Lyme Disease is an illness caused by bacteria that is spread by a species of ticks native to North America, Europe, and Asia. While it is rarely found in South Africa, there have been cases in South Africans who have travelled abroad, and other similar tick-borne illnesses are found here. Early-stage Lyme Disease causes headaches, fever, fatigue/tiredness, joint and muscle pain, swollen lymph nodes, and a specific rash called erythema migrans. This rash begins as redness at the site of a tick bite that spreads up to 30 centimetres or more and may clear in the middle, causing a characteristic “bullseye” appearance. However, erythema migrans does not appear in all people who contract Lyme disease.
When left untreated, Lyme Disease can cause extreme headaches and neck stiffness, severe swelling and pain in the joints, multiple rashes, episodes of shortness of breath and dizziness, one-sided facial paralysis, irregular heartbeat, nerve pain, and inflammation in the brain and spinal cord. More severe, late-stage presentations of Lyme disease may be classified as Lyme Arthritis (joint involvement), Lyme Carditis (heart involvement), or Neurologic Lyme Disease (brain/nerves involvement). Blood tests can be done to detect Lyme Disease but may not be positive until a few weeks after contracting the illness. Your health care provider may make a diagnosis of Lyme Disease if you have the symptoms and have been in an area where Lyme disease is likely and/or have a history of a tick bite. It is important to note that not all tick bites will cause Lyme Disease, and that a small, raised area of redness around a tick bite is normal, and will not always form the “bullseye” rash.
Adequate treatment of Lyme Disease will require a course of antibacterial medication, aka- “antibiotics.” If you have severe symptoms or late symptoms such as irregular heartbeat or nervous system involvement, treatment may begin with IV (intravenous) antibiotics in a hospital setting. Most cases can be treated with oral antibiotics.
Doxycycline is the preferred antibacterial agent for the treatment of Lyme Disease. It is a tetracycline antibiotic that is most often given orally once or twice daily, usually for 10-14 days, but treatment may last up to 28 days depending on symptoms. It is also available as an IV formulation,
Cefuroxime is a cephalosporin antibiotic that is given orally, twice daily, for 14-28 days.
Amoxicillin is a penicillin antibiotic that is given orally, three times daily, for 14-28 days.
Ceftriaxone is a cephalosporin antibiotic that is recommended for IV treatment of severe Lyme disease, such as Lyme Arthritis, Lyme Carditis, and Neurologic Lyme Disease. It is given daily for 10-28 days, and may be transitioned to an oral agent after the first few days of treatment.
Azithromycin is a macrolide antibiotic that is only recommended in patients who are allergic to or can’t otherwise tolerate doxycycline, amoxicillin, cefuroxime, or ceftriaxone. It is available in oral and IV formulations. Because it is not as effective as the other agents, it is recommended that a patient taking azithromycin be more closely monitored for the resolution of symptoms. It is not recommended in Lyme Carditis, because it may cause arrhythmias.
Several common side effects are possible with these antibacterial medications. These include
-Nausea/vomiting -Headache
-Diarrhoea/loose stools -Vaginal yeast infection (can be treated with antifungal)
-Dizziness
More serious side effects that require prompt medical attention are described below.
–Clostridium difficile (C. diff) infection is caused by an overgrowth of “bad” bacteria in the gut due to antibiotics killing the “good” bacteria in the gut. It can cause severe, often bloody diarrhoea and dehydration, and is very contagious. If you have persistent diarrhoea or blood in your stool, contact your doctor right away.
–Allergic reactions to medications can be serious and life-threatening. Signs of an allergic reaction include rash, swelling, and trouble breathing, and may be accompanied by nausea and vomiting.
It is important to complete the full course of antibiotics as prescribed to treat Lyme disease adequately and to prevent a recurrence, even if you start to feel better. Occasionally, some people with Lyme disease may not have full resolution of symptoms and may need a second course.
Lyme disease and other tick-borne illnesses can be prevented by wearing protective clothing and using tick repellent when in an outside area where ticks are common. If you are traveling to an area of high Lyme disease activity and expect to spend a lot of time outdoors, your doctor may consider prescribing one of the above antibiotics for Lyme disease prevention.