Which Areas Are More Likely To Have It
The tick that causes Lyme disease has been moving from the Northeast and upper Midwest into the Southern and Western U.S., Mexico, and Canada. Cases in California and Florida are on the rise. After a drop between 2017 and 2018, the numbers jumped a little bit in 2019.
But most Lyme cases in 2019 were in 15 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin. Washington, DC, is also a hotspot.
In 2019, Pennsylvania had the most Lyme infections, with 6,763. New York was next, with 2,847 cases.
In the Southern U.S., where itâs hotter, ticks stay under leaves so they don’t dry out. This means people donât get Lyme from Southern ticks very often because they don’t usually come out to bite.
Even though people only report about 30,000 cases of Lyme infection in the U.S. each year, there are actually around 476,000 a year. The same tick also can spread other diseases, including babesiosis, anaplasmosis, and Powassan virus. Those diseases are also on the rise in the U.S.
Whoâs likeliest to get Lyme disease?
Boys up to age 15 and men between the ages of 40 and 60 are the most likely to get Lyme disease. Thatâs because they tend to play outside and go camping, hunting, and hiking.
Why are there more ticks now than there used to be?
There are several reasons why Lyme is spreading. Some of these are:
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
Stage : Changing Skin
In stage 3, few signs of Lyme disease appear on the skin. Most problems occur in the heart and nervous system, and these can be serious.
Where you see signs on your skin: If you were in Europe when bit by a tick, you may see changes to your skin in this late stage. These changes usually appear on a hand or foot. Some people develop this change on both of their hands or feet. It can also occur on a knee, elbow, or elsewhere.
What the skin looks like: The skin begins to swell, and you may notice some redness. These signs are caused by having a bacterial infection for a long time. The affected skin may also feel sore.
In time, the skin starts to harden and shrink, causing deep lines to form. If you have hair in the area, it tends to fall out. The sweat glands can die, and the skin often becomes so thin that it tears easily. The medical name for this condition is acrodermatitischronical atrophicans.
In stage 3, you may also see tumors on your skin. It is believed that the long-term infection and swelling in the lymph nodes can lead to a cancer known as cutaneous B-cell lymphoma.
Skin starts to harden and shrink, causing deep lines to form
The medical name for this condition is acrodermatitis chronical atrophicans. Swelling, hardened skin, and deep lines on the foot of someone who has had Lyme disease for years.
When you see signs of changing skin and symptoms: These tend to occur months or years after you are bitten by a tick.
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When Should I Go See My Doctor
Anyone who has been bitten by a black-legged deer tick is at risk for Lyme disease. The highest risk groups include those living in or visiting endemic areas, especially people who spend significant time outdoors such as gardeners, hikers, or outdoor workers.
Patients should seek advice from their doctor if they have a suspicious round expanding red skin lesion, and/or show signs of summer-flu, particularly during Lyme disease season, which is highest-risk late spring through July/August. If those circumstances apply or symptoms persist it is very important to go to a physician.
For the west coast and other more temperate regions Lyme disease can be a year-round concern.
In the later disseminated stages, Lyme disease can be a much more insidious and complex illness. An individual should seek medical care if experiencing symptoms such as prolonged fevers, unexplained fatigue, painful joints, new or unusual headache, or heart or neurologic symptoms. If unexplained viral-like symptoms last for more than 1-2 weeks, please seek the advice of a physician.
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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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:
What Causes Lyme Disease
Lyme disease is caused by bacteria. In the United States, this is usually a bacterium called Borrelia burgdorferi. It spreads to humans through the bite of an infected tick. The ticks that spread it are blacklegged ticks . They are usually found in the:
- Upper Midwest
- Pacific coast, especially northern California
These ticks can attach to any part your body. But they are often found in hard-to-see areas such as your groin, armpits, and scalp. Usually the tick must be attached to you for 36 to 48 hours or more to spread the bacterium to you.
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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.
Pull the tick out with tweezers and save it in a resealable container for identification.
When Should I Call The Doctor
If a tick bites you, call your doctor. Other conditions can cause similar symptoms, so it’s 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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Seek Medical Care Early To Prevent Lyme Disease From Progressing
Its easy to get bit by a tick and not know it. Most people dont feel a tick on their skin or the bite. Checking your skin for ticks after spending time outdoors can help you find a tick and remove it.
Removing a tick can prevent Lyme disease. A tick must be attached to your skin for at least 36 hours to infect you with the bacteria that cause Lyme disease.
Its not always possible to find a tick, so its important to pay close attention to your skin. If you notice any signs of Lyme disease or develop a rash, get medical care right away. Ticks can cause other serious diseases, such as Rocky Mountain spotted fever.
Related AAD resources
ImagesImage 1: Centers for Disease Control and Prevention, Public Health Image Library, Last accessed May 11, 2017.
Images 2, 3, and 7: Used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2011 64:619-36.
Image 6: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
ReferencesBhate C and Schwartz RA.
Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol. 2011 64:619-36.
Lyme disease: Part II. Management and prevention. J Am Acad Dermatol 2011 64:639-53.
