Lyme borreliosis

(Lyme disease)

Bacterial infection

Many possible symptoms

May resemble other diseases

Unreliable tests

Treatments often inappropriate

Can become chronic

Lyme borreliosis

Bacterial infection
Many possible symptoms
May resemble other diseases
Unreliable tests and often inappropriate treatments
No vaccination possible
Can become chronic

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Healthcare professionals General Public

What are the symptoms of Lyme borreliosis?

Lyme borreliosis is a multisystemic disease, meaning it can affect several organs at the same time – for example the skin, the joints (Lyme arthritis), the nervous system (neuroborreliosis), the eyes or the heart [18].

Symptoms range from mild to severe, and differ depending on whether the infection is recent — known as an acute infection — or long-standing, known as a chronic infection. A person may also carry the bacteria without showing any signs, or the first symptoms may not appear until months or even years later [19].

I - Acute infection:

The earliest sign is erythema migrans: a red patch that slowly expands around the bite site. It only appears in 40 to 70% of infected people, between 3 and 32 days after the bite. Its presence is enough to make the diagnosis, without a blood test [21].

The patch is usually painless, sometimes accompanied by burning or itching. It can also take unusual forms: a simple redness, or a persistent red or purple bump [21]. The different forms are illustrated in this document.

This first phase may also be accompanied by flu-like symptoms: fatigue, chills, headache, muscle pain, fever [21]. A high fever with chills outside the flu season points rather to babesiosis or bartonellosis [24].

II - Chronic infection:

After the acute phase — or without any initial symptoms — the infection can become long-lasting. The bacteria reach deep tissues: tendons, cartilage, and the membranes surrounding the heart and the brain [19].

Some symptoms are specific to borreliosis; many others are also found in co-infections such as babesiosis or bartonellosis [25-26].

Symptoms specific to borreliosis

Erythema migrans
Paralysis of one side of the face (Bell's palsy)
Sudden hearing loss
Joint pain that moves from one joint to another
Swollen joints
Inflammation of the heart muscle (Lyme carditis)

Symptoms shared with other infections

General signs — persistent fatigue, sleep disorders, fever, chills
Memory and concentration — difficulty concentrating, memory loss, “brain fog”
Mood — anxiety, depression, obsessive disorders
Pain — headaches, muscle and joint pain, stiff neck, cramps
Abnormal sensations — burning, tingling, pain at the slightest touch
Balance and movement — dizziness, balance and coordination problems, tremors, weakness on one side of the body, speech difficulties
Heart — palpitations, irregular heartbeat
Vision and hearing — visual disturbances, floating spots or threads in the field of vision, sensitivity to light, tinnitus, sensitivity to sound
Digestion and bladder — digestive problems, frequent urge to urinate
Allergic reactions — hives, asthma, skin that marks at the slightest rubbing

Sources: [18-19-25-27-28]

It is possible to have only some of the symptoms.

Step I - Symptom assessment

Diagnosis relies primarily on clinical examination: medical history, the person's account, physical examination and, above all, symptoms. A thorough medical consultation with a specialist is therefore essential.

Borreliosis is nicknamed “the great imitator”: its symptoms resemble those of many other diseases, which often leads to misdiagnoses — fibromyalgia, chronic fatigue syndrome, multiple sclerosis, psychiatric disorders [29-30-31-32].

Many symptoms are shared with co-infections such as babesiosis or bartonellosis [25-26]. It is not uncommon for some people to have several infections at once.

The questionnaire by Dr. Horowitz, a specialist in borreliosis and co-infections, helps assess the likelihood of an infection.

Evaluation questionnaire

Step II - Microbiological testing

It is important to know that there is currently no fully reliable blood test. Quality varies greatly from one test to another, so the result depends heavily on the laboratory performing it. Tests serve to support the diagnosis, never to replace it: a negative test does not rule out an infection [20].

1. The official test in Switzerland:

The recommended procedure is an ELISA, followed by a Western blot for confirmation. This is known as “two-tiered testing” [20].

These tests are indirect: they measure antibodies, i.e. the immune system's response, not the bacterium itself.
They miss up to half of all infections depending on the stage, and do not show whether the infection is active or whether a treatment is working [33-34].
They generally only recognize 3 to 4 of the 7 Borrelia species present in Switzerland, and none of those responsible for relapsing fever (see below).

2. Other possible tests:

There are newer, much more sensitive tests that can detect more species and often co-infections too. They are not recognized for diagnosis in Switzerland: they are performed in laboratories in Belgium, Germany and the USA.

Type	Sensitivity	Detection mode
Line Immunoblot	~93% *	Search for IgM and IgG antibodies directed against the bacteria
Phelix Phage	~92%*	Search for specific microviruses directed towards the bacteria
FISH	*	RNA detection via a fluorescent microscope
EliSpot, IgXSpot	*	Search for immune "T" cells reactive to the bacteria
Nanotrap	*	Search for the bacteria's OspA protein in urine
Sources: [38-39] * There are no large-scale studies available for these tests yet, but they are widely used by physicians who are members of ILADS.

Borrelia species

The 53 known Borrelia species form two groups [40]: those of Lyme borreliosis, transmitted by ticks, and those of relapsing fever, transmitted by ticks and lice. At least 9 species in the first group can infect humans [41], 7 of which are present in ticks in Switzerland [5]. The second group has 14, 6 of which have been observed in Europe [42-43] — in Switzerland mainly Borrelia miyamotoi, whose symptoms are very similar to those of Lyme borreliosis [5-44].

