In the mid-1970s, children in the small US town of Lyme began to fall ill with joint inflammation. A short time later, it emerged that joint inflammation is just one symptom of a complex disease that also affects
and the eyes. What caused this disease, known as Lyme disease, and how it could be treated was not yet known at the time.
It was not until several years later that the cause of the disease was identified: A type of bacteria called borrelia. It was named Borrelia burgdorferi after its discoverer, the physician Willy Burgdorfer.
Borrelia bacteria are primarily transmitted by ticks. Whether insects such as flies and mosquitoes also act as rare carriers is still unclear.
Ticks can be easily removed with tick tweezers © andriano_cz | AdobeStock
Lyme disease is the most common disease transmitted by ticks. Every year, around 30 to 50 (regionally over 100!) out of every 100,000 inhabitants in Germany contract the disease. Around 50 to 100 per 100,000 inhabitants are infected with Lyme borreliosis. Tick bites and the onset of the disease occur much more frequently in the warm season than in the cold season.
The proportion of ticks carrying the Lyme disease pathogen varies depending on the geographical region. In wooded areas where Lyme disease is common, around one in ten to one in three ticks carry the Lyme disease pathogen. By comparison, the pathogens that cause tick-borne encephalitis (TBE), which is also feared, are only found in one in one hundred to one in ten ticks.
Transmission from tick to human takes several hours. This is why only around two to four percent of tick bites actually result in a Borrelia infection. If the tick is noticed and removed 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 inflammation of the skin around the site of the bite. This "migratory redness"(erythema migrans) develops within one to four weeks after the tick bite. However, this symptom only occurs in around thirty percent of Lyme borreliosis sufferers.
Other symptoms at this early stage of Lyme disease can include
very similar to the flu.
Wandering redness in Lyme disease © Ingo Bartussek | AdobeStock
Several weeks to months after the tick bite
After a few weeks to months, severe organic damage can occur.
Bannwarth syndrome (Bannwarth meningopolyradiculitis) is characteristic at this stage. This is a non-purulent inflammation of the meninges and nerve roots. It causes
The heart muscles can also be affected (Lyme carditis), which can manifest itself in cardiac arrhythmia. In addition, severe joint and muscle pain can occur at this stage. They typically move from one joint to another.
Pronounced and persistent joint inflammation is rarely observed at this stage. Skin changes, such as lymphocytoma, are also rather rare: this is a reddish or pale blue lump that can appear on the earlobe, nipples or nose, for example.
Late stage of Lyme disease
The late stage of Lyme borreliosis develops months to years after the tick bite. The typical symptom is then Lyme arthritis: an inflammation of the joints that can be recognized by pain, swelling, restricted movement and overheating of the affected joint. The knee joint is usually affected.
Skin changes can also occur at this stage. These include acrodermatitis chronicaatrophica, a reddish-bluish discoloration and 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 of different stages are present at the same time, and sometimes stages are skipped.
The first step in diagnosing Lyme borreliosis is to take a medical history. The doctor asks the patient about
- a tick bite,
- the occurrence of the "migratory redness" and
- the possible symptoms of Lyme disease described above.
They also examine the affected area thoroughly.
Sometimes the diagnosis is not easy to make, as many of the symptoms can also occur with other diseases. In addition, not every case of Lyme borreliosis is typical. This can make it difficult to diagnose Lyme disease based on symptoms alone.
If Lyme borreliosis is suspected, the doctor will therefore order additional laboratory tests. When infected with Borrelia, the body produces antibodies, which can then be detected in the blood.
However, a positive antibody result only indicates that the patient has recently been exposed to Borrelia bacteria.
As Lyme borreliosis is a bacterial disease, antibiotics are used for treatment. However, there is no universally effective antibiotic that works for every patient and in every case. The choice of antibiotic and the duration of treatment depend on the stage and severity of the disease.
With such individually tailored therapy, the chances of recovery are very good. Almost all patients treated at an early stage are cured.
In later stages, the symptoms often regress only slowly (over weeks to months after the end of treatment). Sometimes it is necessary to repeat the antibiotic treatment. Approximately 90 percent of patients with Lyme arthritis can be cured with appropriate therapy.
In the remaining ten percent of patients with chronic disease, the symptoms persist for a year or longer despite treatment.
In most cases, however, Lyme arthritis heals in these patients over the course of several years.
It is important to know that the symptoms in these chronic cases can persist due to defense processes in the body, even if there are no living pathogens in the body. It is therefore important to warn against uncritical, prolonged or repeated antibiotic treatment.
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 drug therapy can also be helpful. Pain medication or cortisone-free anti-rheumatic drugs such as
- Diclofenac,
- indomethacin or
- ibuprofen,
which, in addition to their analgesic effect, 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 ticks from early summer until fall. If you don't want to miss out on walks in meadows and wooded areas, you should wear protective clothing, i.e:
- closed shoes,
- long pants,
- tuck your trouser legs into your socks.
The ticks are found close to the ground up to a maximum height of 80 cm and are swiped off by grasses or low bushes. A hat is therefore useless.
If you do get caught, the sooner the tick is removed, the less likely you are to be infected. You should therefore check your whole body for ticks after a walk. In children, the tick may also be on the head.
Ticks that are already attached can be grasped by the head with tweezers or tick tweezers (pharmacy) and slowly pulled out of the skin. Do not squeeze the tick and do not apply oil or similar to it! Otherwise it may release more of its saliva containing pathogens.
You should then apply a disinfectant ointment to the bite site.
The part of the tick's head that may remain in the skin is not infectious and will fall off on its own after a few days.
