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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Life Cycle Of B Burgdorferi
The primary vector of Lyme disease in the northeastern and north central United States is the deer tick, Ixodes scapularis. The primary vector in the Pacific coastal area of the country is I.pacificus. Ticks go through four stages in their development , and B. burgdorferi is maintained in ticks as they pass from one stage to the next. When an infected tick bites a human or certain animals , the infectious agent can be transmitted, resulting in disease. Wild rodents and deer are part of the natural life cycle of B. burgdorferi. Infected larval and nymphal ticks feed on small mammals while adult ticks feed on deer. The explosive repopulation of white-tailed deer in parts of the United States has been linked to the spread of Lyme disease. The majority of human Lyme disease cases result from bites by infected nymphs. At this stage the tick is small, less easily detected, and less likely to be promptly removed, which increases the possibility that it will transmit disease. Dogs, cattle, and horses develop disease that may include the joint and heart complications seen in humans. A vaccine is available for dogs, which in addition to protecting them, has a beneficial public health impact by decreasing the proximity of this disease to people. There is no evidence that Lyme disease has been transmitted directly from animal-to-animal, animal-to-human, or human-to-human.
How Does A Person Get Lyme Disease
Lyme disease is transmitted by the bite of an infected deer tick, which also is known as the black-legged tick. Immature deer ticks can be very small, about the size of the head of a pin adult deer ticks are slightly larger. Both can be infected with and transmit Lyme disease. Deer ticks acquire the bacteria by feeding primarily on small mammals infected with the bacteria, particularly the white-footed mouse. Deer ticks infected with the bacteria that cause Lyme disease have been found in Illinois. Areas in the United States where deer ticks are most frequently infected with Lyme disease are the northeastern United States , northern California, and north central states, especially Minnesota and Wisconsin. However, Lyme disease has been reported in almost all states in the United States as well as in many countries throughout the world.
Image source: /content/dam/soi/en/web/idph/files/pictures/babesiosis.jpg
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The Chance Of Getting Lyme Disease
Not all ticks in England carry the bacteria that causes Lyme disease.
But it’s still important to be aware of ticks and to safely remove them as soon as possible, just in case.
Ticks that may cause Lyme disease are found all over the UK, but high-risk places include grassy and wooded areas in southern and northern England and the Scottish Highlands.
Ticks are tiny spider-like creatures that live in woods, areas with long grass, and sometimes in urban parks and gardens. They’re found all over the UK.
Ticks do not jump or fly. They attach to the skin of animals or humans that brush past them.
Once a tick bites into the skin, it feeds on blood for a few days before dropping off.
Lyme Disease Rashes And Look
Circular, expanding rash with target-like appearance.
Expanding rash with central crust
Expanding lesion with central crust on chest.
Expanding erythema migrans
Photo Credit: Reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectivesexternal icon. J Am Acad Dermatol 2011 64:619-36, with permission from Elsevier.
Description:Early, expanding erythema migrans with nodule.
Multiple rashes, disseminated infection
Early disseminated Lyme disease multiple lesions with dusky centers.
Red, oval plaque
Red, expanding oval-shaped plaque on trunk.
Expanding rash with central clearing
Circular, expanding rash with central clearing.
Bluish hued rash, no central clearing
Bluish hued without central clearing.
Expanding lesion, no central clearing
Expanding lesion without central clearing on back of knee.
Red-blue lesion with central clearing
Red-blue lesion with some central clearing on back of knee.
Insect bite hyper-sensitivity
Large itchy rash caused by an allergic reaction to an insect bite.
Fixed drug reaction
Description:A skin condition that occurs up to two weeks after a person takes a medication. The skin condition reappears at the same location every time a person takes that particular medication.
Ringworm
Description:Ringworm is a common skin infection that is caused by a fungus. Its called ringworm because it can cause a ring-shaped rash that is usually red and itchy with raised edges.
Pityriasis rosea rash
Granuloma annulare rash
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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:
- 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.
How To Spot And Remove Ticks
Once youve come in from outside, one of the best ways to check yourself for ticks is to take a shower and bath.
Other than that, do your best to check your clothes, especially the folds of your clothes, knowing that ticks can be very small and hard to spot. Running your hands through your hair is also a good idea.
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Key Points To Remember
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone therefore, the test cannot be used to determine cure.
- Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
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Can Lyme Disease Completely Be Cured
Taking oral antibiotics typically cures Lyme disease after two to four weeks. You may need to get antibiotics through the vein for four more weeks. However, theres no reason to think that Lyme disease stays in you forever after treatment.
A note from Cleveland Clinic
If youre going to spend time in an area that might have ticks, take measures to avoid being bitten. This includes wearing long-sleeved shirts and pants to make it harder for ticks to bite. If you feel sick after being in an area that probably has ticks, make an appointment with your healthcare provider. If your provider prescribes antibiotics, make sure you take all of them as instructed.
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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.
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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Stages Of Lyme Disease And Their Common Symptoms
If you have already been diagnosed with Lyme disease, learning about Lyme stages can help you know what symptoms you might experience. Youll also be able to watch for signs that could mean that your Lyme disease has progressed. Lyme disease symptoms are more likely to progress if you have not been appropriately treated.
