When To Call Your Doctor
Erythema migrans is a hallmark symptom of Lyme disease. If you think you might have been bitten by a tick and youve developed a circular rash, call your doctor as soon as possible. Medical attention is particularly important if you have other symptoms of early-stage Lyme disease, which are usually flu-like.
If left untreated, Lyme disease can cause:
- joint inflammation and pain
- facial palsy
- dizziness
- short-term memory loss
If treated early, Lyme disease can almost always be cured. Call your doctor as soon as you see erythema migrans.
Lyme Disease Frequently Asked Questions
If you have not done so already, remove the tick 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 transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in the highly endemic areas 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 its 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 of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so its important to be alert for any illness that follows a tick bite.
References:
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 thats safe for use when breastfeeding.
Can Lyme Disease Be Prevented
To prevent Lyme disease, you should lower your risk of getting a tick bite:
- Avoid areas where ticks live, such as grassy, brushy, or wooded areas. If you are hiking, walk in the center of the trail to avoid brush and grass.
- Use an insect repellent with DEET
- Treat your clothing and gear with a repellant containing 0.5% permethrin
- Wear light-colored protective clothing, so you can easily see any ticks that get on you
- Wear a long-sleeve shirt and long pants. Also tuck your shirt into your pants and your pant legs into your socks.
- Check yourself, your children, and your pets daily for ticks. Carefully remove any ticks you find.
- Take a shower and wash and dry your clothes at high temperatures after being outdoors
Centers for Disease Control and Prevention
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What Is The Outlook For Someone With Lyme Disease
Most of the people who get Lyme disease and are treated early will be fine.
Post-Lyme Syndrome
Even after proper treatment, some patients may experience lingering fatigue, achiness or headaches. This does not signify ongoing infection and will not respond to additional antibiotics. The majority of people in this group will have symptoms resolve over the next one to six months.
Chronic Lyme Syndrome
Chronic Lyme syndrome is a term used by some that includes the symptoms of Post-Lyme syndrome outlined above. This is a controversial topic with no accepted etiology and no proven cause or association.
When To See Your Gp
You should contact your GP or dial NHS 111 promptly if you feel unwell with any of the symptoms described above after being bitten by a tick or after spending time in areas where ticks may live.
Take this leaflet with you if you are unsure what to say and remember to let your GP know if youve recently had a tick bite or spent time in areas where ticks may live.
Diagnosing Lyme disease can be difficult as many of the symptoms are similar to other conditions. A spreading erythema migrans rash appearing some days after a known tick bite is characteristic and should be treated with antibiotics.
If you dont have this rash but do have other symptoms of Lyme disease, blood tests can be carried out that look for antibodies against the borrelia bacteria.
Blood tests can be negative in the early stages of the infection as the antibodies take some time to reach levels that can be detected.
You may need to be re-tested if Lyme disease is still suspected 4 to 6 weeks after a first negative test result.
If you have long-lasting symptoms, you may be referred to a specialist in microbiology, infectious diseases, rheumatology, or neurology as appropriate for further investigation and management.
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Chronic Lyme Disease Vs Acute And Late Stage Lyme
One reason chronic Lyme disease is harder to detect and treat than Lyme at earlier stages is that chronic Lyme disease symptoms are more wide-ranging and varied. Chronic Lyme disease can cause symptoms of early Lyme disease such as fatigue and muscle aches to recur, but it can also cause new symptoms that affect different parts of the body.
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Key Points For Healthcare Providers
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How To Avoid Tick Bites
To reduce the chance of being bitten:
- cover your skin while walking outdoors and tuck your trousers into your socks
- use insect repellent on your clothes and skin products containing DEET are best
- stay on clear paths whenever possible
- wear light-coloured clothing so ticks are easier to see and brush off
What Happens At Your Appointment
The GP will ask about your symptoms and consider any rash or recent tick bites you know about.
Lyme disease can be difficult to diagnose. It has similar symptoms to other conditions and there’s not always an obvious rash.
2 types of blood test are available to help confirm or rule out Lyme disease. But these tests are not always accurate in the early stages of the disease.
You may need to be retested if you still have Lyme disease symptoms after a negative result.
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Lyme Disease: Signs And Symptoms
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What To Do If You Have A Blacklegged Tick Bite
Remove the tick by pulling it directly out with fine-tipped tweezers. Lift upward with slow and even pressure. Dont twist when removing it. Dont crush it or put soap or other substances on it. Dont apply heat to it.
