Healthy Living

Lyme Disease: The Top 10 Questions

  • Lyme disease is known as “The Great Imitator”, since its symptoms imitate many other conditions. It can affect any organ in the body, including the nervous system, brain, heart, joints, and muscles.
  • Many people who have been diagnosed during the disease's early stages are given oral medication for at least two to three weeks, while people with more severe symptoms such as neurological impairment might require intravenous antibiotics.
  • The most common symptom of Lyme disease is a rash which resembles a bull’s-eye. This rash is known as erythema migrans. It occurs in 70 to 80 percent of individuals infected by a tick bite.

1 What is Lyme disease?

Lyme disease is a type of bacterial infection that is spread to humans by ticks. It is mainly spread by Ixodes ticks or deer ticks and black-legged ticks. These tiny arachnids are usually found in grassy and wooded areas.

Lyme disease

This disease is caused by a spirochete (corkscrew-shaped) bacterium called Borrelia burgdorferi. Lyme disease is known as “The Great Imitator”, since its symptoms imitate many other conditions. It can affect any organ in the body, including the nervous system, brain, heart, joints, and muscles.

Lyme disease and its symptoms can usually be treated and managed effectively if it is detected early on. However, if it is not treated or treatment is delayed, there's a risk that the patient could develop severe and long-lasting symptoms.

2 Who are most at risk of Lyme disease? 

Lyme disease affects people of all ages, although it is most commonly seen in children and older adults. People who work as park rangers and firefighters, who spend most of their time outdoors, are also more vulnerable to the disease since the nature of their work exposes them more often to ticks.

3 How long can you have Lyme disease and not know it?

It could take some time before you know you have Lyme disease. First of all, people usually have no idea that they have been bitten by a tick, since the ticks that spread the disease are small and difficult to see. Thus, a person who has been bitten and infected may not seek medical treatment until symptoms develop.

Secondly, Lyme disease can be difficult to diagnose. Many of the symptoms of Lyme disease mimic those of other conditions such as the flu. 

Thirdly, the symptoms of Lyme disease usually begin appearing between 3 and 30 days. The incubation time can cause confusion regarding the symptoms. The long incubation period often leads to confusing the symptoms with those pointing to other conditions, such as the flu. This is because people are often unaware of or don’t remember having been bitten, or if they do know or remember, do not associate their symptoms with it. If people don’t remember being bitten, they may think that they merely have the flu.

People bitten by ticks realize that they might have Lyme disease only when the rash that goes with it has started to appear (assuming they know about this tell-tale symptom of Lyme disease).

4 Why is Lyme disease often difficult to diagnose?

Being "The Great Imitator", diagnosing Lyme disease can be difficult, and people with Lyme disease are usually misdiagnosed as having other conditions such as chronic fatigue syndrome, multiple sclerosis, fibromyalgia, and various psychiatric disorders such as depression. An incorrect diagnosis of Lyme disease delays the sufferer's getting the right treatment, and the underlying infection progresses unchecked.

Diagnosis can difficult as blood tests may not always detect a positive case. It is recommended that the patient in a suspected case of Lyme disease undergo two types of blood tests, namely, the enzyme immunoassay (EI) and the western blot. When both of these tests are positive, a physician is then able to confirm the diagnosis of Lyme disease.

The accuracy of the tests will depend on the stage of the disease at the time a person is tested. A few weeks right after infection, tests are expected to yield negative results. Thus, the best time to test for Lyme disease is several weeks after the infection starts as this is when the tests are most accurate.

5 Is there a cure for Lyme disease?

Yes, there is a cure for Lyme disease. It is often managed effectively when the disease is detected during its early stages.

Patients who are given with the right antibiotics during the early phases of Lyme disease normally recover quickly and completely. Many people who have been diagnosed during the disease's early stages are given oral medication for at least two to three weeks, while people with more severe symptoms such as neurological impairment might require intravenous antibiotics. The antibiotics that are usually used for oral treatment are amoxicillin, doxycycline, and cefuroxime axetil. On the other hand, patients with certain cardiac or neurological types of disease may need intravenous treatment with medications like ceftriaxone or penicillin.

Treatment for advanced Lyme disease, meanwhile, could run for several weeks, months, or more.

A small number of people continue to have some symptoms after treatment. These often include muscle aches and fatigue. The cause of these continuing symptoms, known as post-treatment Lyme disease syndrome, is unknown, and antibiotic treatment doesn't help. Some experts think that some people who get Lyme disease are prone to developing an autoimmune response that contributes to their continued symptoms. People with post-treatment Lyme disease are prescribed medications for fatigue and pain, and advised to undertake stress-reduction methods including deep breathing or yoga and talk therapy to manage their symptoms.

6 What happens if Lyme disease goes untreated?

Untreated Lyme disease could manifest in a variety of symptoms, depending on the stage the infection is. Among the symptoms are fever, rash, arthritis, and facial paralysis.  

