The key difference between MS and lyme disease is that lyme disease is an infectious disease whereas MS is not an inflammatory disease with no infectious origin. That is, Multiple sclerosis is a chronic autoimmune, T-cell mediated inflammatory disease affecting the central nervous system. Lyme disease, on the other hand, is caused by a spirochete named Borrelia burgdoferi which enters the human body through the bites of lice or ticks.
Both multiple sclerosis and Lyme disease are illnesses that can affect our neurological system.
CONTENTS
1. Overview and Key Difference
2. What is MS
3. What is Lyme Disease
4. Similarities Between MS and Lyme Disease
5. Side by Side Comparison – MS vs Lyme Disease in Tabular Form
6. Summary
What is MS?
Multiple Sclerosis is a chronic autoimmune, T-cell mediated inflammatory disease affecting the central nervous system. This will result in multiple areas of demyelination in the brain and the spinal cord. The incidence of MS is higher among women. MS mostly occurs between patients of 20 and 40 years of age. The prevalence of the disease varies according to the geographical region and ethnic background. Furthermore, patients with MS are susceptible to other autoimmune disorders. Both genetic and environmental factors influence the pathogenesis of the disease. Three commonest presentations of MS are optic neuropathy, brain stem demyelination, and spinal cord lesions.
Pathogenesis
T cell-mediated inflammatory process occurs mainly within the white matter of the brain and spinal cord, producing plaques of demyelination. 2-10 mm sized plaques are usually found in the optic nerves, periventricular region, corpus callosum, brain stem and its cerebellar connections and cervical cord.
In MS, peripheral myelinated nerves are not directly affected. In the severe form of the disease, permanent axonal destruction occurs, resulting in progressive disability.
Types of Multiple Sclerosis
- Relapsing-remitting MS
- Secondary progressive MS
- Primary progressive MS
- Relapsing-progressive MS
Common Signs and Symptoms
- Pain on eye movements
- Clumsy hand or limb
- Unsteadiness in walking
- Mild fogging of central vision/color desaturation/dense central scotoma
- Reduced vibration sensation and proprioception in feet
- Urinary urgency and frequency
- Neuropathic pain
- Depression
- Sexual dysfunction
- Temperature sensitivity
- Fatigue
- Spasticity
In late MS, one can notice severe debilitating symptoms with optic atrophy, nystagmus, brainstem signs, pseudobulbar palsy, spastic tetraparesis, ataxia, urinary incontinence and cognitive impairment.
Figure 01: Symptoms of MS
Diagnosis
A diagnosis of MS can be made if the patient has had 2 or more attacks affecting different parts of the CNS. MRI is the standard investigation for the confirmation of clinical diagnosis. CT and CSF examination will provide further supportive evidence for the diagnosis if necessary.
Management
There is no definitive cure for MS. But there are several immunomodulatory drugs that can modify the course of the inflammatory relapsing-remitting phase of MS. These are known as Disease Modifying Drugs (DMDs). Beta-interferon and glatiramer acetate are examples of such drugs. Apart from drug therapy, general measures such as physiotherapy, supporting the patient with the help of a multidisciplinary team and occupational therapy can vastly improve the living standards of the patient.
Prognosis
The prognosis of multiple sclerosis varies in an unpredictable manner. A high MR lesion load at the initial presentation, high relapse rate, male gender and late presentation are usually associated with a poor prognosis. Some patients continue to live a normal life with no apparent disabilities while some may face severe disabilities.
What is Lyme Disease?
In an overwhelming majority of the cases, Lyme disease is caused by a spirochete named Borrelia burgdoferi, which enters the human body through the bites of lice or ticks. The other less frequently encountered causative agents are B.afzelli and B.garinii.
The reservoir of infection is ixodid (hard tick) which feeds on many large mammals. Birds are also responsible for the spread of these parasitic ticks in an ecosystem. As previously mentioned, spirochetes enter the bloodstream of a human following a bite of ticks whose adult, larval and nymphal stages have the ability to propagate the infection.
Most patients suffering from Lyme disease have a tendency to get Ehrlichiosis as a coinfection.
Clinical Features
The disease progression happens in three stages and the clinical features vary depending on the stage.
Early Localized Stage
The unique feature that defines this initial phase is the appearance of a skin reaction around the site of the tick bite. This is named as Erythema migrans. A macular or papular rash can arise about 2-30 days after the tick bite. The rash usually originates in the area adjacent to the tick bite and then spreads peripherally. These skin lesions have a characteristic bull’s eye appearance with a central clearing. However, these features are not pathognomonic of the Lyme disease. It is possible to have minor general symptoms such as fever, lymphadenopathy, and fatigue during this stage.
