As the sun heats up and summer fun gets underway, one thing is for certain: bugs want to be invited to the party. Living in the Midwest, one illness that sometimes goes unnoticed until it becomes a chronic issue, is Lyme disease. You have probably heard about or know someone that has been bitten by a tick and diagnosed with Lyme. However, there are many misconceptions….
Lyme disease was named after the Connecticut town where the illness was first identified in 1975. The bacteria that causes Lyme disease is called Borrelia burgdorferi, and its family has been around 16-20 million years. Since first identified in Connecticut, Lyme disease has been found in every state, and if left, a lot of undesired symptoms can occur.
The CDC estimates that more than 300,000 people are diagnosed with Lyme disease each year in the US. Of these infections, an unknown number of these diagnoses will result in a chronic, difficult-to-treat illnesses. Lyme disease affects all age groups, with particularly high occurrences among children, especially ages 5-14, and adults 45-64 (CDC, 2013).
One of the most common routes to infection that we hear about is a bite from a tick. However, besides tick bites, there are other ways this disease can be transmitted.
Bugs + Insects:
Tick bites (from all different ticks, not just the common deer tick) are commonly associated with the transmission of Lyme disease. Many other bugs and insects like mosquitoes, fleas, mites and flies can carry Borrelia burgdorferi as well as other infectious pathogens known as co-infections (3,4,5). These insects feed on mammals and then deposit these pathogens through their saliva when they bite a human host.
Transmission of Lyme through blood transfusions is another route to spread this disease. Although low risk, a few studies have found Borrelia burgdorferi in blood of patients with early Lyme disease culture tests (7,8).
Borrelia are likely to be found circulating in the blood sporadically or they may persist for a time period ranging from 2 to 5 weeks and in some cases beyond this time frame (6,7,8,9).
There have been numerous documented reports of Lyme disease transmission during pregnancy. However, there are currently not enough studies with large population sizes of pregnant women to determine the actual Lyme disease transmission rate.
Transmission of Lyme disease in pregnant women is prevented when taking antibiotics. Pros and cons of therapy should be discussed with a provider because antibiotics can have an adverse effect on the microbiome health of mother and baby.
Research studying the transmission of Lyme disease from mother to baby through breastfeeding is limited, but the antigenic material of Borrelia burgdorferi bacteria has been found in breast milk. It is unknown if any infants have been infected through a mother’s milk, and it is not known if that genetic material that is transferred is infectious or not (10).
There are newer studies showing Lyme disease can be sexually transmitted, however we do not know that rate or chance of transmission. Studies show Borrelia burgdorferi in vaginal fluid and male ejaculate of those who have tested positive for Lyme. Lyme disease is a spirochete (a spiral-shaped bacteria), similar to syphilis, which is well-known to be sexually transmitted (2,3).
There are some common myths about Lyme disease that many people (including healthcare practitioners) believe:
- A tick must be embedded in the skin for at least 24 hours to infect a person.
False. Rapid transmission can occur no matter the duration of time the tick was embedded. In some research studies, Lyme bacteria was spread in less than 24 hours. One paper reported a case of Lyme disease transmitted after six hours of tick attachment.
- Just this past week a friend’s son had a tick embedded in his arm, it was the size of a poppy seed. It was on him less than 6 hours and within 3 days he developed a fever, fatigue, enlarged lymph nodes and other common symptoms. He is currently being treated.
- You must have a bullseye rash to have Lyme.
False. Only 10-50% of people actually form the erythema migrans (aka a bullseye rash) seen in common Lyme disease photos. The rash is the result of saliva on skin after the initial bite. A majority of patients with chronic illnesses associated with Lyme disease, usually never knew they were bitten. These people usually venture in the woods, have a house with trees or have animals/pets that commonly have ticks on them.
- Ticks and other insects only spread the one infection we know as Borrelia burgdorferi.
False. Ticks/infectious insects can carry over 237 different types bacteria, over 47 viruses, parasites and more. Common co-infections often found in Lyme disease patients include Babesiosis, Ehrlichiosis, Anaplasmosis, Mycoplasma, Bartonella, STARI, Rocky Mountain Spotted Fever, Rickettsiosis, B. Miyamotoi, Hermsii, Tularemia and more.
In Part 2 we will discuss signs and symptoms as well as testing options. In Part 3 we will discuss potential treatments and prevention methods.
In the meantime, enjoy the sun and check yourself for ticks! If you do have a tick bite, remove the tick with a tweezers (you can easily search this how-to method online), put it in a baggie and send it to a lab to analyze it. It is important to seek treatment as soon as possible. Lyme disease is something I have seen frequently in my clinic and something that people don’t want going from an acute and treatable condition to a lifelong, debilitating disease.
Stephanie Grutz, ARNP, FNP-C
- CDC Provides Estimate of Americans Diagnosed with Lyme disease Each Year. 19 Aug. 2013, www.cdc.gov/media/releases/2013/p0819-lyme-disease.html.
- Middelveen MJ, Burke J, Sapi E et al. Culture and identification of Borrelia spirochetes in human vaginal and seminal secretions F1000Research 2014, 3:309.
- Recovery of Lyme spirochetes by PCR in semen samples of previously diagnosed Lyme disease patients. Gregory Bach, DO, International Scientific Conference on Lyme disease, April 2001.
- Tetow, GJ et. al. Isolation of Borrelia burgdorferi from Arthropods Collected in Texas. Am J Trop Med Hyg, 1991 May; 44(5) 469-74.
- Pokom, P. Incidence of the Spirochete Borrelia burgdorferi in Arthropods and Antibodies in Vertebrates. Csek Epidemiol Mickrobiol Immmunol, 1989 Jan; 38(1) 53-60.
- Kosik-Bogacka, DI et, al. Ticks and Mosquitoes as Vectors of Borrelia burgdorferi S. L. in The Forested Areas of Szczecin. Folia Biol (Krakow) 2007; 55(3-4) 143-6.
- Pavia CS, Plummer MM. Transfusion-Associated Lyme disease – Although Unlikely, It Is Still a Concern Worth Considering. Front Microbiol. 2018;9:2070.
- Wormser GP, Bittker S, Cooper D, Nowakowski J, Nadelman RB, Pavia C. Yield of large-volume blood cultures in patients with early Lyme disease. J Infect Dis. 2001;184(8):1070-1072.
- Gabitzsch ES, Piesman J, Dolan MC, Sykes CM, Zeidner NS. Transfer of Borrelia burgdorferi s.s. infection via blood transfusion in a murine model. J Parasitol. 2006;92(4):869-870.
- Thorp AM, Tonnetti L. Distribution and survival of Borrelia miyamotoi in human blood components. Transfusion. 2016;56(3):705-711.
- About Ticks and Lyme disease. www.lymedisease.org/lyme-basics/ticks/about-ticks/