Lyme Disease

What Is Lyme Disease?

Lyme disease is a tick-borne illness that can cause symptoms throughout the body. “Tick-borne” means an illness that is transmitted from the bite of a tick.

Lyme disease was officially identified in 1975. Today it is the most common tick-borne disease in the United States. It has been reported in every U.S. state except Montana and is especially prevalent in:

  • Southern New England
  • New York
  • The Mid-Atlantic States
  • Wisconsin
  • The coastal and wooded areas of California and Oregon

Lyme disease causes flu-like symptoms, including fever, muscle pain, arthritis-like joint pain, fatigue, and a skin rash. In rare cases, it can lead to temporary paralysis of the muscles in the face, or serious heart or nervous system problems.

Early treatment with antibiotics is important to avoid long-term problems. Although symptoms sometimes last for months, early treatment increases the likelihood that they will clear up completely.

Need To Know:

People treated in the early stages usually recover quickly and completely. A recent study has shown that the general health of people who have had Lyme disease between 1 and 11 years before is similar to that of the general population.

Nice To Know:

In Europe, medical literature from the early 1900s describes a skin rash similar to Lyme disease. Some experts believe Lyme disease may have spread from Europe to the U.S. at that time, but it was recognized only recently as a distinct illness.

Facts About Lyme Disease

  • Lyme disease was first identified in 1975, when a number of cases occurred in Lyme, Connecticut.
  • Lyme disease is more commonly reported in the United States  than any other vectorborne illness. In 2009, it was the fifth most common nationally notifiable disease.
  • In 2010, about 30,000 confirmed and probably cases of Lyme disease were reported to public health officials in the United States.
  • About 75% of the people who contract Lyme disease don’t remember being bitten by a tick.
  • It usually takes at least 36 to 48 hours following a tick bite for the Lyme-causing bacterium (Borrelia burgdorferi) to be transmitted.
  • About 85% of people with Lyme disease get a characteristic rash.
  • Lyme disease has been reported in all U.S. states except Montana. It also is found in Europe, the former Soviet Union, China, Japan, and Australia.
  • The vast majority (94%) of all cases of Lyme disease were reported from 12 states in 2010: Connecticut, Maine, Delaware, New Jersey, New Hampshire, New York, Maryland, Pennsylvania, Massachusetts, Virgina, Maryland, and Wisconsin.
  • In the northeastern and north-central U.S., most cases of Lyme disease are reported from May through August, with the peak in July. In the non-coastal western U.S., the disease most often occurs between January and May. On the West Cost, it most often occurs between November and April.
  • Health officials believe that Lyme disease is under-diagnosed and that as many as 90 percent of cases may go unreported.
  • The highest reported rates of Lyme disease are in children ages 2 to 15 and adults ages 30 to 55.

 

What Causes Lyme Disease?

Lyme disease is caused by a type of bacterium called a spirochete. The particular species of spirochete that is responsible for Lyme disease is called Borrelia burgdorferi, and it is spread by infected ticks.

In the United States, the tick that carries Lyme disease is commonly known as the deer tick, because in its adult form it usually lives on deer. In its immature form (also called the larval form), it lives primarily on the white-footed mouse. About half of these adult deer ticks are infected with the Lyme bacteria. The average deer carries 200 or more deer ticks at any one time. The life cycle of the tick can be interrupted by removing deer from the pool of host animals. In most parts of the US the deer is the only large mammal capable of providing a blood meal to the adult female tick to enable her to lay eggs. These deer carry the ticks into areas where people live, work, and play.

Ticks become infected with the Lyme disease spirochete by feeding on the blood of animals that have the disease.

The tick usually bites people when it is in the nymph stage, between larval and adult. At this point in its life cycle it is very small, about the size of a poppy seed, and difficult to see. Three-quarters of the people who contract Lyme disease don’t even remember being bitten.

When an infected tick bites a person, the spirochetes can enter the skin. This doesn’t usually happen until after the tick has been attached for between 36 and 48 hours.

