Lyme disease can cause devastating effects on your health. Symptoms of Lyme disease can mimic many other diseases and, unless you get the obvious bullseye rash, it may be extremely difficult to pinpoint the cause of your symptoms, leading to a misdiagnosis.
30,000 cases a year are reported to the Centers for Disease Control, but many more are not reported. The CDC estimates that “approximately 300,000 people may get Lyme disease each year in the United States.” Since Lyme disease is not simple to diagnose after it has progressed, the total number of Americans infected each year may be even higher than CDC estimates.
What is Lyme Disease?
Lyme disease originates from a bacterium that is transmitted through the bite of certain types of ticks. Fortunately for humanity, we are not able to transmit it to each other. As a tick goes through its life cycle, it feeds on blood once in each stage. Larva, ticks in the baby stage, do not begin to carry the bacteria until they feed on an animal which carries the organism. However, the nymph and adult may carry it before feeding and transmit it through their bite.
The good news is that normally the tick does not transmit the bacteria until it has been attached for 36-48 hours. So, if you inspect your body for ticks and are able to remove them shortly after they have attached, you are probably safe from developing Lyme disease. The bad news is that this is harder than it seems. Adult ticks are relatively easy to spot but the nymphal stage tick is much more difficult to see or identify. To minimize your chances of developing Lyme disease, be aware of what a tick nymph looks like, and thoroughly check your body after being in areas where ticks thrive.
The first few weeks are called acute Lyme disease. During this stage, symptoms are easily mistaken for the flu and are sometimes accompanied by a rash, called erythema migrans (EM). Somewhere between three and thirty days after being infected, up to 70 or 80 percent of people will develop this rash. It usually grows until it reaches around six inches across but can spread to over a foot in diameter and will last for three to five weeks. It often has a distinct bullseye pattern but may not. Further confusing the issue, some people will develop the rash in multiple places on their body. Luckily, it is rarely painful or itchy.
Other common early symptoms include headache, chills, mild fever, achiness, joint pain, fatigue, and swollen lymph glands. After the first few weeks, it progresses to late Lyme disease. At this point, the bacteria have reproduced and spread enough to cause more severe symptoms.
Joint pains begin to migrate, and the headache, fever, and fatigue worsen. Depending on how the disease affects you, you could have a sore throat, stiff, aching neck, changes in vision, facial palsy, nerve pain, numbness or tingling in your extremities, or shortness of breath.
Some of the more extreme symptoms of Lyme disease include arthritis in one or more large joints with severe pain and swelling, and heart problems, called Lyme carditis. Neurological disorders are also common if your central nervous system is involved, and may result in dizziness, short-term memory loss, difficulty concentrating, mental fog, and confusion.
As you can see, Lyme disease can impact you in a wide variety of ways. While this list seems diverse, it is not exhaustive, and there are many other symptoms observed in those with Lyme disease.
More About the Bacteria Which Cause Lyme Disease
Borrelia burgdorferi is the bacteria commonly known to cause Lyme disease. There are many strains of this bacterium, and at least 16 cause Lyme disease. Once you are exposed to a strain, your body begins creating antibodies, which are Y shaped proteins, that find the intruder and stick to it, so your immune system knows to destroy the antigen. Unfortunately, your body only creates antigens for the specific strain you were exposed to, so it is possible to be infected by multiple different strains of Borrelia that can cause Lyme disease. Researchers also have not determined how long immunity lasts after exposure so it may be possible to be infected by the same strain years later.
In 2016, researchers at the Mayo Clinic found that another Borrelia species called Borrelia mayonii also causes Lyme disease. In addition to the diverse symptoms of Lyme disease caused by Borrelia burgdorferi, when you are infected with B. mayonii you may have additional symptoms of nausea, vomiting and neurological symptoms. Currently, the only way to identify Lyme disease caused by this strain is to identify the bacterium in a blood smear from an infected person or with a different Lyme disease PCR test, which you can only get through the Mayo Clinic.
Another species of Borrelia, known as Borrelia miyamotoi, also causes Relapsing Fever, which humans can get through the bites of ticks and lice. Common symptoms of relapsing fever include a severe headache, nausea, vomiting, high fever, chills, muscle and joint pain, a rash, and delirium. Other, more severe and dangerous symptoms may also occur. The symptoms last three to five days, abruptly clear up, then return a week or two later. Untreated patients may relapse 2 to 10 times.
Testing and Diagnosing Lyme Disease
One of the biggest problems with diagnosing Lyme disease is in recognizing symptoms if the rash is not present. Many patients do not remember getting bitten by a tick or developing the erythema migrans rash. Since Lyme disease mimics so many other diseases, it is easily misdiagnosed. If Lyme disease is suspected, your doctor will diagnose you based on your symptoms, and whether you have been exposed to black-legged ticks. If you have the rash, you can start treatment without any testing. To correctly diagnose Lyme disease, the CDC recommends a two-step process of blood testing.
The first test is an enzyme-linked immunosorbent assay (ELISA or EIA). This test detects whether your body has created antibodies to specific antigens, in this case to Borrelia burgdorferi. The ELISA works by taking a blood sample and introducing a specific antigen to the blood. If antibodies to that antigen are present, the antigens will attach to the antibodies, giving a positive result. However, you can receive a false positive if you have a few other diseases, so if the test is positive or equivocal you then move to