If you live in a Lyme disease endemic area and have a classic bull’s-eye rash, or flulike symptoms after a tick bite, see your doctor right away. Early treatment with antibiotics, usually doxycycline or amoxicillin, cures most cases of Lyme disease.
Symptoms that persist after antibiotic treatment are unlikely to be caused by Lyme disease and may be due to other problems, such as fatigue or a vitamin deficiency.
Symptoms
The bacteria that cause Lyme disease are transmitted by blacklegged ticks, including deer ticks. Most cases occur in the spring and summer when deer ticks are most active. Symptoms can range from a flu-like illness to severe joint pain and swelling, particularly of the knees and other large joints. A characteristic rash called the “bull’s-eye” rash is seen in 70 to 90% of people with Lyme disease. It usually develops 3-30 days after the tick bite. The rash may appear as a circle or an oval with concentric rings, and it does not burn or itch. Other symptoms include fever, chills, headache, swollen lymph nodes, fatigue and muscle or joint pain. The rash is the most common sign of infection and can help make the diagnosis.
If a person with a suspected Lyme disease case has the classic rash and recent tick exposure in an endemic area, he or she can begin treatment without waiting for blood work to confirm the infection. However, most patients do not recall a tick bite or develop the rash and require additional testing.
Untreated Lyme disease can lead to more serious problems such as damage to the joints, heart and central nervous system. These problems, called late disseminated Lyme disease, can last for months or even years and have a devastating impact on a patient’s quality of life.
Most of the 30,000 reported cases of Lyme disease each year in the United States are caused by the bacteria B. burgdorferi. These are usually spread by immature ticks (nymphs) that feed on deer during the spring and summer. The nymphs are smaller than adult ticks and harder to see and remove. Boys up to age 15 and men between the ages of 40 and 60 are more likely to get infected with Lyme disease because they spend more time outdoors where ticks and deer live.
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The bacteria are most likely to be spread when a person goes outdoors in the early morning or at dusk and is bitten by an infected tick. This occurs most often in wooded or grassy areas, but the bacteria can be spread almost anywhere outside. A person can also be bitten by infected ticks indoors, although this is very uncommon.
Diagnosis
A person with Lyme disease has a fever and at least one of the following:
A slowly expanding red patch, sometimes with clear areas in the center (bull’s eye appearance) called erythema migrans. This rash typically occurs at the site of the tick bite. It usually lasts for several weeks and may enlarge to more than 7 inches in diameter. Often there are additional smaller red patches, which may appear at different sites.
If a rash does not develop or flu-like symptoms are present, a blood test for antibodies to the bacteria that cause Lyme disease can help identify the infection. A common laboratory test is the enzyme-linked immunoassay (ELISA) that detects antibodies to B. burgdorferi. A second-level test, the Western blot, confirms positive ELISA results. NIAID supports research to improve diagnostic methods for Lyme disease, and new tests are being evaluated.
When a person thinks they might have Lyme disease, they should see a GP or family doctor. They should describe the symptoms and where they might have been bitten by a tick. The GP may order a blood test for antibodies to B. burgdorferi, which can be done in many medical centers.
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Antibiotics are needed to treat Lyme disease, and the sooner they are started the better the chance of a full recovery. Symptoms can include headache, muscle aches and pains and fever. In some cases, the symptoms may not go away, even after antibiotics have been taken. These are called post-treatment Lyme disease syndrome.
A GP might give you a course of oral antibiotics, such as doxycycline or cefuroxime axetil. In more serious cases, a GP might refer you to hospital for treatment with antibiotics given directly into a vein (intravenous).
People who work or play in forests and grassy areas are most at risk of getting tick bites. Boys up to age 15 and men between the ages of 40 and 60 are more likely than others to be bitten by ticks, possibly because they spend more time outside. If a tick is found on the body, it should be removed with tweezers and disposed of properly. After the tick is removed, monitor the bite area and watch for a rash that develops.
Treatment
The bacteria that cause Lyme disease are destroyed by antibiotics, particularly doxycycline and amoxicillin. They are most effective when taken within three days of the tick bite, but can also be given orally. Antibiotic prophylaxis (preventing infection with antibiotics) is recommended for patients who live in endemic areas and have a confirmed tick bite, especially in children.
In the early stages, a rash called erythema migrans occurs at the site of the tick bite and usually consists of a circular pattern with concentric rings. The rash may expand and can be quite painful. Other symptoms include fever, chills, headache, fatigue, muscle aches, joint pain and stiffness, a feeling of being unwell, and some eye problems such as redness and tearing.
Most people who have this rash recover fully from the infection without further treatment. In rare cases, the infection can spread to the heart and nervous system. If these complications occur, it can lead to a more serious illness including meningitis and severe irregular heart rhythm (cardiac dysfunction).
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In this case, doctors will usually prescribe IV antibiotics followed by a course of oral antibiotics. They will also monitor patients for signs of a Jarisch-Herxheimer reaction, in which the body reacts to the antibiotics and causes inflammation and a flare-up of symptoms.
Other symptoms can be treated with NSAIDs, such as ibuprofen and naproxen. Pregnant women should not take doxycycline or other tetracyclines because they can affect the fetus. Nervous system symptoms, such as numbness and tingling, are often treated with gabapentin or clonidine. It is important to attend all of your doctor’s appointments so they can see how you are doing and determine if any changes are needed in your treatment.
Some patients who are unable to get rid of the rash, or whose rash has not completely cleared up, have what is called persistent Lyme disease syndrome (PLDS). NIAID has funded several placebo-controlled clinical trials to examine the effectiveness of prolonged antibiotic treatment for this condition, but these studies have not found that it improves patient self-reported symptoms such as fatigue and cognitive function.
Prevention
Ticks that spread Lyme disease bite people and other animals. The bacteria can also spread to the heart and joints and cause a rash that looks like a bull’s eye.
The best way to prevent Lyme disease is to avoid tick bites. It’s important to talk to your healthcare provider before going outside. They may recommend repellents with DEET, lemon oil or eucalyptus oil. You can also use clothing and gear treated with permethrin, a chemical that helps kill ticks. Ticks are more likely to be found in wooded and grassy areas, so wearing long pants and sleeves in these areas can help protect you. Tucking pant legs into boots or shoes can help too. You can also wear brightly colored clothes to help you spot ticks more easily.
It usually takes about 36 hours for a deer tick to attach and infect people with Lyme disease bacteria. To reduce the risk of infection, your healthcare provider may prescribe antibiotics for you. They’ll usually be taken orally, but they can also be given as a shot or infusion. If the antibiotics are started in the early stages of Lyme disease, they can prevent illness and decrease the number of symptoms.
Untreated, Lyme disease can cause severe headaches, arthritis, a painful rash that can make the center of the rash look like a bull’s-eye, and nerve problems including facial paralysis and an irregular heartbeat. It can also cause a fever, tiredness and other flu-like symptoms.
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Some people who get Lyme disease never develop a rash. But if the disease isn’t treated, symptoms can recur later in life and include joint pain, facial pain, muscle weakness, headaches, a feeling of being unwell, a stiff neck, and a feeling of tingling or numbness in the arms and legs. In some cases, the disease can spread to the nervous system and brain, causing a wide range of symptoms that can last for weeks, months or even years.
People who have been bitten by an infected tick should always check their bodies for ticks daily. They should also call their healthcare providers right away if they have a rash, fever or other symptoms. If a tick with the bacteria that cause Lyme disease is found, it should be removed immediately. It’s important not to burn, smother or crush the tick, because this can increase your risk of getting the bacteria into your bloodstream.
