Lyme Disease Is On The Rise Again In USA

by Kim Boateng Posted on June 27th, 2018

Houston, Texas, USA: This time of year, the U.S. is crawling with ticks which spread disease when they bite. The most common tick borne ailment is Lyme disease, but the official case count, which helps public health authorities formulate prevention strategies and allocate resources, does  not come close to the actual number.

The U.S. Centers for Disease Control and Prevention, CDC, estimates that the actual prevalence of Lyme disease infections in the U.S. is 10 times higher than the number of reported cases.

An estimated 90 species of these blood-sucking arachnids inhabit the continental United States, and tick-borne diseases have been on the rise over the past three decades. While not all tick bites will make you sick, the critters can transmit at least 19 types of bacteria, viruses, and protozoa known to cause Lyme disease, Rocky Mountain spotted fever, tularemia, and a host of other potentially serious illnesses

Tick-borne diseases have been “steadily going up every year … as the diseases expand to new areas around the country,” Lyle Peterson of the CDC told reporters in a recent conference call announcing the updated infection estimates. Lyme disease accounts for about 80 percent of the tick-borne illnesses in the U.S.

Around 30,000 diagnosed cases of Lyme disease are documented each year, according to surveillance figures published annually by CDC. The real number, the agency says, is more like 300,000. That’s 1.5 times the number of women diagnosed with breast cancer, and six times the number of people diagnosed with HIV/AIDS each year in the US. However, because diagnosing Lyme can be difficult, many people who actually have Lyme may be misdiagnosed with other conditions. Many experts believe the true number of cases is much higher.

Lyme disease affects people of all ages. The CDC notes that it is most common in children, older adults, and others such as firefighters and park rangers who spend time in outdoor activities and have higher exposure to ticks.

What Is Lyme Disease?

Lyme disease is caused by a spirochete—a corkscrew-shaped bacterium called Borrelia burgdorferi. Lyme is called “The Great Imitator,” because its symptoms mimic many other diseases. It can affect any organ of the body, including the brain and nervous system, muscles and joints, and the heart.

Patients with Lyme disease are frequently misdiagnosed with chronic fatigue syndrome, fibromyalgia, multiple sclerosis, and various psychiatric illnesses, including depression. Misdiagnosis with these other diseases may delay the correct diagnosis and treatment as the underlying infection progresses unchecked.

Patients with Lyme disease are frequently misdiagnosed with chronic fatigue syndrome, fibromyalgia, multiple sclerosis, and various psychiatric illnesses, including depression. Misdiagnosis with these other diseases may delay the correct diagnosis and treatment as the underlying infection progresses unchecked.

How Do People Get Lyme Disease?

Most people get Lyme from the bite of the nymphal, or immature, form of the tick. Nymphs are about the size of a poppy seed. Because they are so tiny and their bite is painless, many people do not even realize they have been bitten.

Once a tick has attached, if undisturbed it may feed for several days. The longer it stays attached, the more likely it will transmit the Lyme and other pathogens into your bloodstream.

If pregnant women are infected, they sometimes pass Lyme disease to their unborn children and, while not common, stillbirth has occurred. Some doctors believe other types of human-to-human transmission are possible but little is known for certain.

Where Is Lyme Disease Found?

Lyme disease has been found on every continent except Antarctica. It is found all across the United States, with a particularly high incidence in the East, Midwest, and West Coast. Rates have increased significantly over time. Some of this increase may be because of disease spread, but it is also likely that it reflects growing public awareness of the disease

Not all ticks are infected. Within endemic areas, there is considerable variation in tick infection rates depending on the type of habitat, presence of wildlife and other factors. Tick infection rates can vary from 0% to more than 70% in the same area. This uncertainty about how many ticks are infected makes it hard to predict the risk of Lyme disease in a given region.

In the South, a Lyme-like disease called STARI (Southern Tick-Associated Rash Illness) transmitted by the Lone Star tick has been described. Scientists are still debating about what organism(s) in the Lone Star tick may cause the disease as well as the treatment of patients with a rash in the South. However, Lyme disease has been reported in certain areas of the South and Southeast and patients with STARI may be quite ill. Because of this, patients in the South with a rash should be treated. (Herman-Giddens 2014)

The risk of getting Lyme disease is often reflected in risk maps. Some maps show the number of human cases of Lyme disease reported for surveillance. These maps may not accurately reflect risk because only 10% of reportable Lyme cases are currently captured by CDC surveillance. Other risk maps show the number of infected ticks that researchers have collected in a certain area. These maps are often not accurate because many states and counties have done little or no testing of ticks in the area. The best maps of risk may be canine maps. This is because dogs are routinely screened for Lyme disease through a nationwide program as well as the close association of dogs with humans.

