Lyme disease

From the Center for Disease Control and Prevention (CDC)

Lyme disease is caused by the bacterium Borrelia burgdorferi and istransmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosedbased on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.  Laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to preventLyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases as well.

Signs and symptoms

Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These include fever, rash, facial paralysis, and arthritis.  Seek medical attention if you observe any of these symptoms and have had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.

lyme-symptoms

Early Signs and Symptoms (3 to 30 days after tick bite)

  • Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes
  • Erythema migrans (EM) rash:
    • Occurs in approximately 70 to 80 percent of infected persons
    • Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)
    • Expands gradually over a period of days reaching up to 12 inches or more (30 cm) across
    • May feel warm to the touch but is rarely itchy or painful
    • Sometimes clears as it enlarges, resulting in a target or “bull’s-eye” appearance
    • May appear on any area of the body
    • See examples of EM rashes

Later Signs and Symptoms (days to months after tick bite)

  • Severe headaches and neck stiffness
  • Additional EM rashes on other areas of the body
  • Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
  • Facial palsy (loss of muscle tone or droop on one or both sides of the face)
  • Intermittent pain in tendons, muscles, joints, and bones
  • Heart palpitations or an irregular heart beat (Lyme carditis)
  • Episodes of dizziness or shortness of breath
  • Inflammation of the brain and spinal cord
  • Nerve pain
  • Shooting pains, numbness, or tingling in the hands or feet
  • Problems with short-term memory

Additional notes:

  • Fever and other general symptoms may occur in the absence of rash.
  • A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite, is common. This irritation generally goes away in 1-2 days and is not a sign of Lyme disease.
  • A rash with a very similar appearance to EM occurs with Southern Tick-associated Rash Illness (STARI), but is not Lyme disease
  • Ticks can spread other organismsthat may cause a different type of rash.

Treatment

Patients treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. Patients with certain neurological or cardiac forms of illness may require intravenous treatment with drugs such as ceftriaxone or penicillin.

For detailed recommendations on treatment, consult the 2006 Guidelines for treatment developed by the Infectious Diseases Society of America.

In a small percentage of cases, these symptoms can last for more than 6 months. Although sometimes called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme Disease Syndrome” (PTLDS). The National Institutes of Health (NIH) has funded several studies on the treatment of Lyme disease which show that most patients recover when treated with a few weeks of antibiotics taken by mouth. For details on research into what is sometimes referred to as “chronic Lyme disease” and long-term treatment trials sponsored by NIH, visit the NIH Lyme Disease web site.

Removing a tick

If you find a tick attached to your skin, there’s no need to panic. Several tick removal devices are available on the market, but a plain set of fine-tipped tweezers will remove a tick effectively.

How to remove a tick

  1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

tick-removal

Follow-up

If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick.

Helpful hint
Avoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–do not wait for it to detach.

Testing of ticks

People who have removed a tick often wonder if they should have it tested. Some state or local health departments offer tick identification and testing as a community service or for research purposes (such as evaluating infection rates among ticks in an area). Check with your health department; the phone number is usually found in the government pages of the telephone book or online.

In general, testing of individual ticks is not useful because:

  • If the test shows that the tick contained disease-causing organisms, that does not necessarily mean that you have been infected.
  • If you have been infected, you will probably develop symptoms before results of the tick test are available. You should not wait for tick testing results before beginning appropriate treatment.
  • Negative results can lead to false assurance. For example, you may have been unknowingly bitten by a different tick that was infected.

However, you may want to learn to identify various ticks. Different ticks live in different parts of the country and transmit different diseases. For your own peace of mind, you can save a tick that you have removed from yourself and have it tested later, if you wish. Just tape it to a piece of paper or put it in a small container.

Post-treatment Lyme Disease syndrome

It is not uncommon for patients treated for Lyme disease with a recommended 2 to 4 week course of antibiotics to have lingering symptoms of fatigue, pain, or joint and muscle aches at the time they finish treatment. In a small percentage of cases, these symptoms can last for more than 6 months. Although sometimes called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme Disease Syndrome” (PTLDS).

The exact cause of PTLDS is not yet known. Most medical experts believe that the lingering symptoms are the result of residual damage to tissues and the immune system that occurred during the infection. Similar complications and “auto–immune” responses are known to occur following other infections, including Campylobacter (Guillain-Barre syndrome), Chlamydia (Reiter’s syndrome), and Strep throat (rheumatic heart disease). In contrast, some health care providers tell patients that these symptoms reflect persistent infection with Borrelia burgdorferi. Recent animal studies have given rise to questions that require further research. Clinical studies are ongoing to determine the cause of PTLDS in humans.

Regardless of the cause of PTLDS, studies have not shown that patients who received prolonged courses of antibiotics do better in the long run than patients treated with placebo. Furthermore, long-term antibiotic treatment for Lyme disease has been associated with serious complications. The good news is that patients with PTLDS almost always get better with time; the bad news is that it can take months to feel completely well.

If you have been treated for Lyme disease and still feel unwell, see your doctor to discuss how to relieve your suffering. Your doctor may want to treat you in ways similar to patients who have fibromyalgia or chronic fatigue syndrome. This does not mean that your doctor is dismissing your pain or saying that you have these conditions. It simply means that the doctor is trying to help you cope with your symptoms using the best tools available.

It is normal to feel overwhelmed by your ongoing symptoms. Some things that may help you manage your PTLDS include:

  • Check with your doctor to make sure that Lyme disease is not the only thing affecting your health.
  • Become well-informed. A lot of inaccurate information is available, especially on the internet. Learn how to sort through this maze.
  • Track your symptoms. It can be helpful to keep a diary of your symptoms, sleep patterns, diet, and exercise to see how these influence your well-being.
  • Maintain a healthy diet and get plenty of rest.
  • Share your feelings. If your family and friends can’t provide the support you need, talk with a counselor who can help you find ways of managing your life during this difficult time. As with any illness, Lyme disease can affect you and your loved ones. It doesn’t mean that your symptoms are not real. It means that you are a human being who needs extra support in a time of need.
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