occurred in urban parks and gardens too. The common factor is the presence of deep vegetation and a supply of mammals and birds for ticks to feed on.

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Diagnosis
Doctors diagnose Lyme disease based on your health history and a physical exam. Your doctor may order blood tests, but they are only used to confirm the diagnosis. The techniques used to test your blood are called ELISA and Western blot. Both tests can sometimes give false positive or unclear results. If you have had the infection for less than six weeks, your body may not even be making enough antibodies to be detected in the tests.

Lyme disease affecting the knee must be differentiated from septic (infectious) arthritis, which has both a different cause and a different treatment. The two distinguishing features of septic knee arthritis that set it apart from Lyme knee arthritis are refusal to put weight on the knee and fever (more then 101.5 degrees Fahrenheit). Patients with Lyme disease may have a low-grade fever and pain on weight-bearing but do not exhibit the high fever and refusal to put weight on the affected leg observed more often with septic knee arthritis.

When trying to rule out septic arthritis, the synovial fluid (the lubricating fluid of a joint) or spinal fluid may need to be analyzed. Studies show that patients with septic (infectious) knee arthritis are 3.6 times more likely to have a high synovial fluid cell count compared with patients with Lyme disease. But some patients with Lyme disease have elevated synovial fluid cell count, too so this test is just one of many tools used to diagnose the problem. The fluid can also be cultured to identify the presence of bacteria such as staphylococcus aureus (staph infection), streptococcus pneumonia (strep infection), or other less common types of bacterial infections. Bacteria associated with septic arthritis help rule out a diagnosis of Lyme disease.

Treatment:
If you think you may have been bitten, tell your doctor, and mention where you’ve been walking, especially if you know that there are ticks in that area. When infection with Lyme disease is suspected, blood tests can be used to help support the diagnosis, but don’t identify all cases.

Once Lyme disease has been diagnosed, treatment is with antibiotics which need to be at high dose and may need to be given as a prolonged course , sometimes even intravenously for maximum effect. Some complications of Lyme disease need specific treatments – for example if a person develops a slow heart rhythm, they may need a pacemaker

In most cases symptoms settle (even if treatment isn’t given, symptoms may eventually get better) but Lyme disease can cause more serious long term problems. Given the small amount of research in this area, medical opinion is divided as to the cause and best treatment for long term symptoms.

Prevention:
To prevent Lyme disease, avoid grasslands and wooded areas where incidence of the disease is high. When outside in these areas, apply insect repellent containing DEET (n,n-diethyl-m toluamide) to exposed skin. Apply permethrin (kills ticks on contact) to clothes and avoid getting this substance on the skin because it is toxic.

Wearing long-sleeved shirts and pants tucked into boots may prevent ticks from reaching the skin. Light-colored clothing makes it easier to see ticks.

Check clothing and skin carefully, especially where clothing touches the skin (e.g., cuffs, underwear elastic). Shower after all outdoor activities; if a tick is on the skin but unattached, it may wash off.

Avoid being bitten. Ticks in the nymph stage are tiny and spider-like (about the size of a poppy seed), so are difficult to see. The larger ticks you might see on your pets are the adult stage of the same species. They can attach to any part of the body, especially to moist or hairy areas in the groin, armpits, and scalp.

When camping or walking in places where the ticks may be, the following measures are helpful:

•Wear long sleeves and trousers
•Tuck trousers into socks
•Wear light-coloured clothing so ticks are easier to see
•Try not to sit on the ground in areas of vegetation
•Consider using insect repellents
•Keep to pathways and, where possible, avoid areas of overgrown vegetation
•Check for ticks regularly during the day and especially before going to bed
•Remove any ticks found attached to the skin straight away

Remove ticks using a purpose made tool, or fine forceps, which hold the tick close to the skin without squeezing its body. Apply antiseptic cream after removal. Don’t use your fingers, or apply heat, petroleum jelly or any other creams or chemicals.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/lymedisease1.shtml
http://www.idph.state.il.us/public/hb/hblyme.htm
http://www.healthcommunities.com/lyme-disease/lyme-disease-prevention.shtml?c1=GAW_SE_NW&source=GAW&kw=lymes_disease_signs_and_symptoms&cr5=11776947702
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19617.htm
http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=a8f19ed4a4860e4dc3e8a8c8b2489cbe

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