Lyme Disease Assessment of Treatments
Lyme disease is a result of a tick bite from the species of tick, Ixodes scapularis and Ixodes pacificus. The disease carrying tick puts Borrelia Burgdorferi, or a spirochete, a long, thin spiral shaped bacteria, into the bloodstream of the human host. Symptoms of Lyme’s Disease will show up 36–48 hours after infection and can take months to develop and progress into more serious complications. Immediate symptoms include rash and flu like responses. These can include headaches and noticeable fatigue patterns. Later manifestations of the disease are symptoms of memory loss, severe arthritis, mood changes, joint inflammation, swelled nerves around face, sleep disorders, weakness, paralysis, pain, and cognitive deficits. The later symptoms begin to become noticeable about 2–4 weeks after infection and are typically not noticed and diagnosed until more pronounced and troublesome. The serious implications of this disease like inflammation of the brain and Bell’s palsy, puts pressure on people who are in the outdoors often, and doctors, to recognize symptoms of the disease and correlate them with Lyme’s Disease. Here’s a link to an overview of the disease and treatments. If the disease is treated promptly, most complications can be resolved quickly and easily. If the disease is allowed to progress, which it often times does, there is a greater threat to the patient’s health. In rare cases, Lyme carditis can develop in which the spirochete bacteria invade cardiac tissues inflaming them and can produce a life threatening situation. Lyme disease is a neurological disorder that should be taken very seriously because of its implications to patient’s health, and treatment options should be approached with immediacy and proper care. A discussion of common treatment practices will be provided and analyzed to provide general insight into Lyme disease care.
The only true telltale sign of Lyme disease without having laboratory results showing positive antibodies to the disease is Erythema Migrans (large bullseye looking rash) after recently removing a tick from the body. Otherwise doctors must see symptomology and order for the test to be done and confirmed. For treating the acute symptoms of the disease and to stop its development, doctors should prescribe the first-class of antibiotics to the patient. The first-class of antibiotics are more powerful and hit the disease harder. Three primary options for first-class drugs are doxycycline, the most common, and amoxicillin or cefuroxime. However, pregnant women should avoid doxycycline because of deleterious effects to the child. Lyme’s disease may also harm the pre-natal child so it is important for women to be aware of this and get tested if they notice symptomology. Doxycycline has been shown to be one of the best for knocking out symptoms. It should be noted that first-class antibiotics are reserved for patients that have not developed the more serious symptoms of Lyme’s Disease and for patient that have not experienced any neurological complications. The patient will receive a totally different treatment plan if more harmful symptoms develop.
Treatment without Neurological symptoms
The first-class, first round antibiotics are designed to wipe out the copying of the bacteria. Borrelia Burgdorferi, the genus type of the spirochete that causes Lyme’s, is a slow growing bacteria that has a doubling time of 12 to 18 hours. For the antibiotic to work, it must attack the building of cell walls during the bacteria’s replication process. For this reason, the treatment plan or administration of antibiotics must be over a longer period of time so the bacteria can be fully wiped out. An article posted on the CDC’s website states that patients without neurological symptoms should ascribe to a 28 day treatment plan for course of antibiotics like doxycycline. However, some doctors may choose to only prescribe for 14 days. The former is preferred.
It should be noted that inflammation of tissues, joints, and the brain will subside over a length period of time after antibiotics. A 2 month period should be allotted for inflammation and further symptoms to subside. For this reason, it is also recommended that a re-treatment phase is avoided. There is no scientific evidence for re-treatment for Lyme’s with antibiotics is any more effective than sticking to only the first round of treatment (cite). If neurological symptoms and severe arthritis is present, however, the patient to ascribe to a different treatment plan. The alternative treatment plan allows for the patient to be treated with an even stronger medication but comes along with greater potential for side effects. This treatment plan will be discussed in detail later in the article. For acute and minor symptoms of Lyme’s disease, antibiotics have shown a 90 percent effectiveness rate with no further treatment plans. For this reason, it is important that the disease is identified early on so that doctors can put patient on antibiotic plan and knock out progression of disease right away. Often times the disease is not picked up on right away, and this allows for more serious complications to develop.. A systematic review of pharmacological treatments for children is linked here.
Ceftriaxone, the stronger antibiotic option for patients with more progressive symptoms, is not recommended for acute and minor symptoms. This drug is more likely to induce serious adverse effects to patients and should be reserved for more severe cases. Also, Ceftriaxone is administered via injection into vein or muscle. Oral antibiotics of the first and second classes are then recommended for minor symptomology cases because they are cheaper, easier to administer, and cause less side effects. This is both beneficial for the patients and doctors. Second-class antibiotics like Erythromycin, Azithromycin, and Clarithromycin are recommended for people who are intolerant or should not take first-class antibiotics for whatever reason. Frist-class is recommended first because of their superiority for fighting off this particular type of bacteria. However, there are cases when this does not work so second-class remains the next options. That is if no serious symptoms are present yet. Macrolide antibiotics are also an alternative to these choices but should be avoided if possible because of the decrease in effectiveness. Antibiotic treatments may not hasten symptoms of Bell’s palsy but is recommended to prevent further sequalene. Here’s a link to a good peer-reviewed article on the topic. Although long there are structured sections to click on to zoom in on area of interest. Published by NIH.
