What is Lyme disease?

Lyme disease is an infection caused by the bite of a blacklegged tick (also called deer tick) infected with bacteria. The tick is so small that you may not notice the tick or its bite. Most deer ticks do not carry Lyme disease. Even if a tick is infected, it may not transfer the disease to you. An infected tick that is attached for less than 36 hours is less likely to cause Lyme disease.

If the disease is not diagnosed and treated, the symptoms can last for several years, but they usually get better over time.

What is the cause?

Ticks are found in woodlands, grasslands, and marshlands and at the seashore. Wild birds and animals, as well as domestic animals and pets such as dogs, horses, and cows, can carry ticks. Ticks may climb on humans from animals, leaves, or low-lying brush. Ticks cannot jump or fly.

People usually become infected during the summer, when they are more likely to be exposed to ticks. Hikers, campers, hunters, and people living in wooded or rural areas have a higher risk for Lyme disease. In the US the infection is more common in the northern states.

What are the symptoms?

Lyme disease is hard to diagnose because its symptoms can vary greatly from person to person. The first symptoms may not even be noticed. Symptoms may come and go in cycles lasting a week or longer.

Untreated Lyme disease may progress through these 3 stages:

Stage 1:

In the first month after a bite by an infected tick, you may get a rash at the site of your bite. The rash begins as a large red spot that may be flat or bumpy. The area of the rash feels warm, but it is not painful or itchy. The rash slowly spreads and the red color at the center of the rash may fade, creating what is called a bull’s-eye rash. Sometimes the rash may blister or scab in the center. The thigh, groin, and armpit are common sites for the rash, but it can appear anywhere.

Although most infected people develop a rash, you may not have this symptom, or you may overlook it.

You may feel like you have the flu, with symptoms such as:

• Feeling very tired or drowsy
• Pain or stiffness in muscles and joints
• Headache or jaw pain
• Chills and fever
• Stiff neck

Less common symptoms of early Lyme disease are:

• Red, irritated eyes
• Sore throat and cough
• In men, a swelling of the testicles

Even if you don’t get treatment, the early symptoms usually improve or go away within several weeks. However, you may feel tired, drowsy, and have muscle or joint pain for months after the rash has gone.

Stage 2:

If not treated, Lyme disease can spread to your brain, heart, and joints. Several weeks to months after the first symptoms appear, you may develop:

• Weakness or paralysis of one or both sides of your face
• Fever, headache, and a stiff neck
• Heart problems, such as an irregular heartbeat
• Confusion
• Seizures
• Coma

During this second stage, you may have pain in your joints, tendons, muscles, or bones, usually without joint swelling. These symptoms usually go away within a few weeks.

Stage 3:

After several months of infection, you may have:

• Joint pain and swelling
• Numbness or tingling in your hands and feet
• Trouble concentrating
• Weakness in your arms or legs
• Depression

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have a blood test for Lyme disease. Or you and your provider may decide to start treatment without the test or before the test results are available.

If you were recently bitten by a tick, saving the tick (in a marked plastic bag in your freezer) may help your provider diagnose your symptoms and decide on treatment.

How is it treated?

Lyme disease is treated with antibiotics. In most cases the symptoms go away a few weeks or months after antibiotic treatment, but sometimes the symptoms last several years.

If you are in stages 2 or 3 of the disease, you may need other treatments if you have symptoms that affect your heart, nervous system, or joints.

If you are pregnant or nursing and have Lyme disease, you may pass the disease to your baby. Although this happens rarely, you should call your healthcare provider right away if you are pregnant or nursing and are bitten by a tick or have symptoms of Lyme disease.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. You need to take all of your antibiotic medicine. Do not stop taking antibiotics because you start to feel better or your symptoms go away. Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent Lyme disease?

• In areas of thick underbrush, try to stay near the center of trails.
• When you are outdoors, wear long-sleeved shirts tucked into your pants. Wear your pants tucked into your socks or boot tops if possible. A hat may help, too. Wearing light-colored clothing may make it easier to spot a small tick before it reaches your skin and bites. While you are outside, check for ticks every 4 hours and remove any ticks on clothing or exposed skin.
• Use approved tick repellents on exposed skin and clothing. Don’t use more than recommended in the package directions. Do not put repellent on open wounds or rashes. When using sprays, don’t spray the repellent directly on your face. Spray the repellent on your hands first and then put it on your face, but not near your eyes or mouth. Then wash the spray off your hands.
  • Adults should use repellent products with no more than 35% DEET. Children older than 2 months can use repellents with no more than 30% DEET. Don’t put DEET on a child’s hand or other body part they are likely to put in their mouth. DEET should be applied just once a day. Wash it off your body when you go back indoors. Some products contain more than 35% DEET. The higher concentrations are no more effective than the lower concentrations, but they may last longer. Read the label carefully before applying.
  • Picaridin may irritate the skin less than DEET and appears to be just as effective.
  • Spray clothes with repellents because ticks may crawl from clothing to the skin. Products containing permethrin are recommended for use on clothing, shoes, bed nets, and camping gear. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other insects and can keep working after laundering. Permethrin should be reapplied to clothing according to the instructions on the product label. You can buy clothing and hats pretreated with permethrin. Permethrin does not work as a repellent when it is put on the skin.
• Treat household pets for ticks and fleas. Check pets after they’ve been outdoors.
• Brush off clothing and pets before entering the house.
• After you have been outdoors, undress and check your body for ticks. They usually crawl around for several hours before biting. Check your clothes, too. Wash them right away to remove any ticks.
• If you find a tick attached to your body, you need to remove it.
  • Grasp the tick with tweezers or fingers (covered with gloves or a tissue) as close to the skin as possible. Gently pull the tick straight away from you until it releases its hold. Use a slow gentle pulling motion. Pulling the tick out too quickly may tear the body from the mouth, leaving the mouth still in the skin. If you are unable to remove the tick completely, you may need to see your healthcare provider. Do not twist the tick as you pull, and try not to squeeze its body.
  • After you have removed the tick, thoroughly wash your hands and the bite area with soap and water. Put an antiseptic such as rubbing alcohol on the area where you were bitten.
  • Put the tick in a sealed plastic bag and keep it in the freezer. Identification of the tick may help your provider diagnose and treat any symptoms. If you do not have any symptoms of disease after 1 month, you can throw away the tick.
• Shower and shampoo after your outing.
• Inspect any gear you have carried outdoors.
• If you spend much time hiking, you may want to include a pair of tick tweezers in your first-aid kit. You can buy them at sporting goods stores.
• If you had a shot against Lyme disease (shots were available until 2002) you are probably no longer protected because the vaccine loses its effect over time. A new vaccine may be approved by the FDA in 2015.