Lyme disease is a bacterial (Borrelia burgdoferi) infection transmitted to humans through the bite of an infected black-legged tick, most commonly the deer tick. Because they are so small (about the size of a pin head), they often go unnoticed on the body. In order for Lyme disease to be transmitted, they must be attached for 72 hours or more. However, approximately 50% of patients with Lyme disease do not recall an exposure to a tick bite.

It is important to recognize the signs and symptoms:

What are the signs and symptoms of Lyme disease?

3-30 days after the tick bite:

  • Erythema migrans (EM) rash: this begins usually within 7 days of a tick bite and gradually expands over days, reaching a size of up to 12 inches. Approximately 70-80% of patients will develop this rash. It clears as it enlarges, forming the typical “bull’s eye” appearance. It can appear on any area of the body.
  • Fever
  • Chills
  • Headache
  • Fatigue
  • Myalgias
  • Arthralgias
  • Enlarged lymph nodes

Days to months after the tick bite (later manifestations):

  • Severe headache and neck stiffness
  • Other rashes
  • Arthritis, particularly the knees and large joints
  • Facial palsy
  • Pains in tendons, muscles, joints, bones
  • Palpitations or irregular heart rhythm (Lyme carditis)
  • Dizziness
  • Dyspnea
  • Brain or spinal cord inflammation
  • Nerve pain
  • Neuropathy
  • Short-term memory loss

Lyme disease has been reported on 49 states, excluding Hawaii but 96% of cases are reported in 14 states. It is most common in the New England, Mid, Atlantic, and Mid West states.

While Lyme disease may sound like a scary disease, steps can be taken to prevent it:

  • Protective clothing: Ticks are more common in wooded or rural settings. When outdoors in these areas, closed toed shoes should be worn and pant legs tucked into socks. Also, hats, long-sleeved shirts, and gloves should also be donned.
  • Stick to trails and avoid walking through tall grasses or bushes. Ticks tend to be fond of leaf debris and avoid leaf piles.
  • Keep your dog on a leash.
  • Apply insect repellant with at least 20% DEET to your skin. Parents should apply it to their child’s skin avoiding the hands, eyes and mouth. Follow directions carefully as these products can be toxic. Permetherin products can be applied to clothes or pretreated clothes can be purchased.
  • Tick-proof your yard. Remove leaves and brush where ticks may live. Woodpiles should be placed in sunny areas.
  • Do tick checks on your and your childs skin. This should be done when coming in from the outdoors. Showering immediately may help remove any that are not firmly attached.
  • Remove any ticks found completely and apply antiseptic.

Ticks can be removed safely with tweezers. They should be grasped near the mouth or head and gently retracted. If you do not feel comfortable to do this, see your doctor. Also, if you suspect that you may have been bitten by an infected tick or if you develop any of the symptoms listed above and live in area where Lyme disease is present, see your doctor.

The first cornerstone of treatment of Lyme disease is prevention. However, the key to effective treatment when infection arises is to give it in the earliest stages of disease. Untreated Lyme disease can lead to complications such as meningitis, carditis, and arthritis, which are much harder to treat and may lead to permanent consequences. The usual treatment is a course of antibiotics.

Lyme disease cases may be high where you live, but that is no reason to stay indoors.

For your patients: How to Enjoy the Outdoors without Getting Lyme Disease

About the Author

Linda Girgis MD, FAAFP is a family physician practicing in South River, New Jersey. She was voted one of the top 5 healthcare bloggers in 2016. Follow her on twitter @DrLindaMD.

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