Lyme disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 29, 2016
StartDiseasesLyme disease

Approximately 300,000 Americans are diagnosed with the bacterial infection known as Lyme disease each year. The disease can affect anyone, but it is most prevalent among people who live near wooded areas and who spend considerable time outdoors. Some of the symptoms of Lyme disease mimic other conditions, making it difficult to diagnose. Many individuals with Lyme disease struggle for months or even years before they receive an accurate diagnosis.


Definition & Facts

The condition known as Lyme disease was first recognized in 1975. Researchers noted an unusually high number of cases of juvenile rheumatoid arthritis in and around Lyme, Connecticut. Most of the individuals affected lived near heavily wooded areas with a large population of deer ticks. Several of the individuals reported being bitten by a tick shortly before their symptoms started. They also stated they had developed an unusual rash at the site of the bite.

Researchers were able to connect the symptoms to a bacteria called Borrelia burgdorferi that was transmitted through the bite of the deer tick. Cases of Lyme disease have been reported in almost every state, but it is most concentrated in areas with large deer populations.

Symptoms & Complaints

Symptoms of Lyme disease can vary from person to person and often present in stages. This first symptom is typically a rash that develops at the site of a tick bite. The rash can appear anywhere from three to thirty days following the bite. The rash has a distinctive bull’s-eye pattern and can expand slowly to as much as 12 inches across. In most cases, the rash is not painful or itchy. The individuals may also develop flu-like symptoms, including body aches, fever, chills, and extreme fatigue.

If untreated, the individuals may notice the rash spreading to other parts of their body. They may also begin to experience severe pain and swelling in their joints, especially the knees. Lyme disease can also lead to neurological problems, including temporary paralysis of the facial muscles, impaired muscle movement, and numbness and weakness in the extremities.

In rare cases, individuals with Lyme disease can experience eye inflammation and liver inflammation and heart problems. Anyone experiencing these symptoms following a tick bite should see their health care provider immediately, even if the symptoms seem to go away. Treatments for Lyme disease are much more effective if started early.


The majority of cases of Lyme disease occur when the individual is bitten by a deer tick. These ticks are known carriers of the bacteria B. burgdorferi, which the tick transmits to humans through the bite. The chances of contracting Lyme disease increase the longer the tick remains attached. Unfortunately, deer ticks are only about the size of a poppy seed, so they can be very difficult to spot. These ticks are carried from place to place by host of different animals, including:

  • Deer
  • Skunks
  • Field mice
  • Raccoons
  • Horses
  • Foxes
  • Weasels
  • Squirrels
  • Chipmunks
  • Opossums
  • Shrews
  • Moles

Cases of Lyme disease have been identified on every continent but Antarctica. The majority of cases in the U.S. are concentrated in the Midwest and along the east and west coasts. Those at greatest risk of contracting Lyme disease are individuals who spend a lot of time outdoors in wooded, grassy areas without covering their skin and who do not remove ticks properly or promptly.

Diagnosis & Tests

Because the symptoms of Lyme disease are similar to other conditions, such as chronic fatigue syndrome, as well as other tick-borne diseases, diagnosis can be difficult. The doctor will typically start with a detailed history, including questions about recent outdoor activities in areas known to harbor ticks. This is followed by a complete physical exam to look for the tell-tale rash and to rule out other potential health conditions. If Lyme disease is suspected, the doctor will typically order blood work to confirm the diagnosis.

The enzyme-linked immunosorbent assay test, also known as ELISA, detects antibodies to the B. burgdorferi bacteria. This test can provide false positives and is not always effective in the early stages of the disease before the body has had a chance to develop antibodies to the bacteria. As a follow-up to the ELISA test, the doctor may order a western blot test, which checks for antibodies to several different proteins contained in the B. burgdorferi bacteria.

Treatment & Therapy

A two to three-week course of antibiotics is the treatment of choice for Lyme disease. Patients tend to demonstrate a quicker and more complete level of recovery the sooner they begin treatment. Oral antibiotics are preferred if the Lyme disease is still in the early stages. Doxycycline is the most commonly used antibiotic for adults and children over the age of eight. Amoxicillin or cefuroxime is preferred for younger children and women who are pregnant or breastfeeding.

If the disease progresses to the point that it is affecting the central nervous system, a 14 to 28-day course of intravenous antibiotics may be required. These antibiotics do carry significant side effects, including diarrhea, a decrease in the number of white blood cells, and the possibility of overgrowth infections from antibiotic-resistant bacteria.

In rare cases, individuals may continue to experience Lyme-related symptoms even after treatment. The exact cause of this is unclear, but it may be an autoimmune response triggered by the Lyme disease. The U.S. Food and Drug Administration warns against the use of injectable bismacine for the treatment of Lyme disease. While the compound is safe for oral use in the treatment of ulcers, it can be dangerous in a highly concentrated injectable form. High levels of metal bismuth have been linked to heart failure and kidney failure.

Prevention & Prophylaxis

A few simple precautions can dramatically lower the risk of developing Lyme disease. The best prevention is to avoid grassy or wooded areas known to harbor deer ticks. Individuals who spend time in these areas should take the following steps:

  • Cover up as much as possible.
  • Wear insect repellent
  • Perform a complete body check for ticks after being outdoors.
  • Remove ticks as soon as possible by gently grasping the tick by the head with a pair of tweezers