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Lyme Disease

Do a tick check after coming in from outdoors and watch for these signs of Lyme.
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Last updated April 23, 2021

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What is Lyme disease?

Lyme disease is a bacterial disease transmitted to people by deer ticks. The ticks are infected with the bacteria, Borrelia burgdorferi. It typically takes 24 to 48 hours of a tick feeding on a person for Lyme disease to be transmitted. Symptoms of Lyme disease include fever, headache, fatigue, and a skin rash called erythema migrans, which looks like a bull’s eye.

If it’s not treated, the infection can spread to joints, the heart, and the nervous system, and cause long-term problems. It has been linked to a range of symptoms including migraines, severe joint swelling and pain, and heart palpitations.

Lyme disease is usually treated with antibiotics. For people with chronic Lyme disease, it’s treated with very long courses of antibiotics.

Most common symptoms

Pro Tip

You can have false negative results if the blood tests are taken too soon. This is why it is recommended that those who live or visit high risk areas be treated prophylactically (before the onset of symptoms) rather than wait for symptoms or positive test results. —Dr. Chandra Manuelpillai

Lyme disease can cause different symptoms depending on its stage and the person. Some people may not have any symptoms or do not see a doctor until they’ve had it for a while. Also the symptoms of the stages of Lyme disease can overlap.

After being bitten (about 3 to 30 days post-bite), you may have muscle aches, fatigue, and fever, which can feel like the flu. About 70% to 80% of people get a rash called erythema migrans rash. It looks like a bull’s eye, with a red circle.

Stages of Lyme disease

Main symptoms of early stage Lyme disease

  • Erythema migrans rash: A red circle where you’ve been bitten, appears about 3 to 14 days after the bite. Most of the time it slowly increases in size, often with a clear site in the middle that makes the rash look like a bull’s eye. It usually disappears in about 3 to 4 weeks.
  • Fever (and chills)
  • Fatigue
  • Swollen lymph nodes
  • Headaches
  • Stiff neck
  • Muscle aches
  • Backache
  • Sore throat

Main symptoms of late stage Lyme disease

As the disease progresses, the bacteria start to move through the body causing other symptoms. These symptoms may show up months after the tick bite:

  • Pain, weakness, or numbness in the arms, legs
  • Vision changes
  • Heart problems, such as palpitations, chest pain
  • Facial paralysis (Bell’s palsy)
  • Meningitis
  • Heart palpitations or irregular heartbeat (Lyme carditis)
  • Facial palsy (loss of muscle tone on one or both sides of the face)
  • Impaired short-term memory
  • Dizziness
  • Severe fatigue
  • Shortness of breath
  • Bouts of muscular, tendon or bone pain
  • Arthritis (brief bouts of pain and swelling, particularly in large joints like the knee)

How to remove a tick

Dr. Rx

If you are bitten by a tick, Lyme is not the only disease you can catch. There are many other tick borne diseases. Many are treated by the same antibiotics used to treat Lyme, but some may need different treatments, so talk to your doctor if your symptoms are not going away after antibiotics. —Dr. Manuelpillai

Removing a tick as soon as possible can reduce the risk of Lyme disease as ticks must be attached to the skin for at least a day for the disease to take hold.

If you do find a tick, remove it with fine-tipped tweezers.

  • Grasp the tick as close to the skin’s surface as possible and then steadily pull upward with even pressure to remove the entire tick.
  • Don’t twist or jerk the tick. This can cause the mouth parts to break off and remain in the skin. If this happens, remove the mouth parts with tweezers if you can.
  • Do not crush the tick with your fingers.
  • Clean the bite area and your hands with soap and water, rubbing alcohol, or an iodine scrub.
  • Get rid of a live tick by putting it in alcohol, placing it in a sealed bag, wrapping it tightly in tape, or flushing it down the toilet.

Next steps

Getting diagnosed and treated as soon as possible is essential to avoid complications of Lyme disease. Left untreated, Lyme disease can lead to chronic joint inflammation (Lyme arthritis) particularly of the knees, heart problems (such as abnormal heart rhythm), and neurological problems (such as partial facial paralysis).

