Lyme disease

Introduction

Lyme disease (also known as Lyme borreliosis) is a disease that is transmitted by bacteria known as borrelia. Lyme disease is transmitted to humans through the bite of an infected tick. Various organs can be affected by Lyme disease, for example the skin, joints, heart or nervous system. The disease can be treated with antibiotics.

Ticks infected with borrelia live mainly in deciduous forests with lush undergrowth and can be found throughout Switzerland up to an altitude of 2000 metres above sea level. However, the animals also lurk in bushes, hedges and meadows - for example on forest edges, in parks, in gardens, on lakes or in outdoor swimming pools. As a rule, ticks are active from spring to autumn, but occasionally also in mild winters.

To prevent Lyme disease, it is advisable to wear well-fitting clothing and protective clothing and to avoid spending time in undergrowth.

Symptoms

Experts refer to Lyme disease as a multi-system illness, as it can affect different organs at the same time - for example the skin, joints (Lyme arthritis), nervous system (neuroborreliosis), eyes or heart. In 80-90 per cent of all cases, only skin diseases occur, in 10-20 per cent of cases other organs are affected. The disease is categorised into three stages:

Stage 1/early stage (1-30 days after the bite): A ring-shaped reddening of the skin forms around the sting. This reddening is sharply demarcated and does not hurt or itch. The redness increases in size and then disappears spontaneously. Nevertheless, consultation with a doctor is recommended. Redness is the most important symptom for recognising Lyme disease in the early stages. This first phase can also be accompanied by a flu-like condition - for example general weakness, chills, headache, aching limbs or muscles, fever or conjunctivitis.

Phase 2/early stage (several weeks after the sting): This phase is often accompanied by flu-like symptoms. There may be further reddening of the skin - these may be round or oval or appear as dark red lumps or spots. Meningitis, pain, paralysis or neurological deficits may also occur. In rare cases, Lyme disease attacks the heart, which can lead to inflammation of the heart muscle and pericardium. The eyes can also become inflamed.

Phase 3/late stage (months to years after the bite): This severe stage of Lyme disease is characterised by so-called Lyme arthritis - this is an intermittent or chronic inflammation of the joints. At this stage, the skin on the hands and feet may become bluish in colour and the skin becomes thin (skin disease acrodermatitis). Other symptoms that can occur in this phase are late neuroborreliosis (disease of the nerves) or myositis (inflammatory disease of the muscles). In rare cases, phase three is so severe that parts of the body are paralysed.

Verlauf

In most cases, a tick bite is completely asymptomatic and only around five per cent of all tick bites result in Lyme disease. The earlier the disease is treated with antibiotics, the milder the course and the more reliably later complications such as bacterial joint inflammation (Lyme arthritis) and infestation of the nervous system (neuroborreliosis) are prevented. These complications sometimes lead to life-threatening damage. Basically, if Lyme disease is treated in the first stage (early stage) and the disease is thus cured, it does not progress to stages two and three in 99 out of 100 cases. In very rare cases, symptoms occur in the late stage without symptoms of the early stages having appeared beforehand.

After the disease has passed - when pathogens are no longer active - symptoms such as tiredness, fatigue, concentration problems, headaches or joint pain and depression can persist for months or even years.

Causes

The cause of Lyme disease is an infection with so-called Borrelia bacteria. Borrelia bacteria are often found in birds or small rodents. Ticks in turn become infected when sucking blood from infected animals and can transmit the Borrelia bacteria to humans during the next blood meal.

Ticks infected with Borrelia live mainly in deciduous forests with lush undergrowth and can be found throughout Switzerland up to an altitude of 2000 metres above sea level. However, the animals also lurk in bushes, hedges and meadows - for example on forest edges, in parks, in gardens, on lakes or in outdoor swimming pools. As a rule, ticks are active from spring to autumn, but occasionally also in mild winters.

Diagnosis

A doctor can usually diagnose Lyme disease without a large number of examinations: The medical history, symptoms and findings are often so typical of Lyme disease that they are sufficient for an appropriate diagnosis. In many cases, headaches and muscle pain occur. If the affected person has been bitten by a tick but has no other symptoms, Lyme disease is rather unlikely. Lyme disease can be easily diagnosed by a doctor using telemedical images (typical reddening in the first phase).

Treatment

Lyme disease is treated with antibiotics and can also be completely cured if it is recognised in time. The earlier treatment is started, the more effective it is and the more likely it is that severe courses of the disease will be avoided. There is no immunity, i.e. a new infection is possible at any time once Lyme disease has been overcome.

The most important measure after a tick bite is to remove the tick as quickly as possible. It is then advisable to disinfect the site of the bite and observe it for six weeks. It is also advisable for those affected to note where and when the tick bite occurred and to take a photo of the bite site. If headaches or joint pain, reddening of the skin or flu-like symptoms occur after a tick bite, those affected should contact a doctor.

The tick should be pulled out slowly and evenly in a vertical position using tweezers or a tick card. Pulling too abruptly can result in the tick's head getting stuck in the skin. The earlier the tick is removed, the lower the risk of borrelia transmission. As a rule, transmission begins around 12 to 24 hours after the start of the bite.

Under no circumstances should patients use oil, glue, alcohol or other supposed household remedies against the tick. The use of such products can lead to the tick excreting more of its saliva, which is full of pathogens. These products therefore increase the risk of infection rather than helping.

Prevention

In principle, Lyme disease cannot be prevented directly. In contrast to tick-borne encephalitis (TBE), there is no vaccination against Lyme borreliosis. The best protection against Lyme disease is to avoid tick bites. Well-fitting clothing and avoiding undergrowth offer protection against ticks. Protective products for skin and clothing are also helpful. These protective agents help for a certain time, but they do not offer complete protection.

As tick bites often go unnoticed, your body and clothing should be checked for ticks every time you are in the forest. Ticks prefer warm body parts and soft skin. For this reason, the body should be checked especially between the legs, under the arms, around the navel, on the head, neck and ears.

In our Medgate Doc Channel, Medgate doctors explain the most important points in brief. Dr Manuel Puntschuh, telemedicine specialist at Medgate, explains how to protect yourself optimally against tick bites: