Lyme Disease: A Physician’s Perspective

KRISTOPHER PAOLINO, MD, is an assistant professor of medicine and assistant professor of microbiology and immunology at Upstate University Hospital in Syracuse, N.Y. He previously worked for the Walter Reed Army Medical Center and the Walter Reed Army Institute of Research in Washington, D.C. His research interests include vaccine development, Lyme disease, neglected tropical diseases and malaria.

BSTQ: What has driven your interest in diagnosing and treating Lyme disease?

Dr. Paolino: My clinical training included a master’s degree in tropical medicine and hygiene as part of my third year of infectious disease fellowship, which included extensive time spent learning about various vector-borne diseases. When I moved back to New York, I was struck by the number of Lyme disease cases in the region and decided to focus more of my efforts on working with these patients. Lyme is fascinating given the different clinical presentations, as well as the potential for long-term symptoms due to reasons we do not completely understand.

BSTQ: Tell us about your role in studies to develop a test for Lyme disease.

Dr. Paolino: I have a long history of working in the clinical trial world, dating back to my days at the Walter Reed Army Institute of Research. Our team in the Upstate Global Health Institute at SUNY Upstate has attempted to enroll patients for a few different Lyme diagnostic studies over the past several years. These diagnostic assays have focused on increasing the sensitivity of the testing early in the course of infection. Surprisingly, despite the number of cases of Lyme in our region, recruitment has been difficult. Identifying patients in the early part of Lyme infection, to include those with the classic erythema migrans rash (bull’s eye rash), that have not been on antibiotics for more than five days has proven difficult.

BSTQ: Are there a core set of symptoms with Lyme disease?

Dr. Paolino: Lyme is caused by the spirochete bacteria Borrelia burgdorferi. It can have a variety of signs and symptoms oftentimes associated with the stage of illness. Early localized is associated with the rash, which is not always present and does not always look like a classic bull’s eye, presents with flu-like symptoms such as fevers, headaches and aches/pains. Early disseminated is associated with heart or nervous system involvement. Lyme carditis can result in a problem with the electrical activity of the heart, leading to heart block and slowed heart rate. Patients can present with fatigue or dizziness with any exertion, and may describe loss of consciousness. Lyme meningitis can present with headache, neck stiffness and sensitivity to bright lights. Other nerves can also be affected in the arms and legs, leading to weakness, nerve pain and neuropathy with numbness in the hands and feet. Late disseminated Lyme typically presents with arthritis symptoms, most commonly in the knees, but most joints can potentially be involved. Pain can potentially migrate from one joint to another.

BSTQ: What are some of the psychological impacts on patients with chronic Lyme?

Dr. Paolino: Psychologic impacts of Lyme disease have ranged from new-onset depression, anxiety, panic attacks, PTSD and delusional thoughts. The vast majority of these psychiatric symptoms do not respond to antibiotic treatment and require the care of a mental health professional. These symptoms can be severe and can lead to suicidal thoughts in some cases.

BSTQ: Tell us about the Upstate Medical University’s Lyme and tick-borne disease treatment center.

Dr. Paolino: The tentative date of a “soft” opening will be in May 2025. We look to develop relationships with others in the university system to provide a multidisciplinary approach to care to include psychiatry/clinical psychology, neurology, rheumatology, physical therapy, occupational therapy, as well as a trained herbalist. We also plan on tying in our Global Health Institute research team to continue to try to bring new clinical trial opportunities to the region for Lyme and other tick-borne diseases.

BSTQ: What’s promising on the treatment horizon?

Dr. Paolino: We have been participating in one of the sub-studies for the Pfizer/Valneva Lyme vaccine, and I am excited about what the results of the larger study will show. Providing a safe vaccine to be combined with preventive efforts (education, topical repellents, clothing treatments, tick checks and post-activity showers) will be useful in decreasing risk of acquiring the infection even further. I am also hopeful that efforts to understand post-infectious syndromes such as Long COVID will help us find better approaches for treating patients who suffer with longterm symptoms after Lyme treatment.