When should a physician suspect Lyme Disease?
As a general rule of thumb many physicians would consider Lyme Disease when everything else is negative in a complex medical case. It was quite surprising to me after I received four positives out of four patient cases tested for the Lyme Disease within the recent year. Then the question came about what was in common in these children? I did an extensive review of
both conventional traditional literature and also the Integrative Medicine cases.
My findings made me think that consensus is not there yet and we are not very well educated as physicians on this rapidly growing disease epidemic. Lyme borreliosis is a brain disease as well as a multi-systemic disease caused by spirochetal bacteria. It is an infection that has been burdened with a thousand inaccurate medical diagnosis.
Chronic or persistent Lyme disease – neuroborreliosis – seldom is identified by the symptoms of its most frequent form-subacute encephalitis -an infected/inflamed brain as well as an infected nervous system. However, this is the form in which it most commonly exist. Unfortunately, the syndrome that is falsely considered typical – a bull’s eye rash, fever, positive ELISA test, and / or a swollen large joint – occurs in fewer than half of proven cases. Instead, Lyme borreliosis confirms itself in subtle to profound neuro-psychiatric symptoms such as overriding confusion, loss of organizational skills, decreased concentration, memory loss, mood disorders, irritability, and unprovoked rages – to mention just a few.
Lyme Disease is one of the fastest growing infectious disease in the nation. The Centers for Disease Control and Prevention (CDC) reported over 23,783 new cases in 2002, and the government agency estimates that the total number maybe tenfold higher. The disease caused by the bite of a deer tick infected with the Borrelia burgdorferi (Bb) spirochete and may be complicated by other parasitesor co-infections. It is hard to diagnose because fewer than half of all Lyme patients recall a tick bite or develop the signature erythema migrans (“bullseye”) rash. As a result, many patients go untreated and develop psychiatric and/or neurological symptoms.
These include cognitive losses such as:
* memory Impairment or loss (“brain fog”)
* Dyslexia and word-finding problems
* Visual-spatial processing impairment (trouble finding things, getting lost)
* Slowed processing of information
* Violent behavior, irritability
* Rage attacks/Impulse dyscontrol
* Panic attacks
* Rapid mood swings may mimic bipolarity (mania/depression)
* Obsessive compulsive disorder (OCD)
* Sleep Disorders
* Attention Deficit Hyperactivity Disorder
* ADD/ADHD-like Syndrome
* Autism-like Syndrome
Western blot serologic studies, PCR for Borrelia burgdorferi in blood, serum, cerebrospinal fluid (CSF) and urine, and/or Borrelia antigen testing in urine and CSF are helpful tests. Blood tests should not be used to rule out Lyme Disease when there is a strong clinical presentation.
Most individuals with Lyme Disease respond to antibiotics, but the treatment is highly patient specific.
For more information, visit the ILADS website at www.ilads.org
Aylin Ozdemir, MD, FAAP, ABIHM
Pediatric Associates of Jacksonville
1102 A1A North Suite 104
Ponte Vedra Beach, FL 32082