Lyme disease is an infection caused by the bacterium Borrelia burgdorferi. This spiral-shaped bacterium is most commonly spread by a tick bite. The disease takes its name from Lyme, Connecticut, where the illness was first identified in the United States in 1975.
Where Lyme disease is commonly reported
Lyme disease is a year-round problem in many parts of the United States. Cases of Lyme disease have been reported in nearly all states, but it is most commonly found in the Northeast, upper Midwest, and northwestern states.
The warmer months between April and October are generally the most active for tick populations.
Ticks are to blame
Lyme disease is caused by bacteria that is spread to humans by tick bites. The ticks that carry the bacteria are:
- Black-legged deer tick (northeastern, mid-Atlantic, and North Central United States).
- Western blacklegged tick (Pacific coastal United States).
Ticks prefer to live in wooded areas, low-growing grasslands, and yards.
These ticks can be as small as poppy seeds, and usually attach to hard-to-see parts of the body, such as the groin, armpits, and scalp.
Those at risk for getting Lyme disease
Anyone can get a tick bite. However, there are some factors that can increase your risk for getting Lyme disease. These include:
- Working outdoors in grassy areas where the black-legged deer tick or Western black-legged deer tick is found.
- Being a camper, hiker, or gardener.
- Having pets that can bring the ticks into the home.
- Having exposed skin outdoors which allows ticks to easily attach to bare flesh.
- Improper removal of ticks, especially if the tick’s mouth parts are left in the skin for longer than two days.
Note that if you have had Lyme disease in the past, you are not immune to it. You can contract it again.
What are the symptoms of Lyme disease?
Many people infected with the Lyme disease bacteria do not develop symptoms. If the infection causes symptoms, they vary based on the severity, stage, and how long the person has had the infection.
Early, localized Lyme disease symptoms can occur three to 30 days after you are bitten by an infected tick. They typically resemble flu-like symptoms, and may include:
- Joint pain.
- Muscle pain and aches.
- Stiff neck.
- Low-grade fever and chills.
- Tiredness (fatigue).
- Poor appetite.
- Swollen lymph nodes.
EM rash. One of the more common symptoms of early Lyme disease is the appearance of a red Erythema migrans (EM) rash that:
- Occurs in about 70-80% of people infected with Lyme disease.
- Can appear several days after infection, or not at all.
- May last up to several weeks.
- Might be very small or can grow very large (up to 12 inches across), and may resemble a “bullseye.”
- Can mimic skin problems such as hives, eczema, sunburn, poison ivy, and flea bites.
- Might itch or feel hot, or may not be felt at all.
- May appear on any area of the body.
- Can disappear and return several weeks later.
Weeks to months after the infection, especially without treatment, you may develop later, disseminated Lyme disease symptoms including:
- Additional EM rashes on other areas of the body.
- Eye problems, including inflammation (for example, red eye).
- Episodes of dizziness and short breath.
- Intermittent tendon, muscle, joint, or bone pain, or shooting pains.
- Severe headaches and neck stiffness.
The symptoms of Lyme disease may look like other health problems. And other problems can be mistakenly diagnosed as Lyme disease. Always seek medical attention and talk with your healthcare provider for a proper diagnosis.
How is Lyme disease diagnosed?
A challenging diagnosis
Sometimes diagnosing Lyme disease can be hard. The symptoms may seem like other health problems. It may also not be known if the person was exposed to ticks.
Diagnosis is usually based on symptoms, particularly the typical rash of Lyme disease, along with a history of a known or possible tick bite.
Lab tests can also be used to confirm or rule out a Lyme disease diagnosis. The test usually involves testing a blood sample for antibodies that your body makes in response to the Lyme bacteria.
However, antibodies often take several weeks to develop, so it is recommended to have lab tests performed a few weeks after infection. These lab tests may include:
- Enzyme-linked immunosorbent assay (ELISA) tests. A sample of your blood is collected to detect antibodies of tick borne burgdorferi infection. However, this test can give false-positive readings. It is usually not the sole means for diagnosing Lyme disease.
- Western blot test. Following a positive ELISA test, a Western blot test may be performed to confirm your diagnosis. This blood test detects antibodies to several proteins from the bacteria that causes Lyme disease
- Cerebrospinal fluid tests. If you have nervous system symptoms or joint swelling, your provider may test your cerebrospinal fluid (spine or joint fluid) for Lyme antibodies or the bacteria.
Treating Lyme disease
If you have Lyme disease, your doctor will take into consideration your age, medical history, underlying health conditions, and allergies. They may consult with infectious disease specialists for help with specific treatment decisions.
The best course of action to treat Lyme disease is to take antibiotics. This is usually the only way to encourage rapid and complete recovery. Early antibiotic treatment can also help prevent the complication of Post-Treatment Lyme Disease Syndrome (see “Complications” below), and can relieve the EM rash symptoms as well.
