Lyme disease is the most common tick-borne illness in the United States. It's caused by the bite of a black-legged tick carrying the bacterium Borrelia burgdorferi.

Classic Lyme disease symptoms include a distinctive skin rash at the tick bite site, fever, headache, and unusual tiredness. If not treated early, Lyme disease bacteria can travel to the heart, nervous system, and joints, causing inflammation and additional symptoms.

This article will review the symptoms, diagnosis, and treatment of Lyme disease. Information on where in the United States most infections occur, as well as tips on preventing Lyme disease, will also be discussed.

How Do You Get Lyme Disease?

You can get Lyme disease if a black-legged tick (sometimes called a deer tick) carrying the Borrelia burgdorferi bacterium bites you.

There is no scientific evidence that Lyme disease bacteria can spread from the bites of mosquitoes, flies, fleas, or lice. Pets cannot transmit the disease, although they may bring infected ticks into your home.

While the tick can bite anywhere, common sites include the back, groin, armpit, or lower leg. Children may be bitten on the neck or scalp.

According to the Centers for Disease Control and Prevention (CDC), you cannot get infected by touching, kissing, having sex with, or sharing food or water with another person with Lyme disease.

Related:Causes and Risk Factors of Lyme Disease

Do All Ticks Carry Lyme Disease?

Not all ticks carry Lyme disease. The black-legged tick Ixodes scapularis, most commonly spreads Lyme disease in the United States.

Less commonly, Ixodes pacificus, the western black-legged tick, found in the far western United States, also carries Lyme disease bacteria.

Related:Symptoms of a Tick Bite

U.S. Regions With Black-Legged Ticks

Lyme disease occurs most frequently in the following three U.S. regions:

  • Northeastern states
  • Upper Midwestern states
  • Mid-Atlantic states

Some cases are also reported on the West Coast, particularly in Northern California, Oregon, and Washington.

In 2019, over 90% of Lyme disease cases were reported to occur in the following states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin.

Symptoms and Stages of Lyme Disease

Lyme disease occurs in three stages, and symptoms vary among individuals.

Stage 1: Early Localized Lyme Disease

A skin rash called erythema migrans develops in around 75% of people with the infection. This rash appears at the location of the tick bite, usually within seven to 14 days after the bite but can develop as early as three days and as late as 30 days.

Over several days, the salmon-to-red-colored rash expands outward, becoming redder and sometimes forming a flesh-colored center, called a bull's-eye appearance. The rash often feels smooth, warm, and sometimes itchy, tingly, or tender.

Around 50% of people also experience flu-like symptoms, typically before the rash appears. These symptoms may include:

Learn More:Common and Unusual Symptoms of Lyme Disease

Stage 2: Early Disseminated Lyme Disease

If Lyme disease remains undetected or untreated in stage 1, the bacteria can travel throughout the body via the bloodstream. When the bacteria spread to internal organs, they cause inflammation.

Early disseminated Lyme disease affects the heart and/or nervous system, with symptoms typically manifesting days to weeks after the tick bite. 

Heart inflammation from Lyme disease—Lyme carditis—occurs in around 4% to 10% of untreated people with the infection. Symptoms include:

Nervous system inflammation from Lyme disease— Lyme neuroborreliosis—occurs in up to 12% of untreated people. Symptoms may include:

  • Numbness, “shooting” pain, or weakness in the hands, feet, arms, or legs
  • Facial nerve palsy (weakness in muscles on one side of the face)
  • Headache and stiff neck from meningitis (inflammation of the membranes that cover the brain and spinal cord)

Stage 3: Late Lyme Disease

In late Lyme disease, the inflammation most commonly affects the joints and sometimes the nervous system.

These symptoms occur months to years after the tick bite and may include severe joint pain and swelling, especially in large joints like the knees. Muscle or bone pain that comes and goes can also occur.

Neurological symptoms may include subtle memory problems, difficulty thinking, or abnormal sensations like numbness.

How Soon After a Tick Bites You Do You Get Lyme Disease?

A tick must be attached to the skin for at least 36 to 48 hours to transmit Lyme disease bacteria to a person. Lyme disease symptoms may begin three to 30 days after the tick bite.

How Is Lyme Disease Diagnosed?

The manner of diagnosing suspected Lyme disease depends upon the stage of the disease.

For stage 1, the diagnosis of erythema migrans is based on the person's symptoms, rash appearance, and history of possible tick exposure. If the healthcare provider diagnoses erythema migrans, treatment for Lyme disease is started.

If the cause of the rash is in doubt, blood testing may be performed, and if negative for Lyme disease, repeated a few weeks later.

