Part 2: Why is Lyme disease so difficult to Diagnose and Treat?

Published on April 03, 2017 by Dr. Paul Hrkal

In part one we introduced lyme disease and discussed how it can include many more infections over and above Borrelia burgdorferi (BB). In part two we will explore what makes tick-born infections so poorly understood and hard to diagnosis.

  •   Narrow Definition: The Center for Disease Control (CDC) and Infectious Disease Society of America have restricted the definition of “lyme disease” to only the acute stage of lyme where the “bulls eye” rash (note: this occurs in less than 30% of cases) is present and the patient is experiencing “flu-like” symptoms.  This discounts all the patients with persistent symptoms which means that patients with chronic symptoms fall outside of the diagnostic definition and can’t qualify for treatment.
  •   Accurate lab testing: The standard Canadian, government sponsored test is simply not accurate enough to diagnose BB, missing many infections in the process. The evidence suggests that both the ELISA and western blot tests (testing techniques used to look for the immune system’s response to BB) miss over 50% of BB infections. The other problem is that there are multiple sub-types of BB that cause lyme disease (12 known so far) and these tests only look for one type. The topic of testing will be discussed in more detail more in the lab testing section of part 3.
  •   Wide range of symptoms: Lyme disease has been called the "Modern Masquerader" because the symptoms vary and often change, sometimes getting better and then worse. Some of the most common symptoms are
    •  chronic fatigue
    •  joint pain
    • headaches
    • tendon inflammation
    • heart beat irregularities
    • irritable bowel symptoms
    • neuropathy

These are mentioning only a few of the 350 symptoms that mimic other diseases and disorders that are attributable to Lyme disease. Some degenerative, chronic diseases such as Alzheimer’s disease has been connected to lyme disease. There should be a high level of suspicion of lyme (or another co-infection) if symptoms such as joint pain constantly come and go, flu-like symptoms appear and persist after a trauma (such as car accident), a summer flu (even without a bull’s eye rash) or symptoms get much worse after using a steroid medication (it suppresses the immune system).

  •   Infectious forms and biofilms: BB is a very sneaky and unique organism that changes into different forms depending on its environment. BB can take a spirochete form that can invade nerves and other tissues, or it can become an intracellular bacterium to hide from the immune system inside a cell or a cyst, making it much more resistant to antibiotics. 
    Depending on the current form of BB, it can influence if a test will pick up an infection or if a treatment will work. In addition to the different forms of BB, these bacteria can form biofilms which are a large group of bacteria that join together to form a very resilient colony making them very difficult to destroy.


  •   Co-infections: These are the common microbes that can also are also present in ticks.
    •  Bartonella is a bacterium commonly found in cats (as well as ticks) that strongly affects the nervous system. It can cause symptoms of memory loss, mental processing slowness, brain fog, mood changes such as depression, anxiety, panic attacks and rages. Physically it causes lots of aches and pains like headaches, tendonitis and plantar fasciitis especially in the morning on waking. A classic symptom are abnormal purple and red “stretch” marks or lines on the skin.
    •   Babesia is a parasite that lives in the red blood cells making it similar to malaria. The unique symptoms of babesia are soaking night sweats and feeling chilled (like malaria), chest wall pain, cardiac arrhythmias, extremely low blood pressure, intermittent shortness of breath (also known as air hunger), anemia of unknown origin, upper abdominal pain.
    •    Ehrlichia is a bacterium that causes a sudden onset of high fever, low blood pressure, elevated liver enzymes and low platelets.
  •   Poor understanding, and the lack of consistent treatment guidelines: Here in Canada there is a major issue testing and identifying Borrelia burgdorferi infections. There is even less understanding about co-infections. This makes it difficult to develop a treatment guideline that can be generally implemented. Even in instances where a patient tests positive, treatment is often isolated to a course of antibiotics without addressing other infections, hormonal imbalances and toxicity. This can lead to strong detox reactions and rarely results long terms success. Note: Antibiotics can be effective for acute lyme disease (treated within a few weeks of a tick bite) but are much less effective for chronic lyme.

While the above information paints a bleak picture for patients suffering with Lyme disease and co-infection there is some positive news for Canadians. The Federal government held a conference in May 2016 to create a national framework for addressing the growing concern of Lyme disease. Read the full report here.

Stay tuned for Part 3 where we will discuss how to accurately test for BB infections and review some treatment approaches. If you can’t wait for part 3 and want more information, please visit the following websites:

International Lyme And Associated Diseases Society

http://www.ilads.org/

Canadian Lyme Disease Foundation

https://canlyme.com/

References

Dressler et al. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis. 1993 Feb;167(2):392-400.

Stricker RB, Johnson L. The pain of chronic Lyme disease: moving the discourse backward? FASEB J. 2011 Dec;25(12):4085-7. doi: 10.1096/fj.11-1203LTR.

Schwarzwalder A., Schneider M. F., Lydecker A., Aucott J. N. (2010) Sex differences in the clinical and serologic presentation of early Lyme disease: results from a retrospective review. Gend. Med. 7, 320–329.

Miklossy et al. Borrelia burgdorferi persists in the brain in chronic lyme neuroborreliosis and may be associated with Alzheimer disease. J Alzheimers Dis. 2004 Dec;6(6):639-49; discussion 673-81.

Murgia R, Cinco M. Induction of cystic forms by different stress conditions in Borrelia burgdorferi. APMIS. 2004 Jan;112(1):57-62.

Mayne PJ. Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort. Int J Gen Med. 2014 Dec 23;8:15-26. doi: 10.2147/IJGM.S75825. eCollection 2015.

http://healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/summary-report-lyme-2016-conference-rapport-sommaire/index-eng.php