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Lyme Disease - A Multisystem Disorder With Joint Pains, Heart Block, And Nerve Damage

Updated on February 15, 2016

Deer Ticks Are the Most Common Carriers of Infection

Deer is a common animal host for Lyme disease
Deer is a common animal host for Lyme disease | Source

Lyme Disease - An Overview

Are you an avid traveler who occasionally wanders in the woods, explores new destinations, has a keen interest in wildlife, or a bird watcher, or a naturalist? Do you have pets at home? Do you stay in a stud farm or a dairy farm with lots of cattle grazing around/ (even though you might be regularly taking them to a veterinary practitioner !)

Reading this long list of queries you might think of me to be an obsessive compulsive who washes hands as a ritual or an overzealous health worker who looks for disease and illnesses in every grain of barley. But after reading the following facts, you might pay more attention to this subject.

  • Named after the town of Old Lyme, Connecticut, Lyme disease is the most common vector-borne disease of bacterial origin in the Northern hemisphere.
  • Mice and deer make up the major animal reservoirs of infection.
  • The primary vectors of the disease are hard ticks that parasitize a wide range of animals, including humans.
  • In endemic areas the domestic animals like pets, horses and cattle are frequently infected.
  • The disease can also be transmitted by deerflies, horseflies, and mosquitoes or by direct contact with fluid from infected animals.
  • Once established, the infection can manifest as a skin rash, headache, stiffness of the neck, joint pain, muscle ache and later become a multi-system disorder with nerve damage, cognitive decline and can even lead to paraparesis or weakness and reduced power of the limbs.

Lyme borreliosis is a vector-borne infection mainly transmitted by Ixodid or wood ticks and caused by three different species of a spirochete borrelia, that include the following:

  • Borrelia burgdorferi sensu stricto (found mainly in the U.S.)
  • Borrelia garinii
  • Borrelia afzeli (found in other parts of the world).
  • Borrelia bisseti nov (found in California).

The Ixodid ticks may also transmit other infections like babesiosis, ehrlichiosis, and tick-borne encephalitis along with borreliosis.

The Bacterium Borrelia burgdorfei

Borrelia burgdorferi, the causative agent of this disease is a fastidious, microaerophilic (can grow in low oxygen concentrations) bacterium that grows best at 33 degree Celsius temperature, in a complex liquid medium called Barbour, Stoenner, Kelly (BSK) medium.

Systems That Bear the Brunt of Lyme Disease

Lyme causing bacteria affects which of the following organ systems in our body ?

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Worldwide Distribution of Lyme Disease

The endemicity of this disease correlates with the geographic ranges of certain species of Ixodes vectors.

  1. Ixodes damminni is the principal vector in the North Eastern United States, from Massachusetts to Maryland and in the Mid-Western states of Wisconsin and Minnesota.
  2. Ixodes pacificus is the vector in the Western states of California and Oregon.
  3. Throughout Europe, Ixodes ricinus is the vector.
  4. In Asia, China, and Japan, Ixodes persulcatus is the vector.

In the United States Ixodes damminni also transmits Babesiosis and Ehrlichiosis; In Europe and Asia, Ixodes ricinus and Ixodes persulcatus also harbor and spread encephalitis infections.

Mice and deer make up the major animal reservoirs of Borrelia burgdorferi, but other rodents and birds may also harbor the infection. Domestic animals such as dogs, cattle, and horses can also develop clinical illness usually manifested as arthritis.

Seasonal Variation In Lyme Disease


Lyme Like Illness

There is also a non-culturable spirochete that is transmitted by the Lone Star tick (Amblyomma americanum). This organism produces a Lyme disease-like illness with a skin lesion very similar to that caused by Borrelia.

As the Lone Star tick is found in the Midwest and Southern areas, cases of Lyme disease reported from these areas are probably due to this organism. This condition is better known as Southern tick-associated rash illness (STAR) or Master's disease.

Peculiar Behavior of Lyme Disease Vectors

Lyme disease-carrying ticks feed once during each of the three stages of their life cycle. Larval ticks feed in late summer, nymphs in the following spring and early summer, and adults during the fall.

The mouse is tolerant of the borrelia microbe, a fact that is critical for maintaining the infection.It is the mouse that transmits the infection to larvae in late summer after being infected from the nymphs in early summer.

Most infections occur in spring and summer when nymphs are active, and fewer cases in cooler months (October to April) when adults feed.

This is due to the greater abundance of nymphs; human outdoor activity in spring and summer; and the fact that adult ticks are larger, easier to detect and thus can be removed before the disease gets transmitted (ticks must feed for 24 hours or longer to transmit the infection).

Removal of Lyme Disease Vector

Ixodes ticks are smaller than the more common dog ticks. Because the ticks are so small, the bite is usually painless and goes unnoticed.

