How Is Lyme Disease Diagnosed
It can be hard for doctors to diagnose Lyme disease because:
- The tick bites and rash might not be noticed.
- Many early symptoms seem like the flu or other illnesses.
- Blood tests are not always accurate, especially early in the illness.
Doctors can diagnose early Lyme disease if they see a tick bite and rash. Blood tests usually aren’t helpful in the first month of Lyme disease.
To diagnose late Lyme disease, doctors:
- Ask about symptoms.
- Do blood tests that look for signs of Lyme disease.
Depending on the symptoms, doctors might order other tests, such as a spinal tap, which looks at the fluid around the brain and spinal cord.
Diagnosis Testing And Treatment
You may have heard that the blood test for Lyme disease is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon how long youve been infected. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.
Several weeks after infection, FDA cleared tests have very good sensitivity.
It is possible for someone who was infected with Lyme disease to test negative because:
If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately.
- Report being bitten by a tick, or
- Live in, or have recently visited, a tick-infested area.
Symptoms Of Post Treatment Lyme Disease
- Include severe fatigue, musculoskeletal pain, & cognitive problems
- Can significantly impact patients health and quality of life
- Can be debilitating and prolonged
Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.
The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.
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How Soon After Being Bitten By A Tick Do Symptoms Appear
In Lyme disease, the rash may appear within 3-30 days, typically before the onset of fever. The Lyme disease rash is the first sign of infection and is usually a circular rash called erythema migrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite.
Likewise, people ask, how long does a tick bite last?
Surrounding redness does not expand when observed over 24-48 hrs. Reaction at site of tick bite can last days, even weeks. Lyme rash occurs at the site of the tick bite in 80% of people with early Lyme disease. Incubation period from tick bite to rash is 3-30 days .
What is the best antibiotic to use for tick bite?
Amoxicillin and cefuroxime are commonly used for prophylaxis after a tick bite. These antibiotics do not cover as wide a spectrum of infections as doxycycline does, but are often better tolerated.
How long does it take to know if you have Lyme disease?
This is normal after a tick bite and does not indicate Lyme disease. However, these signs and symptoms may occur within a month after youve been infected: Rash. From 3 to 30 days after an infected tick bite, an expanding red area might appear that sometimes clears in the center, forming a bull& s-eye pattern.
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Stage : Late Disseminated Lyme Disease
Stage 3 or late disseminated Lyme disease is the final stage of the disease. A person may enter this stage if they did not receive treatment for Lyme disease in the early stages, or if their symptoms persisted despite treatment. As such, doctors sometimes refer to this stage as chronic or post-treatment Lyme disease .
Stage 3 Lyme disease can occur after an infected tick bites a person.
A person with stage 3 Lyme disease may experience additional symptoms, including:
- severe joint pain and swelling, known as chronic Lyme arthritis
- heart palpitations or irregular heartbeat, due to Lyme carditis
- inflammation of the brain and spinal cord
- mental fogginess
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Quinine Derivatives To Boost Intracellular Antibiotics
Intracellular
Inside of cells, Lyme may live in cave-like structures called vacuoles. In these vacuoles, Lyme germs create a hostile acidic environment that can limit the effectiveness of various antibiotics. Quinine derivatives, like hydroxychloroquine , can make the inside of cells more basic which can help the tetracyclines and macrolides mentioned above work better.
- Hydroxychloroquine 200 mg 1 pill 2 times a day
Lyme Sci: The Dreaded Jarisch
Lyme disease and tick-borne diseases are complicated illnesses and because of that, treatment can be complex. Patients whove gone through treatment will often say your symptoms get worse before they get better. One of the reasons for this is something called a Jarisch-Herxheimer reaction.
The Jarisch-Herxheimer reaction often shortened just to Herxheimer or herxinghappens after you start antibiotic treatment for spirochetal infections like syphilis, Lyme disease, and tick-borne relapsing-fever.
The reaction was first described in 1895 by Adolf Jarisch, an Austrian dermatologist, and later in 1902 by Karl Herxheimer, a German dermatologist. Both doctors documented a pattern of an increase in symptoms shortly after their syphilis patients started treatment.
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Patterns Of Symptom Persistence
Some patients experience persisting symptoms after standard antibiotic treatment for Lyme disease. Whilst the small amount of low quality evidence available does suggest that more than half of patients make a full recovery from Lyme disease, this still means a significant number of patients do not.
