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Lyme Disease

What is Lyme disease?

Lyme disease is a bacterial disease you can get from ticks. Ticks can be infected with Borrelia burgdorferi (a type of bacteria) and can spread it to you by biting you and attaching to your skin. Black-legged ticks (also called deer ticks) usually spread Lyme disease. Lyme disease got its name from the place where it was first reported in the United States – Old Lyme, Connecticut.

What are the signs and symptoms of Lyme disease?

Not everyone who is bitten by a black-legged tick gets Lyme disease. However, a bull's-eye rash called erythema migrans is one of the main symptoms of Lyme disease, showing up in 70% to 80% of infected people. It appears three to 30 days after a tick bite and can look like a bull’s eye, circle, oval or triangle. The rash can expand until it’s about 12 inches across, and it may appear on any part of your body. It’s usually not itchy or painful.

You may also get a small bump or red spot, like a mosquito bite, at the site where the tick bit you. However, that’s not a sign of Lyme disease.

Lyme disease usually moves through three stages that can affect your joints, heart and nervous system.

Stage 1 - Early localized Lyme disease

Stage 1 usually occurs during the first month (four weeks) after you’re infected. At this point, the bacteria haven’t spread throughout your body. Within days or weeks, you may notice early symptoms of Lyme disease such as:

  • Fever 
  • Fatigue
  • Muscle aches
  • Joint stiffness
  • Chills
  • Headache
  • Swollen lymph nodes

Stage 2 - Early disseminated Lyme disease

Stage 2 usually happens between months one through four after you’re infected. At this point, the bacteria have started to spread throughout your body. You can have the symptoms from stage 1, plus:

  • Additional rashes
  • Severe headaches
  • Stiff neck
  • Brain or spinal cord inflammation
  • Joint, muscle, tendon, nerve or bone pain
  • Joint swelling
  • Dizziness
  • Shortness of breath
  • Neurologic Lyme disease
  • Heart palpitations or an irregular heartbeat (Lyme carditis)
  • Heart abnormalities
  • A loss of muscle tone in the face that causes drooping (facial palsy)
  • Tingling or shooting pain in the hands or feet
  • Short-term memory problems or difficulty concentrating

Stage 3 - Late persistent Lyme disease

Stage 3 can last from four months after infection to years later. At this point, the bacteria have spread to parts of your body like your nerves and joints. You can have the symptoms of stages 1 and 2, plus:

  • Lyme arthritis, which can affect large joints (often the knee)
  • Trouble concentrating (brain fog)
  • More widespread nerve damage (polyneuropathy)

How can you prevent Lyme disease?

The best way to not catch Lyme disease is to avoid being bitten by the infected ticks that spread it. Ticks carrying the bacteria live in places like wooded areas, grass, brush and leaf piles. Your pets can also carry them on their fur. 

t’s very important to be aware of ticks and careful about looking for them whenever you spend time in areas where you may be exposed.

It’s especially important to take precautions if you spend time outdoors in areas where black-legged ticks are prevalent. In the United States, that includes the entire West Coast, the East Coast from Maine to northeastern Virginia and several North-Central states, especially Wisconsin and Minnesota. Lyme disease may also be found in parts of Europe and southern Canada.

You can be bitten whenever the temperature is above freezing, but ticks are most active in late spring, summer and early fall.

These steps can help you prevent tick bites that cause Lyme disease:

  • Wear protective clothing, including long pants, long sleeves and closed-toe shoes or boots when hiking, gardening or doing outdoor activities in places where ticks are likely. Tuck your shirt into your pants and your pants into your socks. 
  • Wear light-colored clothing so it’s easier to see ticks.
  • Use insect repellents recommended by the Environmental Protection Agency (EPA).
  • Treat your clothing, shoes and gear with permethrin (an insecticide).
  • Avoid contact with high grass, leaves or bushes.
  • Walk in the center of trails.
  • Thoroughly check your clothing, gear, skin and pets for ticks after you’ve spent time outdoors. Ticks like warm, damp parts of your body such as the armpits, in and around the ears, inside the belly button, the backs of the knees, the scalp, between the legs and around the waist. Use a hand mirror to check your body thoroughly. 
  • Shower within two hours if there’s a risk you’ve been exposed to ticks.
  • Tumble dry your clothes on high heat for ten minutes if you find any ticks on them.
  • Check for ticks every day on pets that go outdoors. Talk to your veterinarian about tick control options for your pets.
  • Keep your outdoor space tidy. Ticks don’t survive for long in sunny areas.

