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THE DEBATE OVER CHRONIC LYME
The medical and scientific community agree that _Borrelia burgdorferi_ is a spirochete bacterium that infects mammals with what we call Lyme disease. The bacterium can be transmitted through the bite of the blacklegged tick, which is no bigger than the head of a pin. Because of its size, and since it releases numbing agents and antihistamines before it bites, the tick often goes unnoticed until it’s already started the feeding process and latched onto the skin. If the tick is mature and infected with _Borrelia burgdorferi,_ it transmits the bacterium as it feeds. If the tick carries any other bacteria, often called co-infections, those bacteria may get transmitted in the same bite. If the patient develops the infamous bull’s-eye rash and presents flu-like symptoms, then that patient is infected and should be treated with antibiotics to kill the bacteria, regardless of the test result.
The preceding encompasses the extent of the general agreement about Lyme disease. All other characteristics and questions surrounding Lyme are remarkably divisive; the medical community is split down the middle on issues like diagnosis, treatment, and persistence of infection. As a result, there is no definitive information available on various important details concerning the disease, a modern-day medical phenomenon that, according to current tabulation standards, affects at least 300,000 new people per year in the United States alone. There is a sometimes extreme variation among published statements.
The International Lyme and Associated Diseases Society (ILADS) posits that Lyme infection occurs as the tick transmits the bacterium to the mammalian host in its first blood meal. This transmission of the pathogen can occur in a matter of minutes, not hours, days, or weeks, as is often suggested. Early-onset Lyme symptoms, often called “early-localized infection,” normally manifest in the body for one to four weeks after the bite.
As for the bull’s-eye rash, more accurately called _erythema migrans_: since it’s a sure sign of infection—the outside circumference of the bull’seye actually contains the bacterium—the rash can be a blessing, as it ensures treatment. If treated early and properly, Lyme patients have an excellent chance for complete recovery with no further complications.
But, despite the rash’s reputation, only about one-third of people infected with these bacteria present the rash. In fact, two-thirds of those infected never present with the bull’s-eye rash, and often they don’t even know they’re sick. Though they may experience fatigue, achiness, joint pain, fever, and chills, these symptoms are often mistaken for stress or flu—thus, these patients are not treated aggressively, or perhaps not at all. If left untreated, the infection may lie dormant for weeks, months, even years before manifesting more debilitating symptoms. Pain creeps into the muscles of the infected, who may experience weakness and numbness in their extremities. Headaches, described as a tight helmet squeezing the skull, become more frequent. Neurological symptoms may present at this stage, patients perhaps having difficulty sleeping, concentrating, or retaining short-term memories. They can feel besieged: their lives changing
without their knowing why.
The advanced forms of tick-borne diseases are called many names. Late, persistent infection; post-treatment Lyme syndrome; MSIDS; and chronic systemic Lyme disease. This is the most debilitating form of the disease, and also the most contested. Months or years after infection, even if they’ve received treatment, patients can lose complete control over their bodies. Some develop a disorienting form of neurocognitive dysfunction called _Lyme encephalopathis_; those afflicted can get lost on their way home,
can struggle to read, to speak, to hold a fork at dinnertime. Some patients suffer from cardiovascular issues; others must reckon with recurring full-body seizures. Every patient presents symptoms differently in this stage of the disease, which is one of the many reasons it’s so hard to diagnose and to treat.
As I mentioned earlier, ticks can carry a number of bacteria; to date, scientists have discovered more than a dozen tick-borne illnesses, any of which can get transmitted with the Lyme bacterium in a single bite. Three seem to appear alongside Lyme more than others: _Babesia_, _Ehrlichiosis_, and _Bartonella_. _Babesia_ is a malaria-like disease that attacks red blood cells. _Ehrlichiosis_ attacks white blood cells in the immune system. As for _Bartonella_, its influence on the body’s cells is not well understood; until about fifteen years ago, only three human diseases were attributable to _Bartonella_ organisms. We do know that patients infected with both _Borrelia_ and _Bartonella_ report abnormally high levels of neurological dysfunction. Some tick-borne illnesses have only been recently discovered. As such, some illnesses—like Powassan encephalitis, a virus that invades and infects the brain—have no known effective treatment options to date, and are potentially fatal.
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