A tick infected with Borrelia burgdorferi bites a person, beginning the Lyme disease process. The tick stays attached at least two days to transmit the bacteria. Once the bacteria enter the patient's body, the immune system reacts to the bite by developing a rash about seven days later. Unlike an allergic reaction, the rash continues to expand for several days. The patient may develop a fever, headache and joint pains or they may not have any symptoms. According to the American College of Physicians, the second stage of Lyme disease affects the neurological system. Patients may not be able to move half of their face, or they may feel that their arms and legs are weak. Some have abnormally slow heart rhythms. Meningitis, which is inflammation of the brain, produces headaches and a stiff neck. If a patient does not develop symptoms, is incompletely treated or does not respond to treatment, third-stage or late-stage Lyme disease can develop.
Arthritis
The third- or late-stage arthritis usually presents as episodes of pain and significant swelling in large joints, particularly the knees. The Infectious Diseases Society of America reports 10 to 60 percent of untreated patients with Lyme disease will develop joint swelling. Patients also describe chronic muscle pain. Late-stage Lyme disease patients will have positive blood tests for antibodies to B. burgdorferi. The IDSA recommends treatment with doxycycline, amoxicillin or cefuroxime axetil for four weeks. The joint swelling should decrease. An antibiotic-free period is usually tried for several weeks after the course of antibiotics. If the joint swelling does not fully resolve or recurs, the IDSA suggests re-treatment with another four-week course of oral antibiotics or with a two-to-four-week course of intravenous ceftriaxone.
Neurological
The ACP lists late-stage neurological symptoms as memory loss, difficulty concentrating and restless sleeping. The IDSA describes numbness in some patients' hands and feet that extends up the limbs, creating an appearance that the patient has a form of multiple sclerosis. During detailed testing, mild mental abnormalities can be noted. The IDSA describes late-stage Lyme disease presenting with neurological findings and arthritis as rare and late-stage Lyme disease having neurological findings only as even more unusual. The IDSA guideline is treatment with intravenous ceftriaxone for 14 to 28 days. Symptoms may take more than six months to resolve.
Unresponsive to Antibiotics
The IDSA reports that 95 percent of patients who take 10 to 28 days of antibiotics are cured. The listed causes of treatment failure are as follows: not having had Lyme disease, having a simultaneous infection or new illness similar to Lyme disease, or being re-infected by another tick bite. Some patients have persistent joint swelling despite treatment. Physicians are recognizing "antibiotic-refractory Lyme arthritis" may be related to other autoimmune diseases. IDSA recommends that if there are continued symptoms, a rheumatologist or a specialist in arthritic diseases should be consulted.
Tufts University Medical Center, of Boston, has organized its Lyme Clinic as part of Rheumatology's Center for Arthritis and Rheumatic Diseases. The IDSA notes that treatment options include intra-articular injections of corticosteroids; systemic administration of nonsteroidal anti-inflammatory agents; disease modifying anti-rheumatic drugs, primarily hydroxychloroquine; or surgical removal of inflamed joint lining. The IDSA feels that the benefits of long-term antibiotic therapy are outweighed by the risks since long-term antibiotic therapy success can be due to placebo effects, incomplete treatment of another infection or the anti-inflammatory effects of antibiotics. The risks include developing a bowel infection, Clostridium difficile and the emergence of drug-resistant species of bacteria.
References
- Infectious Diseases Society of America: Lyme Disease Facts
- American College of Physicians: Initiative on Lyme Disease: Patient Guide
- "Clinical Infectious Diseases": The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America; Gary P. Wormser, Raymond J. Dattwyler, Eugene D. Shapiro, John J. Halperin, Allen C. Steere, Mark S. Klempner, Peter J. Krause, Johan S. Bakken, Franc Strle, Gerold Stanek, Linda Bockenstedt, Durland Fish, J. Stephen Dumler and Robert B. Nadelman; 2006
- Tufts Medical Center: Lyme Disease Clinic