Swiss serological tests do not detect the species responsible for relapsing fever.

What is Lyme borreliosis?

Lyme borreliosis, or Lyme disease, is a tick-borne infection. It is named after the town of Lyme, USA, where it was identified in 1975 in children who developed joint pain after tick bites [1].

The first bacterium identified as causing this disease is Borrelia burgdorferi, discovered by Willy Burgdorfer. Since then, many other Borrelia species (such as B. garinii, B. afzelii, B. bavariensis, etc.) have been recognized as sources of infection in humans [1].

The name of the disease is misleading: Borrelia are not limited to the USA. They are found all over the world, in both rural and urban areas [2-3].

Mode of transmission

The bacterium is transmitted by the bite of an infected tick. Ticks usually feed on animals; humans are accidental hosts. Ticks are found in forests and meadows, but also in city parks and private gardens [10].

It generally takes 24 to 72 hours for the bacterium to pass from the tick to the person bitten [12], or even less: a study on mice reported 12 hours [13]. Some experts even believe that the bacterium can be transmitted in a matter of minutes if the tick has already fed on another host before biting a human.

Removing a tick as quickly as possible is therefore the best protection. In Switzerland, 5% to 50% of ticks carry Borrelia, and the Swiss Federal Office of Public Health estimates that 10,000 people are infected every year [15].

A tick goes through three stages: larva, nymph, then adult. Only nymphs and adults can transmit Borrelia [11].

Ticks measure from less than 1 mm to 3 mm and easily go unnoticed. Contrary to popular belief, they do not jump or fall from trees: they cling on as you brush past grass or bushes [14].

A bacterium among many infections

Borrelia is one of a group of infectious pathogens that can be transmitted by tick or insect bites [4-5]. In Switzerland, 79% to 83% of ticks carry at least one infectious agent [16]. When other pathogens are present in addition to Borrelia, they are referred to as "co-infections" [6]. In many cases, it is the combination of these different pathogens in the same patient, together with the complex immune response to their simultaneous presence, that causes severe and disabling chronic symptoms [7-8-9 ].

What treatments are available for Lyme borreliosis?

As with diagnosis, treatment has been debated for years among doctors and specialists, especially when the infection becomes chronic — see the Lyme Wars page [45-46].

I - Official treatments:

In Switzerland, physicians are advised to follow the guidelines of the Swiss Society for Infectious Diseases (SSI) for the treatment of Lyme borreliosis [21-22-49].

The SSI considers the management of the disease according to its recommendations to be generally adequate, and recommends antibiotic treatments lasting 10 to 60 days depending on the stage and the patient's symptoms. Only one antibiotic is used at a time, such as doxycycline, amoxicillin, cefuroxime or ceftriaxone.

It currently recognizes the possibility of persistent symptoms after this type of antibiotic treatment, which it defines as "Post-Treatment Lyme Disease Syndrome", but does not recognize the potential persistence of the bacterium after treatment, defined as "chronic Lyme". Re-treatment is therefore not recommended by the SSI, and is even criticized [22-23].

II - Specialized treatments:

A very large number of scientific publications (>700) indicate that the bacteria could persist. Depending on the study, 10 to 20% of patients do not respond to treatment and develop chronic symptoms after official treatment [47-48].

Many doctors and researchers consider the official treatments to be too short and inadequate, and much prefer the term chronic Lyme borreliosis [48]. They offer longer protocols, adapted to the stage of the infection, to co-infections and to the patient's response [27-28].

These treatments can last weeks, months, sometimes years. They generally combine several substances in parallel in order to reach all the forms the bacterium can take to survive: intracellular, cystic, dormant and biofilm [53-54-55]. Their effectiveness has been demonstrated in some studies [50-51-52].

Extracellular forms

Intracellular forms

Cystic forms

Biofilms

The table below shows, by way of example, the active substances used by physicians who are members of ILADS in the USA, as cited in books, conferences and recent scientific publications.

Please note

This table is provided for information purposes only. It does not in any way constitute medical advice or a treatment recommendation. Any decision regarding treatment must be made in consultation with a qualified healthcare professional.

Forms	Therapeutic
Intracellular	Tetracyclines: Doxycycline Minocycline Macrolides: Azithromycin Clarithromycin
Extracellular	Penicillins: Amoxicillin Benzathine penicillin IM Cephalosporins: Cefuroxime Cefdinir
Cystic	Antibiotics: Hydroxychloroquine Metronidazole Tinidazole Phytotherapy: Grapefruit Seed Extract (GSE)
Persistent	Antibiotic: Dapsone Other: Methylene blue Disulfiram Phytotherapy: Oregano, cinnamon, clove EO Cryptolepis sanguinolenta Scutellaria baicalensis Polygonum cuspidatum Berberine
Biofilms	Antibiotics: Rifampin Rifabutin Phytotherapy - Enzymes: Oregano EO Serrapeptase Nattokinase Lumbrokinase Monolaurin

Is there a vaccine?

There is currently no vaccine against Lyme borreliosis. The only one available, LYMERix®, was withdrawn from the market in 2002. A new candidate, VLA15, is in phase 3 of development [56-57].