Lyme Disease Causes, Symptoms, Diagnosis, Treatment, Prevention

Lyme Disease Causes, Symptoms, Diagnosis, Treatment, Prevention


What is Lyme disease? What causes Lyme disease? 


Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, Connecticut. Other clinical symptoms and environmental conditions suggested that this was an infectious disease probably transmitted by an arthropod. Further investigation revealed that Lyme disease is caused by the bacterium, Borrelia burgdorferi. These bacteria are transmitted to humans by the bite of infected deer ticks and cause more than 16,000 infections in the United States each year.

Lyme Disease Causes, Symptoms, Diagnosis, Treatment, Prevention
Lyme Disease

Black-legged ticks ( Ixodes scapularis) are responsible for transmitting Lyme disease bacteria to humans in the northeastern and north-central United States. On the Pacific Coast, the bacteria are transmitted to humans by the western black-legged tick (Ixodes pacificus). Ixodes ticks are much smaller than common dog and cattle ticks. In their larval and nymphal stages, they are no bigger than a pinhead. Ticks feed by inserting their mouths into the skin of a host and slowly take in blood. Ixodes ticks are most likely to transmit infection after feeding for two or more days.

Individuals who live or work in residential areas surrounded by tick-infested woods or overgrown brush are at risk of getting Lyme disease. Persons who work or play in their yard, participate in recreational activities away from home such as hiking, camping, fishing and hunting, or engage in outdoor occupations, such as landscaping, brush clearing, forestry, and wildlife and parks management in endemic areas may also be at risk of getting Lyme disease.

Read more: Lymphangioleiomyomatosis (LAM) Causes, Symptoms, Diagnosis, Treatment

What Are the Symptoms of Lyme Disease?


In the early stages of Lyme disease, you may experience flu-like symptoms that can include a stiff neck, chills, fever, swollen lymph nodes, headaches, fatigue, muscle aches, and joint pain. You also may experience a large, expanding skin rash around the area of the tick bite. In more advanced disease, nerve problems and arthritis, especially in the knees, may occur.

Erythma migrans


Lyme Disease Causes, Symptoms, Diagnosis, Treatment, Prevention
Lyme Disease

Erythema migrans is the telltale rash which occurs in about 70% to 80% of cases and starts as a small red spot that expands over a period of days or weeks, forming a circular, triangular, or oval-shaped rash. Sometimes the rash resembles a bull's-eye because it appears as a red ring surrounding a central clear area. The rash, which can range in size from that of a dime to the entire width of a person's back, appears between three days and a few weeks of a tick bite, usually occurring at the site of a bite. As infection spreads, several rashes can appear at different sites on the body.

Erythema migrans is often accompanied by symptoms such as fever, headache, stiff neck, body aches, and fatigue. These flu-like symptoms may resemble those of common viral infections and usually resolve within days or a few weeks.

Arthritis


After several weeks of being infected with Lyme disease, approximately 60% of those people not treated with antibiotics develop recurrent attacks of painful and swollen joints that last a few days to a few months. The arthritis can shift from one joint to another; the knee is most commonly affected and usually one or a few joints are affected at any given time. About 10% to 20% of untreated patients will go on to develop lasting arthritis. The knuckle joints of the hands are only very rarely affected.

Neurological symptoms


Lyme disease can also affect the nervous system, causing symptoms such as stiff neck and severe headache (meningitis), temporary paralysis of facial muscles (Bell's palsy), numbness, pain or weakness in the limbs, or poor coordination. More subtle changes such as memory loss, difficulty with concentration, and a change in mood or sleeping habits have also been associated with Lyme disease. People with these latter symptoms alone usually don't have Lyme disease as their cause.

Nervous system abnormalities usually develop several weeks, months, or even years following an untreated infection. These symptoms often last for weeks or months and may recur. These features of Lyme disease usually start to resolve even before antibiotics are started. Patients with neurologic disease usually have a total return to normal function.

Heart problems


Fewer than one out of 10 Lyme disease patients develops heart problems, such as an irregular, slow heartbeat, which can be signaled by dizziness or shortness of breath. These symptoms rarely last more than a few days or weeks. Such heart abnormalities generally appear several weeks after infection, and usually begin to resolve even before treatment.

Other symptoms


Less commonly, Lyme disease can result in eye inflammation and severe fatigue, although none of these problems is likely to appear without other Lyme disease symptoms being present.

Lyme disease imitates a variety of illnesses and its severity can vary from person to person. If you have been bitten by a tick and live in an area known to have Lyme disease, see your doctor right away so that a proper diagnose can be made and treatment started.

