TREATMENT OF LYME DISEASE.

Report #6768 3/31/96

You get Lyme disease from a tick bite and it can cause permanent nerve damage and arthritis. Some cases of Lyme disease cannot be cured.

A week or two after a tick bite, a person may develop muscle aches, a fever and tiredness. He may or may not develop a red circle around the red dot where he was bitten. Doctors should treat them at this point with specific antibiotics or they can develop nerve damage or arthritis several months later. Even with treatment, some people will suffer severe arthritis several months later, (2) and without treatment, some can feel better after a few weeks. However, several months later, they may suffer nerve damage characterized by loss of feeling in one part of their body, muscle paralysis or even severe headaches. They may develop severe pain in one or more joints in their bodies.

Doctors usually treat these people with antibiotic injections and some people will get better, but more than 25% of people with arthritis will continue to suffer joint pains (1,4,5). Some doctors treat these people with antibiotics, such as minocycline, continuously for months or years. Blood tests are dependable, but some people with florid Lyme arthritis have negative blood tests for Lyme disease, so it is extremely difficult to make the diagnosis (1).

All people with joint pains or nerve damage should receive blood tests for Lyme disease. There are no antibiotic treatment regimens that are universally effective in preventing or treating Lyme disease. Some people with Lyme arthritis may need to be on antibiotics for months or years.

By Gabe Mirkin, M.D., for CBS Radio News

1) The persistence of B, burgdorferi sl. and clinical recurrences in patients despite seemingly adequate antibiotic treatment is described, The patients had clinical disease with or without diagnostic antibody titers to B, burgdorferi. VP Mursic, W Marget, U Busch, DP Rigler, S Hagl. Kill kinetics of Borrelia burgdorferi and bacterial findings in relation to the treatment of lyme borreliosis. Infection 24: 1 (JAN-FEB 1996):9-16.

2) Patients with erythema migrans can fail to respond to antibiotic therapy, Persistent or recurrent erythema migrans, major sequelae such as meningitis and arthritis, survival of Borrelia burgdorferi and significant and persistent increase of antibody titres against B. burgdorferi after antibiotic therapy are strong indications of a treatment failure, Most, if not all, antibiotics used so far have been associated with a treatment failure in patients with erythema migrans, Roxithromycin and erythromycin are definitely or probably ineffective. However, doxycycline, amoxicillin, cefuroxime, ceftriaxone, azithromycin and high-dose penicillin V perform comparably well. K Weber. Treatment failure in erythema migrans - A review. Infection 24: 1 (JAN-FEB 1996):73-75.

3) Antibiotic treatment is the cornerstone of Lyme arthritis treatment. MA Cimmino, GL Moggiana, M Parisi, S Accardo. Treatment of Lyme arthritis. Infection 24: 1 (JAN-FEB 1996):91-94.

4) W Graninger. A ''minority'' opinion about the diagnosis and treatment of Lyme arthritis. Infection 24: 1 (JAN-FEB 1996):95-97.

5) 35 patients with late stage Lyme borreliosis with involvement of the joints was followed up until 3 years after a 14 day course of 2 g ceftriaxone once daily i.v. Long term clinical results in 26 patients at 36 months were complete response or marked improvement in 19, relapse in six and new manifestations in four of the cases, respectively. M Valesova, H Mailer, J Havlik, D Hulinska, J Hercogova. Long-term results in patients with Lyme arthritis following treatment with ceftriaxone. Infection 24: 1 (JAN-FEB 1996):98-102.