Lyme Disease

Caused by a spirochete bacteria carried by ticks (baby ones may be too small to notice), Lyme Disease occurs mostly in the northeast (from northern Virginia to Maine), and Wisconsin & Minnesota.  Its area is spreading a bit due to global warming.  Tick season is May to November (especially June to August).

There are 3 stages of Lyme Disease:

  • Early —ย  Begins within a month of the tick bite (usually 1-2 weeks).ย  Blood tests are negative.
  • Early Disseminated (spreading)ย  —ย  Begins 3-10 weeks after the bite.ย  Blood tests are usually positive.
  • Late —ย  Occurs months to years later.ย  Blood test positive.

Early Lyme —ย  A rash (see pictures).ย  Begins as a round red spot that doesn’t really itch or hurt, and gradually gets bigger.ย  The center may appear darker, though the middle usually clears eventually & becomes white.ย  There may be vague symptoms like fatigue, fever / chills, feeling icky, achy joints or muscles, headache.ย  But there may not be (there may even not be a rash).

Early Disseminated Lymeย  —ย  Patients may feel icky, like “coming down with something.”ย  New red spots may appear.ย  But the main organs affected are joint, nervous system, and heart. ย 

Joint pains may come and go on both arms and legs, eventually settling in on one knee, ankle, or wrist.  They last a week, get better, and may come back a month or two later.

Nervous system symptoms can include headache with stiff neck and sensitivity to light.  There may be memory problems, mild confusion, trouble concentrating, sleep difficulties, mood and personality changes.  Some people, especially children, may get facial weakness (“Bell’s palsy“), even on both sides of the face.  The feet may feel numb or tingly, sometimes felt in just one arm or leg along with weakness (can seem like “sciatica“, but doesn’t involve a herniated disk).

Heart involvement, less common, is usually just found on an EKG, without symptoms.  Some people may feel skipped beats, lightheadedness, palpitations, fainting, rarely shortness of breath or chest pain.  Serious outcomes like death are extremely rare.

Late Lymeย  —ย  The most common symptom is arthritis, with one swollen joint, usually the knee (occasionally the shoulder, ankle, elbow, others).ย  Swelling lasts weeks to months (rarely years), isn’t as painful as other types of arthritis.ย  Usually there’s no serious joint damage.ย  There may be nervous system symptoms like tingling / weakness in one arm or leg, or mild confusion with difficulty concentrating.

Blood Testsย  — ย These test for antibodies against Lyme (there’s virtually no way to find the germ itself).ย  IgM antibody is the first to appear, it usually goes away in weeks to months, but sometimes remains.ย  IgG antibody appears later, and lasts forever.ย  Since many people in affected areas have gotten Lyme disease with no symptoms, which cured on its own, they may always have IgG in their blood, meaning nothing.

Results depend on the stage of Lyme Disease.  They’re always negative during the early stage, with the classic rash (single spot), and should not be ordered.  In later stages, positive blood tests do not prove a person’s symptoms are due to Lyme disease, but help make the diagnosis if symptoms are typical.  Imagine a person who gets successfully treated for Lyme disease, and then gets Gout.  Their Lyme IgG will be positive (stays positive forever), but that doesn’t help our diagnosis.

Post-Treatment Lyme (“Chronic Lyme”)ย  —ย  Some people have vague symptoms after treatment has been finished, such as fatigue, pains all over, mental slowness.ย  There’s no evidence that additional antibiotic treatment helps.ย  In some studies, the same number of people without Lyme also had similar symptoms.ย  There are clinics specializing in “chronic Lyme” who do their own special blood tests, but there’s no evidence that those are accurate in any way.ย  Such patients are clearly uncomfortable and ill, but it’s not the Lyme bacteria.

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