Lyme Disease: Specialists and Information

In the mid-1970s, there was a cluster of cases of joint inflammation among children in the small U.S. town of Lyme. Shortly thereafter, it became clear that the joint inflammation was merely one symptom of a complex disease that also

• the skin,
• the nervous system,
• the cardiovascular system, and
• the eyes

. At the time, it was not yet known what caused this disease, known as Lyme disease, or how it could be treated.

It was not until several years later that the cause of this disease was identified: a type of bacterium known as Borrelia. It was named Borrelia burgdorferi after its discoverer, the physician Willy Burgdorfer.

Borrelia bacteria are primarily transmitted by ticks. It is currently unclear whether insects such as flies and mosquitoes also act as rare vectors.

Ticks can be easily removed with tick tweezers © andriano_cz | AdobeStock

Lyme disease is the most common tick-borne illness. Each year in Germany, approximately 30 to 50 (and in some regions, over 100!) out of every 100,000 residents develop the disease. About 50 to 100 per 100,000 residents are diagnosed with Lyme disease. Tick bites and the onset of the disease are much more common during the warm season than during the cold season.

The proportion of ticks carrying the Borrelia bacterium varies by geographic region. In forested areas where Lyme disease is common, about one in ten to one in three ticks carries the Borrelia bacterium. By comparison, the pathogens that cause the equally feared early summer meningoencephalitis (ESME) are found in only one in every hundred to ten ticks.

Transmission from the tick to humans takes several hours. Therefore, only about two to four percent of tick bites actually result in a Borrelia infection. So if you notice and remove the tick immediately after the bite, the risk of infection is not very high.

Early Stage of Lyme Disease

A typical symptom of Lyme disease is a circular, slowly expanding area of skin inflammation around the bite site. This “erythema migrans” develops within one to four weeks after the tick bite. However, this symptom appears in only about thirty percent of people with Lyme disease.

Other symptoms in this early stage of Lyme disease may include

• fever,
• muscle aches and headaches,
• swollen lymph nodes, and
• sweating,

which are very similar to those of the flu.

Erythema migrans in Lyme disease © Ingo Bartussek | AdobeStock

A few weeks to months after the tick bite

Severe organ damage can occur after a few weeks to months.

A characteristic feature of this stage is Bannwarth syndrome (Bannwarth meningopolyradiculitis). This is a non-purulent inflammation of the meninges and nerve roots. It causes

• headaches and neck pain, especially at night,
• sensory disturbances, and
• symptoms of paralysis.

The heart muscle may also be affected (Lyme carditis), which can manifest as cardiac arrhythmias. In addition, joint and muscle pain—sometimes severe—may occur at this stage. It typically moves from one joint to another.

Severe and persistent joint inflammation is rarely observed at this stage. Skin changes, such as lymphocytoma, are also relatively rare: This is a reddish or pale bluish nodule that can appear, for example, on the earlobe, the nipples, or the nose.

Late Stage of Lyme Disease

The late stage of Lyme disease develops months to years after the tick bite. A typical symptom at this stage is Lyme arthritis: joint inflammation characterized by pain, swelling, limited mobility, and warmth in the affected joint. The knee joint is most commonly affected.

Skin changes can also occur at this stage. These include, for example, acrodermatitis chronica atrophica—a reddish-bluish discoloration accompanied by cigarette-paper-like thinning and wrinkling of the skin. It occurs particularly on the hands and feet. Eye inflammation is also possible.

Not every patient goes through all stages of Lyme disease. Sometimes symptoms from different stages are present at the same time, and sometimes stages are skipped.

Diagnosing Lyme disease begins with a medical history. During this process, the doctor asks the patient about

• a tick bite,
• the appearance of “erythema migrans,” and
• the possible symptoms of Lyme disease described above.

In addition, the doctor thoroughly examines the affected area.

Sometimes the diagnosis is not easy to make, as many of the symptoms can also occur with other illnesses. Furthermore, not every case of Lyme disease follows a typical course. This can make it difficult, under certain circumstances, to definitively diagnose Lyme disease based solely on symptoms.

If Lyme disease is suspected, the doctor will therefore order additional laboratory tests. When infected with Borrelia bacteria, the body produces antibodies that can then be detected in the blood.

However, a positive antibody test result only indicates that the patient has recently been exposed to Borrelia bacteria.

Since Lyme disease is a bacterial infection, antibiotics are used for treatment. However, there is no universally effective antibiotic that works for every patient in every case. The choice of antibiotic and the duration of treatment depend on the stage and severity of the disease.

With this type of individually tailored therapy, the prognosis is very good. Nearly all patients treated in the early stages are cured.

In later stages, symptoms often subside only slowly (over weeks to months after the end of treatment). Sometimes, a repeat course of antibiotic treatment is necessary. About 90 percent of patients with Lyme arthritis can be cured with appropriate treatment.

For the remaining 10 percent of patients with chronic disease, symptoms persist for a year or longer despite treatment.

In most cases, however, Lyme disease resolves in these patients over the course of several years.

It is important to note that in these chronic cases, symptoms may persist due to the body’s immune response, even when no live pathogens remain in the body. Therefore, indiscriminate, prolonged, or repeatedly administered antibiotic treatment should be avoided.

In very rare cases of Lyme arthritis, it may be necessary to surgically remove the inflamed synovial membrane.

Physical therapies can also provide relief. Temporary medication may also be helpful. Suitable options include pain relievers or corticosteroid-free anti-inflammatory drugs such as

• diclofenac,
• indomethacin, or
• ibuprofen,

which, in addition to relieving pain, also have an anti-inflammatory effect.

The best protection against Lyme disease is to avoid tick bites. The most reliable way to do this is to avoid areas where ticks are present from early summer through fall. If you don’t want to give up walks in meadows and wooded areas, you should wear protective clothing, such as:

• closed-toe shoes,
• long pants,
• tuck your pant legs into your socks.

Ticks stay close to the ground, up to a maximum height of 80 cm, and are brushed off by grass or low bushes. Wearing a hat is therefore of no use.

If you do get a tick, remember: the sooner the tick is removed, the lower the risk of infection. That’s why you should check your entire body for ticks after a walk. In children, ticks can also attach to the head.

If a tick is already attached, you can grasp it by the head with tweezers or tick removal forceps (available at a pharmacy) and slowly pull it out of the skin. Do not squeeze the tick or drip oil or similar substances on it! Otherwise, it may release even more of its pathogen-laden saliva.

Afterward, you should apply an antiseptic ointment to the bite site.

The tick’s head, if it remains in the skin, is not infectious and will fall off on its own after a few days.