3 Major Obstacles to Recovery in Lyme Disease and Tick-borne Illness
One major area of controversy in the world of Lyme disease and tick-borne illness is why some people get better while others only have partial recovery or become chronically ill. We know that tick-borne co-infections, insufficient antibiotic therapy, and delayed diagnosis are big factors in the subset of people that don’t have a straightforward recovery. However, even when all of these areas are adequately addressed, people can still end up with lingering symptoms.
When we have cases that are resistant to treatment, or not responding adequately to therapy, we usually do a thorough review of a person’s “obstacles to cure.” That is, what could be going on in a patient that may be preventing full recovery? While some obstacles like genetics may be harder (but not impossible) to control, we come across many obstacles that can be targeted to facilitate healing. Below are three major obstacles, aside from other infections, that we commonly see in patients with tick borne illness.
1) Immune dysregulation
The immune system may end up driving a lot of the symptoms of tick borne illness. These infections are very good at confusing the immune system so that they are able to persist in the body. This causes the immune system to overreact in certain ways while simultaneously underreacting in the ways that are helpful for clearing infections. The end result is excessive inflammation, lingering infections, and chronic symptoms.
Unfortunately even if infections are successfully cleared, the immune dysregulation caused by having the infection can persist. A confused immune system is the basis for autoimmune diseases, in which the body begins to attack itself. It is not surprising then that there is mounting evidence to suggest infectious triggers of autoimmune conditions. If we just treat the bug without treating the inappropriate immune response, patients may end up with persistent symptoms or overt autoimmunity.
2) Environmental exposures
We often refer to the bucket analogy when thinking about environmental exposures in complex chronic illness. As you are exposed to more and more things throughout your life, your “bucket” or body burden goes up.
Things like pesticides, solvents, plastics, heavy metals, mold/mycotoxin and other environmental toxins can all accumulate in your bucket. Tick borne infections can also make their own toxins that can contribute to the bucket. Everyone has a different sized bucket, and differing abilities to empty the bucket.
When a person’s bucket get’s too full it can begin to overflow, and the things in the bucket that your body may have been able to tolerate previously are now causing problems. Thus, it’s not necessarily the last thing added to the bucket (e.g. tick bite and consequent infections) that are driving all of the new symptoms.
Although treating underlying infections, especially the tick borne ones, will significantly reduce the body burden, it may be important to screen for exposures and further support detoxification for patients that are resistant to treatment and especially in patients that have difficulty tolerating treatment.
3) Mitochondrial dysfunction
Mitochondrial function is particularly susceptible to excessive inflammation and oxidative stress. Thus it is the rule rather than the exception for patients with Lyme, tick-borne illness, and most complex chronic illnesses to have some degree of mitochondrial dysfunction.
While the most well known role of the mitochondria is to create energy for the cell, there is also evidence to suggest that the mitochondria have important cell regulatory activities. In immune cells, the mitochondria housed there are intimately involved in coordinating appropriate immune cell responses to infections and other insults.From this, it's obvious how mitochondrial dysfunction can contribute to persistent infections and vice versa.
The symptoms of mitochondrial dysfunction can also overlap significantly with symptoms attributed to persisting infections. A few big ones are fatigue, muscle pain and weakness, and neurocognitive concerns. This is why we will often layer on therapies to address mitochondrial dysfunction in order to improve symptoms, support the immune system, and to maintain recovery.
Moral of the story
This is by no means a comprehensive list and each patient will end up having a unique set of obstacles to explore. But hopefully it has demonstrated the importance of digging deeper in the setting of Lyme and tick-borne illness, especially in resistant cases. Sometimes the infection or instigating event and subsequent illness is just the tip of the iceberg and other factors must be addressed for complete recovery.
Sources:
Berndtson, K. (2013). Review of evidence for immune evasion and persistent infection in Lyme disease. International journal of general medicine, 6, 291.
López-Armada, M. J., Riveiro-Naveira, R. R., Vaamonde-García, C., & Valcárcel-Ares, M. N. (2013). Mitochondrial dysfunction and the inflammatory response. Mitochondrion, 13(2), 106-118.
