Lyme disease and its symptoms

"Lyme disease or borreliosis is a multisystemic disease (affects various organs and parts of the body), caused by a bacterium: borrelia, a spirochete that is transmitted to humans through the bite of an infected tick", explains Dr. Guanziroli.

“As we are dealing with a multisystem pathology, symptoms can be extremely varied and differ according to the stage of the disease”, continues the doctor.

Stage 1: erythema migrans and borrelia lymphocytoma

From a dermatological point of view, the initial phase of the disease can be characterized by:

• erythema migrans: occurs a few days or a few weeks after the parasite's bite. In addition to the irritation that can be generated at the exact point of the bite, a characteristic ring shape with darker and reddened edges is created around it, while internal area remains lighter. Generally, there is one erythema migrans, but in the rare cases of multiple bites, real erythema may occur in all proximity to the site of contact with the tick.
• borrelial lymphocytoma: it is a raised, asymptomatic, and reddish papulo-nodular lesion that occurs mainly:
  • in children: on the face and at the level of the ear lobe;
  • in adults: in the areola of the nipple and on the scrotum.

Stage 2: systemic diffusion

If left untreated the infection can spread throughout the body with symptoms such as:

• fever;
• chills;
• muscle aches (myalgia);
• joint pain (arthralgia);
• headache;
• severe tiredness and weakness (asthenia);
• burning and itching caused by light and heat (photophobia)

Stage 3: severe effects

In an even more advanced stage, neglected and persistent infection can generate serious complications such as:

• arthritis;
• encephalomyelitis: an inflammatory pathology affecting the central nervous system (brain and spinal cord);
• acrodermatitis chronica atrophicans: a dermatitis that occurs mainly on lower limbs and initially presents with a purplish erythema, poorly defined and associated with edema, while in the final states also with atrophy of the epidermis and dermis. The onset of acrodermatitis chronica atrophicans occurs months to years after the infection;
• peripheral neuropathy: damage and malfunction of the peripheral neurological structures that connect the various parts of the body to the central nervous system, the symptoms of which often accompany chronic atrophying acrodermatitis;
• carditis;
• meningitis.

If you notice that you have been bitten by a tick, you must remove the parasite immediately, before it can transmit the spricocheta borrellia or other possible pathogens, using tweezers and avoiding breakage of the inoculated part which, remaining in the skin, could cause an infection. If you are unable to do this on your own, it is best to contact your doctor.

A bitten patient who has no symptoms is kept under observation and after a few weeks a blood sample may be taken to identify if an antibody titer against spricocheta borrelia has developed.

Diagnosis is essentially clinical and when the patient presents skin lesions compatible with Lyme disease, a biopsy can be performed, following with a cultural examination or other more advanced molecular biology tests that can highlight the presence of the bacterium.

After the diagnosis:

• if the infection is still localized to the skin and joints, the cure is represented by oral antibiotic therapy based on doxycycline. In the event of a pregnancy, allergies or minor patients the drug can be switched to, for example, amoxicillin;
• for the more advanced stages with multisystem involvement (in particular of the central nervous system) the treatment is always antibiotic, usually based on ceftriaxone and administered intravenously;
• for the most serious phases of protracted and undiagnosed infection, the therapeutic approach varies according to the organ or organs involved and to what extent its / their involvement is.

As the ISS recalls, the tick is a parasite that is unable to jump or fly, but which positions itself on top of the vegetation, awaiting the passage of animal or human to which it can cling, which it is identified by its ability to perceive heat and carbon dioxide.

Areas of the body that it bites and into which it creeps are generally:

• lower limbs;
• groin;
• armpits.

In the area to which it attaches it remains for a few days, in which it feeds on blood. The bite is generally painless, as the saliva of the tick contains anesthetic and anti-inflammatory principles that serve to facilitate nourishment. This explains why once the parasite has detached, it is not easy to identify the disease.

Contact with ticks occurs mainly in:

• wooded environments: places with a lot of grass and vegetation such as woods, grasslands, heaths and urban parks.
• stables and animal shelters: ticks are not very selective regarding who they feed on, so they attach themselves to hares, squirrels, deer, dogs, cats etc. For this reason, when you have contacts or frequent places where there are animals that have been in the middle of the vegetation, you must always be careful.

To prevent tick bite and, consequently, Lyme disease, we recommend to:

• in the countryside or wooded places:
  • spray specific repellent products on your exposed skin;
  • use covering clothing, so as to avoid contact with grass and brushwood (long-sleeved clothing, long trousers, socks and ankle-length shoes);
  • carry out all-body inspection at the end of an activity in nature.
• at home and in places frequented by animals:
  • frequently check fur of the animals, especially after a walk in the park or in areas with vegetation, their kennels and the places where they play.
  • apply protective pesticides to animals, where possible, at periodic intervals, so that they are always protected.