Lyme Disease

The danger of tick bites:

While most tick bites are harmless, several species can cause life-threatening diseases. Two of these well-known diseases are Rocky Mountain Spotted Fever and Lyme disease. Ticks can also transmit tularemia (a plague-like disease in rodents that can be transmitted to man), relapsing fever, and a newly identified ailment called ehrlichiosis (an abrupt illness consisting of fever, rash, nausea, vomiting, and weight loss).

What is Lyme disease?

Lyme disease (LD) is a multi-stage, multi-system bacterial infection caused by the spirochete Borrelia burgdorferi, a spiral shaped bacterium that is most commonly transmitted by a tick bite. The disease takes its name from Lyme, Connecticut, where the illness was first identified in the United States in 1975.

According to the Centers for Disease Control and Prevention (CDC), Lyme disease continues to be a rapidly emerging infectious disease, and is the leading cause of all insect-borne illness in the US. The number of annually reported cases has increased 25-fold since national surveillance began in 1982. More than 23,000 infections have been reported in one year in the United States. The majority (95 percent) of cases are reported in Connecticut, Rhode Island, New York, Pennsylvania, Delaware, New Jersey, Maryland, Massachusetts, Maine, Minnesota, New Hampshire, and Wisconsin.

What types of ticks transmit LD?

  • Ixodes scapularis (deer tick)
  • Ixodes dammini
  • Amblyomma americanum (Lone Star tick)
  • Ixodes pacificus

Ticks prefer to live in wooded areas, low-growing grasslands, seashores, and yards. Depending on the location, anywhere from less than 1 percent to more than 90 percent of the ticks are infected with spirochetes.

Lyme disease is a year-round problem, although, April through October is considered tick season, with ticks being very active in the spring and early summer. Cases of Lyme disease have been reported in 45 states in the US and in large areas in Europe and Asia.

What are the symptoms of Lyme disease?

The list of possible symptoms is long, and symptoms can affect every part of the body. The following are the most common symptoms of Lyme disease. However, each individual may experience symptoms differently:

The primary symptom is a red rash that:

  • can appear several days after infection, or not at all.
  • can last a few hours or up to several weeks.
  • can be very small or very large (up to 12 inches across).
  • can mimic such skin problems as hives, eczema, sunburn, poison ivy, flea bites.
  • can itch or feel hot, or may not be felt at all.
  • can disappear and return several weeks later.

Several days or weeks after a bite from an infected tick, a patient usually experiences flu-like symptoms such as the following:

  • headache
  • stiff neck
  • aches and pains in muscles and joints
  • low-grade fever and chills
  • fatigue
  • poor appetite
  • sore throat
  • swollen glands

After several months, arthritis-like symptoms may develop, including painful and swollen joints.

Other possible symptoms may include the following:

  • other neurological symptoms (such as Bell's palsy, a temporary paralysis of facial muscles)
  • heart problems
  • skin disorders
  • eye problems
  • hepatitis
  • severe fatigue
  • limb weakness
  • poor motor coordination

Some people may develop post-Lyme disease syndrome (PLDS), a condition also known as chronic Lyme disease, characterized by persistent musculoskeletal and peripheral nerve pain, fatigue, and memory impairment.

How is Lyme disease diagnosed?

Lyme disease is difficult to diagnose because symptoms are not consistent and may imitate other conditions. The primary symptom is a rash, but it may not be present in up to 10 to 15 percent of cases.

Diagnosis for Lyme disease is a clinical one and must be made by a physician experienced in recognizing LD. Diagnosis is usually based on symptoms and a history of a tick bite. Testing is generally done to eliminate other conditions and may be supported through blood and laboratory tests, although these tests are not absolutely reliable for diagnosing LD.

Research is underway to develop and improve methods for diagnosing LD.

Always consult your physician for a diagnosis.

Treatment for Lyme disease:

Your physician will determine the best treatment plan based on your individual situation. Lyme disease is usually treated with antibiotics for a period of four to six weeks.

Treatment will be considered based on these and other factors:

  • If you are bitten by a tick that tests positive for spirochetes.
  • If you are bitten by a tick and have any of the symptoms.
  • If you are bitten by a tick and are pregnant.
  • If you are bitten by a tick and live in an endemic, high-risk area.

Relapse and incomplete treatment responses occur. Complications of untreated early-stage disease include: joint disease, neurologic disease,  carditis, and hospitalization, some with chronic debilitating conditions.

How can LD be prevented?

Humans do not develop an immunity to LD and reinfection is possible. In 1998, the US Food and Drug Administration (FDA) had approved a new vaccine against Lyme disease called LYMErix. The vaccine was not 100 percent effective, however, and the FDA still recommended using other preventive measures. In 2002, the manufacturer of LYMErix announced that the vaccine would no longer be available commercially.

Some general guidelines for preventing LD include the following:

  • Dress appropriately by wearing:
    • light-colored clothing
    • long-sleeved shirts
    • socks and closed-toe shoes
    • long pants with legs tucked into socks
  • Frequently check for ticks on:
    • all parts of the body that bend: behind the knees, between fingers and toes, and underarms.
    • other areas where ticks are commonly found: belly button, in and behind the ears, neck, hairline, and top of the head.
    • areas of pressure points, including:
      • where underwear elastic touches the skin
      • where bands from pants or skirts touch the skin
      • anywhere else where clothing presses on the skin
    • Visually check all other areas of the body, and run fingers gently over skin. Be sure to also check genital and anal areas, which may easier using a mirror.
  • Also:
    • Shower after all outdoor activities are over for the day.
    • When a tick is found, remove it by grabbing the tick just behind the head with tweezers and pull it out, gently but firmly. Do this without squeezing the tick and especially without twisting the tick, which tends to separate the body from the head. If the head does become detached and remains under the skin, seek medical attention, as it will likely cause infection whether Lyme disease or spotted fever are present or not. The area should be disinfected with alcohol and peroxide after the tick is removed.
    • Ticks can be tested for spirochetes, so place the removed tick in a glass, plastic vial, or plastic storage bag with a moistened cotton swab.
    • Consider using repellents:
      • Products that contain DEET are tick repellents, but do not kill the tick and are not 100 percent effective in discouraging a tick from feeding on you.
      • Products that contain permethrin are known to kill ticks, however, they should not be sprayed on the skin but on clothing.
    • Check pets and children for ticks.