Lyme disease is an infectious disease. It is caused by the bacteria Borrelia burgdorferi sensu lato. B. burgdorferi is transmitted to humans via a tick bite from an infected black-legged or deer tick. The tick becomes infected after feeding on infected deer or mice.
A tick has to be present on the skin for 24 to 48 hours to transmit the infection. Most people with Lyme disease have no memory of a tick bite.
Lyme disease was first reported in the town of Old Lyme, Connecticut in 1975. It’s the most common tick-borne illness in the Pacific Northwest, Northeast, and Northern Midwest United States and in Europe. People who live or spend time in wooded areas are more likely to get this illness. So are people with domesticated animals that are let out in wooded areas
Lyme disease occurs in three stages: early localized, early disseminated, and late disseminated. Symptoms depend on which stage the disease is in.
Stage 1: Early Localized Disease
Symptoms of Lyme disease start one to two weeks after the tick bite. One of the earliest signs is a “bull’s eye” rash. This is a sign that bacteria are multiplying in the blood stream. The rash occurs at the site of the tick bite as a central red spot surrounded by a clear spot with an area of redness at the edge. It may be warm to touch, but isn’t painful and doesn’t itch.
This rash will disappear after four weeks. The formal name for this rash is erythema migrans. Erythema migrans is said to be characteristic of Lyme disease. However, many people don’t have this symptom. Some people have a rash that is solid red. On people with dark complexions, the rash may resemble a bruise.
Stage 2: Early Disseminated Lyme Disease
Early disseminated Lyme disease occurs several weeks after the tick bite. Bacteria are beginning to spread throughout the body. This stage is characterized by flu-like symptoms, such as:
- enlarged lymph nodes
- sore throat
- vision changes
- muscle aches
There is a general feeling of not being well in stage 2. A rash may appear in areas other than the tick bite. Neurological signs such as numbness, tingling, and Bell’s palsy can also occur. This stage of Lyme disease can be complicated by meningitis and cardiac conduction disturbances. The symptoms of stages 1 and 2 can overlap.
Stage 3: Late Disseminated Lyme Disease
Late disseminated Lyme disease occurs when the infection hasn’t been treated in stage 1 and 2. Stage 3 can occur weeks, months or years after the tick bite. This stage is characterized by:
- severe headaches
- arthritis of one or more large joints
- disturbances in heart rhythm
- brain disorders (encephalopathy) involving memory, mood and sleep.
- short term memory loss
- difficulty concentrating
- mental fogginess
- problems following conversations
- numbness in the arms, legs, hands, or feet
Contact your doctor immediately if you have any of these symptoms.
The diagnosis of Lyme disease begins with an assessment of health history and a physical exam. Blood tests are most reliable a few weeks after the initial infection, when antibodies are present.
ELISA(enzyme linked immunosorbent assay) is used to detect antibodies against B. burgdorferi.
Western blot can be used to confirm a positive ELISA. It checks for the presence of antibodies to specific B. burgdorferi proteins.
Polymerase chain reaction (PCR) is used to evaluate people with persistent Lyme arthritis or nervous system symptoms. It is performed on joint fluid or spinal fluid.
Lyme disease is best treated in the early stages. Early treatment is a simple 14 to 21 day course of oral antibiotics. This can eliminate all traces of infection. Medications used to treat Lyme disease are:
- doxycycline - for adults and children older than eight years old
- cefuroxime and amoxicillin - to treat adults, younger children, and women who are nursing or breast feeding
Persistent Lyme disease is treated with intravenous antibiotics for a period of 14 to 21 days. That eliminates infection. However, improvement of symptoms occurs more slowly.
It’s unknown why symptoms like joint pain continue after the bacteria have been destroyed. Some doctors believe that persistent symptoms occur in people who are prone to autoimmune disease.
Lyme prevention mostly involves decreasing the risk of tick bites. The Mayo Clinic recommends taking the following steps to prevent tick bites:
- Dress in long pants and shirts with sleeves.
- Keep a yard that is not tick friendly. This means clearing wooded areas, keeping underbrush to a minimum, and putting wood piles in areas with lots of sun.
- Use insect repellent. Insect repellent with 10 percent DEET will protect you for a period of about two hours. Don’t use more DEET than what is required for the time you’ll be outside. DEET should not be used on the hands of young children or on the faces of children under two months old.
Oil of lemon eucalyptus gives the same protection as DEET when used in similar concentrations. It shouldn’t be used on children under the age of three.
- Be vigilant. Check your children, pets, and yourself for ticks. Don’t assume you can’t be reinfected. People can get Lyme disease more than once.
- Remove ticks with tweezers. Apply the tweezers near the head or the mouth and pull gently. Check to be certain that all tick parts have been removed. Contact your doctor whenever a tick bites you or your loved ones.
Written by: Verneda Lights and Elizabeth Boskey, PhD
Medically reviewed by George Krucik, MD