Lymes Disease

Symptoms

By Mayo Clinic Staff

The signs and symptoms of Lyme disease vary and usually affect more than one system. The skin, joints and nervous system are affected most often.

Early signs and symptoms

These signs and symptoms may occur within a month after you've been infected:

· Rash. A small, red bump may appear at the site of the tick bite. This small bump is normal after a tick bite and doesn't indicate Lyme disease. However, over the next few days, the redness may expand forming a rash in a bull's-eye pattern, with a red outer ring surrounding a clear area. The rash, called erythema migrans, is one of the hallmarks of Lyme disease. Some people develop this rash at more than one place on their bodies.

· Flu-like symptoms. Fever, chills, fatigue, body aches and a headache may accompany the rash.

Later signs and symptoms

In some people, the rash may spread to other parts of the body and, several weeks to months after you've been infected, you may experience:

· Joint pain. You may develop bouts of severe joint pain and swelling. Your knees are especially likely to be affected, but the pain can shift from one joint to another.

· Neurological problems. Weeks, months or even years after you were infected, you may experience inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement.

Less common signs and symptoms

Several weeks after infection, some people develop:

· Heart problems, such as an irregular heartbeat. Heart problems rarely last more than a few days or weeks.

· Eye inflammation.

· Liver inflammation (hepatitis).

· Severe fatigue.

When to see a doctor

If you've been bitten by a tick and experience symptoms

Only a minority of deer tick bites leads to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease. If you think you've been bitten and experience signs and symptoms of Lyme disease — particularly if you live in an area where Lyme disease is prevalent — contact your doctor immediately. Treatment for Lyme disease is most effective if begun early.

 

See your doctor even if symptoms disappear
It's important to consult your doctor even if signs and symptoms disappear because the absence of symptoms doesn't mean the disease is gone. Left untreated, Lyme disease can spread to other parts of your body from several months to years after infection — causing arthritis and nervous system problems. Ticks also can transmit other illnesses, such as babesiosis and Colorado tick fever.

 

Preventing Tick Bites

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Reducing exposure to ticks is the best defense against Lyme disease, Rocky Mountain spotted fever, and other tickborne infections. You and your family can take several steps to prevent and control Lyme disease:

On people(https://www.cdc.gov/lyme/prev/on_people.html)

On pets(https://www.cdc.gov/lyme/prev/on_pets.html)

In the yard(https://www.cdc.gov/lyme/prev/in_the_yard.html)

Lyme disease vaccine(https://www.cdc.gov/lyme/prev/vaccine.html)

Information about natural tick repellents and pesticides(https://www.cdc.gov/lyme/prev/natural-repellents.html)

 

• • On people
  • On pets
  • In the yard
  • Lyme disease vaccine
  • Natural tick repellents & pesticides
• Tick removal and testing
• Transmission
• Signs and symptoms
  
  • Lyme disease rashes and look-alikes
  • Lyme disease stories
  • What you need to know about Lyme carditis
• Diagnosis and testing
  
  • Two-step laboratory testing process
    
    • Understanding the EIA test
    • Understanding the immunoblot test
  • Laboratory tests that are not recommended
  • HHS federal research updates on Lyme disease diagnostics
• Treatment
• Statistics
  
  • How many people get Lyme disease?
  • Surveillance explained
  • Lyme disease maps
  • Lyme disease data tables
  • Lyme disease graphs
  • MMWR reports
  • Case definition and report forms
• Post-treatment Lyme disease syndrome
• Lyme disease FAQ
• Health care providers
• Educational materials
• Why is CDC concerned about Lyme disease?

CDC Lyme Disease Home

#FighttheBite! DHS Encourages Residents to Take Action to Prevent Tick and Mosquito Bites

While many Wisconsin residents are more than ready to take advantage of the warmer weather and enjoy all the resources the state has to offer, the Department of Health Services (DHS) strongly encourages everyone to take care to avoid tick and mosquito bites.

