An Analysis of the Outbreak of Lyme Arthritis During the 1970s

During the late 1970s, an outbreak of what was then called Lyme Arthritis in and around Lyme Connecticut, started the events that have become a nightmare for those stricken with it and has since spread from coast to coast. In 1981, Dr. Willy Burgdorfer and colleagues, managed to isolate the source as a corkscrew spirochete transferred to humans from ticks. They named the spirochete Borrelia burgdorferi, after its founder Dr. Burgdorfer. This was three years after it was discovered the Ixodes dammini tick (now called Ixodes scapularis) was the vector of this terrible disease.

In 1992, the medical community accepted the name Lyme Disease. Dr. Burgdorfer himself contracted the disease, possibly from the infected urine of lab rabbits.

Exactly where this organism originated, and how long it has been infecting people around the world, no one knows. Signs and symptoms, similar to how Lyme disease manifests itself, has been described in European literature as far back as the early 1700s. A German doctor described Lyme disease in the early 1880s, and in great detail in the 1900s by the Swedish physician, Avid Afzelius.

Doctor Afzelius described the ring like lesion (Erytheme migrans Afzelius) and his belief the disease was transmitted by the bite of the Ixodes tick. It is, however, speculated that infected ticks came to North American ports via imported furs over a century ago. As the population expanded, so did the disease.

We now know that Lyme disease has been proven to be spread by other vectors as well as the Ixodes dammini tick.

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It is also spread by the; Ixodes scapularis, Ixodes pacificus, Amblyomma americanum, Dermacentor variabilis, Ixodes neotomae, Haemaphysalis leporis palustris ticks. There are also new types of vectors besides the tick spreading the disease, such as: the flea, the mosquito, squirrels, mice, raccoons, rabbits, birds, and even some dogs and cats.

Ixodes dammini has been found to be the main source of Lyme disease in the eastern United States. The white-tailed deer are the likely primary host of the adult I. Dammini tick. Ticks lay their eggs in the spring and then emerged larvae feed in late summer. The larvae remain quiet throughout the winter and develop into nymphs in the spring. The nymphs feed in May and June, just before the peak appearance of human infection in early July. Scientists believe tick larvae acquire the infection from white-foot mice and then transmit it to humans as nymphs.

The adults, which feed any time from late fall to the late spring, probably do not account for many human cases because they are large enough to be detected and removed before the spirochete is transmitted. Nymphs cause 70% to 90% of all causes of Lyme disease. They prowl the outdoors in the late spring and summer, when people are doing the same. Because they are so small, they are tough to spot on clothing or skin to remove. Fortunately, a nymph bite does not guarantee a case of Lyme disease. The nymph may not be infected. An infected tick, whether nymph or adult, must feed for 24 hours on a human host before injecting its spirochetes. This leaves time to spot and remove them.

If the spirochete does enter a human blood stream, phagocytes are the cells primary first-line defense against bacterial pathogens and will begin their advancement on the foreign organism. A dense infiltration of mature neutrophils has been found at the site of tick bites. However, knowledge about the interaction between Borrelia burgdorferi and the phagocytes is unknown. These microorganisms are internalized by human polymorphonuclear leukocytes and monocytes- macrophages even during the preimmune stage of infection. In fact, immune reaction to Borrelia burgdorferi is not essential, although it facilitates its uptake.

Spirochetes are engulfed by conventional or coiling phagocytes and in either case are finally found inside closed phagosomes, where structural alterations of the microorganisms are apparent with microscopical observation. Because, the spirochete is engulfed in an envelope and because the antibody response might be slow, the Borrelia burgdorferi can become impossible to find within the body. (3) Also, the spirochete can hide within our white blood cells and isolating the pathogen in human tissue becomes extremely difficult.

A further complication is that the average Lyme patient does not show positive antibodies against Borrelia burgdorferi infection for at least four to six weeks after the infected bite, and actually never become Bb antibody positive. Yet another problem with detecting this disease is that Lyme tests cross- react with other common infections, and produce false positive results. Even a two-week course of oral antibiotics may then cause a Lyme patient to test negative for the rest of their life, even if the infection persists.

About half of untreated people develop arthritis, usually in the knees but also in large joints. In one in ten who develop arthritis, it becomes chronic and causes permanent joint damage. Pain in the muscles, ligaments, tendons, joints, and long bones is typical. It can also cause joint pain in the absence of swelling.

Antibiotics are useful against all stages of the disease, particularly the first stage. At a conference on Lyme disease sponsored by the National Institute of Health, a panel of experts recommended that most adults with early Lyme disease receive amoxicillin plus prebenecid (a drug that keeps amoxicillin from being excreted.) When administered early in the infection, these antibodies can wipe out the Borrelia burgdorferi spirochete and cure virtually all cases of Lyme disease.

If Lyme disease is untreated for years, symptoms will still persist despite the use of antibiotics. It is unclear whether these people remain infected with the spirochete or if they produce antibodies that attack their own tissues. This can happen is a host shares the same protein with the spirochete. The most awaited Lyme disease medical breakthrough would be a vaccine that could wipe out Lyme entirely. A vaccine that uses a piece of the Borrelia burgdorferi, called surface A protein, has been found to protect mice against different strains of the spirochete, by Yale researchers. The vaccine must be tested to see if it will still work against mutated forms of the spirochete before being used on people.

Infection with Borrelia burgdorferi has many symptoms such as: unexplained chronic fatigue, encephalitis, meningitis, paralysis of the face, heart problems, fainting, dizziness, shortness of breath, and the tell tale bulls eye rash around the tick bite site.

Chronic fatigue syndrome or fibromyalgia, a musculoskelatal pain syndrome, may be causing the symptoms in some cases, not Borrelia burgdorferi. Neither of these diseases will respond to antibiotic treatments like Lyme disease and therefore can be ruled out easily. Many doctors misdiagnose Lyme disease. Therefore, if you have many of the unexplained symptoms you need to find a doctor who specializes in Lyme disease to run an ELISA and a Western Blot blood test. Then the correct course of antibiotics and medications need to be prescribed as soon as possible.