Your healthcare provider may recommend:
- Oral antibiotics. As a standard treatment for early Lyme disease, you may be prescribed a pill of amoxicillin or doxycycline antibiotics to fight the infection. You may be directed to take these medications for 14 to 21 days. Even if you start to feel better after a few days, you should finish all of the antibiotics prescribed to you to make sure all bacteria are eliminated.
- Intravenous (IV) antibiotics. If Lyme disease is affecting your central nervous system, you may be recommended a 14-28 day course of IV antibiotics, in which the medication is administered directly into your bloodstream to eliminate more severe infections.
Antibiotics are the only effective treatment for Lyme disease. There are a variety of alternative therapies to alleviate Lyme disease symptoms, but these have not been proven or tested by scientific evidence and should be discussed with your doctor beforehand.
Frequently asked questions (FAQs) about Lyme disease
Although most cases of Lyme disease can be cured within 2-4 weeks, an infected person can experience symptoms that last more than 6 months after treatment. This main complication is known as Post-Treatment Lyme Disease Syndrome (Post-Lyme Disease Syndrome, PTLDS). The cause of PTLDS is not known, but some believe that the bacterial infection can trigger autoimmune responses that cause symptoms long after the infection has been cured.
There is no proven treatment for PTLDS, but short term antibiotics to treat early Lyme disease is the best way to prevent the complication. If you have been treated for Lyme disease and continue to feel unwell or experience symptoms, be sure to see your health care provider to discuss alternative options to manage your symptoms.
Additionally, the following complications may arise if Lyme disease is left untreated:
- Chronic symptoms of joint inflammation (Lyme arthritis) with severe pain and swelling typically in the knees.
- Heart problems, including inflammation of the heart (myopericarditis) and problems with an irregular heartbeat (Lyme carditis).
- Inflammation of the brain and spinal cord.
- Nervous system symptoms, such as numbness in the arms or legs, tingling and pain.
- Neurological symptoms, such as trouble with speech, memory, and concentration (Neurologic Lyme Disease).
- Neurologic symptoms of inflammation (meningitis) and weakness and facial paralysis (Bell’s palsy, facial palsy).
The best way to prevent Lyme disease – as well as other tick-borne diseases – is by protecting yourself against ticks and their bites.
If you live in heavily wooded areas that are prone to ticks, practice the following to prevent infection:
- Know where to expect ticks, such as in grassy, bushy, or wooded areas, and try to avoid these areas.
- Use insect repellent when you go outdoors, such as those containing DEET, picaridin, or Oil of Lemon Eucalyptus.
- Treat your clothing or gear with products containing 0.5% permethrin (a tick-repellent).
- Wear light-colored clothing so it will be easy to spot ticks on clothing.
- Wear long-sleeved shirts and long pants, being sure to tuck your shirt into your pants and pants into socks to prevent ticks from easily getting access to your skin.
- Check yourself for ticks when back indoors, especially under the arms, around the ears, inside the navel, behind the knees, in and around the hairline, between the legs, and around the waist.
- Check your clothing, gear, and pets when you come back indoors for ticks and remove any if found. You can also put your clothes and gear in the dryer to kill ticks.
- If you have pets – especially dogs – ensure they also have medicated insect repellent to protect them from getting ticks.
- Shower promptly after being outdoors.
- Remove ticks promptly if you find them on you.
- Reduce the tick habitat in your yard by clearing tall grass and brush, creating a barrier of wood chips or gravel between lawns and wooded areas, using pesticides (acaricides for ticks), and frequently mowing the lawn.
To remove a tick if found, follow these steps:
- Use fine-tipped tweezers that have been sterilized and grasp the tick as close to the surface of your skin as possible.
- Using even pressure, pull upward steadily. Make sure you do not twist or jerk as parts of the tick’s mouth can break off inside your skin. If this happens, the mouth parts can be removed with tweezers as well.
- Once the tick has been removed, thoroughly clean the bite area and your hands with soap and water or rubbing alcohol
- Dispose of a live tick by drowning it in alcohol, sealing it in a bag, wrapping it tightly in tape, or flushing it down the toilet. Never try to kill the tick by crushing it between your fingers as you could still get bitten again.
Some home remedies recommended include painting the tick with nail polish, petroleum jelly, or using heat to make the tick detach from the skin. Avoid these methods, as it is imperative to remove the tick as quickly as possible rather than waiting for it to detach.
If you develop a rash or fever within several weeks of removing a tick, be sure to contact your healthcare provider and inform them when the bite occurred and where you likely picked up the tick.
Center for Disease Control and Prevention (CDC). Signs and Symptoms of Untreated Lyme Disease (https://www.cdc.gov/lyme/signs_symptoms/index.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Lyme Disease (https://www.ncbi.nlm.nih.gov/books/NBK431066/)
MedlinePlus: National Library of Medicine. Lyme Disease (https://medlineplus.gov/lymedisease.html)