- Delayed recovery from some or all symptoms is experienced by some patients, after their antibiotic treatment has ended, which may last weeks, months or years. It is considered normal for some patients convalescing from a severe illness to feel ill for up to six months. Some people who catch Lyme disease, and are treated with antibiotics, feel ill for longer than six months.
- Symptom relapse occurs for some patients. They start to feel better, but then feel worse again either immediately, or some months, after they have finished their course of antibiotics.
- No improvement at all occurs for a small number of patients.
Caudwell LymeCo Charity conducted a patient survey in 2016 and received 424 written responses to the question How has having Lyme disease affected your quality of life?
Clearly, the patients who make little or no long-term improvement want to know why they are still ill. Regrettably, the small amount of research carried out so far gives us very little by way of an answer.
Study Shows Evidence Of Severe And Lingering Symptoms In Some After Treatment For Lyme Disease
In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue…
In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue, pain, insomnia and depression do indeed persist over long periods of time for some people, despite largely normal physical exams and clinical laboratory testing.
Post-treatment Lyme disease syndrome is a real disorder that causes severe symptoms in the absence of clinically detectable infection, says John N. Aucott, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Lyme Disease Clinical Research Center.
The findings, published in the December issue of Frontiers in Medicine, could spur further investigation into the cause of persistent symptoms, a source of medical controversy. As Lyme disease rates have steadily climbed in the United States since it was first recognized in the mid-1970s, so have reports of a collection of symptoms that patients commonly refer to as chronic Lyme disease. Experts in the field have questioned the validity of this term because of the lack of direct evidence in this group of patients of ongoing infection with Borrelia burgdorferi, the bacterium that causes Lyme disease.
Other Johns Hopkins researchers who participated in this study include Alison W. Rebman, Ting Yang, Erica A. Mihm, Mark J. Soloski and Cheryl Novak.
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Which Areas Are More Likely To Have It
The tick that causes Lyme disease has been moving from the Northeast and upper Midwest into the Southern and Western U.S., Mexico, and Canada. Cases in California and Florida are on the rise. After a drop between 2017 and 2018, the numbers jumped a little bit in 2019.
But most Lyme cases in 2019 were in 15 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin. Washington, DC, is also a hotspot.
In 2019, Pennsylvania had the most Lyme infections, with 6,763. New York was next, with 2,847 cases.
In the Southern U.S., where itâs hotter, ticks stay under leaves so they dont dry out. This means people donât get Lyme from Southern ticks very often because they dont usually come out to bite.
Even though people only report about 30,000 cases of Lyme infection in the U.S. each year, there are actually around 476,000 a year. The same tick also can spread other diseases, including babesiosis, anaplasmosis, and Powassan virus. Those diseases are also on the rise in the U.S.
Whoâs likeliest to get Lyme disease?
Boys up to age 15 and men between the ages of 40 and 60 are the most likely to get Lyme disease. Thatâs because they tend to play outside and go camping, hunting, and hiking.
Why are there more ticks now than there used to be?
There are several reasons why Lyme is spreading. Some of these are:
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Who Gets Lyme Disease
Anyone bitten by an infected deer tick can get Lyme disease. Most U.S. cases of Lyme disease happen in Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin. But Lyme disease is found in other parts of the U.S., Europe, Asia, and Australia too.
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What Are The Risk Factors For Post Treatment Lyme Disease
Risk factors for Post Treatment Lyme Disease include:
- Delay in diagnosis
- Increased severity of initial illness
- Presence of neurologic symptoms
Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. PTLD is especially common in people that have had neurologic involvement. The rates of Post Treatment Lyme Disease after neurologic involvement may be as high as 20% or even higher. Other risk factors being investigated are genetic predispositions and immunologic variables.
In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.
Can Lyme Disease Be Prevented
Not all cases of Lyme disease can be prevented. But you can help protect your family from tick bites. If you go into an area where ticks live, be sure to:
- Stay in the middle of the trail, instead of going through high grass or the woods.
- Wear closed shoes or boots, long-sleeved shirts, and long pants. Tuck pant legs into shoes or boots to prevent ticks from crawling up legs.
- Use an insect repellent.
- Consider treating clothing and gear with permethrin to repel ticks. When used properly, permethrin is safe for all ages. But don’t use it on clothing or other material a child may suck on or chew.
- Wear light-colored clothing to help you see ticks more easily.
- Shower and wash hair after being outside to remove ticks before they attach.