After feeding the tick drops off in 2-4 days. If a tick is found, it should be removed immediately.

The best way to accomplish this is to grab the mouth part- not the body - where it enters the skin, with a pair of fine-tipped tweezers and pull firmly and repeatedly until the tick releases its hold.

You can even save the tick in a bottle of alcohol for future identification, especially if symptoms develop.

Lyme Disease in a Summary

  • Lyme disease is a common vector-borne infection that can occur during hiking, camping, or hunting trips and residence in wooded and rural areas.
  • Mice and deer are the common animal hosts to the disease carrying Ixodes sp of ticks.
  • The infection begins with an annular, red-colored patch on the skin, and can spread throughout the body.
  • During early stages of infection severe headache, migratory muscle, bone, and joint pains are common, along with a mild degree of heart block.
  • In late stages of the disease, the immune system gets affected, leading to chronic severe disabling knee joint arthritis, mood disturbances, and memory loss.

Signs and Symptoms of Stage - 1 (Early Localized Infection)

After being inoculated into the skin, borrelia organism may migrate outward, producing a characteristic skin lesion, and may also spread via the bloodstream to other parts of the body.

Following an incubation period of 3 to 32 days, Erythema migrans (a skin rash characteristic of the disease) occurs at the site of tick bite, beginning as a red spot or a pimple that expands to form a large annular lesion, with a bright red outer border, and central clearing.

Due to the very small size of Ixodes species, most people do not remember a preceding tick bite.

Sometimes the center of the lesion may become intensely red and swollen, else the expanding patch shows several rings within the outer ring. Areas where clothes are tightly fitted to the skin, such as the thigh, groin, and underarm area are the most common sites where this lesion develops.

Perhaps as many as 25% of the people do not exhibit this characteristic skin sign, or it may go unnoticed.

A flu-like illness, with fever, chills, and muscle ache occur in about half of the individuals.

The skin rash resolves within a month even without treatment.

Clinical Presentation of Lyme Disease

Erythema migrans skin rash
Headache and neck stiffness
Chronic knee arthritis
Flu-like illness
Migratory joint pains without swelling
self resolution
Heart block
Red-violet patches on front of forearms and legs

Clinical Manifestations of Stage - 2 (Early Disseminated Infection)

Within days to weeks after the onset of skin rash, the microbe spreads through the bloodstream to different parts of the body.

It then causes annular skin lesions similar to the initial lesion but smaller in size at multiple sites, along with a severe headache, a mild stiffness of neck, fever, chills, migratory muscular and bone pains, joint pains (usually without joint swelling) lasting for hours or days, and severe fatigue.

Various other signs like swelling of lymph nodes, enlargement of spleen and liver, sore throat, dry cough, and conjunctivitis may also accompany.

These early symptoms reduce in intensity or disappear completely within several weeks even without taking any treatment.

Within several weeks after the onset of illness, around 8% of the individuals suffer from cardiac problems. The most common abnormality is a fluctuating degree of atrioventricular block (first degree, Wenckebach, or complete heart block).

In some people the borrelia spirochete bites the heart harder, leading to inflammation of the heart muscle, left ventricular dysfunction, and enlargement of heart as a whole.

In rare instances, it can even lead to a chronic cardiomyopathy.


Signs and Symptoms of Stage - 3 (Late Persistent Infection)

Months after the onset of infection about 60% of the individuals who have received no antibiotic treatment, develop frank arthritis.

The typical pattern comprises of intermittent attacks of arthritis in large joints (especially the knees), lasting for weeks to months in a given joint.

Small joints and structures around them may also be affected, mainly during early attacks.

The rate of recurrence reduces each year. However in a small percentage of cases, the involvement of large joints - usually one or both knees - becomes chronic, and may lead to erosion of bone and cartilage.

In such people, on analysis their joint fluid has a very high count of white blood cells (on an average, 25,000/micro liter) and antibodies to OspA and OspB protein (major outer surface protein of Borrelia), but lack Borrelia DNA in synovial fluid as detected by PCR.

Tests for rheumatoid factor or antinuclear antibody test for lupus erythematosus usually give negative results.

Although less common, chronic nervous system involvement may become apparent months or years after the onset of infection, sometimes following long periods of latent infection.

It begins as subtle changes in mood, memory, or sleep disturbances and progresses to tingling in the nerves or pain along particular spinal nerve segments.

Acrodermatitis Chronica atrophicans is a late skin manifestation associated with Borrelia afzelli infection in Europe and Asia. Seen mainly in elderly women, the lesion begins insidiously with reddish to violaceous discoloration on acral surfaces of arms and legs (on the front of forearms and legs) and gradually develop hardening and thinning of skin over a period of years.

Lyme disease is caused by the spirochete Borrelia burgdorferi and transmitted by vectors of Ixodes species that carry the microbe in their intestines.