What should you do if you’re bitten by a tick?

If you’re bitten by a tick, remember that most people who are bitten by ticks do not get Lyme disease. Removing it the right way can help lower the risk that you’ll get Lyme disease. In fact, ticks need to be attached to you for at least 24 hours to infect you. 

Here’s what to do to remove a tick from your body:

  1. Use fine-tipped tweezers to grasp the tick as close to the skin as possible.
  2. Pull upward with steady, even pressure. Don’t twist or jerk the tick since that can cause parts to break off and remain in the skin. If parts break off, try to remove them with tweezers. If you can’t, leave them alone and let the skin heal.
  3. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape or flushing it down the toilet. Don’t crush it with your fingers.
  4. After removing the tick, clean the bite area and your hands with rubbing alcohol or soap and water.

Don’t try covering a tick with petroleum jelly or nail polish or exposing it to heat to make it release its grip. These methods are designed to make the tick detach, but you don’t want to wait for that to happen. You want to get it off your skin as quickly as possible.

How is Lyme disease diagnosed?

If you think you might have Lyme disease or if you have a rash or fever within several weeks of removing a tick, see your health care provider. If you do have Lyme disease, it’s important to get diagnosed and treated quickly, so you can keep the disease from getting worse. 

Tell your doctor if you know you were bitten by a tick. However, most people who have Lyme disease don’t remember being bitten. You may not feel a bite from a young tick (called a nymph). They are only about the size of a pinhead, so they are hard to see.

Diagnosing Lyme disease can be difficult because there are many symptoms, and early test results can sometimes be inaccurate. Therefore, health care providers rely on many factors to make a diagnosis.

Your provider will check your symptoms, review your medical history and request blood tests that can detect antibodies against the Lyme bacteria. It can take several weeks for these antibodies to develop, so your test might not be positive for Lyme disease right away. You need to have two positive blood tests to be diagnosed with Lyme disease.

How Is Lyme disease treated?

In areas where Lyme disease is common, most primary care providers and pediatricians (children's doctor) can treat Lyme disease. In other areas, you may want to see an infectious disease specialist. 

The good news is that when Lyme disease is diagnosed early and treated with antibiotics, it’s curable. If you have Lyme disease, your doctor will probably prescribe a 10-day to four-week course of antibiotics (such as doxycycline, amoxicillin, cefuroxime or azithromycin) to get rid of the infection. You must take all your medication, even if you feel better. In severe cases of Lyme disease, you may need intravenous (IV) antibiotics. 

About 5% to 15% of people with Lyme disease have longer-term symptoms similar to fibromyalgia (unexplained pain throughout the body) or chronic fatigue syndrome, such as joint pain, headaches, fatigue and difficulty thinking. If these symptoms last for more than six months, it’s called post-treatment Lyme disease syndrome (PTLDS) or chronic Lyme disease. Scientists aren’t sure what causes it, but it could be an overreaction of your immune system.

These symptoms can improve over time, but it can take many months. There’s no medical treatment and taking more antibiotics doesn’t make a difference. However, it may help to:

  • Rest
  • Eat a healthy diet
  • Reduce stress
  • Keep in close communication with your health care providers, including an infectious disease specialist, rheumatologist (arthritis and inflammation doctor) and/or neurologist (nervous system doctor)

Where can you get more information?

Here are some places where you can find additional information about Lyme disease, connect with others and access support:

If you’re concerned about a tick bite, rash, fever or other symptoms that could be signs of Lyme disease, a health care provider can help.