Lyme disease.

 

In more than 26 years of work as a general practitioner, I have also treated many patients with Lyme disease. This certainly does not make me a specialist in this disease, but I would like to share a few thoughts on the subject. The relevant section in the German edition of the "Handbook Toxoplasmosis" will be supplemented accordingly from mid 9/2025. To make room for this, case 15 has been removed from the book, but this documentation can still be viewed in the ‘27 case studies’.​    An updated English version of the actual 3rd German edition of the "Handbook Toxoplasmosis"  is expected to be published in early 2027.

​

This bacterial disease is mainly transmitted by ticks. In case of a Borrelia infection (not always!!), a typical redness of the skin develops at the site of the bite after a few days and slowly spreads. Borrelia bacteria, like Toxoplasma, are usually located within cells and can cause similar symptoms. The most reliable differences in symptoms are that Borreliosis usually causes severe joint pains that migrate from joint to joint, a characteristic I have not yet observed in Toxoplasmosis. Sometimes the joints are also swollen and inflamed, which also does not occur in Toxoplasmosis. Migrating muscle pain and abnormal sensations in different locations can also occur in Lyme disease. 

 

Another distinctive feature is the frequent occurrence of shooting pains in different parts of the body several times a day, which only last for a few seconds; these do not occur in Toxoplasmosis. The severity of symptoms can also vary in Toxoplasmosis, but they do so as a whole, all over the body simultaneously; the picture is, so to speak, ‘calmer’ than the sometimes chaotic course of symptoms in Lyme disease.  Standard antibody tests and PCR are not sufficiently reliable. If these tests yield negative results in cases with typical symptoms, additional LTT Testing (see website of the IMD lab, Berlin) or Elispot is strongly recommended. These tests are significantly more sensitive, but even if the results are negative, they do not rule out Lyme disease with certainty.

​​​

II would also like to point out that involvement of the nervous system (Neuroborreliosis) can be confirmed by detecting Borrelia antibodies in the cerebrospinal fluid (CSF), but there is no evidence that the absence of these antibodies in the CSF would definitively rule out Neuroborreliosis. ​

​

​

​

​

​​

​

​

​

​

​

​

​

 

​

Treatment: In the early stages of Lyme disease, many antibiotics are effective, for example Doxycycline 2 x 100 mg daily, Clarithromycin 2 x 500 mg, Amoxicillin 3 x 1000 mg, or Cefuroxime 2 x 500 mg, all taken for at least 14 days, often for 4 weeks – but in any case until all symptoms have subsided.

​

In the event of relapses (= recurrences) in later stages of the disease, the symptoms can become very pronounced again, and the Borrelia can be present in a coccoid form, which makes them significantly less sensitive to antibiotics. These forms appear under the microscope as cysts, which is why they are often referred to as the cyst stage. At this stage, Lyme disease is extremely difficult to treat; even Ceftriaxone infusions are often ineffective, and it can take years to effectively control Lyme disease. One possible solution is to use medication that break open these ‘cysts’. This can be achieved with Metronidazole 3 x 400 mg daily or Fluconazole 200-400 mg once daily. The latter is actually an antifungal agent, but is very effective against cyst forms of Lyme disease.  (see in: Schardt FW. Clinical effects of fluconazole in patients with neuroborreliosis. Eur J Med Res. 2004 Jul 30;9(7):334-6. PMID: 15337633.)

​

The following combination has proven to be very effective in my work, even for these difficult stages of the disease: 

 

1 week of Metronidazole 400 mg 3 x 1 + Clarithromycin 500 mg 2 x 1, then 1 week of fluconazole 200-400 mg 1 x  1, to be continued on a weekly basis for at least 4 weeks. This has helped several of my patients significantly.

 

A detailed discussion of the treatment of Lyme disease and all possible co-infections would exceed the scope of the "Handbook Toxoplasmosis",  I  recommend to search for specialized literature in this field.