“The Lyme Wars,” by Michael Specter, The New Yorker, 7/1/2013.
Recently I spent the morning hiking around nearby Brandywine Creek State Park. I would have preferred to hike through the wooded areas where the shade would be cooler, but I chose to stay on the mown paths in the open fields. I commonly hear of people’s long and difficult fight with Lyme disease, and like most now, I avoid wooded areas that may harbor deer ticks. Even in our suburban area, we are almost overrun with deer. Like Canadian geese, their exploding population has turned them into pests.
The treatment of Lyme disease is often straightforward. A person hikes in the woods or just cleans up their back yard and within a few days notices a bull’s-eye target on their arm, a bright-red ring of rash surrounding a speck of a bite from a deer tick. Recognizing the sign of Lyme disease, but with no other debilitating symptoms, they go immediately to their doctor who puts them on a standard, 3-week regimen of antibiotics, and the patient soon recovers with only minor discomfort and no aftereffects.
But that’s not how it always turns out. Perhaps there was no telltale rash or other symptoms, and the bite went unnoticed. Perhaps the victim did everything right. They noticed the bite, received the antibiotic treatment, and thought themselves cured. But then, a year or more later, some 20% of those infected are hit with a diverse host of vague and mysterious symptoms, such as headache, joint pain, neck stiffness, burning muscles, unexplained fevers, bladder dysfunction, weight loss, a feeling of being in a mental fog, anxiety, and depression. They can be severe enough to keep the patient bedridden. Any of them can have other causes (they sound to me like ordinary old age). A laboratory test of our antibodies can suggest the presence of the Lyme disease bacteria, but the the antibodies take weeks to develop and a test taken too soon will not show them. Even then, the test often gives false results, both negative and positive. As a result, any group of unexplained symptoms often is incorrectly attributed to chronic Lyme disease. Another regimen of antibiotics usually provides temporary relief, but the symptoms continue to come and go for years, perhaps for life. Many Lyme specialists believe subsequent antibiotics only suppress the symptoms but rarely, if ever, cure the disease. Insurance companies almost never pay for them, and desperate patients turn to alternative medicine. The symptoms eventually subside on their own and the patients gratefully credit whatever they had been doing. But the disease is not cured and is likely flare up again someday.
Lyme disease is increasing rapidly. The number of reported cases has tripled since 1991, spreading from Lyme, Connecticut, where it was first described in 1977, all the way to Florida today. In 1982, the cause of the infection was discovered to be a previously unknown bacteria, Borrelia burgdorferi.
Scared yet? The bacterium enters the bloodstream from the tick bite, covering itself with the proteins in the tick’s saliva, and quickly hides in other parts of the body where it is harder for antibiotics to reach. Like HIV, it suppresses the immune system and easily morphs into other strains. The bacteria is so adaptable, several strains are often found in the same tick. Moreover, at least four other pathogens can be transmitted by the deer tick, and more than one can infect the victim at the same time. Each can be the source of some of the symptoms, and, together, they can weaken the immune system even more. One tick-born parasite, Babesia, invades red blood cells, causing mild fever and diarrhea, especially when combined with Lyme disease, and has to be treated very differently. It can be present in half of the Lime disease infections. The best course of treatment for the advanced stages of Lyme disease is still debated. (There are ten times as many bacteria cells in our bodies than human cells. An alien could accurately describe humans as simple support systems for bacteria.)
The good news is that the tick takes at least 36 hours to transmit the bacteria. Find it and remove it before then and the chance of infection drops dramatically. Even going unnoticed, a tick bite is not a death sentence; only 1% of bites results in an infection.
Ticks were common when I was growing up, but they were just disgusting and not especially harmful. Everyone seemed to have their own method of removing them, such as smothering them with Vaseline or holding a lit cigarette close to them, causing them to let go and move off. The recommended technique now, as then, is to tug on them gently with tweezers, trying not to break off their legs. But leaving an imbedded leg or two is better than doing nothing. And get to a doctor for the initial antibiotic treatment before the bacteria can hide.