Have you ever had a flu-like syndrome in the middle of the summer? Did you have any new symptoms or worsening joint pain following the flu-like syndrome? In a Lyme-endemic region like Vermont, tick borne illness could be the culprit for those symptoms. Flu-like symptoms, headache, neck stiffness, and facial paralysis are symptoms of early Lyme disease, a condition most commonly diagnosed from spring through fall seasons when ticks are most active. Ticks are a type of arachnid often found in wooded or grassy areas populated by deer, squirrels, mice, lizards, rabbits, and birds.
Lyme disease is a complex illness caused by a spirochete, a spiral-shaped bacteria called Borrelia, transmitted by a deer tick (black legged tick) or lone star tick bite. There are at least 18 pathogenic strains of Borrelia, the most common being
Borrelia burgdorferi. Northeastern states, including Pennsylvania, New York, New Hampshire, Maine, Connecticut, and Vermont, are considered some of the highest incidence areas for Lyme disease. This infection is commonly known by its characteristic bulls-eye rash (aka. Erythema migrans). However, an erythema migrans rash does not always present with a target-like appearance and the rash does not occur in a significant percentage of patients. It is possible to have Lyme disease or another tickborne illness without presence of an erythema migrans rash.
Ticks can also transmit more than just Borrelia species. Anaplasma, Ehlrichia, Babesia, Rickettsia, and Bartonella are common co-infections associated with Lyme. Transmission rates of Borrelia and associated co-infections vary by organism. Some viruses, like Powassan virus, can also be transmitted by a tick bite. It is very common for a patient diagnosed with Lyme disease to be struggling with more than one infection.
The previous paragraph mentioned symptoms of early Lyme disease. Untreated Lyme disease can spread and become disseminated Lyme disease, manifesting with symptoms in the musculoskeletal, cardiac, and neurological systems. Symptoms include (but are not limited to) fever, night sweats, brain fog, migratory joint pain, joint swelling, lightheadedness, palpitations, mood changes, numbness/tingling, gastrointestinal symptoms, and shortness of breath. Diagnosis of disseminated Lyme disease can be difficult since these symptoms are characteristic of other medical diagnoses such as chronic fatigue syndrome, fibromyalgia, multiple sclerosis, rheumatoid arthritis, and other autoimmune conditions.
Lyme disease is considered a clinical diagnosis, mostly based on a patient’s history and physical exam. Lab results can be supportive of the diagnosis but an immunoassay or Western blot does not have to be positive to make the diagnosis. Various factors contribute to a high prevalence of false negatives in Lyme disease testing. Antibodies do not appear in the blood until several weeks after the tick bite. In some chronically ill individuals, the immune system is not healthy enough to produce a sufficient antibody response. The standard two-tiered test for Lyme disease tests for Borrelia burgdorferi. It does not detect other Lyme-causing Borrelia species. Testing accuracy changes with duration and complexity of infection since the test results are reflective of the individual’s immune response. The more sensitive C6 ELISA test is not currently included in testing standards of care. Comprehensive tick-borne illness testing may or may not be covered by health insurance depending on the lab and insurance plan.
Treatment of early Lyme disease often includes the use of antibiotics or herbal extracts for one to three months. Disseminated Lyme disease treatment on the other hand is typically more complex and can take months to years. A combination of antibiotics, herbal extracts, supplements, diet and lifestyle changes may be used to improve the overall health of the body while addressing the infection.
During the summer, preventing illness includes protecting yourself from Lyme disease and associated tick-borne illnesses. Methods of prevention include: dressing in light colored clothing, tick checks after every outdoor activity, and wearing insect repellent. When checking for ticks make sure to inspect warm and moist areas like armpits, backs of knees, groin, in and around the ears. It can be a helpful habit to throw your clothes in the wash and shower right after coming in from a wooded or grassy area. If you do find a tick, look at the scutum of the tick to identify it. Ticks can be sent to TickReport or Ticknology for identification and pathogen testing. If you are concerned that a new rash may be erythema migrans, take a picture and contact your physician. If you think you may be suffering from a tick-borne illness, take the MSIDS questionnaire online. This questionnaire was developed by Richard Horowitz, MD to improve the assessment of Lyme disease and the associated bacterial, viral, parasitic, and fungal infections. This questionnaire is available as a pdf on the lymeactionnetwork.org website. For more detailed information on tick-borne illness prevention, refer to a book such as Dr. Alexis Chesney’s, Preventing Lyme & Other Tickborne Diseases.
Dr. Laurel Erath is a naturopathic doctor at Rutland Integrative Health.