Lyme disease is an infectious disease that is caused by a bacteria called “Borrelia burgdorferi”. The bacteria is transferred to the human body through insect bites from infected tick black-legged ticks or deer ticks. Nonetheless, the transmission of this bacterium into the human bloodstream can lead to the development of Lyme disease. It can affect anyone ranging from children to old age people however, people who spend most of their time outside are at high risk such as hikers, campers, and people whose occupations require them to be outside.

Lyme disease has been on the rise for the past few years, CDC reported more than 620,000 cases of Lyme disease annually worldwide in 2022. Furthermore, Lyme disease is common in various parts of the world including Europe, especially in Germany, Austria, and Sweden however, it has also been reported in Asia and Australia.

As we explained above being outside is a major risk factor for Lyme disease however, environmental changes and increased human encroachment into the natural habitat are contributing factors in in the increased prevalence of Lyme disease.

What are the symptoms of Lyme Disease?

Signs and symptoms of Lyme disease can be diverse which is why, we have divided them into early and late signs and symptoms:

Early Signs and Symptoms

Typically, 3 to 30 days following a tick bite are when early-stage Lyme disease symptoms manifest. These initial warning signs and symptoms could be:

1.  Erythema Migrans: Approximately 70-80% of infected individuals get this rash, sometimes known as a “bull’s-eye” rash. During several days, the rash begins at the location of the tick bite and progressively spreads, frequently clearing up in the middle as it does so. In most cases, it doesn’t hurt or itch.
2. Flu-like Symptoms: These could include lymph node swelling, fever, chills, headache, lethargy, and aches and muscles in the body.

Late Signs and Symptoms

If left untreated, more severe symptoms appear. The late symptoms may appear in weeks, months, or even after a yearr of the original infection. These late signs and symptoms may include:

1. Severe Joint Pain and Swelling: This can cause persistent arthritis, especially in large joints like the knees and the hip joint.
2. Neurological issues: These can include numbness or weakness in limbs, poor muscle action, Bell’s palsy (temporary facial paralysis), meningitis (inflammation of the membranes around the brain), and much more.
3. Heart issues: Lyme carditis, for example, can result in arrhythmias, or abnormal heartbeats.

Signs and Symptoms in Children

Children with Lyme disease can show similar symptoms to adults however, they may also experience:

1. Neck stiffness and severe headaches may indicate meningitis.
2. Behavioral Changes: Weariness, agitation, and difficulty focusing.
3. Sleep Disruptions: These include difficulty sleeping or sleeping too much.
4. Additional Physical problems: Swollen lymph nodes, sore throat, and gastrointestinal problems such as nausea or abdominal pain.

This is where parents’ and caregivers’ attention comes into play. They should vary if a child has been in any tick-infested area and strat showing these symptoms, it could be an early sign that he may be developing Lyme disease.

How Is It Diagnosed?

Clinical Evaluation

A clinical evaluation is the main method which is used to diagnose Lyme disease. It is based on the patient’s symptoms, medical history, and exposure. Some of the most important elements of the clinical evaluation are:

Symptom Examination: When diagnosing Lyme disease, a medical professional will assess for symptoms such the erythema migrans (EM) rash, flu-like symptoms, and other indications. However, some studies have suggested that Lyme disease may sometimes present even without the characteristic EM rash.

Exposure History: during this part of the exam, your doctor will ask about any history of exposure to ticks or any travel history.

Laboratory Examinations

Lab tests can help confirm the diagnosis of Lyme disease. These tests can come in handy when a person does not have the characteristic EM rash whereas other symptoms are positive. These tests then serve as the gold standard for making a diagnosis.

• Two-Tier Testing: The Centers for Disease Control and Prevention (CDC) recommends a two-tiered serological testing approach:
• First Tier: The CDC advises an enzyme immunoassay (EIA) or immunofluorescence assay (IFA) to detect antibodies against Borrelia burgdorferi.
• Second Tier: If the first test is positive, a Western blot test is performed to confirm the presence of specific antibodies (IgM and IgG) for Borrelia burgdorferi. The IgM test is most useful during the first few weeks of infection whereas the IgG test is more reliable in the late stages of the disease.
• Polymerase Chain Reaction (PCR): It is used to detect the genetic material of Borrelia burgdorferi in body fluids such as joint fluid (synovial fluid) and cerebrospinal fluid.  
• Other Tests: In cases of suspected Lyme neuroborreliosis, additional tests such as cerebrospinal fluid analysis may be performed to look for signs of infection in the nervous system.

More tests such as cerebrospinal fluid analysis may be needed if Lyme neuroborreliosis is suspected. 

What are the challenges faced During the Diagnosis?

Various challenges arise when diagnosing Lyme disease. For example, symptoms can overlap with other conditions like viral infections, chronic fatigue syndrome, and various autoimmune conditions, which can make them non-specific. Furthermore, non all patients may show the characteristic features of Lyme disease. Lab tests are extremely useful however, even those tests have their limitations. Tests that use IgG and IgM antibodies are ineffective in early diagnosis as your body requires time to create these antibodies, which can lead to a false negative result. Similarly, false positives can also occur due to cross-reaction with exposure to other bacteria or any previous exposure.

Moreover, some settings over-rely on tick testing which does nothing unnecessarily delay the diagnosis whereas some physicians even make the diagnosis based on the clinical presentation. It may not be as accurate but early treatment provides a better prognosis. 

Conclusion

Lyme disease is a tick-borne infectious disease with symptoms that can be similar to various other conditions. It presents with rash, and flu-like symptoms however, if left untreated, these symptoms can be very severe, which may include your nervous system, joints, and even cardiovascular system. Early diagnosis of Lyme disease is the key to complete recovery and preventing the development of any morbid health conditions.

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