If you dont have a Lyme disease diagnosis, its helpful to know that Lyme disease can cause a variety of seemingly unrelated symptoms throughout your body. If you develop symptoms listed below, especially after youve gotten a tick bite or spent time in an area where Lyme disease is common, you can ask your doctor whether you might have Lyme disease and if you should be tested for it. .
There are three stages of Lyme disease. Early localized, or Stage 1, Lyme disease occurs soon after being infected, when Lyme bacteria are still close to the site of the tick bite. Common symptoms of early localized Lyme disease include a rash or mild, flulike symptoms. Over time the Lyme bacteria can spread, or disseminate, to other parts of the body, causing more serious symptoms associated with early disseminated or late disseminated Lyme disease. This is more likely if you are not diagnosed and treated early.
How Is Lyme Disease Spread
Lyme disease is spread by the bite of an infected black-legged tick. The tick usually must be attached to a person for at least 24 hours before it can spread the germ. Black-legged ticks in Massachusetts can also carry the germs that cause babesiosis and human granulocytic anaplasmosis). These ticks are capable of spreading more than one type of germ in a single bite.
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Diagnosis Of Lyme Disease
Diagnosis is currently based on clinical findings supported by several types of laboratory tests. One type of test seeks to isolate the actual organism from the EM skin lesion, blood, joints, and cerebrospinal fluid. Other types of tests attempt to detect antibodies formed by the patients immune system against the organism. Currently, serology tests are poorly standardized and physicians must interpret them with caution. They are insensitive during the first several weeks of infection and may remain negative in people treated early with antibiotics. Test sensitivity increases when patients progress to later stages of the disease, but a small proportion of Lyme disease patients never develop a positive blood test result. Another complicating factor is that there can be a cross-reaction in the blood test, giving a false positive result for Lyme disease in persons who really have conditions such as syphilis, Rocky Mountain spotted fever, human immunodeficiency virus infection, infectious mononucleosis, lupus or rheumatoid arthritis. Although present diagnostics are not perfect, great strides have been made in the past twenty years. More sensitive and specific tests for Lyme disease are being developed.
When Symptoms Persist
Some people experience Lyme disease symptoms for a long time. Just as COVID-19 patients with persistent symptoms are called long haulers, Lyme disease can also be a long-haul illness. There are many paths to long-haul Lyme. Someone might have gone undiagnosed and untreated for months or years while their illness progressed. Or, they may have been diagnosed and treated right away, but still experience ongoing symptoms.
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Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States. Annals of Clinical and Translational Neurology, January 2022.
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What Are The Symptoms
Many body systems can be affected by Lyme disease. Symptoms vary from person to person and can come and go. Symptoms are generally classified into early or late. Early symptoms occur days to weeks after a person becomes infected. Early symptoms include:
- Flu-like symptoms such as muscle aches, joint pain, fatigue, headache, stiff neck, chills, fever, or swollen lymph nodes
- Paralyzed muscles of the face
- Palpitations or disturbances of heart rhythm
- An expanding rash called erythema migrans, or EM. The EM appears 1-30 days after the bite of an infected tick, expands over a one to two week period, and then disappears. More EMs, not necessarily at the site of the tick bite, can show up later. The EM is usually painless. The EM varies in shape and appearance. On dark skin the EM can look more like a bruise. The EM is not present in some people, or it may occur on a part of the body that is difficult to see
Painful redness that occurs less than 24 hours after a tick bite and does not expand is more likely to be a local allergic reaction to the tick’s saliva. These symptoms can disappear without treatment but the infection may still be present. If early Lyme disease symptoms are not recognized and treated adequately, the disease may progress and be more difficult to treat.
Late symptoms occur weeks, months, or years after becoming infected. Late symptoms may be the first sign of Lyme disease in some people. Late symptoms include:
Diagnosis and Treatment
Lyme Disease In Young Children
There is currently very little published medical research documenting Lyme disease symptoms in young children, and none on babies, or on patients in the UK.
One research paper describes the neurological symptoms in 96 children in North America. The main symptom in this category was encephalitis , which children would experience as very severe headache and blurred vision, which could eventually become blindness:
The most frequent neurologic symptom was headache, and the most common sign was facial palsy. Less common manifestations were sleep disturbance, and papilledema associated with increased intracranial pressure. Signs and symptoms of peripheral nervous system involvement were infrequent. The most common clinical syndromes were mild encephalopathy, lymphocytic meningitis, and cranial neuropathy . In contrast with adult patients with neurologic Lyme disease, meningoradiculitis and peripheral neuropathy syndromes were rare.
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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:
Symptoms Of Disseminated Lyme Disease Can Occur Days To Months After The Initial Infectionvermont Department Of Health
Symptoms may include one or more of the following
- Muscle and joint pain
According to the Vermont Department of Health, Lyme disease may spread to various parts of the body. This is called disseminated Lyme disease.
Symptoms associated with disseminated Lyme disease:
- Numbness and pain in the arms or legs
- Paralysis of facial muscles (usually on one side of the face, also known as Bells palsy
- Numbness or tingling in the hands and feet
- Problems with concentration and short-term memory
Possible Symptoms in Children and Adolescents
Sensitivity to Light, Sound or Touch Slow Processing Speed Encephalopathy Facial Paralysis Skin Rash Sometimes only one symptom will be present, or a child may experience multiple symptoms.
According to an unpublished CDC study, 79% of children with Lyme disease experience a decrease in their number of friends, 41% have suicidal thoughts, and 11% made a suicide gesture.
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