Lyme Disease History
Lyme disease, sometimes referred to as Lyme infection
or borreliosis, is a bacterial illness, transmitted to humans by the bite of deer ticks (Ixodes ticks) carrying a bacterium known as Borrelia burgdorferi. The disease has been reported in the Northeast, Mid-Atlantic, North Central, and Pacific coastal regions of the United States (see map) and in Europe, where it was first described almost 100 years ago. It is most prevalent in the northeastern and Midwestern states of the U.S., with about 96% of reported cases occurring in 14 states, including Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.
Doctors at New Haven's Yale Medical Center first described and named Lyme disease in the U.S. in 1977, after an unexpected number of residents in Lyme, Conn., were found to have a "new" and unusual illness.
What Are Lyme Disease Causes and Risk Factors?
B. burgdorferi bacteria cause Lyme disease. The bacteria have a complex life cycle, spending part of their life in the deer tick and part in some mammals such as mice and deer.
Humans are not a part of the bacterium's life cycle but can become infected when bitten by the tick. Lyme disease is not contagious and cannot be passed from person to person.
While dogs and cats can get Lyme disease, there are no reported cases of these animals spreading the disease to their owners. However, dogs and cats can bring the infected ticks into the home, which is one reason why tick protection for pets is important. Talk to a veterinarian about the right type of tick control for any pets.
Risk factors for getting Lyme disease include the following:
- Living in the northeastern or Midwestern U.S. states where the disease is most prevalent
- Being outdoors in the woods or areas that have tall grass, shrubs, or brush
- Fishing, camping, hunting, yard work, hiking, and other outdoor activities in tick-infested areas
- Having bare, unprotected skin when outdoors in high-risk areas
- Pets who are not protected against ticks may bring them indoors.
- Not removing attached ticks promptly
What Are Signs and Symptoms of Lyme Disease?
Early signs and symptoms of Lyme disease occur from three to 30 days after a tick bite and include
- Muscle and joint aches
- Swollen lymph nodes
- General feeling of being unwell (malaise)
The initial infection can occur with minimal or no signs or symptoms. But many people experience a flu-like primary illness or a characteristic rash several days to a few weeks following a tick bite. This rash may feel warm to the touch but is rarely itchy or painful.
The flu-like illness usually occurs in the warm weather months when flu (influenza) does not occur.
The rash is a red rash that grows in size daily. It is called erythema migrans and occurs in about 70%-80% of infected individuals.
The U.S. Centers for Disease Control and Prevention (CDC) defines this rash as a skin lesion that typically begins as a red spot and expands over a period of days to weeks to form a large round lesion, at least 5 cm (about 2 inches) across, and up to 30 cm (12 inches). A red circular spot that begins within hours and is smaller is usually a reaction to the tick bite.
When the rash occurs at the site of the tick bite, it is called a primary lesion. Multiple secondary lesions can occur that are a reaction to the infection and are not due to multiple tick bites. All of these lesions can enlarge to the size of a football. This growth in size of the red spots on the skin is characteristic of Lyme disease.
The red spots may be circular or oval.
As it grows, the rash can remain red throughout, although it often can develop a clear central area. In a minority, it may take on the appearance of a target with multiple rings (alternating red with clear skin), called a bull's-eye lesion.
Symptoms and signs in children are similar, though younger children are more likely to have skin lesions occur on the head or neck and older children on the extremities.
Left untreated, signs and symptoms of the primary illness usually will go away on their own within a few weeks, although the rash may recur.
Days to months later, additional symptoms of Lyme disease may occur. The organs affected later in the course of the disease may lead to the following conditions and complications:
- Facial palsy
(Bell's palsy) is paralysis of the facial nerve that causes the facial muscles to be uneven
and droop. This may get better without treatment.
- Meningitis causes headache, fever, and stiff neck.
- Nerve inflammation causes pain, numbness, and tingling in the arms or legs.
- Shooting pains may interfere with sleep and cause insomnia.