Figure 02: Rash with Bull’s Eye Appearance
Early Disseminated Disease
The spread of infection from the original site happens via blood and lymph. As the body starts to respond to this, the patient may complain of mild arthralgia and malaise. In some occasions, one can note the development of metastatic erythema migrans. Neurological involvement becomes apparent usually few months after the initial infection. This is confirmed by the occurrence of lymphocytic meningitis, cranial nerve palsies, and peripheral neuropathy. The incidence of Lyme disease associated carditis and radiculopathy varies depending on certain epidemiological factors.
Late Disease
Arthritis affecting the large joints, polyneuritis, and encephalopathy are the clinical features in the late stage of the disease. Neuropsychiatric problems may arise as a result of the involvement of brain parenchyma. Acrodermatitis chronica atrophicans is a rare complication of advanced Lyme disease.
Diagnosis
During the initial stage of the disease, the diagnosis can be made based on the clinical features and the history. Culturing of the organisms from the biopsy samples is not usually reliable and is time-consuming (because the process takes at least six weeks to give satisfactory results).
Antibody detection is not useful right at the onset of the disease, but gives extremely accurate results during the early disseminated and late stages.
The increased availability of advanced techniques such as PCR has expedited the process of diagnosis and treatment of Lyme disease, thus minimizing the life-threatening complications.
Management
- The most recent guidelines advise not to treat the asymptomatic patients with positive antibody test results.
- Standard therapy consists of a 14-day course of doxycycline (200 mg daily) or amoxicillin (500 mg 3 times daily). But in case of the disseminated disease with arthritis, the therapy extends to 28 days.
- Any neuronal involvement should be managed by the administration of beta-lactams parenterally for 3- 4 weeks.
Prevention
- Use of protective clothing
- Insect repellents
- The risk of infection in the first few hours of the tick bite is considerably low. Therefore removal of the tick immediately decreases the chance of any advanced disease.
What are the Similarities Between MS and Lyme Disease?
- Both diseases affect the neurological system.
What is the Difference Between MS and Lyme Disease?
Definition and Clinical Features
Multiple Sclerosis is a chronic autoimmune, T-cell mediated inflammatory disease affecting the central nervous system. In contrast, Lyme disease is caused by a spirochete named Borrelia burgdoferi, which enters the human body through the bites of lice or ticks. Multiple sclerosis is a non-infectious disease whereas Lyme disease is an infectious disease. This is the key difference between MS and lyme disease
Moreover, the clinical features of MS include pain on eye movements, mild fogging of central vision/color desaturation/dense central scotoma, reduced vibration sensation and proprioception in feet, clumsy hand or limb, unsteadiness in walking, urinary urgency and frequency, neuropathic pain, fatigue, spasticity, depression, sexual dysfunction and temperature sensitivity. However, in Lyme disease, a macular papular rash appears during the initial stage of the disease; the neurological manifestations occur later. In addition, arthritis affecting the large joints, polyneuritis, and encephalopathy are the clinical features in the terminal stage of the disease.
Diagnosis and Treatment
A diagnosis of MS can be made if the patient has had 2 or more attacks affecting different parts of the CNS. MRI is the standard investigation for the confirmation of clinical diagnosis. CT and CSF examination can provide further supportive evidence for the diagnosis if necessary. In Lyme disease, the diagnosis can be made based on the clinical features and the history during the initial stage of the disease. Although antibody detection is not useful right at the onset of the disease, it gives accurate results during the early disseminated and late stages.
Furthermore, the standard therapy for Lyme disease consists of a 14-day course of doxycycline (200 mg daily) or amoxicillin (500 mg 3 times daily). But in case of the disseminated disease with arthritis, the therapy lasts for 28 days. However, there is no definitive cure for MS. But, But there are several immunomodulatory drugs that can modify the course of the inflammatory relapsing-remitting phase of MS. Apart from drug therapy, general measures such as physiotherapy, supporting the patient with the help of a multidisciplinary team and occupational therapy can vastly improve the living standards of the patient.
Summary – MS vs Lyme Disease
To sum up, the basic difference between MS and Lyme disease is their origin and type. Multiple sclerosis is a noninfectious inflammatory condition but Lyme disease is an infectious disease whose main cause is an infectious agent.
Reference:
1. Kumar, Parveen J., and Michael L. Clark. Kumar & Clark clinical medicine. Edinburgh: W.B. Saunders, 2009.
Image Courtesy:
1. “05 Hegasy Multiple Sclerosis Wiki EN CCBYSA” By Guido4 – Own work (CC BY-SA 4.0) via Commons Wikimedia
2. “Bullseye Lyme Disease Rash” By Hannah Garrison – en:User:Jongarrison (CC BY-SA 2.5) via Commons Wikimedia