Lyme disease and ticks

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.

First, some behavioral tips:

Prevention is the best protection:

• Use tick repellent if necessary 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. But you can also pull out the tick with your fingernails.
• 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.
• Check your immunization record to see if your 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 illness or other non-specific symptoms (fever, headache, aching limbs) also seek medical attention and report the tick bite.

What is Lyme disease?
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 don’t bite!).
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 tick’s intestine, it takes about 24 hours for these bacteria to be transmitted to humans.

How can you protect yourself from Borrelia?
By protecting yourself from ticks. Vaccination does not exist in Germany. The vaccination available in the U.S. does not protect against the Borrelia species that is most common in Germany.

Does it make sense to have ticks that have been removed tested for Borrelia?
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.

Can Borrelia also be transmitted by other insects?
To date, no other insects are known to be vectors.

How do you recognize a Borrelia infection?
In 90% of infected persons (after days to weeks) the so-called erythema migrans (in German “Wanderröte”) appears. Up to 1/3 of infected persons additionally suffer from general symptoms such as a general feeling of illness and possibly an increase in temperature. Very rarely, erythema migrans occurs on several parts of the body at the same time, an exception being involvement of other organs in the early stages.

One tenth of infected persons do not show erythema migrans, but after an incubation period of days to weeks after the tick bite, general symptoms such as fever, fatigue or joint pain appear. Since these symptoms can be similar to those of a “summer flu”, in the case of a previous tick bite, it is imperative to think of Lyme disease and prescribe an antibiotic, otherwise the heart, nervous system or joints may become involved.

Does blood always have to be drawn to detect Lyme disease?
No. If erythema migrans occurs, antibiotic treatment should be started in any case. This skin condition is so typical that even if the test result is negative (i.e. there are no antibodies in the blood), therapy is started because the antibodies are often not detectable until much later.

If no erythema migrans has occurred (in about 10% of affected persons), but flu-like symptoms develop (temperature > 38°, feeling of illness, muscle and joint pain), the antibodies are determined (IgM = antibodies of the early infection phase, IgG = antibodies of the late infection phase, positive after 4 weeks at the latest) as they can be a diagnostic aid.

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!), a positive test result does not always indicate an active, “fresh” Lyme disease but only indicates that the immune system had contact with Borrelia at some point in life.
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 indicate a non-specific reaction of the immune system to another, usually already healed infection.

The lymphocyte transformation test is also not suitable for confirming the diagnosis of Lyme disease.

How is Lyme disease treated?
In principle, Lyme disease can also be cured without therapy; the human immune system then develops antibodies that probably provide lifelong protection against a new Borrelia infection. 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 the diagnosis of “Lyme disease” are repeatedly treated with antibiotics, sometimes for months, completely unnecessarily and without any scientific basis, which 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 here that lacks any medical, scientific basis.
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.

What is “chronic Lyme disease”?
The existence of a so-called “chronic Lyme disease” 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 also occurs in the normal population.

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 to get more information, this page of the Bavarian State Office for Health and Food Safety is recommended:

Page of the Bavarian State Office for Health and Food Safety

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

Sources
Bavarian State Office for Health and Food Safety
at- Arzneimitteltelegramm 2014 Issue 45
Bavarian Medical Journal Issue 4 / 2013
German Medical Journal 2009 / 106 (5)