Understanding Borrelia: Symptoms, Testing & Treatment for the Primary Lyme Bacteria
by Dr. Bill Rawls
In 1975, a mysterious illness causing arthritis in children showed up in Lyme, Connecticut and adjacent communities in the United States. It might have flown under the radar if not for one significant detail: A cluster of people (39 children and 12 adults), all bitten by ticks, also suddenly became ill simultaneously. Incidentally, it was at a time when more and more people were moving out of cities and into the suburbs to build homes in the tick-filled wooded countryside.
The illness, characterized by arthritis and an unusual rash around the tick bite, was first thought to originate from a viral agent. The real offender wouldn’t enter the spotlight until 1981, when a researcher named Dr. Willy Burgdorfer noticed that the symptoms of this new illness had striking similarities to a tick-borne condition long recognized in Europe called erythema migrans (EM), named for the associated rash migrating from a tick bite. Dr. Burgdorfer and his colleagues isolated the microbial culprit, a corkscrew-like organism (called a spirochete), from the blood of the victims, and a new pathogen rose to the forefront.
The microbe was named Borrelia burgdorferi (after Dr. Burgdorfer), and the illness was aptly termed Lyme disease after its place of origin. Once people became aware of the new microbe and the illness it caused, cases started popping up all over New England and beyond. Lyme disease seemed to be the newest plague.
In actuality, however, for more than 100 years, physicians in both North America and Europe had long-recorded illness associated with a migrating rash surrounding tick bites. But because they lacked a Lyme disease vaccine and effective treatment options, and because the illness was debilitating but not life-threatening, tick-borne diseases never garnered much attention.
Unfortunately, not much has changed since then in the medical community. Though Lyme is the most common vector-borne disease in the U.S., it’s still difficult to define and difficult to treat. It’s rarely life-threatening, though. Thus, many doctors today turn a blind eye to it. At the heart of this dilemma is a fundamental lack of understanding of the true nature of Borrelia burgdorferi.
What has changed, however, is public awareness. Many people not only know about Lyme disease, but there is more public interest in it than ever before. This is largely due to vigorous advocacy efforts of patients, organizations, and celebrities openly sharing their stories about navigating the illness.
Borrelia burgdorferi is a stealth microbe that insidiously makes people chronically miserable, often for a lifetime. People no longer accept that they have to live with a chronic debilitating illness — rightfully, they want solutions.
Here, we’ll take a closer look at this covert pathogen, the symptoms of Lyme disease, testing and diagnoses, and solutions for overcoming it and restoring your health.
Symptoms Associated with Borrelia
Lyme disease symptoms will differ from one person to another. Some people may hardly experience any symptoms, while others become severely ill or have persistent, debilitating symptoms.
Despite the politicized and controversial nature of Lyme, there is one thing nearly everyone can agree on: The earlier you catch the illness, the better the chances for a successful outcome. If it goes untreated due to such factors as misdiagnosis or delayed diagnosis, you could be in for an uphill battle to regain your health.
Acute (Early-Stage) Lyme Disease
Symptoms of Acute Lyme Disease
One of the most well-known of the early signs and symptoms of Lyme disease is the classic “bull’s-eye” rash (erythema migrans) that appears several days, or sometimes weeks, after getting a tick bite. For the bull’s-eye rash, redness extends outward from the tick bite with an outer, more prominent red ring.
Although the bull’s-eye rash has long been considered definitive proof of Lyme disease and more accurate than laboratory blood tests, even the rash may not be absolute. Only half to a third of people with Lyme disease will get a classic-looking rash, and only 10% of reported bull’s-eye rashes are associated with the presence of borrelia in the blood.
Other acute Lyme disease symptoms include:
- Fatigue or tiredness
- Neck stiffness
- Muscle aches
- Low-grade fever
- Cardiac symptoms such as chest pain, shortness of breath, and feeling faint, which can be indicative of Lyme carditis, a serious heart manifestation of the disease
Note: A high fever and swollen lymph nodes generally indicate a coinfection with another microbe is present as well.
Having a history of tick bites, along with the bull’s-eye rash and other Lyme disease symptoms, is the most reliable way to diagnose infection with borrelia. If it looks like a duck and walks like a duck, it probably is a duck. However, even this type of diagnosis is far from absolute.
