Lyme disease: How does transmission occur and how does it manifest? + Treatment

Lyme disease is a multi-systemic infectious disease of bacterial origin. Humans become infected with this disease after being bitten by an insect. This spot is typically reddened by a large rash. It can take place in a lighter form. Chronic disease is sometimes treated for many years.

In our country, borreliosis is most often transmitted by ticks.

However, statistically it occurs in approximately 10 percent of ticks in Slovakia. Ticks are not only transmitted by bacteria of this disease. They are also carriers of other infections and parasites. These can further complicate the course of the disease itself.

You often ask: What is Lyme disease and how is it transmitted? What are its symptoms, risks and consequences? How to get rid of it and how is it treated? What is the precaution? 

It is stated that for the transfer, the tick must be attached to the skin for at least 24 hours.

There is no effective vaccination against Lyme disease for its prevention.

Is a multi-system disease, affecting the skin, nervous system, including the brain and brain membrane, but also the muscles, bones,  joints and heart. And if one does not notice it, there is a great risk that it will go into a chronic and long-term stage.

Lyme borreliosis is the most common disease transmitted from animals to humans, these diseases are technically referred to as anthropozoonoses.

The longer the disease persists, the more internal organs and tissues it attacks. Subsequently, a longer treatment time is required. However, it is reported that up to 50% of cases are asymptomatic, ie asymptomatic.

Lyme borreliosis is caused by the bacterium Borrelia. Several types of Borrelia are known. It is currently 12, of which the following subtypes are dangerous for humans:

• Borrelia burgdorferi, or Borrelia burgdorferi sensu lato
• Borrelia burgdorferi sensu stricto - only this subtype occurs in North America
• Borrelia afzelii 
• Borrelia garinii

Borrelia afzelli and Borrelia garinii are the most widespread in Europe . Manifestations of their infection are diverse, with the subtype Borrelia gurgdorferi sensu stricto, which occurs mainly in North America, mostly having cardiac complications.

The disease got its name from the American city of Old Lyme. In 1975, several people were infected with Borrelia. But it wasn't until 1981 that borreliosis was identified as the cause of the infection. Willy Burgdorfer is responsible for her identification. 

This bacterium is mainly hosted by small vertebrates. Such as rodents, small mammals, big game, but also reptiles, birds. Borrelia bacteria have been found in mosquitoes, flies or fleas and other blood-sucking insects. However, pinching and pinching of the tick are considered to be the main source of infection.

Information from the EPIS indicates that 92 cases of the disease were recorded in June 2017. And in 2016, there were 78 cases. Of this amount, the following took place:

• 60 cases for tick attachment
• 15 cases were unknown
• 15 cases after being bitten by other insects

Clinically, these diseases manifested themselves as a form of:

• erythema migrans 54 times
• articulated 22 times
• neurological 8 times
• skin 4 times
• eye 2 times
• with fever 1 time
• asymptomatic 1 time

The disease is of bacterial origin and is therefore caused by the bacterium Borrelia burgdorferi.

The bacterium is spirally coiled and belongs to the group of spirochetes. In nature, this bacterium occurs mainly in small mammals, but also in birds and reptiles. It is transmitted to humans after being bitten by insects, especially ticks. 

Risk, therefore, stays in the increased incidence of ticks, but also the lack of protection against them. It is important to look at the body after staying in high-risk areas. One does not have to feel the pinching of the tick, ie it's ticking.

Ticks, ie Ixodina, are hematophagous parasites. Which means they feed on blood. There are 7 species in Central Europe. At the same time, they are divided into exophilic ones, which actively seek their host, and endophilic ones, which they experience in shelters. 

Their representatives include mostly exophilic forceps, namely:

• Common Tick - Ixodes ricinus
• Flood tick - Haemaphysalis concinna
• steppe tick - Haemaphysalis punctata
• Wood-ticking tick - Haemaphysalis inermis
• Dermacentor reticulatus
• steppe leech - Dermacentor marginatus
• Hedgehog Tick - Ixodes hexagonus (endophilic species)

The tick is widespread throughout Europe, North Africa, and Southwest Asia. Its occurrence is influenced by several factors, such as the presence of the host, the temperature and humidity of the environment, but the vegetation type of the environment.

The tick does not occur on sandy soils, in wetlands. But not even in cultivated soils or vineyards. Not even in spruce or pine forests, and where the pH is less than 7.

A suitable environment is with a temperature of 5 - 32 ° C and air humidity around 80%. Deciduous, mixed forests, groves, meadows, and even pastures are typical. Altitude from 600 - 1000 meters above sea level.

Their main hosts are mice, rats, squirrels, hedgehogs, hares, birds, reptiles such as lizards. These animals are their hosts, but also carriers of various diseases, such as Lyme disease. Pets and humans are not carriers of pathogens, but only hosts. However, in this group produce different, and serious illness.

Thus, borreliosis transmission is secured from infected insects after being bitten. Human-to-human transmission of Lyme disease only occurs during pregnancy. Lyme disease spreads from mother to child, ie from a pregnant woman to a fetus. Otherwise, transmission is not possible.

The symptoms of Lyme disease are diverse. The disease breaks out after an incubation period, which usually lasts from 2 to 32 days, but sometimes several months. Otherwise, the manifestations of the disease are divided into three-time stages.

The first stage is marked by the development of skin redness. It has a typical manifestation, like a red spot with central fading. This redness is technically referred to as erythema migrans (EM). It occurs mainly at the site of tick tingling. However, not everyone will show up. 

Thus, a typical symptom is the occurrence of larger redness. Reminiscent of reddening of the skin in the form of a local occurrence. This is a  sign of the tick attaching, and, on average, this redness is about 5 centimeters.

