Podcast: WHAT DOES YOUR DOCTOR SAY?

Episode: How to recognize and treat Lyme disease?

Leading: Dariusz Litera

Guest: Dr. Ewa Jarowicz, infectious disease specialist

Duration: 15 minutes

A tick bite often triggers a wave of anxiety in patients, most often related to the risk of Lyme disease. However, much of this anxiety stems from incomplete or inaccurate information available online, which makes it difficult to assess the situation rationally and act appropriately.

In this podcast episode, Dr. Ewa Jarowicz explains how Lyme disease is diagnosed in practice, what symptoms are truly important, and when treatment should be initiated. The conversation also addresses the issue of overdiagnosis and challenges in the doctor-patient relationship in the context of popular health myths.

Full podcast transcript

[00:00:00] Introduction – are we always at risk of Lyme disease after a tick bite?

Dariusz Litera:

It happened. We return from a mountain hike or simply a walk and find it on our skin. It's not so bad if it's just walking around. It's worse if it's already bitten us and is now feasting on our blood. We've learned how to remove such uninvited guests. The only question that remains is the consequences. A red flag goes off in our head, asking: am I at risk of Lyme disease after a tick bite? And today, your doctor is infectious disease specialist Dr. Ewa Jarowicz. Good morning.

Dr. Ewa Jarowicz:

Good morning, hello everyone.

[00:00:32] Is diagnosing Lyme disease difficult?

Dariusz Litera:

Is diagnosing and treating Lyme disease a very difficult task for a doctor?

Dr. Ewa Jarowicz:

No. For an infectious disease specialist, this isn't difficult. The problem arises more often with the patient, who—influenced by information found online—does not always agree with the diagnosis or rule out the disease.

The treatment itself is simple – we have wide access to antibiotics, outpatient and inpatient treatment, and good diagnostic tests.

[00:01:17] Patient "from the Internet" - a challenge in the office

Dariusz Litera:

Isn't it more difficult when a patient comes in with a ready-made treatment idea?

Dr. Ewa Jarowicz:

This is the most difficult situation. The patient comes in convinced they have Lyme disease and expect a specific antibiotic. However, very often they have to be told that they don't have the disease.

There are many myths about Lyme disease circulating online. Ruling out the disease and convincing a patient to do so can be more difficult than treating it.

[00:02:28] Why is trust in your doctor crucial?

Dariusz Litera:

The doctor-patient relationship is based on trust. We cannot compete with the doctor in making therapeutic decisions.

Dr. Ewa Jarowicz:

If a patient comes to the doctor, it means they still have doubts. The doctor's role is to address these concerns and avoid subjecting the patient to unnecessary treatment that may have side effects.

[00:03:45] Early symptoms of Lyme disease – not just rash

Dariusz Litera:

What are the most common early symptoms of Lyme disease?

Dr. Ewa Jarowicz:

Redness most often appears at the injection site. This may be preceded by general symptoms, known as prodromal symptoms: malaise, malaise, low-grade fever, and flu-like symptoms.

They do not always occur, but their presence in combination with a sting may direct the diagnosis.

[00:04:37] Erythema or allergic reaction – how to tell the difference?

Dariusz Litera:

Is it easy to confuse an allergic reaction with Lyme disease rash?

Dr. Ewa Jarowicz:

These changes may look similar, but they differ in nature.

The allergic reaction appears quickly, is often itchy, burning, may be raised and accompanied by swelling.

Lyme disease erythema:

- does not itch,

- it doesn't hurt,

– it is not convex,

– is often noticed by accident.

A rash is defined as a lesion at least 5 cm in diameter. Smaller, itchy lesions are most often an allergic reaction.

[00:06:49] How is Lyme disease diagnosed?

Dariusz Litera:

How do we diagnose Lyme disease?

Dr. Ewa Jarowicz:

The clinical picture is crucial. In the case of erythema migrans, the diagnosis is made solely on the basis of skin symptoms – without laboratory testing.

Serological tests may be negative at this stage because antibodies develop with a delay. We don't wait for the results—we begin treatment immediately.

[00:07:50] Laboratory diagnostics – when and what tests?

Dariusz Litera:

Are there any other diagnostic tests?

Dr. Ewa Jarowicz:

The basis is an ELISA test (IgM and IgG antibodies). If the result is positive, we perform a confirmatory Western Blot test.

You should not start diagnosis with Western Blot if the ELISA result is negative – this is an error.

[00:09:12] When does treatment begin?

Dariusz Litera:

What are the criteria for starting antibiotic therapy?

Dr. Ewa Jarowicz:

We don't treat test results - we treat symptoms.

First, we assess the clinical symptoms, examine the patient, and only on this basis, supported by tests, do we make a decision on treatment.

Lyme disease is the so-called "great imitator" – its symptoms can resemble many other diseases, so diagnosis requires experience.

[00:10:58] What is the treatment for Lyme disease?

Dariusz Litera:

What is most important in treatment?

Dr. Ewa Jarowicz:

Patient-physician cooperation is crucial. It's important to follow recommendations and not extend therapy on your own.

Standard treatment usually lasts 2–3 weeks and is sufficient. Prolonged use of antibiotics can lead to complications.

[00:11:44] The effects of untreated Lyme disease

Dariusz Litera:

What are the consequences of untreated Lyme disease?

Dr. Ewa Jarowicz:

Late forms of the disease, e.g. chronic arthritis, may appear even after 2–3 years.

If left untreated, the disease can lead to joint damage, severe degenerative changes and chronic pain.

[00:13:00] Lyme disease – a disease with many faces

Dr. Ewa Jarowicz:

Lyme disease can also affect the nervous system and heart.

Examples include facial nerve paralysis and cardiac conduction disorders. These are rare cases but require careful diagnostic testing and medical consultation.

[00:15:09] Ending

Dariusz Litera:

Dr. Ewa Jarowicz said this in the podcast "What Does Your Doctor Say?" Thank you.

Dr. Ewa Jarowicz:

Thank you very much.

Key takeaways for patients:

• Lyme disease is not difficult to diagnose for a specialist, but requires proper clinical assessment.
• Not every tick bite means illness
• Erythema migrans is a key symptom – it does not itch or hurt
• General symptoms may resemble a flu-like infection.
• Diagnosis begins with an ELISA test, not a Western Blot.
• Positive results without clinical symptoms are not treated
• Antibiotic treatment usually lasts 2–3 weeks
• Patient-doctor cooperation is crucial
• Untreated Lyme disease can lead to joint, neurological and cardiac complications.

Information about participants:

Guest: Dr. Ewa Jarowicz, a physician and infectious disease specialist specializing in the diagnosis and treatment of infectious diseases and liver diseases. She has experience in the treatment of tick-borne diseases, viral hepatitis, as well as antiretroviral therapy and HIV prevention.

Presenter: Dariusz Litera, medical editor, health communications specialist, and creator of the podcast CO NA TO TWÓJ ELEKARZ. He has been involved in patient education for years, conducting interviews with specialists in various fields of medicine.

ATTENTION!

This material is for educational purposes only. It does not replace a medical consultation. If you experience any disturbing symptoms, consult a doctor.