Lyme Disease

What is it and How is it Contracted?

Lyme disease is an infection transmitted through the bite of an infected deer tick. Lyme disease results when the bacteria from a tick infected with a spirochete form of bacterium, known as Borrelia burgdorferi, enters the blood stream and begins to invade other body tissues. In addition to deer, the tick also can be found on some birds and rodents.

Lyme disease is most often contracted in the late spring and early summer months when outdoor activities are beginning to peak. During the fall season, hikers and hunters are at increased risk for contracting Lyme disease.

In spring the tick is in the nymph stage, which is considerably smaller than an adult tick. It is very easy to have been bitten and infected by the nymph without ever knowing it. In general, the tick needs to be attached to someone at least 36 hours to transmit the infection.

The bacteria that cause Lyme disease are named after the discoverer, Willy Burgdorfder, Ph.D. The first case of Lyme disease in the United States was diagnosed in 1975 when a cluster of children in Lyme, Conn., developed a peculiar form of arthritis. More than 157,000 cases have been reported to health authorities in the U.S. since 1982, when a systematic national surveillance started.

Where is Lyme disease most prevalent?

In 2002, 23,763 cases of Lyme disease were reported to the CDC. Ninety-five percent of these cases were from Connecticut, Delaware, Rhode Island, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Hampshire, New York, Pennsylvania and Wisconsin. Children ages 5 to 14 and adults 40 and older have the highest incidence rates, according to the CDC.

The prevalence of Lyme disease in the northeast regions of the United States is due to the presence of large numbers of the deer ticks’ preferred hosts, which include white-footed mice and deer, and their close proximity to humans. At greatest risk are people in endemic areas who visit grassy, wooded locations inhabited by white-tailed deer and mice in the Northeast and upper Midwest states and along the Northern Pacific coast of California.

What are symptoms and signs?

The early symptoms associated with Lyme disease are often overlooked. They include fever, fatigue, headache, body aches and joint pain. Between 80 percent to 90 percent of persons infected with Lyme disease will also notice an expanding characteristic rash called erythema Chronicum migrans.

This rash, which may take on a bull’s eye appearance, can appear as early as three days or as late as 30 days after exposure. It most often (but not always) appears at the site of the tick bite and can range in size from a few centimeters to the entire diameter of a person’s back. Some people will present with a rash on more than one region of the body.

Left untreated, Lyme disease spirochetes will invade other body systems and may cause more severe and potentially debilitating symptoms. Advanced symptoms of Lyme disease include arthritic complications (hot, painful, swollen joints), neurological complications (headache, dizziness, mental confusion, numbness and paralysis), and cardiac complications (chest pain, palpitations or shortness of breath).

How is the diagnosis of Lyme disease made?

Making a definitive diagnosis of Lyme disease can be difficult because the bacteria responsible for Lyme disease are difficult to isolate or culture from body tissues and fluids. Physicians who suspect Lyme disease may order a blood test, called an ELISA test, to look for the presence of antibodies against Borrelia burgdorferi in the patient’s blood. Another blood test called Western blot analysis is used to confirm whether the initial ELISA test is truly positive (so-called 2 tier testing). A new rapid test has been approved called PreVue B. It can be done in one hour at the doctor’s office, but many physicians, especially those in states with little Lyme disease, may not have the test available. Positive PreVue B tests need to be confirmed by standard ELISA and Western immunoblot. As many as 20 percent to 30 percent of patients with early Lyme disease may get a negative rapid test result, despite having the disease. Antibody levels may be too low to detect the disease in a patient’s blood during the first few weeks following infection. If a patient’s blood tests are negative and the physician still suspects Lyme disease, the tests can be repeated in two to four weeks.

Many times physicians will rely on patient history and symptoms when deciding whether to treat a patient for Lyme disease. In fact, if a physician decides the clinical history and rash are typical for Lyme disease, blood testing is unnecessary. Recent travel to an area where Lyme disease is more common is a very important piece of information; so make sure to tell your doctor if you have been on vacation, camping or hiking, particularly if it was in the Northeastern United States. The diagnosis of Lyme disease may be made by exclusion, meaning that other possible causes of the illness can been ruled out. Remember that because the tick usually infects humans when it is very young and very small, most patients with Lyme disease will not recall having had a tick bite.

