Lyme disease, also known as borreliosis, is the most common tick-borne disease in Switzerland. It is caused by the bacterium Borrelia burgdorferi, also called Borrelia, and it can have serious effects on the skin, joints, nerves and heart if left untreated. As there is currently no vaccine for Lyme disease, protection against ticks, early diagnosis and targeted treatment are crucial.
Lyme disease at a glance
Lyme disease is an infectious bacterial disease transmitted in Europe primarily by a bite from a castor bean tick (Ixode ricinus). In Switzerland, an estimated 5 to 30 percent of ticks are infected with Borrelia burgdorferi, and in some regions as many as 50 percent. Since there are different species of Borrelia, different organs may be affected as the disease progresses. According to the Federal Office of Public Health, around 10,000 people in Switzerland contract Lyme disease every year.
The first symptoms of Lyme disease usually appear a few days to weeks after the tick bite, typically as a “bull’s-eye” rash (erythema migrans). Without early treatment, the illness can progress and lead to chronic symptoms such as joint inflammation and nerve or heart problems.
Causes
The cause of Lyme disease is an infection with the bacterium Borrelia burgdorferi, which is transmitted to humans by a bite from an infected tick (usually Ixodes ricinus, the castor bean tick). Borrelia bacteria are located in the tick’s intestine and usually only enter the bloodstream after a prolonged period of feeding. Not every tick bite will automatically lead to infection. The longer the tick stays on the body, the higher the risk of infection.
Disease progression
The progression of Lyme disease is highly variable and depends largely on the time of diagnosis and treatment. If left untreated, the illness progresses gradually in various stages, each with different symptoms. While the infection is usually curable in its early stages, protracted Lyme disease can lead to serious long-term consequences that permanently impair quality of life for those affected.
Stage I – early local stage
The early stage of Lyme disease usually develops a few days to weeks after a tick bite. In this stage, the first signs of the illness appear, which can be noticed both on the skin and from general symptoms.
Skin changes (“bull’s-eye” rash, borrelial lymphocytoma)
Lyme disease often manifests itself in the early stages by a typical “bull’s-eye” rash, or target rash (erythema migrans). In more than half of cases, this appears as a ring-shaped redness of the skin that slowly spreads around the area of the bite. In rare cases, borrelial lymphocytoma, a light red, nodular swelling near the tick bite, can also develop.
General symptoms
Since skin changes do not always appear, it is important to also take general symptoms seriously. Typical symptoms are flu-like symptoms such as tiredness, fatigue, headaches, mild fever and muscle and joint pain. Although these symptoms are non-specific, they can be early signs of Lyme disease – especially after a tick bite.
Stage II – early disseminated stage
When Borrelia bacteria spread through the body’s bloodstream weeks to a few months after the tick bite, a variety of symptoms can occur in different organs.
Nervous system (early neuroborreliosis)
Early neuroborreliosis often manifests itself in severe migratory nerve pain, inflammation of the nerve roots and cerebral meninges, as well as impairment of individual cranial nerves. This constellation of symptoms is also known as Bannwarth syndrome. Paralysis of the facial muscles (facial palsy) is particularly characteristic, which often occurs on both sides, resulting in a crooked or mask-like facial expression.
Joints (Lyme arthritis)
The pathogens can also penetrate the joints and cause painful joint inflammation. The knee is usually affected, causing swelling, redness and restricted movement. In some cases, a pronounced joint effusion (fluid build-up) can form, which must be punctured by a doctor.
Heart (Lyme carditis)
If the heart is affected, conduction disorders develop, which can trigger cardiac arrhythmia. Inflammation of the heart muscle (myocarditis) or the pericardium (pericarditis) is also possible, which can be accompanied by chest pain, dizziness or shortness of breath.
Eyes
Rare but possible are inflammatory changes in the eye triggered by Borrelia. These range from simple conjunctivitis to more severe forms such as inflammation of the iris (uveitis) or the cornea (keratitis), which can affect vision if left untreated.
Stage III – late stage
If Lyme disease remains untreated or does not fully heal for months to years, it can develop into late-stage Borreliosis. During this phase, chronic or recurring symptoms occur that affect several organs and can severely impair quality of life for those affected.
Skin (Acrodermatitis chronica atrophicans)
A typical late-stage skin manifestation is Acrodermatitis chronica atrophicans. Initially, redness and swelling can be observed. Later, the skin becomes thinner, parchment-like and turns bluish. Over time, the veins become clearly visible. These changes often occur on the extensor (outer) surfaces of the arms and legs and can remain permanently.
Nervous system (late-term neuroborreliosis)
Chronic inflammatory involvement of the brain and spinal cord can develop in the nervous system. Those affected suffer from a wide range of neurological symptoms such as sensory disorders, paralysis, memory and concentration disorders and psychological changes. The symptoms are highly variable and can progress over years.
Joints (late-term Lyme arthritis)
In the area of the joints, recurrent or chronic arthritis can often develop. This mainly affects the knees but can sometimes also affect other large joints. Typical symptoms include swelling, pain and restricted movement, which occur in flare-ups and can persist over a long period of time.
Symptoms of Lyme disease
The symptoms of Lyme disease vary greatly and develop differently depending on the stage of disease. Typical in the early phase is a “bull’s-eye” rash (erythema migrans), a reddening of the skin around the bite area. Flu-like symptoms such as tiredness, headaches, fever, or muscle and joint pain can also occur early.
If the infection spreads further, nerve inflammation, facial paralysis, joint pain or cardiac arrhythmia may also occur. If untreated in the late stage of the illness, chronic joint inflammation, neurological disorders or skin changes can often occur, which can significantly impair quality of life for those affected.
Diagnosis
The diagnosis of Lyme disease is primarily based on the clinical signs. A “bull’s-eye” rash (erythema migrans) is a particularly clear indication of infection. In the case of non-specific symptoms after a tick bite, additional laboratory clarification may be necessary.
The laboratory diagnostics are carried out in two steps: First, a screening procedure (usually an ELISA test) is carried out, followed by an immunoblot for confirmation if the result is positive or borderline. For specific manifestations such as neuroborreliosis, a lumbar puncture may be necessary to test the cerebrospinal fluid (CSF) for borrelia-specific antibodies and signs of inflammation. In individual cases, samples from skin or synovial (joint) fluid can also be used for directly detecting pathogens.
Treatment
Early detection of Lyme disease can be successfully treated in most cases. Antibiotics are the treatment of choice: They stop the proliferation of Borrelia bacteria and prevent the infection from spreading further in the body. The earlier the treatment begins, the higher the chance of a complete recovery without any permanent damage.
In the early stages, treatment with tablets, usually doxycycline or amoxicillin, is usually sufficient. If organs are affected or the illness is already at a later stage, tablets are no longer sufficient as a treatment. In these cases, the patient is switched to intravenous antibiotic therapy. Preparations such as ceftriaxone, cefotaxime or penicillin G are used, which are administered over several weeks.
In rare cases, a new or prolonged course of antibiotics may be necessary if symptoms persist despite treatment. Particularly in the case of neuroborreliosis, subsequent rehabilitation is often necessary, as the illness can be severe and can have lasting effects on the nervous system.
Prevention
At present, no vaccine exists for Lyme disease exists. This makes protection from tick bites all the more important: we recommend wearing clothing that covers the arms and legs in woods and meadows, applying insect repellents and thoroughly inspecting the body after being in the outdoors for a long time.
If a tick is found, it should be removed as quickly and correctly as possible. As Borrelia bacteria are found in the tick’s intestine and are only transmitted after a prolonged period of feeding, early removal significantly reduces the risk of infection.
