Lyme Disease
Topic OverviewWhat is Lyme disease?Lyme disease is an infection
that is spread by ticks. You can get Lyme disease if you are bitten by an
infected tick. But most people who have had a tick bite don't get Lyme
disease. It's still important to see your doctor if you have a tick attached to
you that you can't remove. Lyme disease is common in the United
States. It can also be found in Canada, Europe, and Asia. What causes Lyme disease? Lyme disease is caused
by bacteria. Infected ticks spread the bacteria by biting people or
animals. Two types of ticks carry the Lyme disease bacteria in the
U.S. They are: - Deer ticks. They spread the disease in the Northeast
and Midwest.
- Western black-legged ticks. They spread
the disease along the Pacific coast, mostly in northern California and
Oregon.
Remove ticks as soon as you notice them. Infected
ticks usually don't spread Lyme disease until they have been attached for at
least 36 hours. What are the symptoms? One sign of Lyme disease
is a round, red rash that spreads at the site of a tick
bite. This rash can get very large. Flu-like symptoms are also
common. People in the early stages of Lyme disease may feel very tired and
have headaches, sore muscles and joints, and a fever. These
symptoms can start at any time, from 3 days to up to a month after you have been
bitten. Some people don't have any symptoms when they are in the early stages
of Lyme disease. And they may not even remember getting a tick bite. If Lyme disease goes untreated, you can have more serious symptoms over
time. These include: - Swelling and joint pain (like
arthritis).
- Tingling and numbness in your
hands, feet, and back.
- A lack of energy that does not get better.
- Trouble focusing your thoughts.
- Poor memory.
- Weakness or
paralysis in your face muscles.
How is Lyme disease diagnosed? Your doctor will
ask you questions about your symptoms. Your doctor will also ask about your activities to try to find out if
you have been around infected ticks. You may have a blood test to see if you
have certain
antibodies in your blood that could mean you have the
disease. How is it treated?The main treatment for Lyme
disease is
antibiotics. These medicines usually cure Lyme disease
within 3 weeks of starting treatment. It's important to get
treatment for Lyme disease as soon as you can. If it goes untreated, Lyme disease can lead to problems with
your skin, joints, nervous system, and heart. These can occur weeks, months, or
even years after your tick bite. The problems often get better with
antibiotics, but in rare cases they can last the rest of your life. Can you prevent Lyme disease?The best way to
prevent Lyme disease is to protect yourself from ticks. Cover up as much skin
as you can when you're going to be in wooded or grassy areas. Wear a hat, a
long-sleeved shirt, and long pants with the legs tucked into your socks. And
keep in mind that it's easier to see ticks on light-colored clothes. Use a bug repellent that has a chemical (such as DEET, IR3535, or Picaridin) to keep away ticks. Check your pets for ticks after they've been outside.
You can't get Lyme disease from your pet. But your pet can bring infected ticks
inside. These ticks can fall off your pet and attach to you. Check your clothing and outdoor gear after you have been outside. Remove any ticks you find. Then put your clothing in a clothes dryer on high heat for 1 hour to kill any ticks that might remain. Frequently Asked QuestionsLearning about Lyme disease: | | Being diagnosed: | | Getting treatment: | | Ongoing concerns: | |
Cause Lyme disease is caused
by Borrelia burgdorferi bacteria. Infected ticks spread the bacteria by biting people or
animals. Two types of ticks carry the Lyme disease bacteria in the
U.S. They are: - Deer ticks. They spread the disease in the Northeast
and Midwest.
- Western black-legged ticks. They spread
the disease along the Pacific coast, mostly in northern California and
Oregon.
Dogs, cats, and horses can become infected with Lyme
disease bacteria, but they can't pass the illness to humans. But infected
ticks may fall off the animals and then bite and infect humans. SymptomsThe symptoms of Lyme disease depend on the stage of the disease. You may first notice symptoms weeks to months after the tick bite. If the disease isn't treated, it may progress from mild symptoms to serious, long-term disabilities. - In the first stage, you may have a rash
(erythema migrans) at the site of the tick bite. You may also have a lack of energy or a headache and stiff neck. Sometimes people have no symptoms at this stage.
- In the second stage, symptoms may include memory problems and pain and weakness in the arms and legs.