Both ticks and mosquitoes can transmit various illnesses. Lyme disease, which is spread by ticks, and West Nile virus, which is transmitted by mosquitoes, account for most of the disease spread by ticks and mosquitoes in Wisconsin.

A recent report from the Centers for Disease Control and Prevention (CDC) shows Wisconsin among the top 20% of states reporting cases of tick-borne disease in the country. Wisconsin reported 4,299 cases of Lyme disease in 2017, the highest number reported in our state to date.

In addition, there were 51 human cases of West Nile virus reported in 2017, the highest number in Wisconsin since 2012. Certain dead birds can be an indication of West Nile virus in an area. DHS encourages anyone who finds a sick or dead bird to call the dead bird reporting hotline at 800-433-1610.

Many people consider ticks and mosquitoes to be an annoyance when they’re enjoying outdoor activities; however, both can make people sick . Yet, if people take simple precautions, they can enjoy the outdoors while avoiding serious illness.

Here are some things you can do to protect yourself from illnesses spread by mosquitoes and ticks:

• Use EPA-approved repellent (link is external) and apply according to label instructions.
• Wear light colored long-sleeved shirts and long pants.
• Use permethrin-treated clothing and gear.
• Take steps to control ticks on pets (link is external).
• Check for and safely remove ticks from family and pets.
• Take steps to control mosquitoes outside your home.

If you have not done so already, remove the tick(https://www.cdc.gov/lyme/removal/index.html) with fine-tipped tweezers.

The chances that you might get Lyme disease from a single tick bite depend on the type of tick, where you acquired it, and how long it was attached to you. Many types of ticks bite people in the U.S., but only blacklegged ticks(https://www.cdc.gov/lyme/transmission/index.html) transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in the highly endemic areas(https://www.cdc.gov/lyme/stats/index.html) of the northeastern and north central U.S. are commonly infected. Finally, blacklegged ticks need to be attached for at least 24 hours before they can transmit Lyme disease. This is why it's so important to remove them promptly and to check your body daily for ticks if you live in an endemic area.

If you develop illness within a few weeks of a tick bite, see your health care provider right away. Common symptoms(https://www.cdc.gov/lyme/signs_symptoms/index.html) of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so it's important to be alert for any illness that follows a tick bite.

 

There is no credible scientific evidence that Lyme disease is spread through sexual contact. Published studies in animals do not support sexual transmission (Moody 1991; Woodrum 1999), and the biology of the Lyme disease spirochete is not compatible this route of exposure (Porcella 2001). The ticks that transmit Lyme disease are very small and easily overlooked. Consequently, it is possible for sexual partners living in the same household to both become infected through tick bites, even if one or both partners doesn’t remember being bitten.

References:

Porcella SF, Schwan TG, 2001. Borrelia burgdorferi and Treponema pallidum: a comparison of functional genomics, environmental adaptations, and pathogenic mechanisms. J Clin Invest 107: 651-6.

Woodrum JE, Oliver JH, Jr., 1999. Investigation of venereal, transplacental, and contact transmission of the Lyme disease spirochete, Borrelia burgdorferi, in Syrian hamsters. J Parasitol 85: 426-30.

Moody KD, Barthold SW, 1991. Relative infectivity of Borrelia burgdorferi in Lewis rats by various routes of inoculation. Am J Trop Med Hyg 44: 135-9.

 

There are no reports of Lyme disease being spread to infants through breast milk. If you are diagnosed with Lyme disease and are also breastfeeding, make sure that your doctor knows this so that he or she can prescribe an antibiotic that’s safe for use when breastfeeding.

 

Although no cases of Lyme disease have been linked to blood transfusion, scientists have found that the Lyme disease bacteria can live in blood from a person with an active infection that is stored for donation. Individuals being treated for Lyme disease with an antibiotic should not donate blood. Individuals who have completed antibiotic treatment for Lyme disease may be considered as potential blood donors. The Red Cross provides additional information on the most recent criteria for blood donation.

