What is Lyme Disease?

Lyme disease is a tick-borne bacterial disease that often comes with vague, mysterious symptoms, making it difficult to diagnose correctly. It can copycat hundreds of other diseases and is difficult to diagnose since it is confused with other diseases. It can persist stealthily for years, and unfortunately, these patients can be treated wrong. Because its symptoms are mixed with a multitude of diseases, Lyme disease is referred to as “the great imitator” or “the silent killer.” Lyme disease can copy a wide variety of diseases, including chronic fatigue syndrome, fibromyalgia, ALS, Alzheimer's disease, depression, insomnia, and autoimmune disorders such as rheumatoid arthritis and multiple sclerosis. The first case occurred in 1977 in Lyme, Connecticut. The disease was named after the town.

HeadofInfectious Diseases and Clinical Microbiology  Yeditepe University Hospitals Prof. Dr. Meral Sönmezoğlu answered all the questions we had about Lyme disease:

How many diseases does Lyme imitate? (250 in some sources, 365 in others) Can you list the most known of these diseases?

Numerous diseases resemble the symptoms of Lyme disease such as headache, rash, fever, and facial paralysis, and can be confused with Lyme disease. However, the most important condition for associating these symptoms with Lyme disease is tick contact.

Autoimmune diseases such as chronic fatigue syndrome, fibromyalgia, als, Alzheimer's disease, depression, Rheumatoid Arthritis, and Multiple Sclerosis are among the diseases similar to Lyme disease and considered to be a differential diagnosis.

Does the presence of this bacterium in the body make you sick? Is it possible not to notice this? (Approximately 3-7 million people in Turkey live with this bacterium in their bodies.) Is this correct?

The causative agent of Lyme disease is Borrelia burgdorferi, a spirochete bacteria. In Asia and Europe, Borrelia afzelii and Borrelia garinii species are more common. It is only transmitted to humans by the bacteria passing from the tick to human blood during tick adhesion and blood sucking. Transmission of bacteria causes disease. However, some patients may not notice tick contact. The true incidence and prevalence of the disease in Turkey are not known with certainty. However, in some studies, Lyme seropositivity in Turkey was found to be between 2-44% in serological test scans in blood. However, with the available data, Lyme disease is not considered to be a serious public health problem in Turkey.

Is this disease just tick-borne? Do we sense the bite? After how many days does it start to show symptoms? What are the early signs?

It can only be transmitted by the adhesion of the bacterium called borrelia, which is the causative agent, to humans. It is difficult to notice if the tick bite occurs with those smaller than the adult tick called the larva or nymph. If the tick is carrying a borrelia and has infected it, a painless red lesion of 5 cm appears where the tick is attached after 1-2 weeks. This lesion, called Eritema Marginatum, is likened to the target board because it is a spot in the middle. This typical rash occurs in 70% of patients. Apart from this stain, there may be fever, headache, muscle aches, and watering in the eyes. If it is detected and treated during this period, the disease ends. In untreated people, these rashes remain for 2-3 weeks and go away on their own, but after 3-12 weeks, they pass to the second period. In this period, weakness, headache, dizziness, palpitations, chest pain, difficult breathing, and joint pains begin, and common rashes may occur. These symptoms can last for a year.

In this period, patients who are not diagnosed and treated go to the third period. Years later, neurological and rheumatological symptoms begin.

How does this disease occur in people who have never been bitten by a tick? Apart from ticks, can this bacteria be transmitted from mosquitoes and other blood-sucking insects such as lice?

Lyme disease is transmitted only by a tick. Diagnosed patients may not have noticed the tick, but there is no other way to transmit it. It is not transmitted from vectors like other blood-sucking mosquitoes except for ticks.

Is there a risk of Lyme after each tick bite or fly bite? Is it necessary to take these tests?

In our country, there is much different tick contact in each geographical region. However, the number of patients diagnosed with Lyme disease is low. Not every tick contact is a transmission of disease. People who do not have any symptoms of the disease are not tested just because they have tick contact.

How many Lyme patients have been diagnosed in Turkey?

People with tick contact in our country mostly apply for fear of Crimean Congo disease. However, admission with signs of disease is low. The true incidence and prevalence of the disease in Turkey are not known with certainty. However, in some studies, Lyme seropositivity in Turkey was found to be between 2-44% in serological test scans in blood. However, with the available data, Lyme disease is not considered to be a serious public health problem in Turkey.

What should a person with Lyme disease do? What kind of treatment process is going on?

