Lyme Disease Prevention and Treatment Options

Introduction 

Being the most common vector-borne disease in the United States, Lyme disease observes approximately 30,000 cases each year (Lyme Disease). This number is large in itself but doesn’t even scratch the surface when it comes to the number of affected individuals each year. According to recent estimates presented by the CDC, approximately 300,000 people may get Lyme disease each year. These cases are primarily concentrated in the upper midwest and northeast regions of the US (but have been found in Europe as well). Many of them don’t even make it into the state public health authorities, so the estimate of 300,000 comes from the CDC’s compilation of clinical, laboratory, and survey records (Kuehn). 

Lyme disease is caused by the bacterium Borrelia burgdorferi and Borrelia garinii (plus others) and is transmitted through the bite of an infected black-legged tick, specifically Ixodes ticks. The bacteria causes infection by migrating through tissues and invading cells and evading our immune system. Primarily through Ixodes scapularis, also known as a deer tick, exposure to these ticks can be year-round, but they are most active during the warmer summer months from April to September. It’s essential to be wary of your trips outdoors, especially in grassy, bushy, or wooded areas, and even near animals. So, for example, walking your dog, camping, gardening, or hunting could all bring you closer to ticks. The issue with Lyme disease is that it is ecologically favored, and that makes it hard to avoid it, making it a constant public concern(Steere). 

Interestingly, Lyme disease wasn’t considered as a separate disease before 1976. Numerous children in the Lyme, Connecticut area were thought to have juvenile rheumatoid arthritis (Lyme arthritis) but were later found to have a late form of a tick-transmitted disease whose manifestations had been recognized before in Europe. After this understanding, Lyme disease was officially recognized (Steere). 

Preventing Bites 

Before getting into the treatment's specifics, the first and best way to avoid the disease is by preventing bites. Despite warnings, only 40-50% of adults actually take precautions against tick bites. Being aware and conscious of these precautions can prevent years of difficulty and pain. Keep in mind that grassy and wooded areas could bring you closer to ticks, so wear clothes containing 0.5% permethrin. They remain protective even after several washes are in camping gear and clothing. When walking on trails, try to walk in the middle of the trail to avoid the bushy areas (“Preventing Tick Bites on People”). 

After you come back indoors, check your clothing for ticks as they can be carried on your clothing. Try to find any that you can spot and then put your clothes into the dryer on high heat for 10 minutes to kill any that you couldn’t spot the first time around. If the clothes need to be washed,

put them through hot water instead of cold or medium. Additionally, examine the camping gear and pets for ticks, as they can be carriers too. Shower soon after returning indoors (within 2 hrs) as this has shown to reduce the risk of Lyme disease and other tick-related diseases (“Preventing Tick Bites on People.”). 

Areas to check on the body: 

1. Underarms
2. In and around the ear
3. Inside belly button
4. Back of the knees
5. Inside and around the hair
6. Between legs
7. Around the waist

When pulling ticks off the skin, use tweezers to grab the tick as close to the skin as possible and pull upward steadily. Dispose of the tick by placing it in alcohol, putting it in a sealed container, wrapping it tightly with tape, or disposing of it in the toilet (“Tick Removal and Testing”). 

After Transmission 

• Stage 1: Localized infection of the skin followed for days or weeks.
• The incubation period of 3 - 32 days: a slowly expanding lesion--called erythema migrans--forms at the site of the bite- for 70-80% of the cases (Bratton, 567). These erythema migrans are the circular rashes that develop at the site of the bite and mimic the look of a “bulls eye”. The area of the rash will be red, the edges might be raised, and it might be around 6 inches/ 15 cm across (“Lyme Disease Symptoms and Treatments”).
• In the US, skin lesions and flu-like symptoms coincide (symptoms such as headaches, fever, fatigue, chills, neck stiffness).
• Stage 2: Infection spreads for months to years
• The bacteria disseminate quickly and easily by binding to proteins on the cell as an unidentified host. This leads to multiple secondary rashes (erythema migrans) on the skin (Bratton, 568)
• Stage 3: Persistent Infection
• After weeks of spreading, the disease can still survive in localized areas of the body. It remains dormant, so the symptoms are minimal or even absent. They can spread to the joints, the nervous system, or other skin areas, and their ability to survive and spread their remains dynamic.
• Specific complications can occur, including:

■ Inflammatory arthritis 

■ Nervous system: numbness in the limbs, facial muscle paralysis, memory issues and more.

■ Meningitis: inflammation of the surrounding membranes of the brain and spinal cord- can cause severe headaches, light sensitivity and stiffness in the neck. 

■ Heart complications: inflammation of the heart muscles, heart blockage and failure (“Lyme Disease Symptoms and Treatments”). 

• A Lyme disease symptom check has been provided by lymedisease.org and can be used as a scan (“Do You Have Lyme Disease?”).

*The infection is dynamic for each patient. Some may only have localization infection, while others may only see the later manifestations of the disease, such as arthritis. 