Treatment with Neurological Symptoms
Now that we have discussed treatment of minor and acute symptoms in positive cases of Lyme’s Disease we must talk about more serious and unnoticed cases. When the disease has progressed significantly with symptoms like stiff and inflamed joints, cognitive deficit, tremendous fatigue, paralysis of facial muscles, cardiac tissue invasion, or persistent painful headaches, the next level of treatment should be prescribed. Ceftriaxone or Penicillin G are two drugs that would be appropriate for treating these symptoms. Like described earlier, these drugs can be injected into veins or muscles. They are primarily used for progressive symptoms, especially when there are neurological complications. Ceftriaxone can have great therapeutic properties for things like meningitis, joint infection’s, and skin infections.
Also, these drugs are more powerful in knocking out the disease. Ceftriaxone is generally well tolerated but can have side effects like changes in white cell count, local reactions, rash, or diarrhea. Because of some of these side effects this medication is reserved for advanced cases of Lyme’s. Ceftriaxone and Penicillin G selectively and irreversibly inhibit cell wall synthesis when bacteria is replicating. This is possible because the drugs bind to trans-peptidases, the things that catalyze peptidoglycan polymers that form cell walls and inhibit there production. These medications are completely absorbed and are not available orally. These drugs are especially good at penetrating tissues and body fluids including CSF fluid. This fact explains why they are so effective at treating central nervous system infections. The 14- day plan for treatment with these drugs is typically followed by another 28 day plan with oral antibiotics. This combination of drugs should fully dismantle the disease and its effects after a month or two.
There are special cases of Lyme’s that can allow for the disease to be more dangerous or threatening. In cases of Lyme carditis, when the heart becomes inflamed from the spirochete, cardiac tissues swell and can present further complication. The spirochete can cause issues like AV heart block, atrial fibrillation, and acute heart failure. Although this is present in only 1 percent or less of cases, it is something that cannot be ignored. Hospitalization is recommended in cases such as this with administration of ceftriaxone. Such can be done with an IV of drugs. Depending on severity and condition of patient, they may be advised to spend up to 2 weeks in the hospital for proper monitoring. A follow up dose of oral antibiotics will be prescribed after initial treatment. Chronic subjective symptoms may continue after antibiotic treatment. It remains relatively unclear why conditions persist, but most likely is from residual effects and presence of lingering bacteria. Such symptoms that could remain are things like joint and muscle pain, paresthesia, and fatigue. There is not much data on incidence, prevalence, and pathogenesis in post-Lyme complications. As mentioned earlier, there is no biological evidence of benefits to prolonged treatments with antibiotics and re-treatment. These treatments listed seem to be of the most effective and sought after. Conditions of negative symptomology have been shown to subside after all of these treatments with really high effective rates. It should be noted the severity that this disorder can reach and doctors and patients alike should be keenly aware and advised on recognizing Lyme’s disease.
To conclude, Lyme’s disease is a disorder to be worried about if you are outdoors often, especially in the woods or tall grasses. The neurotoxins, or spirochetes, if not treated for right away will begin to degrade the cells of the body. Specifically nerve cells. This process does not happen until an accumulation of the spirochete is present and after a prolonged build up. With the treatment of this disease by antibiotics, our bodies are able to develop a resistance to the spirochetes and erase their effectiveness. Because of the dangers of the disease, along with its ability to go unnoticed, the rest of this article will stress the importance of prevention, awareness, and control over the disease. For anybody who frequents in the outdoors, deet, permethrin, and other bug sprays are recommended to ward off threats for ticks that carry the disease. In combination with these repellants, long-sleeves, pants, long socks, and hats are recommended to be worn in the outdoors. This second component of prevention along with the first will significantly decrease the chances of obtaining the diseases. Also, after going on hikes or walking through tall grass, when home, a thorough lookover of all skin and hair should be done. Especially a fine comb being run through hair, along with a shower. These prevention mechanisms can virtually eliminate the chance of becoming infected and should be strictly followed.
For any reason that these steps are not followed, chance for coming down with the disease is significantly increased. The next most important thing is to understand the symptomology. Noticing signs of the disease are key to prompt treatment and success in elimination. Again, the accumulation of the spirochete is the root of the serious threats that this disease poses. Most people fail to identify symptoms until late into progression and are more at risk for a serious complication. Sometimes this disorder can be confused for other medical disorders like multiple sclerosis. Part of the responsibility is on doctors too to make connections, but they might not always ask where or what you have been doing. It is important to use this education for empowerment of the threat. Its evitable that a frequent outdoors goer will be latched onto by a tick and becoming at risk for this disease. From the reading before, its easy to see that a simple prescription of antibiotics is enough to combat this disease. Be aware of the risks, stays ahead of the game, enjoy the time in the outdoors, and recognize symptoms quickly in a worst case scenario.