Last year, many observers had speculated that pop singer Justin Bieber, 25, was battling severe depression. This week Bieber responded on Instagram to a TMZ report that he was, instead, recuperating from Lyme disease.
"While a lot of people kept saying Justin Bieber looks like sh**t, on meth etc. they failed to realize I've been recently diagnosed with Lyme disease, not only that but had a serious case of chronic mono which affected my skin, brain function, energy, and overall health. These things will be explained further in a docuseries I'm putting on YouTube shortly. you can learn all that I've been battling and OVERCOMING!! It's been a rough couple years but getting the right treatment that will help treat this so far incurable disease and I will be back and better than ever"
The 10-part docuseries, Justin Bieber: Seasons, which will air in late January, reportedly shows Bieber and his family discussing the multiple symptoms the Canadian singer had been experiencing during 2019. Before finally being diagnosed late in the year, he received a variety of treatments which only made the symptoms worse.
Bieber's wife of four months, Hailey Baldwin Bieber, supported him in a tweet: "For those who are trying to downplay the severity of Lyme disease. Please do your research and listen to the stories of people who have suffered with it for years. Making fun of and belittling a disease you don't understand is never the way, all it takes is educating yourself."
What is Lyme Disease?
Lyme disease is the most common vector-borne disease in the U.S. Lyme disease is caused by the bacterium Borrelia burgdorferi and rarely, Borrelia mayonii. It is transmitted to humans through the bite of infected blacklegged ticks. The blacklegged tick (or deer tick, Ixodes scapularis) spreads the disease in the northeastern, mid-Atlantic, and north-central U.S. The western blacklegged tick (Ixodes pacificus) spreads the disease on the Pacific Coast.
Lyme Disease causes more than 300,00 illnesses each year in the U.S. According to the Centers for Disease Control (CDC), the number of cases of Lyme disease reported to the CDC has increased steadily over the past 25 years. In addition, the disease appears to be expanding geographically: The number of counties with an incidence of ≥10 confirmed cases per 100,000 persons increased from 324 in 2008 to 415 in 2018.
What are the Symptoms of Lyme Disease?
The symptoms of Lyme disease can be divided into four stages:
1. Early localized stage (3-30 days post-tick bite)
- Red, expanding rash called erythema migrans (EM)
- Fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes
Not all people get the erythema migrans rash. General symptoms may be the only evidence of infection. Some people get a small bump or redness at the site of a tick bite that goes away in 1-2 days, like a mosquito bite.
More about Erythema Migrans:
- Rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite after a delay of 3-30 days (average is about 7 days)
- Rash gradually expands over a period of several days and can reach up to 12 inches (30 cm) across. Parts of the rash may clear as it enlarges, resulting in a "bull's-eye" appearance
- Rash usually feels warm to the touch but is rarely itchy or painful
- EM lesions may appear on any area of the body
2. Early disseminated stage (days to weeks post-tick bite)
Untreated, the infection may spread from the site of the bite to other parts of the body, producing an array of specific symptoms that may come and go, including:
- Facial or Bell's palsy (muscle weakness on one or both sides of the face
- Severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord)
- Pain and swelling in the large joints (such as knees)
- Shooting pains that may interfere with sleep
- Heart palpitations and dizziness due to changes in heartbeat
Many of these symptoms will resolve over a period of weeks to months, even without treatment. However, lack of treatment can result in additional complications, described below.
3. Late disseminated stage (months-to-years post-tick bite)
Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often affected, particularly the knees.
Up to 5% of untreated patients may develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with short-term memory.
4. Lingering symptoms after treatment (post-treatment Lyme disease syndrome)
Approximately 10-20% of patients with Lyme disease have symptoms that last months to years after treatment with antibiotics. These symptoms can include muscle and joint pains, cognitive defects, sleep disturbance, or fatigue. The cause of these symptoms is not known, but there is no evidence that these symptoms are due to ongoing infection with B. burgdorferi. This condition is referred to as Post-treatment Lyme disease syndrome (PTLDS). There is some evidence that PTLDS is caused by an autoimmune response, in which a person's immune system continues to respond, doing damage to the body's tissues, even after the infection has been cleared. Studies have shown that continuing antibiotic therapy is not helpful and can be harmful for persons with PTLDS.
How is Lyme Disease Diagnosed?
Lyme disease can be difficult to diagnose for several reasons. Many of the common symptoms associated with the disease, such as headaches, dizziness, and joint/body pain, also occur with other diseases. The most distinct symptom of Lyme disease, erythema migrans (EM), does not appear in at least one quarter of people who are infected with Lyme bacteria. Also, current diagnostic tests do not always detect early Lyme disease since antibodies take time to rise to detectable levels. In addition, antibodies normally persist in the blood for months or even years after the infection is gone; therefore, the test cannot be used to determine cure. Lastly, infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
The Centers for Disease Control and Prevention (CDC) currently recommends a two-tiered testing approach: a conventional enzyme-linked immunoassay (ELISA) test, followed by a Western Blot test. The ELISA is a blood test that detects antibodies but does not test for B. burgdorferi itself. A positive result from this first-level screening may suggest current or past infection. The ELISA is designed to be very "sensitive," meaning that almost everyone who has Lyme disease (and some people who do not) will test positive. If the screening test is negative, it is highly unlikely that the person has Lyme disease and no further testing is recommended. If the screening test is positive or inconclusive, a Western blot test should be performed to confirm the results.
Because treatment is generally more effective in early stages of the disease, it is important to develop new tools that can help doctors make an early diagnosis. On July 29, 2019, the Food and Drug Administration (FDA) cleared several Lyme disease serologic assays with new indications for use, allowing for an enzyme immunoassay (EIA) rather than western immunoblot assay as the second test in a Lyme disease testing algorithm.
How is Lyme Disease Treated?
According to the National Institute of Allergy and Infectious Disease, for early Lyme disease, a short course of oral antibiotics, such as doxycycline or amoxicillin, cures the majority of cases. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy.
After being treated for Lyme disease, a minority of patients may still report non-specific symptoms, including persistent pain, joint and muscle aches, fatigue, impaired cognitive function, or unexplained numbness. These patients often show no evidence of active infection and may be diagnosed with post-treatment Lyme disease syndrome (PTLDS).
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.