Abstract
Lyme Disease is a vector born disease spread by ticks globally. In America, nearly 95% of the cases are found in the North Eastern states, it has spread to every state of the nation. Though the debate on how to diagnose and treat Lyme Disease is widely controversial, research shows that Lyme Disease symptoms do last years at a time, greatly affecting the quality of life of an individual. (NIH, 2016) Diagnostic criteria used is inherently flawed and inaccurate and due to symptoms that mimic many other chronic diseases, making an early diagnosis of Lyme Disease extremely difficult for providers. Due to this major controversy on how to treat and diagnose patients with Lyme Disease, research into this arena is at a stalemate and is vastly unfair to the 300,000 people that contract Lyme Disease yearly in the U.S.
Introduction to Lyme’s Disease
Nature of the Disease
Lyme Disease is a bacterial disease caused by Borrelia burgdorferi, a spirochete bacterium, and is now the most common vector-borne disease in the United States. (American Journal of Nursing, 2018) It is both acute and chronic, though this debate is still ongoing. No known underlying causes have been reported, though Lyme Disease is known to be the underlying cause for many other chronic diseases due its presentation.
Clinical Picture
It is transmitted mainly by the deer tick, or Ixodes, on the East Coast, and the Black-Legged Tick on the West Coast. (Lyme’sDisease.org, 2018) It can also be transmitted from pregnant mother to fetus via placenta. Due to its common symptoms, misdiagnosis’s usually range anywhere from fibromyalgia, multiple sclerosis and chronic fatigue, to depression, anxiety, and other mental health issues. (NIH, 2015) Lyme Disease is both acute and chronic, with much controversy, with chronic risk severity being much higher. This disease has a key symptom of a red rash that looks like a bull’s eye and usually develops soon after infection. However, this sign only presents in a very small amount of cases. Other signs and symptoms include fatigue, fever, headache, stiff neck, body aches, pain and swelling in joints with long term symptoms including neuropathy, cognitive and memory dysfunction, insomnia, and psychiatric issues. (2) Along with these signs and symptoms of Lyme Disease, blood tests can be done as well. Some of the other tests include Lyme antibodies detection, Borrelia burgdorferi antibodies test, Borrelia DNA Detection, IgM/IgG by Western Blot, Lyme disease test (CSF), Borrelia antibodies, IgM/IgG. (MedlinePlus, 2018) However, these diagnostic tests have known to be unreliable, especially in the early stages of detection. Once Lyme Disease has been detected, antibiotic treatment is used as the frontline of defense for acute cases. The longer the bacteria progresses, the more difficult it is to treat.
The ideas on how to treat Lyme Disease is widely controversial. There are two competing medical societies that debate continually on the nature and treatment of Lyme. The first is the Infectious Disease Society of America (IDSA), treating Lyme Disease as an acute infection, easily treatable by short course antibiotics (<20days) and does not agree that Lyme can be chronic. The spirochetes, they say, cannot exist long term in the body, especially after antibiotic treatment. (National Institute of Health, 2011) (LymesDisease.org, 2018) The opposing society is the International Lyme and Associated Diseases Society (ILADS), taking the approach that Lyme can be chronic and more severe, difficult to treat and diagnose, creating a chronic infection that can affect every area of the body. (ILADS, 2018) For people who did not treat Lyme in the early stages, their quality of life greatly diminished with 72% of known Chronic Lyme’s Disease patients reporting their quality of life as poor. (PubMed, 2014) The next disease under that was 64% of Congestive Heart failure patients reporting their quality of life as poor. (2) This survey was done to test a variety of factors in patients with Chronic Lyme’s Disease (CLD) as compared to other chronic conditions. Studies show that Lyme’s disease can also be a chronic condition, with possible symptoms persisting for years. (National Institute of Health, 2011) (National Institute of Health, 2016) (New England Journal of Medicine, 2016)
Descriptive Epidemiology
Statistics
According to the Center for Disease Control (2018), an estimated 300,000 people are affected with Lyme Disease every year. However, even this number could be far lower than the actual number due to the difficulty in diagnosing Lyme Disease with 1 in 10 cases actually being reported. (Global Lyme Alliance, 2018) This number of cases is key because it is 1.5x more cases than breast cancer and 6x more annual cases than HIV. (LymeDisease.org, 2018) Since 1982, the number of cases being surveilled has increased 25x, (Global Lyme Alliance, 2018) showing this to be a major issue in our country today.
