Introduction to Lyme Disease in New Jersey

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New Jersey is #2 in the nation for all CDC surveillance cases reported from 1990 to 2010, with the total number of cases meeting CDC surveillance criteria (a stricter measure) at 38,387. This data does not include all cases which fall outside the stringent criteria definition.

It’s important to remember that the CDC – Centers for Diseases Control and Prevention- has stated that Lyme disease is underreported by a factor of 10 to 12, so adding a “zero” to a Lyme statistic may yield a more accurate number for practical purposes.

The CDC criteria are meant for SURVEILLANCE, not Lyme disease diagnosis, treatment, reimbursement, or standards of care, states CDC.

It is important for patients and physicians to remember that Lyme disease is a clinical diagnosis, and that fewer than 50% of patients remember a tick bite.

Also, fewer than 50% of patients show a bull’s eye rash, so absence of rash does not equal absence of Lyme disease.

[Clinical diagnosis definition: The estimated identification of the disease based on signs, symptoms and medical history of the patient rather than merely on laboratory examination or medical imaging]

Lyme and tickborne disease testing is erratic at best, and can be up to 40% inaccurate, so it is important to re-test if symptoms persist and to use a laboratory that is experienced in detecting Lyme disease and other tickborne infections.

The American College of Physicians recognizes that blood tests… “cannot diagnose Lyme disease alone, but they are used to confirm a diagnosis,” and that “anti-Borrelia burgdorferi antibodies may take up to 2 to 6 weeks after infection to appear in the blood. Therefore, a blood test immediately following a tick bite will not be able to determine whether or not a person has been infected since not enough time has passed for antibodies to develop.”

CDC also first recognized New Jersey as endemic for Babesiosis, another tickborne disease caused by a protozoa, in 2002.

Bartonella, another tickborne coinfection, is present in approximately as many ticks in New Jersey as Lyme disease (33% for Lyme disease, 34% for Bartonella henselae) and can manifest with severe symptoms mimicking Lyme disease including neurological problems. New Jersey patients should discuss testing for a range of tickborne infections together with Lyme disease during their visit(s) with their physician.

Young people are especially hard-hit by Lyme disease and tickborne coinfections in New Jersey, and the consequences can cause physical, neurological and psychiatric manifestations that can interfere with the ability to attend school, perform necessary classwork, and meet routine developmental milestones.

When more than one tickborne infection is present, the patient picture can be one of greater severity of symptoms with a longer-lasting illness as documented in medical literature and so it is important to identify the full range of tickborne infections present in the patient.

It is important to know that researchers published, in an initial study of patients with Lyme arthritis performed from 1977 to 1987, that Lyme arthritis patients with tissue hype HLA-DR2 and HLA-DR4 had a more severe arthritis and chronic disease.

There has been much controversy over whether Lyme disease is a short-term, easily cured disease or whether it can be chronic and persisting. Recent studies have indicated that, in fact, it appears both can be true.

Besides patient-to-patient variability, greater severity when tickborne coinfections are present, and variation due to patient tissue type, some studies suggest that a genetic flaw in how antibiotics attach to bacterial cell walls may affect some patients’ ability to be effectively treated.

More recent studies have shown that the spirochete-shaped Borrelia burgdorferii bacteria which causes much of the Lyme disease found in America takes other forms (such as the “cyst” or round form) or can be encompassed in a biofilm, and that antibiotics which are effective against one form of the bacteria may not be effective against others or able to penetrate the biofilm.

A Stonybrook study showed that there are several strains of the Lyme disease bacteria which vary in their properties, some causing no disease at all, while others cause a mild and easily-cured disease, and yet some cause a chronic and persisting disease which disseminates throughout the body (and reproduces differently with DNA exchange). [CURE UNKNOWN: Inside the Lyme Epidemic, by Pamela Weintraub, 2008. St. Martin's Press, First Edition pp. 342 - 345.]

Thus there is no “right” side to the Lyme disease controversy; Lyme disease can be a disease that is easily cured in one patient and a chronic, persisting, and debilitating disease in the next. Therefore it is important to be informed, to treat early on, and to seek a physician who treats adequately and who can accurately determine your disease picture and treat, over time, based on the total clinical picture.