Place the tick in a resealable container. See if you can identify what kind of a tick it is.
Immediately after removing the tick, wash your skin well with soap and water or with rubbing alcohol.
Not all ticks carry Lyme. The Lyme bacteria is transmitted only by blacklegged ticks in their nymph or adult stage.
Save the tick to show your doctor. The doctor will want to determine if its a blacklegged tick and if theres evidence of feeding. Ticks enlarge as they feed. Your risk of getting Lyme from an infected tick increases with the length of time that the tick fed on your blood.
Summary:
Pull the tick out with tweezers and save it in a resealable container for identification.
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Later Signs Of Lyme Disease
What if Lyme disease isnt detected early on? The longer that disease-causing bacteria linger in the body, the more they disseminate, and as these microbes spread to tissues throughout the body, they can trigger a litany of symptoms. CDC says these may include:
- Severe headaches and neck stiffness
- Additional EM rashes. These lesions may pop up on other areas of the body
- A type of facial paralysis known as Bells palsy
- Arthritis with severe joint pain and swelling. Knees and other large joints are vulnerable
- Intermittent pain in tendons, muscles, joints, and bones
- Nerve pain
- Shooting pains, numbness, or tingling in the hands or feet
You might have persistent or episodic symptoms, says Dr. Green. Pain that seems to move through the body? Thats common too. The hallmark of late Lyme is migratory joint pain: today my right knee hurts and tomorrow Im limping on my left ankle, and, oh, my third finger of my right hand swelled up, and, oh, my neck has swelled up, she says.
In rare cases, Lyme disease bacteria can enter the tissues of the heart. This complication, called Lyme carditis, can lead to lightheadedness, fainting, shortness of breath, heart palpitations, or chest pain.
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Early Symptoms Of Lyme Disease
Early symptoms will typically develop 1 to 4 weeks after being bitten, however, they can appear anytime between 3 to 30 days after exposure.
Many people with early-stage Lyme disease develop a distinctive circular red rash usually, but not always, at the site of the tick bite.
The rash is often described as looking like a bulls-eye on a dart board and is known as erythema migrans. The affected area of skin will be red and the edges may feel slightly raised.
The size of the rash can vary significantly and it may expand over several days or weeks. Typically, its around 15cm across but it can be much larger or smaller than this.
Some people may develop several rashes on different parts of their body. However, around one in every 3 people with Lyme disease do not report seeing a rash.
As well as a rash, people with early Lyme disease may experience any of the following:
- flu-like symptoms such as fever and sweats, chills, fatigue, neck pain or stiffness, headaches, joint or muscle pains
- paralysis of the facial muscles, typically only on one side of the face
- nerve pains, which may be shooting, sharp or prickly and which follow the course of the nerve
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Can Lyme Disease Be Prevented Or Avoided
The best way to prevent Lyme disease is to avoid being bitten by ticks. When you are outdoors, follow these guidelines:
- Avoid areas that are wooded, brushy, or have tall grass.
- Walk in the center of trails.
- Use an insect repellent with at least 20% DEET. It can be put on clothing or sparingly on the skin. Dont apply it to the face or hands of children.
- Treat clothing, tents, or other gear with repellents containing 0.5% permethrin.
- Wear light-colored clothing. This makes it easier to see and remove ticks from your clothes.
- Wear a long-sleeved shirt and long pants. Tuck your pant legs into your socks or boots for added protection.
After you get home, check everything and everyone for ticks.
- Bathe or shower as soon as you can to wash off any ticks that have not attached to you.
- Check your entire body for ticks. Use a mirror for places you cant see. Check your children and your pets. Common tick locations include the back of the knees, groin area, underarms, ears, scalp, and the back of the neck.
- Check any gear you used, including coats, backpacks, or tents.
Tumble dry clothes or blankets on high heat in the dryer for 10 to 15 minutes. This should kill any ticks. If clothes are dirty, wash them in hot water and dry on high heat for 60 minutes.
