When A Lyme Diagnosis Is Tricky
There are several reasons it can be hard to diagnose Lyme disease.
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Tests are less accurate for a short period of time after you first become infected. Thats because Lyme tests look for proteins created by your immune system to help you fight off infection , rather than for the infection itself, and it can take a few weeks for your body to make enough antibodies to cause a positive test.
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The only sure sign of Lyme disease is an erythema migrans rash, which often has a bullseye shape. But up to 30% of people who get Lyme disease never get a rash. It is also possible that a person may not notice a rash before it goes away.
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Symptoms of Lyme disease like fever and body aches can also be caused by other illnesses. This may result in Lyme diagnoses being missed because symptoms are attributed to another illness.
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Using todays tests, it is difficult to distinguish between an old Lyme disease infection and a new one.
Thats why Lyme disease cases may be missed, and as many as 40% of Lyme disease cases are not diagnosed until a later stage of the disease. By that time, Lyme disease is harder to treat, and long-term complications are more likely, so an early, accurate diagnosis is very important.
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Lyme Disease From Nymphs
Come fall, larvae grow to poppy seed sized nymphs.
Nymphs remain inactive throughout the winter and early spring. In late spring, the nymph will begin looking for a host.
Once a nymph finds a host, it will latch on for four or five days. It will engorge with blood and swell to several times its original size.
If infected in the larval stage, the nymph may give Lyme disease to its host.
If the nymph was not infected as a larva but the host is, the nymph will become a carrier.
Up to 25% of nymphs carry the Lyme disease spirochete in endemic areas of the northeast and upper midwest.
Like tick larvae, nymphs prefer small mammals and birds but
your pet can be a suitable substitute.
They are also the most dangerous.
To give Lyme disease to your dog, ticks must feed for 24 to 36 hours.
Because nymphs are so small, they often go unnoticed until theyre engorged. This makes the nymph most likely to spread Lyme disease.
In fact, all human cases of Lyme disease come from infected nymphs.
Once engorged, the nymph will drop off its host and molt into an adult in the comfort of fallen leaves.
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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Can You Get Lyme Disease From Other People Or Animals
“There’s no evidence that Lyme disease can be transmitted sexually or by touching or kissing a person who has it,” says Dr. Kuritzkes. One widely reported study from 2014 found that the bacterium that transmits Lyme disease could be , which sparked fears that the disease could be passed between sexual partners. “But there’s never been a reported case of sexual transmission,” says Dr. Kuritzkes, and most experts don’t believe you can “catch” Lyme disease in this way.
In rare cases, Lyme disease has been transmitted from a pregnant woman to her fetus or placenta. Fortunately, according to the CDC, treating an infected woman with antibiotics seems to protect the fetus from any negative effects. There’s also no evidence that Lyme disease can be passed through breastfeeding.
And while there have been no reports of Lyme disease being transmitted through a blood transfusion, scientists say it could potentially happenso people who are being treated for Lyme disease should not donate blood.
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Dogs are less likely to be bitten by deer and western blacklegged ticks, although it does happenso it’s still important to check your pets after time spent outdoors and to remove any ticks you find. You can also talk to your veterinarian about preventive treatments that can reduce the risk of your pets being bitten by ticks or about a vaccine that can protect dogs from the disease.
Investigation Of Suspected Lyme Disease
Erythema migrans is a clinical diagnosis and does not require confirmation by laboratory testing. Lyme disease is not a notifiable disease so there is no statutory requirement to notify clinically suspected cases to the local Health Protection Team.
The 2018 NICE Lyme disease guideline provides detailed advice about when a diagnosis of Lyme disease should be suspected and about which tests to use and when.
The NICE Lyme disease guideline also contains a useful summary diagram of the routine serological testing recommendations for Lyme disease.
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Later Symptoms Of Lyme Disease
More serious symptoms may develop if Lyme disease is left untreated or is not treated early. These can include:
- pain and swelling in the joints
- nerve problems such as numbness or pain in your limbs
- memory problems
- difficulty concentrating
Some of these problems will get better slowly with treatment. But they can persist if treatment is started late.
A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome. This is known as post-infectious Lyme disease. It’s not clear exactly why this happens. It’s likely to be related to overactivity of your immune system rather than continued infection.
