Dr Richard Horowitz on Lyme Rashes

Lyme disease Can Present As An Acute Or Chronic Illness

A solid, spreading rash (resembling a bacterial infection/cellulitis or ‘spider bite’) or a bullseye rash is present in approximately 50 percent of those with Lyme disease.

Symptoms of acute Lyme disease can present as:

  • flu like symptoms with fevers;
  • fatigue;
  • muscle, joint pain and nerve pain (which can be migratory);
  • swollen glands;
  • sore throat;
  • nausea and vomiting;
  • headaches;
  • stiff neck;
  • light sensitivity; and
  • may include Bell’s palsy and other neuropsychiatric symptoms.

Chronic symptoms of Lyme disease (also referred to as post-Lyme disease treatment syndrome, late stage Lyme, post Lyme disease syndrome, post-infectious Lyme disease, Multiple Systemic Infectious Diseases Syndrome or MSIDS) is often associated with co-infections.[note]Aucott J, et al. Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis 2009;9:79[/note]

In the US, the bullseye rash (erythema migrans) of Lyme disease is only present in approximately 25% of cases.
The other 25% of the time, it resembles a solid spreading rash which could be confused
with a bacterial infection of the skin (cellulitis) or spider bite

Symptoms of Disseminated Lyme

An EM rash with one or multiple symptoms such as neck stiffness accompanied with headaches, light and sound sensitivity, memory and concentration problems, vertigo, dizziness, difficulty walking, cranial nerve palsies, paresthesias (face and/or scalp tingling/numbness/burning sensations) and sudden unexplained neuropsychiatric symptoms (including mood changes and sleep disorders) are indicative of an infection in the Central Nervous System (CNS). Tingling, numbness, burning sensation in the hands and feet with an EM rash is suggestive of an infection in the peripheral nervous system. A diagnosis of Babesia should also be considered if there are associated unexplained fevers, chills, flushing, day and/or night sweats, and/or an unexplained cough with shortness of breath (“air hunger”) with a severe clinical presentation that does not respond to doxycycline.

Six Signs That Your Aches And Pains May Be Due To Lyme Disease

1. You have more than one symptom. Lyme disease is a multi-systemic illness. A classic constellation of symptoms might include fatigue, pain, insomnia, cognitive problems and mood swings with anxiety and depression.
2. Symptoms come and go with good and bad days.
3. Migratory joint, muscle and nerve pains (tingling, numbness, burning and/or stabbing sensations) come and go and migrate to different parts of the body. These can be classical signs of Lyme disease.
4. In women, symptoms tend to worsen right before, during, or after the menstrual cycle as hormonal changes can affect symptoms.
5. Symptoms worsen or improve after antibiotic therapy (for Lyme or an unrelated infection like a urinary tract infection or upper respiratory infection). If symptoms worsen, this can be associated with a Jarisch–Herxheimer (or Herx)[note]http://www.tiredoflyme.com/alka-seltzer-gold-glutathione-and-lemon-juice-for-lyme-disease-herxheimer-reactions.html[/note] reaction which is a reaction to endotoxin-like products (or spirochetes) released by the death of harmful microorganisms within the body during antibiotic treatment.
6. You have positive blood tests for Lyme and associated tick-borne diseases.

Testing For Lyme Disease Can Be Difficult

Tests for Lyme disease are unreliable (ELISA, Western blot).

There are many different strains (over 300 worldwide)[note]http://www.ilads.org/lyme/about-lyme.php[/note] of Borrelia.  Such as Borrelia burgdorferi sensu stricto (originating from USA, Europe, North Africa), Borrelia afzelii (Europe, Asia), Borrelia garinii (Europe, Asia, North Africa), Borrelia valaisiana, Borrelia lusitaniae (Portugal, Italy, North Africa) and Vasculitis, Borrelia spielmanii (Holland, Germany, Hungary, Slovenia).

Positive Laboratory testing for any one of five bands on the Western Blot that are specific for exposure to a Borrelia species are the 23 (Osp C), 31 (Osp A), 34 (OspB), 39, 83-93 and confirm exposure to Lyme disease (Borrelia burgdorferi sensu stricto or other borrelia species).[note]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735370/ Rebman A, et al.  The Clinical Symptom, and Quality-of-Life Characterisation of a Well-Definied Group of Patients with Post-treatment Lyme Disease Syndrome. Front. Med. 4:224. 14 Dec 2017[/note]

Are Your Symptoms Due to Lyme Disease?

Take the Horowitz Lyme-MSIDS Questionnaire (HMQ)

This is a validated screening tool to determine the probability of having Lyme and associated tick-borne illness (without an EM rash). Patients can have up to 16 different reasons why they remain ill and Dr Horowitz calls his multifactorial diagnostic and treatment model MSIDS: Multiple Systemic Infectious Disease Syndrome. The HMQ  was recently validated by researchers at the State University of New Paltz, and shown to be a reliable screening tool.[note]Empirical Validation of the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire for Suspected Lyme Disease. Maryalice Citera*, Ph.D., Phyllis R. Freeman, Ph.D., Richard I. Horowitz, M.D., International Journal of General Medicine 2017:10 249–273  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590688/[/note]

Completing the MSIDS questionnaire will confer results.

  • A score greater than 63 suggests a high probability of Lyme disease;
  • Between 45-62 suggests a probable case of Lyme disease;
  • 25-44 suggests a possible case of Lyme disease; and
  • Healthy individuals scored below 24.