Lyme disease

Reviewed by Jessica Muñoz, Jessica Muñoz is a registered nurse and educator with 20 years of experience in critical care emergency nursing, specializing in patient care, education, and evidence-based practice. She holds multiple certifications and serves as a Patient Safety Coordinator.

Lyme disease stands as the most prevalent vector-borne illness in the United States. It stems from infection by the bacteria Borrelia burgdorferi or, in rare cases, Borrelia mayonii. This ailment is conveyed to humans through bites from infected black-legged ticks. Typical symptoms include headaches, fatigue, fever, and a distinctive skin rash called erythema migrans. Left untreated, the infection can disseminate to the heart, joints, and nervous system.

Lyme disease diagnosis commonly relies on symptomatology, physical examination such as the presence of rash, and potential exposure to infected ticks. Accurate diagnosis is achieved through laboratory tests utilizing validated techniques. Typically, treatment with antibiotics leads to complete recovery within a few weeks. Prevention strategies involve applying pesticides, using insect repellents, prompt tick removal, and minimizing tick habitats. It’s worth noting that the ticks responsible for transmitting Lyme disease may also transmit other tick-borne illnesses.

Signs and symptoms

Lyme disease, if left untreated, can produce wide-ranging signs and symptoms, based on the stage of infection. The symptoms can include rash, fever, arthritis, and facial paralysis.

If Lyme disease goes untreated, it can manifest a variety of symptoms that vary depending on the stage of infection. These symptoms may include rash, fever, arthritis, and facial paralysis.

Early signs and symptoms of Lyme disease may include fatigue:

• Fever, chills, headache, joint and muscle aches, and swollen lymph nodes, mainly if no rash is present.
• The characteristic erythema migrans (EM) rash typically develops at the site of a tick bite within 3 to 30 days, with an average onset of 7 days.
• This rash can appear anywhere on the body and is observed in approximately 70 to 80% of individuals affected by a tick bite.
• It expands slowly over several days and can reach sizes of up to 30 cm or more. Although it feels warm to the touch, it is often not painful or itchy. It may take on a target or “bulls-eye” appearance as it enlarges, though this is not always true.

Later signs and symptoms

• Facial palsy (loss of droop or muscle tone on one or both sides of the face)
• Severe headaches and neck stiffness
• Additional erythema migrans rashes on other areas of the body
• Arthritis with swelling and severe joint pains, especially in the knees and other large joints.
• Lyme carditis - heart palpitations or an arrythmia.
• Episodes of dizziness or shortness of breath.
• Severe pain in muscles, joints, tendons, and bones.
  • Pain in the nervous system
  • Numbness, tingling in the feet or hands, stabbing pain
  • Inflammation of the spinal cord and brain

Transmission

Ticks carrying the bacterium B. burgdorferi can attach themselves to any body region, often preferring concealed areas like the armpits, scalp, and groin. An infected tick takes at least 36 hours to transmit the bacterium into the body.

Many Lyme disease cases stem from bites by nymph ticks, which are immature and difficult to detect due to their small size. Nymph ticks typically feed during the warmer months of summer and spring. While adult ticks can also transmit the bacteria, they are more easily spotted and removed before they can cause infection.

Risk factors

Living or vacationing in specific regions can heighten the risk of contracting Lyme disease, as can certain professions and outdoor activities. Common risk factors for Lyme disease include:

• Spending extended periods in grassy or wooded areas, particularly in the heavily wooded regions of the Midwest and Northeast, where deer ticks are prevalent. Students and children who frequently engage in outdoor activities in these areas face elevated risks.
• Having exposed skin increases the likelihood of ticks attaching themselves. To mitigate this risk, wearing long sleeves and pants when in tick-prone areas is advisable. Adults working outdoors in tall grass or weeds and their pets are also at increased risk.
• Improper or delayed removal of ticks can lead to Lyme disease transmission. If a tick remains attached for 36 to 48 hours or more, bacteria from the bite can enter the bloodstream. Prompt removal within two days significantly reduces the risk of infection.