How is Lyme disease diagnosed?


In early Lyme disease, doctors can sometimes make a diagnosis simply by finding the classic red rash (described above), particularly in people who have recently been in regions in which Lyme disease is common. The doctor might review the patient's history and examine the patient in order to exclude diseases with similar findings in the joints, heart, and nervous system. Blood testing for antibodies to Lyme bacteria is generally not necessary or helpful in early stage disease, but it can help in diagnosis in later stages. (Antibodies are produced by the body to attack the bacteria and can be evidence of exposure to the bacteria. These antibodies can be detected using a laboratory method called an enzyme-linked immunosorbent assay [ELISA].) Antibodies, however, can be false indicators of disease, since they can persist for years after the disease is cured. Moreover, false-positive tests in patients with nonspecific findings (those that are not specifically suggestive of Lyme disease) can lead to confusion. Currently, the confirmatory test that is most reliable is the Western Blot assay antibody test. More accurate tests are being developed.

Generally, Lyme blood testing is helpful in a patient who has symptoms compatible with Lyme disease, who has a history of a tick bite at least a month prior, or who has unexplained disorders of the heart, joints, or nervous system that are characteristic of Lyme disease.

How Is Lyme Disease Treated?


Most cases of Lyme disease are curable with antibiotics. This is so true that some authors of Lyme disease research have stated that the most common cause of lack of response of Lyme disease to antibiotics is a lack of Lyme disease to begin with! The type of antibiotic depends on the stage of the disease (early or late) and what areas of the body are affected. Early illness is usually treated with medicines taken by mouth, for example, doxycycline (Vibramycin), amoxicillin (Amoxil), or cefuroxime axetil (Ceftin). Of note, doxycycline should not be used in pregnancy or in children under 8 years of age.

Therefore, if a person finds a typical bull's-eye skin rash (described above) developing in an area of a tick bite, they should seek medical attention as soon as possible. Generally, antibiotic treatment resolves the rash within one or two weeks with no long-term consequences. Later illness such as nervous-system disease might require intravenous drugs; examples are ceftriaxone (Rocephin) and penicillin G.

For the relief of symptoms, pain-relieving medicines might be added. Swollen joints can be reduced by the doctor removing fluid from them (arthrocentesis). An arthrocentesis is a procedure whereby fluid is removed from a joint using a needle and syringe under sterile conditions. It is usually performed in a doctor's office. Rarely, even with appropriate antibiotics, the arthritis continues. It has been suggested by researchers that sometimes joint inflammation can persist even after eradication of the Lyme bacteria. This has been explained as an ongoing autoimmune response causing inflammation of the joint that was initially stimulated by the original bacterial infection. The doctor also can use oral medications such as ibuprofen (Motrin, Nuprin) to reduce inflammation and improve function.

Following treatment for Lyme disease, some people still have persistent fatigue and achiness. This general malaise can take months to slowly disappear, although it generally does so spontaneously without the use of additional antibiotic therapy. There is no evidence that the Borrelia infection causes chronic fatigue syndrome or fibromyalgia. Although some patients with Lyme disease may develop these problems, as with other patients who get chronic fatigue or fibromyalgia, long-term antibiotics will not hasten recovery.

How Can I Prevent Getting Lyme Disease? Home remedies for Lyme Disease


Fortunately, the cause of Lyme disease is known and the disease can be prevented. Essential to prevention is the avoidance of deer ticks. Although generally only about one percent of all deer ticks are infected with the Lyme disease bacterium, in some areas more than half of them harbor the microbe.

Most people with Lyme disease become infected during the late spring, summer, and early fall when immature ticks are out looking for their meal. Except in warm climates, few people are bitten by deer ticks during winter months.

Deer ticks are most often found in wooded areas and nearby grasslands, and are especially common where the two areas merge, including neighborhood yards where deer occasionally roam. Ticks do not survive long on sunny lawns, they dry out quickly and die.

Try these tips to prevent tick bites:

  • Wear long sleeves and tightly woven clothing that is light in color when walking in wooded areas so the ticks can be seen more easily.
  • Wear your shirt tucked into your pants, and your pants tucked into your socks or boots.
  • Walk in the center of trails through the woods to avoid picking up ticks from overhanging grass and brush.
  • Keep grass trimmed as short as possible.
  • Apply tick repellents with DEET to your clothing, shoes and socks before going out. Another tick repellent called permethrin, designed to be placed on the clothing can be used alone or in combination with DEET. (Although highly effective, these repellents can cause some serious side effects, particularly when high concentrations are used repeatedly on the skin. Infants and children may be especially at risk for adverse reactions.)
  • Check yourself, your family, and your pets routinely for ticks, especially after a trip outdoors.
  • Shower and shampoo your hair if you think you may have been exposed to ticks.
  • Check your clothes for ticks and wash them immediately in order to remove any ticks.

