Synonyms
Lyme disease, Lyme borreliosis, Lyme disease, Lyme arthritis, erythema chronicum migransEnglish: borreliosis
Definition
Lyme borreliosis is a bacterial disease transmitted by the bite of a thyroid tick. The consequences of the infection range from simple skin symptoms to neurological symptoms and so-called Lyme arthritis. Borreliosis was first observed in 1975 in the small town of Lyme in the US state of Connecticut and was described as Lyme arthritis (Lyme joint inflammation). In contrast to the tick-borne TBE (Early Summer Meningo Encephalopathy), a viral disease, you cannot be vaccinated against Lyme disease! However, it is easily treatable with antibiotics (bacteria killing drugs).
Epidemiology
The pathogen causing the disease Lyme disease, the bacterium Borrelia burgdorferi, belongs to the family of spirochetes and has the ability to survive in the tick’s intestine. Through the tick bite it enters the human bloodstream. Borrelia burgdorferi can lie extracellularly (outside the body cells) protected between connective tissue fibres or can also survive intracellularly in phagocytes (scavenger cells / defence cells), so that they can persist for a long time in the host (borrelia carrier) “undetected” by the immune system. In addition, the Lyme disease bacteria have the ability to “camouflage” themselves. Once the body’s own defence has identified the bacteria as foreign bodies and started to defend itself, the Borrelia bacteria change their surface so that they are no longer recognised by the antibodies (body’s own defence substances; see immune system).
Is Lyme disease contagious?
The Lyme disease is basically not contagious. At least a transmission from person to person has never been proven or observed. The transmission is therefore exclusively via the blood contact of the tick to the human.
Symptoms of Lyme disease
Second stage: In this stage, the main symptom is a burning pain that starts at the nerve roots (radicular). It can be observed that this pain is often located near the reddening of the nerves or the tick bite. This is an inflammatory reaction that affects nerve roots, especially the cranial nerves.
In addition, the pathogen (meningitis) can cause meningitis, which can lead to neck stiffness, headaches and other neurological deficits. After the name of the discoverer, this is also called Bannwarth syndrome or meningopolyneuritis. This can occur weeks to months after the infection by the tick.
In addition to these characteristic pains, paralysis also occurs due to the inflammation of the nerve root by the borreliosis pathogen. This is mainly an asymmetric paralysis, i.e. only one side fails and not both. As the roots of the cranial nerves are often affected, facial muscles are lost.
The cranial nerve called facial nerve is most frequently affected. This nerve mainly supplies the facial muscles that are responsible for our facial expression. Far less frequently, the heart walls can be affected.
Depending on which layer of the heart wall is inflamed, this is called myocarditis, pericarditis or pancarditis. This can thus lead to cardiac arrhythmia by infecting the body’s pacemaker systems. Another rarer symptom at this stage is lymphadenosis cutis benigna.
This is a blue-reddish colored soft knot or elevation. The cause of this knot is the penetration of white blood cells (lymphocytes) into the skin by the Borrelia infection. Frequent locations of this benign nodule are earlobes, neck, armpits, genital area and also nipples.
Third stage: In this stage painful joint inflammation and muscle inflammation can also occur (arthritis and myalgia). These inflammations can jump from joint to joint or from muscle to muscle. This stage occurs months to years after the tick bite.
The joint inflammation, also known as Lyme arthritis, is often chronic and can occur in one or more joints. The most common joints affected are the knee joint, then the ankle joint, elbow joint, finger and toe joints, carpal joints and jaw joint. Another typical picture of the disease at this stage is Acrodermitis chronica trophicans.
This is characterized by a dark bluish discoloration of the skin and a very thin skin. In the course of the disease, the bluish discoloration of the skin appears first, which may be somewhat swollen. However, it does not cause any symptoms.
This is followed by a steady decrease in the subcutaneous fatty tissue and thus a strong reduction in the thickness of the skin. This causes the skin vessels to shine through. In addition, a hardening of the skin can occur due to the formation of fibres (fibrosis) in the skin.
This occurs preferentially on the fingers and extensor sides of the limbs. Furthermore, joints and nerves can also be affected later after the appearance of Acrodermitis chronica trophicans. A very rare form of the Lyme disease is the encephalomyelitis.
This is characterised by paralysis of one or both extremities. Enzphalomyelitis is a very rare form of Lyme disease. This is characterised by paralysis of one or both extremities.
Overall, it is difficult to recognise Lyme disease. As mentioned before, months to years can pass between the individual stages, which makes it difficult to see all symptoms in context. You only have to think about when you last had the feeling of having summer flu and whether you would remember this when you go to the doctor with joint pain.
Most symptoms of Lyme disease are very unspecific and can also be caused by a number of other diseases. To make matters worse, there are a large number of “atypical courses” in which only a few or even only one of the symptoms mentioned is manifested. Although antibody detection can be used at any stage of Lyme disease, it then has different success rates.
Especially in the early stages of Lyme disease, antibody formation can only be detected in 10%-40% of cases. In the late stage the antibodies are practically always detectable, although there are also isolated cases in which the examination of the blood remains “silent”. Even if the antibodies are detected in the blood, this result is only of limited use, since it may also be an “old, healed” infection.
Basically, two types of antibodies can be detected: Antibodies of the IgM type indicate early infection (mostly stage I of Lyme disease or without symptoms) while antibodies of the IgG type indicate late infection (stage II + III) or a longer past infection which may be completely healed. For antibody detection, there are the simpler screening tests, such as the so-called ELISA test, and the more complicated confirmatory tests, such as the immunoblot or western blot test, which give you the certainty that the test was not false positive. This means that in order to determine a current or past Borrelia infection, a positive screening test should be followed by a confirmatory test, so that one can really be sure that anti-Borrelia antibodies have actually been detected. The level of antibody detection (titer) is of little value for the diagnosis.
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