  • The infection causes local symptoms, such as a rash near the bite.
  • It may also travel in the blood to more distant tissues.
  • Additional symptoms can be caused by the body’s own reaction to the invader.

Who Is At Higher Risk?

Anyone exposed to ticks is at risk for Lyme disease, including pets. Lyme disease is more common in:

  • Children between the ages of 5 and 14
  • Adults between the ages of 30 to 49
  • Golfers
  • Campers
  • People who work outdoors
  • People who spend a lot of recreation time outdoors

One study has indicated that Lyme disease can pose the most problems for people over age 70.

There is no evidence that people can get Lyme disease from the air, from food or water, through sexual contact, or directly from wild or domestic animals.

According to the Centers for Disease Control, no one has gotten Lyme disease through the bites of mosquitoes, flies, or fleas; or through blood transfusions or other contact with infected blood or urine.

Nice To Know:

Deer in the Neighborhood

Lyme disease has arisen as farms and forests give way to expanding suburban development. Deer habitat has been increasingly crowded out by residential subdivisions. With few predators left to keep down their numbers and the neighborhoods far too congested for hunting, the deer population becomes larger than the diminished woodlands can support.

Deer compete with people for space in grassy parks, public “green space,” and even backyard gardens. They feast on carefully tended landscaping. Their close proximity brings deer ticks closer to people, too, and Lyme disease is a result.

For many suburbanites, the novelty of pointing out the deer gamboling on the nearby hillside has worn thin, and control measures are being put into place. These include 9 to 10 ft high fences, culling the deer herd to reduce their numbers below 8 per square mile or moving the animals. The latter is no longer permitted due to the risk of spreading chronic wasting disease. Likewise contraception of deer is only available in a controlled study of isolated herds, such as on an island: such drugs are injected by darts and each animal is tagged to prevent human consumption.

The issue of too many deer has also generated debate among community planners about how development ought to be restricted to limited areas, resulting in proposals for more traditional “cluster communities” with larger blocks of green space around them, so that humans and deer can regard each other from a safe distance.

What Are The Symptoms Of Lyme Disease?

The classic symptom of Lyme disease is a characteristic rash, called erythema migrans, near the bite. An estimated 85% of people with Lyme disease get this rash.

  • The rash starts as a small red spot at the site of the tick bite.
  • Over the next few days or weeks, the rash expands into a circle or oval.
  • Sometimes the rash resembles a bull’s eye (a red ring surrounding a clear area with a red center).
  • The rash can range from the size of a dime to more than a foot in diameter.
  • As infection spreads, the rash can appear at different locations on the body.

Nice To Know:

Recognizing the Lyme Disease Rash

The characteristic rash of Lyme disease appears in more than 8 out of 10 cases. It begins as a red dot and then expands. Sometimes the redness fades in the center area, leaving a rash often described as looking like a “bull’s-eye.”

Anyone with an unusual rash should see a physician. It’s best to photograph the rash if possible, in case it disappears by the time of the appointment.

With or without the rash, the infection is often accompanied by:

  • A generalized feeling of illness (malaise)
  • Fatigue
  • Fever
  • Headache
  • Stiff neck
  • Overall aching

If Lyme disease is untreated, about 60% of people will experience symptoms of arthritis (joint inflammation) within several months of being infected:

  • In Lyme disease, arthritis is most commonly felt in the knees.
  • The arthritis can shift from one joint to another.
  • Arthritis symptoms may persist or may occur intermittently.
  • About 10% to 20% of people with untreated Lyme disease will go on to develop chronic arthritis.

Other symptoms also may appear, caused by inflammation in various areas of the body:

  • Neurological (nervous system) symptoms are seen in about 15% of people with Lyme disease. They can include partial paralysis of the face (a condition called Bell’s palsy), numbness or weakness of the limbs, and a change in mood or sleeping habits.
  • Less than 10% of the time, the heart can be affected by disorders that include irregular heartbeats (arrhythmias) and inflammation of the sac around the heart.
  • Less commonly, Lyme disease can result in eye infection, hepatitis (a disease that affects the liver), or encephalitis (inflammation in the brain).

