Lyme Disease

Lyme Disease is a bacterial infection transmitted to humans exclusively by an infected deer tick. The deer tick is black and in most cases, no bigger than a pinhead.

Early signs of Lyme Disease resemble flu symptoms including fatigue, chills, fever, headache, muscle and joint pain, and a skin rash manifested in a circular patch that slowly expands.

Untreated, Lyme Disease can cause heart inflammation, affect the nervous system, cause muscle weakness, result in meningitis or inflammation of the covering of the brain, arthritis, and neurological disorders including memory loss, confusion, and emotional lability.

The diagnosis of Lyme disease may be supported by a simple blood test. Occasionally other tests including PCR on joint or spinal fluid only may be useful to help establish the diagnosis. Most patients respond to antibiotic therapy administered for 10-60 days. It may take up to 9 months after completing therapy for the resolution of some symptoms. Prolonged antibiotic therapy will not hasten recovery.

For detailed information on Lyme Disease, contact the Center for Disease Control at www.cdc.gov, or call ID Care at 908-281-0221.

Lyme Disease - Questions & Answers:

1. What is Lyme disease?
Lyme disease is a bacterial infection that is transmitted to humans by the bite of infected deer ticks.

2. How is Lyme disease spread?
An infected deer tick transmits Lyme disease when it feeds on an animal or human for 36-48 hours or more. Lyme disease is not spread by other types of ticks nor is it spread by mosquito or fly bites. It is not contagious from person to person.

3. How do ticks carrying Lyme disease differ from other ticks?
The most important distinction is size. The deer tick that transmits Lyme disease is much smaller than the common dog tick. In the spring and summer the nymphal stage of the deer tick is about the size of a pinhead. The adult tick that is slightly larger transmits infections in the fall.

4. What are the early symptoms of Lyme disease?
The earliest signs of Lyme disease are flu-like symptoms (fatigue, chills, fever, headache, muscle and joint pains) and a very characteristic skin rash called erythema migrans, commonly referred to as a bull’s eye rash. This rash generally appears as a red circular patch that expands slowly, often to a very large size. It has an average diameter of 5 to 6 inches (range 2 inches to 2 feet). The center of the patch may clear as the rash enlarges, resulting in a ring-like appearance. The rash may be warm but is usually not painful. Smaller secondary rashes may appear at other sites, including the face. The rash appears an average of 1 to 2 weeks after the tick has fed (range = 3-30 days).

5. What are the later symptoms of Lyme disease?
Some of the symptoms of Lyme disease may not appear until weeks or months after the initial onset of illness. The infection may inflame the heart, leading to disturbances of the heart rhythm. Lyme disease may affect the nervous system causing muscle weakness of the face and limbs or pain and numbness. Meningitis, an inflammation of the covering of the brain, may occur resulting in a stiff neck and severe headache. In later stages of the disease, arthritis may develop and the joints may become red, swollen and painful. Large joints such as the knee, elbow, or shoulder are commonly affected, whereas the ankle, wrist, jaw, and finger joints are affected less often. True arthritis usually affects only one or two joints. Arthritis involving multiple joints is less likely to be a result of Lyme disease. Lyme disease may also cause disabling neurological disorders such as confusion, memory loss, and emotional lability. These late-stage neurological symptoms are less common in Lyme disease acquired in the United States than in Lyme disease acquired in European countries.

6. How is Lyme disease diagnosed?
Lyme disease is diagnosed from its clinical features and with the aid of blood tests when necessary. When the erythema migrans rash is observed, no serologic tests are necessary. For later manifestations of the illness, serologic tests are generally used. Often the serologic test does not become positive until several weeks after the onset of illness. A positive blood test does not necessarily mean that the symptoms are due to Lyme disease. Other types of infections may interfere with Lyme disease testing and result in a false positive test. The level of the antibody does not correlate with disease activity and it cannot be used to monitor success of therapy. Antibody levels may remain elevated for months to years after successful treatment.

Other diagnostic tests that are occasionally used to help in the diagnosis include a molecular biological test, known as PCR, on joint or spinal fluid, a nuclear medicine quantitative SPECT scan of the brain, and neuropsychological tests. Patients with late-stage Lyme disease affecting the brain may have characteristic memory deficits that may be demonstrated on standardized neuropsychological tests. PCR tests on blood and urine have not yet been demonstrated to reliably correlate with disease activity. The Centers for Disease Control and Prevention and the Food and Drug Administration recently (2/11/05) published a warning regarding testing for Lyme disease (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a6.htm). Some laboratories offer tests whose accuracy and clinical usefulness has not been established.

Because of over reliance on the blood tests, Lyme disease tends to be over diagnosed, particularly in people with vague symptoms. With all of the media attention given to Lyme disease, increasing numbers of people are requesting blood tests for themselves or their children, even though their symptoms are not actually suggestive of Lyme disease. Such patients may subject themselves to costly diagnostic evaluations and potentially harmful treatment.

7. Can Lyme disease be treated and cured?
Yes. Most Lyme disease patients treated in early stages of the disease when only the rash and flu-like symptoms are present, will respond favorably to therapy and remain well. Even among patients not treated until later stages of the disease, the majority respond to therapy. In a small proportion of cases, symptoms may recur and additional courses of antibiotics are necessary. Rare patients with arthritis (swollen joints) may not respond to repeated courses of antibiotics. Other therapies including steroids and even surgery may be required for symptomatic relief. Permanent damage to joints occurs in a small number of patients.

