Lyme Disease and Related Tick-Borne Infections

Description

Alternative Names

Complications

Prompt treatment with antibiotics is very effective in curing Lyme disease in nearly all infected people, including children. A 2003 study showed that the long-term outcome of patients with Lyme disease who are treated with antibiotic therapy is excellent. It should be noted that even if Lyme disease has been successfully treated, it may be possible to become reinfected with Lyme disease again at a later date. The risk appears to occur only in patients who had been treated for the rash, however. In those who developed arthritic symptoms as well, the antibody response appears to persist and prevent reinfection.

Complications of Late-Stage Lyme Disease

People at highest risk for persistent symptoms are those who go the longest before treatment. Fortunately public vigilance has significantly reduced the rates of late-stage Lyme disease. Antibiotics given at late stages will relieve symptoms in most people, although an estimated 10% will continue to have problems. Also at risk for persistent symptoms are those who show evidence of having severe infections. Retreatment at later stages has been shown to be effective in about three quarters of these patients.

Left untreated, Lyme disease can spread (disseminate). The infection may affect almost any part of the body and cause the following complications:

• Severe arthritis.
• Persistent fatigue.
• Mood disturbances and loss of concentration.
• Neuropathy (numbness, tingling, or other odds sensations in the hands, arms, feet or legs).
• Life-threatening disorders affecting the heart, lungs, or nervous system can occur, but are very rare.

Chronic Arthritis. Without treatment, 60% of patients develop intermittent joint inflammation, especially in the knees. After several severe attacks the condition may become chronic, but it often responds to intravenous or long-term oral antibiotics.

About 10% of treated patients experience persistent pain in the joints. Researchers are trying to determine if this represents and actual chronic infection caused by the spirochete or if it is a persistent and abnormal immune response. In the later case, antibiotics are not effective. To date, investigators have not detected higher levels of immune factors ordinarily associated with inflammation, although one study reported increased traffic of B-cells into the affected tissues. B-cells are important immune factors in producing infection fighters, which can trigger inflammation.

Persistent Neurologic Disorders. In general neurologic problems persist in 5% of patients, although some studies have reported much higher rates--up to 50%. Persistent symptoms usually include headache, attention and memory problems, and depression. Patient may also experience neurologic pain, numbness, or abnormalities in the face. Neurologic symptoms generally resolve and improve within a year. More studies are needed.

Heart Problems. About 5% of untreated patients experience acute heart events from electrical conduction problems caused the infection. Heart symptoms can appear within a few days to several months after the onset of disease. They include:

• Arrhythmias (irregular heartbeats).
• Pericarditis (inflammation of the lining of the heart) occurs in about 5% of patients.

Lyme-related heart problems nearly always resolve without serious consequences within a week. About 30% of patients may need a temporary pace maker, however. In very rare cases, these heart rhythm abnormalities have been fatal. There is some debate about whether there are any long-term consequences to the heart, such as the development of congestive heart failure in some patients. One study of patients who had had Lyme-related heart effects reported no greater long-term risk for heart problems than in people without a history of Lyme disease.

Miscellaneous Complications. Other complications reported include:

• Problems in the eye, including swelling that can cause pain and sensitivity to light.
• Hepatitis (inflammation in the liver).
• Respiratory difficulties.

Infections in the Pregnant Patient. The occurrence of any infection during pregnancy is of special concern. While the current research indicates that complications during pregnancy due to Lyme disease are very rare, pregnant women should still adhere scrupulously to preventive measures.

• Some studies indicate that Borrelia burgdorferi may be transmitted to the fetus during pregnancy, with the risk highest during the first trimester. If this occurs, however, it is likely to be very rare and not an issue of great concern. There is no evidence of any severe effects in the offspring of infected pregnant women.
• There are no reports of human infant Lyme disease infection from breast feeding. Studies on animals, however, have reported transmission of the organism to infant mice through breast milk, but these findings do not appear to be applicable to people.

Post-Lyme Disease Syndrome

Symptoms persist in many patients after antibiotic treatment, although reports vary as to duration and location of symptoms. In general, about a third of patients have symptoms that last a few weeks. In 10% to 15% of cases, patients complain of persistent symptoms such as fatigue, muscle aches, and headache lasting years after completing antibiotic treatments for the initial infection. This syndrome, which resembles chronic fatigue syndrome (CFS) or fibromyalgia, is referred to as chronic Lyme disease, or post-Lyme disease syndrome. It seems to be reported more frequently in patients who experienced early neurologic symptoms during the initial infection, particularly if their treatment was delayed.

Much controversy surrounds chronic Lyme disease, however, including whether it represents an actual persistence of the original infection, whether it is a persistent inflammatory reaction to the infection, and whether it can be treated.

In most cases of post-Lyme syndrome, advanced diagnostic techniques fail to detect any persistent infection. (Even if there is some evidence of residual immune activity, it does not mean that the Lyme infection is active.) Some physicians contend, however, that Lyme disease was inadequately treated to begin with and that the infection persists, but that the antibody levels are too low to be detected. These physicians recommend intensive antibiotic treatments.

A number of studies, however, have reported no differences between groups of patients with post-Lyme disease syndrome who received intensive antibiotic treatments versus those who received sham antibiotics. In addition, other studies have reported no evidence of persistent Borrelia infection in many patients with post-Lyme disease syndrome. These results strongly suggest that the condition in some patients has other causes.

Different experts have suggested the following causes for the conditions:

• Some believe it may be due to a persistent and abnormal immune response. In such cases, the patient develops an autoimmune response, in which the body produces immune factors that target its own cells and causes inflammation and injury.
• Others posit that the persistent symptoms were due to an initial misdiagnosis and that many of these patients never had Lyme disease to begin with.
• Still other experts theorize that a co-infection with ehrlichiosis, babesiosis, or other tick-borne pathogens may be the cause of persistent symptoms in many of these patients.
• Because symptoms of post-Lyme syndrome are so nonspecific, some physicians believe they are simply psychological. Others believe that such thinking is a disservice to patients who experience genuine suffering and pain. Depression is certainly a common symptom of both early and late-stage Lyme, but may be a physical result of the disease.

Overall, studies report a low incidence of persistent Lyme disease. Reports from centers that have years of experience treating Lyme disease in children have been reassuring and state that there are very few cases of long-term or untreatable illness.