Prevention

Avoiding areas where deer ticks thrive, particularly densely wooded regions with tall grass is the most effective means of preventing Lyme disease. Additionally, simple precautions can significantly reduce the risk:

• Cover up: When working outdoors in wooded or grassy areas, wear long shoes, a long-sleeved shirt, pants tucked into socks, gloves, and a hat. Steer clear of low bushes and long grass, sticking to designated trails. Keep pets on leashes.
• Use insect repellent: Apply insect repellent containing at least 20% DEET to exposed skin. Ensure children are similarly protected, avoiding contact with eyes, mouth, and hands. Exercise caution with chemical repellents and follow instructions diligently. Consider treating clothing with permethrin or purchasing pretreated garments.
• Tick-proof your surroundings: Clear away foliage and debris where ticks may reside. Regularly mow lawns to eliminate ticks in grass. Stack wood in sunny, dry areas to deter tick-carrying rodents.
• Check for ticks: After spending time in grassy or wooded areas, thoroughly inspect yourself, children, pets, and clothing for ticks. Deer ticks can be minuscule and may require careful examination.
• Shower promptly: Upon returning home, shower to remove any ticks lingering on the skin. Using a rough washcloth may help dislodge ticks that are not yet attached.
• Be vigilant: Even with a robust immune system, Lyme disease can recur. Remove ticks promptly with tweezers, grasping near the mouth or head and pulling steadily. Avoid ticks by flushing them down the toilet or placing them in alcohol. Apply antiseptic to the bite area.

Diagnosis

A healthcare professional will conduct a physical examination to identify any symptoms or rashes indicative of Lyme disease.

Testing may not be conducted during early and localized infection.

Several weeks after initial infection, blood tests become valuable as antibodies appear in the bloodstream. The healthcare provider may recommend the following tests:

• ELISA: Used to detect antibodies against B. burgdorferi.
• Western blot: Confirms a positive ELISA test by detecting antibodies to specific B. burgdorferi proteins.
• Polymerase chain reaction (PCR): This test is used to assess individuals for persistent Lyme arthritis or symptoms affecting the nervous system. It is conducted on cerebrospinal or joint fluid (CSF). Although PCR tests on CSF for Lyme disease detection are not frequently recommended due to low sensitivity, a negative result does not rule out Lyme disease. Conversely, most individuals exhibit positive PCR results in joint fluid prior to antibiotic therapy.

Treatment

Lyme disease is typically treated using antibiotics, with earlier initiation of treatment leading to smoother recovery.

Oral antibiotics are the primary treatment for early-stage Lyme disease. Doxycycline is commonly prescribed for adults and children over eight years old, while amoxicillin or cefuroxime is recommended for younger children, adults, and pregnant or breastfeeding women.

Treatment durations typically range from 10 to 21 days, with shorter courses proving equally effective in some cases.

In cases where the disease spreads to the central nervous system, intravenous antibiotics may be administered for 14 to 28 days. While effective in eliminating infection, complete recovery may take time.

It’s important to note that intravenous antibiotics can lead to various side effects, including mild to severe diarrhea, decreased white blood cell count, or infection with antibiotic-resistant organisms unrelated to Lyme disease.

Some individuals may experience lingering symptoms after treatment, known as post-treatment Lyme disease syndrome (PTLDS). The cause of these symptoms is not fully understood, and further research is needed to explore potential autoimmune responses.

While some experts speculate that certain individuals may be predisposed to autoimmune reactions following Lyme disease, additional investigation is required to clarify this relationship.

Work cited

• Lyme Disease, 2022. Centers for Disease Control.Lyme Disease , CDC
• Lyme Disease, 2023. Mayoclinic.org. Lyme disease - symptoms and causes - Mayo Clinic
• Everything You Need to Know About Lyme Disease, 2024. Healthline.com. Lyme Disease: Symptoms, Treatment, and Prevention