Ronald J. Grisanti, DC, DABCO, DACBN, MS, CFMP
Early Localized Lyme
The classic sign of early local infection with Lyme disease is a circular, outwardly expanding rash called erythema migrans, or EM rash, which may occur at the site of the tick bite three to 30 days after the bite. The textbook presentation of the EM rash commonly appears as a bull’s eye, hence its nickname “bull’s eye rash.” Unfortunately, the EM rash is absent in more than 50% of Lyme disease cases, which is one reason an acute Lyme infection may be missed by many physicians. The physician should consider Lyme when a patient presents with flu-like illness, fever, malaise, muscle soreness, and headache after camping, hiking, or gardening.
Early Disseminated Lyme
In early disseminated Lyme, the bacteria will spread through the bloodstream, contributing to muscle, joint, and tendon pain. Dizziness and headaches, heart palpitations, severe fatigue, and mood changes are common.
Chronic Lyme Disease
Chronic Lyme disease presents a challenge to the astute clinician because the Infectious Diseases Society of America (IDSA) denies its very existence, while the International Lyme and Associated Diseases Society (ILADS) believes the Lyme infection exists past 30 days, causing ongoing symptoms and disability.
Joseph Burrascano, MD, a physician at the forefront of Lyme disease treatment and research in the United States, and author of “Advanced Topics in Lyme Disease: Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illness,” offers the following definition:
For a diagnosis of chronic Lyme disease, these three criteria must be present:
- Illness present for at least one year.
- Persistent major neurologic involvement (such as encephalitis/encephalopathy, meningitis, etc.) or active arthritic manifestations (active synovitis).
- Active infection with Borrelia burgdorferi (Bb), regardless of prior antibiotic therapy (if any).
ILADS, the US-based organization that recognizes chronic Lyme disease, has adopted a set of treatment guidelines that have been widely used in clinical practice (available at www. ilads.org). They state the following:
“Chronic Lyme disease is inclusive of persistent symptomatologies including fatigue; cognitive dysfunction; headaches; sleep disturbance; and other neurologic features such as demyelinating disease, peripheral neuropathy and sometimes motor neuron disease; neuropsychiatric presentations; cardiac presentations including electrical conduction delays and dilated cardiomyopathy; and musculoskeletal problems.”
Lyme disease is known as the “Great Imitator.” Its list of symptoms is long and