Long-Term Lyme Disease Associated with Particular Bacterial Strain

Ticks are known for causing a wide range of illnesses, with the most common being Lyme disease - a bacterial illness that affects hundreds of thousands of people worldwide. The U.S. Centers for Disease Control and Prevention (CDC) estimates that there are about 475,000 new cases of Lyme disease each year in the U.S.; however, only about 36,000 cases are reported to the CDC.  

Symptoms of Lyme Disease
Lyme disease has a wide range of symptoms and severities that can include:

• Fatigue
• Muscle aches and pain
• Joint pain
• Headaches (often severe)
• Fever
• Chills
• Neck stiffness
• Rash, known as erythema migrans, a reddened area near the tick bite. As rash expands, it usually develops a red ring around the outside that has a “bull's eye” appearance.
• Neurological issues
• Arthritis, joint pain and swelling
• Heart issues such as palpitations, irregular heartbeat, heart disease 
• Facial palsy
• Periodic dizziness and/or shortness of breath
• Brain and/or spinal cord inflammation
• Nerve pain
• Shooting pains, numbness, or tingling in the hands or feet

Types of Lyme Disease
Cases are categorized as localized or disseminated. Localized describes a case that has not spread throughout the body, while in disseminated cases, the bacteria have spread to other tissues and organs.

Localized cases are generally easier to treat than disseminated; physicians treat for this type of Lyme disease with common antibiotics. And most cases of Lyme disease are cleared up within a few weeks. However, some patients continue struggling with  debilitating symptoms months, sometimes even years, after their treatment ended. This is referred to as Post-Treatment Lyme Disease Syndrome (PTLDS).

Some experts believe PTLDS is caused by longer-term bacterial infection that sets off an auto-immune response, raising the risk for Guillain-Barre syndrome, reactive arthritis, rheumatic heart disease, according to the CDC. Other experts disagree, theorizing that PTLDS develops from undetected infection or causes unrelated to the initial Lyme disease infection. And of course, another premise is that PTLDS may be prompted by the type of bacterial strain that caused the Lyme disease.

For the most part, PTLDS lacks a standard treatment plan. Doctors often prescribe a long-term course of antibiotics, but it may not work and can create additional health problems.

There are at least 18 known species of Lyme-causing bacteria. In a new study, an international team of researchers investigated how different strains of Lyme disease influenced the level disease severity experienced among patients. They found a link between certain bacterial genetic markers and severe disease, according to a study published in PLOS Pathogens.

The study included 299 participants from the northeastern and midwestern U.S. and central Europe with early Lyme disease that was classified as either localized or disseminated. Eight participants were removed from the final analysis due to lack of medical records, leaving the results to be based off 291 participants.

Lyme disease bacterial samples were taken from skin biopsies on the bulls-eye area of rashes. Researchers wanted to determine if genetic signatures of bacteria were related to symptoms and to understand why American and European patients experience Lyme disease differently. They also hoped to identify strains responsible for PTLDS. They found:

• Particular genetic markers were connected to symptom severity; these results confirmed outcomes from previous, smaller studies. 
• Genetic of bacterial strains fluctuated by region, explaining the variance in symptoms. 
• Predominant strains found in the Northeast U.S. -- RST1 OspC type A strains -- caused more invasive, disseminated infections with severe symptoms.
• Strains commonly found in Europe often led to neurological symptoms and chronic skin conditions. 
• Specific proteins on the surface of the bacteria contributed to spread beyond the infection beyond the tick bite, through the blood to other tissues and organs. This is the point in which serious disease develops.
• Strains involved in PTLDS were not identified. However, researchers are leaning on results from previous research that linked the risk for developing PTLDS to elevated immune system markers, regardless of how quickly treatments begin.  

“This is the first study to identify these strains,” says Bernard Kaminetsky, MD, medical director, MDVIP. “And it’s important to know, as it can help lead to better methods of prevention and treatment.”

Lyme disease season runs between March to mid-May and mid-August to November. During those periods, try these tips to help protect yourself against Lyme disease.

“If you think you may have been exposed to ticks or are experiencing Lyme disease symptoms, home test kits are available,” says Kaminetsky. “However, I recommend talking to your doctor. They can order the CDC-recommended two-step blood test process.”

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