What's the Story with Lyme Disease?

by Holly Coltart

Seasoned procrastinators may have noticed that the Mail Online has taken a particular interest in Lyme disease: the infection caused by the spirocheate bacteria Borrelia. Certainly, there is a Dracula-like horror to illness. Small animals such as birds and rodents carry the bacteria and it is transmitted to humans via ticks, which feed first on the infected animals and next on their unsuspecting human victims. Laboratory reports from Public Health England also show that cases are increasing; 1,112 people were diagnosed in 2013, more than four times as many as in 2001. However, does this warrant the 16 Mail Online articles mentioning the disease in their title since the start of October? At the time of writing, that is 16 articles in as many days. It is interesting to consider why Lyme disease has become such a prominent story.

One factor is that a number of well-known people in the public eye have recently come forward as having Lyme disease.  Yolanda Foster, star of reality television series The Real Housewives of Beverly Hills, documents her battle with the infection on social media. She recently revealed that her daughter, model of the moment Bella Hadid, is also affected. Singer Avril Lavigne, presenter Bear Grylls and billionaire cofounder of Phones4U John Caudwell are other recognisable sufferers recently mentioned in the media. It is important to remember that these cases are reported precisely because the sufferers are well known, and therefore have access to a public forum in which to discuss their illness that the average person does not. All the same, the sudden influx of articles on Lyme disease creates the feeling that it is on the rampage. It is the scaremongering potential of Lyme disease that makes it an appealing story. Fortuitously for the press, John Caudwell provided the perfect headline when he described it as ‘one of the greatest threats to public health in our time’.

Furthermore, the capacity for Lyme disease to terrify the public is increased by the fact that it can be difficult to diagnose. Most people with the disease initially develop a distinctive bull’s eye rash known as erythema migrans. In Europe, around a third also develop non-specific flu-like symptoms, although this is much more common with species of Borrelia found in the US. Erythema migrans is pathognomonic of Lyme disease; current NICE guidelines suggest there is no need to test individuals displaying the rash before commencing treatment. The problem arises when people don’t develop the rash or fail to recognise it as a cause for concern, perhaps because they don’t associate it with being bitten by a tick. This is the case for a third of people with erythema migrans in Europe, who do not recall a tick bite. In such situations, patients may only present to their GP once the rash has subsided and they display late symptoms weeks to months after initial infection. Most commonly in the UK, late symptoms are associated with infection of the nervous system such as facial palsy, meningitis and radiculopathy. If people are not aware of being bitten, or of even being potentially exposed to ticks, it can be very difficult to link these symptoms with Lyme disease. For the media however, a delay in diagnosis only ever equals failure on the part of the medical profession and an opportunity for criticism. From the articles mentioning Lyme disease one could suggest that just as the reader is in imminent danger of infection, so too are they at risk from the ineptitude of health professionals.

In light of all of this, is there indeed a cause for panic? Although laboratory-confirmed diagnoses have risen steadily since reporting began in 1986, the effect of factors such as increased awareness of the disease, greater access to diagnostic facilities and sensitivity of tests cannot be discounted.  What’s more, the disease is still very rare with mean incidence rates at around 1.73 cases per 100,000 in the UK. If there is cause for concern, it is in the way medical issues are reported in the media. Although the aforementioned articles go some way in raising awareness simply because they mention the disease, their intention for the most part is sensationalism rather than information. This is especially remiss in cases such as this where public awareness of Lyme disease could go a long way in alleviating the fears that the press itself is responsible for inciting. The British Infection Association found erythema migrans to be the presenting sign in 90% of cases in Europe. That means that 90% of cases of Lyme disease can be diagnosed on sight and treated immediately. People need only know that if they develop a rash or become unwell after being bitten (or potentially bitten) by a tick that they should contact their GP. Of course, doctors too must also arm themselves with information: so that they have a higher index of suspicion of Lyme disease, and as reassurance for the people now convinced they are infected as a result of recent reporting on the condition.