Philip A. Gilly, MD, FAAFP
Family
Practice Board Certified
Lyme disease is an infection caused by a kind of bacteria (germ) called a spirochete (spy-ro-keet). The disease is carried by deer ticks. It can be given to animals and humans through tick bites. Deer ticks are tiny. They are about the size of a poppy seed or a sesame seed.
The highest rates of Lyme disease are in rural and suburban areas in the northeastern and midwestern states. Lyme disease is also found in other parts of the United States, as well as in Europe, Asia and Australia. Nearby areas of high prevalence, called “endemic”, include the state of Connecticut and the lower Hudson River Valley.
The best way to prevent Lyme Disease is to wear light-colored clothing that covers most of your skin when you go into the woods. Wear long-sleeved shirts and pants instead of shorts. Tuck your pant legs into your socks for added protection. A vaccine is in the process of being developed.
Use an insect repellent containing DEET or permethrin. Apply DEET sparingly to skin according to label directions. Don't apply it to the face and hands of children. Put permethrin only on clothes. Check your skin and your children's skin--body and scalp--carefully every night for ticks and rashes. You aren't likely to get Lyme disease if the tick has been attached to your skin for less than 48 hours. If you live in a wooded area, consider applying an acaricide to your yard in the spring. An acaricide is a chemical that kills ticks. Only use it outside, not on your clothes or body.
The first thing to do when you find a tick on your skin is: Don't panic. Using a pair of tweezers, grasp the tick body as close to your skin as possible. Pull in a steady upward motion until the tick comes out. Be careful not to squeeze the tick body. If any tick parts remain in the skin, try to carefully remove them the same way you would a splinter. Then wash the area and your hands with soap and water. Don't use the old methods of putting petroleum jelly, nail polish, kerosene, gasoline or matches on the tick to try to remove it.
After the tick is removed, watch the area and the rest of your skin over the next month for a rash. If you get a rash, see your doctor. Be sure to tell your doctor that you were bitten by a tick and when. Only people who get sick and/or get a rash after being bitten by a tick need antibiotics. If you are bitten by a tick and don't get sick or get a rash, you don't need antibiotics.
The best way to find out if you have Lyme disease is to talk to your family doctor about your symptoms. Blood tests aren't always necessary to make the diagnosis. People with early Lyme disease, who have been sick for less than a month, often haven't yet developed antibodies to the disease, which means they won't have a positive blood test.
The American College of Physicians released guidelines in December of 1997 recommending that blood tests only be done when there is likelihood of exposure and the clinical signs are consistent with the disease, not just aches and pains.
Also, if a person with early Lyme disease takes antibiotics, he or she may never have a positive Lyme disease test. Some people with early Lyme disease have a positive test that remains positive even after they take medicine for 30 days. Therefore, the test isn't very useful for checking you after treatment for Lyme disease.
The blood test is almost always positive in people who have been sick for over four weeks and who haven't taken antibiotics. People with joint swelling or nervous system disease may need to have special tests. Your doctor may recommend draining fluid from the swollen joint or the spinal canal to check for clues to your condition.
Lyme disease is treated with antibiotics. Early Lyme disease responds very well to treatment. In most cases, 30 days of treatment with an antibiotic kills the live bacteria in the body. It's important for you to take all the medicine your doctor prescribes to prevent the spread of Lyme disease to your joints, nervous system or heart. If you have problems with the medicine, don't quit taking it. Call your doctor and talk to him or her about your problems.
The earliest sign of Lyme disease is a rash, which appears one to 30 days after a tick bite. This rash, called erythema migrans (ear-a-theem-a my-granz), usually starts at the site of the tick bite. It may begin as a small red spot and grow larger. The center may fade, creating a "bull's eye," or ring appearance. Some people with Lyme disease have many red spots. The rash may burn, hurt or itch, or it may be unnoticed.
Some people with Lyme disease start to feel ill around the time they notice the rash. They may have fever, chills, headaches, stiff neck, fatigue, muscle aches and joint pain. In a few people, early Lyme disease can spread to the heart or the nervous system. If Lyme disease spreads to the heart, the person may feel an irregular or slow heart beat. Early spread of Lyme disease to the nervous system can cause the face to droop (a condition called Bell's palsy).
If Lyme disease isn't treated, it can spread to the rest of the body. The later symptoms of late Lyme disease include arthritis (painful, swollen joints) and nervous system problems. Lyme arthritis often affects only one of the large joints, such as the knee. Sometimes, it may affect more than one joint. The symptoms of the nervous system disorder of late Lyme disease may include trouble concentrating, loss of memory, muscle weakness, and tingling and numbness in the arms and legs. Lyme disease is a rare cause of such nervous system disease.
This information provides a general overview on Lyme disease and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the American Academy of Family Physicians and from Dr. Gilly’s Health Resource Directory.
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