Chronic (Late-Stage) Lyme Disease
Chronic Lyme disease is rarely fatal, but it can make you miserable for a lifetime. Typically, people with chronic Lyme disease look normal on the outside. Routine screening labs at the doctor’s office often come back as normal, which can be extremely frustrating for patients because they are often discounted as not being ill.
Inside, however, deep in tissues, a chronic war is going on between a hidden microbe (or microbes) and the person’s immune system. This results in a broad spectrum of seemingly unrelated symptoms.
Symptoms of Chronic Lyme Disease
When Lyme disease becomes late-stage, persistent, or chronic, a different set of symptoms may emerge from the initial onset of the infection. These symptoms can include:
- Tooth pain
- Chronic infection
- Chronic fatigue
- Chronic pain
- Migrating arthritis or joint pain
- Muscle pain
- Chronic flu-like symptoms
- Neck stiffness and creaking
- Bell’s palsy (paralysis or weakness in the facial muscles of one side)
- Brain fog or loss of cognitive function
- Heightened sensitivity and agitation to noise and sound
- Ringing in the ears
- Sleep disorders or trouble sleeping
- Visual changes or blurry vision
- “Floaters” in vision and eye discomfort
- Dizziness and instability
- Muscle twitching
- Paresthesias (burning or tingling in feet and hands)
- Tremors (head and hands)
- Chest pain
- Irregular heart beats
- Shortness of breath or difficulty catching breath
- Unstable bladder
- Gastrointestinal (GI) or digestive dysfunction
The severity of a person’s symptoms is highly dependent on the person’s genetic makeup and the strength of their immune system. In symptomatic chronic Lyme disease, the immune system and the microbes reach a standoff. If the balance is tipped more in favor of the immune system, symptoms are less. If the balance is tipped more in favor of the microbe, symptoms will be greater.
Disease progresses, not because the microbe is winning, but because the chronic tug-of-war between the immune system and microbes accelerates the aging process. Tissues break down faster, and the individual becomes more susceptible to other chronic diseases. People who have had chronic Lyme disease for a long time have more difficulty overcoming it because there is more accumulated damage that must be reversed.
Developing tests to detect and diagnose Borrelia burgdorferi is a real challenge for a number of reasons that have to do with the qualities of the bacteria itself. Borrelia burgdorferi:
- Hides deep in tissues, making the stealth pathogen difficult to diagnose
- Can live inside cells (intracellular)
- Has elaborate ways of tricking the immune system
- Changes its genetic signature readily
- Doesn’t require high concentrations of microbes to cause illness
In the United States, mainstream Lyme testing is specific for Borrelia burgdorferi, but there are approximately 21 other species of borrelia that fall within the category of Lyme disease, as reported in the journal Healthcare (Basel). In Europe, two different species of borrelia — Borrelia afzelii and Borrelia garinii — are more common than Borrelia burgdorferi as a cause of Lyme disease.
Because of the mobility of people, different borrelia species are circulating around the world. This contributes another layer of difficulty to accurate diagnosis. It is becoming evident that other species are much more common than once thought.
Signs and Labs
Bull’s-Eye Rash (Erythema Migrans)
The classic bull’s-eye rash is signified by redness extending outward from the tick bite site with an outer, more prominent red ring. Symptoms of Lyme disease associated with a history of tick bite and bull’s-eye rash are the most reliable way to diagnose infection with borrelia, but even that is far from being absolute.
There are likely other types of microbes that can cause a bull’s-eye rash. And remember that more than half of people with Lyme disease won’t have a classic presentation of a bull’s-eye rash, and only one in 10 bull’s-eye rashes are associated with the presence of borrelia in the blood.
The most definitive test for proving the presence of a microbe is growing it in a lab from a tissue or blood sample. Because borrelia exists in such low concentrations in blood and tissues, and because borrelia is so difficult to grow under artificial conditions, cultures are generally not useful for diagnosing Lyme disease.
EIA tests (ELISA and ELFA)
This tests the host’s blood for antibodies produced against borrelia. The Centers for Disease Control (CDC) defines this test as an important screening test for Lyme disease. But in clinical practice, most healthcare providers who treat Lyme disease find that this Lyme disease test has poor predictive value and limited usefulness. It has no value for diagnosing persistent or chronic Lyme.
PCR for B. burgdorferi
Short for polymerase chain reaction, PCR tests directly for borrelia DNA in the host’s blood, tissues, or urine. Historically, PCR has had limited accuracy, but improvements in the technique are positioning PCR for microbial DNA as the future of testing. At some point, it may be possible to define a person’s entire microbiome.
