BU Today: How prevalent is Lyme disease?

Pranay Sinha: Lyme disease is most common in the northeastern United States. The number of reported cases is likely an underestimate of actual cases. Some estimates put the annual Lyme cases at about 300,000 per year.

BU Today: Has COVID-19 affected the incidence of Lyme? One might assume it dropped last year as people curtailed outdoor activities, but as caregivers and hospitals were swamped with COVID patients, did the capacity to treat Lyme and other diseases suffer?

Pranay Sinha: The impact of COVID-19 on Lyme disease remains to be described through epidemiological studies. It is certainly possible that reduction in outdoor activities such as camping and hiking may have decreased the incidence of Lyme disease.

What is more likely is that since acute Lyme disease presents with nonspecific symptoms—such as fevers, chills, sweats, malaise, and others—which overlap with COVID-19, at least some patients may have been misdiagnosed. Additionally, given that individuals avoided healthcare facilities for fear of contracting COVID-19, it is likely that many presented later and with more advanced forms of Lyme disease, such as Lyme arthritis.

BU Today: What’s the best-practice treatment, and how effective is it? 

Pranay Sinha: The treatment depends upon the form of the disease. For early phases of disease, which are marked by rash, muscle and joint pain, and fevers, we use doxycycline for 10 to 14 days, and up to 21 days if the disease is severe. Doxycycline also treats anaplasmosis, another infection that Lyme-carrying ticks can transmit. Pregnant women and young children are generally treated with amoxicillin. For more advanced presentations that involve the heart or the central nervous system, we use intravenous ceftriaxone. 

BU Today: How many patients make a full recovery, and what are the consequences for those who don’t?

Pranay Sinha: Patients with early Lyme disease generally have an excellent prognosis. This includes individuals with heart and nervous system involvement.

About 60 percent of individuals who are not treated for early Lyme disease can progress to develop Lyme arthritis, which can persist for years before resolving on its own. However, we can speed up the resolution of Lyme arthritis with antibiotics. Around 90 percent of Lyme arthritis patients who receive antibiotics should experience improvement within one to three months. Some individuals may require a second course of antibiotics. There is also a small group of patients in whom the symptoms of arthritis can persist after they complete antibiotics. The symptoms of arthritis in these patients appear to be caused by a post-infectious inflammatory phenomenon rather than chronic infection.

BU Today: Is there a pressing need for treatment or prevention of Lyme disease?

Pranay Sinha: As the old adage goes, prevention is better than cure. When spending large amounts of time outdoors, it’s important to wear clothing that covers your skin and use insect repellents to prevent tick bites. Checking yourself and your loved ones for ticks after outdoor excursions is also important, although ticks can easily be missed. Using tick collars and medicated shampoo for your furry, four-legged friends is important; otherwise they’ll bring eight-legged friends home with them. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease, as it can wash off unattached ticks and is also a good opportunity to do a tick check. And don’t forget that it is totally possible to pick up Lyme disease in your garden; you don’t have to venture into the great wilderness.