1. What role does the tick life cycle play in tick-borne illness?
Each tick will feed on 3 hosts during a 2 year lifecycle― one each at nymph, larval and adult stages. Because ticks attach to various host animals and feed on their blood, ticks harbor a variety of bacteria and viruses in their gut. These blood-borne bacteria are easily spread from the first host – often a rodent or bird― which “picks up” the nymph in a moist dirt bed― to the second host, a dog or deer. Blood-borne bacteria from the tick’s first two hosts are transmitted to its final host, which is sometimes a human. Depending on what is absorbed from the previous blood meal(s), ticks may transmit bacteria or viruses which cause disease to both people and animals. (Remember, however, that not all bacteria will cause disease.)
For example, ticks get the bacteria that causes Lyme Disease by feeding on white-footed mice, “the reservoir” of this infectious disease. This unique kind of bacteria is called a spirochete. It has a corkscrew shape, like a Slinky™ and can curl up and has the ability to collapse into a dormant “round body" to survive when conditions are unfavorable―such as when a host is receiving antibiotic treatment in an attempt to kill it. When conditions change, the spirochete bacteria can unravel and continue causing tissue damage and disease.
2. Why is tick-borne borreliosis called “Lyme Disease” in the US?
The most common tick-borne infection globally is caused by the dangerous spirochete bacterium genus called Borrelia. In most countries around the world, infection with this type of bacteria is called borreliosis. The black-legged tick (sometimes called a “deer tick”) carries Borrelia burgdorferi in the USA, while other ticks are known to carry B. miyamotoi, B. hermsii, B. parkerii, and B. turicatae. In other countries related illnesses are caused by B. afzelli and B. garinii.
The Borrelia burgdorferi spirochete was first identified in association with clusters of rare diagnoses of juvenile arthritis in neighborhoods in Lyme, Connecticut, circa 1977. This discovery occurred when a parent who worked in Public Health brought together investigators that observed the condition had a seasonal pattern and similar “Bulls-Eye” rashes; it was determined to be due to seasonal surges in tick bites in areas with wooded boundaries. The studies, localized to Lyme, coined the non-specific label of “Lyme Disease” since the pathogen was initially unknown.
Meanwhile, Dr. William Burgdorfer, a microbiologist searching for the organism which caused Rocky Mountain Spotted Fever (another common tick-borne infection), met an unidentified spirochete while sampling ticks in Colorado. He was able to connect it to the skin from rashes in the cases of orphan “Lyme Arthritis”, thus connecting it as the causative agent. Despite this, the unscientific name, and the strong association with arthritis, has stuck for “Lyme Disease”, whereas the extent of disease was not limited to these narrowly defined cases.
The telltale bulls-eye rash and aching joints aren’t always present or seen with borreliosis. The bacterium may evade the host’s immune system and exploits weak areas in the body, with symptoms that can include: brain fog, headaches, hallucinations, flu-like symptoms, Bell’s Palsy, rashes, fever, muscle pain, meningitis, seizure activity, chronic fatigue, and in advanced cases left untreated, neurodegenerative disease and paralysis.
3. How is borreliosis diagnosed?
The various bacteria transmitted from ticks to humans are surprisingly difficult to diagnose. Because ticks bite with an anesthetic so we can’t feel them, you may be unaware that a tick has bitten you. The wide array of tick-borne illness symptoms makes diagnosis even more challenging. In addition to Borrelia bacteria, ticks carry numerous other infections such as Mycoplasma (“walking pneumonia”), Babesia (a parasite that infects red blood cells), Tularemia (bacteria contracted from mainly rabbits which may cause ulcers or swollen glands), and Anaplasma (which infects immune cells), among others. Symptoms of these infections may overlap, as well as be “additive” if more than one infection is contracted per tick (a reality that is increasing).
A bulls-eye rash itself is diagnostic of Borrelia burgdorferi. If you develop such a rash, take photos and document its progression (it should enlarge over time)―and seek medical attention. Common misdiagnoses are fungal infections and spider bites, so photograph and document well in case you need a second opinion.
4. How long after a tick bite might you see symptoms?
Adding to the diagnosis conundrum, the incubation period for tick-borne illness varies. Symptoms may appear from four weeks up to several months after the bite.
One red flag for tick-borne illness is flu-like symptoms in the summer months. The flu virus is not present in North America in the summertime, and such symptoms can be a telltale sign of tick-borne illness. It is important to seek medical attention for a suspected tick bite if you experience a “summer flu”.