Lyme Disease Symptoms

Symptoms of early Lyme disease may present as a flu-like illness (fever, chills, sweats, muscle aches, fatigue, nausea and joint pain). Some patients have a rash or Bell’s palsy (facial drooping). However, although a rash shaped like a bull’s-eye is considered characteristic of Lyme disease, many people develop a different kind of Lyme rash or none at all. Estimates of patients who develop a Lyme rash vary widely, ranging from about 30% to 80%.

For example, a CDC report on Lyme carditis, which can be fatal, found that only 42% of cases had a rash.

If Lyme disease is not diagnosed and treated early, it may become late-stage or chronic. This may also occur when early treatment is inadequate. While some symptoms of chronic or late stage Lyme disease are similar to those of early Lyme there are important differences.

Lyme disease may spread to any part of the body and affect any body system. Typically, it affects more than one body system. In our survey, which drew over 5,000 responses, patients with chronic Lyme disease reported an average of three severe or very severe symptoms, with 74% reporting at least one symptom as severe or very severe.

Many Lyme symptoms, such as fatigue, cognitive impairment, joint pain, poor sleep, mood problems, muscle pain, and neurological presentations also occur in other diseases. Hence, the symptoms of Lyme disease significantly overlap those of chronic fatigue, fibromyalgia, rheumatoid arthritis, multiple sclerosis, Parkinson’s disease, ALS, depression and Alzheimer’s disease. Many Lyme patients report being misdiagnosed with a different condition before being properly diagnosed with Lyme disease.

In order for the Centers for Disease Control (CDC) to recognize a Lyme case for surveillance purposes, there must be “objective” findings, such as positive blood tests, Bell’s palsy or joint swelling (even though Lyme blood tests are unreliable and the CDC’s accepted “objective” indicators are not common).

This situation contributes to what many experts view as severe undercounting of Lyme disease by the CDC.

Lyme Disease Diagnosis

Lyme disease is a clinical diagnosis—based on your medical history, symptoms and exposure to ticks. Because the typical diagnostic tests for Lyme are so insensitive, a negative test result does not mean you don’t have Lyme. There are many reasons why someone who actually has Lyme may have a negative test result. There may not have been time for antibodies to develop; the immune system may be suppressed; or the person may be infected with a strain the test doesn’t measure.

Lyme disease is known to inhibit the immune system and 20-30% of patients have falsely negative antibody tests.

Tests can not only help to diagnose a disease, but also to manage an illness. A good test can help a doctor assess the severity of disease, estimate the patient’s prognosis, monitor the course of disease progression, stability or resolution, detect relapse, and select drugs or adjust therapy. Unfortunately, a test with this capability does not exist for Lyme disease.

Lyme Disease Treatment

The International Lyme and Associated Diseases Society (ILADS), regards Lyme disease as often difficult to diagnose and treat, resulting in persistent infection in many patients. ILADS recommends individualized treatment based on the severity of symptoms, the presence of tick-borne coinfections and patient response to treatment.

Early Lyme Disease

ILADS doctors are likely to recommend aggressive and longer antibiotic treatment for patients. They may, for instance, treat “high risk” tick bites where the tick came from an endemic area, was attached a long time, and was removed improperly.

Late Or Chronic Lyme Disease

Experts agree that the earlier you are treated the better, since early treatment is often successful. Unfortunately, a substantial portion of patients treated with short-term antibiotics continue to have significant symptoms. The quality of life of patients with chronic Lyme disease is similar to that of patients with congestive heart failure. Doctors don’t agree about the cause of these ongoing symptoms. The primary cause of this debate is flawed diagnostic testing. There is currently no test that can determine whether a patient has active infection or whether the infection has been eradicated by treatment.

ILADS physicians believe that ongoing symptoms probably reflect active infection, which should be treated until the symptoms have resolved. These physicians use treatment approaches employed for persistent infections like tuberculosis, including a combination of drugs and longer treatment durations.

The ideal antibiotics, route of administration and duration of treatment for persistent Lyme disease are not established. No single antibiotic or combination of antibiotics appears to be capable of completely eradicating the infection, and treatment failures or relapses are reported with all current regimens, although they are less common with early aggressive treatment.

All medical treatments have risks associated with them. While the safety profile of antibiotics is generally quite good, only the patient (in consultation with his or her physician) can determine whether the risks outweigh the potential benefits of any medical treatment.

An ILADS doctor may consider the possibility of tick-borne coinfections, particularly if a patient does not respond to treatment or relapses when treatment is terminated. Other factors to consider are immune dysfunction caused by Lyme; silent, opportunistic infections enabled by the immune dysfunction; hormonal imbalance caused by Lyme; and other complications.

Considerations While On Treatment

Antibiotics can wipe out beneficial intestinal flora, leading to a wide variety of additional health problems. It is important to take probiotics while on antibiotics to maintain a healthy balance of gut bacteria. Furthermore, antibiotics may interact with other drugs, supplements or food.

Author

Kim Boateng

Kim Boateng

Staff Writer
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