Lyme

Lyme disease unit

Physician in charge:

Judit Bodrogi MD
infectologist, internist


REFERRED PATIENTS ONLY

Patients will be seen during office hours and need to first secure an appointment by calling our appointment line:
+35 52 511-866

Office hours:
Monday-Friday: 15:00-16:00

Things to know about Lyme disease and its prevention

- What is Lyme borreliosis?

Lyme borreliosis or "tick-borne disease" is a bacterial disease spread by ticks infected with Borrelia burgdorferi bacteria.

- What is Borrelia Burgdorferi?

The bacterial agent causing Lyme borreliosis. Due to its remarkable adaptive properties, it can hide for years and decades in an untreated host.

- How does Lyme borreliosis develop?

Lyme borreliosis is caused by tick-borne bacteria entering the skin lesion during a tick bite. The disease does not spread from man to man in any way. It does spread from diseased animals to humans through ticks as vectors.

- Is it exclusively spread by ticks?

Yes. The agent may reside in a vegetative state in ticks' mid-intestines for months and years. Tick bites are not painful and often go undetected for as long as a few days, during which time reverse blood flow may occur, delivering infected blood from the tick into the wound; alternatively, swarms of bacteria highly proliferated in the salivary gland are the source. Additionally, ticks can get infected in earlier phases of their development, a low percentage even hatches from the egg already infected.

1. Other bloodsuckers are detected upon their painful bite and soon removed.

2. Other bloodsuckers are practically free of B. burgdorferi infection, or the agent either ceases to be infective, stops proliferating, or quickly dies in them.

- Does everyone who has been tick-bitten get the disease?

Probably not. Not, because there is one virally infected tick for a thousand, but caution is important as there are at least a hundred (!) bacterially infected ones. In other words, potentially, every one thousandth bite can cause a viral, but every tenth (!) one can cause a bacterial infection. Not, because the disease develops less frequently when we are healthy, though physical, psychological, and mental stress will increase the risk of the disease developing.

- I am vaccinated, so I am protected!

But not against ticks! Ticks spread a number of different diseases. Infected ticks can spread bacteria into the “open” bite wound as soon as after a few (4 to 8) hours. Vaccination only protects from viral meningitis, while the agent causing Lyme borreliosis is eradicated by antibiotics.

- Can Lyme borreliosis be prevented?

A good preventive strategy is to avoid, repel, detect as soon as possible all kinds of ticks, and to remove them properly using a pair of dedicated forceps. It is strongly advised to avoid tick-infested forest-side areas, nettle growth territories, and to perform a tick inspection after passing through such places.

- Is there vaccination available against Lyme borreliosis?

Not as yet, but immense research effort is being put into the issue. The agent's unusual variability and the resemblance between certain bacterial proteins and human tissue proteins mean that scientists need to identify a component that remains stable throughout the pathological pathway and is dissimilar to human tissue. This will effectively ensure immunity without ever causing harm to our system.

Symptoms and treatment of the disease

- Why and for how long is the bite's site to be kept under surveillance?

For at least a month or, preferably, 4 to 6 weeks because the host's reaction might only come after such lengths of delay. Be sure to make a note of the tick bite's assumed geographic location and date. In case you were administered antibiotics since that time, make a note also of the applied substance's name and dosage.

- What characterises the early skin inflammation distinctively indicating the disease?

The lesion is an alternating series of concentric rings of inflamed and unaffected skin. Most often a single, barely inflamed outer ring surrounds a central disc of inflammation, with a pale stripe of skin in between. It might also appear as a homogeneously and intensively inflamed reddish patch. It grows in size day by day. Diameters vary from 5 cm to as big as a hundred cm's, with practically no associated pain, sometimes protruding to some extent out of the normal skin surface. Development could take anywhere between a few hours to a whole month – or never take place altogether. In the latter case, repeated laboratory tests and clinical diagnosis can establish the presence of Lyme borreliosis. It is imperative to seek medical attention when there is reason for suspicion.

- Does Lyme borreliosis only have this one single distinctive symptom?

Yes, it does. That is why it is so important to recognize this apparently harmless skin inflammation as soon as possible. However, we are looking at a generalised disease that culminates either immediately or in a delayed fashion in a cornucopia of symptoms. “Summer flu” or a spell of unexplained cold (with fever, headache, muscle and joint pain, fatigue) associated with time spent in the outdoors are a reason for suspicion.

- How long can the disease's dormant period last?

Lyme borreliosis can attack any one of our organs after delays of months, years, or even decades. It is because the microbes can spread anywhere with circulation and when the circumstances are right (host immunity weakens), produce chronic inflammation. Spontaneous recovery is not proven beyond doubt but might occur. Effective pharmaceutical treatment is readily availabe.

- What delayed symptoms are caused by Lyme borreliosis?

The ailment mostly causes chronic skin inflammation (skin scars), but is known to affect the nervous system (neuritis, primarily that of the cerebral nerves, meningitis, encephalitis), joints and musculature (primarily the major joints), and the heart (pericarditis, arrhythmia).

- Is diagnosis possible in spite of there being a myriad of symptoms?

Yes, it is. Even if the skin inflammation is absent or remains undetected. It takes a joint effort though: the patient and the medical staff performing laboratory and clinical diagnostic tests must talk over and evaluate all complaints, symptoms, and findings together.

- How do laboratory tests help?

• By detecting host antibodies indicative of the presence of infection,
• by giving evidence that the host is carrying pathogenic bacteria,
• by assessing the current antibiotic sensitivity of the given strain of Borrelia burgdorferi,
• by providing proof of the disease's activity through immune complex detection.

- Is there a chance that Lyme borreliosis can persist with negative diagnostic findings?

Yes – exceptionally. If complaints and symptoms persist, a repeated set of extended diagnostic tests must be applied in an effort to establish the presence of the disease, together with investigating again into the circumstances of becoming ill, the history of symptoms developing, antibiotics possibly prescribed for unrelated infections, and anything noticed upon administration thereof. That's when diagnosing Lyme borreliosis really turns into a conundrum.

- Is Lyme borreliosis curable?

Yes, and perfectly so. The causative agent Borrelia burgdorferi is sensitive to a number of drugs and is effectively killed by a variety of antibiotics.

Complete recovery will depend on:

• rapidness of diagnosis,
• administration of effective, sufficiently dosed and sustained antibiotic treatment,
• properly timed re-treatment, subject to necessity.

- For how long do patients need treatment?

Based on current antibiotic practice, the duration is at least 4 to 6 weeks. Patients' complaints and symptoms indicate a life cycle of most probably 2 to 3 weeks for the pathogen, and treatment should cover at least two life cycles. A repeat run may be necessary.

- Do all patients need repeat treatments?

NOT if their infection is recent – that is why it is important to seek medical attention as soon as possible. Chronic cases probably DO NEED repeat courses because the pathogens will reside intracellularly, in areas remote to circulation, in vegetative state, or in other unusual developmental forms more frequently and in greater numbers, and that is when and where the efficiency with which the immune system and antibiotics can damage/destroy them is limited.

- What is the ideal timing of treatment?

It is doubtable to treat prompted by no more than a known high level of tick infestation, with no symptoms observed – this will increase the risk of treatment insufficiency. Treatment is most effective at the time of full blown complaints, symptoms and laboratory findings, so timing must prefer the active disease phase if possible. Recurrence (indicated by positivity of repeat lab tests) means that long term follow-up therapy is advisable for at least 3 years. In case of a reinfection (high titre in the early phase) it is an immediate must.