The Lyme disease bacterium can infect several
parts of the body, producing different symptoms at different times. Not all patients with Lyme disease will have all
symptoms, and many of the symptoms can occur with other diseases as well. If you believe you may have Lyme disease,
it is important that you consult your health care provider for proper diagnosis.
The first sign of infection is usually a circular rash called
erythema migrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a
tick bite after a delay of 3-30 days. A distinctive feature of the rash is that it gradually expands over a period of
several days, reaching up to 12 inches (30 cm) across. The center of the rash may clear as it enlarges, resulting in
a bull’s-eye appearance. It may be warm but is not usually painful. Some patients develop additional EM
lesions in other areas of the body after several days. Patients also experience symptoms of fatigue, chills, fever, headache,
and muscle and joint aches, and swollen lymph nodes. In some cases, these may be the only symptoms of infection.
Untreated, the infection may spread to other parts of the body within
a few days to weeks, producing an array of discrete symptoms. These include loss of muscle tone on one or both sides
of the face (called facial or “Bell’s palsy), severe headaches and neck stiffness due to meningitis, shooting
pains that may interfere with sleep, heart palpitations and dizziness due to changes in heartbeat, and pain that moves from
joint to joint. Many of these symptoms will resolve, even without treatment.
After several months, approximately 60% of patients with untreated infection
will begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often
effected, particularly the knees. In addition, up to 5% of untreated patients may develop chronic neurological complaints
months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems
with concentration and short term memory.
Most cases of Lyme disease can be cured with antibiotics, especially
if treatment is begun early in the course of illness. However, a small percentage of patients with Lyme disease
have symptoms that last months to years after treatment with antibiotics. These symptoms can include muscle and joint
pains, arthritis, cognitive defects, sleep disturbance, or fatigue. The cause of these symptoms is not known.
There is some evidence that they result from an autoimmune response, in which a person’s immune system continues to
respond even after the infection has been cleared.
Lyme disease is diagnosed based on symptoms, objective physical findings (such as erythema migrans, facial palsy, or arthritis), and a history of possible exposure to infected ticks. Validated laboratory tests can
be very helpful but are not generally recommended when a patient has erythema migrans. For detailed recommendations
on serologic testing, click here.
When making a diagnosis of Lyme disease, health care
providers should consider other diseases that may cause similar illness. Not all patients with Lyme disease will develop
the characteristic bulls-eye rash, and many may not recall a tick bite. Laboratory testing is not recommended for persons
who do not have symptoms of Lyme disease.
forms of laboratory testing for Lyme disease are available, some of which have not been adequately validated. Most recommended
tests are blood tests that measure antibodies made in response to the infection. These tests may be falsely negative in patients
with early disease, but they are quite reliable for diagnosing later stages of disease.
CDC recommends a two-step process when testing blood
for evidence of Lyme disease. Both steps can be done using the same blood sample.
1) The first step uses an ELISA or IFA test. These tests are designed to be very “sensitive,” meaning that almost everyone with Lyme disease, and some
people who don’t have Lyme disease, will test positive. If the ELISA or IFA is negative, it is highly unlikely that the person has Lyme disease, and no further testing is recommended. If the
ELISA or IFA is positive or indeterminate (sometimes called "equivocal"), a second step should be performed to confirm the results.
2) The second step uses a Western blot test. Used
appropriately, this test is designed to be “specific,” meaning that it will usually be positive only if a person
has been truly infected. If the Western blot is negative, it suggests that the first test was a false positive, which can
occur for several reasons. Sometimes two types of Western blot are performed, “IgM” and “IgG.”
Patients who are positive by IgM but not IgG should have the test repeated a few weeks later if they remain ill. If they are
still positive only by IgM and have been ill longer than one month, this is likely a false positive.
CDC does not recommend testing blood by Western blot
without first testing it by ELISA or IFA. Doing so increases the potential for false positive results. Such results may lead to patients being treated for Lyme disease
when they don’t have it and not getting appropriate treatment for the true cause of their illness. For detailed recommendations
for test performance and interpretation of serologic tests for Lyme disease, click here.
Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not
been adequately established. These tests include urine antigen tests, immunofluorescent staining for cell wall-deficient forms
of Borrelia burgdorferi, and lymphocyte transformation tests. In general, CDC does not recommend these tests. Click here for more information. Patients are encouraged to ask their physicians whether their testing for Lyme disease was performed using validated methods
and whether results were interpreted using appropriate guidelines.
who have removed a tick often wonder if they should have it tested. In general, the identification and testing of individual
ticks is not useful for deciding if a person should get antibiotics following a tick bite. Nevertheless, some state or local
health departments offer tick identification and testing as a community service or for research purposes. Check with your
health department; the phone number is usually found in the government pages of the telephone book.