If an infected tick bites, it will not transmit the infection until it has had the opportunity to have its blood meal. This takes time, thus there is value in inspecting your body after outdoor activities in areas where Lyme disease is known to occur. Newly attached ticks can be easily removed before they transmit the infection.

Pregnant women should be especially careful to avoid ticks in Lyme disease areas because the infection can be transferred to the unborn child. Such a prenatal infection can make the woman more likely to miscarry.

Preventative antibiotics are not generally used following all tick bites, but may be used in some special circumstances; a recent study showed that such preventive use of antibiotics is very effective.

If you are bitten by a tick, the best way to remove it is by taking the following steps:

  • Tug gently but firmly with blunt tweezers near the "head" of the tick until it releases its hold on the skin
  • To lessen the chance of contact with the bacterium, try not to crush the tick's body or handle the tick with bare fingers
  • Swab the bite area thoroughly with an antiseptic to prevent infection
  • DO NOT use kerosene, Vaseline, fingernail polish, or a cigarette butt
  • DO NOT squeeze the tick's body with your fingers or tweezers.

Prevention and Control for Lyme Disease


Avoid tick habitats


Whenever possible, avoid entering areas that are likely to be infested with ticks, particularly in spring and summer when nymphal ticks feed. Ticks favor a moist, shaded environment, especially areas with leaf litter and low-lying vegetation in wooded, brushy or overgrown grassy habitat. Both deer and rodent hosts must be abundant to maintain the enzootic cycle of B. burgdorferi. Sources for information on the distribution of ticks in an area include state and local health departments, park personnel, and agricultural extension services.

Use personal protection measures: 


If you are going to be in areas that are tick infested, wear light-colored clothing so that ticks can be spotted more easily and removed before becoming attached. Wearing long-sleeved shirts and tucking pants into socks or boot tops may help keep ticks from reaching your skin. Ticks are usually located close to the ground, so wearing high rubber boots may provide additional protection. 

The risk of tick attachment can also be reduced by applying insect repellents containing DEET (n,n-diethyl-m toluamide) to clothes and exposed skin, and applying permethrin (which kills ticks on contact) to clothes. DEET can be used safely on children and adults but should be applied according to Environmental Protection Agency (EPA) guidelines to reduce the possibility of toxicity.

Lyme Disease Causes, Symptoms, Diagnosis, Treatment, Prevention
remove attached ticks

Perform a tick check and remove attached ticks: 


The transmission of B. burgdorferi (the bacteria that causes Lyme disease) from an infected tick is unlikely to occur before 36 hours of tick attachment. For this reason, daily checks for ticks and promptly removing any attached tick that you find will help prevent infection. Embedded ticks should be removed using fine-tipped tweezers. DO NOT use petroleum jelly, a hot match, nail polish, or other products. Grasp the tick firmly and as closely to the skin as possible. With a steady motion, pull the tick's body away from the skin. The tick's mouthparts may remain in the skin, but do not be alarmed. The bacteria that cause Lyme disease are contained in the tick's midgut or salivary glands. Cleanse the area with an antiseptic.

Taking preventive antibiotics after a tick bite: 


The relative cost-effectiveness of post-exposure treatment of tick bites to avoid Lyme disease in endemic areas (areas where the disease is known to occur regularly) is dependent on the probability of B. burgdorferi infection after a tick bite. In most circumstances, treating persons who only have a tick bite is not recommended. Individuals who are bitten by a deer tick should remove the tick promptly, and may wish to consult with their health care provider. Persons should promptly seek medical attention if they develop any early signs and early Lyme disease symptoms, ehrlichiosis, or babesiosis.

Strategies to reduce tick abundance: 


The number of ticks in endemic residential areas may be reduced by removing leaf litter, brush- and wood-piles around houses and at the edges of yards, and by clearing trees and brush to admit more sunlight and reduce the amount of suitable habitat for deer, rodents, and ticks. Tick populations have also been effectively suppressed through the application of pesticides to residential properties. Community-based interventions to reduce deer populations or to kill ticks on deer and rodents have not been extensively implemented, but may be effective in reducing the community-wide risk of Lyme disease. New approaches such as deer feeding stations equipped with pesticide applicators to kill ticks on deer, and baited devices to kill ticks on rodents, are currently under evaluation.