- Muscle weakness
- Brain swelling (encephalitis) causes learning difficulties, confusion, and dementia.
- Intermittent episodes of arthritis last about a week and usually involve the knee or wrist.
This involves severe joint pain, stiffness, and swelling. These may recur over periods of weeks to months, and if the Lyme disease remains untreated, about 10% of people who have these episodes develop persistent arthritis in the knee. Occasionally, people with Lyme disease can present with an acute arthritis in the knee without a clear history of a rash or other joint complaints.
- Pain in the tendons, muscles, and bones.
- Episodes of shortness of breath.
- Inflammation of the heart (carditis) results in heart palpitations or an irregular heartbeat (Lyme carditis), which can also result in dizziness or passing out.
- Inflammation of the brain and spinal cord
- Difficulty with short-term memory
Is Lyme Disease Contagious?
Lyme disease is not contagious and cannot be transmitted from person to person. The only way humans can get Lyme disease is through the bite of an infected blacklegged tick.
What Specialists Treat Lyme Disease?
A primary-care provider (PCP) such as a family practitioner, internist, or child's pediatrician may initially diagnose Lyme disease. In areas where Lyme disease is common, these physicians often treat the illness, as well. However, you may be referred to a specialist for treatment. Rheumatologists specialize in diseases that affect the joints and muscles, including infectious diseases such as Lyme disease. You may also see a neurologist if you experience nerve problems or an infectious disease specialist who can help treat Lyme disease in the later stages.
When Should Someone Seek Medical Care for Lyme Disease?
Seek immediate medical attention if you live in or have visited an area where Lyme disease is common and you experience a flu-like illness or develop a red or target-like (bull's eye) rash anytime from late spring to early fall. Prompt treatment at this early stage reduces the risk of further symptoms of Lyme disease.
- Remove any attached ticks by pulling them off your body. The CDC recommends the following tick-removal process:
- Grasp the tick with fine-tipped tweezers as close to the skin's surface as possible.
- Pull upward with steady, even pressure. Don't twist or jerk the tick or mouth-parts may break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are cannot remove the mouth easily with tweezers, leave it alone and let the skin heal.
- After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
- If the tick is still alive, dispose of it by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.
- However, removing ticks promptly is more important than how you remove them. If you cannot remove an attached tick, see a doctor, who will remove it.
- You do not need to save the tick to get it tested. The CDC states this is generally not useful because even if the tick contains disease-causing organisms, it does not necessarily mean you have been infected with the bacteria that cause Lyme disease; and if you have been infected, symptoms will likely develop before tick testing results come back and you should be treated as soon as possible.
- Following tick removal, see a doctor if any flu-like symptoms or rash develop within the next three weeks. If a rash develops, draw a line around it with ink that does not wash off (such as a Magic Marker or Sharpie) each day to see if it is growing.
- Young children with fever and severe headache should see a doctor immediately, because these may be their only symptoms.
- Outdoor workers and anyone whose hobbies or recreational activities place them in wooded or brush areas should be particularly aware of these symptoms because their environmental exposure increases contact with the deer tick and is a risk factor for contracting Lyme disease.
Lyme disease should be treated promptly. See a doctor or go to a hospital's emergency department immediately.
- When the initial disease is not treated, your symptoms may go away, but additional late stage symptoms and complications of Lyme disease can occur months later.
- When this happens, Lyme disease can affect the heart, muscles and joints, or the nervous system. Since these symptoms can occur with other diseases, be sure to tell a doctor about travel to areas with a high tick population or if you have any possible exposures to ticks (from pets, gardening, walking, or camping in wooded areas, etc.).
If you are pregnant and are bitten by a tick, see a doctor immediately. If you become infected with Lyme disease during pregnancy, the illness can infect the placenta and may result in stillbirth. Lyme disease is not transmitted through breast milk.
Questions to Ask the Doctor About Lyme Disease
If you have an identifiable tick bite but no symptoms have begun, there is a question as to whether preventive treatment should be started. If the symptoms of Lyme disease have started, the question is what antibiotic treatment will be used, by which route it will be administered, and how long it should be taken.
