Your Brain On... Lyme Disease

Ayesha Sherzai (0:00)

It starts with a bite. Sometimes you don't even notice it. But weeks later, your skin develops a rash, your joints ache, your thoughts feel slow, your energy vanishes. Very quickly, symptoms can spiral into something a lot more serious. And this tiny bite from a tiny tick speaks to some huge problems with our healthcare system, like inequality in the distribution of treatment and diagnosis and the speed at which misinformation can destroy public trust in the scientific method. In this episode, we're talking about Lyme Disease and we'll be speaking to two experts on the matter, Dr. John Aucott, Director of the Johns Hopkins Lyme Disease Clinical Research Center and Dr. Richard Marconi, Professor of Microbiology and Immunology at Virginia Commonwealth University. This is Your Brain On Lyme Disease.

So Dean, Lyme Disease is an incredibly interesting topic. I say that often for every disease, but this one is important because it has many touch points. It touches on a disease that we're learning more about, but it also is almost a meeting point of multiple different social, economic, psychological, cultural, and historical inefficiencies of our health care system and as human beings in general. There are even racial inequalities that come into foray. There's lack of access and health care for people who suffer from this disease. There's vaccine skepticism involved in this, and of course, the progress that we've made to learn more about this disease.

Dean Sherzai (1:49)

It's a perfect symbol of how one disease can actually affect so many different systems. Especially a disease that is very unusual in its character. Its diagnosis is difficult, its symptoms are difficult. Often people don't really know much about it. In that uncertainty, what's created is incredible amount of distrust, incredible amount of chaos, and that's where we actually can learn about our health care system properly by looking at a disease like this. Why we need to address this in a much broader way is because, in that gap, there's a lot of people that actually suffer, a lot of people that don't get care, a lot of people that are ignored, a lot of people that actually the medical system disregards and puts down. How often have we heard patients say that, my doctor said that it's all in your head? And this is where proper language, proper conversation around scientific methodology has to come in. Not from a top-down perspective, from a broader conversation that society must have, but around one language, which is a scientific method.

Ayesha Sherzai (2:51)

Beautiful. I think this is a good point to actually go ahead and define the disease before we can introduce our speakers.

Dean Sherzai (2:57)

Absolutely.

Ayesha Sherzai (2:58)

So, definition. So Lyme disease is a multi-system disease, and that basically means that multiple different parts of your body and systems of the body are involved, and it's caused by a bacteria called Borrelia burgdorferi. It's a mouthful, but I think it's been hammered in our brains during medical school, and especially in the neurology residency program. And it's transmitted to humans through a bite by a tick. It's commonly known as deer tick, and it's the most common vector borne illness in the United States, and especially in the Northern Hemisphere. So what happens is after a tick bite, the bacteria Borrelia burgdorferi enters the blood stream, and it starts spreading everywhere. And early on, it causes a localized infection. It actually causes a rash, and that rash is called erythema migrans.

Dean Sherzai (3:49)

A very unique rash, because every test we took during medical school, and even thereafter, there was a picture of that target, target sign, and that's unique to this infection.

Ayesha Sherzai (4:00)

It's burned in our minds. So that's basically the very characteristic rash. Sometimes it's not there, sometimes it doesn't even look like an erythema migrans, but you usually get a rash and then a localized infection. And that infection, if it's treated right away, that's it. That's the treatment of Lyme Disease and people don't tend to have chronic issues. However, if this continues to go on for a long period of time, the disease can become chronic.

Dean Sherzai (4:30)

Now, what's interesting is for those that are not treated or even not treated well, about 10% to 15% of them become neuroborreliosis. And that means that they have these neurological symptoms such as headaches, fatigue, fogginess, as well as radiculopathy, which is these sharp pains going down the arm or the legs. This is a fairly common disease, isn't it?

Ayesha Sherzai (4:51)

Yeah, it has to do with how sneaky this bacteria is. It really knows how to save itself. It actually morphs and what happens is it starts creating this biofilm or a very protective covering made out of protein around it. It becomes almost invisible to the immune system. It evades it and it lives in systems where we don't have very active immune systems such as the central nervous system. Sometimes it can actually live in muscles and tissues and joints as well. Living in the brain, it can cause all the neurological symptoms that you described. It's just fascinating that it starts almost acting like a parasite where it just pops up ahead and it becomes active when the immune system is on the lower side and it continues to replicate and replicate. That's why people have months and years of chronic issues with Lyme Disease. But like you said earlier, the symptoms can be so vague and it can be just brushed off as being tired all the time or having some aches and pain related to arthritis, but it actually may be Lyme. The numbers are scary, statistics and epidemiology. The CDC estimated that nearly 500,000 Americans are diagnosed and treated with Lyme Disease every year. That's half a million people every single year experiencing Lyme Disease.