How Is Lyme Disease Diagnosed?

In an area where Lyme disease is common, the rash may be enough for a physician to make a diagnosis. A flu-like illness along with the rash is common, and the physician will also probably look for muscle and joint tenderness, especially around the knees.

When the rash is absent, Lyme disease may be hard to diagnose because the other symptoms mimic those of many diseases. It is important to consider it, however, because early treatment is much more effective at preventing long-term problems.

Blood Tests For Lyme Disease

Physicians do not usually rely on blood tests alone to confirm or rule out Lyme disease, because these tests are expensive and can be undependable. The most widely performed Lyme disease blood tests are:

  • Enzyme-linked immunoabsorbent assay (ELISA)
  • Indirect immunofluorescence assay (IFA)
  • PreVue burgdorferi antibody detection assay

These tests detect the antibodies that the immune system produces to fight Lyme disease.

However, the antibody tests can sometimes give false-positive results (which indicate disease when the disease in question is not present) or false-negative results (which indicate no disease when disease actually is present).

  • False-positive results can occur when the test picks up antibodies to other spirochetes, including those that cause syphilis or dental infections.
  • False-negative results may occur if a recently infected person has not yet produced enough antibodies for the test to detect. Drugs such as steroids may reduce the amount of antibodies in the bloodstream and can cause a false negative as well.

Because of the uncertainty involved in the standard Lyme disease tests, positive results must be followed up with another blood test called the Western blot.

  • The Western blot creates a graph figure that shows bands of different colors or shading that doctors use to interpret a person’s immune response.
  • The ability of the Western blot to detect Lyme disease antibodies reduces the number of false positives obtained with the ELISA test.

Researchers are working on new tests to detect Lyme disease that promise to be more reliable than the procedures that are currently available.

Other Tests

Other tests that can be used to diagnose Lyme disease, or to determine the extent to which it has affected the body, include:

  • A spinal tap (lumbar puncture), in which a needle is gently placed into the spine through the back and a small amount of fluid is withdrawn, may be useful for an early diagnosis of Lyme disease in people who are experiencing symptoms involving their nervous system.
  • Single photo emission computed tomography (SPECT) is an advanced imaging procedure that can reveal patterns in the brain that could indicate whether Lyme disease is affecting the central nervous system.

Nice To Know:

Lyme Disease or Ringworm?

Because of the “bull’s-eye” description to describe the Lyme disease rash, the condition commonly called ringworm is sometimes confused with Lyme disease, especially by parents worried about children who play in the grass.

  • Ringworm is a skin infection caused by the same fungus that causes athlete’s foot and jock itch.
  • It usually leaves a ring-shaped mark that is clearly defined and much smaller than the Lyme disease rash.
  • It is easily treated by regular application of an anti-fungal ointment for a few weeks.
  • Unlike Lyme disease, ringworm is spread among people.

Nice To Know:

What Other Conditions Resemble Lyme Disease?

Many other conditions cause a rash or other symptoms similar to those of Lyme disease.

  • The bites of many insects and spiders can cause a skin reaction.
  • Scleroderma is a progressive illness that causes arthritis-like symptoms.
  • Pain, swelling, or stiffness of the joints may be a sign of arthritis that is unrelated to Lyme disease.
  • In children, rheumatic fever, which can follow strep throat, can cause symptoms similar to Lyme disease.
  • Other infections can produce a fever, headache, and muscle aches.
  • Mononucleosis (which often affects teenagers) and viral meningitis (which often affects children) can cause severe fatigue and other Lyme-like symptoms.
  • Other tick-borne illnesses that can be mistaken for Lyme disease include Rocky Mountain spotted fever (most prevalent in the Mid-Atlantic States) and a new infection transmitted by the Lone Star tick (most prevalent in the southern United States).

 

What Is The Treatment For Lyme Disease?