Because it is so challenging to identify, tick-borne illness can go undiagnosed for years, during which time the spirochetes reproduce readily and invade various systems of the host. In addition, there may be more than one tick-borne infection present, which complicates the diagnosis and treatment and can mean a multitude of symptoms that don’t align with a single diagnosis.
“I presented with recurrent upper respiratory infections, swollen glands, brain fog, and autoimmunity, which affected my hormones, digestion and nervous system. Because arthritis wasn’t my principle complaint, it took 2 years for me to be tested for Lyme Disease,” said Krista Hewlett Keegan, a neuroscientist who left medical school due to her disability with undiagnosed neurological Lyme Disease. “When he said he wanted to test me, I agreed but told my doctor I thought Lyme was unlikely because I didn’t see a tick or have an acute fever, which is what Infectious Disease medical classes taught for recognizing borrelia infections. The wide range of presentations just wasn’t discussed. Even 2 years after symptoms began, my Lyme test wasn’t positive, so the bacteria spread for several more years and my symptoms kept getting worse.”
5. How is tick-borne illness treated?
Early Diagnosis. As with many diseases, the sooner you treat tick-borne bacterial infections, the better. If someone has a classic bulls-eye rash and is diagnosed with borreliosis early, the antibiotic doxycycline, given in a long course over four to six weeks, may clear the disease effectively. This particular antibiotic covers a broad range of tick borne infections.
Late Diagnosis. For infections that have lingered undiagnosed for months or years, treatment will take longer and become much more comprehensive due to complications caused by the infection. For example, adults experiencing muscle aches or leaky gut symptoms who were treated briefly for Lyme Disease in childhood may still have an active tick-borne infection which went dormant in the presence of antibiotics but has since re-emerged. In fact, I see many such patients who became labeled with Fibromyalgia, Depression or Chronic Fatigue Syndrome later in life.
Standards of Care. There are conflicting standards of care for the treatment of borreliosis cases where a faulty negative diagnostic test is suspected. This ranges from (i) when & how to diagnose it, (ii) how to treat it, and (iii) how long that treatment should last. Furthermore, some people continue to have symptoms after the initial treatment.
The Infectious Disease Society of America (IDSA) defines one standard of care, which says that persistent symptoms following a diagnosis and treatment of borreliosis is due to errors of the immune system (autoimmunity) which becomes labeled as “Post-Treatment Lyme Disease Syndrome”, or PTLSD. There is little treatment for PTLSD; patients are given encouragement that their “symptoms are real”, but continue with symptomatic impairments similar to the original infection. They may also be given repeated rounds of immunosuppressants, such as cortisone injections in painful joints. This type of care is criticized by some, since immunosuppressive agents are contraindicated (meaning, potentially harmful) if in fact there is an ongoing infection. While proving that the infection persists (the needle in the haystack) is challenging, proving that it doesn’t is nearly impossible. Indeed, no alternative markers for “autoimmune diagnosis” have been made.
The International Lyme and Associated Disease Society (ILADS) also has a recognized standard of care for tick-borne illness, and emphasizes that other infections (“co-infections”) are under-diagnosed. ILADS trained clinicians recognize that borreliosis and its related co-infections can be difficult to diagnose, and can go dormant when antibiotics are present.
“Lyme-literate” clinicians who follow the ILADS standard of care prescribe multiple rounds of antibiotic treatment spaced apart over several years to target hidden reservoirs of dormant bacteria that re-emerge after each round of antibiotics, with the ultimate goal of eradicating the infection from the body in a Goal Directed manner (similar to the treatment for Tuberculosis, which isn’t “one size fits all”). They also target “biofilms” – protective layers that help bacteria survive in adverse environments such as household plumbing, hot tubs and dental infections – which these clinicians believe help the bacteria persist for long periods of time despite immune surveillance and treatment.
In addition, integrative medical practices may be incorporated into treatment of long-term tick-borne infection, including full bodily support for cellular detoxification, nutritional guidance, immune support, and herbal antiparasitics.
“By the time I was diagnosed, I had been suffering from borreliosis for 4 years; therefore one course of antibiotics wasn’t enough. I had integrative treatment including antibiotics for 18 months― with progress the whole time,” Keegan continued. “Lyme Disease changed the course of my life, but I was lucky enough to make a full recovery.”
Suspect you or a loved one may have borreliosis? Request a consultation.