For now, testing is available for the most common species of borrelia and many common species of coinfections with other stealth microbes. Testing is most accurate during acute infection and much less precise during chronic infection.
Many companies are offering microbial DNA testing, but a few are leading the charge. One, DNA Connexions, tests DNA in either blood or urine specimens for Borrelia burgdorferi and 10 of the most common coinfections. Testing kits are available online for $650.
The Western blot for Borrelia burgdorferi relies on the production of antibodies by the host’s immune system for different parts (antigens) of the bacteria. Antibody production may not kick in for several days to weeks after an infection has been acquired, and it’s dependent on the host’s ability to mount an immune response.
The Western blot test may provide a more accurate diagnosis of Lyme disease than most other available tests, but testing is more valuable for the late acute stage than with chronic illness. In addition, the test is oriented toward a diagnosis of Borrelia burgdorferi — not other species of borrelia that may cause Lyme disease.
Because borrelia shares antigens with other bacteria, multiple positive antibodies (called bands) are required for a true positive test. The Western blot is performed for both IgM and IgG antibiotics in an effort to separate acute from chronic illness.
IgM Antibody Response
IgM antibodies show acute Lyme disease. Testing can be positive as early as one week after infection and remains positive for six to eight weeks after initial exposure. CDC guidelines require two positive bands out of three (bands 23-25, 39, 41). But IGeneX labs add three extra bands (31, 38, 83-93), making it a more sensitive test. Note that bands 31 and 38 were removed from the CDC criteria during the development of an unsuccessful vaccine and were never replaced.
IgG Antibody Response
The IgG antibody becomes present a few months after initial infection. IgG antibodies are more indicative of chronic disease. CDC guidelines require five positive bands out of 10 (18, 23-25, 28, 30, 39, 41, 45, 58, 66, 83-93). However, the IGeneX criteria is two bands out of those same six. Note: Band 41 is specific for the flagella (tail) of spirochetes, but it is not absolutely specific for borrelia.
False Test Results
Acute viral infections can cause false-positive results. Recent data reported from IGeneX shows that some Lyme patients may have only restricted IgM response to Borrelia burgdorferi. Because Lyme patients have different immune systems, only approximately 70% of those with Lyme disease will generate a positive Western blot. Patients who test positive for rheumatoid factor or Epstein-Barr virus may have false-negative tests.
IGeneX Western Blot is around $125. IGeneX is now offering PCR testing for Borrelia miyamotoi (associated with relapsing fever) for between $265 and $295, as well as immunofluorescence testing (FISH) for bartonella, babesia, anaplasma, ehrlichia, and rickettsia.
Aperiomics testing uses metagenomic sequencing with blood samples, tissue swabs (oral and nasal), urine specimens, or fecal samples to identify every known bacteria, virus, fungus, and parasite — their database alone contains more than 37,000 microorganisms.
Aperiomics tests for both Lyme disease and coinfections, but it will likely come with a hefty price tag. Since stealth microbes often hide in various tissues throughout the body, the company recommends testing kits that collect blood, swab, urine, and fecal samples, which can cost upwards of a few thousand dollars.
Remember that no test is entirely definitive, and the results might not change the trajectory of your treatment. Before you splurge on costly testing, talk with your healthcare provider about how new information can be used to advance your recovery.
Developed by Armin Schwarzbach, MD, PhD, ArminLabs offers Lyme testing for several species of borrelia. The tests measure such markers as T-cell function (Elispot), B-cell function (IgA, IgM, and IgG antibodies), and natural killer cells (CD57 and CD56). Additionally, they offer testing for several coinfections, viruses, parasites, and fungi. A typical panel of tests could cost several hundreds of dollars.
Direct Tick Testing
If you kept the tick that bit you, it is possible to have the tick checked for certain microbes. Though not a medical diagnostic tool, tick testing helps to identify whether or not the tick is infected with Borrelia burgdorferi. Some companies test for other borrelia species and coinfections, but no test covers all possible tick-borne disease.
Testing from TickReport ranges from $50 for a basic panel of borrelia species to $200 for a more comprehensive panel for borrelia species and coinfections.
Also, IGenex and ArminLabs have tick-test kits, which look for pathogens like borrelia, tick-borne relapsing fever (TBRF), babesia, anaplasma, ehrlichia, bartonella, and rickettsia.