The National Institutes of Health (NIH) has funded several studies on the treatment of Lyme
disease. These studies have shown that most patients can be cured with a few weeks of antibiotics taken by mouth. Antibiotics
commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. Patients with certain neurological
or cardiac forms of illness may require intravenous treatment with drugs such as ceftriaxone or penicillin.
Patients treated with antibiotics in the early stages of the infection usually recover rapidly
and completely. A few patients, particularly those diagnosed with later stages of disease, may have persistent or recurrent
symptoms. These patients may benefit from a second 4-week course of therapy. Longer courses of antibiotic treatment have not
been shown to be beneficial and have been linked to serious complications, including death.
Studies of women infected during pregnancy have found that there are no negative effects
on the fetus if the mother receives appropriate antibiotic treatment for her Lyme disease. In general, treatment for pregnant
women is similar to that for non-pregnant persons, although certain antibiotics are not used because they may affect the fetus.
If in doubt, discuss treatment options with your health care provider.
|The Lyme disease
bacterium, Borrelia burgdorferi, normally lives in mice, squirrels and other small animals. It is transmitted among these animals
– and to humans -- through the bites of certain species of ticks.
|In the northeastern
and north-central United States, the blacklegged tick (or deer tick, Ixodes scapularis) transmits Lyme disease. In
the Pacific coastal United States, the disease is spread by the western blacklegged tick (Ixodes pacificus). Other
tick species found in the United States have not been shown to transmit Borrelia burgdorferi. Blacklegged
ticks live for two years and have three feeding stages: larvae, nymph, and adult. When a young tick feeds on an infected animal,
the tick takes the bacterium into its body along with the blood meal.
The bacterium then lives in the gut of the tick.
If the tick feeds again, it can transmit the bacterium to its new host. Usually the new host is another small rodent, but
sometimes the new host is a human.
Most cases of human illness occur in the late spring and summer when the tiny nymphs are most active and human outdoor activity is greatest.
Although adult ticks often feed on deer,
these animals do not become infected. Deer are nevertheless important in transporting ticks and maintaining tick populations.
Image showing appearance and relative sizes of
adult male and female, nymph and larval ticks including deer ticks (Ixodes scapularis), Lone star ticks (Amblyomma
americanum), and dog ticks (Dermacentor variabilis). Of those pictured, only the Ixodes scapularis
ticks are known to transmit Lyme disease.
There is no evidence that Lyme disease
is transmitted from person-to-person. For example, a person cannot get infected from touching, kissing or having sex with
a person who has Lyme disease.
Lyme disease acquired during pregnancy
may lead to infection of the placenta and possible stillbirth, however, no negative effects on the fetus have been found when
the mother receives appropriate antibiotic treatment. There are no reports of Lyme disease transmission from breast milk.
Although no cases of Lyme disease have been linked to blood transfusion,
scientists have found that the Lyme disease bacteria can live in blood that is stored for donation. Individuals being treated
for Lyme disease with an antibiotic should not donate blood. Individuals who have completed antibiotic treatment for Lyme
disease may be considered as potential blood donors. Information on the current criteria for blood donation is available on
the Red Cross website http://www.redcross.org/donate/give/.
Although dogs and cats can get Lyme disease, there is no evidence
that they spread the disease directly to their owners. However, pets can bring infected ticks into your home or yard. Consider
protecting your pet, and possibly yourself, through the use of tick control products for animals.
You will not get Lyme disease from eating venison or squirrel
meat, but in keeping with general food safety principles meat should always be cooked thoroughly. Note that hunting and dressing
deer or squirrels may bring you into close contact with infected ticks.
There is no credible evidence that Lyme disease can be transmitted through air, food, water, or from the bites
of mosquitoes, flies, fleas, or lice.
to ticks is the best defense against Lyme disease and other tick-borne infections. There are several approaches you and your
family can use to prevent and control Lyme disease.
Lyme disease vaccine is no longer available. The vaccine manufacturer discontinued production in 2002, citing insufficient
consumer demand. Protection provided by this vaccine diminishes over time. Therefore, if you received the Lyme disease vaccine
before 2002, you are probably no longer protected against Lyme disease. |