What is Lyme disease?
Lyme disease is caused by a bacteria, Borrelia burgdorferi, which you can get if an infected deer tick (also called black-legged tick) bites you. Ordinary "wood ticks" and "dog ticks" don’t carry the infection.
The first recognition of Lyme disease, also called borreliosis, began in 1975 when many children received a diagnosis of juvenile rheumatoid arthritis in Lyme, Connecticut, and two neighboring towns. Researchers found that bites from infected deer ticks were responsible for the outbreak of arthritis.
What are the stages (phases) of Lyme disease?
Lyme disease may evolve through phases (stages), which can overlap and cause symptoms that may involve the skin, joints, heart or nervous system. These stages are:
- Early localized Lyme disease (weeks one through four).
- Early disseminated Lyme disease (months one through four).
- Late persistent, late disseminated or just late Lyme disease (after four months, even up to years later).
How common is Lyme disease?
In the United States, about 30,000 cases of Lyme disease are reported to the U.S. Centers for Disease Control and Prevention (CDC) each year. But there are other, diagnosed cases that aren't reported.
Symptoms and Causes
What are the symptoms of Lyme disease?
Signs and symptoms of early Lyme disease typically include:
- A reddish rash or skin lesion known as erythema migraines (EM). The rash starts as a small red spot at the site of the tick bite anywhere from one week after to four weeks after the bite. The spot expands over a period of days or weeks, forming a circular, triangular or oval-shaped rash. The rash may look like a bull’s eye because it appears as a red ring that surrounds a clear center area. The rash can range in size from that of a dime to the entire width of a person's back. As infection spreads, several EM rashes (lesions) can appear at different sites on your body.
- Stiff neck.
- Body and joint aches.
- Swollen lymph nodes (swollen glands).
Signs and symptoms of the second stage of Lyme disease (the early disseminated stage) may include:
- Multiple areas of rash.
- Paralysis of facial muscles (Bell's palsy).
- Heart block or an interruption of the electrical system of the heart.
- Areas of numbness or abnormal feelings (neuropathy).
Signs and symptoms of untreated late Lyme disease, which may happen from months to a year after infection, may include:
- Recurring episodes of swollen joints (arthritis). This typically affects large joints like the knee.
- Difficulty concentrating, known as “brain fog.” This is a form of encephalopathy or damage to the brain.
- Damage to nerves all over your body, including your skin, muscles and organs (polyneuropathy).
Diagnosis and Tests
How is Lyme disease diagnosed?
A healthcare provider will diagnose Lyme disease based on symptoms, physical findings (like a rash) and whether or not you've been in an area populated by infected ticks.
Many people don’t remember or know that they’ve been bitten by a tick. This is because the tick is tiny, and its bite is usually painless.
Your provider will confirm the diagnosis using a blood test. If your first blood test is negative for Lyme disease, you won't need another test. If the first test is positive or equivocal, your provider will conduct the test again. You have to have two positive (or sometimes equivocal) results to be diagnosed with Lyme disease.
Management and Treatment
How is Lyme disease treated?
Antibiotics, usually doxycycline or amoxicillin, are effective treatments for Lyme disease. How long your treatment lasts depends on the stage of infection. In general, it’s true that the sooner you’re treated, the quicker and more complete the recovery.
Pregnant people should receive treatment for Lyme disease as well. There is, however, no evidence that a fetus can get the infection from its parent. There’s also no strong evidence that miscarriages are more likely after Lyme disease.
What should I do if a tick bites me?
If a tick bites you, the best way to remove it is by taking the following steps:
- Tug gently but firmly with blunt tweezers near the "head" of the tick at the level of your skin until it releases its hold on your skin.
- Avoid crushing the tick's body or handling the tick with bare fingers because you could expose yourself to the bacteria in the tick.
- Wash the bite area thoroughly with soap and water.
- Don't use kerosene, petroleum jelly (such as Vaseline®) or hot cigarette butts to remove the tick.
