April-2011 LYME: “DISEASE” or “INFECTION”  ??

For many people Lyme Disease is a much feared health problem. Probably if it were called Lyme Infection instead of Disease, fewer people would be so worried about it, but it would still scare some.  It is, after all, an infection with a type of germ that we can kill with the appropriate antibiotics (doxycycline, amoxicillin, cefuroxime), much like strep throat is an infection that we can always kill with penicillin or amoxicillin. The hysteria around lyme infections are in part due to the following facts:

  • As a relatively new infectious agent, we as physicians have had to learn how to identify it and what lab testing is really accurate.
  • In doing so, we as doctors have struggled with sorting out what symptoms are from the infection and what symptoms are NOT from the infection.  A classic example is that many symptoms of depression and other mental health problems have sometimes been erroneously considered to be from this infection.
  • Sometimes patients with symptoms that are not TRULY from the Lyme agent (Borrelia) but are in fact from other causes are mis-diagnosed with “Lyme Disease.”  The classic example seems to have been the countless number of patients with other disorders (including mental health problems, fibromyalgia and others) who were misdiagnosed as having a Lyme infection.

So, if your daughter has a sore throat and we determine that it is actually strep throat, and we treat it with penicillin and she totally recovers, did she have “strep disease” or did she have a “strep infection?”  I would argue that calling this strep “disease” only makes you unnecessarily worry more about her.  I’d rather see you worry about how you’re going to pay for college or how you’re going to instill in her the proper values such that she will choose a partner that treats her well!

But when should you worry about someone having a Lyme Infection? A child may develop a round, red rash called “erythema migrans” (click here to see a picture of this rash)  at the site where the tick has bitten him or her. It usually appears after an incubation period of 7 to 14 days. It tends to be surrounded by a light ring, often called a halo, or a bull’s-eye. It can be warm to the touch and in some people, it may itch or burn. Most people, however, will not feel anything out of the ordinary. The rash usually grows in size over a period of days or weeks. Along with the rash, your child can develop other symptoms, many of them flu-like, that may include:

  • Fever
  • Fatigue
  • Headaches
  • Mild neck stiffness
  • Muscle and joint aches

Your child will not have cold symptoms, like coughing and a runny nose.  Sometimes the infection is more widespread throughout the body, and multiple rashes can develop in addition to these symptoms. Sometimes children experience involvement of the nervous system, including meningitis and temporary paralysis of the facial muscles (Bell’s palsy).  Children can also develop a form of arthritis called Lyme arthritis that affects the knees and other large joints, or infection of the heart that can lead to an abnormal heart rhythm.  Fortunately, if children are treated in the early stages, then the infection is gone.

-Dr Mendes