Justin Bieber (Getty)

    Justin Bieber’s Lyme disease revelation shows why a quick diagnosis is vital

    27 January 2020

    Justin Bieber is one of the world’s best-selling music artists, having sold over 150 million records, and is in the top three most followed global users of Twitter. Speculation had been increasing on social media recently as to his frail physical appearance and whether recreational drugs may be playing a part in this but in the last fortnight the 25-year old has announced that his condition is due to a diagnosis of Lyme disease for which he is receiving treatment. He also declared that he is suffering from glandular fever which has been impacting his overall health.

    Lyme disease – named after the American town where it was first described – is a bacterial infection caused by being bitten by a tick infected with the germ borrelia. Although still unknown to many people its incidence in the UK has been steadily increasing in recent years and there now may be several thousand cases annually although exact numbers are unclear because many resolve with no treatment, and the affected person may not be aware of having the disease.

    Most cases of Lyme disease in the UK have been from the southern counties and are typically found in outdoor areas such as national parks, forests and downs. Outdoor and forestry workers in these areas are therefore most at risk but tourists and walkers are also often affected too.

    Fortunately, most ticks in this country are not infected by the Lyme disease bacterium so the majority of tick bites are harmless and only infected ticks that bite and cling on to the skin cause this health problem. Ticks do not fly or jump but climb onto people as they brush past the long grass or foliage they are found in. Most people diagnosed with Lyme disease have no recollection of being bitten but the longer an infected tick remains in contact with the skin the greater the chance of infection developing.

    The classical skin reaction at the site of a Lyme infected tick bite is called a ‘bullseye’ rash where there is a single red mark that occurs several days later and which slowly spreads out in a circle over several days. As it does so, a paler inner area develops leading to the typical bullseye appearance. (This is different to other insect bites that often cause a more immediate generalised red blotchy mark that soon fades.) It is not usually painful or itchy and many people do not even notice it, with it slowly clearing away within a month.

    There may be flu-like symptoms at this time in around a third of bitten people and although the body may clear the infection completely with no treatment it may progress to stages of the disease where there are joint pains – especially of the knees – dizziness, breathlessness, weakness and malaise and problems with memory and concentration. In the long-term there may be chronic fatigue and joint pains called ‘post-Lyme syndrome’ which can be mistaken for other problems such as fibromyalgia or chronic fatigue syndrome.

    The diagnosis in its initial stage is made from the clinical appearance of the rash and the symptoms present but in its later stages blood tests are required although these are not always conclusive. Fortunately, most people are diagnosed at an early stage before the disease progresses, and are treated with a course of antibiotics for several weeks. Recent treatment guidelines now state that anyone with the classical rash of Lyme disease should be treated for it automatically without waiting for any tests to be done.

    Infection with Lyme disease does not confer future immunity from the disease in an individual so tick bite prevention measures need to continue. These include being aware of areas where infected ticks may live, wearing long-sleeved shirts and long trousers when walking, and inspecting your body for ticks every day if there is a chance you may have been exposed to them. If a tick is found, do not squeeze it or try to pull it off with your fingers. Instead, use a tick removal device to pull it up and away from the skin without crushing it.

    Although it can be difficult to treat post-Lyme disease, most cases fortunately slowly clear with time so we can expect the Justin Bieber trajectory to continue, and with an upcoming documentary series on his health issues in the pipeline, Lyme disease will remain in the spotlight for some time to come.