Wednesday, April 14, 2021

Lyme disease

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Lyme Disease

Lyme disease is a tick-borne systemic infection cause by a spiral organism, Borrelia burgdorferi, characterized by neurologic, joint, and cardiac manifestations. Lyme disease is carried by a tiny tick. It begins with a bite and a rash that can be so slight, you may not even notice. However the consequences can be serious, sometimes even fatal. Lyme disease can create symptoms that mimic a wide variety of other diseases, ranging from juvenile arthritis to multiple sclerosis to Alzheimer's disease.

The birth of Lyme disease started in Lyme, Connecticut. The disease was found in the 160's. Polly Murray moved to Lyme, Connecticut in 15 with her four children. Within a few years of living in Lyme she began having periodic flu-like illnesses, headaches, and odd rashes. When she first went to the doctor they thought she had rheumatic fever and the doctors gave her penicillin. This helped for a little while but the symptoms returned in the spring and summer. In the early 170's Murray asked her doctor if this illness could be a delayed reaction to a tick bite, because she knew she had been bitten by ticks over the years. The doctor said no because she had no symptoms of Rocky Mountain spotted fever and in those days that was the only disease people thought was caused by ticks. Soon kids all over her neighborhood were coming down with the same symptoms. Murray kept at it and told everyone about the problems she had and had no answers for them. Later research found that her problems came from a tick called a Ixodes dammini tick.

Symptoms of Lyme disease can be highly variable from one person to another and also can vary dramatically over time in one person. Although there is a classic pattern of illnesses in Lyme disease, it is not expressed in nearly half of all patients. This can make spotting the disease extraordinary difficult and living with it frustrating and painful. The disease progresses in three stages. In the first stage the symptom most commonly experienced by people with Lyme disease is a distinctive rash. This symptom is only experienced with about 60% of patients with Lyme disease. This rash is called EMC, which means a "red, chronic, migrating rash." It is most likely to appear a week after the tick bite but may occur from two to thirty days after such a bite. if not treated the rash will disappear on its own, usually within about three weeks. Along with the rash, or often in its absence, the patient often experiences a flu-like illness. About 60 to 80 percent of those who have the rash will experience such flu-like symptoms simultaneously. The symptoms may include headache, fever, chills, aching muscles, stiff neck, loss of appetite, sore throat, nausea, and vomiting. Months later the second stage will kick in which includes various neurologic, cardiac, and joint manifestations. The third stage which eventually occurs in some untreated patients, is characterized by chronic arthritis and various neurologic problems. Some patients do not experience any of these symptom. In these cases doctors wonder if the patients will ever experience any symptoms of Lyme disease.

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One of the greatest problems surrounding medical care for Lyme disease is the problem of diagnosis. Diagnostic tests are not likely to be done unless the physician has what is known as high index of suspicion of the disease, which means that he or she is ever on the lookout for it. Even when Lyme disease is suspected, currently available diagnostic tests often yield false negative results and are believed to identify correctly only about half of all confirmed cases, especially early in the disease. If not diagnosed and treated promptly, the disease may seem to disappear only to resurface months or years later. The diagnostic blood test currently available commercially for Lyme disease does not actually look for Borrelia burgdorferi but the spirochete that causes the disease. The two general blood test used an immunofluorescence test and an ELISA. Two other tests are used in research laboratories. One is the cell test and the other actually seeks the spirochete. Many physicians are pinning their hopes on a new test for Lyme disease now under development. It looks neither for the spirochete itself nor for the antibodies. Rather, it seeks out spirochete antigens in blood or urine and would therefore allow the disease to be diagnosed even before antibodies formed.

Depending on the individual patient, and one of several drugs antibiotics may be used, usually starting with oral drugs, pills, given for at least ten to fourteen days. When the patient has Lyme disease there are many medications available. In adults Tetracycline, 500 milligrams by mouth four times a day or Phenoxymethyl penicillin, 500 milligrams by mouth four times a day. In children age eight and older Tetracycline, 1.5 milligrams per kilogram of body weight, by mouth every six hours (up to two grams per day) or Phenoxymethyl penicillin, 1.5 milligrams per kilogram of body weight, by mouth every six hours (up to two grams per day). In children under eight years of age Erythromycin, 1.5 milligrams per kilogram of body weight, by mouth every six hours (up to two grams per day).

If you have Lyme disease once in your life you should never forget it. Whenever you have new symptoms in the future, even symptoms that seem totally unrelated, and you see a physician, be sure to give the doctor a complete medical history, including your bout with Lyme disease. Our experience with Lyme disease is too short of duration to know for sure what lies ahead. Once cured you may never have new symptoms, but then again, you may. Only the collective experience of patients and physicians working together with full knowledge will eventually yield all the answers.

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