• Lyme Disease

    Definition

    Lyme disease is a bacterial infection. The infection is spread from the bite of an infected deer tick.

    Causes

    Lyme disease is caused by bacteria found in some deer ticks. An infected tick passes Lyme disease to humans through its bite.
    If untreated, the bacteria can pass into the blood. The blood will carry it through the body. The bacteria may then settle in various body tissues. The spread of the infection can cause a number of symptoms, ranging from mild to severe.

    Risk Factors

    Factors that increase your risk of Lyme disease include:
      Living in the northeastern, northwestern, mid-Atlantic, or upper north-central regions of the United States and northwestern California
      • Peak tick season in the northeast is April through September
    • Outdoor activities, such as hiking, camping, and gardening in areas/seasons with deer ticks
    • Living near or going to wooded, grassy areas
    • Working outdoors such as surveying, landscaping, forestry, gardening, and utility company service work

    Symptoms

    The symptoms of Lyme disease will be different in each person. They can also range from mild to severe.
    The first sign may be a red rash. The rash starts as a small red spot at the site of the tick bite. It will then spread over the next few days or weeks to form a circular or oval-shaped rash. Sometimes the rash resembles a bull's eye with a red ring around a clear area with a red center. The rash may cover a small dime-sized area or a wide area of the body.
    Lyme Disease Rash
    IMAGE
    This is an example of a Lyme disease rash shaped like a bull's eye. It may not always be this shape, nor will a rash always appear.
    Copyright © Nucleus Medical Media, Inc.

    Early Infection

    In the first 3-30 days after the bite, if the infection has not spread you may notice:
    • Rash
    • Muscle and joint aches
    • Headache
    • Fever
    • Fatigue
    • Swollen glands
    These symptoms do not necessarily mean you have Lyme disease, even if you have spent time outdoors. See your doctor right away if you have these symptoms and think you have been exposed to a tick.

    Early Disseminated Infection

    An infection that has begun to spread may cause the following symptoms in days to weeks after the bite:
    • Multiple lesions
    • Persistent headache, stiff neck
    • Diffuse numbness, tingling, burning
    • Intermittent joint pain and swelling
    • Impaired motor coordination
    • Irregular heart rhythm
    • Muscle pain and swelling
    • Facial paralysis (Bells palsy)

    Late Infection

    Symptoms can develop in months or years after the tick bite in untreated infections. These symptoms may occur regularly or intermittently and include:
    • Painful inflammation of the joints (arthritis)
    • Trouble with concentration or memory
    • Shooting pains, numbness, and tingling
    Less common symptoms of late Lyme disease include:
    • Heart abnormalities
    • Eye problems, such as conjunctivitis
    • Chronic skin disorders
    • Limb weakness
    • Persistent motor coordination problems

    Diagnosis

    A doctor may be able to diagnose Lyme disease based on your symptoms and the history of a tick bite.
    After four weeks of Lyme disease, your body may create antibodies against the infection. Your doctor may look for these antibodies with a blood test. The blood test cannot confirm or rule out Lyme disease. Instead, the results of the blood test will be used in combination with your symptoms and personal history to make a diagnosis.

    Treatment

    Lyme disease responds well to antibiotics. These medications can kill bacteria. Antibiotics used most often include:
    • Doxycycline—cannot be used in women who are pregnant or children under 8 years of age
    • Amoxicillin—can be used in women who are pregnant or children under 8 years of age
    • Cefuroxime
    The length of your antibiotic treatment will depend on your condition. You may need to take them for 10 days to 3 weeks or more. You may be given the antibiotics by mouth or by injection.
    To relieve pain from chronic arthritis you doctor may recommend:
      Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • Ibuprofen (Advil, Genpril, Medipren, Motrin, Nuprin, Rufen)
      • Naproxen sodium (Aleve, Anaprox, Naprosyn)
    • Steroid injection directly into the joint

    Prevention

    Try the following to help prevent Lyme disease:

    Outdoors

    If you live or are visiting northeastern, northwestern, mid-Atlantic, or upper north-central regions of the United States and northwestern California:
    • Avoid areas that are likely to be infested with deer ticks such as moist, shaded, wooded, or grassy areas
    • When going to wooded, grassy areas, especially in spring and summer:
      • Wear light-colored clothing with a tight weave to spot ticks easily.
      • Wear enclosed shoes.
      • Wear a long sleeve shirt. Tuck it into your pants.
      • Tuck pants into socks or boot tops.
      • Wear a hat.
    • Stay on cleared, well-traveled paths and walk in the center of trails to avoid overgrown grass and brush. Avoid sitting on the ground or stone walls.
    • Remove leaf litter, brush, and woodpiles from around the home and the edges of the yard.
    Insect repellent can help prevent tick bites. Repellents containing DEET can be applied to clothes and exposed skin. Repellents that have permethrin can be applied to pants, socks, and shoes, but not to skin. Repellents can cause eye irritation and skin reactions. Be sure to read the label for instructions on application, including:
    • Do not apply near eyes, nose, or mouth.
    • Do not apply to children's hands.
    • Wash your skin when you return indoors.

    Tick Management

    Deer ticks are unlikely to pass the infection unless they are in contact with the skin for at least 24 hours. After spending time outdoors in risk area:
    • Do a full-body check for ticks at the end of a day spent outdoors. Consider bathing or showering within 2 hours of coming indoors.
    • Check your child for ticks. Make sure to check for hidden areas like the hair, around the ears, or behind the knees.
    • Check pets and gear for ticks.
    • Put clothes worn outdoors in the dryer for 20 minutes. This will kill any unseen ticks.
    If you do find a tick, remove it by doing the following:
    • Use a pair of tweezers to grasp the tick by the head, as close to the skin as possible.
    • Pull directly outward. Use gentle but firm forces. Do not twist the tick out. Try not to crush the tick's body or handle it with bare fingers. This can spread the infection.
    • Wipe the site with an antiseptic to prevent infection.
    There are some steps that do not help. They may cause more problems.
    • Do not put a hot match to the tick.
    • Do not cover the tick with petroleum jelly, nail polish, or any other substances.
    If you have been bitten by a deer tick, especially if you live in an area where Lyme disease is common, you should watch for a rash to appear. It may take about one month after the bite for the rash to show.

    Medication

    If you have a tick bite and live in a high-risk area, your doctor may recommend a dose of the antibiotic doxycycline. This may reduce the risk of contracting Lyme disease if taken within 72 hours after a tick bite. However, this antibiotic can have serious side effects in children less than 8 years old. This prevention step is only used in people older than 8 years.
    The risk of catching Lyme disease after a single tick bite is low. Many experts do not recommend preventive antibiotic treatment.

    RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    Lyme Disease Foundation http://www.lyme.org

    CANADIAN RESOURCES

    Communicable Disease Control http://www.gov.mb.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    Diaz JH. The diagnosis, management, and prevention of common ectoparasitic infections. J La State Med Soc. 2006;158:90-98.

    Loewen PS, Marra CA, et al. Systematic review of the treatment of early Lyme disease. Drugs. 1999;57:157-173.

    Lyme disease. Centers for Disease Control and Prevention (CDC). Available at: http://www.cdc.gov/lyme. Updated July 26, 2012. Accessed September 26, 2012.

    Lyme disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated June 29, 2012. Accessed September 26, 2012.

    Lyme disease. lymedisease.org. Available at: http://www.lymedisease.org/lyme101/lyme%5Fdisease/lyme%5Fdisease.html. Accessed September 26, 2012.

    Lyme disease. National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/lymedisease/Pages/lymeDisease.aspx. Updated March 29, 2011. Accessed September 26, 2012.

    Lyme disease. American Academy of Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/lyme-disease.html. Updated January 2010. Accessed September 26, 2012.

    Nadelman RB, Nowakowski J, et al. Prophylaxis with single dose doxycycline for the prevention of Lyme disease after an Ixodes Scapularis tick bite. N Engl J Med. 2001;345:79-84.

    Weiner HR. Lyme disease: questions and discussion. Compr Ther. 2006;32:17-19.

    Wormser GP, Dattwyler RJ, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089-1134.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Warshafsky S, Lee DH, Francois LK, Nowakowski J, Nadelman RB, Wormser GP. Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis. J Antimicrob Chemother. 2010;65(6):1137-1144.

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