Lyme disease is an infection that derives from a tick bite. The disease has a variety of symptoms, including changes affecting the skin, heart, joints and nervous system. It is also known as borrelia or borreliosis. Most cases of Lyme disease occur in the spring and summer months. Lyme disease is reported most often in the Northeastern US from Maine to Maryland, in the Midwest in Minnesota and Wisconsin, and in the West in Oregon and Northern California. It has also been reported in China, Europe, Japan, Australia, and the parts of the former Soviet Union. It cannot be caught from an infected person. At this time, there is no vaccination for Lyme disease.
The disease is divided into three distinct phases:
Symptoms start a few days to a month after a tick bite. The classic “bull’s eye” lesion does not need to develop for a diagnosis of Lyme disease. If left untreated, the disease can spread to the lymph nodes.
Multiple skin lesions are seen, along with flu-like symptoms and head, neck and joint pain. There may also be heart or nerve symptoms as well, such as arthritis, which can develop over a few months to up to 2 years after the initial infection.
The heart, joints, and nervous system can be affected. Symptoms can develop over a few months to years after the initial infection and may be difficult to treat.
Some patients with Lyme disease feel like they have caught influenza – the symptoms can include drowsiness, headaches, mild fever, joint and muscle pains and swollen lymph glands. Erythema migrans, the classic unraised red “bull’s-eye” lesion on the skin, will appear days to weeks after the bite. However, about 25% of affected people never get this lesion.
With immediate and appropriate treatment the erythema migrans rash will often disappear within two weeks. Even without treatment, most cases of erythema migrans will go away without leaving permanent effects. But treatment lessens the risk of later symptoms in your nervous system and joints. If the nervous system, joints, or heart are affected, two to three years may pass before the symptoms go away. In rare cases a chronic disease with permanent symptoms may develop. This may happen several years after the tick bite.
In the early stages (erythema migrans) oral antibiotic treatment may be sufficient. If there are other symptoms, he or she will arrange hospital admission for further investigation and possible further treatment with antibiotics. Medicines used against Lyme disease include oral doxycycline (except in children), amoxicillin or cephalosporin antibiotics. These are the first usual choices. When antibiotics by injection are being given, then benzylpenicillin, cefotaxime and ceftriaxone are the usual choices. No particular choice or method is superior to another – the decision is made by the infectious disease specialist and is dependent on the individual circumstances.
About 15 % of people with borrelia develop so-called neuro borrelia, between one and five weeks after the tick bite. The central nervous system is affected and the symptoms that result are very mixed and not specific:
- The symptoms often begin with back pain, typically between the shoulder blades and in the neck like a slipped disc. The pain worsens at night.
- Distorted feelings around the area of the bite. The nerves become numb, especially in the face. This may occur at any time up to four weeks after the pain began.
- Sometimes neuro borrelia may present itself as meningitis, with fever, headache and stiffness in the neck.
- In rare cases, the disease may become chronic, with a slowly developing destruction of the nervous system, numbing, partial hearing impairment and the development of dementia.
Neuro borrelia demands immediate treatment, usually with an admission to hospital.
If you suspect you have had a tick bite and may have contracted Lyme disease, call your doctor. If you have found a tick on your skin and removed it, you may want to save the tick in a small container of alcohol so that it can be used for identification. Ticks begin transmitting Lyme disease about 24–48 hours after attaching to the host. You can reduce your chances of getting Lyme disease by removing the tick within 48 hours. Observe the bitten area for the appearance of a rash for up to a month after the bite. It is probably best to call your doctor for further guidance if you think you have been bitten by a tick. If a rash or other early symptoms of Lyme disease develop, see a physician immediately.