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How Do You Know If Its A Herx And Not An Adverse Drug Reaction
It is important to distinguish between a herx and an adverse drug reaction . The onset of a Herxheimer reaction is somewhat diagnostic of a spirochetal infection. So, if youre being treated for Lyme based on a clinical diagnosis, the herx can actually be a good sign that you are killing the right bacteria.
Ive talked to patients whove had Herxheimer reactions and almost all of them tell me it is a very intense experience. One patient described it as an altered state. Said one: Every cell in my body feels like its being crippled. Its mentally overwhelming and physically exhausting. I usually have a pulsing feeling in my body which distinguishes it from a medication side effect.
Adverse drug reactions, on the other hand, can range from mild to severe and can be mistaken for a herx. So how do you tell the difference?
Another patient distinguishes the two reactions as follows: Herxes for me seem to be more all over and include psych symptoms. Drug reactions seem to be more in line with what is described in the drug manufacturers papers. With antimicrobials, you can have both simultaneously, of course.
Mild ADRs will typically resolve shortly after the medication is stopped. On the other hand, a severe allergic reaction, called anaphylaxis, causes swelling of the airways, and can be fatal if not treated immediately .
Antimicrobials That Kill Growing Phase Spirochetes
Extracellular
Penicillins
- Amoxicillin 500 mg 1 to 2 pills 3 times a day. Alternatively as an alternative to IV antibiotics take 3 to 4 pills 3 times a day.
- Amoxicillin/Clavulanic Acid 875 mg/125 mg 1 pill 2 times a day
- Bicillin LA 2.4 million units IM 3 times a week with one day between each injection
Cephalosporins
- Ceftriaxone 2 gm IV 2 times a day for 4 days in a row then off for 3 days of each 7 days
- Cefotaxime 2 gm IV every 8 hours
- Cefuroxime 500 mg 1 pill 2 times a day
- Cefdinir 300 mg 1 pill 2 times a day
Additional IV Antibiotics
Vancomycin, imipenem, and ertapenem are possible alternatives if someone is allergic to Ceftriaxone or Cefotaxime.
Intracellular and Extracellular
- Clarithromycin 500 mg 2 pills 2 times a day
- Azithromycin 500 mg 1 time a day or 500 mg IV 1 time a day
Tetracyclines
- Doxycycline 100 mg 1 or 2 pills 2 times a day or 200 to 400 mg mg IV 1 time a day
- Minocycline 100 mg 1 pill 2 times a day
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Can Lyme Disease Be Prevented Or Avoided
The best way to prevent Lyme disease is to avoid being bitten by ticks. When you are outdoors, follow these guidelines:
- Avoid areas that are wooded, brushy, or have tall grass.
- Walk in the center of trails.
- Use an insect repellent with at least 20% DEET. It can be put on clothing or sparingly on the skin. Dont apply it to the face or hands of children.
- Treat clothing, tents, or other gear with repellents containing 0.5% permethrin.
- Wear light-colored clothing. This makes it easier to see and remove ticks from your clothes.
- Wear a long-sleeved shirt and long pants. Tuck your pant legs into your socks or boots for added protection.
After you get home, check everything and everyone for ticks.
- Bathe or shower as soon as you can to wash off any ticks that have not attached to you.
- Check your entire body for ticks. Use a mirror for places you cant see. Check your children and your pets. Common tick locations include the back of the knees, groin area, underarms, ears, scalp, and the back of the neck.
- Check any gear you used, including coats, backpacks, or tents.
Tumble dry clothes or blankets on high heat in the dryer for 10 to 15 minutes. This should kill any ticks. If clothes are dirty, wash them in hot water and dry on high heat for 60 minutes.
Antimicrobial Herbs That Kill Growing Phase Spirochetes & Cysts
Intracellular and Extracellular
Based on my observations, these herbal combination options have as good of a chance as the prescription options. They appear to kill intracellular and extracellular Lyme too based on the clinical benefit I see in my medical practice.
- Cats Claw and Otoba Bark Tinctures 30 drops of each 2 times a day. Start at 5 drops 2 times a day and add 1 drop per dose per day until you reach 30 drops 2 times a day. If you get a Herxheimer reaction, stop increasing the dose until it has passed.
- Cats Claw and Japanese Knotweed 30 drops of Cats Claw 2 times a day and ½ tsp of Japanese Knotweed 3 times a day. Work up to these doses over 30 days. Start Cats Claw at 5 drops 2 times a day and add 1 drop per dose per day until you reach 30 drops 2 times a day. Start the Japanese Knotweed at ¼ tsp 3 times a day and in two weeks increase to ½ tsp 3 times a day.
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