Borreliose
Information on Lyme disease
What is Lyme disease?
Lyme disease (in Europe mainly Lyme borreliosis) is an infectious bacterial disease transmitted by ticks. The most common pathogen in Europe is the bacterium Borrelia burgdorferi.
Ticks are found not only in Germany, but also in many other European countries, as well as in Russia and Asia. In Germany, around 200,000 people fall ill every year. Five different species of ticks are currently known to transmit Lyme disease. They absorb the pathogens through the blood of wild animals and can then transmit them to humans, among other things.
The disease progresses in different stages and is characterized by different symptoms. Since there is currently no vaccination, special attention is paid to prevention.
Causes of Lyme disease
Infection with Lyme disease occurs through a tick bite. Depending on the region, 5-35% of ticks are infected with Lyme disease pathogens.
However, not every bite from an infected tick means that the bacteria have been transmitted. It is assumed that this only happens in about 5% of cases. This can be explained by the fact that the Lyme disease pathogens must first be activated in the tick's intestine. The longer the tick's sucking action lasts, the greater the likelihood of the bacteria being transmitted.
Tick bites are common from March to November, but the infection is diagnosed all year round because the disease sometimes only becomes noticeable after a delay.
Prevention: How do you protect yourself from tick bites?
The top priority in the prevention of Lyme disease is to avoid tick bites. It is recommended to avoid walking through tall grass or to wear long, light-colored clothing and closed shoes.
In addition, certain substances, so-called repellents, can be applied to keep ticks away. These are based on different mechanisms of action, but they often have a certain smell that has a deterrent effect on the animals. They run a little way along the skin, but then fall off after a short time.
It should be noted that even the application cannot guarantee 100% protection and only the treated area of skin is protected. The corresponding products can be purchased in a pharmacy or drugstore.
What should you do if you are bitten by a tick?
Preventive measures do not always prevent a tick bite.
After a long stay in tall grass, the body should therefore be thoroughly checked for ticks. The small animals are easy to overlook, especially in hairy areas. If a tick is noticed, it should be removed as quickly as possible.
The ticks should be removed from the skin with tweezers without squeezing them. Special tick tweezers, which are available in various drugstores or pharmacies, can be helpful for this. The bite site should then be disinfected if possible.
If symptoms such as reddish skin discoloration in the area of the bite occur after a tick bite, a doctor should be consulted.
Lyme disease symptoms: Overview of the different stages
A Lyme disease infection can cause typical symptoms within three days, but can also remain unremarkable for many weeks. The course can typically be divided into three different stages, with the first two also being grouped together as the early stage. The third stage is then considered the late stage of the disease.
Stage I
The first stage is characterized by the so-called erythema migrans. The term means something like erythema migrans and describes a circular spreading redness around the tick bite site. This is usually accompanied by recurring symptoms such as fever, fatigue, joint and muscle pain.
This stage can last for up to six weeks. However, it should not be forgotten that erythema migrans only occurs in about 50% of cases and the absence of erythema does not rule out Lyme disease.
Stage II
In the second stage of the disease, the patient's nervous system can be affected. This symptom is therefore also known as neuroborreliosis and is usually observed around six months after the infection.
This can include severe nighttime nerve pain, numbness, mainly in the face, and paralysis. The reason for this is inflammation of the nerve roots, which is triggered by the bacteria.
As the early stages of an infection progress (around 2-10 months), nodules can form, mainly on the earlobes and nipples. These nodules are painless, reddish to brown in color, and are called lymphocytomas.
In addition to the nervous system, the heart muscle can also be affected. This can be inflamed as part of a condition known as myocarditis, which usually causes very variable symptoms in those affected.
Stage III
The late stage of the disease affects the period from six months to several years after the infection. Chronic inflammation of the skin, joints or nervous system can occur here.
In the case of chronic joint inflammation, this is referred to as Lyme arthritis. The large joints such as the knee or shoulder joint are usually affected.
Chronic neuroborreliosis occurs very rarely, but can then affect the brain and lead to, among other things, perception or gait disorders.
In addition to these typical symptoms described, a manifestation of the disease in the area of the eyes can also occur at any stage. It must also be noted that an infection with Lyme pathogens does not necessarily have to progress in these stages and a variable course is very common.
Diagnosis of Lyme disease
Although Lyme disease can be divided into three stages in many cases, the symptoms and the temporal course of the disease can also be very variable, making diagnosis difficult.
Initial clues for the diagnosis of Lyme disease can be gathered as part of a detailed anamnesis by asking about the symptoms of the disease. This is particularly important because the symptoms may only appear several months after a tick bite and are therefore usually no longer associated with the bite.
The suspicion is then confirmed by various laboratory tests.
In this context, a distinction is made between methods that detect the pathogen itself and those that reflect the immune system's reaction to the bacteria. The latter includes the detection of IgM and IgG antibodies. Since the body initially produces IgM antibodies and only later IgG antibodies, this usually provides the first indications of the progression of the disease.
Direct detection of the pathogen is the search for Lyme disease DNA from affected regions. This can be skin biopsies, samples of the joint fluid and the cerebrospinal fluid (CSF).
Lyme disease therapy
In the early stages, Lyme disease is treated with a two-week dose of the antibiotic doxycycline.
If the infection is already advanced, antibiotics are prescribed for a period of up to four weeks. The antibiotic ceftriaxone is preferred. To achieve a high level of effectiveness, this is often administered intravenously so that it enters the blood directly.
Currently, no vaccine against Lyme disease is approved in Germany.
Lyme disease complications and prognosis
If left untreated, Lyme disease can progress. In the second stage, inflammation of the brain and meninges occurs (meningoencephalitis), which can lead to life-threatening conditions. Myocarditis or chronic Lyme arthritis can also significantly reduce the quality of life for those affected.
Fortunately, most patients respond well to antibiotic therapy and the symptoms disappear completely.
In some cases, however, certain symptoms persist permanently or for a period of several years. This is particularly common in neuroborreliosis. The permanent damage to the nerve roots can lead to permanent paralysis.
Re-infection with Lyme pathogens is also possible.
Which doctors and clinics are specialists in Lyme disease?
As Lyme disease is an infectious disease, specialists in internal medicine who specialize in infectious diseases are the most competent people to contact. They specialize in both the diagnosis and treatment of a Borrelia infection.
Finding a suitable specialist for the respective disease can be a major challenge for patients. We have therefore made it our mission to bring patients together with the most competent specialists in order to enable treatment at the highest medical level and in accordance with the latest scientific standards.
All of the doctors listed here have been carefully checked by us and selected based on their expertise in the field of Lyme disease. They are all specialists in the field of infectious diseases and have extensive experience. Bonn University Hospital is one of the best hospitals in Germany.
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