Lyme disease

Answer 1

Definition

Lyme disease is an inflammatory disease spread through a tick bite.

This article offers a general overview on Lyme disease. For specific information, see:

• Lyme disease - primary
• Lyme disease - early disseminated
• Lyme disease - chronic persistent

Alternative Names

Borreliosis

Causes, incidence, and risk factors

Lyme disease is caused by the bacterium Borrelia burgdorferi (B. burgdorferi). Certain ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick.

Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut, in 1975. Cases have now been reported in most parts of the United States. Most of the cases occur in the Northeast, some parts of Minnesota and Wisconsin, the mid-Atlantic states, and along the Pacific coast. Lyme disease is usually seen during the late spring, summer, and early fall.

There are 3 stages of Lyme disease.

• Stage 1 is called primary Lyme disease.
• Stage 2 is called secondary Lyme disease and early disseminated Lyme disease.
• Stage 3 is called tertiary Lyme disease and chronic persistant Lyme disease.

Risk factors for Lyme disease include:

• Doing activities that increase tick exposure (for example, gardening, hunting, or hiking)
• Having a pet that may carry ticks home
• Walking in high grasses

Symptoms

Not everyone infected with these bacteria gets ill. If a person does become ill, the first symptoms resemble the flu and include:

• Chills
• Fever
• Headache
• Lethargy
• Muscle pain

There may be a "bulls eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can be larger than 1 - 3 inches wide.

Symptoms in people with the later stages of the disease include:

• Body-wide itching
• Joint inflammation
• Stiff neck
• Unusual or strange behavior

Note: Deer ticks can be so small that they are almost impossible to see. Many people with Lyme disease never even saw a tick.

Signs and tests

A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most commonly used is the ELISA for Lyme diseasetest. A western blot test is done to confirm ELISA results.

A physical exam may show joint, heart, or brain problems in people with advanced Lyme disease.

Treatment

Everyone who has been bitten by a tick should be watched closely for at least 30 days.

Most people who are bitten by a tick do NOT get Lyme disease.

A single dose of antibiotics may be offered to someone soon after being bitten by a tick, if all of the following are true:

• The person has a tick that can carry Lyme disease attached to their body. This usually means that a nurse or physician has looked at and identified the tick.
• The tick is thought to have been attached to the person for at least 36 hours.
• The person can begin taking the antibiotics within 72 hours of removing the tick.
• The person is over 8 years old and is not pregnant or breastfeeding.

A full course of antibiotics is used to treat people who are proven to have Lyme disease. The specific antibiotic used depends on the stage of the disease and the symptoms.

See also:

• Lyme disease - primary
• Lyme disease - early disseminated
• Lyme disease - chronic persistent

Anti-inflammatory medications, such as ibuprofen, are sometimes prescribed to relieve joint stiffness.

Expectations (prognosis)

If diagnosed in the early stages, Lyme disease can be cured with antibiotics. Without treatment, complications involving the joints, heart, and nervous system can occur.

Rarely, a person will continue having symptoms that can interfere with daily life. Some people call this post-Lyme disease syndrome. There is no effective treatment yet for this syndrome.

Complications

Advanced stages of Lyme disease can cause long-term joint inflammation (Lyme arthritis) and heart rhythm problems. Nervous system (neurological) problems are also possible, and may include:

• Decreased concentration
• Memory disorders
• Nerve damage
• Numbness
• Pain
• Paralysis of the face muscles
• Sleep disorders
• Vision problems

Calling your health care provider

Call your health care provider if you have symptoms of Lyme disease.

Prevention

When walking or hiking in wooded or grassy areas:

• Spray all exposed skin and your clothing with insect repellant (spray outdoors only, do not use on face, use just enough to cover all other exposed skin, don't spray under clothing, don't apply over wounds or irritated skin, wash skin after going inside)
• Wear light-colored clothing to make it easier to spot ticks
• Wear long-sleeved shirts and long pants with the cuffs tucked into shoes or socks
• Wear high boots, preferably rubber

Check yourself and your pets frequently during and after your walk or hike.

Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp.

See also: Tick removal

References

Steere AC. Borrelia burgdorferi (lyme disease, lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 242.

Clark RP, Hu LT. Prevention of Lyme disease and other tick-borne infections. Infect Dis Clin North Am. 2008;22:381-396.

Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.

Feder HM Jr., Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP. Ad Hoc International Lyme Disease Group. A critical appraisal of "chronic Lyme disease." N Engl J Med. 2007;357:1422-1430.

Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. 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. 2007;69:91-102.

Answer 2

Definition

Lyme disease is a bacterial infection spread through the bite of the blacklegged tick.

See also: Lyme disease - what to ask your doctor

Alternative Names

Borreliosis; Bannwarth syndrome

Causes, incidence, and risk factors

Lyme disease is caused by bacteria called Borrelia burgdorferi (B. burgdorferi). Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick.

Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut, in 1975. In the United States, most Lyme disease infections occur in the following areas:

• Northeastern states, from Virginia to Maine
• North-central states, mostly in Wisconsin and Minnesota
• West Coast, particularly northern California

There are 3 stages of Lyme disease. (See below for symptoms.)

• Stage 1 is called early localized Lyme disease. The infection is not yet widespread throughout the body.
• Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.
• Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

Risk factors for Lyme disease include:

• Doing outside activities that increase tick exposure (for example, gardening, hunting, or hiking) in an area where Lyme disease is known to occur
• Having a pet that may carry ticks home
• Walking in high grasses

Important facts about tick bites and Lyme disease:

• In most cases, a tick must be attached to your body for 24 - 36 hours to spread the bacteria to your blood.
• Blacklegged ticks can be so small that they are almost impossible to see. Many people with Lyme disease never even saw a tick on their body.
• Most people who are bitten by a tick do not get Lyme disease.