Lyme disease is treated with antibiotics taken by mouth, such as:

  • Cefuroxime axetil (Ceftin), which was approved by the FDA in 1996 for the treatment of early Lyme disease.
  • Amoxicillin
  • Doxycycline (also effectively treats most other tick-borne diseases; not given to children under age 9, pregnant women, or women who are breastfeeding because it can stain the permanent teeth developing in young children or unborn babies)
  • Penicillin
  • Erythromycin (for people allergic to penicillin)

Early treatment with antibiotics is important to avoid long-term problems. People treated in the early stages usually recover quickly and completely.

  • Antibiotics can speed the healing of the rash.
  • Arthritis symptoms usually go away within a few weeks or months following antibiotic therapy.
  • After antibiotic therapy, some people still experience muscle aches, persistent fatigue, and trouble with memory and concentration. Research is continuing on how best to treat these persistent symptoms.

Do Pain Relievers Help?

Symptoms such as mild joint pain and headache may continue even in people who are taking antibiotics. Pain relievers do not help to combat Lyme disease but may relieve some of the symptoms. They include:

  • Acetaminophen (for example, Tylenol)
  • Nonsteriodal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen

Nice To Know:

In rare cases, treatment for Lyme disease may involve more than medication:

  • If a person’s arthritis symptoms are severe and persistent, joint surgery may be necessary.
  • Heart problems may require a temporary pacemaker.

What Happens If A Pregnant Woman Gets Lyme Disease?

Pregnant women should be especially careful to avoid getting a tick bite, because Lyme disease can be transmitted to an unborn child. Although rare, it can make a woman more likely to miscarry or deliver a stillborn child.

Antibiotics that can be given to pregnant women with Lyme disease include amoxicillin, cefuroxime axetil, or penicillin.

Pregnant women should not take aspirin or ibuprofen. Acetaminophen is considered safe to take during pregnancy.

How Can Lyme Disease Be Prevented?

The best way to prevent Lyme disease is to:

Protective Measures

Avoiding wooded or grassy areas, especially between May and August, is one way to prevent getting bitten by ticks. But many people live or work in such areas, or enjoy outdoor recreation. To help prevent tick bites:

  • Wear protective clothing such as hats, long sleeves, and long pants tucked into socks or boots. Light-colored clothing allows ticks to be spotted more easily.
  • Apply tick repellant containing DEET on exposed skin (except on the face, and also avoid putting the repellant on the hands of young children), or treat clothing with permethrin, which kills ticks.
  • Keep to the center of trails, avoiding grasses and brush.
  • Inspect clothing often while outdoors, and have a companion inspect your back. Inspect children at least daily, and every few hours in heavily infested areas.
  • Shower and check your body carefully for ticks after outdoor activities, especially the groin, navel, armpits, head, and behind knees and ears. Have someone check your back, or use a mirror.
  • Wash clothes and put them in the dryer for at least 30 minutes to kill any remaining ticks.
  • Keep lawn mown and brush cut back. Avoid plantings attractive to deer and other animals. Limit watering of lawn. In some areas, careful use of environmental insecticides may be advisable.
  • Keep domestic animals out of tick-infested areas, check them for ticks, and use tick-control products as recommended by your veterinarian.

Reduce the number of deer

  1. People living in Lyme Disease areas should consider lobbying their town or state legislators to reduce the deer herd to less than 8 per square mile so that the tick’s life cycle is interrupted. Interrupting the tick’s life cycle is the way to prevent and eventually eradicate Lyme disease. The aim would be to go back to the pre-Lyme era when there were very few deer in the community.
  2. Take part in a town-wide plan to reduce deer numbers in your area
  3. Avoid attracting deer with unprotected plantings or bird feeders

For more information go to www.deeralliance.com the Fairfield County Municipal Deer Management Alliance, a group of 13 towns in Connecticut trying to advocate for more responsible deer herd management so that Lyme can become a disease of the past.

How To Information:

How to Handle a Tick Bite

Finding a tick on your body doesn’t necessarily mean you will get Lyme disease. Keep in mind that:

  • It is the tiny deer tick – not every kind of tick – that transmits Lyme disease.
  • Not all deer ticks are infected.
  • The microorganism that causes Lyme disease takes 36 to 48 hours to be transmitted.

