Other infections, such as human immunodeficiency virus (HIV) and bacterial meningitis require more aggressive treatment and may become, as in the former case, a lifelong condition. Where does Lyme disease fall on this continuum of infection?
Mutating Lyme Disease Bacteria
Our knowledge of Lyme disease bacteria, Borrelia burgdorferi sensu lato, has grown exponentially in the past couple of decades, with researchers recently discovering their ability to form biofilms that can evade most antibiotics. Different strains of Borrelia are present in different countries and even within the same area as the bacteria mutate and evolve. Realising that Lyme disease bacteria evolve as they try to survive and replicate makes it easy to see why vaccinating against Lyme disease, using the same old strains for testing purposes and sticking to the same antibiotics for treatment is foolhardy.
Immune System Evasion is Not an Absence of Lyme Disease
Borreliosis is usually contracted through a tick bite and elements of tick saliva actually make it more likely that infection occurs as they trick the human immune system into ignoring the invading bacteria. This gives Lyme disease a headstart on the normal immune response, allowing it to disseminate through the body initially unimpeded for the most part. Instead of being stopped at the site of attack the Lyme disease bacteria can enter the bloodstream and travel to parts of the body far from the tick bite, playing a microbial cat and mouse game with neutrophils and T-cells.
Asymptomatic Lyme Disease
Without treatment with antibiotics the borrelial bacteria will not be cleared from the body naturally. Lyme disease infection does not go away by itself, it may simply lay dormant for short periods of time before regrouping and proliferating to trigger new symptoms. Some people may remain infected with Lyme disease and be asymptomatic for many years, only for postmortem investigations to find bacteria in their heart, liver, joints and even the brain. How this relates to death rates from Lyme disease is unknown but it is possible that persistent, unrecognized Borreliosis contributes to morbidity and mortality more than is reported.
Lyme Disease Co-Infections
It is also important to remember that Lyme disease bacteria do not exist in isolation. Oftentimes, the tick transmitting Borrelia also carry co-infections such as Babesiosis, Mycoplasma, Ehrlichiosis and Bartonella. Symptoms from myriad infectious agents can confound physicians as they overlap, relapse, accentuate each other or are absent during treatment for one infection, only to re-emerge after treatment ends.
Longstanding Unrecognized Lyme Disease
A person may suspect they are infected with Lyme disease but test negative on existing Lyme disease assays. This patient may feel better of their own accord, without treatment, believing that the Lyme disease infection has gone away by itself. However, without antibiotics the bacteria will almost always remain in the body to some degree, with the potential for relapsing symptoms. Patients may be prescribed antibiotics for an unrelated condition and find that the treatment has the benefit of eradicating Lyme disease infection they were unaware they had but which was responsible for mild symptoms such as fatigue, joint pain or cognitive difficulties.
Eradicating Lyme Disease
As symptoms of Lyme disease can so easily mirror the aches and pains of ordinary life it is reasonable to suspect that many people are living with Lyme disease without knowing. Lyme disease infection does not go away by itself so it is important to be properly tested, diagnosed and treated if infection is suspected.