Lyme disease.

Last updated Thursday, December 23, 2004

Figure 1 - Common ticks are very small

Figure 2 - Expanding skin rash

Figure 3 - Rash with Lyme disease may look like a red ring with a clear center

About

Basics of lyme disease

Immediate medical attention

It is important to recognize the symptoms early and see your doctor to prevent more serious problems.

Early signs of Lyme disease may include a flu-like illness out of season, an expanding skin rash, and joint pain. If left untreated, Lyme disease can cause serious nerve or heart problems, as well as arthritis.

Incidence

People who live or work in or enter wooded or marshy areas are most at risk for Lyme disease. During spring and summer, these areas are home to a very tiny tick (see figure 1). Some of these ticks carry a kind of bacteria that causes Lyme disease. When the ticks bite people or pets, they can pass along this bacteria.

If you live or vacation in areas where ticks carry Lyme disease, it's important to:

1. avoid ticks,
2. recognize symptoms, and
3. seek medical care early.

Prevention

These are several things you can do to avoid tick bites, including:

1. wearing protective clothing
2. checking yourself, children, and pets for ticks
3. clearing away brushy or grassy areas near your home that attract ticks

The ticks that carry Lyme disease can be hard to spot. They are much smaller than the common dog tick. Immature ticks are about the size of a head on a common pin and are a little larger after they fill with blood.

The ticks go through cycles. They may feed on birds, chipmunks, white-footed mice, deer, cows, horses, cats, and dogs. They fall off these animals into tall grasses in marshes or fields or into brush in wooded areas. Then the ticks develop to their next life stage, and bite people and animals. Most people are bitten by immature ticks during spring and summer. Adult ticks are larger and can bite at other times of the year.

You can take steps to reduce your chances of getting bitten by ticks. When you go into wooded or marshy areas, wear long-sleeved shirts, long pants tucked into socks, and closed-toed shoes. Light-colored clothing makes ticks easier to spot. Shower when you come in from outdoors, and wash your clothes immediately. You may want to keep dogs and other family pets from roaming outside during times of the year when ticks are active.

Tick repellents may help protect you, but you should read the labels carefully before using them. Some should not touch skin and may only be safely used on clothing. Your veterinarian may suggest a tick collar or other repellent for your pet.

You can lower your chances of getting Lyme disease by inspecting yourself and your children for ticks when you come in from outdoors. Look closely at the hair, ears, underarms, trunk of the body, groin, and backs of the knees. Inspect your pets, too, before letting them indoors. Pets may carry ticks into the house that fall off and bite family members.

Even with the best precautions, you may find an attached tick. Remove it gently with a pair of tweezers. Be careful not to squeeze the body of the tick. Save the tick in a jar with a moist piece of tissue paper, if later identification by experts is needed. Wipe the skin near the bite with an antiseptic and wash your hands with soap and water.

Homeowners can help reduce the chances of having ticks in the yard. Clear brush and cut long grass near the house. Wood piles attract mice and should be placed away from the house. Bird feeders should be put at the edge of the yard.

Certain parts of the country have reported more cases of Lyme disease. These include the Northeast and Middle Atlantic states from Massachusetts to Virginia, the North Central States, and Northern California. Most states have reported cases. The disease is fairly common in many countries in Europe.

Initial symptoms

You are more likely to spot early signs or symptoms of Lyme disease, rather than see the tick or its bite, because the tick is very small. It's also easy to miss early symptoms of Lyme disease.

Early symptoms

In its early stage, Lyme disease may be a mild illness with symptoms like the flu, or it may appear as an expanding skin rash. The flu-like symptoms can include a stiff neck, chills, fever, swollen lymph nodes, headaches, fatigue, muscle aches, and joint pain. This flu-like illness usually occurs out of flu season, in the spring and summer when ticks bite.

Symptoms

The rash of Lyme disease is different from the small red area that often develops just around the bite from a common tick. Many people bitten by an infected tick develop a large, expanding skin rash around the area of the bite (see figure 2). Some people may get more than one rash. The rash may feel hot to the touch and is usually not painful. Rashes vary in size, shape, and color, but often look like a red ring with a clear center (see figure 3). The outer edges expand slowly in size.

It is easy to miss the connection between the rash and a tick bite. The rash develops from three days to as long as a month after a tick bite. Almost one third of people with Lyme disease never get the rash.

Joint pain

Joint or muscle pain may be another early sign of Lyme disease. These aches and pains may be easy to confuse with the pain that comes with other types of arthritis. Unlike many other types of arthritis, this pain seems to move or travel from joint to joint. It lasts only a short time in any one joint.

Progression

Later signs of Lyme disease:

• Problems with the nervous system
• Heart problems
• Arthritis, especially in knees

If you notice any of these signs, contact your doctor.

In later stages, Lyme disease may be confused with other medical problems. These problems can develop weeks to years after the first tick bite. For instance, Lyme disease can cause problems with the nervous system that look like other diseases. These include symptoms of stiff neck, severe headache, and fatigue, usually linked to acute viral meningitis. They may include drooping of the muscles on the face called Bell's palsy, or weakness, pain, or numbness elsewhere in the body. Lyme disease can also mimic symptoms of other chronic, disabling diseases of the nervous system. A small percentage of people may develop difficulty in thinking and mood disorders. Treatment is more difficult and less successful in later stages.

Lyme disease may cause other serious problems. It can cause heart problems, such as an irregular or slow heartbeat. Lyme disease can result in intermittent attacks of arthritis in a few large joints. A small percentage of people get a disabling, chronic type of arthritis that most often affects the knees. Researchers think the chronic arthritis of Lyme disease may be linked to how the body's defense or immune system responds to the infection.

It is important to watch for Lyme disease in pets, such as dogs, and farm animals, such as horses and cows. A fever, swollen joints, poor appetite, lameness that comes and goes, or a reluctance to move may be the first clues that infected ticks are in your area. If you notice any of these signs in your pet, see your veterinarian.

Diagnosis

Early treatment of Lyme disease symptoms with antibiotics can prevent the more serious medical problems of later stages.

If you suspect that you have symptoms of Lyme disease, contact your doctor. If you are pregnant and notice warning signs, see your doctor as soon as possible.

It may take your doctor some time to diagnose Lyme disease. It may look like so many other illnesses, including the flu and arthritis. To diagnose Lyme disease, your doctor may ask about the history of your symptoms, examine you, and conduct laboratory tests.

Early, uncomplicated Lyme disease can be treated with antibiotics. Different types of antibiotics are used in adults and in children. Your doctor can tell you which antibiotics are currently recommended for Lyme disease. Sometimes symptoms come back after treatment. If this happens, it is important to see your doctor.

Resources

You can turn to your doctor, the Centers for Disease Control and Prevention, your health department, or extension service for more information on Lyme disease.

You can get recorded information on Lyme disease by calling the Centers for Disease Control and Prevention (CDC) at 404-332-4555. CDC provides information on Lyme disease to health professionals and the public. CDC also works with the state health departments to track cases of Lyme disease.

Your state or local health department can tell you if Lyme disease has been reported in your area. Your doctor should also report cases of Lyme disease to the health department.

Your county agricultural extension service can advise you on where ticks may be found in your area. They may also be able to supply more information about repellents, treating pets, and the use of insecticides for tick control.

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

Adapted from a pamphlet originally prepared for the Arthritis Foundation. This material is protected by copyright.