How Are Dogs Tested For Lyme Disease
Diagnosis is made by a combination of history, physical signs, and diagnostics. For dogs, the two blood tests for diagnosing Lyme disease are called the C6 Test and Quant C6 test. Veterinarians perform both.
The C6 test detects antibodies against a protein called C6. Presence of the antibodies suggests an active Lyme infection. The C6 antibodies can be detected three to five weeks after an infected tick bites a dog and may be found in the bloodstream even before the dog shows signs of illness.
The next step is to do a Quant C6 test. This, along with urinalysis will help determine if antibiotic treatment is necessary.
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How Do I Remove A Tick
You should know how to remove a tick just in case one lands on you or a friend. To be safe, remove the tick as soon as possible.
If you find a tick:
- Use tweezers to grasp the tick firmly at its head or mouth, next to your skin.
- Pull firmly and steadily on the tick until it lets go of the skin. If part of the tick stays in your skin, don’t worry. It will eventually come out. But call your doctor if you notice any irritation in the area or symptoms of Lyme disease.
- Swab the bite site with alcohol.
Note: Don’t use petroleum jelly or a lit match to kill a tick. They won’t get the tick off your skin quickly enough, and may just cause it to burrow deeper into your skin.
How You Get Lyme Disease
If a tick bites an animal carrying the bacteria that cause Lyme disease, the tick can become infected. The tick can then transfer the bacteria to a human by biting them.
Ticks don’t jump or fly. They climb on to your clothes or skin if you brush against something they’re on. They then bite into the skin and start to feed on your blood.
Generally, you’re more likely to become infected if the tick is attached to your skin for more than 24 hours. Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin.
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Resources For Maine Residents
Public Law, Chapter 340, LD 597, 126th Maine State Legislature: An Act to Inform Persons of the Options for the Treatment of Lyme Disease
- Acknowledges difficulty in diagnosing and treating Lyme disease
- Information on risks of long term antibiotic therapy
Public Law, Chapter 235, LD 422, 127th Maine State Legislature: An Act to Improve Access to Treatments for Lyme Disease
- Allows licensed physicians to prescribe long-term antibiotic therapy to eliminate infection or to control a patients symptoms
How Is Lyme Disease Transmitted
Ticks usually live in woods or tall grasslands in Canada, the United States, Europe, and Asia. Ticks can become infected with Borrelia burgdorferi by feeding on infected wild animals, and then can spread the bacteria when they feed on blood from the host. Ticks cannot fly they hang onto small bushes or tall grasses and are usually found close to the ground. They wait for an animal or person to pass near them and when the animal or person makes contact, the ticks attach themselves to the skin to feed.
In North America, Lyme disease is transmitted mainly by two species of ticks:
- Blacklegged tick , Ixodes scapularis.
- Western blacklegged tick, Ixodes pacificus.
The Public Health Agency of Canada states that there no evidence that Lyme disease can spread from person-to-person. Pets, especially dogs, can get Lyme disease, but there is no evidence that pets can spread the infection directly to humans. They may, however, carry infected ticks into the home or yard which may increase the chance of transmission.
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Who Is At Risk For Lyme Disease
Anyone can get a tick bite. But people who spend lots of time outdoors in wooded, grassy areas are at a higher risk. This includes campers, hikers, and people who work in gardens and parks.
Most tick bites happen in the summer months when ticks are most active and people spend more time outdoors. But you can get bitten in the warmer months of early fall, or even late winter if temperatures are unusually high. And if there is a mild winter, ticks may come out earlier than usual.
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What Is On The Horizon For Lyme Testing
Because Lyme bacteria are not usually present in high enough numbers to be detectable, blood tests to look for Borrelia are not helpful.
Better diagnostic tests are needed that are direct and can detect infection at all stages of Lyme disease. Researchers are studying new diagnostic methods using better antibody tests, direct detection methods, and different ways to measure immune response to Lyme disease.
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What Are The Clinical Signs Of Lyme Disease
Some people with Lyme disease develop a characteristic bullâs-eye rash at the site of the bite within three to thirty days. If this occurs, the disease can be easily diagnosed at an early stage.
However, signs of Lyme disease are more difficult to detect in animals than in people. The characteristic rash does not develop in dogs or cats. In fact, Lyme disease is practically unheard of in cats.