- In the third stage, symptoms may include swelling and pain (like arthritis) in the joints, not being able to control facial muscles, and numbness and tingling in the hands, feet, or back.
If you don't have symptoms during stage 1, your first symptoms may be those found in stage 2 or 3. What HappensLyme disease is caused
by a bite from a tick that is infected with bacteria. When an infected tick bites you, bacteria travel
to the tick's salivary glands and then into your body through your skin. It
takes about 24 hours for a tick to attach itself to the skin and begin to feed.
The tick generally must be attached to you for about 36 hours in order for it
to transmit the Lyme disease bacteria. There are three stages of Lyme disease. If the disease isn't treated, it may progress in stages from mild symptoms to serious, long-term disabilities. What Increases Your RiskThe main risk factor for
Lyme disease is exposure to ticks that are infected
with Lyme disease bacteria. In areas where Lyme disease is widespread, such as the northeastern
United States and Canada, several
factors may increase your risk, including: - Spending time outdoors during the warm months of the year when
ticks are most active. This is usually between
May and November, with peak activity in June and July.
- Having indoor/outdoor pets. They can bring infected ticks into
the house. Although dogs and cats can become infected with the Lyme disease
bacteria, they cannot pass the illness to humans. But the infected ticks can
drop off the animal and then bite and infect a person.
- Having a stone fence or a bird feeder near your house. Stone
fences often become homes for mice, and mice may feed on spilled seed from a
bird feeder. Where there are mice, there are ticks.
Remove ticks right away, as soon as you notice them.
Your risk for getting Lyme disease increases the longer a tick is attached to
your body. Ticks generally cannot transmit Lyme disease until they are attached
for at least 36 hours. When To Call a DoctorCall your doctor if: - A tick is attached to your body and you are unable to remove the
entire tick.
- You have a circular red rash that expands over the course of
several days, especially if you know you were recently exposed to ticks. You may also have flu-like symptoms, such as fatigue, headache, stiff
neck, fever, chills, or body aches.
- You feel very tired or have joint pain (especially with redness
and swelling), irregular heartbeats, severe headache, or neck pain.
- You are pregnant or nursing and you think you may have been
exposed to ticks.
Who to seeThe following health professionals can diagnose and
prescribe treatment for Lyme disease or complications of Lyme disease: To prepare for your appointment, see the topic Making the Most of Your Appointment. Exams and TestsLyme disease
is often hard to diagnose. Your doctor will take a careful medical history and do a physical
examination to help diagnose early Lyme disease. You may be asked if you
have recently visited an area where you may have been exposed to ticks. The
doctor will ask about your symptoms and look for physical signs of Lyme disease. The clearest physical sign is an expanding, circular red
rash (called
erythema migrans). Lyme disease tests are blood tests that help confirm a diagnosis of Lyme
disease. These tests can detect
antibodies to the bacteria that cause Lyme disease, but they may not be needed. The decision about
when to use blood tests for Lyme disease depends on
whether your doctor strongly thinks you have Lyme disease and whether the test
results will change the course of your treatment. Other tests,
such as a skin
biopsy, may be done to confirm a diagnosis. If possible, put the tick
that was attached to you in a dry jar or a ziplock bag and take it to the
doctor with you. Sometimes tests can be done on the tick to see if it is a
carrier of Lyme disease. Treatment OverviewLyme disease is
treated with
antibiotics. The type of antibiotic your doctor gives you and the number
of days you take it will depend on your symptoms and the stage of the disease. Talk
to your doctor if you have any questions about your antibiotic
treatment. Early treatment
Antibiotic treatment for early Lyme disease is effective, and symptoms usually
go away within 3 weeks of treatment. The
earlier antibiotic treatment is started after infection, the faster and more
completely you will recover. If
Lyme disease isn't diagnosed and treated until later problems arise, it may
take you a long time to get better. Or you may need more treatment. Later treatmentIf the disease gets worse, treatment options include: - Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
aspirin or ibuprofen. These are usually helpful for symptoms of
arthritis that can occur with late Lyme disease.
- Oral antibiotics. These may be used for achy joints caused by chronic Lyme arthritis. But
joints that have been badly damaged by Lyme arthritis may take a long time to
get better, or antibiotics may not improve symptoms.