How Do Doctors Diagnose Lyme Disease?
Doctors base a diagnosis of Lyme disease on a careful and detailed history and a complete physical examination supported by laboratory testing when appropriate.
- The doctor will ask whether you know if a tick has bitten you and will gather information about your outdoor exposure in an area with a high tick population.
- Physical examination findings are important, especially the presence of erythema migrans.
- If there is doubt whether a rash is due to Lyme disease, the doctor might measure its size and then remeasure one to two days later. Erythema migrans usually exhibits an increase in size of the rash, often expanding by about ½ inch every day.
- Some physical findings help to distinguish Lyme disease from other infectious ailments.
- Doctors may perform blood tests to examine for antibodies to the bacteria.
- Antibodies can be absent early in the course of a Lyme infection (in the first few weeks), so a negative test result may be misleading at that time.
- There are two tiers of blood tests used to diagnose Lyme disease, a screening test (Lyme ELISA or IFA) and, if that test is positive or equivocal, a more specific test (Western blot). A positive Western blot test result confirms current or past infection. Especially in regions of the country where Lyme disease is very common, patients can have positive test results for Lyme disease but have clinical problems that are explained by another condition. A screening test (a Lyme titer) is not considered sufficient to make a diagnosis of Lyme disease; the Western blot has to be positive also. The accuracy of these tests is very good, but it depends on the stage of the disease. In early stages, a negative test is expected; however, after a few weeks, the ELISA and IFA tests have good sensitivity and accuracy.
- Once a Lyme blood test is positive, it will remain positive for a long time even with successful treatment. Repeat blood tests after treatment are not helpful in determining further care.
- Ixodes ticks can carry other organisms in addition to B. burgdorferi, and these can cause illnesses that can mimic Lyme disease or can even occur along with Lyme disease. The two most important infections are ehrlichiosis (HGE) and babesiosis. Doctors also may perform liver function tests and blood counts to examine the red blood cells and other tests for these two conditions.
- Another tick-borne illness called Rocky Mountain spotted fever can cause a rash but is not the same illness as Lyme disease.
- People with severe headaches may need a spinal tap to determine if there is inflammation in the nervous system (meningitis, encephalitis) and to test for Lyme antibodies in the spinal fluid.
- Doctors may perform an ECG if you have possible heart complications.
- CT scans and MRI of the brain may be performed to rule out other conditions that can cause similar symptoms.
Are There Lyme Disease Home Remedies?
Health departments in areas with high rates of infection have undertaken campaigns to raise public awareness and educate the public on facts about Lyme disease.
- It is known that certain outdoor areas are highly infested with deer ticks and should be avoided if possible -- these include woods and brush areas.
- Generally, the tick counts on suburban lawns are much lower.
Lyme disease should never be treated with home remedies alone. Antibiotics are needed to cure the illness, however, some home remedies may help ease symptoms as you recover. Consult a doctor before taking
an herbal supplement or natural remedy as they may interact with medications you already take or may cause unwanted side effects.
- Nattokinase is an enzyme made from fermented soybeans that some believe can help treat their Lyme disease symptoms. There are currently no studies to support this.
- Probiotics (such as Lactobacillus acidophilus) can be taken to help reduce diarrhea or yeast infections that are side effects of prescribed antibiotics.
- Beta-glucan is a type of fiber believed to stimulate the immune system, though there are no studies that prove this.
- Garlic oil may be able to repel tick bites. One small study showed it was effective as a tick repellant when used on properties where ticks tend to live. Another small study showed that people who took garlic as a supplement reported fewer tick bites. More study is needed to determine if garlic is an effective tick repellant. It may also interact with several medications.
- Essiac is an herbal formula that contains burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm (Ulmus fulva), and rhubarb (Rheum palmatum) and is reported to help treat Lyme disease, but there are no studies that prove it is effective, or whether it will interact with medications.
What Are Lyme Disease Treatments and Medications?
