Lyme disease is on the brink of becoming the world’s latest pandemic, and one of the main reasons is because we don’t know enough about it. We do know exactly where it comes from and how it’s spread – but once the disease enters the body, it becomes one of the most complicated infections in existence. Part of our lack of knowledge is due to a lot of miseducation. The chronic form of Lyme isn’t even fully accepted as a legitimate condition, and as a result, misdiagnosis rates are high. The symptoms produced by the disease over the long term are also very general and hard to diagnose in the first instance. Important questions need to be asked concerning how Lyme affects people differently. Gender is one area of study; race is another. So are certain races more susceptible to Lyme? And does Lyme affect races differently?
These are not easy questions to answer. Many, many cases of Lyme go undiagnosed or misdiagnosed every month all over the world. This is down to many factors, most notably lack of visibility around Lyme as a whole. Even as this changes for the better in 2019, experts estimate that the prevalence of Lyme disease is far higher than we might think. The CDC (Centers for Disease Control and Prevention) concludes that there are roughly 300,000 new cases of Lyme every year, and that only a low percentage of these make it through to a successful diagnosis. Part of the problem is that Lyme disease is actually a catch-all term for two distinct disorders.
The cause of both is the Borrelia burgdorferi bacteria, transmitted to humans via tick bite. The acute and chronic phases of Lyme are distinct from each other and manifest in totally different ways. The acute form lasts a few weeks and appears soon after the bite. It presents with fever, headaches, chills and fatigue, and often won’t be severe. The danger here is that symptoms can be easily ignored. But if Lyme is caught in this acute window, it is much easier to treat, and can usually be dealt with via a round or two of antibiotics. Chronic Lyme can cause much more debilitating complications, due to the appearance of inflammation symptoms. During the later stages of the disease, infection recedes (but crucially is still present) and the immune system starts to overreact. Prevalent symptoms like joint pain, muscle aches and fatigue can quickly overwhelm patients, while more serious issues like cardiological and neurological complications can also ensue.
Chronic Lyme affects each patient differently; but does Lyme distinguish between races? For an in-depth look at this question, we turn to a study completed in 2000, which focused on the American state of Maryland. In the United States, where Lyme was first discovered, the instances of Lyme disease are thought to be disproportionately high among the white population, due in large part to geographical factors. The disease was discovered in Connecticut, and has long been associated with the Northeast of the U.S.A. The populace in this part of the country is predominantly Caucasian, so obviously the instances of Lyme would predominantly affect white people. To better understand any racial distinctions the disease makes, the researchers focused on Maryland, which had previously reported higher incidences of African American Lyme cases (almost 10% of all cases) than other areas of the U.S.
The results of the study proved interesting. Among the different manifestations of Lyme disease, the greatest discrepancy was found in cases of erythema migrans, the expanding rash found in the early stages of Lyme. However, there were greater incidences of arthritis (a chief and prevalent symptom of Lyme) among African Americans. Thus, there was found to be a negative association between the extracutaneous manifestation of arthritis and the early marker of infection – the expanding rash. The cause of this is thought to be the difficulty in identifying the rash on darker-coloured skin. Given that arthritis is the most common complication stemming from untreated Lyme, it’s logical that under-recognised initial symptoms in the African American community would lead to higher instances of typical complications.
In addition to this: beyond race, where you live and what kind of lifestyle you conduct plays a big part in how at risk for Lyme you are. White middle-class people might have a tendency to both live rurally and spend more time outdoors, especially in the Northeastern areas of the country. This is prime tick feeding ground, as the climate is particularly suited for ticks. Additionally, middle-class people are better placed to financially afford medical care than low-income families. All these factors must be carefully considered when examining the broad picture of Lyme. When geographical and economical angles are considered, it makes sense that the majority of Lyme patients are ultimately Caucasian.
But this doesn’t mean that Lyme education shouldn’t continue all over America, and indeed the world. If anything, it means that African American people must be even more vigilant for the acute symptoms of Lyme, as their darker skin makes rashes harder to spot. A bullseye rash is the definitive symptom of acute Lyme; if it’s present after a tick bite, there can be no question of Borrelia infection. Unfortunately, many doctors don’t know what to look for, as they’re not Lyme-literate. Specialists like BCA-clinic have been striving for years to better educate the public at large about both the symptoms and danger of Lyme. No matter what race you are, better education will lead to higher visibility, and ultimately more successful treatment.