What Are The First Signs And Symptoms Of Lyme Disease
In the first early localized stage of Lyme disease the skin at the site of the tick bite becomes infected with Borrelia burgdorferi bacteria which can cause an expanding round or oval red skin lesion called erythema migrans. This may or may not be associated with flu-like symptoms within days to a month after the tick bite such as achiness, chills, fever, sweats, fatigue, malaise, headache, stiff neck, muscle soreness, joint pain, swollen lymph nodes, and sore throat. The combination of the skin lesion and flu-like symptoms are the primary manifestations of acute stage Lyme disease. Acute Lyme disease is not associated with typical cold-like symptoms of runny nose, prominent cough, or prominent diarrhea.
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How To Remove Ticks
Tick bites aren’t always painful. You may not notice a tick unless you see it on your skin. Check your skin and your children’s or pets’ skin after being outdoors.
To remove a tick:
The risk of getting ill is low. You don’t need to do anything else unless you become unwell.
Stage : Quickly Expanding Rash
After being bitten by a black-legged tick, a quickly growing rash can appear. This is the earliest stage of Lyme disease, known as stage 1.
Most people who develop a rash, get it within days or weeks of being bitten by a tick.
Where you see the rash: If you develop a rash, it appears near the tick bit you. For most people, that means the back, groin, armpit, or a lower leg. However, a tick can bite you anywhere.
What the rash can look like: You may see a spot or bump on the skin, which is the bite mark. Around or near the bite mark, a rash develops. Some people see the bulls-eye rash . You can also have one of the other rashes shown here.
Early rash caused by Lyme disease
Notice the bite mark in the center of this early rash, which will expand quickly.
Bull’s-eye rash on woman’s upper arm
This is another early sign of Lyme disease.
Lyme disease rash with lighter color on the outside
This rash has expanded, but you can still see the bite mark in the center.
Rash from Lyme disease has begun to clear
As the rash begins to clear, the redness fades.
If you develop a rash during this stage, you may notice that it:
-
Feels smooth and warm to the touch
-
Causes a burning sensation
-
Itches or feels painful
-
Has an outer edge that feels scaly or crusty
When the rash and symptoms begin: According to the Centers for Disease Control and Prevention , the rash begins 3 to 30 days after the tick bites you.
About 50% of people who have Lyme disease develop flu-like symptoms , which include:
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How Is Lyme Disease Diagnosed
To make a diagnosis, your health care provider will consider:
- Your symptoms
- How likely it is that you were exposed to infected blacklegged ticks
- The possibility that other illnesses may cause similar symptoms
- Results of any lab tests
Most Lyme disease tests check for antibodies made by the body in response to infection. These antibodies can take several weeks to develop. If you are tested right away, it may not show that you have Lyme disease, even if you have it. So you may need to have another test later.
When Should I Call The Doctor
If a tick bites you, call your doctor. Other conditions can cause similar symptoms, so its always a good idea to discuss them with your doctor. That way you can get checked and treated, if needed. Call right away if you get a red-ringed rash, lasting flu-like symptoms, joint pain or a swollen joint, or facial paralysis.
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What Should I Do If I Think I Have Chronic Lyme Disease
Rarely, people treated for Lyme disease can later develop post-treatment Lyme disease syndrome where symptoms of aches, fatigue and brain fog can last for months after initial diagnosis.
Doctors dont know why some people develop long-term problems, though it could be due to an autoimmune response triggered by the initial infection.
Post-treatment Lyme disease can be hard to diagnose because the symptoms are vague and similar to other conditions such as rheumatoid arthritis or depression.
Its important to talk with your doctor if youre experiencing symptoms of chronic Lyme disease but its also important to be wary of certain treatments some doctors may recommend.
Unfortunately, some medical practitioners will give people six or nine months of antibiotics with no evidence that its of benefit, Sanford explains. Studies show people with long-term symptoms dont do better with long-term antibiotics.
Not only is it not helpful, but long-term treatment with antibiotics can also cause uncomfortable side effects and contribute to the development of bacteria that can resist antibiotics.
Because of how vague the symptoms are and how inaccurate the tests can sometimes be, diagnosing chronic Lyme disease can be difficult. Misdiagnosis can happen, so if youre concerned, consider getting a second opinion.
A Leading Cause Of Misdiagnosis Is The Failure To Recognize The Lyme Disease Rash When Present
Available blood tests are antibody-based for Lyme disease and do not accurately diagnose Lyme disease in the first few weeks of infection. False negative tests are a problem in acute Lyme disease. Therefore, early Lyme disease is a clinical diagnosis. Recognizing signs and symptoms can be vital to receiving appropriate early treatment and patient care, especially in the COVID-19 era.
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