Diagnosis

The variable signs and symptoms of Lyme disease are nonspecific and often are found in other conditions, so diagnosis can be difficult. What's more, the ticks that transmit Lyme disease also can spread other diseases at the same time.

If you don't have the characteristic Lyme disease rash, your doctor might ask about your medical history, including whether you've been outdoors in the summer where Lyme disease is common, and do a physical exam.

Lab tests to identify antibodies to the bacteria can help confirm the diagnosis. These tests are most reliable a few weeks after an infection, after your body has had time to develop antibodies. They include:

  • Enzyme-linked immunosorbent assay (ELISA) test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis. This test might not be positive during the early stage of Lyme disease, but the rash is distinctive enough to make the diagnosis without further testing in people who live in areas infested with ticks that transmit Lyme disease.
  • Western blot test. If the ELISA test is positive, this test is usually done to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.

Treatment

Antibiotics are used to treat Lyme disease. In general, recovery will be quicker and more complete the sooner treatment begins.

Antibiotics

  • Oral antibiotics. These are the standard treatment for early-stage Lyme disease. These usually include doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women. A 14- to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective.
  • Intravenous antibiotics. If the disease involves the central nervous system, your doctor might recommend treatment with an intravenous antibiotic for 14 to 28 days. This is effective in eliminating infection, although it may take you some time to recover from your symptoms. Intravenous antibiotics can cause various side effects, including a lower white blood cell count, mild to severe diarrhea, or colonization or infection with other antibiotic-resistant organisms unrelated to Lyme.

After treatment, a small number of people still have some symptoms, such as muscle aches and fatigue. The cause of these continuing symptoms, known as post-treatment Lyme disease syndrome, is unknown, and treating with more antibiotics doesn't help. Some experts believe that certain people who get Lyme disease are predisposed to develop an autoimmune response that contributes to their symptoms. More research is needed.

Bismacine

The Food and Drug Administration warns against the use of bismacine, an injectable compound prescribed by some alternative medicine practitioners to treat Lyme disease. Bismacine, also known as chromacine, contains high levels of the metal bismuth. Although bismuth is safely used in some oral medications for stomach ulcers, it's not approved for use in injectable form or as a treatment for Lyme disease. Bismacine can cause bismuth poisoning, which may lead to heart and kidney failure.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner who might refer you to a rheumatologist, infectious disease specialist or other specialist.

Here's some information to help you prepare for you appointment.

What you can do

  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • Create a list of medications, vitamins and supplements you take.
  • Take a family member or friend along, if possible. Someone who accompanies you might remember something that you missed or forgot.
  • Write down questions to ask your doctor.

For Lyme disease, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • What is the best course of action?
  • What alternatives are there to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did your symptoms start?
  • Did a tick bite you?
  • Have you been in wooded areas? If so, where?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
April 03, 2016
References
  1. Lyme disease. Centers for Disease Control and Prevention. http://www.cdc.gov/lyme/. Accessed July 28, 2015.
  2. Hu L. Clinical manifestations of Lyme disease in adults. http://www.uptodate.com/home. Accessed July 28, 2015.
  3. Hu L. Treatment of Lyme disease. http://www.uptodate.com/home. Accessed July 28, 2015.
  4. Shapiro ED. Borrelia burgdorferi (Lyme Disease). Pediatrics in Review. 2014;35:500.
  5. Bismacine/chromacine. U.S. Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150503.htm. Accessed July 28, 2015.