 

No. Lyme disease is spread through the bite of a blacklegged tick (Ixodes scapularis or Ixodes pacificus) that is infected with Borrelia burgdorferi. In the United States, most infections occur in the following endemic areas:

• Northeast and mid-Atlantic, from northeastern Virginia to Maine
• North central states, mostly in Wisconsin and Minnesota
• West Coast, particularly northern California

Maps showing the distribution of human cases are based on where people live, which because of travel, is not necessarily where they became infected. Cases are sometimes diagnosed and reported from an area where Lyme disease is not expected, but they are almost always travel-related.

 

The lone star tick is primarily found in the southeastern and eastern United States. Lone star ticks do not transmit Lyme disease. However, you are correct to be concerned about this very aggressive species. The lone star tick (Amblyomma americanum) can spread human ehrlichiosis, tularemia, and Southern Tick-Associated Rash Illness (STARI).

The rash of STARI is a red, expanding “bull' s eye” lesion that develops around the site of a lone star tick bite. The rash usually appears within seven days of tick bite and expands to a diameter of 8 centimeters (3 inches) or more. The rash should not be confused with much smaller areas of redness and discomfort that can occur commonly at tick bite sites. Unlike Lyme disease, STARI has not been linked to arthritis, neurological problems, or chronic symptoms. Nevertheless, the similarity between the STARI bull’s eye rash and the Lyme disease bull’s eye rash has created much public confusion. The pathogen responsible for STARI has not been identified.

In contrast, Lyme disease in North America is caused by a specific type of bacteria, Borrelia burgdorferi, which is transmitted by two species of blacklegged ticks, Ixodes scapularis and Ixodes pacificus. While blacklegged ticks exist in the southern U.S., their feeding habits in this region make them much less likely to maintain, sustain, and transmit Lyme disease.

 

You may have heard that the blood test for Lyme disease(https://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html) is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon the stage of disease. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.

Several weeks after infection, currently available ELISA, EIA and IFA tests and two-tier testing have very good sensitivity.

It is possible for someone who was infected with Lyme disease to test negative because:

1. Some people who receive antibiotics (e.g., doxycycline) early in disease (within the first few weeks after tick bite) may not develop antibodies or may only develop them at levels too low to be detected by the test.
2. Antibodies against Lyme disease bacteria usually take a few weeks to develop, so tests performed before this time may be negative even if the person is infected. In this case, if the person is retested a few weeks later, they should have a positive test if they have Lyme disease. It is not until 4 to 6 weeks have passed that the test is likely to be positive. This does not mean that the test is bad, only that it needs to be used correctly.

 

If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately. Untreated Lyme disease during pregnancy may lead to infection of the placenta and possible stillbirth.

Thankfully, no serious effects on the fetus have been found in cases where the mother receives appropriate antibiotic treatment for her Lyme disease. In general, treatment for pregnant women with Lyme disease is similar to that of non-pregnant adults, although certain antibiotics, such as doxycycline, are not used because they can affect fetal development.

Additionally, there are no reports of Lyme disease transmission from breast milk.

 

Maybe. The blacklegged ticks that transmit Lyme disease can sometimes also transmit babesiosis and anaplasmosis. Fortunately, Lyme disease and anaplasmosis are treated with the same antibiotics, so if you are receiving treatment for Lyme disease, anaplasmosis will be treated at the same time (Wormser et al. 2006). Babesiosis is a parasitic disease that is treated with different medications. If your Lyme disease symptoms do not seem to be going away after taking antibiotics, see your health care provider.

There is, however, a great deal of misinformation regarding tickborne coinfections on the internet. The possibility of having three or more tickborne infections or having pathogens such Bartonella or Mycoplasma (which have not been shown to be tickborne), is extremely unlikely.

