Lyme disease is a bacterial infection that is spread through the bite of one of several types of ticks.
Borreliosis; Bannwarth syndrome
Lyme disease is caused by bacteria called Borrelia burgdorferi (B. burgdorferi). Blacklegged ticks and other species of ticks can carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with B. burgdorferi. You can get the disease if you are bitten by an infected tick.
Lyme disease was first reported in the United States in 1977 in the town of Old Lyme, Connecticut. The same disease occurs in many parts of Europe and Asia. In the United States, most Lyme disease infections occur in the following areas:
There are 3 stages of Lyme disease.
Risk factors for Lyme disease include:
Important facts about tick bites and Lyme disease:
Symptoms of early localized Lyme disease (stage 1) begin days or weeks after infection. They are similar to the flu and may include:
There may be a "bull's eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can be large and expanding in size. This rash is called erythema migrans. Without treatment, it can last 4 weeks or longer.
Symptoms may come and go. Untreated, Lyme disease can spread to the brain, heart, and joints.
Symptoms of early disseminated Lyme disease (stage 2) may occur weeks to months after the tick bite, and may include:
Symptoms of late disseminated Lyme disease (stage 3) can occur months or years after the infection. The most common symptoms are muscle and joint pain. Other symptoms may include:
A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most commonly used is the ELISA for Lyme disease test. An immunoblot test is done to confirm ELISA results. Be aware, though, in the early stage of infection, blood tests may be normal.
In areas where Lyme disease is more common, your health care provider may be able to diagnose early disseminated Lyme disease (Stage 2) without doing any lab tests.
Other tests that may be done when the infection has spread include:
Persons bitten by a tick should be watched closely for at least 30 days to see if a rash or symptoms develop.
A single dose of the antibiotic doxycycline may be given to someone soon after being bitten by a tick, when all of these conditions are true:
A 10 day to 4-week course of antibiotics is used to treat people who are diagnosed with Lyme disease, depending on the choice of drug:
Pain medicines, such as ibuprofen, are sometimes prescribed for joint stiffness.
If diagnosed in the early stages, Lyme disease can be cured with antibiotics. Without treatment, complications involving the joints, heart, and nervous system can occur. But these symptoms are still treatable and curable.
In rare cases, a person keeps having symptoms that interfere with daily life after they have been treated with antibiotics. This is also known as post-Lyme disease syndrome. The cause of this syndrome is unknown.
Symptoms that occur after antibiotics are stopped may not be signs of active infection and may not respond to antibiotic treatment.
Stage 3, or late disseminated, Lyme disease can cause long-term joint inflammation (Lyme arthritis) and heart rhythm problems. Brain and nervous system problems are also possible, and may include:
Call your health care provider if you have:
Take precautions to avoid tick bites. Be extra careful during warmer months. When possible, avoid walking or hiking in the woods and areas with high grass.
If you do walk or hike in these areas, take measures to prevent tick bites:
If a tick is attached to you, follow these steps to remove it:
Bhate C. Lyme disease: part II. Management and prevention. J Am Acad Dermatol. 2011;64:639-653.
Centers for Disease Control. Lyme disease. Page last updated November 15, 2013. Available at: http://www.cdc.gov/lyme. Accessed February 25, 2014.
Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91-102.
Steere AC. Borrelia burgdorferi (lyme disease, lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 242.
Wright WF. Diagnosis and management of Lyme disease. Am Fam Physician. 2012;85:1086-1093.