Lyme disease is the most reported vector-borne illness (diseases transmitted through mosquitoes, tick and flea bites) in the United States. The CDC estimates that there are nearly 300,000 new cases every year – that’s an average of approximately 800 infections per day. People who are diagnosed early and receive proper treatment consisting of 28-30 day antibiotic therapy usually recover rapidly and completely. However, others who are correctly diagnosed and treated sometimes fail to fully recover, and, for a variety of reasons, still others go undiagnosed and untreated.

This article explores 4 reasons why Lyme disease may go undetected and/or become a chronic illness.
 

1) It is not always possible to confirm a tick bite

A key component of early
diagnosis is recognition of
the characteristic “bull’s-eye”
rash. Courtesy of the Centers for
Disease Control & Prevention,
Public Health Image Library.
The only way you can contract Lyme disease is through a tick bite. About 50% of all the ticks found in the northeast region of the country are infected with the parasite Borrelia Burgdorferi responsible for Lyme disease.  If you develop the telltale bull’s-eye rash (medically referred to as Erythema Migrans), there is no disputing that fact that you have Lyme disease, but not all patients report having the rash.

Ticks vary from the size of a poppy seed to a sesame seed, which make them hard to see; and they prefer latching onto hard-to-see areas of the body such as armpits, groin, or scalp, so it’s likely you won’t notice its presence. This means, more often than not, you won’t know if you’ve been bitten, and by the time you start feeling sick – the incubation period for Lyme ranges from a few days to a few weeks – the tick will be long gone.
 

2) Lyme disease symptoms are very similar to other non-tick borne chronic illnesses.

Another factor that can make it difficult to obtain an accurate diagnosis is the similarity of symptoms that present with Lyme and other tick-borne diseases (fever, chills, fatigue, headache, and joint aches) with those of many other non-tick borne illnesses, such as flu and other viral or bacterial infections.

If left undiagnosed and untreated, there can be detrimental effects on the body’s musculoskeletal and nervous systems, causing symptoms such as chronic joint pain & headaches, extreme fatigue, and mood disorders that can subsequently be misdiagnosed as fibromyalgia, chronic fatigue syndrome, or depression. This similarity of symptoms can cause delays in getting tested, and in turn causing delays in treatment.

There is also evidence indicating that chronic cases of Lyme disease (when symptoms persist after taking the typical short-term dose of antibiotics – also called Post Treatment Lyme Disease) contribute to a sustained inflammatory condition throughout the body that interferes with the healthy functioning of the nervous system. Known as Central Sensitization Syndrome, CSS has been implicated in several chronic illnesses and pain conditions, including fibromyalgia, chronic fatigue syndrome, and depression.

3) The patient may also be co-infected with another tick-borne disease.

Ticks can carry multiple bacteria and parasites, including babesiosis, ehrlichiosis, anaplasmosis, bartonella and Rocky Mountain Spotted Fever (also called Spotted Fever Rickettsiosis), and it’s not uncommon to see patients with multiple tick-borne infections, but, you won’t find them if you don’t look.  In fact, some studies suggest that as much as 30 percent of ticks that carry Lyme also carry another infectious agent which produce similar symptoms to those of Lyme disease, but require completely different antibiotics and lengths of treatment.  Because of this, it is extremely important for physicians to test for all forms of tick-borne diseases and not just for Lyme.

4) Laboratory tests, while important, have room for improvement

Unless you’re among the small percentage of people who present the classic bull’s-eye rash exclusive to Lyme disease, a confirmed diagnosis is a little trickier. A blood test, which takes just a few minutes of a patient’s time and will likely come with an additional financial cost to either you or your health insurance company, can get you another step closer to a diagnosis – and more importantly – a treatment. But before deciding to run diagnostic testing, a doctor must consider a patient’s physical symptoms and a comprehensive history which assesses their personal exposure risk. For example, if an individual is experiencing some suspicious symptoms and often hikes or horseback rides, and/or owns a pet that spends time outdoors, a Lyme test is in order.

Unfortunately, the tests aren’t perfectly reliable, especially if the order includes testing for Lyme and other tick-borne diseases. Different labs have varying levels of sensitivity, and some testing can miss some cases of infection. To accurately interpret test results your physician needs to understand the sensitivity and specificity – or, in other words, the limitations — of the lab testing they are ordering.

So what’s the takeaway?

Be your own healthcare advocate. The best medicine is prevention; so before recreating outdoors, cover your body in light-colored clothing, use an insect repellant on yourself and make sure to treat your pet; take the time to check yourself and your pet for ticks after spending time outdoors.

If you do notice Lyme-like symptoms, talk to your doctor immediately and ask to be tested.

Every individual is unique in their genetic makeup, medical history, and environmental exposures and each of these factors can affect how Lyme disease manifests itself in your body. If some of your symptoms persist, even after you have been treated — don’t give up! Be your own advocate; keep asking questions and seeking answers until you find the right treatment options for you.

 

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