Lyme disease & ticks facts and myths

Due to diverse and partly misleading information, there is great uncertainty regarding Lyme disease.

In the following, we, the practice of Dr. Frühwein and Partners, would like to help you gain some clarity about this disease. As an infectious disease practice, we have decades of experience in the diagnosis and treatment of Lyme disease.

Prevent tick bites

is the best protection

  • If necessary, use tick repellents (e.g. skin sprays based on DEET) when you go out into nature
  • After spending time outdoors, check for ticks in the evening (especially the back of the knee, pubic region, belly button area, armpits, hairline). This is the best protection against a Borrelia infection: the shorter the suction period, the less likely a Borrelia transmission!
  • Take a shower in the evening: ticks that are “on the lookout” can be rinsed off in this way.
  • When removing a tick, it is best to do so with tweezers; grasp the tick just above the skin and pull it out slowly and straight; however, you can also pull the tick out with your fingernails (important here: do not squeeze the tick’s body; do not twist it out; at most, carefully shake and twist it back and forth to make it easier to pull out; do not use glue, oil, vinegar, alcohol, etc.).
  • Even if the stinging apparatus remains in the skin, there is no risk of infection, it simply falls off later with the scab that forms.
  • As with all skin injuries, a tick bite carries the risk of tetanus infection; check your vaccination record to see if tetanus protection is still in place (lasts 10 years). If you are not sure, go to your family doctor
  • If the tick has been undetected for more than 24 hours, observe the bite site. If after a few days, rarely up to weeks, a circular redness appears around the injection site, see a doctor. He will then prescribe you an antibiotic
  • If you develop a general feeling of sickness or other non-specific symptoms (fever, headache, aching limbs), also consult a doctor and report the tick bite

Lyme disease, also called Lyme borreliosis, is an infection caused by Borrelia bacteria. Borrelia is a bacterial species transmitted by tick bite (ticks bite, they do not bite). The disease is well treatable by antibiotics.

In Germany, about 5 – 35% of all ticks (depending on the federal state) are infected with Borrelia. Since the Borrelia bacteria are located in the intestine of the tick, it takes about 12-24 hours for the bacteria to be transmitted to humans after a bite.

By protecting yourself from ticks. Vaccination does not exist in Germany.

No. Because even if Borrelia is detected in the tick, you are not automatically infected. A positive result is not a sufficient basis for therapy.

To date, no other insects are known to be vectors.

In more than 80% of infected persons, the so-called migratory redness (erythema migrans) appears after 1 – 2 weeks (rarely up to 4 weeks). This is an enlarging reddish spot that spreads locally around the injection site (diameter > 5 cm). This distinct, outward-moving annular redness of the skin is often paler in the center than at the edges.

Very rarely, erythema migrans occurs on several parts of the body at the same time. In 10 to 30%, the migratory flush is accompanied by additional general symptoms such as feeling ill, temperature increase, fatigue, muscle or joint pain, similar to the symptoms of a “summer flu”.

Since a Borrelia infection can occur in rare cases (in approx. 10% of those affected) even without the typical wandering redness, it is imperative to think of a Lyme disease and to prescribe an antibiotic if the above-mentioned symptoms occur in the case of a previous tick bite, since otherwise the heart, nervous system or joints may be involved.

No. If erythema migrans occurs, antibiotic treatment should be started in any case. This skin condition is so typical that therapy is started even if the test result is negative (i.e. antibodies are absent in the blood), since the antibodies are often not detectable until much later.

If no erythema migrans has occurred, but there are the flu-like symptoms mentioned above, the antibodies are determined (IgM = antibodies of the early infection phase, IgG = antibodies of the late infection phase), as they can be a diagnostic tool.
If there are no symptoms after a tick bite, a blood sample is not recommended!

Because: 5 – 10% of the healthy population have a positive IgG (and / or IgM!), in some regions even 20% of adults.
A positive test result therefore does not always indicate an active, “fresh” Lyme disease but merely indicates that the immune system has had contact with Borrelia at some point in its life. This is because high antibody levels can remain in the blood for many years after an earlier, possibly unnoticed infection.

Furthermore, the IgM antibodies are not necessarily specific for Borrelia. Non-specific means: antibodies are detectable in the blood, which according to laboratory expression are directed against Borrelia, but de facto only show a non-specific reaction of the immune system to another, usually already healed infection.

Other test methods, such as the lymphocyte transformation test or antigen detection from urine, are not suitable for confirming the diagnosis of Lyme disease.

In principle, Lyme disease can also be cured without therapy, since the human immune system develops antibodies against it. Nevertheless, antibiotic therapy is recommended after the appearance of erythema migrans or flu-like symptoms after tick bite to avoid complications (see above).

Borrelia bacteria are sensitive to many well-tolerated antibiotics, which means that Lyme disease can be treated well. The therapy should extend over a maximum of 21 days, usually 14 days are sufficient.

Unfortunately, patients with a suspected diagnosis of Lyme disease are often treated unnecessarily and without scientific basis for months with high-dose therapy regimens that can be accompanied by severe side effects.

Since Lyme disease does not cause any specific symptoms, it is often used as an “embarrassment diagnosis” for symptoms that can also be found in people who have never had contact with Borrelia. If positive blood values are then added, a therapy is justified that has no proven medical benefit.

It should be emphasized once again that Lyme disease can be a serious illness if it is not detected and treated in the first few weeks.

If left untreated, Lyme disease can be a protracted illness involving the nervous system, joints, or heart. These different clinical pictures are divided into early and late stages.

Early manifestations (weeks to months after infection) include wandering redness and nerve and cardiac involvement. Late manifestations (months to years after tick bite) are mainly joint inflammation and skin changes.

A Borrelia infection can be treated in all stages of the disease; therapy is usually most successful in the early phase. Spontaneous healing is also possible at any stage of the disease.

However, the existence of a so-called “chronic Lyme disease”, often also called “post-Lyme syndrome”, is not scientifically proven. This diagnosis is occasionally made in people with non-specific complaints that have nothing at all to do with actual Lyme disease (fatigue, chronic pain, etc.) and occur with equal frequency in the general population.

The speculations and fears about possible connections of a Borrelia infection with a multitude of unspecific clinical pictures and complaints unfortunately often lead to overdiagnosis and overtherapy (see above).

In principle, Lyme disease is a disease with a good prognosis!

However, as with many medical problems, Lyme disease cannot always be assumed to be exclusively known. Medicine is a science in flux. We try to look at each case individually. If you would like more information, we recommend this page from the Bavarian State Office for Health and Food Safety:

http://www.lgl.bayern.de/gesundheit/infektionsschutz/infektionskrankheiten_a_z/borreliose/index.htm

And if you are still unsure or have questions: make an appointment at the practice of Dr. Frühwein and Partner!

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