Lyme disease is a complex array of chronic infection, inflammation, toxicity, and immune dysregulation. It is the number one vector-borne disease in theUnited Statestoday and is reaching epidemic proportions. As of 2009, there were approximately 38,000 reported cases of Lyme to the Center for Disease Control (CDC), although estimates may be as high as 500,000 cases in theUnited States.
There is great controversy within the medical community about the prevalence and diagnosis of Lyme. For example, the CDC provides stringent diagnosis criteria that should be used for research, but are usually used by clinicians to make patient diagnoses. Additionally, the CDC does not believe there is in fact chronic, ongoing Borrelia infection. They state that patients who continue to experience symptoms even after antibiotic treatment are suffering from “post-treatment Lyme disease syndrome”, which they feel is only an auto-immune condition.
Lyme disease is most commonly caused by the spirochete bacteria Borrelia burgdorferi, although there are at least nine other types of Borrelia bacteria, and these other species may also be able to cause Lyme.
Humans are infected when a deer tick (Ixodes species) bites a deer infected with Borrelia and becomes infected itself. The tick then bites a person and transmits the Borrelia through its saliva. There are different estimates as to how long a tick needs to be attached to transmit Borrelia, but all sources agree that the longer the time, the greater the chance.
It is also important to know that Borrelia has been found in the 49 contiguous United States and throughout Canada; there are no areas free of Borrelia. Lyme also isn’t spread by deer and deer ticks alone. Borrelia has been found in gray squirrels, Western fence lizards, Northern Pacific seabirds, robins, and sparrows, as well as mosquitoes and fleas; it can not by transmitted by dog ticks. There is also evidence that it can be passed via blood transfusion, placental transfer, sexual transmission, and breastfeeding. However, in these human-to-human cases, it is imperative that a positive test be interpreted in light of a person’s clinical presentation; a positive test may simply indicate a past exposure, rather than a chronic infection. There are people who can clear the infection without it becoming chronic so not everyone with a positive test needs treatment.
Co-infections and Opportunistic Infections
Other infections, including Babesia, Bartonella, and Ehrlichia, can also be transmitted with Borrelia, and are considered common co-infections. Babesia is a protozoa that invades red blood cells. There are more than 100 species and at least four of them have been shown to cause human disease. Bartonella is a bacteria that also lives within cells and at least six species know to infect humans. Ehrlichia is a bacteria within the Rickettsiae family (e.g., Rocky Mountain Spotted Fever) and lives within white blood cells and mast cells.
Other infections may not be directly transmitted with Borrelia, but may occur opportunistically due to the immune dysregulation that Borrelia can cause. These can include bacteria, fungi/yeast, viruses, and parasites.
Because of this, Drs. Daniel Newman and Stacey Rafferty think it might be more appropriate to refer to chronic Lyme Disease as Multiple Chronic Infectious Disease Syndrome (MCIDS).
All of these infections can complicate the diagnosis and symptom picture and may need to be addressed individually as part of the overall treatment plan. Many of these infections can also trigger auto-immune conditions, which again may create a more complicated clinical picture.
Signs and symptoms will vary greatly between an acute and chronic infection and may be complicated by other infections, toxicity, and underlying conditions.
People with an acute infection often manifest with a fever, headache, fatigue, and general flu-like symptoms. Very few infected people will manifest the classic “bulls-eye” rash; some research indicates only eight to ten percent of people will show this acute manifestation, and often the rash may simply be a solid red area. Also, very few people remember a tick bite, as the Ixodes ticks are about the size of a poppy seed, and infection can be latent for months to years after the original bite.
Main symptoms of a Lyme infection will be neurological symptoms, muscle and/or joint pain weakness that comes and goes and varies in location, fatigue, sleep disturbances, and cognitive dysfunction. Other symptoms can include:
other rashes lymphocytoma
fever or low temp chills, sweats
recurring flu-like symptoms headache
stiff/cracking neck anxiety
Bell’s palsy blood pressure instability
getting lost lightheaded
mood swings low stamina
sleep disturbances pressure in eyes, blurry vision
heart palpitations shortness of breath
ears ringing sound sensitivity
poor balance, vertigo stomach upset
digestive irregularities menstrual irregularities, lack of menses
irritable bladder abdominal/pelvic pain
electric/numb sensations low libido
Many of these symptoms will come on gradually and cycle on usually a four to six week cycle; for menstruating women, symptoms may be notably worse before or during their menses.
On a physical exam, there may be diffuse musculoskeletal pain, clammy hands and feet, vertical ridges in the nails, spasms of the muscles along the spine, hyper-reflexes, extreme cold (oral temperatures of 96-97.9 degrees) and cold extremities, abdominal distention, plantar tenderness in the feet, joint cracking, heart irregularities, mottled or dark spots on skin, psoriasis, yeast, swelling, and browning of teeth.
