One of the most controversial and poorly understood topics in healthcare is Lyme Disease. Since there is so much (mis) information on the internet and most family doctors don’t have any training on how to diagnosis and treat this infection. The goal of this article to give a very brief overview of Lyme Disease and the other chronic infections. Based on my experience with patients and my own learning journey as a clinician, here are the most commonly asked questions.
What is “Lyme disease”?
Classic Lyme disease is caused by a bacterium called Borrelia burgdorferi (BB). The most common carrier of BB is deer ticks found in northeastern US and Canada but cases have been found all over the world. As of 2006, the Center of Disease Control (CDC) estimates that Lyme disease is the fastest growing infectious disease in North America and maybe even worldwide. A recent study by the Public Health Agency of Canada and published in the Journal of Applied Technology indicated the speed of tick invasion in eastern Canada is predicted to increase from 18% in 2010 to over 80% by 2020. The two major factors dramatically influencing this rate of speed are more migratory birds carrying ticks coming across Canadian borders and climate warming (ticks die in sub-zero temperatures.)
Unsuspecting humans and animals walking through woodlands and brushy areas may be bitten by a tick and never know it. Animals such as cats, dogs, and migratory birds also carry ticks into more populated, urban areas. More recent research and case reports have also found that BB can be transmitted by other insects such as horse flies or mosquitos, through sexual intercourse, blood transfusions, through the placenta and breastfeeding. These forms of transmission are not nearly as common and have not been as well studied as the tick bite route of transmission but could explain how a person can get lyme disease without a tick bite.
BB lives in the digestive system and salivary glands of the tick and at the time of the bite are transferred into the host. One problem with making an immediate BB infection diagnosis is that only 30-50% (as low as 10%) get the classic bulls eye rash. This means that people can get bitten, progressively become ill and never suspect lyme disease. Some people don’t get acute lyme (rash, joint pain, fatigue and flu-like symptoms) disease or only experience a very mild form which can be easily mistake for a common flu. The BB infection can become silent and latent and become reactivated later in life.
What is becoming clear to lyme-literate clinicians is that the term “lyme disease” does not adequately encompass the number of possible infections and whole body dysfunction that patients suffering with “lyme disease” experience. Renown Lyme expert Dr Richard Horowitz MD coined the term Multiple Chronic Infectious Disease Syndrome (MCIDS) that better describes the wide range of caused of symptoms associated with Lyme disease. Chronic BB infection can wreak havoc on the immune system opening the door for more opportunistic infections such as Chlamydia pneumonia, mycoplasma and viruses. In most cases, it’s tough to know which infection came first but the fact remains that very few lyme patients have only BB but rather have multiple chronic infections.
The other major factor is that BB is NOT the only infection transmitter through a tick bite. A tick can also contain bacteria called Bartonella, Babesia and Ehrlichia/Anaplasma. They have a whole unique set of symptoms that ravage the body along with BB. It is possible to have 3 or 4 of this “co-infections” present at the same time. We’ll discuss these other bacteria more later in part 2. The presence of a devastated immune system and multiple co-infections makes treatment incredibly difficult but a lyme-literate practitioner will understand how to systematically identify and address each infection starting with the one that is dominate in a patient.
Stay tuned for Part 2 where we will discuss why is lyme disease so difficult to diagnose and treat. If you can’t wait for part 2 and want more information, please visit the following websites:
International Lyme And Associated Diseases Society
Canadian Lyme Disease Foundation
Leighton, P. A., Koffi, J. K., Pelcat, Y., Lindsay, L. R. and Ogden, N. H. (2012), Predicting the speed of tick invasion: an empirical model of range expansion for the Lyme disease vector Ixodes scapularis in Canada. Journal of Applied Ecology, 49: 457–464.
Kuehn BM. CDC estimates 300,000 US cases of Lyme disease annually. JAMA. 2013 Sep 18;310(11):1110. doi: 10.1001/jama.2013.278331.
Stricker RB, Johnson L. The pain of chronic Lyme disease: moving the discourse backward? FASEB J. 2011 Dec;25(12):4085-7. doi: 10.1096/fj.11-1203LTR.
Mayne PJ. Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort. Int J Gen Med. 2014 Dec 23;8:15-26. doi: 10.2147/IJGM.S75825. eCollection 2015.