8. What antibiotics are used to treat Lyme disease?
Doxycycline or amoxicillin are used to treat most patients with Lyme disease. Cefuroxime axetil (Ceftin), clarithromycin (Biaxin), and azithromycin (Zithromax) have also been shown in clinical studies to have activity in the early stages of Lyme disease. These last three drugs are much more costly than amoxicillin and doxycycline and have not been shown to be any more effective than the standard agents. In fact, in one study, Zithromax was shown to be less effective than amoxicillin. Combinations of oral antibiotics will only increase side effects and expense without improving outcome.

Intravenous antibiotics such as ceftriaxone (Rocephin), cefotaxime (Claforan), and penicillin G are used to treat central nervous system involvement such as meningitis.

9. How long do I need to be treated for Lyme disease?
Oral antibiotics are usually given for up to 21 days for early Lyme disease and for up to 60 days for Lyme arthritis. A recent study demonstrated no benefit in administering 20 days of antibiotics as compared to 10 days of antibiotics for early Lyme disease. Intravenous therapy is usually prescribed for 14-28 days depending on the severity of the illness and the response to therapy. A patient’s symptoms may take from six to nine months to completely resolve after antibiotics are completed. A longer course of antibiotics will not hasten resolution of the symptoms. Occasionally a patient’s symptoms will recur or progress after treatment and a second course of antibiotics may be prescribed. Any patient whose symptoms either do not improve or worsen after therapy must be thoroughly reevaluated to assure that the diagnosis is correct. Another illness may cause symptoms that are mistakenly ascribed to Lyme disease.

10. Do the antibiotics have side effects?
Any medication may have side effects in some patients. Rash, diarrhea, vaginal yeast infections, fever, and the risk of other infections with antibiotic resistant bacteria are a few of the more common side effects that may occur. Therefore, it is important to prescribe antibiotics only if they are truly needed and not to treat for a longer duration than is necessary.

11. Should I have a repeat blood test after I have been treated?
No. The blood test measures what is called an antibody, the body’s response to fighting an infection. It does not measure the infection itself. Antibodies may remain positive for many years after infection, and thus a repeat test provides no information regarding success of treatment.

12. Are there special problems if Lyme disease occurs during pregnancy?
Lyme disease acquired in pregnancy may lead to infection of the fetus. Although rare cases of fetal infection resulting in malformations and miscarriage have been reported, there have been no reported instances of an adverse outcome when the expectant woman was adequately treated.

13. Where does Lyme disease occur?
Lyme disease occurs in a nearly worldwide distribution in Europe, northern Asia and North America. In the United States, 95% of Lyme disease infections occur in three areas: (1) Mid-Atlantic and New England States from Maryland to Boston; (2) Upper mid-west in Wisconsin and Minnesota; (3) Pacific coast, especially northern California.

14. Is Lyme disease spreading?
Yes. The tick that carries Lyme disease is now present in areas of the country where it had not been recognized previously. The tick can be spread by birds, deer, and by humans transporting pets, including horses.

15. Where am I likely to be exposed to ticks carrying Lyme disease?
The ticks prefer wooded areas and overgrown fields. However, in many suburban areas where residential lawns and parks are located within or near woods, ticks may be found in the borders between maintained areas and woods, and even among ornamental plantings and on lawns. Local health departments, park or extension services may have information on the local distribution of ticks.

16. Do other illnesses cause symptoms similar to Lyme disease?
Yes. Although the erythema migrans rash of Lyme disease is unlikely to be caused by other illnesses, a ring-shaped rash that appears hours rather than days after a tick bite is not a sign of Lyme disease. It is a local irritation that also occurs with other insect bites. Other infections and diseases may cause rashes that mimic the erythema migrans rash of Lyme disease.

Pain, swelling, or stiffness of joints may indicate various forms of arthritis such as rheumatoid or osteoarthritis. Reiter’s syndrome, another type of arthritis, may occur after gastrointestinal or venereal infections. Children may develop juvenile rheumatoid arthritis or rheumatic fever. All of these diseases may cause symptoms that may be confused with Lyme disease.

Other infections may cause fever, headache, muscle aches, and fatigue. Examples include enteroviral infections, leptospirosis, Rocky Mountain spotted fever, and ehrlichiosis. If persistent severe fatigue is a prominent symptom, mononucleosis, chronic fatigue syndrome, fibromyalgia and even depression may be the cause.

17. Is there a vaccine available against Lyme disease? Should I take it?
On December 21, 1998, the Food and Drug Administration (FDA) licensed LYMErix, a new vaccine against Lyme disease. In 2002, GlaxoSmithKline withdrew the vaccine from the market citing poor sales.

18. What should I do if I get a tick bite?
There is no reason to panic, as the chances of contracting Lyme disease are low. The safest and most effective way to remove an attached tick is to grasp the tick’s mouth area with clean tweezers as close to the skin as possible. If tweezers are not available, fingers should be wrapped first in tissue. Then, pull upward with a steady, even pressure. Do not twist. Take care not to crush the tick or to handle it with bare fingers. Also, do not put a hot match to the tick or try to smother it with petroleum jelly, nail polish, or other noxious substances, since this only prolongs exposure time and may cause the tick to eject the Lyme organisms into the body. Once the tick is removed, wash the bite area with soap and water or with an antiseptic to destroy any contaminating microorganisms.

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