Lyme disease, which results from the bites of specific types of ticks,
causes a skin rash in its early stage as well as infection in joints,
nervous system and other organs in later stages. When diagnosed and treated
early, symptoms usually resolve quickly. Individuals with later stages
of infection are more likely to experience lingering symptoms such as
fatigue, poor sleep, and muscle and joint pain.
Fast Facts
What lyme disease is
 |
| The erythema migrans rash starts as a small red mark and,
over subsequent days, gradually enlarges in diameter to at least
two inches and sometimes as large as 10 or more inches. |
|
Lyme disease is an infection caused by Borrelia burgdorferi which
belongs to the spirochete family of bacteria. This bacterium lives inside
certain ticks (the deer tick in the Northeast and Upper Midwest) and can
be spread to humans by the bite of an infected tick.
In its early localized stage, Lyme disease consists
of a skin rash, called erythema migrans, that appears at the tick bite
site from three days to several weeks later. This rash, starts as a small
red mark and, over subsequent days, gradually enlarges in diameter to
at least two inches and sometimes as large as 10 or more inches.
If the rash goes unnoticed and untreated, or does not occur (as is the
case approximately 10-25 percent of the time), the bacterium may spread
through the bloodstream to the rest of the body initiating an early
disseminated stage of infection which occurs in the weeks following
the tick bite. At this point, the infected person may develop an array
of signs and symptoms including multiple skin rashes, fever, joint pain,
muscle pain, and headaches. Infection in about five percent of individuals
will involve the heart, causing a temporary blockage of the normal heart
rhythm. In approximately 20 percent of cases, the infection will affect
the nervous system resulting in severe headache and stiff neck, paralysis
of the muscles of the face or painful inflammation of nerves. Still other
individuals will have no symptoms at all.
If Lyme disease goes unrecognized or untreated with the appropriate antibiotic
course, late stage infection may occur months to even
years after the onset of infection, and can affect the joints or nervous
system.
Lyme arthritis (late stage) causes swelling of one or both knees and,
less often, can affect other, predominantly large, joints of the body.
Late infection of the nervous system may also occur, however, the clinical
manifestations and treatment have been less well defined and agreed upon.
Peripheral nerves may be affected, leading to numbness or tingling or
less often weakness. Infection of the brain may lead to difficulty
with sleep pattern, memory and concentration.
What causes lyme disease
Lyme disease is caused by the transmission of Borrelia
burgdorferi bacteria living inside of infected ticks. These
ticks can be so small (the size of a poppy seed) as to go unnoticed,
feeding at the site of attachment to the skin for several days before
dislodging. The Lyme bacteria, which resides in the tick gut, travels
to the mouthpart and is injected into the skin.
In the United States, Lyme disease is endemic in
most of the Northeast, the upper Midwest and, to a lesser degree, in
California and the Pacific Northwest region. The illness is named after
the town of Old Lyme, Connecticut where the first cases of Lyme disease
were recognized in 1975.
Other tick-borne infections may resemble a “rashless” Lyme disease,
and may even occur together with lyme disease (coinfection). These
also require prompt medical attention for proper diagnosis and treatment.
Who gets Lyme disease
People most at risk for Lyme disease are those who live or spend leisure
time in areas with a high density of infected ticks. In the Northeast and
Upper Midwest regions, there is a sharp peak of infection in the late spring
and early summer months when the tiny nymphal form of the tick is feeding.
A second smaller peak of Lyme disease occurs in the fall when the adult
tick feeds. In comparison, the risk of tick bites are lower during the late
summer after the nymphal ticks have all become inactive and molted, and
in the winter when cold and snowfall render the adult ticks temporarily
dormant.
How Lyme disease is diagnosed
To optimize diagnostic accuracy, the Centers for Disease Control has
recommended a two-step approach that uses an ELISA blood test to look
for evidence of particular antibodies in the immune system's response
to the infection followed by a second test (Western blot) to confirm a
borderline or positive results.
In certain circumstances, a person who does not have Lyme disease may
have a false positive on a blood test or someone who has Lyme disease
may register a false negative (this occurs commonly in the early weeks
of the infection or more rarely later). Therefore, lab testing should
be used only when patients show possible symptoms of the disease.
How Lyme disease is treated
In the majority of cases, early stage Lyme disease is treated successfully
with two-three week courses of oral antibiotics. Early infection involving
the nervous system or heart may require intravenous antibiotics.
Even when the infection is detected after significant delay or at its
later stages, antibiotic treatment is still successful in most patients.
However, some patients will have lingering symptoms following treatment.
General measures of good health such as exercise, good nutrition, and
recognition and treatment of any emotional problems that may coexist or
develop as a result of prolonged illness also are important adjuncts to
treatment.
Living with Lyme disease/broader health impacts
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| Physician follow-up is also strongly recommended in the treatment
of Lyme disease. |
|
When Lyme disease is diagnosed and treated early, the symptoms most often
resolve quickly. Individuals with early stage Lyme disease who remain
undiagnosed for extended periods of weeks to months or those who have
late stage infection of the nervous system are more likely to have a variety
of lingering symptoms such as fatigue, poor sleep, and muscle and joint
pain even after treatment.
In these cases, proper rest and pacing of activities, and adjustment
of schedule and expectations, followed by a gradual return to normal activity
level is advised. Physician follow-up is also strongly recommended.
Further treatment with antibiotics should be reserved for the rare case
in which ongoing active infection is demonstrated.
Prevention
Ticks do not jump and must brush onto an individual after direct contact.
Ticks also are susceptible to drying out and prefer sheltered environments.
Vaccination is not presently available against Lyme disease. Therefore
the risk of Lyme disease can be significantly reduced by taking appropriate
precautions:
• Avoid habitats such as tall grass, leaf-covered ground,
and brush.
• Stick to open pathways, cut grass or sand environments which
carry a much lower risk of tick exposure.
• Wear light colored clothing for early detection of ticks
and tuck the hems of long pants into socks when feasible to block skin
access.
• Conduct tick checks regularly, particularly in tick habitats.
If a tick is found, removing it with a fine-tipped tweezers within 24-36
hours of tick attachment usually will prevent disease transmission. If
a tick is found and the duration of attachment is likely to be greater
than 24-36 hours or is unknown, it is advised that you consult with your
physician.
Points to Remember
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Blood tests may be negative in the first weeks of infection.
Therefore early stage Lyme disease should be diagnosed and
treated based on an individual's exposure risk and the presence of
typical signs of symptoms.
-
Other tick-borne infections may resemble
a “rashless” Lyme
disease. These also require prompt medical attention for proper
diagnosis and treatment.
-
Vaccination is not presently available against Lyme
disease.
To find a rheumatologist
For more information about rheumatologists, click
here.
For a listing of rheumatologists in your area, click
here.
For more information
The American College of Rheumatology has compiled this list to give you
a starting point for your own additional research. The ACR does not endorse
or maintain these Web sites, and is not responsible for any information
or claims provided on them. It is always best to talk with your rheumatologist
for more information and before making any decisions about your care.
The American Lyme Disease Foundation has an informative website about
Lyme disease and other tick-borne infections at www.aldf.com or
can be reached by calling 800-876-LYME.
Updated May 2005
By Robert Kalish, MD, and reviewed by the American College of Rheumatology.
