Infection

What is Lyme disease?

Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by the bacterium Borrelia burgdorferi. The disease is classified by the World Health Organisation as an infectious or parasitic disease. Borrelia burgdorferi belongs to the bacterial genus ‘Borrelia’. These in turn are members of a larger family of bacteria called Spirochaetes.

How does Lyme disease infection occur?

In nearly all cases it is transmitted to humans by the bite of a tick infected with these bacteria. In a population of ticks, only some will carry the infection.

What is Borreliosis?

The disease resulting from infection with Borrelia burgdorferi is referred to as Lyme disease or Lyme borreliosis. There are many species of Borrelia bacteria worldwide, not all of them cause disease. Three species are currently known to cause disease in the UK. They are Borrelia burgdorferi (sensu stricto), Borrelia afzelii and Borrelia garinii. They are very closely related and all cause a broadly similar disease process. An infection caused by Borrelia bacteria can be termed a ‘Borreliosis.’

How does Lyme disease start?

A clinical case of Lyme disease occurs when a person is infected by a tick bite. Symptoms follow after an incubation period that may last between two days and 3 1/2 months. However, on some occasions, the bacteria do not cause disease straight away. The bacteria can enter a phase in which they do not cause symptoms but are still present. They may still have the potential to cause active disease at a later stage.

Is Lyme disease a New Illness?

Studies of the DNA taken from ticks in the Natural History Museum show the infection was in the UK in Victorian times. Therefore, it is almost certainly not a new illness. However, it does appear to be becoming more common. It was known in Europe under different names in the early 20th century and was carried by Neolithic “Ӧtzi the Iceman”.

Symptoms

What are the symptoms of Lyme disease?

Lyme disease can affect any part of the body and cause many different symptoms. The commonest symptoms relate to the person feeling unwell, having flu-like symptoms, extreme tiredness, muscle pain, muscle weakness, joint pain, upset digestive system, headache, disturbances of the central nervous system and a poor sleep pattern. In some cases a characteristically shaped, expanding ‘bull’s eye’ rash appears on the skin. However, a rash in any form is not a universal symptom. If the rash does occur, it is termed Erythema migrans or EM rash. It may manifest in a chronic form and be known as Erythema chronicum migrans or ECM rash. The list of symptoms known to be associated with Lyme disease is long and diverse. The symptom pattern varies from person to person.

What are the commonest symptoms at onset?

Early symptoms can include feeling unwell or ‘flu-like’, EM rash, headache, stiff neck, muscle pain, tender glands and sensitivity to temperature, sound and light levels.

Does Lyme disease affect mental functioning?

Like some other diseases caused by spirochaetes, there is a possibility that the infection can cross into the central nervous system. If the infection proceeds along this course then symptoms that affect mental function may occur. If the illness proceeds to this neurological stage, it is termed neuroborreliosis. This serious condition needs skilled treatment.

Treatment

What is the treatment for Lyme disease?

Treatment is with antibiotics and is most effective if started as early as possible in the disease. Those treated promptly usually make a complete recovery. There is growing scientific and anecdotal evidence that suggests long term treatment may be necessary in some cases. Treatment is aimed at reduction and elimination of the bacteria. If there is delay before treatment is begun, there may be less chance of a full recovery. The outlook varies from person to person. Whilst it is extremely unusual for the illness to be fatal, symptoms can range from mild to very severe. It is not in a patient’s best interests for the disease to remain untreated.

Will my doctor treat me for Lyme disease?

If you have this diagnosis your doctor should treat you. However, many doctors are not familiar with treating Lyme patients. In this case, you may do better to see a doctor who is familiar with the disease. Always try to keep your GP involved and informed. A worsening of symptoms called a Jarisch-Herxheimer reaction may complicate the start of treatment. This does not occur in every case but if it should occur further medical advice should be taken. Lyme disease is an infectious disease and the primary aim of treatment is eliminating the infection by the use of antibiotics. Other medicines may also have a place in treatment. Response to treatment varies from patient to patient.

Diagnosis

Is there a test for Lyme disease?

The Centers for Disease Control and Prevention (CDC) state that the diagnosis of Lyme disease is based on symptoms, physical findings and the patient’s history. There are several laboratory tests that aim to detect this infection, however, none of them can be guaranteed to rule out Lyme disease. If positive they support the diagnosis.

How do I know if I’ve got Lyme disease?

Lyme disease is not an easy diagnosis to make. This is especially so if the patient has no rash and does not recall an episode of tick bite. If a patient remembers a tick bite and then becomes unwell, Lyme disease is a possibility. Negative test results do not necessarily mean it is absent. After all exclusionary tests have been done; the diagnosis can be made on clinical grounds alone.

Lyme in the UK

How prevalent is Lyme disease in the UK?

The number of cases confirmed by blood testing in the UK has risen from 346 in 2003 to about 1200 in 2012. Public Health England (PHE) acknowledges that confirmed cases do not necessarily reflect all the cases of the disease. PHE official estimates suggest there could be up to 3,000 new cases occurring in the UK every year. The true number of cases is not known, and may be higher still. Since full recovery may not take place in many cases, the total number of people affected is accumulating.

Who gets Lyme disease and Why?

In the United Kingdom, Lyme disease is known to be carried by the sheep tick, Ixodes ricinus, the Hedgehog tick I hexagonus and the fox or English dog tick I canisuga. Ticks can also feed on deer, other small mammals such as mice and on birds. The sheep tick prefers to live in long grass, woods and moorland, although it does not occur exclusively in these habitats. The other two ticks live mainly in the homes of their hosts (hedgehogs, foxes and badgers) but can be deposited wherever these animals travel. People who live or work in the parts of the country where the tick is prevalent are likely to be at greater risk, as are those in urban areas with overgrown gardens or with extensive parks. However, cases of the disease are widespread and it is possible that the full picture of tick distribution is not yet fully understood. Anyone can get Lyme disease if a tick that is carrying the infection has bitten them.

Do other diseases accompany Lyme disease?

Several other infections can sometimes be found in tick secretions. If these are also passed into the bloodstream, they too may establish and complicate the symptoms and outlook.

Can Lyme disease be prevented?

There are many measures you can take to protect yourself from ever falling victim to this nasty infection. There is however, no vaccine available at present. Prevention relies on people being aware of the risk that ticks present and using sensible measures to avoid being bitten. These measures include wearing suitable clothing and frequently checking the skin for ticks. It is also essential to know how to remove a tick properly if it is still present and to go promptly for medical advice if you notice any symptoms. Lyme Disease Action publishes a leaflet about tick removal.