Lyme Disease & Tick-Borne Illness
What Is Tick-Borne Illness?
Tick borne disease (TBD) refers collectively to the various infectious pathogens (bacteria, viruses, fungi, protozoa, parasites) that can be transmitted via the bite of a tick, often referred to as co-infections. Lyme disease, aka borreliosis, is caused by the infectious agent B. burgdorferi in the United States; B. afzellii, B. garinii more commonly seen in Europe.
It has been called the second great imitator, after syphilis. Like syphilis it is a slow growing spirochete. Unlike syphilis, it has the largest genome of any bacteria, and is able to avoid immune detection through various mechanisms. As well, it can re-activate past infections, like Epstein Barr or mycoplasma, often thought of non-pathogenic in the immune-competent host.
Treatment for TBD will vary depending on whether the condition is considered acute or chronic. ILADS is our governing organization, helping clinicians diagnose and treat Lyme disease without bureaucratic interference.
Not all tick bites require antibiotic treatment, but each do require a careful assessment to determine possible transmission of pathogens. Persons with prior history of Lyme disease, symptoms suggestive of transmission with or without EM rash, or who have compromised immune function generally need immediate treatment with pharmaceuticals to minimize the risk of long-term illness. Others may benefit by botanical antimicrobials or immune supportive therapies. Generally, a combined approach is preferred.
Chronic tick-borne diagnosis; however, involves a more thorough assessment and involved treatment plan, requiring a deep dive with a functional multi systems approach. Some patients are genetically or epigenetically predisposed to chronic Lyme disease. Often the underlying conditions must be addressed along with the infection. And again, a combined integrative approach is ideal.
Controversy in the Diagnosis of Lyme illness.
One of the issues in the field of tick borne illness is the lack of agreement between two sides of the debate: The IDSA (Infectious Disease Society of America) along with the CDSA (The Centers for Disease Control and Prevention) and Ilads (The International Lyme and Associated Diseases Society). The two groups each have differing definitions of what Lyme disease is, how it presents, how to test for it, what criteria is needed for diagnosis, and how to treat. And the term Chronic Lyme disease is not well accepted by the IDSA. Thus the conversation to advance the field stalls over these definitions; the field gets passed over for research dollars and many people go on to suffer long term symptoms without adequate treatment.
What makes a difficult field harder to understand and treat is that tick borne illness presents very differently in everyone. And it's not always pathogenic all the time in every person. What works for one person may not be effective for another. Due to the intelligent nature of the borrelia spirochete to first invade, to then very quickly decode the complexity of the immune system it's landed in, it will then take control causing over stimulation in some areas and deficiencies in others. When this process goes on for some time, it becomes very difficult to discern what is human and what is other thus making treatment hugely variable and individualized.
Tick borne illness is a clinical diagnosis; and it is imperative to listen for patterns to the symptoms. Laboratory data may support the clinical suspicion but antibody testing is unreliable, with many false negatives, made more difficult because of immune suppression by the pathogens. As a result, many individuals are misdiagnosed, have a delayed diagnosis, or are inappropriately or incompletely treated. We use numerous labs to support the diagnosis depending on many individual factors and include Stony Brook tick lab and Igenex labs.
Lyme Disease Testing
Currently there is no reliable objective test to confirm cure and eradication of infection. There are over 300 strains of Bb worldwide and 100 strains in the US. False positives and false negatives often occur, though false negatives are far more common. In fact, some studies indicate up to 50% of the patients tested for Lyme disease receive false negative results. As a result, the CDC relies on clinicians to make a clinical diagnosis based on a patient's symptoms, health history, and exposure risks. Diagnostic tests cannot yet accurately identify the earliest stage of Lyme disease when making the diagnosis is crucial. Because of this as well as the inconsistent ability to identify the hallmark rash, early Lyme disease is difficult to diagnose in a community practice setting. Providers who are experienced in recognizing LD will treat when symptoms typical of the illness are present, even without a positive test, in an effort to prevent the development of chronic Lyme disease.
In general, you can think of LD as having three categories: acute, early disseminated, and chronic. The sooner treatment is begun after the start of the infection, the higher the success rate. Under-treated infections will inevitably resurface, usually as chronic Lyme, with its tremendous problems of morbidity and difficulty with diagnosis and treatment and high cost.
What is the definition of “Chronic Lyme Disease?”. Based on clinical data from Ilads (the International Lyme and Associated Disease Society), to be said to have chronic LD these three criteria must be present:
Illness present for at least one year (this is approximately when immune breakdown attains clinically significant levels).
Have persistent major neurologic involvement (such as encephalitis/encephalopathy, meningitis, etc.) or active arthritic manifestations (active synovitis).
Still have active infection with Bb, regardless of prior antibiotic therapy (if any).