Additionally, the co-infection organisms can have their own sets of more specific signs and symptoms that may occur with or alternately with those of Borrelia:
- Babesia: fever, chills, day/night sweats, anxiety, fear, obsessions/compulsions, pressure headaches, insomnia, joint pain more predominantly in the ankles, wrists, and hands, difficulty taking a full breath(air hunger), easy bruising, red spots on skin (cherry angiomas), dark spots on base of nails, abnormal reflexes, night sweats, joint pain in the knees and ankles, and vertigo
- Bartonella: ice pick headache, cognitive difficulties, seizure, painful/burning soles of feet upon rising, photophobia, sensation of pressure behind the eyes, purple stretch marks, browning of the skin, swollen lymph nodes, abdominal tenderness, fever, and very small tremors of the muscles
- Ehrlichia: High fevers with sweating, low white blood cell and platelet counts, elevated liver enzymes, extremely tender muscles, and liver enlargement
It is important to know that chronic Borrelia infection can mimic or trigger a huge list of conditions, including:
Multiple sclerosis Amyotrophic lateral sclerosis
Alzheimer’s disease Parkinson’s disease
Rheumatoid arthritis Dementia
Chronic fatigue without pain Recurrent acute aseptic meningitis
Charcot Marie-Tooth Guillian Barre
Polymyalgia rheumatica Polymyositis/dermatomyositis
Fibromyalgia Multiple Chemical Sensitivity
Bipolar disorder Schizoaffective disorder
Chronic EBV Thyroid disease/Hashimoto’s/Grave’s
Hyperparathyroidism Addison’s disease/adrenal insufficiency
Reflex sympathetic dystrophy Fungal hypersensitivity
If a person presents with one of these conditions, Lyme disease should be considered and any testing should be evaluated in light of these diagnoses.
The CDC recommends two tiers of testing: the Elisa test followed by a Western Blot for confirmation. The difficulty with this recommendation is that the Elisa is highly unreliable for Lyme- there are some estimates that up to 35-40% of people who have had the Borrelia actually found in their bodies will show a negative Elisa test. While the Western Blot is more accurate, it is only done to confirm a positive or equivocal Elisa test if one is following the CDC recommendations exactly.
The Western Blot looks for reactivity at different protein weights that creates a banding pattern on the test and different types of spirochetes and/or parasites may give reactivity at these bands. The IgG bands specific to Borrelia burgdorferi are 18, 21-23, 28, 31, 34, 39, 83, and 93 kD. Most labs do not include bands 31 and 34 as they were used in the development of a Lyme vaccine (no longer in use). According to the CDC, a positive test has reactivity at 5 or more of the IgG bands numbers18, 23-25, 28, 30-39, 45, 58, 66, and 93 or 2 or more of the IgM bands numbers 23-25, 39, or 41. The most important thing to know about the CDC criteria is that they are for use in investigational research, NOT CLINICAL DIAGNOSIS. IGeneX labs uses a more clinically relevant evaluation system whereby a positive test is indicated by 2 reactive bands of the 23-25, 31, 34, 39, 41, and 93 kD weights.
There are some challenges with the Western Blot test in general. For example, the test results will be affected by how much of the blood sample was used, how often it was diluted, the types of strips used and how they were stored as well as the skill of the person reading the tests. Also, there can be cross-reactivity with hepatitis, Epstein-Barr virus, and Herpes simplex virus at bands 31 and 34, and band 41 is specific for some kind of spirochete bacterium, but not necessarily Borrelia. The current testing is also skewed toward the Borrelia burgdorferi, so testing may be negative if one of the other Borrelia species is the cause. Also, if the person is highly immunosuppressed, they may show a negative test because their immune systems are unable to make enough antibodies to the Borrelia. Therefore, results must ALWAYS be interpreted in light of clinical presentation.
Because Borrelia can live in a cyst form, the Western Blot test may also come back as a negative if most of the organism is in this stage. In cases where there is a negative test but high clinical suspicion, the person may be asked to do a trial of Lyme-specific anti-microbial treatment, especially cyst disruption, and repeat the test.
Currently, the testing for the co-infection organisms can be even more challenging with greater limitations. Therefore, while a positive result on any of these tests is truly a positive, a negative result does not necessarily rule out the infection. Again, clinical presentation and possibly response to trial of treatment becomes more important.
Treatment for Lyme (and any co or opportunistic infections) must have three main components:
- Eliminate the infection,
- Optimize the person’s natural immunity, and
- Correct imbalances that created the hospitable environment for the infection originally.
Borrelia can live in several different states, including a cyst form, and antimicrobial treatment needs to include therapies that target each of these forms. Many of the natural anti-microbial treatments can also be effective against other bacteria, viruses, fungi, and protozoa, but there are times when the treatment focus needs to change slightly as one of the other co- or opportunistic infections may become dominant.
It is important to recognize that there is little research on herbal anti-microbials directly with Borrelia and most of the information has come from trials with other spirochete bacteria. However, many of these formulas have shown clinical success, and that is significant especially with a disease that is so clinically driven. At times, pharmaceutical antibiotics may be needed, and in those cases, anti-fungal treatments are necessary to prevent worsening fungal imbalances. In either case, treatment for Lyme, including rebalancing and immune optimization, can take years, especially as the infection will go through its own natural cycle or flaring and dormancy periods. The good news is that there are many treatment options with emerging clinical success that can be used, and while Borrelia can cause many cognitive and psychological symptoms, I don’t believe Lyme is just “all in your head”.
Center for Disease Control website
Lyme Disease Diagnosis and Integrative Treatment: A Practical Course for Naturopathic Physicians. Dr. Daniel Newman, MD, ND, MSOM and Dr. Stacey Rafferty,BSN,ND, LAc. April 2012.
Rheumatology and Clinical Psychoneuroimmunology and Oriental Medicine. Dr.Satya Ambrose,ND, LAc. February 2010.
Case Management and Treatment for Lyme Disease. Dr.Mikhael Adams,ND. December 2009.