If you think or know you were bitten by a tick but are unsure if it was infected with Lyme disease, contact your doctor so that you can be tested. Lab tests can identify the presence of antibodies that your body has produced in reaction to the Lyme bacteria.

A two-stage testing process is used to assess possible Lyme disease infection. These blood tests are most reliable when they are done a few weeks after the tick bite because it takes that long for your body to produce measurable levels of Lyme disease antibodies.

About 95% of people who have been infected for over a month develop antibodies to the Lyme disease bacteria. However, if antibiotics were taken, the antibodies may not be present.

  • The first test is the enzyme-linked immunosorbent assay (ELISA), which detects antibodies to Borrelia burgdorferi. However, it sometimes provides false-negative results (missing the diagnosis) during the early stages of Lyme disease. And it can also provide false-positive results (detecting antibodies that are not there).
  • If the ELISA test is positive, a Western blot test, which detects antibodies to several proteins of Borrelia burgdorferi, can confirm the diagnosis.
  • Sometimes, a sample of joint fluid or cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is taken to look for genetic fragments of the Lyme disease bacteria.

Treatment

Both early- and late-stage Lyme disease are treated with prescription antibiotics and both respond to these therapies. However, early treatment is best and more likely to prevent complications.

Those who live or visited areas considered high risk for Lyme disease should be treated prophylactically (before symptoms start) since their risk of developing Lyme is much much higher.

People with late-stage Lyme may need additional treatments, depending on their symptoms.

What is post-treatment Lyme disease?

Pro Tip

The most common chronic symptom of Lyme disease is arthritis. Patients have pain and swelling of one or more joints, which can come and go and move from joint to joint (migratory arthritis). If left untreated, joint inflammation and damage may be permanent. —Dr. Manuelpillai

Some people continue to have symptoms even after being treated with antibiotics. They may have pain, fatigue, or difficulty thinking that lasts for more than 6 months after treatment. This is called post-treatment Lyme disease syndrome (PTLDS).

Doctors don’t know why some people develop PTLDS. Some believe the Lyme triggers an autoimmune response that causes symptoms even after the infection is gone.  There are other theories as well.

Unfortunately, there is no proven treatment for PTLDS. People with PTLDS usually get better over time, but it can take many months or even years to feel completely better.

How do you prevent Lyme disease?

  • Avoid known tick-infested areas, especially in May, June, and July. Some local health departments and park systems provide information on the local tick infestation.
  • Walk in the center of trails to limit contact with overgrown grass, brush, and leaf litter. Ticks perch on the tips of grasses, leaves, and shrubs and crawl onto people and animals as they brush against them.
  • Don’t let your pets wander into tall grasses and weeds.
  • Wearing a hat, long sleeves, and pants and tucking your pants into your socks and your shirt into your pants can limit the exposure of your skin to ticks.
  • Light-colored clothing can make the dark-colored ticks easier to spot if they do land on your clothes.
  • Spray insect repellents containing DEET (diethyltoluamide) on exposed skin and clothing.
  • Remove clothing after being outdoors and wash and dry them at a high temperature.
  • Shower or bathe as soon as possible after coming in from the outdoors.
  • Perform daily tick checks even if you’ve only been outdoors for a short time.
Share your story

Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS Governing Council and the student representative to the Illinois State Medical Society (ISMS) Education and Health Workforce committee. She completed an internship year with UCLA-Harbor Medical Center's Department of Internal Medicine followed by an emergency medicine residency program at Boston Medical Center (2011) while also serving as the resident representative to the Massachusetts Medical Society (MMS) committee on Student Health & Sports Medicine. She then started working at Saints Medical Center (later Lowell General Hospital/Saints Campus and Main Campus) in Lowell Massachusetts where she served as the Continuous Quality Improvement Director for the emergency medicine group, as well as was the representative for the emergency department on the Sepsis, Stroke and PCI Quality Assurance and Compliance Committees. She joined Buoy Health in 2019. She currently works in multiple emergency departments both in the community and academics, as well as previously worked in multiple urgent care centers. She believes this mix of experiences has given her a unique perspective on the care of acute illnesses.

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