Lyme disease: symptoms, treatment, who to contact for diagnosis

All the useful information on Lyme disease, from symptoms to treatment to what to do if a tick bites you

Maria Elena Perrero

A systemic disease triggered by the infection of a bacterium, the Borrelia burgdorferi, which is transmitted to humans through the bite of one infected tick: the Lyme disease is a complex disease, which manifests itself in most cases at a dermatological level, therefore on the skin, but which in a second phase becomes a systemic disease, affecting other organs and systems, including the central nervous system and that cardiac. And that if not treated properly and promptly it can become chronic. “Precisely at this time of year, between spring and summer, with trips and walks in the countryside or in the low hills, the risk of being bitten by a tick infected with borrelia increases”, warns the professor Massimo Clementifull professor of Microbiology and Virology of the Vita-Salute San Raffaele University, director of the Laboratory of Microbiology and Virology of the San Raffaele Hospital in Milan and author, together with the virologist Giorgio Palù, of the essay Virosphere.

Lyme disease: symptoms and course

The name of this infection comes from Lymea city in the United States where, in 1975, the first case of this was identified systemic disease. “In Lyme County this disease was discovered later a juvenile arthritis epidemic. Arthritis is in fact one of the symptoms of this pathology, but certainly not the only one – underlines a Official Active Professor Clementi -. Lyme disease is characterized by an initial state characterized by skin lesioninitially the sting of the mint, which then evolves, over a period of time ranging from a few days to a month, into a migrating erythema around the site of the sting “. Among others symptoms of the disease you can have them fever, chills, muscle and joint pain, headache, asthenia, photophobia, meningitis, myocarditis. “Among the most serious symptoms, in the untreated clinical forms, there can also be encephalomyelitis and chronic arcodermatitis atrophying in the lower limbs ”, emphasizes the virologist. It is difficult to say after how long the first symptoms appear: “Sometimes they appear immediately, sometimes only after months: it depends on the modality in which the Borrelia it spreads in our body after infecting us. There is a wide variability, and this can confuse the diagnosis ”.

What is Lyme Arthritis

The cutaneous one is the first and most evident manifestation of Lyme diseasewhich however can also begin with a secondary disease following this form: “It is thearthritis, generally monoarticular, ie affecting only one joint, unlike other forms of arthritis that depend on systemic diseases. Typically arthritis takes a knee, but it is not excluded that it affects other joints, such as the shoulder, for example – adds the virologist -. In addition to arthritis they can also occur neurological symptomslike a meningitis or one peripheral neuropathy with paralysis of peripheral nerves such as the facial nerve. Or even symptoms cardiacgenerally myocarditis or arrhythmias. This, however, only in the most serious cases “, emphasizes Professor Clementi, who warns:” Lyme disease can be fatal since both the neurological and cardiac forms can compromise life, as well as, above all, the quality of life. If we are dealing with young subjects, in general, we do not arrive at death, if we are dealing with subjects with previous pathologies this hypothesis could occur “.

Lyme disease: treatment and medication

Fundamental to the care of Lyme disease it is a correct and quick one diagnosis, “Which is not always easy, since there are not always evident symptoms – underlines Professor Clementi -. If, for example, there is no or no manifestation in the skin, the arthritis that will follow the symptom in the skin could lead with difficulty to a diagnosis of Lyme disease, since it could be an indication of many other pathologies “. Diagnosis is made by laboratory analysis precisely because the symptoms are rather nonspecific. As for the cure, “this is based on antibiotics to which Borrelias are sensitive, such as pennicillins, tetracyclines, cephalosporins. You must be sure that the therapy leads to the complete elimination of microorganisms, after which the subject returns to life as usual. Also because Borrelia does not normally tend to develop resistance to antibiotics. The important thing, therefore, is to have a precise diagnosis as soon as possible, since it is difficult to think of Lyme disease in the first place “.

When Do We Talk About Chronic Lyme Disease?

If therefore normally from the Lyme disease it heals, there are also cases of chronic disease: “It is a form that has not been subjected to timely treatment and which progresses over time, becoming systemic – explains the virologist – Chronic Lyme disease can lead to increasingly severe symptoms due to the replication of Borrelia in various organs and systems. The symptoms are related to the affected organs and systems. The therapy must be done immediately after the detection of the infection “.

What to do in case of a tick bite

If you realize you have been stung by one mint, and maybe this is still attached to our skin, the first thing to do is to go to the emergency room, suggests the virologist: “It is good not to detach the tick by yourself, but to have it removed by the doctors, in a sterile environment. If the mint there is, it can be useful for a quick diagnosis. If the tick did not stick to the injection site but we have a macula on the skin and we have been in the countryside or in the low hills, it will still be good to go to the emergency room. Here you will be able to have one serological diagnosis, with the search for antibodies in the blood, or molecular, with PCR (Polymerase chain reaction or polymerase chain reaction), with which it is possible to identify the nucleic acids of Borrelia both in the tissues and in biological fluids, such as joint fluid, in the case of arthritis, or the fluid of the pericardium, in the case of pericarditis “. Even a blood test may be sufficient but, the virologist warns, “the antibodies against borrelia are positivized after 8-15 days. Therefore, it is a question of a somewhat late research compared to that of nucleic acids with PRP “.

Who to contact for diagnosis

And if in case of symptoms only at the cutaneous level could it be natural to first turn to a dermatologist, if in doubt, Professor Clementi recommends going to the emergency room, recalling any walks in the fields, including previous ones: “The disease is dermatological in the first place, but then it becomes systemic. And if in some the arthritic form, it can also become a disease of the central nervous system or heart. This is why it is good to go to the emergency room “. Professor Clementi, with a past at the Trieste hospital, recalls how some areas of Italy are more subject to the presence of Borrelia burgdorferi: “The whole area of ​​eastern Italy is a spreading area of ​​Borrelia. For some decades the Veneto Region has set up an observatory which has shown how the front has moved from central Europe to Friuli-Venezia Giulia and Veneto to Lombardy ”. From an epidemiological point of view, according to the data collected by the Ministry of Health in 2000, in the period 1992-1998, about a thousand cases of Lyme borreliosis. The regions most affected are Friuli Venezia Giulia, Liguria, Veneto, Emilia Romagna, the Autonomous Province of Trento, while reports are sporadic in the central-southern regions and islands.

Is Lyme disease cured?

As mentioned, if the diagnosis is correct and rapid, the chances of recovery are very high. “It is cured, it can be cured, if the infection is diagnosed promptly. You can get there in several ways, but there diagnosis is very important, because it is always followed by an effective therapy ”, assures Professor Clementi. Also because if it is true that the cases of Lyme disease compared to those of tick bite are a fraction, it is also true that they are on the rise, the virologist tells us. “Ticks are becoming more and more infected and wild animals are becoming more and more infected. And not only fawns and roe deer, so much so that hunters know it and immediately put the killed animals in plastic bags so as not to be stung, but also more common animals such as squirrels in epidemic areas have ticks “.

How to prevent Lyme disease?

For the prevention small gestures are enough: “First of all, wear long, covering clothes, especially in areas where ticks or wild animals are known to be infected with them. So choose trousers that are not too light “. To find out any bites, it is a good idea to inspect your body at the end of the nature walk, looking for any ticks remained attached or of puncture marks on the skin. “And remember that you can be stung even if you ride a bike. If you then carry your dog in the fields it is good to check their fur, as ticks can attack dogs which can then transmit them to humans “. Precisely for these reasons also i children they must be careful not to get too close to wild animals, including the cute squirrels, which can be vectors for ticks. The same goes for stables: even in this case the animals can be reservoirs of ticks.

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