It is important to remove an attached tick as soon as possible. To remove a tick:

  • Grasp it gently with fine tweezers, as close to the skin as possible.
  • Carefully pull straight out.
  • Do not squeeze the tick with the tweezers, to avoid forcing more bacteria into the skin.
  • Do not attempt to remove the tick with fingers, lighted cigarettes, matches, nail polish, petroleum jelly, etc.
  • Apply an antiseptic to the area of the bite to help prevent bacterial infection.

What About The Lyme Disease Vaccine?

In 1998 the FDA approved a vaccine for Lyme disease, called LYMErix, for people ages 15 to 70, but it was withdrawn from the market in 2002, due to lack of commercial success and pressure from Lyme advocacy groups. A vaccine is still available for animals. It is possible the vaccine could be re-introduced if there was a significant demand for its return. Those that had the vaccine were mostly pleased with it. It had an efficacy of 76%.

Like most vaccines, LYMErix causes the body to produce antibodies against the disease. However, the Lyme disease vaccine is unusual because the antibodies it generates seem to enter the body of the biting tick and kill the spirochetes there, instead of fighting their battle in the human bloodstream.

The FDA emphasized at the time that the LYMErix vaccine is not 100 percent effective, and it shouldn’t be used as a substitute for other measures such as protective clothing or tick repellent. It required three injections over a period of a year. It is not known how long protection against Lyme disease lasts after vaccination.

There was some concern at the possibility of a small chance of arthritis as a side effect of the vaccine. This can occur if the body is “fooled” and reacts as if it were fighting off an actual Lyme disease invasion. Inflammation such as that which occurs in Lyme-related arthritis is a side effect of the vaccine.

Of the 600,000 people who received the LYMErix vaccine the first year it was available, 29 reported experiencing chronic arthritis. However, in some cases this might not have been a reaction to the vaccine, but rather a failure of the vaccine; that is, a symptom of an actual Lyme disease infection.

Nice To Know:

Protecting Your Pets

Household pets can get Lyme disease too. In animals, the typical symptoms include joint soreness and lameness, fever, and loss of appetite.

Three Lyme disease vaccines are available for dogs – LymeVax, Galaxy Lyme, and Canine Recombinant Lyme. Healthy dogs can be vaccinated when they are nine weeks or older. There is no vaccine currently available for cats.

Checking pets for all types of ticks before letting them come into the house will reduce the risk of infection for both pet and owner.

Lyme Disease: What Is The Outlook?

The long-term prognosis for Lyme disease caught early is excellent. Although symptoms sometimes last for months, early treatment increases the likelihood that they will clear up completely. A recent study has shown that the general health of people who have had Lyme disease between 1 and 11 years before is similar to that of the general population.

If Lyme disease is ignored or inadequately treated, nerve damage, heart problems, and arthritis can become difficult to treat. Only in rare instances do the symptoms of Lyme disease become chronic. Fatalities are extremely rare.

Keep in mind that is it possible to become re-infected with Lyme disease at a later date. The body’s natural immune response to the disease appears to diminish gradually in the years after infection.

Nice To Know:

Controlling Deer Ticks

Researchers are trying to develop an effective strategy for ridding areas of deer ticks.

  • Spraying pesticide in wooded areas in the spring and fall has been shown to substantially reduce, for more than a year, the number of adult deer ticks living there. Large-scale spraying, however, may be too expensive and may raise environmental or health concerns.
  • Researchers have tried introducing tiny stingerless wasps, which feed on immature ticks, into tick-infested areas. The effectiveness of this strategy is under investigation.
  • Feeding stations for deer have been built in some areas, so that a tick-killing chemical can be applied to the animals. One such program in Texas eliminated 98% of the adult ticks in the study area within two years.

Lyme Disease: Frequently Asked Questions

Here are some frequently asked questions related to lyme disease:

Q: Does Lyme disease occur outside the United States?

A: Yes, Lyme disease occurs worldwide. In Europe, the tick that spreads the disease usually lives on sheep in its adult stage rather than on deer.

Q: How do ticks become infected?

