How to Recognize Lyme Disease and Tick-borne Infections

July 03, 2021

This is a recording of “How to Recognize Lyme Disease and Tick-borne Infections,” a Zoom meeting held on June 3, 2021, sponsored by Dinno Health. The speaker is Dr. Jean J. Barry, MD, a board certified physician who has a private practice in Concord, MA. She has expertise in Lyme and Tickborne disease. She received a B.A. from Dartmouth College, M.S. in Physiology and Biophysics from Georgetown University and M.D. from New York University. She completed her internship and residency at Harvard Medical School/ Beth Israel Deaconess Hospital in 2003. She is currently on the Carlisle, MA Board of Health, chair of the Carlisle Board of Health Lyme Disease Subcommittee and a corporator at Emerson Hospital in Concord, MA.

Below is an excerpt of her presentation:

Why do I care about Lyme disease? My son presented to me when he was six years old with this diffused rash as you can see right here, all over his torso one morning, and this is early disseminated Lyme disease. These are bulls eye rashes. He had been lying on the couch feverish for about a week, about a month prior to this rash. So just as a quick note, if you do have any flu-like symptoms, fever, neck stiffness, things like that, certainly suspect Lyme disease if this happens in the summer.

These are more photos that I took of my son. You can see he’s got these very faint, circular lesions. These were all over his body. Some are solid, some have central clearing that are more typical of bullseye but as we discuss in a minute, the bullseye rash, the presenting rash of Lyme disease, is not always the typical that you think of in a textbook.

Lyme disease cases have been increasing significantly over the past 20 years. They were primarily clustered in the northeastern United States, a few cases out in the mid-west and really not seen much elsewhere. These two areas are starting to join and you’re starting to see a larger distribution of the ticks that carry Lyme disease.

In terms of distribution by age, we see a bimodal type of distribution. You see younger people presenting,  typically five year-olds just like my son. And then later on in life, we see around middle life, middle age people around 45, 50 tend to present. It’s not really clear why this might be. People have theories but there’s really no specific reason. This may have something to do with the immune system. This is just something that has been noted for a number of years that these are the two groups that you see larger numbers of cases of Lyme disease.

Looking at Lyme cases by month, and this is acute Lyme disease that we’re talking about, typically presenting with a rash or fever, stiff neck, things like that. You can see how between May and July, this is the greatest activity of the nymph. The nymph is thought to transmit most cases of Lyme just because it’s so small and people often have no idea that they’ve even been bitten.

Now what do we mean by Lyme disease? When we talk about Lyme, specifically, we’re talking about the Borrelia species that can cause a constellation of symptoms that meet the criteria of what we think of as Lyme disease. I’ll get into the symptoms in just a minute. But when I am talking about Lyme and my patients are talking about Lyme, we’re often lumping in the co-infections. So we’re often, even though a lot of people don’t even check for this, they often get lumped in because we’re really talking about tick-borne disease when you’re talking about Lyme disease. There’s quite a bit of overlap in terms of symptoms and even treatment. The other thing that gets overlooked is this chronic inflammatory response syndrome or immune dysfunction. This is frequently present with patients who have chronic or persistent infection with Lyme disease or co-infections. The other things that we need to look for, too, when you’re talking about Lyme disease, things such as nutritional deficiencies, endocrine disorders, autoimmune disorders, and sleep disorders. These are very common in people with persistent chronic symptoms.

So the definition of Lyme, the treatment of Lyme and tick-borne disease is quite variable depending on what doctor you see. One of the reasons for that is there are two major camps in medicine. In the United States, the Infectious Disease Society of America, this is the IDSA, they attribute chronic Lyme symptoms to post-treatment Lyme disease syndrome, which is by their definition not an active infection, and does not warrant treatment with antibiotics. ILADS [International Lyme and Associated Diseases Society] on the other hand is a group of doctors that believe that this is in fact an active infection if you are treated with the CDC recommended protocols and you still have symptoms, it’s still appropriate to treat with antibiotics because this is still an active infection. The other important part of the way ILADS treats and addresses Lyme disease is that they really look into the co-infections and these really are quite common. And so just as a disclosure, this is really the camp that I fit into more than IDSA. Certainly both groups have valid points but this is really becoming the kind of more solid way to view Lyme, tick- born disease based on current research.

Watch the video to get the full discussion on:

  1. Limitations of current testing
  2. Treatment options currently available
  3. What to do if you’re bitten by a tick