Finally, local or state agencies, such as universities, may offer tick testing at little to no cost as part of research and data collection projects. But availability often depends on funding and differs from state to state.
Conventional Medical Solutions
In the acute stage of Lyme disease, antibiotics are the appropriate standard of care. During the first two weeks after a tick bite, there is an opportunity to reduce the concentration of microbes within the host using conventional antibiotics before the microbes disseminate deeper into tissues.
Healthcare professionals routinely recommend 100 mg of doxycycline taken twice daily for 2 to 3 weeks. Metronidazole (500 mg) or tinidazole (500 mg) taken twice daily can be added to cover borrelia in a cyst form (borrelia bacteria that coats itself with a protein as a protective measure against antibiotic therapy) or for a wider range of possible coinfections.
Some providers prescribe clindamycin as an oral antibiotic treatment, which has a high association with overgrowth of Clostridium difficile in the gut (a pathogen that causes bloody diarrhea). Clindamycin should only be used topically or intravenously.
Because 10% to 20% of people treated for acute Lyme disease will continue to have lingering symptoms, some healthcare providers may consider turning to a combination drug regimen like that mentioned in the journal Discovery Medicine. For example, the research indicates an antibiotic cocktail of daptomycin, doxycycline, and ceftriaxone was able to eradicate borrelia in mice. While the study is certainly encouraging for improved treatment outcomes, human clinical trials are still needed to determine the safety and efficacy of the three-drug cocktail.
It’s unlikely antibiotic therapy will ever eliminate all of the microbes; it just helps to give the immune system the upper hand. After the microbes have disseminated into tissues, antibiotic therapy is less likely to eradicate the infection.
Aside from antibiotics, a healthy immune system is essential for preventing chronic disease. If symptoms like fatigue or migrating arthritis persist, repeat antibiotics generally provide a transient benefit or no benefit at all.
Natural Solutions for Borrelia
The best approach to overcoming chronic Lyme disease is one that suppresses harmful microbes, supports immune system functions, enhances the body’s innate healing properties, and has a low potential for toxicity. Enter herbal therapy.
When it comes to chronic Lyme disease, herbs are essential components of getting well. Herbal therapy works for a number of reasons, including:
- Herbs enhance immune function and healing, a necessary key to getting well.
- Herbs contain antimicrobial, anti-inflammatory, antioxidant, and other health-enhancing properties without causing harm to the body.
- The antimicrobial properties of herbs also support the friendly bacteria of your microbiome.
- Multiple herbs can be used to gain overlapping benefits because the potential for toxicity is very low.
- Many herbs provide activity against bacteria, viruses, protozoa, and yeast — characteristics not found in synthetic antibiotics.
- Herbs and other natural therapies can slowly etch away at any biofilms (clusters of bacterial microorganisms that stick to surfaces) that are present; some herbs enhance the ability of the immune system to do the work.
- Herbs have the ability to balance hormones and improve energy and stress tolerance.
Which herbs are the best options to support the body’s healing efforts? The following natural remedies will assist you on your road to recovery.
Native to the Amazon, cat’s claw contains immune-modulating properties to calm an overtaxed immune system and decrease inflammation. The herb is a staple among Lyme disease protocols due to its antimicrobial qualities. It has historical use in easing arthritis pain as well.
Suggested dosage: 400-800 mg two to three times daily (inner bark standardized to 3% alkaloids or 10:1 concentrate inner bark is preferred). It is especially important to take this herb with food, as it is activated by stomach acid. If you take acid-blocking drugs, cat’s claw won’t have a significant impact on you.
Side effects: The herb is generally well tolerated, but occasional stomach upset has been reported.
With antibacterial, antiviral, and antiparasitic properties, andrographisdefends against a wide range of microbes. The multi-tasking herb has immune-enhancing, cardioprotective, and liver-protective qualities. Like cat’s claw, andrographis is a mainstay among natural Lyme protocols.
Suggested dosage: 200-800 mg (extract standardized to 10-30% andrographolides) two to three times daily
Side effects: Approximately 1% of people who take andrographis develop an allergic reaction with whole-body hives and itching skin. This is a higher percentage than most other herbs. The reaction will resolve gradually over several weeks once the herb has been discontinued.
Used for centuries in traditional Asian medicine, Japanese knotweed has powerful antimicrobial activity and may fight against a range of stealth microbes. Additionally, the herb crosses the blood-brain barrier, which can be useful for addressing neurological Lyme disease. It also protects the central nervous system, contains anti-inflammatory properties, and supports immune function.