Symptoms

Symptoms of early localized Lyme disease (Stage 1) begin days or weeks after infection. They are similar to the flu and may include:

• Body-wide itching
• Chills
• Fever
• General ill-feeling
• Headache
• Light-headedness or fainting
• Muscle pain
• Stiff neck

There may be a "bull's eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can be quite large and expanding in size.

Symptoms may come and go. Untreated, Lyme disease can spread to the brain, heart, and joints.

Symptoms of early disseminated Lyme disease (Stage 2) may occur weeks to months after the initial tick bite. They may include:

• Paralysis or weakness in the muscles of the face
• Muscle pain and pain or swelling in the knees and other large joints
• Heart problems, such as skipped heartbeats (palpitations)

Symptoms of late disseminated Lyme disease (Stage 3) can occur months or years after the initial infection. The most common symptoms are muscle and joint pain. Other symptoms may include:

• Abnormal muscle movement
• Muscle weakness
• Numbness and tingling
• Speech problems

Signs and tests

A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most commonly used is the ELISA for Lyme diseasetest. A western blot test is done to confirm ELISA results.

In areas where Lyme disease is more common, your health care provider may be able to diagnose early disseminated Lyme disease (Stage 1) without doing any lab tests.

Other tests that may be done, when the infection has become more widespread, include:

• Electrocardiogram
• Echocardiogram to look at the heart
• Spinal tap (lumbar puncture to examine spinal fluid
• MRI of the brain

Treatment

Anyone who has been bitten by a tick should be watched closely for at least 30 days.

A single dose of antibiotics may be offered to someone soon after being bitten by a tick, if all of the following are true:

• The person has a tick that can carry Lyme disease attached to their body. This usually means that a nurse or physician has looked at and identified the tick.
• The tick is thought to have been attached to the person for at least 36 hours.
• The person can begin taking the antibiotics within 72 hours of removing the tick.
• The person is over 8 years old and is not pregnant or breastfeeding.

A 2 - 4-week course of antibiotics is used to treat people who are diagnosed with Lyme disease. The specific antibiotic used depends on the stage of the disease and the symptoms.

Pain medications, such as ibuprofen, are sometimes prescribed to relieve joint stiffness.

Expectations (prognosis)

If diagnosed in the early stages, Lyme disease can be cured with antibiotics. Without treatment, complications involving the joints, heart, and nervous system can occur. However, these symptoms are still treatable.

Rarely, a person will continue having symptoms that can interfere with daily life even after they have been treated with antibiotics. Some people call this post-Lyme disease syndrome. The cause is unknown.

Complications

Stage 3, or late disseminated, Lyme disease can cause long-term joint inflammation (Lyme Arthritis) and heart rhythm problems. Brain and nervous system problems are also possible, and may include:

• Decreased concentration
• Memory disorders
• Nerve damage
• Numbness
• Pain
• Paralysis of the face muscles
• Sleep disorders
• Vision problems

Calling your health care provider

Call your health care provider if you have:

• A large, red, expanding rash that may look like a bull's eye
• Had a tick bite and develop weakness, numbness, or tingling, or heart problems
• Symptoms of Lyme disease, especially if you may have been exposed to ticks

Prevention

Take precautions to avoid direct contact with ticks. Be extra careful during warmer months. Whenever possible:

• Avoid wooded or bushy areas, or areas with high grasses and leaf litter.
• Walk in the center of trails.
• Check yourself and your pets frequently during and after your walk or hike.

When walking or hiking in wooded or grassy areas, spray all exposed skin and your clothing with insect repellant.

See also: Bug repellent safety

You may also treat clothing, such as boots, pants, and socks, with a product that contains permethrin. It remains protective for several washings.

Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Shower soon after coming indoors to wash off any unseen ticks.

See also: Tick removal

References

Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. 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. 2007;69:91-102.

Lyme disease. CDC. Page last updated April 12, 2011. Viewed August 24, 2011.

Steere AC. Borrelia burgdorferi (lyme disease, lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 242.

Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.

Reviewed By

Review Date: 08/26/2011

A.D.A.M. Editorial: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital (3/11/2011).

Answer 3

Having a tick attached to your body isn't just getting a little too close to nature. The tick can make you seriously ill with Lyme disease.

Lyme disease is caused by bacteria called Borrelia burgdorferi. Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick, mostly in northeastern states and on the West Coast.

The good news is that usually a tick has to be attached to your body for 24 to 36 hours to infect you. The bad news is that blacklegged ticks are so small they're almost impossible to see. Many people with Lyme disease never even see a tick on their body. But most people bitten by a tick do NOT get Lyme disease.

So, how do you know for sure that you have Lyme disease?

The flu-like symptoms of Lyme disease usually start days or weeks after you've been bitten. You might have Itching all over your body; Chills, fever, and light headedness; Or perhaps a Headache, muscle pain, and a stiff neck.

You'll probably see a "bull's eye" rash on your body. It can get pretty big. After a few weeks, the muscles in your face might feel weak or even paralyzed. Your knees and other joints may swell and hurt. You might even notice your heart skipping some beats. Eventually, your muscles might move strangely, you may feel numbness or tingling, and you may start to have trouble speaking.

A doctor will test your blood for antibodies that are trying to fight the bacteria in your blood. One of these tests is called the ELISA test, and you'll often have a second test called the Western blot test to confirm you have Lyme disease.

To treat Lyme disease, you may need to take antibiotics for up to a month. Pain medicines from the drug store can help soothe your joint stiffness.

If it's caught early, Lyme disease is pretty easily treated. Without treatment, you can have heart, muscle, and even nerve problems. So the next time you're out in the woods or high grass, wear protective clothing, and do check yourself for ticks once you get home.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.