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:

• Stage 1 Lyme disease
• Stage 2 Lyme disease
• Stage 3 Lyme disease

Alternative Names

Borreliosis

Causes, incidence, and risk factors

Lyme disease is caused by the bacteria Borrelia burgdorferi (B. burgdorferi). Certain ticks carry the 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 US. Most occur in the Northeast, upper Midwest, and along the Pacific coast. Lyme disease is usually seen during the late spring, summer, and early fall.

There are three stages of Lyme disease.

• Stage 1 is called primary Lyme disease.
• Stage 2 is called secondary Lyme disease.
• Stage 3 is called tertiary Lyme disease.

Risk factors for Lyme disease include walking in high grasses, doing activities that increase tick exposure, and having a pet that may carry ticks home.

Symptoms

Not everyone infected with the 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 with 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. Therefore, 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 causes Lyme disease. The most common one used is the ELISA for Lyme disease test. 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

Most people who are bitten by a tick do NOT get Lyme disease. Antibiotics may be offered to someone who isn't sick if:

• They have a tick that can carry Lyme disease attached to their body
• The tick is estimated to have been attached to them for at least 36 hours
• They can begin taking the antibiotics within 72 hours of removing the tick
• They are over 8 years old and are not pregnant or breastfeeding

Antibiotics are used to treat Lyme disease. The specific antibiotic used depends on the stage of the disease and the symptoms.

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 joints, the heart, and the 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. Unfortunately, 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. Neurological problems are also possible, and may include:

• Decreased concentration
• Memory disorders
• Nerve damage
• Numbness
• Pain
• Paralysis of the facial muscles
• Sleep disorders
• Visual disturbances

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

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(14):1422-30.

Halperin JJ, Shapiro ED, Logigian E, 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(1):91-102.

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):1089-134.