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
Learn The Stages Of Lyme Disease
Lyme disease occurs in three stages: early localized, early disseminated and late disseminated. However the stages can overlap and not all patients go through all three. A bulls-eye rash is usually considered one of the first signs of infection, but many people develop a different kind of rash or none at all. In most cases, Lyme symptoms can start with a flu-like illness. If untreated, the symptoms can continue to worsen and turn into a long-lived debilitating illness.
Stage 1: Early Localized Disease
Symptoms with early localized Lyme disease may begin hours, a few days or even weeks after a tick bite. At this point, the
infection has not yet spread throughout the body. Lyme is the easiest to cure at this stage.
Symptoms may include:
- skin rash, which may or may not look like a bulls eye
- flu-like illness, including chills and fever
- muscle soreness and joint pain
- swollen lymph nodes
- sore throat
Stage 2: Early Disseminated Lyme
Early disseminated Lyme may occur several weeks or months after the tick bite. Bacteria are beginning to spread throughout the body. In addition to flu-like symptoms, this stage is often characterized by increase in symptoms such as:
- pain, weakness or numbness in the arms, legs
- vision changes
- heart problems, such as palpitations, chest pain
- rash may appear on body
- facial paralysis
Stage 3: Late Disseminated Lyme Disease
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What Are Signs And Symptoms Of The Third Stage Of Lyme Disease
Late stage Lyme disease can result when treatment is unsuccessful or started too late due to unrecognized symptoms or misdiagnosis. The late disseminated stage occurs months or years after initial infection and can have a major impact on a patients health and quality of life. Late Lyme arthritis is a third stage Lyme disease manifestation that involves fluid accumulation and pain in joints, particularly in the knee joints. Late neurologic disease is a 3rd stage condition that can also be debilitating and difficult to diagnose. Late disseminated Lyme disease symptoms include a variety of symptoms that are often neurologic in origin including: numbness in extremities, mental fogginess and concentration problems, and difficulty following conversations or processing information.
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Lyme Disease Symptoms Also Occur In Other Diseases
Many Lyme symptoms, such as fatigue, cognitive impairment, joint pain, poor sleep, mood problems, muscle pain, and neurological presentations also occur in other diseases. Hence, the symptoms of Lyme disease significantly overlap those of chronic fatigue, fibromyalgia, rheumatoid arthritis, multiple sclerosis, Parkinsons disease, ALS, depression and Alzheimers disease. Many Lyme patients report being misdiagnosed with a different condition before being properly diagnosed with Lyme disease.
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:
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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.
What Are The Signs And Symptoms Of Lyme Disease
Early symptoms usually appear within 3 to 30 days after the bite of an infected tick. In 60-80 percent of cases, a circular bull’s eye rash about two inches in diameter, called erythema migrans, appears and expands around or near the site of the tick bite. Sometimes, multiple rash sites appear. One or more of the following symptoms usually mark the early stage of Lyme disease: chills and fever, headache, fatigue, stiff neck, muscle and/or joint pain, and swollen glands. If Lyme disease is unrecognized or untreated in the early stage, more severe symptoms may occur. As the disease progresses, severe fatigue, a stiff aching neck, and tingling or numbness in the arms and legs, or facial paralysis can occur. The most severe symptoms of Lyme disease may not appear until weeks, months or years after the tick bite. These can include severe headaches, painful arthritis, swelling of the joints, and heart and central nervous system problems.
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What Are The Stages Of Lyme Infection
There are three stages:
- Early localized Lyme: Flu-like symptoms like fever, chills, headache, swollen lymph nodes, sore throat, and a rash that looks like a bull’s-eye or is round and red and at least 2 inches long
- Early disseminated Lyme: Flu-like symptoms like pain, weakness, or numbness in your arms and legs, changes in your vision, heart palpitations and chest pain, a rash , and a type of facial paralysis known as Bellâs palsy
- Late disseminated Lyme: This can happen weeks, months, or years after the tick bite. Symptoms might include arthritis, severe fatigue and headaches, dizziness, trouble sleeping, and confusion.
About 10% of people treated for Lyme infection donât shake the disease. They may go on to have three core symptoms: joint or muscle pain, fatigue, and short-term memory loss or confusion. This is called post-treatment Lyme disease syndrome. It can be hard to diagnose because it has the same symptoms as other diseases. Plus, there isn’t a blood test to confirm it.
Experts arenât sure why Lyme symptoms donât always go away. One theory is that your body keeps fighting the infection even after the bacteria are gone, like an autoimmune disorder.
Stage : Early Localized Disease
Symptoms of Lyme disease usually start 1 to 2 weeks after the tick bite. One of the earliest signs of the disease is a bulls-eye rash.
The rash occurs at the site of the tick bite, usually, but not always, as a central red spot surrounded by a clear spot with an area of redness at the edge. It may be warm to the touch, but it isnt painful and doesnt itch. This rash will gradually fade in most people.
The formal name for this rash is erythema migrans. Erythema migrans is said to be characteristic of Lyme disease. However, many people dont have this symptom.
Some people have a rash thats solid red, while people with dark complexions may have a rash that resembles a bruise.
