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Lyme Disease

Lyme disease is characterized by infection with the spirochete (type of bacteria) Borrelia burgdorferi. Ticks transmit these organisms. Humans are also susceptible to Lyme disease. Lyme disease is only spread by ticks: it cannot be directly transmitted between dogs, from dogs to humans, from humans to dogs, or between humans. Lyme disease is most common on the two coasts and in the upper Midwest. The most common vector for this organism is the deer tick.

There are 3 main phases of infection seen in the dog: acute, subclinical, and chronic.

Acute Phase: The incubation period for the disease is 2-5 months. During this time the following signs may be evident:

Lameness in one or more limbs

Painful, stiff joints

Sensitivity to touch

Fever

Anorexia

Depression

Not all animals clearly exhibit these signs, which may last only 1-2 days.

Subclinical Phase: may last for months to years.

Typically no clinical signs are evident in animals during this phase.

Chronic Phase: This stage may begin several months or years after initial infection.

Recurrent lameness

Lethargy

Decreased appetite

In rare cases, Borrelia burgdorferi can infect and reproduce in the kidneys, heart or the nervous system. In these cases, long-term prognosis is very poor and clinical signs related to these organs will be evident.

Diagnosis

There are in-house tests now available to detect infection with Borrelia burgdorferi. Even if the animal is not showing any clinical signs but has been infected with Borrelia, the test result will be positive. This initial screening test tells us the animal has been infected. The test must be run at least 4-6 weeks post tick exposure.

The next step is to gauge the severity of infection by sending blood in for a quantitative assay. This test allows us to quantify how much antibody to Borrelia is present. That number typically correlates with the severity of the disease. Depending upon the animal’s clinical signs, further laboratory testing may be warranted to assess liver and kidney function, blood cell counts, etc.

We are now routinely using the 4Dx test which checks for heartworm infestation, Lyme disease, Anaplasma and Ehrlichia infection (other tick-borne diseases). In some cases of clinical disease, it is optimal to check paired antibody levels several weeks apart.

Treatment

Treatment is dependent upon the severity of infection (antibody numbers & clinical signs). If antibody levels are high, doxycycline is initiated for one month. Doxycycline is the antibiotic of choice but may cause gastrointestinal upset in some dogs. Doxycycline should be given with food to decrease the GI effects.

If this still doesn’t alleviate the side effects, there are several other antibiotics that are active against Borrelia burgdorferi. If the antibody levels are very low and the patient is not exhibiting clinical signs, it is recommended to re-test in 6 months as treatment has not shown to be effective/necessary in patients with very low antibody levels.

If there are associated renal problems, carditis, etc. these issues are harder to deal with and may not carry a positive outcome. Again, the vast majority of Lyme positive dogs do not experience these maladies.

Follow-Up

It is very important to continually check antibody levels in patients with current or past infections. A screening test should be performed at 6 months after the first positive test (whether or not treatment was initiated). If this test is again positive, quantitative levels should be obtained to monitor efficacy of treatment, possibility of re-infection, need for further treatment or potential chronic disease.

Prognosis

Current research suggests that in most cases of uncomplicated Lyme disease, antibiotic therapy alleviates the clinical signs of the disease. Checking antibody levels will help us assess prognosis as well. Animals that are not showing clinical signs, have low-moderate antibody levels, and are treated with appropriate antibiotics have the best chance of completely clearing the infection.

Once dogs are showing clinical signs and have a high antibody load, their chances of completely clearing the infection decrease. After antibiotic therapy, the clinical signs are gone but the spirochete may not be completely cleared from the body. In these cases, there is a chance of recurrence of clinical signs in the next months-years of the dog’s life. This is another important reason to continue to monitor antibody levels in these patients.

Once an animal has been infected and treated they are susceptible to re-infection, so prevention is important even in currently infected dogs.

Prevention

There are two main areas of prevention for Lyme disease: vaccination and tick control.

Vaccination: Although the Lyme vaccination is not 100% (no vaccine is) it drastically reduces the chances of infection. Since we do have a high rate of Lyme infection in this area, it is recommended to start vaccinating for Lyme disease as a puppy.

Tick Control:This is another important aspect of prevention. Keeping your dog away from heavily wooded areas will decrease contact with ticks. There are also several tick control products (including flea control) that are effective. Advantix and Frontline are the most popular, they are both topical agents applied monthly. It is important to use these agents throughout the entire tick season: early spring to late fall.

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