Lyme Disease on the Rise in Sibiu: Expert Advice on Prevention, Symptoms, and Treatment

38 people were diagnosed, in Sibiu, with Lyme disease in the first three months of 2023. Last year, there were, in total, 127 people for whom the diagnosis of this disease was confirmed. Most of the diagnosed people come from the city (see the table at the end of the article). The statistic is a worrying one, all the more so since in the years 2021-2022, Sibiu was in first place in the country in the number of people diagnosed with Lyme disease, according to the authorities. Unfortunately, year after year Sibiu county exceeds the national average incidence. Doctor Victoria Bîrlutiu, head of the Infectious Diseases Department at the Sibiu County Hospital, answered a series of questions regarding this situation for the Council Tower. It is important to note that due to climate change, the period of activity of ticks has extended from the end of February to October-November, so it is important to be vigilant and protect ourselves as much as possible to avoid contacting a disease which can cause serious complications.

Read also: “Pediatric specialist on tick bites: Sibiu is an endemic area with a higher incidence of Lyme disease”

Reporter: 38 people diagnosed since the beginning of the year and 127 last year. What can you tell us about these numbers? Is this a worrying statistic? Has the number of people diagnosed increased in recent years?

Dr. Victoria Bîrlutiu: If we look at the statistics of the last 5 years, according to the National Institute of Public Health, in Romania, at the national level, in 2018, 532 cases of Lyme disease were confirmed, in 2019, 410 cases, in 2020 179 cases, in 2021, 142 cases and in 2022 a number of 526 cases, to which are added probable cases, where the tests were in a border zone between positive and negative, called equivocal results. In national statistics, Sibiu County ranks first in the number of people diagnosed with Lyme disease in 2021-2022 and second in 2020, annually exceeding the national average incidence. The incidence of Lyme disease was reduced during the pandemic, with an upward trend re-emerging from 2022 with the resumption of normal recreational activities.

What do you recommend the people of Siberia to do in case of a tick bite, concretely: to go to the hospital or not to remove it, to undergo antibiotic treatment or not, to take a Lyme disease detection test or not?

After every walk in nature, we recommend a careful observation of the skin, to find possible tick bites as quickly as possible, the interval of the first hours being the lowest risk of transmission of the bacteria that causes Lyme disease (Borrelia spp). Often, the bite is in areas that are hard to reach for your own examination – in the scalp, armpits, groin or behind the knees, etc. and it is not always about the presence of the adult tick, but also about small larvae or nymphs, which can be confused with moles and remain in the skin for a longer time.

Specialists’ advice is to go to the doctor, the Emergency Service, pediatrics or adults, depending on the age group, because the incomplete extraction of the tick, at home, leads to the release of all the infectious content in the skin (we are also talking about other types of bacteria, viruses that can be present separately or concurrently with Borrelia in the same tick and that can be transmitted at the same time). Lyme disease prophylaxis is recommended, even more so in areas like ours, it is necessary, according to the national protocol, to administer a single dose of antibiotic immediately after the tick is extracted, an antibiotic appropriate to the patient’s age and possible allergies.

What are the symptoms of Lyme Disease? When should we worry?

The appearance of migratory erythema in the area where the bite occurred, marks the first stage of the disease, 3-30 days after the bite, for which the person in question should immediately go to the doctor for treatment. Treated at this time, Lyme disease does not progress to the feared stages II and III, dominated by the neurological, joint or cardiovascular manifestations that it causes. Unfortunately, only one out of 4 patients who develop the disease have erythema migrans (a red area of ​​at least 3 cm, which increases in size in the absence of treatment, sometimes having the appearance of a red circle in the periphery and of a normal color in the center), other patients have manifestations general- fever, muscle, joint or headache pain, increase in the size of the nodes in the area of ​​the bite and others do not have any manifestation that suggests the transmission of the Borrelia bacteria. In these patients, after 2-3 months, the articular, cardiac or neurological manifestations (meningitis, facial paralysis, etc.) may appear or, even later, the disabling neurological ones.

It would be useful for all those who have tick bites to carry out prophylaxis and to watch for any local changes or those that I mentioned previously, for which they should go to the doctor.

If a person has been bitten repeatedly by ticks, even without symptoms, is it recommended to get tested for Lyme disease?

Testing for Lyme disease is performed approximately 28 days after the bite, in those who are symptomatic or when the presence of some manifestations, even in the absence of the bite, suggests this condition (joint, neurological manifestations, the presence of erythema migrans) because sometimes, the moment of the bite of the tick goes unnoticed. Not all bites are associated with Lyme disease, a small number compared to the total number of bites present the transmission of the bacterium (3-10% depending on the area and the circulation of the vector), but re-infection is also possible, being several species of Borrelia that can cause the disease- in Europe, so here too, we are talking about B. burgdorferi, B mayonii, B afzelii, B garinii, B spielmanii.

What are the most relevant such tests?

The first test that is performed, screening, is the ELISA test, no sooner than 28 days, which highlights the antibodies of recent infection IgM or in other cases, the passage through infection, antibodies of the IgG type that remain positive throughout life. This test is complemented by a confirmation test, Western blot that does not cause false positive or false negative reactions, through interference with other antibodies that appear against other types of bacteria with similar structural elements. These tests are also performed on cerebrospinal fluid in people with possible neuroborreliosis.

Can we also use commercially available tests (pharmacies, online stores)?

The recommendation is to carry out the two tests, through the Sibiu Public Health Directorate, in possible or suspected cases of Lyme disease, through the family doctor or the Infectious Diseases Clinic.

There are other tests, available in accredited laboratories in the private system, in addition to the two presented, such as the lymphocyte transformation test for Borrelia, PCR tests from the skin lesion or joint fluid, tests to determine the chemokine CXCL13 in cases of neuroborreliosis, a situation in which and cerebral magnetic resonance can reveal changes – demyelinating lesions, which, however, are not specific for borreliosis.

What is the most important thing that Siberians should know about this condition?

In the warm and especially rainy season, the circulation of ticks has become extremely important in the area of ​​our country. After any outing in nature, it is advisable to check your skin so that the presence of a tick does not go unnoticed. Appropriate clothing to protect your skin, use of sprays with active substances to remove ticks, supervision and vaccination of pets should be considered.

There is no vaccine for the prevention of the disease in humans, so only non-specific protective measures, along with how to watch for possible tick bites and remove them as quickly as possible, as well as prophylaxis, are the keys to not getting the disease. It is important to know that in addition to Lyme disease, there can also be co-infections transmitted during the same incident, some treatable similar to Lyme disease, others, viral, serious, such as tick-borne encephalitis (against which there is vaccination prophylaxis).

What other factors, apart from the tick bite, cause this disease to occur?

Ticks pick up the bacteria from mice, deer, but are not the only ones capable of transmitting Borrelia. Borrelia spp. are also identified in flies, ticks and even mosquitoes (Culex pipiens).

Is there anything else to pass on?

Yes, due to climatic changes, the period of activity of ticks has extended from the end of February to October-November. Tick ​​infestations can occur throughout this period, so my advice is to be protective of yourself.

Also read: He learned he had Lyme after six months of misdiagnoses: from epilepsy to cancer. “It wasn’t the top doctors who helped me, but the doctors who got involved”

Detailed status of people diagnosed with Lyme disease since the beginning of the year

Status of people diagnosed with Lyme disease in 2022

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