In many cases, the infection does not come with a characteristic or diagnostic symptom.
Treating Lyme borreliosis is a complex task for specialists. If a positive result confirms that a patient is infected with Lyme disease, there is still an open question whether this causes (all of) their symptoms or not. This is a valid question, because in many cases, the infection is not accompanied by a characteristic or diagnostic symptom. Only the Lyme rash (Erythema migrans) and Lymphadenosis Benigna (erythematous swelling usually in the earlobe), which occurs mainly in children, are of diagnostic value.
In the chronic cases, histological examination is required to differentiate Acrodermatitis Chronica from other skin symptoms. If there is no specific skin symptom, then it depends on the doctor’s expertise and experience to conclude a diagnosis from the set of symptoms, excluding other diseases, essentially with differential diagnostics – points out Dr. Klára Esztó, dermatologist, clinical allergo-immunologist, Lyme disease specialist.
– For example, if a patient with a joint complaint comes to me, I can only tell them that they have a Lyme borreliosis infection if this is supported by many other circumstances: be it their medical history, a tick bite, their lifestyle, or a laboratory diagnostic result. It’s like a puzzle, the specialist explains.
The red rash caused by Lyme borreliosis can be mistaken for an allergy or spider bite site. For a definite diagnosis, sometimes we must wait, but certainty is more important than speed, as the effectiveness of therapy depends on an accurate diagnosis.
It is not possible to say whether a Lyme borreliosis treatment has killed all the bacteria in the subject’s body, however, it can reduce the number of bacteria to such a low level that the patients can live their life asymptomatically, work, have no pain, and the infection caused by the bacterium doesn’t hinder them during their life.
“To the best of our knowledge, we can’t say that a treated patient is not infected anymore!” According to research, once this bacterium enters the human body, it remains there in many cases, says dr. Klára Esztó.
It is fortunate – but we can also consider it a curse for a successful diagnosis – that this bacterium multiplies very slowly in humans, the amount of bacteria in a patient waves in three-week generation cycles. Strange, but true: this bacterium essentially does not like being in humans because we are too hot for it with our body temperature above 36 degrees, while its reproductive optimum is below 35 degrees.
Measurable amounts of antibodies normally develop about six weeks after the first infection. A direct blood test can be done earlier, but if no bacteria are found, it does not rule out infection. If, on the other hand, a positive result is obtained, the test is definitive, and the infection is certain.