- Don't squeeze the tick's body with your fingers or tweezers.
Can Lyme disease be prevented?
Most people with Lyme disease get the infection during the late spring, summer and early fall when immature ticks are out feeding. In warm climates, few tick bites take place during winter months.
Deer ticks are most often found in wooded areas and nearby grasslands. They’re especially common where the two areas merge, including neighborhood yards where deer occasionally roam. Ticks don’t survive long on sunny lawns. They dry out quickly and die.
Although only about 1% of all deer ticks carry Lyme disease-causing bacteria, there are areas in which over 50% of the ticks carry the bacterium. The diseased ticks are often found in the U.S. Northeast and upper Midwest areas. Ticks also live in coastal areas.
Black-legged ticks can get the infection from animals other than deer. Mice, voles and some squirrels can carry the bacteria.
How can I prevent tick bites?
The following tips can help you avoid tick bites:
- To repel ticks, you may want to spray your clothing with permethrin, an insecticide commonly found in lawn and garden stores. Insect repellents that contain a chemical called DEET can also be applied to clothing or directly onto your skin. Read the labels carefully. Don’t overuse it. Too much may be harmful.
- Minimize skin exposure to both ticks and insect repellents by wearing long pants and long-sleeved shirts that fit tightly at the ankles and wrists.
- Wear a hat, tuck your pant legs into socks and wear shoes that leave no part of your feet exposed.
- Wear light-colored clothing to make it easier to detect ticks.
- Walk in the center of trails to avoid picking up ticks from overhanging grass and brush.
- After outdoor activities in an "at risk" area, always do a tick check and then shower, scrubbing with a washcloth.
- Get rid of any ticks on your clothes by putting them in the dryer for 15 minutes. This will kill any ticks attached to the clothes by drying them out.
- Pets may bring ticks into your home. Discuss ways to prevent ticks on your pet with your veterinarian.
Outlook / Prognosis
What is the outlook for someone with Lyme disease?
Most of the people who get Lyme disease and receive treatment early will be fine. Treatment can cure Lyme disease but you might still have some long-term effects. Untreated Lyme disease may contribute to other serious problems but it’s rarely fatal.
Post-treatment Lyme disease syndrome
Even after proper treatment, some people (estimated at 5% to 15%) may experience lingering fatigue, achiness or headaches. This is known as post-treatment Lyme disease syndrome or PTLDS. The symptoms don’t mean that you still have an infection. PTLDS probably won’t respond to additional antibiotics. The majority of people in this group will have symptoms that resolve at some point over the next six months.
Chronic Lyme disease
Chronic Lyme disease is a term used by some for a condition in a person who had Lyme disease and the symptoms of PTLDS. Some people consider chronic Lyme disease to be the same as PTLDS. However, some people receive a chronic Lyme disease diagnosis without a Lyme disease diagnosis. Sometimes, extended treatment with antibiotics helps.
This term may be why some people think a Lyme disease infection can occur without being bitten by a tick. There isn't enough proof that mosquitoes can transmit Lyme disease. Many researchers dislike using the term “chronic Lyme disease.”
When should I see my healthcare provider?
If you feel sick after having spent time in areas where ticks might live, you should make an appointment with your healthcare provider.
If you received a Lyme disease diagnosis and you don’t feel well after taking all of your antibiotics, contact your provider. This is especially true if you have symptoms like a stiff neck or mental confusion.
Frequently Asked Questions
Can Lyme disease completely be cured?
Taking oral antibiotics typically cures Lyme disease after two to four weeks. You may need to get antibiotics through the vein (intravenously) for four more weeks. However, there’s no reason to think that Lyme disease stays in you forever after treatment.
A note from Cleveland Clinic
If you’re going to spend time in an area that might have ticks, take measures to avoid being bitten. This includes wearing long-sleeved shirts and pants to make it harder for ticks to bite. If you feel sick after being in an area that probably has ticks, make an appointment with your healthcare provider. If your provider prescribes antibiotics, make sure you take all of them as instructed.
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