Lyme disease: obstacles to diagnosis and effective treatment – Medical News Bulletin



Lyme disease

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Lyme disease is a bacterial infection that is spread when a person is bitten by an infected tick. A recent study examined the factors that influence diagnosis and effective treatment.

Lyme disease is a bacterial infection spread by ticks. Although Lyme disease is associated with deer ticks, other species can also spread the disease. Individuals increase their risk of being bitten by an infected tick when they participate in outdoor activities in affected areas, forested areas or in areas with tall grasses. Out-of-home animals can also take infected ticks into their homes.

Prevention strategies

The best prevention strategies are to prevent the sign from adhering to the skin. Avoiding forested, overgrown areas works best to prevent tick bites. However, as individuals go hunting or walking, caregivers advise to use insect repellents and wear hats, long-sleeved shirts and long trousers that have been put on shoes with closed toe. Individuals are also advised to brush off clothes before entering the house and to do a visual scan of ticks on the skin.

If a person finds ticks on his body, it is vital to remove them as quickly as possible. If a tick is attached to the skin, a pair of tweezers can help to grasp the tick between the head and the skin and gently pull away. It is good if there are parts of the mouth, because this part of the tick does not pass on the disease and it will work itself out of the skin.

Stages and symptoms

Lyme disease consists of three phases:

  • Early Lyme disease phase: May last up to 90 days and includes the spread of borrelia burgdorferi spirochetes (long, spirally coiled cells) at the site of the bite
  • Early spread Lyme disease: The bacteria start to spread through the body
  • Late Lyme disease: The bacteria have spread throughout the body. This phase is characterized by the appearance of a lesion and target rash, called erythema migrans lesions, at the site of the bite that can occur in the first month after the bite (on average seven to ten days) and usually within three to four months.

Once the bacteria enter the bloodstream, it causes inflammation in the joints and the nervous system. In some cases, other organs can also be affected. The most common symptoms of Lyme disease are musculoskeletal pain, fatigue, headache, nausea, numbness, neck pain and cognitive disorders. It is not known how the spirochetes cause symptoms, but some researchers claim that they stem from the body's autoimmune response to the bacterium.

Regardless of the pathology, chronic Lyme borreliosis can significantly affect the quality of life of a person. According to a study of 3,000 people with chronic Lyme disease, 43% reported that they can not work due to the severity of their symptoms. In addition, 50% indicated that they have been ill for more than 10 years.

The general model of total patient delay (GMTPD)

In a recent study published in BMJ openAmerican researchers conducted in-depth interviews (2014-2017) with 26 people (22-70 years) who had confirmed the diagnosis of Lyme disease.

Each person was asked about their experiences with diagnosis and treatment and their answers were coded to identify common themes based on the GMTPD stages:

  1. Valuation Delay: Time between the onset of symptoms and the distraction of disease
  2. Sickness delay: time between the distraction of illness and the decision to request medical attention
  3. Behavior delay: the time between the decision to seek help and calling an appointment
  4. Schedule delay: time to the actual appointment
  5. Treatment delay: time between appointment and treatment

Factors that influence the diagnosis

Misattribution has led to assessment, illness and behavioral delays

Because ticks are very small, not all affected people are aware that they have been bitten. Moreover, it appears that the subsequent skin rash does not appear to have the form of the characteristic target or does not appear to be at all. For example, only 10 participants reported a result, 3 of which were in the form of a rose. In just five cases, the result was serious enough for the people to seek medical attention.

In general, patients were quick to schedule medical follow-up as soon as they started to experience other symptoms such as fatigue and joint pain; however, since the three phases of Lyme disease overlap and the second phase can be skipped, the diagnosis was still difficult.

Nearly 35% of the participants were sent for consultation with neurologists and rheumatologists and initially diagnosed with other disorders. It should be noted that delays in the planning were not a significant obstacle to the care for one of the participants.

Testing for Lyme disease

Unlike throat inflammation, there is currently no way to grow the bacteria to test for Lyme disease. A practical approach is to test the tick. However, this is not always possible. If a person begins to experience some symptoms or if erythema rash appears, a diagnosis can be confirmed using serological tests or a Western Blot test with IgG to search for antibodies against Lyme disease in the blood.

Again, laboratory tests such as these are not always sensitive enough to identify the presence of Lyme disease. Some tests produce "false negatives", meaning that the test does not indicate Lyme disease if the person has it.

Factors that influence effective treatment

Delays in the healthcare system

Due to the health insurance system in the United States, the lack of adequate health insurance has contributed to delays in the treatment of different participants.

Lack of research

According to current protocols, infected individuals must be prescribed two to four weeks of treatment with antibiotics such as amoxicillin or doxycycline. However, there is a lack of research regarding the dosage or duration of the antibiotic treatment needed to eradicate the symptoms and prevent relapse. Also, it is currently difficult to assess whether people with chronic Lyme disease respond well to treatment because there is no definitive way to determine if the infection is being resolved. Future research into these problems can only help to reduce the number and severity of both symptoms and complications caused by Lyme disease.

Family

Participants reported that they sought medical help and treatment more quickly when family members asked for it. In some cases, Lyme disease was only diagnosed and treated when the family member demanded that they be transferred to another medical professional or hospital.

In conclusion, the GMTPD was a useful tool for assessing the obstacles to the diagnosis and effective treatment of Lyme disease. Understanding these obstacles will help lead to better treatments and better dissemination of information.

Written by Debra A. Kellen, PhD

References:

(1) Donta, S.T. (2012). Problems in the diagnosis and treatment of Lyme disease. The open neurology diary, 6, 140.
(2) Hirsch, A. G., Herman, R. J., Rebman, A., Moon, K. A., Aucott, J., Heaney, C., & Schwartz, B. S. (2018). Barriers to diagnosis and treatment of Lyme disease in the US: qualitative research. BMJ open, 8(6), e021367. doi: 10.1136 / bmjopen-2017-021.367
(3) Johnson L, Wilcox S, Mankoff J, Stricker RB. Severity of chronic Lyme disease compared to other chronic disorders: a quality of life research PeerJ. 2014.
(4) Medline Plus. Lyme disease. Retrieved on June 25, 2018 via https://medlineplus.gov/ency/article/001319.htm


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