A: Ticks become infected with the Lyme disease spirochete by feeding on the blood of animals that have the disease.

Q: When are people most likely to contract Lyme disease?

A: The nymph-stage ticks that generally bite humans and spread Lyme disease are most active between May and August, but infection is common throughout the summer and fall.

Q: Can pets get Lyme disease?

A: Household pets and domestic animals can get Lyme disease; symptoms include joint swelling and soreness, lameness, loss of appetite, and fever. There are three Lyme disease vaccines available for dogs, which can be given any time after the age of nine weeks. The vaccine is not currently available for cats. Pets can also carry ticks into the house, thereby exposing the owners to risk. Using the effective flea and tick prevention measures available from veterinarians will reduce the likelihood of problems for pet and owner alike.

Q: Is it possible to get Lyme disease in another way than from a tick bite?

A: Lyme disease could theoretically spread by contact with infected blood or urine (for example, through blood transfusions). However, there is no documentation of this actually happening. There is no evidence that Lyme disease is spread through casual contact, sexual relations, directly from deer or other animals, or through air, food or water. One case of Lyme disease from a horsefly or deer fly bite was written up in the New England Journal of Medicine in 1990, but the Centers for Disease Control (CDC) does not believe that the disease is transmitted by flies, fleas, or mosquitoes. It is rare, but possible, for Lyme disease acquired during pregnancy to be transmitted to the fetus.

Q: Can a person contract Lyme disease more than once?

A: It does seem possible for re-infection to occur once a person or animal has seemingly recovered from Lyme disease.

Lyme Disease: Putting It All Together

Here is a summary of the important facts and information related to lyme disease:

  • Lyme disease is a potentially serious but treatable illness spread by ticks.
  • Ticks carrying Lyme disease are prevalent in most of the United States.
  • Most people who contract Lyme disease do not remember being bitten by a tick.
  • Lyme disease is generally identified by its symptoms, with blood tests used to support the diagnosis.
  • The most common symptoms of Lyme disease include a spreading rash and a flu-like illness. Arthritis symptoms are common, especially in the knees.
  • Lyme disease is treated with antibiotics; early intervention is the best way to reduce the likelihood of chronic problems.
  • The long-term prognosis for Lyme disease treated early is excellent.
  • Untreated Lyme disease could cause problems with the heart and nervous system.
  • Prevention of tick bites and prompt removal of attached ticks is important to help avoid infection.
  • A Lyme disease vaccine is available for people ages 15 to 70.

Lyme Disease: Glossary

Here are definitions of medical terms related to lyme disease:

Antibiotics: Drugs that work against bacteria

Antibodies: Substances produced by the immune system to fight foreign invaders such as disease-causing microorganisms

Arthritis: Inflammation of a joint

Bacteria: Microscopic germs that can cause infection

Bell’s palsy: Partial facial paralysis due to inflammation around a facial nerve

Ceftin: Trade name for the antibiotic cefuroxime axetil, approved by the FDA in 1996 for treatment of Lyme disease

DEET: An insect repellant effective against ticks, for use on exposed skin but not on the face or on the hands of young children

Erythema migrans: Spreading rash characteristic of Lyme disease infection

False negative: Test result indicating no disease when disease is actually present

False positive: Test result indicating disease when the disease in question is not present

Nymph: Immature stage of a tick’s life cycle, between larval and adult, when transmission of Lyme disease to humans is most likely to occur

Permethrin: An insecticide effective against ticks, for use on clothing

Spirochete: A type of bacteria with a slender spiral shape

Lyme Disease: Additional Sources Of Information

Here are some reliable sources that can provide more information on lyme disease:

National Institutes of Health Lyme Lines National Institute of Allergy and Infectious Diseases 
http://medlineplus.nlm.nih.gov/medlineplus/lymedisease.html

Lyme Disease Foundation 
Phone: (860) 525-2000
http://www.lyme.org/”

American Lyme Disease Foundation, Inc. 
Phone: (914) 277-6970
http://www.aldf.com/

The Lyme Disease Network of New Jersey 
http://www.lymenet.org/

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