Treatment Options 

If you develop a rash or face flu-like symptoms after outdoor time or exposure to tick prone environments, check in with your doctor and let them know about the timeline of your symptoms. Primary treatment is with antibiotics, including: 

1. Doxycycline - 100mg orally, twice daily - for those aged 9 or above (nonpregnant). 2. Amoxicillin - 500 mg orally, 3 times daily.
2. Cefuroxime Axetil- 500 mg orally, twice daily or 30 mg/kg per day divided, twice daily 4. Erythromycin - 250 mg orally, 4 times daily; or 30-50 mg/kg per day divided, 3 or 4 times daily
3. This can be used for who are allergic to penicillin or those who can’t take tetracycline (Bratton, 569)

Treatment Duration - varies per individual is based on the stage and severity of the infection (Bratton, 569) 

1. Localized skin infections: 14-day treatment
2. Early disseminated infection: 21 days
3. Lyme disease-associated arthritis: 30 to 60 days
4. Late or severe disease (neurological, cardiovascular manifestations): need IV antibiotics (cefotaxime - 2g every 8 hrs or penicillin - 5 million U every 6 hrs for 4 weeks) a. The late disease may have treatment failures, and retreatment may be necessary. (Bratton, 570)

Plant-Derived Treatments 

1. Cryptolepis sanguinolenta and Polygonum cuspidatum (Feng)
2. Cryptolepis sanguinolenta is a plant native to Ghana, Africa, traditionally to treat “malaria, tuberculosis, hepatitis, and septicemia.” Previous preclinical studies have shown to be anti-inflammatory, anti-fungal, and antimalarial properties. The

components that make up Cryptolepis sanguinolenta, like cryptolepine, have been shown to cause the “morphological changes and cellular breakdown” (Feng). b. They tested these two plant-based traditional medicines along with ten others on the primary bacteria responsible for Lyme disease, Borrelia burgdorferi. They grew the bacteria in vitro, meaning that it was out of the biological setting (this is also a limitation of the study, considering the effects are observed directly on the bacteria, not when it’s in the body). They conducted two trials, one with the bacteria in the stationary phase and one while the bacteria was growing. 

1. Cryptolepis sanguinolenta acted against growing B.burgdorferi and also the non-growing stationary phase of the bacteria. This has not been documented before, as Cryptolepis sanguinolenta is traditionally used for malaria. Again, more studies in vitro and in vivo are needed to investigate the full potential of the Cryptolepis sanguinolenta treatment.
2. Polygonum cuspidatum, organically cultivated from China, was traditionally used for “anti-tumor, antimicrobial, anti-inflammatory, neuroprotective, and cardioprotective effects” (Feng). In general, this plant has antibacterial and anti-biofilm effects. Biofilms result from bacterial (or fungal, protists) growth on surfaces, eventually forming a film over it. Polygonum cuspidatum has polyphenol resveratrol as one of its main active components. Resveratrol is a class of polyphenols that act as antioxidants that, by their nature, protect against free-radicals, which are known to cause numerous issues, including cancer. Another active ingredient, Emodin, has been shown to act against the stationary phase of B.burgdorferi.
3. The toxicity levels observed are low, but GI issues and diarrhea can occur (although stopping or decreasing usage can resolve those issues).

f. The antibiotics, doxycycline and cefuroxime, along with the other herbs, were unable to eradicate the stationary phase of the B.burgdorferi bacteria. g. These were the two plant-based products that reduced B.burgdorferi activity both in stationary and growing phases.

Work Cited 

Bratton, Robert L., et al. “Diagnosis and Treatment of Lyme Disease.” Mayo Clinic Proceedings , vol. 83, no. 5, 1 May 2008, pp. 566–571., doi: https://doi.org/10.4065/83.5.566. “Do You Have Lyme Disease? Take the Lyme Disease Symptom Checklist Test.” LymeDisease.org, www.lymedisease.org/lyme-disease-symptom-checklist/. 

Feng, Jie, et al. “Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-Growing Forms of B. Burgdorferi.” Frontiers, Frontiers, 9 Jan. 2020, 

www.frontiersin.org/articles/10.3389/fmed.2020.00006/full. 

Kuehn, Bridget M. MSJ. “CDC Estimates 300 000 US Cases of Lyme Disease Annually.” JAMA, American Medical Association, 18 Sept. 2013, 

jamanetwork.com/journals/jama/article-abstract/1738891?appId=scweb. Lyme Disease. 16 Dec. 2019, www.cdc.gov/lyme/index.html. 

“Lyme Disease Symptoms and Treatments.” Symptoms & Treatments - Illnesses & Conditions | NHS Inform,www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/lyme-dis ease. 

“Preventing Tick Bites on People.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Sept. 2019, www.cdc.gov/lyme/prev/on_people.html. Steere, Allen C., et al. “The Emergence of Lyme Disease.” The Journal of Clinical Investigation, American Society for Clinical Investigation, 15 Apr. 2004, www.jci.org/articles/view/21681. “Tick Removal and Testing.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Apr. 2019, www.cdc.gov/lyme/removal/index.html. “Treatment.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Sept. 2020, www.cdc.gov/lyme/treatment/index.html.

 

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