âAffected dogs have been described as if they were walking on eggshells.â
Many dogs affected with Lyme disease are taken to a veterinarian because they seem to be experiencing generalized pain and have stopped eating. Affected dogs have been described as if they were walking on eggshells. Often these pets have high fevers. Dogs may also begin limping. This painful lameness often appears suddenly and may shift from one leg to another. If untreated, it may eventually disappear, only to recur weeks or months later.
Some pets are infected with the Lyme disease organism for over a year before they finally show symptoms. By this time, the disease may be widespread throughout the body. Non-specific signs which may indicate that Lyme disease is affecting the kidneys include vomiting, lethargy, anorexia , and weight loss. The kidney form of the disease is less common, but often fatal.
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Where Are Ticks Found
Ticks are found throughout the UK and in other parts of Europe and North America. There are a high number of ticks in the Scottish Highlands.
They can be found in any areas with deep or overgrown plants where they have access to animals to feed on.
They’re common in woodland and moorland areas, but can also be found in gardens or parks.
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How Do Borrelia Bacteria Make Their Way Into Ticks And Humans
Humans, ticks, and Borrelia spirochetes are players in a complex pathogen-vector-host relationship:
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Ticks pick up disease-causing germs , including Lyme disease bacteria, while feeding on mice, birds, chipmunks, shrews, and other small animals .
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The ticks then become carriers of those infections, and can pass them on to new hosts humans and larger animals, such as pets and deer when they bite them for their next blood meal.
Over their life cycle, black-legged ticks have many opportunities to pick up Lyme disease bacteria and transmit the pathogens to humans, pets, and other animals.
Moving Forward With Chronic Illness
Today Tait works as a writer and speaker. Her first book publishing in August, The View from Rock Bottom: Discovering Gods Embrace in our Pain, chronicles her journey with her health and how it impacted her faith. Writing gives her the freedom to work from home, but shes well aware that for many years the financial burden has been on her husband, a software developer.
They recently took a rare vacation to Mexico. It was the first time theyd been on a plane together since their honeymoon more than a decade ago.
Tait has days when she feels strong enough to attend a speaking engagement at a church or play with her kids at the park. But she also has days when she struggles to move her body and relies on her cane.
For Tait, the hardest part is knowing that she would, in all likelihood, be completely healthy today had she just been diagnosed sooner. And the scariest part is knowing that it was all out of her hands.
I was asking for the right tests. I was saying the right things. I was showing up constantly and saying, This isnt working, Im not well. But eventually you start to doubt yourself, when you hear enough times that maybe its all in your head.
Now that she has answers, she can at least begin to move forward.
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Who Gets Lyme Disease And At What Time Of Year
Lyme disease is transmitted via the bite of infected ticks, which attach to any part of the body, but often to moist or hairy areas such as the groin, armpits, and scalp.
While everyone is susceptible to tick bites, campers, hikers, and people who work in gardens and other leafy outdoor venues are at the greatest risk of tick bites. As many a suburban gardener can attest, with the expansion of the suburbs and a push to conserve wooded areas, deer and mice populations are thriving, too, providing ample blood meals for ticks. For lyme disease to be transmitted, a tick needs to feed on the host for 24-48 hours.
In the majority of cases, tick bites are reported in the summer months when ticks are most active and people spend more time outdoors. But this can extend into the warmer months of early autumn, too, or even late winter if temperatures are unusually high. Similarly, a mild winter can allow ticks, much like other insects, to thrive and emerge earlier than usual.
Signs And Symptoms Of Untreated Lyme Disease
Seek medical attention if you observe any of these symptoms and have had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs.
Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These include fever, rash, facial paralysis, and arthritis.
The appearance of the erythema migrans rash can vary widely.
- Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash
- Erythema migrans rash :
- Occurs in approximately 70 to 80 percent of infected persons
- Begins at the site of a tick bite after a delay of 3 to 30 days
- Expands gradually over several days reaching up to 12 inches or more across
- May feel warm to the touch but is rarely itchy or painful
- Sometimes clears as it enlarges, resulting in a target or bulls-eye appearance
- May appear on any area of the body
- Does not always appear as a classic erythema migrans rash
Swollen Knee
- Severe headaches and neck stiffness
- Additional EM rashes on other areas of the body
- Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
- Intermittent pain in tendons, muscles, joints, and bones
- Heart palpitations or an irregular heart beat
- Episodes of dizziness or shortness of breath
- Inflammation of the brain and spinal cord
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