The treatment can be started by diagnosing the patient who has a red spot on the place where the tick is attached 1-2 weeks after the tick contact and presents with symptoms of fever and weakness without the need for testing due to the typical appearance. However, blood tests will confirm the diagnosis. In the first period, the treatment is with a drug called doxycycline for 10 days.  Longer-term treatment is given during the 2nd and 3rd periods. Children under 8 years of age are given amoxicillin or Cefuroxime, not doxycycline, for 14 days. 

Are there any medications that should be used continuously after the Lyme patient's treatment process?

Some patients develop symptoms called Lyme syndrome after treatment, but antibiotics are not given for these symptoms. 5% of patients continue to experience weakness, muscle, and joint pain.

Is there a vaccine for Lyme disease?

Lyme disease is not fatal. The heaviest case is heart and brain involvement. It responds well to treatment. Since it is a very common disease in the United States (there are more than 300,000 case reports every year), the vaccine was introduced in 1998 but stopped in 2002 due to low demand and short-term protection.

Is Lyme disease transmitted from person to person?

Lyme disease cannot be transmitted from person to person.

Which bacteria carry Lyme disease to humans? 

The causative agent of Lyme disease is Borrelia burgdorferi, a spirochete bacteria. In Asia and Europe, Borrelia afzelii and Borrelia garinii species are more common. It is only transmitted to humans by the bacteria passing from the tick to human blood during tick adhesion and blood sucking. 

Which tick species are capable of carrying this bacteria and in which cities in our country?

Ixodes ricinus ticks, which have the potential to transmit Lyme disease, are seen in Turkey. Ixodidae is seen in all seasons of the year in areas with moist and suitable ground cover, especially in the Black Sea Region, open parts of the Marmara Region to the Black Sea climate, and especially in coastal regions.

In particular, tick lives where the moisture rate is high, the base vegetation is frequent or spilled and stacked leaves are seen intensively, small mammals such as mice, squirrels are common in natural areas.

Why is Lyme disease called the ''Great Imitator''?

This name is given since its symptoms are associated with a large number of diseases. Lyme disease can show a variety of symptoms that mimic a wide variety of diseases, including chronic fatigue syndrome, fibromyalgia, ALS, Alzheimer's disease, depression, insomnia, and autoimmune disorders such as RA and Multiple Sclerosis.

Are there cases in the world diagnosed with ALS, or MS but actually have Lyme disease?

Yes, reports are made. Therefore, since every patient diagnosed with MS and ALS has a complete treatment option, Lyme tests are performed, and a differential diagnosis is made.

Lyme tests are known to give false positivity. How many different tests should be performed?

Screening is performed with tests that measure IgM and IgG antibodies against bacteria in the blood with the ELISA method in the patient who is thought to have Lyme. If these tests are reactive, verification is performed with the western blot test.

The patient who received Lyme treatment and whose symptoms are gone still has this bacterium for a long time. Is it accurate?

Lyme treatment is very successful in 1st and 2nd stages. During this period, the bacteria disappear from the body in patients who are treated.

Is Lyme Disease a fatal disease if left untreated or delayed?

Lyme is not fatal except in the form of carditis involving the heart and meningitis located in the brain. Treatment success is also high in these forms.

Is there a possibility of recurrence of Lyme Disease after one treatment?

Yes, it is possible to get sick again with tick contact.

Some patients have been mistaken for other diseases for years and have been wrongly treated. Why is Lyme Disease so difficult to diagnose?

The lesion called erythema migrans, which occurs 1-2 weeks after the first contact with Lyme disease, is very typical for diagnosing. But if this diagnosis does not come to mind, it can be confused with other diseases in later periods. The most important distinguishing characteristic is the realization of the tick adhesion.

What kind of test is done to diagnose Lyme Disease? Can I have this test done in a private hospital?

Screening is performed with tests that measure IgM and IgG antibodies against bacteria in the blood with the ELISA method in the patient who is thought to have Lyme. If these tests are reactive, verification is performed with the western blot test.

Where is Lyme disease most likely to occur in the world and Turkey?

Lyme disease is common in countries in the northern hemisphere. The countries with the most case reports are the USA and then the European countries. Case reports are also increasing in Turkey. It is mostly seen in the Black Sea and Marmara Region and Thracian.

What should be considered to prevent Lyme Disease? 

The most effective way to prevent the disease is to avoid contact with ticks. It is important to cover the arms and legs, it is necessary to use tick-repellent spray in places that are not covered. It is very important to wear socks and long-sleeved shirts when walking on soil and grass in open areas or picnic areas and to look for ticks in the evening and to remove them in a short time without mechanically shredding them when ticks are found. It is very effective to take three days of preventive antibiotics when there is tick adherence in an area where Lyme notification is made.

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