Chronic Lyme Disease

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CHRONIC LYME DISEASE

Did you know that Lyme disease can become chronic? Do you check yourself and

your children frequently after participating in high-risk activities? Tick

bites should always be taken seriously.

When diagnosed in the early stages, Lyme disease is usually curable.

However, if it progresses to later stages before diagnosis, symptoms can

sometimes develop into chronic ailments. Lyme disease (LD) may also become a

chronic condition in patients who are treated inappropriately.

(Inappropriate treatment may include the wrong type of antibiotic, low

dosage prescriptions, not finishing prescribed antibiotics and other patient

compliance issues.) Two specific issues that may contribute to chronic LD or

recurring symptoms include diagnostic procedures and proper tick removal.

Diagnosing Lyme Disease

Unfortunately, diagnosing LD can be difficult in some patients. The most

common first symptom of LD is a rash around the site of the tick bite. A

rash may be easily overlooked, especially by patients who are unaware of

their exposure to a tick. Patients who are not familiar with LD may not

recognize the rash, or they may not think the rash is severe enough to seek

medical attention.

Another problem with LD is the potential for misdiagnosis. There are tests

available to screen the blood for antibodies. (The body produces these

antibodies in response to the bacteria that causes the infection.)

Unfortunately, a high number of both false positive and false negative

results are produced with these testing procedures. For example, when blood

tests are conducted within one month of infection, a false negative result

is possible because the incubation period for LD is 7 to 14 days. This means

that the body does not start to produce enough antibodies to be detected

until after this length of time. There are also other factors that

contribute to the reliability of the current LD tests.

The FDA recommends that healthcare providers use a complete clinical

evaluation including medical history, symptoms, high-risk activities and

possible exposure to ticks in the diagnostic process of early stage LD. The

blood tests may be used for supplemental purposes but should not be the

preferred diagnostic tool. This complicated diagnostic process emphasizes

the importance of prevention.

Preventing Lyme Disease

Most cases of LD are preventable. For more information on LD prevention,

visit Lyme Disease - What's Your Risk? (link to other article) One important

aspect of prevention is properly removing a tick when found on the body.

How To Remove A Tick

Ticks will climb upward until they find a protected place where they can

attach to the skin. Some common hiding places may include under the armpits,

the hairline, inside the navel or behind the knees. After attaching,

infected ticks will not begin transmitting LD for at least 36 to 48 hours.

This is why frequent body checks are so important. If one finds a tick

before it has been attached for this length of time, the risk of infection

is decreased. Proper tick removal may also contribute to the risk of LD.

The American Lyme Disease Foundation (ALDF) recommends using " unrasped

fine-pointed tweezers " to remove a tick. (These tweezers have tips that will

close tightly together.) A tick should be grasped with the tweezers at the

head where the tick enters the body. Grasping the body of the tick may cause

the infected bacteria to be squeezed into the skin. With a solid grip, the

tick can be pulled firmly, NOT twisted, out of the skin. After removal,

putting the tick in a jar of alcohol will kill it. The site of the bite

should always be cleaned thoroughly and monitored for up to 30 days. ALDF

also recommends against using matches, alcohol or petroleum jelly to get the

tick to pull out of the bite as these methods may actually cause more

problems.

Recurring Symptoms

Research suggests that LD infection can recur in patients who have not been

treated thoroughly or properly. Some patients have also reported recurring

symptoms even after an appropriate treatment plan has been followed and

recorded. The reason for recurring symptoms and progression to a chronic

state is still unknown. The American Lyme Disease Foundation (ALDF) reports

that the National Institutes of Health (NIH) plans to fund a research study

that will investigate possible reasons why and how LD can progress to a

chronic state after appropriate treatment. The study will also examine what

is considered appropriate treatment and the specific effectiveness of

different treatment options. Hopefully, this type of research will produce

new testing procedures to provide more accurate diagnostic results in the

near future!

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Reviewed by J. Adashek, MD, FACOG

November 1, 2000

Copyright ©2001 AmericasDoctor