The rash can occur with or without systemic viral or flu-like symptoms.
Other symptoms commonly seen in this stage of Lyme disease include:
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What Do I Do If I Find A Tick On My Skin
Dont panic. Use fine-tipped tweezers to grasp the tick as close to the skins surface as possible. Pull up with steady, even pressure. Be careful not to squeeze or twist the tick body. Sometimes parts of the tick remain in the skin. You can leave them alone or carefully remove them the same way you would a splinter. Do not use heat , petroleum jelly, or other methods to try to make the tick back out on its own. These methods are not effective.
Wash the area where the tick was attached thoroughly with soap and water. Keep an eye on the area for a few weeks and note any changes. Call your doctor if you develop a rash around the area where the tick was attached. Be sure to tell your doctor that you were bitten by a tick and when it happened.
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 Is The Outlook For Someone With Lyme Disease
Most of the people who get Lyme disease and treated early will be fine.
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 1-6 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.
Living With Lyme Disease
Most people treated in the early stages of Lyme disease make a quick and complete recovery. Some may experience symptoms for a few weeks after treatment. If you were treated for Lyme disease but you still dont feel well, call your family doctor. He or she can make sure there isnt something else wrong. They can help you find ways to ease your symptoms. Some patients have found relief with treatments typically used for chronic fatigue syndrome or fibromyalgia.
Other things you can do to help manage Lyme disease include:
- Educate yourself.There is a lot of inaccurate information to be sorted through, especially on the internet. Ask your doctor if you have questions.
- Track your symptoms.Keep a diary of your sleep patterns, eating habits, exercise routines, and how youre feeling. You or your doctor may be able to make connections between them.
- Take care of yourself.Eat a healthy diet. Exercise as regularly as you can. Get plenty of rest.
Find support. It can be hard to not feel well and not know why. Some people may think your symptoms arent real. Talk to friends and family. If they cant offer support, talk with a counselor who can help you.
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Lyme Disease And The Cdc
In order for the Centers for Disease Control to recognize a Lyme case for surveillance purposes, there must be objective findings, such as positive blood tests, Bells palsy or joint swelling . The chart below reflects the CDC-reviewed surveillance case manifestations from 2001 to 2010.
This situation contributes to what many experts view as severe undercounting of Lyme disease by the CDC.
How We Care For Lyme Disease
The Division of Infectious Diseases at Boston Children’s provides comprehensive care for children and adolescents with Lyme disease and other infections. Our services include consultation, evaluation, treatment, and management of long-term complications of Lyme disease.
The commitment and compassion with which we care for all children and families is matched only by the pioneering spirit of discovery and innovation that drives us to think differently, to find answers, and to build a better tomorrow for children everywhere.
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How Is Lyme Disease Treated
With early-stage Lyme disease, youâll take antibiotics for about 10 days to 3 weeks. The most common ones are amoxicillin, cefuroxime, and doxycycline. The antibiotics will almost always cure your infection. If they donât, you might get other antibiotics either by mouth or as a shot.
If you donât treat your Lyme infection, you might need oral antibiotics for symptoms like weakened face muscles and irregular heartbeat. You may need antibiotics if you have meningitis, inflammation in your brain and spinal cord, or more severe heart problems.
If your Lyme is late stage, the doctor might give you antibiotics either by mouth or as a shot. If it causes arthritis, youâll get arthritis treatment.
Thereâs no therapy for post-treatment Lyme disease syndrome.
When Should You See A Doctor If You Think You Have Lyme
The rash is a pretty good indication that you may have been bitten. Take a photo of the rash and see your doctor. At this stage, treatment with antibiotics will probably work.
If you don’t have the rash but have symptoms like fatigue, fever, and headache but no respiratory symptoms like a cough, you may want to talk to your doctor.
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Can Individuals Be Re
Relapses are recurrent symptoms that are the result of failure to cure the original infection, whereas re-infection is the recurrence of symptoms as a result of a new exposure to an infected tick, leading to a new infection. Although erythema migrans lesions can relapse if not treated with antibiotics , their recurrence after successful treatment is more likely to be re-infection than relapse .
Re-infection can occur in as many as 2%21% of patients living in endemic areas who have had Lyme disease . On examination, re-infection typically presents with an erythema migrans lesion at a different site than the original lesion more than 12.5 years after the original infection and not within 11 months of the first infection . In one series, 79% of patients with re-infection presented with erythema migrans at a different site than the previous infection, and 21% presented with a febrile illness with myalgias. Re-infection after late Lyme disease characterized by arthritis or neuroborreliosis is very rare .
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.
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Ongoing Symptoms Of Lyme Disease
A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years.
It’s not clear why this happens to some people and not others. This means there’s also no agreed treatment.
Speak to a doctor if your symptoms come back, or do not improve, after treatment with antibiotics.
The doctor may be able to offer you further support if needed, such as:
- referral for a care needs assessment
- telling your employer, school or higher education institution that you require a gradual return to activities
- communicating with children and families’ social care
Page last reviewed: 05 July 2021 Next review due: 05 July 2024