It progresses in three phases, consisting of expanding skin lesions, cardiac and neurological disease, and progressing into arthritis and a chronic neurological syndrome.


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    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thanks for your feedback ladyguitarpicker.

    • ladyguitarpicker profile image

      stella vadakin 

      3 years ago from 3460NW 50 St Bell, Fl32619

      I have been bitten by ticks, and was fortunate enough to get them off and then I used iodine on the bites. A very necessary hub.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thanks for your feedback Smaley.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thanks for adding this useful information Jill.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thanks for your feedback pjware. Wishing your son a speedy recovery.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thank you for your feedback Beth.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Hi donotfear. Lyme disease is indeed a very common vector borne illness. Thanks for your feedback.

    • donotfear profile image

      Annette Thomas 

      3 years ago from Northeast Texas

      I must chime in here, from personal experience. I have written my own account of my illness here on Hubpages. Both tests currently being used to detect Lyme disease are inaccurate and were never meant to be used to diagnose or confirm the bacteria. It states on the actual tests that physicians should not base their diagnosis on tests alone; it is a clinical diagnosis. Unfortunately, doctors don't know this, are not being told, and obviously never read the fine print on the tests. They automatically just order the useless test because that's what they have been told to do.

      There are over 20 strains of borrelia on our continent.

      I promise you that the bacteria that causes Lyme does not discriminate to which tick it enters; nor do ticks know state lines. The southern version is as you say; borrelia lonestari. It is called that because it has a different biological structure than traditional borrelia burdorferi, which is found on the east coast. The CDC refuses to recognize it as true Lyme because they ....well, we don't know why, but I have my suspicions. Dr. Masters made a great case for the southern lyme argument, but they ignored him.

      Why not take a look at my articles, especially the one 'Lyme Disease: Hidden Epidemic of Arkansas.

      Thank you.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thanks for the feedback Elizabeth Li.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Hi lymelightlisa. According to the guidelines, individuals suspected with Lyme disease are subjected to a two step test approach, with ELISA being the initial test as it is highly sensitive and Western blot being the confirmatory test. Cetrain tests like PCR and urinary antigen detection are not used on a routine basis. PCR is very useful to detect Borrelia burgdorferi DNA in the synovial fluid having an 85% accuracy, but in case of neuroborreliosis its sensitivity varies from 25-38%. I also agree there are a lot more symptoms than I have mentioned. I tried to include as much as I could. In most situations the infection begins lot early than when it gets diagnosed due to chances of subclinical or latent infection. That is why symptoms come and go at random without a well defined progression as in a theoretical situation. A nd indeed the chances of reinfection are very high. Thanks for your inputs.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      I agree with you RockyMountainMom. There are chances of both false negative and false positive test results that need to be correlated clinically. And as per the guidelines established by the American College of Physicians the diagnosis is indeed clinical and laboratory tests are meant to confirm it.

    • profile image


      3 years ago

      Actually.... It is a very well-known fact that Lyme Disease is vastly under reported!!! Um, it is the biggest epidemic in the U.S. The CDC claims there are around 300,000 new cases of Lyme each year. However, a few studies/surveys have actually shown that the number is closer to 1-2 million new cases each year. The under reporting of Lyme is due to the improper lyme guidelines and misinformation set by the CDC, ISDA, FDA, NEGM, etc. For example, FDA has decided to only approve Lyme tests that are only 30% accurate when there are a number of tests available that are closer to 90% accurate. in addition, the guidelines are based off of the New England journal of medicine and their own biased studies. In addition, they choose to ignore the 300 peer reviewed studies that show that Lyme is a chronic reoccurring infection. It's a domino effect after that. The CDC and the ISDA base the Lyme guidelines off of biased studies. End result? Millions of people like me going undiagnosed and being treated poorly... With no insurance coverage to boot. I am somewhat taken back by the lack of symptoms you have written as well. There are faaaaaaaar more symptoms than you have written. I had zero rash... A lot of lyme sufferers are bit on the base of their head underneath their hair. Each patient eventually experiences a lot of the same symptoms, but there is definitely no timeline that you can write as to which symptoms appear first! there is no order. I had random symptoms come and go for 6 years before experiencing close to 60 different symptoms once the lyme had progressed.

    • RockyMountainMom profile image


      3 years ago from Montana

      I am still confused, though. You are demonstrating further reasons that Lyme is under-diagnosed, because patients with Lyme would appear serologically negative in the cases you just described, even though they have lyme. And even when timing better, test results are highly likely to miss the presence of Lyme disease.

      Lyme is a clinical diagnosis, but this is often misunderstood, and inaccurate tests are used to deny treatment, which is far more dangerous than early treatment for a patient that was not infected.

