Lyme Disease

After an infected tick bites an individual, the organism can cause early local Lyme disease. This resembles a mild flu-like illness and there may be a rash at the site of the bite.

If the organism spreads through the body by the bloodstream, it can affect many body systems. This widespread infection is known as disseminated Lyme disease.

Early local Lyme disease often starts with a mild flu-like illness. The person may complain of the following signs and/or symptoms:

• characteristic rash (erythema migrans)
• fatigue
• fever
• headache
• muscle aches
• stiff neck
• swollen lymph nodes

The most obvious sign of Lyme disease is the rash, commonly at the site of the tick bite. The rash may begin the day of the bite, or up to 30 days later. It starts as a red, circular lesion, which may feel hot and itchy. As it gets bigger, the center often clears and the red area grows outward in multiple concentric circles. The skin looks normal in the middle, making the lesion resemble a bull's-eye on a dartboard.

The lesion may grow to over 20 inches in diameter. Within a few days, a few individuals may develop additional lesions. In 3 to 4 weeks, the lesions are replaced by small red blotches, which may continue for several weeks.

General symptoms of disseminated Lyme disease may include:

• confusion
• fever, which may come and go
• marked fatigue
• severe headaches
• severe muscle pain

Depending on the body systems involved, disseminated Lyme disease may also cause any of the following:

• arrhythmias, or irregular heartbeats
• behavioral changes, including depression and personality changes
• cognitive impairments
• difficulty swallowing or speaking
• joint pain and swelling
• meningitis, which is inflammation of the membranes lining the spinal cord
• muscle weakness or paralysis
• sleep disorders
• visual impairments

These symptoms tend to come and go over a number of weeks if the person is not treated.

These symptoms may also be caused by many other serious medical conditions and should be reported to a healthcare professional right away.

Weeks to years later, frank, or unmistakable, arthritis can occur, with marked swelling of the joints. Recurrent attacks can lead to chronic arthritis, with severe joint damage.

Lyme disease is carried by certain species of ticks, including the following:

• deer ticks in the northeastern and north-central parts of the United States
• sheep ticks in Europe
• Taiga tick in Asia
• western black-legged ticks in other parts of the U.S.

A person in these areas increases his or her risk of acquiring Lyme disease from a tick bite with the following activities:

• camping
• clearing brush
• fishing
• forestry
• landscaping
• hiking
• hunting
• living in a wooded or overgrown environment
• parks management

Lyme disease can also be passed to an unborn child if the baby's mother has the disease during pregnancy, but this can be treated effectively for both the mother and the child she is carrying.

People can prevent Lyme disease by avoiding tick bites. Here are several tips to help avoid tick bites.

• Check daily for ticks on the body.
• Use tick repellants (insect repellants).
• Wear protective clothing such as long pants (tucked into socks) and long-sleeved shirts in wooded areas.

At present, there is no vaccine to help prevent Lyme disease in humans. One 2001 study showed that a single dose of the antibiotic doxycycline, taken right after a bite from a deer tick, may be effective in preventing Lyme disease. Researchers recommend limiting this antibiotic prevention to people in high-risk areas who have had a tick attached to their skin for a day or two. It should not be given to pregnant women or children under the age of 8 years.

Early Lyme disease is usually diagnosed by the presence of the bull's-eye rash. An antibody titer blood test is often done to confirm the diagnosis. The spirochetes that cause Lyme disease can also be cultured from blood or a biopsy of the rash. However, the culture is difficult and often takes months to complete.

Untreated Lyme disease may cause permanent disabilities from arthritis, critical nervous system and nerve damage, and occasionally cardiac arrest.

Lyme disease is not directly contagious from person to person. However, people with untreated Lyme disease can pass it on by donating blood. A pregnant woman with Lyme disease can pass the infection to her unborn child.

Lyme disease is treated with antibiotics, including the following:

• doxycycline
• amoxicillin
• ceftriaxone
• cefuroxime
• cefotaxime

Other medications may be used to treat symptoms of Lyme disease. For example, seizures may be treated with anticonvulsant medications. Ibuprofen may be given for fever or joint pain.

Antibiotics and other medications used to treat Lyme disease may cause stomach upset or allergic reactions . Some of the antibiotics may cause light sensitivity.

With effective treatment, individuals usually recover from Lyme disease without further problems. In some individuals, the disease lasts a long time or the symptoms come back. These people may need repeated treatment. There is currently controversy about the effectiveness of long-term antibiotics for chronic Lyme disease. Research continues in this area.

Any new or worsening symptoms should be reported to the healthcare professional.