It is faded in the middle. It's painless. It usually disappears after a few days. At the same time, sometimes it may disappear and appear elsewhere, hence the designation migrating erythema. This complicates the observation of this typical symptom.

However, Lyme disease is also characterized by increased fatigue, body temperature, headaches, nausea,  swollen lymph nodes, which are painless, and muscle or back pain. However, these are relatively vague flu-like symptoms that many people may underestimate.

Later, however, the nervous and cardiac systems are affected. Symptoms such as photophobia, tingling sensations, tingling, and skin and joint symptoms are associated. Swelling of the joints and partial paralysis of some nerves also occur.

This is significant for the second stage, which indicates the spread of bacteria throughout the body and into various organs. And then the disease can manifest itself as meningitis, neuritis, cardiac arrhythmia, conjunctivitis, arthritis, hepatitis, skin inflammation, Borrelia lymphocytoma, so-called solid infiltrate.

In the third stage, atrophic changes occur on the skin, especially in the area of ​​large joints - acrodermatitis. But also as damage to the CNS, ie the central nervous system, manifested by dementia or polyneuritis. On the joints with long-term inflammation, ie chronic arthritis.

Stage-borne symptoms of Lyme disease 

Lyme disease manifests itself typically, but also atypically, even, sometimes asymptomatically. 

In the first stage there are:

• migrating erythema, ie erythema migrans at the site of the bite
• erythema may disappear and appear elsewhere in the body
• increase in body temperature to fever
• enlargement of the lymph nodes
• fatigue
• pain in muscles, limbs
• and other general symptoms such as influenza

After a few weeks to months, the second stage begins, this is manifested by:

• skin changes, as in the first stage, as well as multiple rednesses
• generalized enlargement of the lymph nodes
• fatigue
• Headache
• inflammation of the nerves - neuritis (for example, inflammation of the facial nerve, but also as inflammation of the meninges)
• inflammation of the heart muscle - myocarditis
• inflammation of the eye, keratitis - inflammation of the cornea
• vision disorders
• ear inflammation
• whistling in the ear or hissing - tinnitus
• liver damage
• inflammation of the pancreas
• pain muscles
• inflammation of the joints, ie arthritis, and associated joint pain, limbs

The last third stage manifests itself one year, sometimes several years after infection, as:

• Acrodermatitis Chronica atrophicans - which is degeneration of the subcutaneous tissue, the skin is mainly colored in places of large joints, red to blue-red, it is thin, blood vessels shine through it
• chronic neuritis and peripheral neuropathy - nerve damage

Lyme disease can be diagnosed well in case if you show typically. This is done by catching redness on the skin, ie migrating erythema. And also on the basis of anamnesis and symptoms. However, if it manifests itself atypically, diagnosis is difficult.

Overall, the diagnosis of Lyme disease is relatively difficult. Examination of a blood sample is being addressed, but in some cases may not show the presence of infection or show false positivity. The cerebrospinal fluid test is also used, namely the PCR method in the cerebrospinal fluid, in the synovial fluid of the joint, or in the urine. ELISA tests are most often used.

The course can be individual, some people show redness and other symptoms more quickly when it is an acute form. However, in certain cases, especially if the disease is discovered later, the form is rather long-term and chronic.

The first stage of the disease

At first, Lyme disease is manifested by vague flu-like symptoms, which may later subside for a short time. At the same time, the bacterium begins to penetrate the central nervous system, joints, or the cardiovascular system, with partial paralysis also occurring in the final stages.

Lyme disease, which is typically manifested by erythema migrans, usually begins within 3 to 30 days after being bitten by an insect, ie a tick. Erythema, redness is limited, without elevation. And in the place of the bite. It is faded in the central area. The skin is not painful.

At this stage, general symptoms such as weakness, fatigue, muscle pain, fever, and regional lymph nodes may increase. The symptoms are general and can be described as influenza. However, early diagnosis is very important at this stage.

The transition of borreliosis to the second stage

Subsequently, if the disease is not treated, it progresses to the second stage. This can occur after weeks to months. Skin changes may also occur at this stage. And not just at the injection site. Borrelia lymphocytoma also appears. This is painless swelling, especially in the area of ​​the ear, nipple,  or spinal cord, ie the scrotum.

Bacteria spread further throughout the body, where they attack other body systems. Lymph nodes can be swollen in the whole body. In the case of the nervous system, various neuritis develops, up to meningitis. Inflammation and paralysis of the facial nerve are common.

If it affects the heart, it can result in carditis. An example is a myocarditis, which is inflammation of the heart muscle. Inflammation is the cause of valve defects but can result in heart failure. Heart rhythm disorders are present. Of these, AV blockage occurs.

Joint injuries are very common. Arthritis is manifested by swelling of the joints, of course, also by their pain. It typically affects the knee joint and other large joints. In the case of untreated borreliosis, it is normal for the symptoms to subside after a few weeks to months.

The eyes are affected at any stage, and this also applies to their various parts. It may initially manifest as conjunctivitis, which is an inflammation of the conjunctiva. Difficulties such as redness of the eye, impaired vision, sensitivity to light, double vision are associated. But also painful eye movement and many other serious problems.

Consequences of Lyme borreliosis in the third stage

The third stage is a sign of untreated borreliosis. Chronic encephalitis, encephalomyelitis, meningoencephalitis are rare. Damage to the peripheral nerves, ie peripheral neuropathy, manifests itself as impaired sensitivity or tingling (paraesthesia).

The mentioned acrodermatitis Chronica atroficans is a typical manifestation of this late stage. Degenerative skin changes such as redness or reddish-blue discoloration of the skin. The skin is thin and the blood vessels shine through it. Developing the subcutaneous induration, nodules (nodules), especially the bones (patella, elbow).