Population at Risk
Lyme Disease affects more of the Caucasian race than any other. 89% of the cases affect White or Caucasian race, 6.8% Black, 1.6% Asian/Pacific Islander, and 1.5% in American Indian/Alaskan Native. (CDC, 2017) It is unknown why there is such a disproportionate amount of cases affecting the Caucasian race. More research is needed in this field to find many of the unanswered questions.
Trends
Lyme Disease affects more of the North Eastern to upper Midwestern states of America far more than any other state with 95% of the cases being reported there. (Global Lyme Alliance, 2018) (CDC, 2018) Some suggest that the reason why this disease affects more of the North Eastern states is due to the fact of its origin. The first known set of cases, causing Lyme’s to register on the public scale, was in 1975 when a lady and her family all reported the symptoms. This happened in Lyme, Connecticut, hence the disease name, and soon exploded to 51 cases. (History of Lyme, 2015) One reason some think it started only in those states was because of a failed lab experiment on ticks around that same time, on an island just off of Lyme, Connecticut’s coast called Plum Island, known for its animal experiments. Though this disease is mainly in those states, Lyme’s can be found in nearly every state and multiple countries. However, this surge in the North Eastern states could be simply due to the perfect wooded habitats those states contain needed for that particular tick to survive.
Determining incidence and prevalence with a disease that is vastly underreported is difficult. For although there were roughly 30,000 confirmed cases by the CDC in 2017, they estimate that there is roughly 300,000 cases annually. Compared to 12,000 confirmed cases in 1997 by the CDC (2017), this disease is spreading at a rapid pace. As far as who contains the disease now, it cannot be determined due to the ongoing controversy of acute vs chronic.
Outlook
The outlook for this vector born disease, so far, does not look promising. From 2016-2017, there was a confirmed 10% rise in confirmed cases, (CDC, 2018) and has been steadily spreading over the past 25 years in number and location. A recent surge in Japan has caused great concern over the spread and future of this vector born disease. With Japan being so diverse in its habitats for ticks, it creates difficult problems with the numerous subspecies of ticks carrying different forms of the bacterium. (Journal of Infection and Chemotherapy, 2018) The controversy over the two leading medical societies has led to disagreements on proper treatments, all at the cost of the patient. Like previously stated, the quality of life for Lyme’s Disease patients has been significantly reduced, leading to greater issues than any other chronic disease, (PubMed, 2014):
According to this survey of CLD patients, 43% of CLD patients had to stop working entirely due to the complications CLD brought to their body. (PubMed, 2014)
As of now, pushes to fund research into tick born disease as a whole is being conducted. This is a needed factor in global health and the fact that very little attention is spent on Lyme Disease is astonishing. With roughly 300,000 people being infected each year (CDC, 2018) Lyme Disease has a major impact on society on the global scale, with chronic symptoms becoming debilitating and life altering.
Public Health
Interventions
According to the CDC (2018), the best prevention for Lyme Disease is to avoid being bitten by a tick. With no vaccine and little long term antibiotic effectiveness, preventing the tick bite is the only way known to prevent Lyme Disease. A person may be exposed year-round to Lyme Disease, but April-September are the most active times for ticks and is the highest probability of being bitten. (CDC, 2018) Aside from education, the CDC also recommends spraying gear and clothes with Permethrin and using EPA approved insect repellants. Once coming inside from the outdoors, check your body, as well as pets, for possible exposure to ticks and shower as soon as possible.
Disease Control and Prevention
Nationally, the CDC (2018) is leading the research into Lyme Disease, helping to fund new programs and educate the nation state by state. Multiple research studies are being conducted by the CDC with results pending. Global Lyme Alliance (2018) also created an ambassador program with 11 ambassadors to help educate communities on how to recognize, treat, and prevent Lyme Disease. Worldwide, there is little to no effort to reduce Lyme Disease. However, in April of 2018, Congress signed an appropriations bill that allowed more funding into the research, treatment, and prevention to help ease the growing spread of this bacteria. (LymeDisease.org, 2018) The only mutual efforts to prevent the spread that these agencies possess is in educating the public.
Conclusion
Lyme Disease is being spread rapidly by ticks throughout our nation, and more recently, our globe, using deer, rodents, birds, and other animals to spread. 300,000 people are contracting this pathogen annually (CDC, 2018), far more than HIV or breast cancer. The symptoms of long-term Lyme severely debilitate and affect the quality of life of the patient with 43% of those patients having to quit their jobs entirely. (PubMed, 2014) The ongoing debate and controversy over how to treat Lyme by the two different medical societies is severely affecting the outcomes of millions of people. With an estimated $492 million spent annually on attempting to treat Lyme Disease (CDC, 2018), more research needs to be conducted and the medical community must come to an agreement for our nation to move forward on this issue.
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