Lyme Disease

What is Lyme disease?

Lyme disease is an infection caused by the bacteria Borrelia burgdorferi and Borrelia mayonii. The infection is primarily spread to humans by bites from infected deer ticks, also known as black-legged ticks. People bitten by an infected tick may develop an inflammatory condition, which first affects the skin and then may spread to the joints, nervous system, and other parts of the body.

The ticks that cause Lyme disease are tiny, about the size of the head of a pin or a speck of dirt. They can be found anywhere on the body but tend to attach themselves to areas such as the scalp and groin. Not everyone who finds these ticks on their body will be infected by Borrelia, and many who are bitten will not develop Lyme disease. This is because not every tick is infected and because it can take from 24 to 72 hours after a tick attaches to transmit the bacteria.

According to statistics available from the Centers for Disease Control and Prevention (CDC), more than 40,000 cases of Lyme disease are reported in the U.S. each year. Cases are mostly concentrated in the Northeast and upper Midwest. In 2015, about 95% of Lyme disease cases were reported from 14 states, but the CDC says that the areas with high incidence of Lyme disease appear to be expanding. (See the map on this CDC web page.) The vast majority of the cases occur in the spring and summer when people spend more time outside and the ticks are most active.

The CDC estimates that the actual number of people in the U.S. who are diagnosed with Lyme disease each year is roughly 10 times the number reported. The higher estimate of 400,000 cases annually is based on data from ongoing studies. This higher estimate does not mean that many Lyme disease cases go untreated, says the CDC, only that they may go unreported to state and federal public health laboratories. Low disease estimates from under-reporting can create an inaccurate picture of the scope of a public health problem such as this, especially when the incidence may be so much higher than previously thought. Better estimates obtained from the ongoing studies can help increase awareness of the issue, providing additional incentive for the general public, government, and medical community to focus on this disease and its prevention.

Post-Treatment Lyme Disease Syndrome
For some people with Lyme disease, symptoms of fatigue, pain, or joint and muscle aches persist even after treatment with antibiotics. For a small percentage of cases, these symptoms can last over 6 months. This is known as Post-Treatment Lyme Disease Syndrome (PTLDS). The exact cause of PTLDS is unknown. PTLDS is sometimes mistakenly referred to as chronic Lyme disease. Research is ongoing to better understand the cause of this syndrome. For more information, see the CDC web page on PTLDS.

About Lyme Disease

Signs and Symptoms
Lyme disease occurs in stages, with the early infection confined to the area around the tick bite and progressing to early disseminated and then to late Lyme disease.

Early signs and symptoms can develop from 3 to 30 days after the tick bite and may include:

Characteristic rash at the site of the tick bite: one of first symptoms is usually a rash that appears a few days to a month after the bite (the average is about 7 days). About 70% to 80% of people infected with Borrelia burgdorferi will develop the characteristic circular rash called erythema migrans. It typically spreads outward from the bite site and may eventually measure up to 12 inches (30 centimeters) or more across. It may resemble a "bulls-eye" and may feel warm to the touch but usually is not painful or itchy. Some people may develop multiple red rashes and others may not have, or remember having, a rash. Note that it is common to see a small bump or redness that develops soon after a tick bite that may look like a mosquito bite. However, this bump or redness generally goes away in one or two days and is not a sign of Lyme disease. (See Related Images for examples of erythema migrans.)

Headache

Fatigue

Fever and chills

Muscle and joint aches

Swollen lymph nodes

Borrelia mayonii seems to produce other symptoms, including nausea and vomiting, and may cause a rash that is more spread out (diffuse) and lacks the bull's eye target appearance.

If Lyme disease is left untreated, additional signs and symptoms may develop several days to months after a tick bite, including:

Muscle and joint pain (may be intermittent)

Facial weakness and paralysis (Bell's palsy)

Numbness and pain in arms and legs

Neck stiffness and severe headaches (meningitis)

Chest pain and irregular heart beat (rare)

Eye irritation, redness, pain, and blurred vision (rare)

Intermittent arthritis with joint pain and swelling, especially in larger joints like the knees

Memory loss, difficulty concentrating, and changes in sleep patterns

Spells of dizziness or shortness of breath

Shooting pains, numbness, or tingling in the hands or feet

Inflammation of the brain and/or spinal cord
Tests
A healthcare practitioner may diagnose Lyme disease if you:

Have signs and symptoms, such as the presence of an erythema migrans (EM) or "bull's-eye" rash

Have been bitten by a tick and/or live in or visited an area where Lyme disease is most commonly found

In cases where history and symptoms are sufficient to diagnose Lyme disease, a laboratory test is not usually ordered.

Lyme disease testing may be ordered when you have signs and symptoms that suggest you have the infection. The CDC does not recommend Lyme disease testing for people who do not have any symptoms.

The preferred test is a blood test to detect two classes of antibodies produced by the body in response to a Borrelia infection:

Borrelia IgM (immunoglobulin M) antibodies can usually be detected in the blood about two to three weeks after infection. IgM levels increase and then peak at about six weeks and then begin to decline.

IgG (immunoglobulin G) antibodies cannot be detected until several weeks after infection. Levels peak about four to six months later and may remain at high levels for several years.

The CDC recommends that two different methods be used to detect these antibodies and to confirm a diagnosis of Lyme disease.

The initial test may use methods such as an enzyme immunoassay (EIA) or immunofluorescence (IFA) method to measure Borrelia IgM and/or IgG antibodies. The initial test is intended to be very sensitive so that it will detect as many cases of Lyme disease as possible. However, it may be positive with infections caused by other bacteria similar to Borrelia, such as a different tick-borne disease or syphilis, or in other conditions such as an autoimmune disorder (e.g., lupus).

The CDC recommends that any positive or indeterminate results from an initial test be followed by a second test, called a Western blot that detects specific antibodies to multiple antigens, to confirm the initial findings.

If you have symptoms that suggest your central nervous system is affected (meningitis), then testing may be performed on a sample of cerebrospinal fluid (CSF).

In special cases, PCR (polymerase chain reaction) testing may be performed on a sample because it is a more sensitive way of detecting an infection with Borrelia. However, this is not an FDA cleared or approved test method and it is not widely available. The CDC does not currently recommend PCR testing for the diagnosis of Lyme disease.
Treatment
Lyme disease is usually treated with antibiotics taken by mouth for 2-4 weeks. Some people with severe infections may require antibiotics administered through a vein (intravenous). In most cases, those with Lyme disease recover rapidly and completely. In some cases, especially with late-stage Lyme disease, some joint pain and nerve damage may persist. For more on Lyme disease treatment, see this CDC web page.
Prevention
Currently, there is no vaccine available to prevent Lyme disease, but standard precautions to avoid exposure to ticks and tick bites can greatly reduce the risk of becoming infected. These include:

Wearing light-colored long-sleeved shirts and pants

Tucking pant legs into socks

Wearing closed shoes

Avoiding wooded and grassy areas, especially in spring and early summer, walking in the center of trails

Using a tick repellant that contains 20-30% DEET (N, N-diethyl-m-toluamide) or permethrin

Checking for ticks after spending time outside

Removing ticks as soon as they are found

Pets should also be routinely checked for ticks.

Related Images

View Sources

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