- Doctors will treat primary or early Lyme disease with oral antibiotics, including doxycycline (Vibramycin), cefuroxime (Ceftin), penicillins, amoxicillin (Amoxil), or erythromycin (Ilotycin, Ery-Ped, Ery-Tab). In early stages, the disease can be curable with just this antibiotic treatment.
- Pregnant women are usually treated with penicillins or erythromycin. Doxycycline is generally avoided as it may affect the development of the fetus.
- Doctors may treat late-stage cases of neurological, heart, or arthritic Lyme disease with intravenous antibiotics (usually ceftriaxone [Rocephin]) in the hospital or as an outpatient.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) may be recommended to help relieve pain and inflammation.
Follow-up for Lyme Disease
Follow-up with continued care is important for people who have early Lyme disease but who fail to improve rapidly and completely.
- Doctors must consider other treatment options and rule out other illnesses that may be mistaken for Lyme disease.
- People with later-stage disease who require IV antibiotics or hospitalization must be monitored in the weeks following their treatment.
- Improvement in the symptoms of Lyme disease, particularly in the heart and nervous system, may occur gradually over a period of months. Lack of immediate improvement in all your symptoms is not a sign of unsuccessful treatment.
How Can People Prevent Lyme Disease?
There is currently no vaccine available to prevent Lyme disease; however, there are three approaches to preventing Lyme disease.
- Try to stay out of woodlands and brush areas where the tick thrives, especially during the peak season of summer and early fall.
- Wear garments that will create barriers to the tick attaching to the skin and biting.
- Tuck pant legs into socks so ticks cannot easily crawl the short distance from the ground to just above the sock line. Wear light-colored clothing to better identify ticks.
- The application of the insecticide DEET (low-concentration preparations are recommended) to clothing and skin (This should be limited in children to prevent absorption of too much DEET.) has been found to decrease tick bites and the chance for Lyme disease infections.
- Deer ticks need to remain attached to the skin for about 24-48 hours to transmit the Borrelia bacteria to the skin. Inspect all areas of the body after outdoor activity.
- If you notice a bite, it is very important to watch for symptoms, which usually show up in about three weeks.
- Ticks attach to areas that are warm and moist, such as
- the groin,
- the armpits,
- the underside of a woman's breasts,
- the neck and hairline.
- If you see a tick,
promptly remove it (see previous section on When Should Seek Medical Care
for Lyme Disease for instructions on tick removal). This greatly reduces the likelihood of an infection.
- Disinfect the bite site thoroughly with alcohol or other skin antiseptic solution.
- Use of gasoline, petroleum, and other organic solvents to suffocate ticks,
as well as burning the tick with a match, should be avoided.
- Treatment of tick bites within 72 hours of a bite with a single dose of doxycycline has been reported to prevent Lyme disease. This may be appropriate if you live in an endemic area and have removed an engorged tick or multiple ticks. You should discuss this with a doctor.
What Is the Prognosis for Lyme Disease?
- When treated early, the prognosis for most people with Lyme disease is rapid improvement and minimal complications from the disease. Later stages of illness are avoided by effective treatment of early Lyme disease.
- People with later stages of the disease may also do well when they are diagnosed soon after their later-stage symptoms first occur.
- A small percentage of people with Lyme disease do not fully recover, or recover very slowly, and have a condition called post-treatment Lyme disease syndrome (PTLDS), in which symptoms of fatigue, pain, or joint and muscle aches last for more than six months following treatment.
- Long-term effects of Lyme disease may include residual facial palsy or residual knee pain. Other people develop chronic muscle and joint pains, fatigue, and concentration difficulties that seem to have arisen from the time of the original Lyme disease infection. While these chronic and recurring symptoms have been called chronic Lyme disease, recent studies have not shown any evidence of Borrelial infection in the blood or spinal fluid, and further antibiotic therapy does not appear to have a durable effect in relieving the condition. For the present, patients with this problem are being treated with supportive measures aimed at symptomatic relief.