Early Symptoms (3 to 30 days after the tick bite)

  • Fever, chills, fatigue, headache, swollen lymph nodes, joint pain, and muscle aches
  • Erythema migrans (EM) rash
    • Occurs in about 70 to 80 percent of people with the infection
    • Starts in the area of the tick bite after a delay of 3 to 30 days, with an average of 7 days
    • Spreads out gradually within a few days, with the surface areas reaching up to 12 inches or more
    • Warm to the touch but not painful or itchy
    • It sometimes clears up as it becomes enlarged, resulting in a “bull's-eye” appearance
    • May appear on various parts of the body

Later Symptoms (days to months after the tick bite)

  • Severe neck stiffness and headaches
  • Arthritis with swelling and severe joint pain
  • Additional EM rashes on other regions of the body
  • Facial palsy
  • Heart palpitations (Lyme carditis)
  • Short-term memory problems
  • Shooting pains, tingling, or numbness in the hands or feet
  • Brain and spinal cord inflammation
  • Episodes of dizziness
  • Nerve pain

A person should seek medical help if any of the above symptoms are observed and acquired after tick bite.

7 Can you get Lyme disease from a pet or bed bugs?

Most individuals get Lyme disease from the bite of an immature tick, called a nymph. Nymphs are just a bit smaller than the size of a poppy seed, which is less than 2 mm, and therefore difficult to see. Nymphs feed during the summer and spring months. Many people don't know they have been bitten because these ticks are so small and their bites do not cause pain. Meanwhile, adult ticks can also pass on Lyme disease bacteria; however, these ticks are much larger and easier to spot, and thus are removed before they can transmit the bacteria. These ticks are usually active during the cooler months of the year.

Ticks can attach themselves to any region of the body and are usually found in areas like the armpits, scalp, and groin. In almost all cases, the tick must be attached to the host for at least 36 to 48 hours before the bacterium is transmitted.

Dogs and cats get Lyme disease, although there is no direct evidence that they can spread the disease directly to humans. However, pets can and do bring infected ticks into the home and yard.

8 What should you do if you have been bitten by a tick?

The first thing to do is remove the tick properly. Any inappropriate removal of the tick, such as by squeezing it, holding a hot match to it, or applying a Vaseline or oil on it will only increase the possibility of it transmitting bacteria to you. The tick must be removed by using fine pointed tweezers to grasp it from the side where it meets the skin (rather than pulling it off upward) and then gently pulling it in the direction opposite to that in which it is embedded.

The longer the tick is attached to the skin, the higher the risk of Lyme bacteria transmission and infection. However, there is still a chance of getting Lyme disease even if the tick is attached for less than 24 hours.

When the tick is removed, it is a good idea to keep it in case you want to get it tested for Lyme or other pathogens. Also, the doctor may want to see the tick and check whether it is the kind of tick that causes Lyme disease.

If an individual is bitten by the tick that carries Lyme disease, also called deer tick, the physician will recommend one of these two approaches:

  • Observe if signs and symptoms of infection develop and then respond accordingly
  • Immediately initiate preventive treatment

9 How soon after the tick bite do you start to experience the rash or other symptoms of Lyme disease?

Symptoms of Lyme disease can begin at any time between 3 and 30 days after infection. The most common symptom of Lyme disease is a rash which resembles a bull’s-eye. This rash is known as erythema migrans. It occurs in 70 to 80 percent of individuals infected by a tick bite. The part that is directly around the tick bite might be red, raised, and may appear like the usual bug bite. In addition, the rash is in a circular pattern with its outer ring darker than the center. Note, though, that not all people who get Lyme disease get this type of rash.

Early Signs of Lyme Disease Are:

  • headache
  • muscle aches
  • fever
  • fatigue

Other individuals with Lyme disease suffer more advanced symptoms of the disease. Joint pain and stiff neck might happen in the early stages up to several months after the tick bite. Severe headaches as well as shooting pains in the body may also occur. In addition, dizziness and changes in the heart rate are advanced symptoms of Lyme disease.

10 Can a person get Lyme disease twice?

A person can get Lyme disease again regardless of whether he has had it previously, and irrespective of whether the disease was managed with antibiotics and the person recovered. If a person is again exposed to the bacteria through another tick bite he can be re-infected and will again require treatment. If the individual develops symptoms after the initial treatment and recovery, he should see the doctor to confirm whether it is a new infection or the symptoms from the previous infection have recurred. However, with Lyme disease, it can be difficult to differentiate whether the symptoms are due to a new infection or the previous one.

If the person was not exposed again to tick bites, it might be a recurrence of symptoms which can be the result of either another unrelated illness, a Borrelia-triggered immune mediated symptom complex, or a re-emergence of the first infection that had been only partially treated.

In most cases of Lyme disease, a single erythema migrans rash and fever can be a sign of a new acute infection. However, some people experience recurrent erythema migrans rashes, also referred to as satellite rashes, which may come about later in the course of the disease.