Understanding Lyme Disease*

Prevention and early treatment are key to stopping Lyme disease.

What Is Lyme Disease?

Lyme disease is caused by spiral-shaped bacteria called Borrelia burgdorferi. It is carried by infected deer ticks. A tick becomes infected by feeding on an animal that carries the bacteria. Infected ticks then transmit the disease to humans. The bacteria travel through the bloodstream, causing a number of symptoms, including fever, headache, stiff neck, body aches, and fatigue (Table 1^1-5). Once a tick attaches itself to the body, it feeds on the person’s blood. As it is feeding, the tick infects the person with Lyme disease bacteria. The tick must be attached to the body for 36 to 48 hours to transmit Lyme disease.

Symptoms of early Lyme disease usually begin 1 to 2 weeks after a tick bite (range: 3 to 30 days).⁶ For most, but not all, patients, the first symptom is a rash, which can start as a small red spot where the tick bite occurred and can take a range of shapes. Approximately 80% to 90% of patients with Lyme disease have the rash as the initial symptom, although some specialists believe the percentages are much lower.³ Sometimes the rash looks like a bull’s-eye, appearing as a red ring around a clear area with a red center. The rash is not painful or itchy and lasts about 3 to 5 weeks. As the infection spreads, rashes can appear at different sites on the body and grow larger. There are 3 stages of Lyme disease (see “Stages of Lyme Disease“^3,4,6-9).

How Is Lyme Disease Diagnosed?

Because symptoms may resemble other types of disorders such as ringworm infection and spider bites, laboratory tests are done to confirm that an individual has Lyme disease. If a person has a rash that resembles a bull’s-eye, the person is automatically diagnosed with Lyme disease and treatment is started.

Is Lyme Disease Contagious?

Lyme disease is rarely transmitted from person to person, although recent research confirms that person-to-person transmission can occur.¹ Ticks cannot jump or fly and do not drop from above onto passing animals. Animals acquire ticks only by direct contact. This is true for humans as well. If the tick is removed within 24 to 36 hours, the risk of being infected is low. To remove the tick, it should be grasped with fine-tipped tweezers at the head or mouthparts. Do not grasp the tick by the body. Remove the tick by gently pulling it straight out.^3,6

How Is Lyme Disease Treated?

Lyme disease is treated with antibiotics. Depending on the antibiotic selected, you may have to take medication for up to 21 days or longer. Even if your doctor is not sure you have Lyme disease, he or she may still prescribe antibiotics. Complete recovery from Lyme disease is extremely likely. If antibiotic therapy is started in the early stages of Lyme disease, recovery is more likely to occur within 1 to 2 weeks.⁸ When treatment is delayed, response to treatment may be slower, but most people will have a complete recovery.¹⁰ In these individuals, it may take weeks or months for the symptoms to go away. Up to 20% of patients do not recover, causing them to have relapsing debilitating symptoms.

Can I Do Anything to Prevent Lyme Disease?

Unfortunately, there is no vaccination against Lyme disease.¹ Online Table 2 lists several things you can do to prevent Lyme disease.

Table 2: Steps to Reduce Lyme Disease

• Wear long pants and long-sleeve shirts. Tuck shirts into pants and pant legs into socks to keep ticks on the surface of your clothing.
• Wear light-colored clothing. It makes it easier to spot ticks.
• Spray clothing with the repellent permethrin, which can be purchased in lawn and garden stores. Never apply permethrin directly to the skin.
• Spray exposed clothing and skin with a repellent containing 20% to 30% DEET to prevent tick bites. Children should not be exposed to products containing more than 10% DEET.
• Pregnant women should avoid areas known to have ticks. Lyme disease can be transmitted to the fetus.
• Keep long hair tied back.
• Avoid sitting on the ground.
• Avoid wooded areas and shady grasslands. Deer ticks are common in these areas.
• Clean your backyard, and remove yard litter that may attract deer and rodents.
• Once indoors, check for ticks, especially on the hairy areas of the body. Wash all clothing that was worn.
• Before letting pets indoors, check for ticks. Pets can also develop Lyme disease and should wear a tick prevention collar.

Where Can I Find More Information?

Useful and easy-to-understand information can be found at the National Library of Medicine (http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?query=lyme+disease&v%3Aproject=nlm-main-website).

Dr. Zanni is a psychologist and health-systems consultant based in Alexandria, Virginia.

*This online version includes information that has been updated since the printed version.

References

• Embers ME, Narasimhan S. Vaccination against Lyme disease: past, present, and future. Front Cell Infect Microbiol. 2013;3:6.
• Poland GA. Vaccines against Lyme disease: what happened and what lessons can we learn? Clin Infect Dis. 201;52(suppl 3):s253-s258.
• Murray TS, Shapiro ED. Lyme disease. Clin Lab Med. 2010;30:311-328.
• Meyerhoff J. Lyme disease. http://emedicine.medscape.com/article/330178-overview. Accessed December 21, 2013.
• Olena A. Understanding Lyme. The Scientist Magazine. December 1, 2013.
• Wright WF, Riedel DJ, Talwani R, Gilliam BL. Diagnosis and management of Lyme disease. Am Fam Physician. 2012;85:1086-1093.
• National Institute of Neurological Disorders and Stroke. Neurological complications of Lyme disease information page. www.ninds.nih.gov/disorders/lyme/lyme.htm. Accessed December 21, 2013.
• Krause P, Bicknstedt L. Lyme disease and the heart. Circulation. 2013;127:e451-e454.
• American Lyme Disease Foundation. Lyme disease. www.aldf.com/lyme.shtml. Accessed December 21, 2013.
• Mayo Clinic Staff. Lyme disease. www.mayoclinic.com/health/lyme-disease/DS00116. Accessed December 21, 2013.
• National Institute of Allergy and Infectious Diseases. A history of Lyme disease, symptoms, diagnosis, treatment. www.niaid.nih.gov/topics/lymedisease/understanding/pages/intro.aspx. Accessed December 21, 2013.