      False negative test results are extremely common, and Lyme disease is ultimately a clinical diagnosis. Testing is very inaccurate and should not be used to preclude a Lyme diagnosis when symptoms and other indications are present, due the extremely high rates of false negatives and the use of tests that only test for one strain (as well as testing protocols that were designed for reporting purposes but continue to erroneously be used diagnostically). The NIH and a broad body of peer reviewed evidence from the past three decades of research speaks extensively to the inadequacies of these tests.

      It can take many rounds of testing to detect Lyme disease, so that many patients have multiple rounds of tests show up negative even when Lyme is present.

      Rates of misdiagnosis are currently at least 1 in 10, as per the CDC, and the current rate of underdiagnosis is staggering. Over 270,000 new cases of Lyme go undiagnosed or misdiagnosed each year in the U.S. alone, per new estimates released by the CDC this past year.

      I think it is dangerously misleading to speak of this disease as over-diagnosed, as it feeds into current misconceptions that already keep doctors from treating (even WITH positive test results) and keep patients from knowing they may need to push for further testing and for doctors to base their diagnosis on clinical criteria, rather than highly inaccurate test results.

      It is critical that doctors and patients understand that Lyme is a clinical diagnosis.

      It is also critical to understand that not treating based on test results alone can be even more costly than it has been for me.

      I don't think you can appropriately call a disease with 270,000 or more undetected cases per year overdiagnosed, but you can perpetuate the myths that inhibit detection by doing so.

    • Elizabeth Li 1991 profile image

      Danyang Li 

      3 years ago from China

      Once saw a woman diagnosed with lyme and unfortunately her brain was infected so she suffered painly, and though very rich, money can not completely cure the disease so it is so horrible a disease and this hub is very useful to make people learn about it and take precautions against it.

    • profile image


      3 years ago

      Over diagnosed Lyme disease? I don't think someone that has suffered for many many years and have come very close to death because of it, I can assure you it is extremely underdiagnosed. Also please tell me where these doctors are that are incorrectly diagnosing Lyme diagnosine and prescribing antibiotics unnecessarily when you can barely get prescribed antibiotics with a positive test?

    • profile image


      3 years ago

      This is very important to share.

    • profile image 

      3 years ago

      You are correct RockyMountainMom.

      Lyme disease is rarely on any doctors radar for consideration. Once each medical specialists determine you do not fit into their 'box of knowledge', they deem that your illness and suffering must be 'all in your head'.

      My son has been suffering mounting symptoms for the past 7 years and even though testing negative for all 'common' tests and ONLY positive for Lyme, the doctors are still saying it must be a 'new syndrome' or nothing at all.

      EDUCATION is needed for all medical staff to consider, recognize, diagnose and fully treat Lyme and co-infections to end all this needless suffering.

      How is it anyone would receive unlimited treatment if bitten by anything else but a tick?

    • profile image


      3 years ago

      I have been sick for 8 years. Lyme is not over diagnosed but rather it is under diagnosed and misdiagnosed. Sadly our dr.'s are undereducated and misinformed and so the public remains untreated and sick for far longer than necessary. Many live are destroyed by the misinformation and denial of the real illnesses that result from having Lyme disease improperly treated.

    • RockyMountainMom profile image


      3 years ago from Montana

      Hi there, I have a few notes so far that are pretty near and dear to my heart, as I have been sick for four years with Lyme disease, but would not have been if I hadn't been misdiagnosed for the first three years. I wanted to let you know that wood ticks are vectors of Lyme, but not in the same classification as deer ticks. And that many more types of ticks (both hard and soft bodied, well beyond Ixodes) can transmit lyme. Also, many patients don't recall a rash or even a tick bite.

      But, most importantly, this disease is not over diagnosed. It is drastically under-diagnosed. Hundreds of thousands of cases are missed each year, making that statement quite dangerous for those of us suffering after misdiagnosis, and for roughly 270,000 patients whose Lyme will be missed each year in the U.S.

      I will try to read the rest of your article later, but sadly am too upset at the moment to continue reading.

      I lost my career, my life savings, every activity I enjoyed, my dignity, and for a very long time, my ability to care for my kids.

      So it is very difficult, with so many thousands of us suffering from the failure of recognition of this illness, to a statement such as that.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Chronic fatigue syndrome and fibromyalgia are both associated with Lyme disease. Wishing you good health and a great day. Thanks for your feedback manatita44.

    • shraddhachawla profile imageAUTHOR


      3 years ago

      Thanks for your views Jo.

    • manatita44 profile image


      3 years ago from london

      Comprehensive, indeed!

      I do get chronic fatigue which some thinks can be associated. Still, I'm not too bad right now, inshal'lah. Great and thorough HUb.

    • tobusiness profile image

      Jo Alexis-Hagues 

      3 years ago from Lincolnshire, U.K

      A comprehensive account of Lyme disease. Educational and useful. Very well done.


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