If you believe that you may be infected with Lyme disease, you should seek medical care at once. Keep in mind that in regions where Lyme disease is not common, any neurologic, arthritic or cardiac problems are most likely the result of something besides Lyme disease, especially if the characteristic rash never appeared. Once suspected, however, the sooner that treatment is initiated following infection, the quicker and more complete the recovery will be.

How to Treat?

When treated in its earliest stage (the first few weeks after infection), Lyme disease is almost always completely curable. Oral antibiotics for two to four weeks are very effective in fighting the first stage of Lyme disease. Doxycycline and amoxicillin are the two most commonly prescribed antibiotics. Ceftin®, Zithromax® or other drugs related to these may also be used.

Late stage (or chronic) Lyme disease occurs when patients either never received antibiotics during the early stage of the disease or whose treatment did not kill all of the bacteria that causes the disease. Chronic Lyme disease is not as easily treated as first stage (early) Lyme disease and may require intravenous antibiotics for at least two weeks, depending on the severity of the illness. The nature of chronic Lyme disease (also referred to as post-Lyme syndrome) has caused debate among some doctors and patients. Many patients with persistent symptoms of fatigue and muscle aches after treatment think this condition comes from recurring active infection, although studies of patients treated with adequate amounts of antibiotics have not proven this. However, the original infection can recur when treatment is too brief, doses are too low, inappropriate antibiotics are prescribed or the patient doesn’t comply with treatment. Studies suggest relapsing symptoms in adequately treated patients may be the result of tissue damage caused by the original infection, rather than the actual disease persisting.

Treatment for chronic Lyme disease is tailored to the patient’s individual symptoms and manifestations of the disease. However, most patients with an advanced form of Lyme disease, even those with arthritis, will recover with standard treatment.

Infection with the Lyme disease bacterium unfortunately does not provide make you immune to future infections. Lyme disease can occur more than once if someone is re-infected with the Lyme disease bacterium.

How to Prevent?

Avoid tick-infested areas.

  • Wooded, bushy, grassy areas are more likely to harbor ticks, especially in the months of May, June and July.
  • Cutting and clearing of brush and tall grass around houses and gardens may help to lower the tick population.
  • Chemical insecticides containing DEET can help to control ticks. Spring and fall applications are best.

Provide personal protection when engaging in outdoor activities.

  • Wear light-colored clothing so that ticks can be easily spotted.
  • When camping, hiking or working outdoors, wear long-sleeved shirts and closed-toe shoes. Tuck your pants legs into socks or boots, and tuck shirts into trousers. Keep long hair tied back and wear a hat.
  • Apply insect repellent containing DEET to outerwear before venturing into tick-infested regions.
  • Walk in the center of trails when hiking to avoid overgrown grass and trees.

Inspect yourself, children and pets daily after outdoor activities.

  • Recent studies suggest that an infected tick must be attached to a person’s skin for at least 36 to 48 hours to transmit Lyme disease. The sooner that a tick can be removed, the greater the chance for avoiding Lyme disease.
  • Remove clothing and shower as soon as possible after coming indoors. Since ticks take several hours to attach themselves to the skin, they can be washed away if noted early.
  • Ticks may be as small as a pinhead. When performing inspections, pay close attention to the groin, armpits, neck and scalp.
  • Pets should be checked before entering the house because they, too, can carry ticks into the house. Pets also can develop symptoms of Lyme disease.

What Is the Best Way to Remove a Tick?

Using a pair of fine-tipped tweezers, grasp the tick as close to the skin as possible and pull it straight out until it releases its hold on the skin. To reduce the chance of contact with the bacterium, try not to crush the tick’s body. After removing the tick, thoroughly cleanse the bite area with soap and water.

Don’t use mineral oil or Vaseline to remove a tick because this may cause the tick to inject bacteria into the skin. Remember, if you remove a tick before it is attached for more than 48 hours, you can greatly reduce the chance of contracting Lyme disease.

Lyme Disease Risk Quiz

Answer the following questions to determine if you are at increased risk for developing Lyme disease.

  1. Do you live near or otherwise frequent wooded, grassy regions?
  2. Do you have pets that go outdoors?
  3. Do your hobbies include hiking, camping, gardening or other activities where a lot of time is spent in the outdoors?
  4. Do you work outside?
  5. Do you live or vacation in the eastern and upper mid-western regions of the United States?
  6. Is your property cluttered with leaf litter, brush or woodpiles?

If you answered yes to any of the above questions, you could be at increased risk for contracting Lyme disease. Click below to learn more about Lyme disease and find out how you can reduce your risk of getting it.