Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by a bacterium named Borrelia spread by ticks.
The most common sign of infection is an expanding area of redness on the skin, known as erythema migrans, that appears at the site of the tick bite about a week after it occurred.
Symptoms of Lyme disease
The signs and symptoms of Lyme disease vary. They usually appear in stages, but the stages can overlap.
Early signs and symptoms
A small, red bump, similar to the bump of a mosquito bite, often appears at the site of a tick bite or tick removal and resolves over a few days.
This normal occurrence doesn’t indicate Lyme disease.
However, these signs and symptoms can occur within a month after you’ve been infected:
Rash. From three to 30 days after an infected tick bite, an expanding red area might appear that sometimes clears in the center, forming a bull’s-eye pattern.
The rash (erythema migrans) expands slowly over days and can spread to 12 inches (30 centimeters) across. It’s typically not itchy or painful but might feel warm to the touch.
Erythema migrans is one of the hallmarks of Lyme disease, although not everyone with Lyme disease develops the rash. Some people develop this rash at more than one place on their bodies.
- Other symptoms. Fever, chills, fatigue, body aches, headache, neck stiffness and swollen lymph nodes can accompany the rash.
Later signs and symptoms
If untreated, new signs and symptoms of Lyme infection might appear in the following weeks to months. These include:
- Erythema migrans. The rash may appear on other areas of your body.
- Joint pain. Bouts of severe joint pain and swelling are especially likely to affect your knees, but the pain can shift from one joint to another.
- Neurological problems. Weeks, months or even years after infection, you might develop inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell’s palsy), numbness or weakness in your limbs, and impaired muscle movement.
Less common signs and symptoms
Several weeks after infection, some people develop:
- Heart problems, such as an irregular heartbeat
- Eye inflammation
- Liver inflammation (hepatitis)
- Severe fatigue Causes In the United States, Lyme disease is caused by the bacteria Borrelia burgdorferi and Borrelia mayonii, carried primarily by black-legged or deer ticks. Young brown ticks often are no bigger than a poppy seed, which can make them nearly impossible to spot.To contract Lyme disease, an infected deer tick must bite you.
The bacteria enter your skin through the bite and eventually make their way into your bloodstream.
In most cases, to transmit Lyme disease, a deer tick must be attached for 36 to 48 hours.
If you find an attached tick that looks swollen, it may have fed long enough to transmit bacteria. Removing the tick as soon as possible might prevent infection.
Diagnosis of Lyme disease
Doctors diagnose it based on symptoms and a history of tick exposure.
Two-step blood tests are helpful if used correctly. But the accuracy of the test depends on when you got infected.
In the first few weeks of infection, the test may be negative, as antibodies take a few weeks to develop.
Tests aren’t recommended for patients who don’t have Lyme disease symptoms.
Aucott says the most promising development in the fight against Lyme disease are better diagnostic tests that are accurate in the first few weeks after exposure.
The earlier the treatment, the less likely the disease will progress. Aucott says he expects the tests to be available soon.
Doctors may not recognize symptoms, especially those who practice in areas where Lyme infection isn’t prevalent, and up to 30% of the infections are not accompanied by a rash.
Stages of Lyme infection
There are three stages:
- Early localized Lyme: Flu-like symptoms such as fever, chills, headache, swollen lymph nodes, sore throat, and typically a rash that has a “bull’s-eye” appearance or is uniformly round and red and at least 5 centimeters in size
- Early disseminated Lyme: Flu-like symptoms that now include pain, weaknessor numbness in the arms and legs, vision changes, heart palpitations and chest pain, a rash, and facial paralysis (Bell’s palsy)
- Late disseminated Lyme: This can occur weeks, months, or years after the tick bite. Symptoms might include arthritis, severe fatigue and headaches, vertigo, sleep disturbances, and mental confusion.
While experts don’t understand it, roughly 10% of people treated for Lyme infection do not shake the disease.
They may go on to have three core symptoms — joint or muscle pain, fatigue, and short-term memory loss or mental confusion.
This is called post-treatment Lyme disease syndrome.
It’s considered controversial because its symptoms are shared with other diseases and there isn’t a blood test to diagnose it, Aucott says.
There are theories as to why Lyme symptoms become chronic.
One is that the body continues fighting the infection long after the bacteria are gone, much like an autoimmune disorder.
Treatment of Lyme Disease
Lyme disease is best treated in the early stages. Early treatment is a simple 14 to 21 day course of oral antibiotics to eliminate all traces of infection. Medications used to treat Lyme disease include:
- doxycycline for adults and children older than 8 years old
- cefuroxime and amoxicillin for adults, younger children, and women who are nursing or breastfeeding
Persistent or chronic Lyme disease is treated with intravenous antibiotics for a period of 14 to 21 days.
Though this treatment eliminates the infection, your symptoms improve 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.
Prevention of Lyme Disease
Lyme disease prevention mostly involves decreasing your risk of experiencing a tick bite.
Take the following steps to prevent tick bites:
- Wear long pants and long-sleeve shirts when in the outdoors.
- Make your yard unfriendly to ticks by clearing wooded areas, keeping underbrush to a minimum, and putting woodpiles 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, and don’t use DEET on the hands of young children or on the faces of children less than 2 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 3.
- Be vigilant. Check your children, pets, and yourself for ticks. Don’t assume you can’t be infected again; 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.