Your risk for Lyme disease

IN April rocker Avril Lavigne revealed that she was bedridden for five months due to Lyme disease, a condition that left her feeling like she was dying.

The 30-year-old Canadian guitarist and singer confirmed social media exchanges about her illness, which is generally spread by bites from ticks.

“It felt like having all your life sucked out of you,” she said in an AFP report.

Dr Tanesha Davis, internist, said Lyme disease is an infectious disease cause by a spirochete (a type of bacteria) transmitted by ticks, specifically the black-legged tick.

“It’s important to note that different ticks produce different diseases and therefore not all ticks will cause Lyme disease,” she said.

Dr Davis explained that deer ticks are commonly associated with the disease and animals carrying the tick include the white-footed field mice, deer, raccoons, opossums, skunks, weasels, foxes, shrews, moles, chipmunks, squirrels, and horses.

She said the bacteria enters the human body through the skin as a result of a tick bite and later on infects other parts of the body including the brain, nerves, heart and joints, which causes the disease to manifest itself in a variety of ways.

Dr Davis said while she has not seen any cases in her practice, it is not uncommon.

“Lyme disease is now the most common vector-borne infection in the United States and Europe. About 300,000 cases are reported annually in the United States. However, it can be found in every part of the world except Antarctica. It has no borders and incidence has been increasing worldwide,” she warned.

The internist explained that the disease can present in stages, which vary from an acute stage to a chronic stage, and the infection usually begins with a characteristic expanding skin lesion, then after several days to weeks may spread to different sites.

“At this stage patients may present with meningitis (infection of the covering of the brain), neuritis (infection of the nerves), carditis (inflammation of the heart or its surroundings) and musculoskeletal pain. Months or years later patients may develop arthritis, encephalopathy (disease of the brain) or polyneuropathy (disease affecting peripheral nerves causing weakness and numbness). Most patients will experience early symptoms of the disease during the summer,” she said.

Dr Davis further explained that after the characteristic skin lesion, the disease may spread through the blood and lymphatic system to other organs. However, to control and eradicate the bacteria, the body mounts a response, which results in the death of the bacteria within weeks or months.

“This serves to control the widely disseminated infection and the generalised symptoms. However, if no antibiotics are administered they can survive in localised niches for several more years such as the joints (causing arthritis) and the brain and nerves causing encephalopathy and polyneuropathy respectively,” she said.

According to Dr Davis, because of the small size of the tick, most patients will not remember the preceding tick bite and after about three to 32 days of receiving the bite the skin lesion may be noted.

“A patient may notice fever, chills, or stiffness to the neck. Joint pains generalised weakness, profound malaise and fatigue may also be noted. In children the optic nerve (related to the eye) may be affected and may lead to blindness.”

Dr Davis said when it affects the heart patients may report chest pain and other symptoms in keeping with a failing heart; for example, leg swelling and shortness of breath.

“The pain in the joints is described as migratory during this time (it moves) lasting for hours or days and affects one or two locations at a time,” she said.

She explained that months after the attack patients develop frank arthritis — usually multiple large joints, and despite adequate treatment with antibiotics, 10 per cent of patients may develop chronic pain in their joints, severe headache, neurocognitive symptoms including difficulty in concentration, paresthesias (sensation of burning, numbness, tingling, itching or prickling) and fatigue.

Dr Davis said to diagnose this disease an adequate history may be necessary, including recent travel with documentation of contact with the tick.

“We then proceed to identify the bacteria with specific lab investigation. We can also identify the response to the infection (antibody identification). The limitation with the antibody test at times is that they don’t adequately differentiate an active from an inactive infection,” she said.

“Most people will recover with minimal or no residual deficits. As with most things, prevention is better than cure and avoiding tick-infested areas and the use of tick repellant is recommended. No vaccine is currently available,” she said.

–KH