Diagnosis and Treatment of Lyme Disease

LYME’S DISEASE (BORRELIOSIS)

 

What is Lyme Disease

  • Borreeliosis is commonly known as both “Lyme’s disease” and “Lyme Disease.” It got its name because the first case was reported in New Lyme, Connecticut, in 1977.

  • It’s caused by several species of Borrelia bacteria. These bacteria are most commonly transmitted by the tick species Ixodes, better known as the deer tick. Other tick species can transmit the disease as well.

In the majority of cases Lyme disease begins with localized skin symptoms. Only later does it progress to include heart, eye, joint, and nervous system symptoms. Erythema chronicum migrans is marked with a red “bullseye” shaped rash, which is often used to informally diagnose the disease before serological tests confirm the infection. This rash typically spreads to other areas of skin, losing its distinctive bullseye appearance.

For a disease as potentially serious as Lyme’s surprisingly little research has been done. In a series of case studies done in Europe it was determined that systemic symptoms were uncommon. About 5% of patients displayed arthritis and other joint symptoms, 3% had neurological involvement, 2% showed lymphatic system involvement, and a further 1% developed cardiac symptoms. Similar results were seen in America, with the key difference being less serious and extensive skin symptoms (rash). As can be seen, Lyme disease varies widely between patients. Some will display virtually no symptoms while others will experience debilitating ones.

 

How Do You Diagnose Lyme Disease

Blood testing is done not to screen for the bacteria itself but for the antibodies the body produces in response to it. This being said, serum testing may be falsely negative in patients with only a minor rash. False-negative results may be obtained for up to 6 weeks in these individuals. In areas with high rates of infection 4% to as many as 50% of residents may test positive for Lyme disease. Only a relatively small percentage will ever display symptoms, however.

Early, aggressive treatment with antibiotics is the only known effective treatment for Lyme’s. If caught early enough, treatment may prevent systemic infection thus solving the problem before it begins. Currently no Lyme disease vaccines exist, and avoiding tick exposure is the only known means of prevention. If a bite is caught early enough and the tick is removed within 36 hours, including its mouthparts, infection may be avoided.

 

 

Treatment of Lyme disease:

First-line treatment: Aggressive antibiotic therapy administered as soon as Lyme disease is suspected is widely accepted as the best approach. Lyme’s responds well to penicillin, tetracycline, and cephalosporins.

A two to four week course of treatment is required. Longer treatment duration has not been shown to be helpful. While the above mentioned skin changes may resolve without antibiotics, treatment is still necessary to prevent or limit further systemic infection. Even if this antibiotic treatment is successful, symptoms of joint pain and fatigue may take about three months to subside. Here are some basic treatment guidelines:

  • 100 mg oral doxycycline is administered twice daily for ten to twenty-one days. Studies have shown no additional effectiveness past twenty days. Note, however, that treatment failure is possible with antibiotic therapy of any duration.

  • 500 mg oral amoxicillin once a day for fourteen to twenty-one days. Amoxicillin is the most accepted antibiotic for both pregnant women and children. In children under the age of ten, a dosage of fifty mg per kilogram of body weight should be given in three divided doses at morning, mid-day, and evening.

  • Patients with facial palsy or a first degree cardiac block as their only symptoms should be treated with the previously mentioned medications for twenty-one days.

  • Patients exhibiting joint involvement should be placed on a thirty day oral regimen. This can be repeated again if symptoms fail to improve. If at this point symptoms are still present parenteral treatment is the best option.

  • Studies have shown ceftriaxone as one of the most effective intravenous options. Parenteral treatment with this drug is also indicated in patients with severe neurological or cardiac involvement. In this case, asymptomatic second-degree heart block and symptomatic first-degree heart block are regarded as severe cardiac involvement. Revommended dosage is 2 g given intravenously for fourteen days. In all cases of severe cardiac involvement patients should remain in hospital for continuing cardiac monitoring for the duration.

Alternative treatments for Lyme disease:

  • Cefuroxime is the preferred medication in cases where patients are allergic to doxycycline and amoxicillin. 125 mg should be given twice a day, with one dose given at morning and the second at night. Alternate dosing guidelines are 30 mg per kg of body weight in two divided doses, morning and night. As per the previous regimens treatment should continue for fourteen to twenty-one days.

  • In patients who can’t tolerate cefuroxime the preferred medication is erythromycin. Dosage is 250 mg given three times a day. Alternate dosing is 30 mg per kg of body weight given in three divided doses, morning, mid-day, and evening. Treatment should be given for fourteen to twenty-one days.

  • For patients who can’t tolerate intravenous cefuroxime, the antibiotic cefotaxime is an effective alternative. Cefotaxime is also the recommended agent for the treatment of cardiac and neurological involvement. Dosage is 2 g given intravenously every eight hours for fourteen to twenty-one days. Penicillin G sodium at 3.3 million intravenous units may also be used, given every four hours for fourteen to twenty-one days.

Follow up:

In all cases of potential neurological or cardiac involvement regular follow up is recommended.

Ancillary treatment for Lyme disease:

  • As a prophylactic measure, 200 mg of doxycycline given in one dose has been shown to be effective. Epidemiological studies have shown an effectiveness of 87% after a known tick bite.

  • In areas where Borreliosis is especially common, long clothing and insect repellent containing DEET should be used.

  • Manually checking for ticks in these endemic regions is recommended. This enables prompt removal of the tick in order to reduce the chances of infection.

 

Of special note: https://www.bvfootclinic.com/skin-diseases-of-the-foot/

The diagnosis of erythema chronicum migrans must be made clinically, as serum testing will be negative at this stage of infection. Antibiotic therapy should still be administered if infection is possible.

Consult a dermatologist:

  • If a skin biopsy is needed to confirm an unclear diagnosis.

  • To examine lesions in which lymphocytoma or acrodermatitis chronicum atrophicans may be suspected.

If you have a strange rash on your foot or lower legs, Call 878-313-3338 for an appointment today!