Four Stages of Lyme Disease: Borrelia burgdorferi

Lyme Disease is a vector borne illness caused by Borrelia Burgdorferi(Bb) a spirochete which is passed on to humans primarily by infected ticks. There are 21 known species of Borrelia and 3 genotypes of B.burgdorferi.  Ticks are small arachnids and can carry numerous bacteria, viruses and protozoa such as Rickettsia, Bartonella, Ehrlichia chaffeensis, and Babesia. The tick has a two year life cycle, going from larva to nymph to adult, requiring blood at each stage. Many bites occur during the nymph phase. The typical nymph is about the size of a poppy seed.

Each year there are about 30,000 confirmed cases of Lyme in the U.S. The current CDC approved Lyme test is only capable of detecting infection after the body has produced antibodies. Depending upon ones immune response, this can take 4-6 weeks to several months . In addition, the North American antibody detection kits [ELISA and Western Blot] are looking for a single strain of Bb--the B31 Strain.*  Lyme is a clinical diagnosis, therefore the CDC recommends that treatment begin with the earliest clinical symptom, typically a Lyme rash. Following a tick bite, many people experience flu-like symptoms--body aches, fever, fatigue, and joint pain making it difficult to distinguish from other common illnesses unless there is a telltale rash. Because many cases are diagnosed clinically (without a blood test) Lyme is an underreported illness. In addition, if you live in an area where Lyme is common you are much more likely to receive a prompt and proper diagnosis. However if you live in an area where doctors are untrained in Lyme, you may go undiagnosed. Currently, the CDC estimates the actual number of Lyme cases may be closer to 300,000 each year.[1]

Lyme can be divided into 3 Stages, plus a newly recognized Syndrome:

• Stage 1- Primary Lyme Disease (days to weeks following infection):
• Itching &/or Erythema Migrans 
• Chills and Fever 
• Fatigue
• Headache and Lightheadedness
• Joint and Muscle Pain and Stiffness
• Stage 2 - Early or Secondary Lyme Disease (3 weeks to 3 months):
• Facial Muscle Weakness or Paralysis (Bell's Palsy)
• Myalgia (Muscle Pain)
• Arthralgia (Joint Pain 
• Cardiac Abnormalities and Palpitations
• Stage 3 - Late Stage Lyme Disease (Months to Years);
• Muscle Weakness
• Paresthesias (numbness, tingling, burning, prickling feeling of the skin)
• Difficulty with Speech
• Irregular Muscle Movements (spasms, cramps, twitching)
• Neuroborreliosis (Lymphocytic meningitis, Cranial Neuritis & Painful Radiculoneuritis)
• Post Treatment Lyme Syndrome (aka Chronic Lyme)
• 20% of Lyme patients will go on to develop chronic symptoms 

Clinical Presentation of Lyme Disease (Borrelia burgdorferi)

• 70% will have a erythematous rash. 
• 30% will develop a classic bulls-eye rash called erythema migraines (EM)
• 20% will develop no symptoms beyond the rash
• 4-8% will develop cardiac symptoms
• 11% will develop neurologic symptoms*
• 45-60% will manifest arthritis [2]

If Lyme is diagnosed and treated early, most will recover without further incident. The longer one goes without treatment the more severe the symptoms. The Borrelia spirochete has the ability to infect every tissue in the body. The later the stage of diagnosis, the more difficult it is to treat the infection. 

It is my theory that the 30% who never develop a rash and go undiagnosed; or those who recieve inadequate treatment; or those who go years until recieving a proper diagnosis, are at higher risk for developing late stage Lyme. There is also evidence that individual genetics play a role in the body's ability to recover from Lyme. I will be addressing genetics in a later post. 

* I will specifically address Lyme testing in my next post.

** I will be talking about Late Stage, Post Treatment Lyme, and Neuroborreliosis in future posts. 

Note: I am a licensed Health Professional, but I AM NOT A DOCTOR. I cannot diagnose nor can I prescribe treatment. While I will attempt to provide citations the basic information contained in this blog is simply my opinion. 

References:
1.  CDC.org 19 August 2013. CDC Provides estimate of Americans diagnosed with Lyme disease each year.  

2. Annals of Internal Medicine 1 November 1987. The Clinical Evolution of Lyme Arthritis