Infrequently, early Lyme disease may be diagnosed by performing a polymerase chain reaction (PCR) test on a skin biopsy (a sample of skin) of the rash. This test looks for the DNA (genetic coding) of Borrelia burgdorferi.

Blood tests used to diagnose Lyme disease include:

  • Enzyme-linked immunosorbent assay (ELISA) detects Lyme disease antibodies (proteins made by the immune system to fight invaders). Sometimes the ELISA test produces a false-positive result, the test reads positive because it is detecting antibodies to other proteins, not those fighting Lyme disease. Due to this false-positive risk, a Western blot is used to confirm the positive ELISA result.
  • Western blot also detects antibodies to bacteria causing Lyme disease. However, it uses a more specific technique than the ELISA test. Results from this test are reported as positive bands. The more positive bands, the higher the chance you have Lyme disease.

Lyme Disease Treatment

The mainstay treatment of Lyme disease is antibiotics. The specific antibiotic regimen recommended depends upon the stage of the disease and your symptoms:

  • Early localized Lyme disease is treated with a daily, oral (by mouth) antibiotic, usually Vibramycin (doxycycline), Amoxil (amoxicillin), or Ceftin (cefuroxime). The dosing schedule is around two to three weeks.
  • Early disseminated Lyme disease is treated with either an oral or intravenous (IV, within the vein) antibiotic, depending on the seriousness of the symptoms. For example, oral antibiotics may treat mild heart inflammation or facial palsy, whereas IV antibiotics are used to treat meningitis.
  • Late Lyme disease is also treated with either oral or IV antibiotics. Joint problems are treated with oral antibiotics for 30 days, whereas neurological symptoms are treated with IV antibiotics for two to four weeks.

Early treatment of Lyme disease significantly lowers the duration and severity of symptoms. However, even if the infection is found in stages 2 or 3, antibiotic therapy is successful for most people.

Understanding Chronic Lyme Disease

Most cases of Lyme disease are curable with antibiotic therapy. That said, some people have symptoms, including widespread pain, fatigue, and cognitive problems (those involving thinking, reasoning, and remembering), that persist for more than six months after treatment.

This condition is called post-treatment Lyme disease syndrome, sometimes used interchangeably with a more vague, poorly defined term, "chronic Lyme disease."

Individuals with chronic Lyme disease experience a range of nonspecific symptoms due to a presumed Lyme disease infection.

With both post-treatment Lyme disease syndrome and chronic Lyme disease, no scientific evidence exists that taking antibiotics for longer than the recommended duration improves symptoms.

Antibiotic therapy cures most cases of Lyme disease. However, about 1 in 10 develop post-treatment Lyme disease syndrome.

Tips for Living With Chronic Lyme Disease

If you have chronic Lyme disease symptoms, self-care and adopting coping strategies can help you navigate this challenging time until you feel well again.

The following behaviors can help optimize how you feel:

Learn More:Living With Lyme Disease

How to Prevent Lyme Disease

Black-legged ticks thrive in moist, humid conditions, especially in wooded or grassy areas.

If you are in a tick-infested region, the following strategies can help prevent tick bites:

  • Walk in the middle of trails and avoid contact with tall bushes, overgrown grass, or leaves.
  • Prevent ticks from gaining access to your skin by wearing long pants tucked into socks and long-sleeved shirts tucked into pants.
  • Use a tick-repellant with DEET (N, N-diethyl-meta-toluamide) on adult skin. Talk with your pediatrician about applying DEET on your child, as a lesser concentration may be needed.
  • Apply a product containing 0.5% permethrin to your clothing and gear. Permethrin is a pesticide that cannot be applied directly to the skin.

After being outdoors, even in your yard, place the clothes you wore in a dryer on high heat to help kill any possible ticks.

Then, examine your body at least once daily for ticks. Pay special attention to moist areas on your body, like under your arms or in your belly button.

If you see a tick, remove it with clean, fine-tipped tweezers right away. If the tick has been attached to your skin for less than 24 hours, the likelihood of getting Lyme disease is minimal.

Even if the tick is removed 24 hours or less after exposure, monitor yourself for Lyme disease symptoms, like a rash or fever, for the next few weeks. Don't hesitate to contact your healthcare provider immediately if any symptoms are present.

Related:How to Prevent Lyme Disease

Outlook for People With Lyme Disease

Most people with Lyme disease recover well and are cured after treatment.

For the 10% of individuals who develop post–Lyme disease syndrome, the good news is that their symptoms (e.g., pain, fatigue, and cognitive problems) usually resolve over time.

Nevertheless, suppose you are experiencing lingering nonspecific symptoms and are told you have post–Lyme disease syndrome or chronic Lyme disease. In that case, it's essential to see a healthcare provider to rule out alternative, treatable medical conditions.

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