Centers for Disease Control and Prevention:
Signs and symptoms of untreated Lyme disease. Page last updated October 26, 2016. Last accessed May 2, 2018.
Lyme disease: transmission. Page lasted updated March 4, 2015. Last accessed May 2, 2018.
How Is Lyme Disease Spread
Not all deer ticks are infected with the bacteria that cause Lyme disease. Ticks can become infected if they feed on animals such as mice and other mammals that are infected. The disease can be spread when an infected tick bites a person and stays attached for a period of time. In general, the tick must be attached for 36 to 48 hours or more. Lyme disease does not spread from one person to another. Transfer of the bacteria from an infected pregnant woman to her fetus is extremely rare.
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Treating Lyme Disease While Pregnant
Treatment for pregnant women with Lyme disease is similar to that of non-pregnant adults. However, certain antibiotics, such as doxycycline should not be used as it can affect your unborn child.
Research shows that there are no life-threatening effects on the child when a pregnant woman receives appropriate antibiotic treatment for Lyme disease.
Treatments Your Physician May Prescribe
Lyme disease can be treated and cured with one of several oral antibiotics for 34 weeks. The skin rash will go away within a few days of beginning treatment, but other symptoms may persist for up to a few weeks. In severe cases of Lyme disease where the nervous system is involved, the antibiotic may need to be given intravenously. In late stage Lyme disease, symptoms may not go away completely, but should improve.
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Why Are Antibiotics The First Line Of Treatment For Lyme Disease
The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. Antibiotics go into the bacteria preferentially and either stop the multiplication of the bacteria or disrupt the cell wall of the bacteria and kill the bacteria . By stopping the growth or killing the bacteria the human host immune response is given a leg up to eradicate the residual infection. Without antibiotics, the infection in Lyme disease can evade the host immune system and more readily persist.
Stage : Small Oval Rashes Or A Reddish Lump
When a tick that causes Lyme disease bites you, it infects you with bacteria. Without treatment, the bacteria can spread to other areas of your body. Stage 2 begins when the bacteria spread to other parts of your body.
During this stage, you may see small, oval rashes on your skin. Some people develop a bluish-red lump.
Where you see these signs: Because the infection has spread, small rashes can appear anywhere on your skin, except for your palms and soles. Most rashes appear on the arms, legs, and face.
Some people develop a lump, which your doctor may refer to as borrelial lymphocytoma. In children, this lump tends to appear on an earlobe. Adults often see a raised growth form around a nipple.
Borrelial lymphocytoma on a childs ear
This can appear in stage 2 of Lyme disease.
What you may see on your skin: The rashes that appear during stage 2 differ from the rash that can appear in stage 1. In stage 2, the rashes stay the same size rather than grow larger.
When the rashes, lump, and symptoms begin: About 30 to 45 days after the tick bites you, you may notice rashes or a lump. These can also take longer to appear, sometimes six months or more.
Some people develop symptoms, which make them feel ill, including:
Shortness of breath and dizzy spells
Bells palsy, which causes one half of the face to droop
Heart problems, such as chest pains or an irregular heartbeat
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What Are The Symptoms Of Lyme Disease
Symptoms of Lyme disease can be different from person to person.
Early signs and symptoms of Lyme disease usually start 3 to 30 days after you have been bitten by an infected blacklegged tick. Most people experience mild flu-like symptoms soon after being bitten, while a small number may have more serious symptoms, sometimes weeks after the bite.
Early signs and symptoms of Lyme disease may include:
- Rash, sometimes shaped like a bull’s eye )
- Muscle and joint aches
- Swollen lymph nodes
If left untreated, more severe symptoms may occur and can last from months to years. Severe symptoms may include:
- Severe headaches
- Facial paralysis
- Intermittent muscle, joint, tendon and bone aches
- Heart disorders , known as Lyme carditis
- Neurological disorders
- Arthritis with severe joint pain and swelling, particularly the knees and less commonly in other joints such as the ankle, elbow and wrists.
In rare cases, Lyme disease can lead to death usually because of complications involving infection of the heart.
When To See Your Gp
After being aware of your symptoms of Lyme disease or feeling a happened bite, you should know it is time to see your GP. However, you have to let him know if you have been in woodland or some areas in which ticks live so that he can give you the most effective treatments as well as the appreciate advice.
In fact, the diagnosis of Lyme disease is quite difficult because some of its symptoms are similar to other illnesses. If you have a rash after some days of a tick bite, you can treat it with appropriate antibiotics while not waiting for a blood test result.
However, blood tests should be carried out to find out the exact diagnosis of Lyme disease after a few weeks. These tests cannot be exact in the early stage of infection and the second test should be done if you also suspect an existing Lyme disease. For example, GP in the United Kingdom uses both of the blood tests to ensure the diagnosis of Lyme disease is accurate as a single test can sometimes give a positive result though a person does not have the infection.
Finally, if you have long-lasting or post-infectious Lyme disease symptoms, you should see a specialist in infectious or microbiology diseases so that they can send your blood sample to the national laboratory where further tests are carried out.
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