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How does Lyme cause fatigue, autoimmune disease and neurological symptoms?

What is persistent Lyme Disease?

Lyme is a bacterial infection caused by Borrelia burgdorferi and transmitted by a tick. The incidence of Lyme disease in the United States has approximately doubled since 1991. Approximately 300,000 people get Lyme disease each year in the United States. This does not take into account missed cases that were never tested. Around 10-20% of those treated with antibiotic continue to have persistent symptoms or develop disease related complications later on. Another group of patients that develop persistent symptoms are those who were tested but the results were falsely negative. The current 2 tiered diagnostic testing only identifies 30-40% of cases. Hence 60% cases are missed if conventional methods for testing are used. These patients are never treated and develop long term Lyme related complications.

What are the symptoms of persistent Lyme Disease?

Lyme disease occurs in 3 stages as outlined below. However, not every patient will go through all stages. There could be weeks, months or years between the stages or patients may experience an overlap of symptoms from the different stages at the same time. A patient is diagnosed with persistent Lyme If he/she continues to experience the symptoms in any of the 3 stages after completion of antibiotics for Lyme treatment and they continue for months. However, any individual who has the following symptoms needs to be checked for Lyme disease to identify and treat the cause.

1. Early localized: Even though the classic sign of this stage is a circular rash, many people may never see a rash. Other symptoms include fever and chills, flu like symptoms, headache and stiff neck, muscle and joint pains as well as swollen lymph nodes. In some cases, the patient may directly progress to the second or third stage.

2. Early Disseminated: A person may experience all of the above symptoms. In addition, they may experience neurological symptoms such as burning, tingling, numbness, fibromyalgia, poor memory, and concentration. In addition, there might be redness of the eye or other visual symptoms. The individual could also experience episodes of redness and swelling of different joints. There might be palpitations because of abnormal heart rhythms or chest pain along with shortness of breath from inflammation of the heart .

3. Late Disseminated: This stage is marked by serious symptoms indicating severe inflammation including psychiatric symptoms such as anxiety, depression with suicidal thoughts, panic attacks and brain fog, severe headaches, persistent inflammation of joints and inflammation, and bell's palsy. 

Why do antibiotics fail to control Lyme disease in those who are treated?

Unfortunately individuals who are diagnosed with chronic Lyme keep on getting repeated rounds of antibiotics and some may receive then for months and years. These individuals may have symptomatic relief for a short period of time but will often have recurrence of symptoms. Research shows that long term antibiotics are not always successful in eradicating persistent Lyme disease. In addition, there are a lot of side effects associated with taking oral and In antibiotics including allergic reactions, digestive issues, bleeding from the digestive tract, inflammation of the gall bladder requiring surgery, infections, blood clots and deaths from injectable antibiotics. 

 

There are multiple reasons why antibiotics fail to control the Lyme disease. First explanation is that the bacteria is inside the cells making it difficult to penetrate the cell hence the antibiotics are only partially successful at killing the bacteria. The second reason is the the persistent symptoms are related to a heightened state of inflammatory response. Even though the bacteria is no longer present, it activated the immune system which led to inflammation and the body's ability to deactivate the immune system and suppress the inflammation is inadequate or non-existent.

How does Lyme trigger Autoimmune Disease?

Research shows that when the human immune system is exposed to Lyme disease for a long time, it creates a state of persistent inflammation. This inflammation causes dysfunction of the immune system. As a result the immune system produces a lot of different antibodies. Some of the antibodies directed against the bacterial protein start to attack human proteins because these proteins look similar to each other. This phenomenon is termed as molecular mimicry. 

The persistent inflammation in these individuals constantly keeps the immune system in a state of hyper-activation and this hyper-activation constantly causes production of more inflammation leading to a vicious circle with no end.

How does Persistent Lyme lead to Sarcoidosis?

Sarcoidosis is an inflammatory disease that is characterized by nodules that form in different parts of the body. These nodules often called granulomas consists of inflamed tissues made up of lots of white blood cells cells (macrophages and lymphocytes) that make up the immune system of the body. When the body is exposed to a a persistent infection or toxin, the immune system gets activated. These immune cells constantly release inflammatory substances called cytokines and chemokines. The purpose of this activity is to contain the infection and/or toxin. Unfortunately persistent Lyme exposure impairs a very important part of the immune system called the regulatory cells or suppressor cells. These cells are crucial for deactivating the immune system once it has controlled the infection or contained a specific toxin. Hence the immune system continues to stay active and produce more and more inflammation in the form of granulomas in different organs.

Functional approach to persistent Lyme Disease?

A functional approach to persistent Lyme looks at all the different mechanisms that have been activated by the infection as well as assesses the factors that effect the body's own immune system to fight both the infection, calm the inflammation and revive the balance in the immune system. Below is a diagram that provides an overview of the approach. Remember that each individual will have different reasons for breakdown of the immune system hence the approach needs to be individualized. Most patients with persistent Lyme are very sensitive and so the practitioner needs to be very skilled in addressing  the identified issues.

 

 

 

 

 

 

 

 

 

References

1. https://www.epa.gov/sites/production/files/2017-02/documents/print_lyme_2016.pdf

2. https://www.cdc.gov/lyme/datasurveillance/index.html

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477530/

4. https://www.cdc.gov/lyme/signs_symptoms/lymecarditis.html

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397473/

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477530/#BX1

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337124/

8. https://www.ncbi.nlm.nih.gov/pubmed/15214872

9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857538/

10. https://www.ncbi.nlm.nih.gov/pubmed/1333393

11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126827/

12. https://www.ncbi.nlm.nih.gov/pubmed/15214872