Suggested dosage: 200-800 mg Japanese knotweed (standardized to 50% trans-resveratrol) two to three times daily
Side effects: Exercise caution when using Japanese knotweed if you’re taking anticoagulants — resveratrol has blood-thinning properties. Avoid the herb if you’re pregnant.
Since the beginning of recorded time, garlic has been used for medicinal purposes. The active ingredient in garlic is called allicin, and it contains antiprotozoal, antiviral, and antifungal properties. Additionally, it assists in supporting the immune system and balances the flora of the microbiome.
Suggested dosage: 180-1200 mg of stabilized allicin product two to three times daily (dosage is dependent on the garlic preparation used)
Side effects: Although raw garlic can cause stomach upset, stabilized allicin products are associated with few side effects and are generally well tolerated.
Considered a medicinal mushroom, reishi is a strong adaptogen known for its antimicrobial and immune-modulating properties. It helps to mitigate inflammatory cytokines and supports the immune system’s ability to deal with pathogenic microbes. Reishi offers protective qualities to the liver and heart as well.
Suggested dosage: 1-2 grams (1000-2000 mg) whole mushroom powder or 150-500 mg standardized extract (minimum 20% beta-glucans preferred) two to three times daily.
Side effects: Typically, reishi is extremely well tolerated with rare side effects and no known toxicity.
This herb has antimicrobial properties, dulls cytokines, and bolsters immune health. Chinese skullcap works synergistically with other herbal remedies to enhance their effectiveness. It also has naturally-occurring melatonin, which may help to induce sleep.
Suggested dosage: 400-1000 mg two to three times daily. Root extract, preferably 3-year old plant with pronounced yellow color, standardized to >30% baicalin is preferred. (Note that American skullcap does not offer the same antimicrobial properties and should not be substituted.)
Side effects: Even at high doses, side effects are rare and most often limited to gastrointestinal discomfort.
The Bottom Line
Depending on the stage at which you’ve been diagnosed with Lyme disease, you may require a combination of conventional and natural solutions to get a handle on borrelia and potential coinfections and get well. The most important part of recovery is making a long-term commitment to yourself. Although it may take several months to begin experiencing a change in your health, if you stay committed, better health is certainly within reach.
Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme. You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.
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- I cringe whenever I hear the word “rare” being used regarding any aspect of Lyme/MSIDS. They’ve been using this word with abandon since Lyme was “discovered” over 40 years ago and they’ve had to recant that word often. Since doctors are not actively looking for tick-borne illness, and are woefully uneducated on how to diagnose clinically, as well as the fact testing is so abysmal but still heavily relied upon, there is no way of truly discerning prevalence. It might be “rarely ” reported on in the literature, but that is world apart from what happens in the real world. Words matter. We desperately need post-mortem work done: https://madisonarealymesupportgroup.com/2018/04/13/chronic-lyme-post-mortem-study-needed-to-end-the-lyme-wars/ For a great read: https://madisonarealymesupportgroup.com/2020/11/21/can-tick-borne-diseases-be-fatal-what-you-should-know-about-tick-related-deaths/ and https://madisonarealymesupportgroup.com/2019/12/21/patients-can-die-when-lyme-carditis-is-not-treated/
- Regarding the issue of persisting symptoms, that too has been very under-reported for the same reasons. Our public ‘authorities’ won’t even admit persistence exists, and patients are falling through the cracks like cookie crumbs. How can prevalence be estimated when testing misses over 70% of cases? For a great read on the numbers of those that go on to suffer with symptoms: https://madisonarealymesupportgroup.com/2019/02/25/medical-stalemate-what-causes-continuing-symptoms-after-lyme-treatment/
- Dr. Rawls states that it is highly unlikely antibiotics will ever eradicate the Lyme organism entirely. I could say the same, exact thing about herbs or ANY other treatment as Lyme/MSIDS is relapsing and persistent in nature and extremely resistant and stealthy. I DO agree it often takes many things to get on top of this illness and that keeping an open mind about treatment is imperative. Like so many other health issues, obtaining balance in the body is also a key with tick-borne illness. Unfortunately, these pathogens overwhelm the body and they need to be seriously dealt with before you can ever hope to regain homeostasis. So while antimicrobial treatment is not the only key to treatment, it’s an important one.