Overview

Lyme disease is caused by four main species of bacteria: Borrelia burgdorferi, Borrelia mayonii, Borrelia afzelii and Borrelia garinii bacteria. Borrelia burgdorferi and Borrelia mayonii cause Lyme disease in the United States, while Borrelia afzelii and Borrelia garinii are the leading causes of Lyme disease in Europe and Asia. The most common tick-borne illness in these regions, Lyme disease is transmitted by the bite of an infected black-legged tick, commonly known as a deer tick.

You're more likely to get Lyme disease if you live or spend time in grassy and heavily wooded areas where ticks carrying the disease thrive. It's important to take common-sense precautions in areas where ticks are prevalent.

Symptoms

The signs and symptoms of Lyme disease vary and usually appear in stages.

Early signs and symptoms

A small, red bump often appears at the site of a tick bite or tick removal and resolves over a few days. This is normal after a tick bite and does not indicate Lyme disease.

However, these signs and symptoms may occur within a month after you've been infected:

  • Rash. From 3 to 30 days after an infected tick bite, an expanding red area might appear that sometimes clears in the center, forming a bull’s-eye pattern. The rash (erythema migrans) expands slowly over days and can spread to 12 inches (30 centimeters) across. It is typically not itchy or painful.

    Erythema migrans is one of the hallmarks of Lyme disease. Some people develop this rash at more than one place on their bodies.

  • Flu-like symptoms. Fever, chills, fatigue, body aches and a headache may accompany the rash.

Later signs and symptoms

If untreated, new signs and symptoms of Lyme infection might appear in the following weeks to months. These include:

  • Erythema migrans appearing in other areas of your body.
  • Joint pain. Bouts of severe joint pain and swelling are especially likely to affect your knees, but the pain can shift from one joint to another.
  • Neurological problems. Weeks, months or even years after infection, you might develop inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement.

Signs and symptoms caused by the bacterium Borrelia mayonii may also include:

  • Nausea and vomiting
  • Diffuse rashes (rather than a single bull's-eye rash commonly associated with Lyme disease)

Less common signs and symptoms

Several weeks after infection, some people develop:

  • Heart problems, such as an irregular heartbeat. Heart problems rarely last more than a few days or weeks.
  • Eye inflammation.
  • Liver inflammation (hepatitis).
  • Severe fatigue.

When to see a doctor

If you've been bitten by a tick and have symptoms

Only a minority of blacklegged tick bites leads to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease. Lyme infection is unlikely if the tick is attached for less than 36 to 48 hours.

If you think you've been bitten and have signs and symptoms of Lyme disease — particularly if you live in an area where Lyme disease is prevalent — contact your doctor. Treatment for Lyme disease is more effective if begun early.

See your doctor even if symptoms disappear

It's important to consult your doctor even if signs and symptoms disappear — the absence of symptoms doesn't mean the disease is gone. Left untreated, Lyme disease can spread to other parts of your body from several months to years after infection, causing arthritis and nervous system problems. Ticks also can transmit other illnesses, such as babesiosis and Colorado tick fever.

Causes

In the United States, Lyme disease is caused by Borrelia burgdorferi and Borrelia mayonii bacteria, carried primarily by blacklegged or deer ticks. The ticks are brown and, when young, often no bigger than a poppy seed, which can make them nearly impossible to spot.

To contract Lyme disease, an infected deer tick must bite you. The bacteria enter your skin through the bite and eventually make their way into your bloodstream. In most cases, to transmit Lyme disease, a deer tick must be attached for 36 to 48 hours. If you find an attached tick looks swollen, it may have fed long enough to transmit bacteria. Removing the tick as soon as possible may prevent infection.

Risk factors

Where you live or vacation can affect your chances of getting Lyme disease. So can your profession and the outdoor activities you enjoy. The most common risk factors for Lyme disease include:

  • Spending time in wooded or grassy areas. In the United States, deer ticks are most prevalent in the Northeast and Midwest regions, which have heavily wooded areas where deer ticks thrive. Children who spend a lot of time outdoors in these regions are especially at risk. Adults with outdoor occupations also are at increased risk.

    In the first two stages of life, deer ticks in the United States feed on mice and other rodents, which are a prime reservoir for Lyme disease bacteria. Adult deer ticks feed primarily on white-tailed deer.

  • Having exposed skin. Ticks attach easily to bare flesh. If you're in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants. Don't allow your pets to wander in tall weeds and grasses.
  • Not removing ticks promptly or properly. Bacteria from a tick bite can enter your bloodstream if the tick stays attached to your skin for 36 to 48 hours or longer. If you remove a tick within two days, your risk of acquiring Lyme disease is low.

Complications

Left untreated, Lyme disease can cause:

  • Chronic joint inflammation (Lyme arthritis), particularly of the knee
  • Neurological symptoms, such as facial palsy and neuropathy
  • Cognitive defects, such as impaired memory
  • Heart rhythm irregularities

Prevention

The best way to prevent Lyme disease is to avoid areas where deer ticks live, especially wooded, bushy areas with long grass. You can decrease your risk of getting Lyme disease with some simple precautions:

  • Cover up. When in wooded or grassy areas, wear shoes, long pants tucked into your socks, a long-sleeved shirt, a hat and gloves. Try to stick to trails and avoid walking through low bushes and long grass. Keep your dog on a leash.
  • Use insect repellents. Apply insect repellent with a 20 percent or higher concentration of DEET to your skin. Parents should apply repellant to their children, avoiding their hands, eyes and mouth. Keep in mind that chemical repellents can be toxic, so follow directions carefully. Apply products with permethrin to clothing or buy pretreated clothing.
  • Do your best to tick-proof your yard. Clear brush and leaves where ticks live. Keep woodpiles in sunny areas.
  • Check yourself, your children and your pets for ticks. Be especially vigilant after spending time in wooded or grassy areas. Deer ticks are often no bigger than the head of a pin, so you may not discover them unless you search carefully.

    It's helpful to shower as soon as you come indoors. Ticks often remain on your skin for hours before attaching themselves. Showering and using a washcloth might remove unattached ticks.

  • Don't assume you're immune. You can get Lyme disease more than once.
  • Remove a tick as soon as possible with tweezers. Gently grasp the tick near its head or mouth. Don't squeeze or crush the tick, but pull carefully and steadily. Once you've removed the entire tick, dispose of it and apply antiseptic to the bite area.
April 03, 2016
References
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