- Intravenous (IV)
antibiotics. These are commonly used to treat
nervous system problems such as tingling and numbness
or conditions such as
meningitis.
- Antibiotics plus other treatments. These are used to
help people who develop serious heart problems, such as severe
irregular heartbeat or
pericarditis, from Lyme disease. But these problems are extremely
rare. Heart problems may start getting better on their own, even before
antibiotics or other treatment has started.
People with partial
facial paralysis as a result of Lyme disease may improve on their own without
more treatment. Even after successful
treatment for Lyme disease, you can get it again. So it is important to
continue to protect yourself against tick bites. PreventionLyme disease can be prevented by avoiding and removing ticks. You can also get the disease again after successful treatment, so it is important to continue to protect yourself against
tick bites. Lyme disease isn't
contagious and cannot be spread from person to person. But there are certain precautions
you can take to prevent the spread of the illness. If you have active Lyme disease, don't donate blood. The
bacteria that cause the illness can be transmitted this way. If you have been treated for Lyme disease, you may be able to donate blood, but
check with the blood bank first. A pregnant woman may be able to pass Lyme disease to her unborn
child, but proven cases are rare. Lyme disease hasn't been shown to cause
birth defects or fetal death. MedicationsAntibiotics are the main treatment for
Lyme disease. The first course of antibiotics almost always cures the
infection. But if symptoms continue, more evaluation may be needed. The type of antibiotic prescribed, the amount, and whether the medicine is taken
orally, as an injection, or through a vein
(intravenous, or IV) depends on how bad your symptoms
are and how long you've had Lyme disease. - Oral antibiotics are prescribed for
early Lyme disease. They are also usually prescribed first
for
chronic Lyme arthritis.
- Intravenous
(IV) antibiotics are used if:
- Your
nervous system is affected by late Lyme disease and
you have bad headaches, neck pain, weakness or numbness in the arms or legs, or
problems with thinking or memory.
- Lyme
disease bacteria or
antibodies against the bacteria have been found in
your spinal fluid.
- Either oral or intravenous antibiotics may be used to
treat late Lyme disease symptoms.
Should you use antibiotics?Different antibiotics may be
used to treat children and adults. The decision to take medicines for Lyme disease may be based on one or
more of these factors: - You have symptoms of Lyme disease, especially the red,
circular rash, and a history of exposure to ticks in geographic regions where
Lyme disease is known to occur.
- Blood tests show that you have antibodies to the Lyme disease bacteria in
your blood, spinal fluid, or joint fluid.
- You are pregnant or breastfeeding and are bitten by a
tick.
In rare instances, Lyme disease symptoms may not go away
even after antibiotic treatment has cured the infection. There are a number of
possible reasons why symptoms may take longer to improve: - Tissue or nerve damage caused by untreated Lyme disease may be
severe or even irreversible.
- You may not actually have Lyme disease or may have another
illness at the same time with symptoms that don't respond to antibiotic
treatment. Lyme disease may trigger
fibromyalgia or
myalgic encephalomyelitis/chronic fatigue syndrome. Or you may be
misdiagnosed as having Lyme disease when you really
have a chronic fatigue condition.
Other Places To Get HelpOrganizationsCenters for Disease Control and Prevention: Division of Vector-Borne Diseases (DVBD) (U.S.) www.cdc.gov/ncezid/dvbd U.S. Environmental Protection Agency: Insect Repellents-Reducing Insect Bites www2.epa.gov/insect-repellents ReferencesOther Works Consulted- Halperin JJ, et al. (2007). Practice parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 69(1): 91-102.
- Tompkins DC, Luft BJ (2009). Lyme disease and other spirochetal zoonoses. In DC Dale et al., eds., ACP Medicine, section 7, chap. 7. Hamilton, ON: BC Decker.
- Wormser GP, et al. (2006). The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 43(9): 1089-1134. [Erratum in Clinical Infectious Diseases, 45(7): 941.]
CreditsByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerChristine Hahn, MD - Epidemiology
W. David Colby IV, MSc, MD, FRCPC - Infectious Disease Current as ofMarch 23, 2017 Current as of:
March 23, 2017 Last modified on: 8 September 2017
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