The chance of having multiple tickborne infections depends on your location. Several studies have looked at the prevalence of these different organisms in ticks, though methods and locations are very different. Studies have shown that the rate of coinfection in blacklegged ticks varies by region from 1 to 28%. The most common coinfection in ticks is Borrelia burgdorferi (Lyme disease) and Anaplasma phagocytophilum (anaplasmosis). The frequency of tickborne coinfections in Lyme disease patients from endemic areas ranges from 4 to 45% (Swanson et al. 2006). From 2 to 12% of patients with early Lyme disease may also have anaplasma infection, and 2 to 40% of patients with early Lyme disease may also have babesia infection, depending on the region (Wormser, 2006).

References:

Lantos PM, Wormser GP. Chronic coinfections in patients diagnosed with chronic Lyme disease: a systematic review. Am J Med. 2014 Nov;127(11):1105-10. Epub 2014 Jun 12.

Swanson, et al. Coinfections acquired from Ixodes ticks. Clin Microbiol Rev. 2006 Oct;19(4):708-27.

Wormser, Gary. Clinical practice. Early Lyme disease. N Engl J Med. 2006 Jun 29;354(26):2794-801.

Wormser 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.

 

Probably not. First, you should only have an immunoblot (such as an FDA-approved Western Blot or striped blot) test done if your blood has already been tested and found reactive with an EIA or IFA.

Second, the IgM Western Blot test result is only meaningful during the first four weeks of illness. If you have been infected for longer than 4 to 6 weeks and the IgG Western Blot is still negative, it is highly likely that the IgM result is incorrect (e.g., a false positive). This does not mean that you are not ill, but it does suggest that the cause of illness is something other than the Lyme disease bacterium. For more information, see the in-depth discussion regarding testing for Lyme disease.

As with many infectious diseases, there is no test that can “prove” cure. Tests for Lyme disease detect antibodies produced by the human immune system to fight off the bacteria (Borrelia burgdorferi) that cause Lyme disease. These antibodies can persist long after the infection is gone. This means that if your blood tests positive, then it will likely continue to test positive for months or even years even though the bacteria are no longer present.

A research tool called PCR can detect bacterial DNA in some patients. Unfortunately, this is also not helpful as a test of whether the antibiotics have killed all the bacteria. Studies have shown that DNA fragments from dead bacteria can be detected for many months after treatment. Studies have also shown that the remaining DNA fragments are not infectious. Positive PCR test results are analogous to a crime scene – – just because a robbery occurred and the robber left his DNA, it doesn' t mean that the robber is still in the house. Similarly, just because DNA fragments from an infection remain, it doesn' t mean the bacteria are alive or viable.

 

No. The tests for Lyme disease detect antibodies made by the immune system to fight off the bacteria, Borrelia burgdorferi. Your immune system continues to make the antibodies for months or years after the infection is gone. This means that once your blood tests positive, it will continue to test positive for months to years even though the bacteria are no longer present. Unfortunately, in the case of bacterial infections, these antibodies don't prevent someone from getting Lyme disease again if they are bitten by another infected tick.

 

No. Patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely. Most patients who are treated in later stages of the disease also respond well to antibiotics, although some may have suffered long-term damage to the nervous system or joints. It is not uncommon for patients treated for Lyme disease with a recommended 2 to 4 week course of antibiotics to have lingering symptoms of fatigue, pain, or joint and muscle aches at the time they finish treatment. In a small percentage of cases, these symptoms can last for more than 6 months. These symptoms cannot be cured by longer courses of antibiotics, but they generally improve on their own, over time.

 

WHAT IS NEW?

When enjoying time outdoors, it is important to be aware of ticks and take steps to protect yourself. View the short video on this page for tips on protecting yourself from Lyme disease. For more information on Lyme disease in your community (link is external), check out the Wisconsin Environmental Public Health Tracking Portal.

 

FACT SHEET ON OUR NEW WEBSITE

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