The Rundown on Lyme Disease in the U.S. with Dr. Clarke

What is Lyme disease?

Dr. Clarke: Lyme disease is an infection caused by a spirochete called Borrelia burgdorferi, which initiates an inflammatory response. The Borrelia bacteria is transferred between hosts by the black-legged tick called Ixodes scapularis during a blood meal. The White-footed mouse, Peromyscus leucopus, is the principal, natural reservoir host and they appear to be tolerant to infection by Borrelia. With deforestation and climate change however, casual hosts, such as humans, dogs and other domestic mammals, have become new reservoirs. Humans are not adapted to managing a Borrelia infection, which may manifest in humans as a health complication we call Lyme disease. 

How prevalent is Lyme disease in the U.S.?

Dr. Clarke: This is a major healthcare issue, particularly in New England and the Upper Midwest. National surveillance reports by the Centers for Disease Control and Prevention show around 30,000 cases per year. However, the impact is generally considered to be underreported. A more realistic number could be greater by an order of magnitude, and actual disease incidence could be as high as 300,000 cases per year. Lyme disease is considered the “Hidden Pandemic”.

What are the symptoms, and how is Lyme disease detected early on?

Dr. Clarke: The bulls eye rash (erythema migrans) is specific to Lyme disease and appears early in the infectious process but will gradually disappear during the disease progression. Other common symptoms are headache and muscle ache, joint pain, fatigue, brain fog, chills and fever. Unfortunately, these symptoms are common to other conditions, such as a cold virus — mistaking the early symptoms for Lyme disease is all too common. Other symptoms can appear, such as hearing loss, numbness and nerve problems. Some patients will develop facial palsy, showing a droop like Bells’ Palsy. Coordination may also be impacted. Other symptoms can include nausea, vomiting and weight loss.

What are the lasting impacts of untreated Lyme disease?

Dr. Clarke: In later stages of the disease, the Borrelia bacteria becomes established in joints and lymph nodes. Once the bacteria have taken up residence in these tissues, recovery by antibiotic treatments becomes increasingly difficult. Two common problems are the development of arthritis in major joints and, in some rare cases, the heart may become inflamed/enlarged and present as myocarditis. Even in cases of early antibiotic intervention, there are some patients that do not appear to respond to treatment. 

Patients that carry the infection for extended periods of time may also develop neurological problems. Neuroborreliosis is a devastating condition that can cause chronic pain, cognitive dissonance and depression. Lymes myocarditis has caused a low number of deaths, however, the emotional impact of neuroborreliosis has lead to a far greater number of deaths due to suicide. There is a significant population that experience long-term problems, sometimes referred to as “Persistent or Post-Treatment Lyme Disease Syndrome.” Cases of Persistent Lyme Disease are estimated to be approaching 100,000 cases per year. 

Why is education important regarding this specific tick-borne illness?

Dr. Clarke: There are three practical concerns about Lyme disease. First, this is a difficult disease to accurately diagnose since many of the symptoms can be misinterpreted for other health problems. The nature of the infections is not well understood. We can explain the early symptoms of Lyme disease, but the late-stage problems are an enigma. 

Second, if you like outdoor activities that involve moving through high grass or wooded areas, then Lyme disease must be on your radar for preventative measures. Early treatment is imperative since antibiotic therapy is most effective at the early stage of infection. 

The third concern is the magnitude of infections and the likelihood of over-treatment of patients experiencing Lyme-like symptoms. The most common treatment for someone presenting with early signs of Lyme disease is a large course of antibiotics. The potential excessive use of antibiotics may eventually have a large impact on the rise of antibiotic-resistant pathogens in our environment, which has become an imminent issue for the World Health Organization. 

Lyme disease is a major, yet underreported, health care problem for the nation. More emphasis needs to be placed on characterizing the disease mechanism, developing reliable diagnostic tools, and of course, finding a cure that works for established infections. Knowledge is a powerful tool for prevention, so please check yourself for ticks after venturing into the more rugged areas of your community.