Lyme disease symptoms and treatment

Lyme disease or Lyme borreliosis is an infection caused by a group of spiral-shaped bacteria (spirochetes) which are transmitted to humans following a bite from an infected tick. Ticks are commonly found in grassy and wooded areas, including urban gardens and parks.

Tick activity increases in spring and peaks between April to June, reducing over the summer months. However, it can increase again in early autumn and continues at low levels throughout the winter.

The true incidence of Lyme disease is unknown. However, Public Health England estimates that there are 2,000-3,000 new confirmed cases of Lyme disease each year in England and Wales, although not all cases are confirmed by laboratory testing (PHE, 2018). About 15% of cases are acquired when people are abroad.

Infection occurs most frequently in the New Forest, Salisbury Plain, Surrey and West Sussex, Exmoor, the South Downs, parts of Wiltshire and Berkshire, the Lake District, the North York Moors, the Thetford Forest (Norfolk), and the Scottish Highlands, but any area harbouring Ixodes ticks may have the potential for Lyme borreliosis transmission.

Lyme disease may be more prevalent in central, eastern and northern Europe (including Scandinavia) and parts of Asia, the US and Canada.

Some symptoms of Lyme disease can include:

• Erythema migrans (Lyme disease rash)
• Fatigue
• Fever and sweats
• Swollen glands
• Headache
• Malaise
• Migratory joint or muscle aches and pain
• Neck pain or stiffness
• Paraesthesia
• Impaired vision
• Facial palsy
• Cognitive impairment, such as memory problems and difficulty concentrating

Lyme disease typically occurs in 3 stages.

Early localised

This is the initial stage of Lyme disease and can occur within hours or weeks after a bite from an infected tick. Symptoms in this phase include an oval skin rash at the point of the bite, fever, fatigue, muscle and joint pains, flu-like symptoms and swollen lymph nodes.

Early disseminated

This stage may occur weeks or months after the tick bite and shows that the bacteria is starting to spread around the body. In addition to the symptoms in the first stage, you may also experience inflamed and painful joints, headache, neck stiffness, difficulty concentrating or sleeping, weakness or numbness in the arms and legs, vision changes, heart problems and facial paralysis.

Late disseminated

This stage occurs when Lyme disease is left untreated. This can occur months or even years after the initial bite and can result in inflammatory migratory arthritis, severe headaches or migraines, severe fatigue, dizziness, irregular heart rhythm and worsening cognitive impairment.

Lyme disease is easiest to treat and cure in its early stage. Stages can sometimes overlap and not all patients may experience all three stages of Lyme disease.

In the initial stage of Lyme disease, a rash will appear around the bite of the tick. This rash usually doesn’t itch but is a sign of the infection spreading through skin tissues. Up to a third of people with Lyme disease don’t have a rash.

The Lyme disease rash, known as erythema migrans that appears on infected individuals, has the following features:

• Appearance – round or oval target-like appearance with a central red spot surrounded by a clear circle and then a red circle on the outside. Pink, red, or purple in colour. Usually flat but may be slightly raised, a vesicle or pustule is present at the centre in 5% of people.
• Size – usually expands over days to weeks. The diameter is usually larger than 5cm (median 16cm) and can sometimes be as large as 70cm.
• Location – a solitary lesion at the site of a tick bite. Often on the legs, at flexor creases (knees, axillae, and groins), around the waistband, under the breasts, near to straps (which impede the forward progress of ticks), or(particularly in children) at the hairline or the upper parts of the body.
• Timing – it usually becomes visible from 1-4 weeks (but can appear from 3 days to 3 months) after a tick bite and lasts for several weeks.

Lyme disease is caused by an infected tick passing the bacteria, Borrelia burgdorferi, to a human during its feeding cycle. The tick can become infected during its larval or nymph stage after it feeds on small animals like mice, squirrels and birds that carry the bacteria causing Lyme disease. When the infected tick gets onto you and bites, the bacteria can enter your skin and eventually make its way into your bloodstream.

Where you live can increase your risk of coming into contact with an infected tick. Some common risk factors of Lyme disease include:

• Spending time in grassy, weedy or wooded areas
• Having exposed skin when you spend time in grassy areas
• Not removing an attached tick properly from your skin within 36 hours

Lyme disease is not passed on from person to person. It has not been shown that Lyme disease can be spread from person to person through blood transfusions, infected animals, kissing and is not sexually transmitted.

If you have had Lyme disease once and have been treated with antibiotics and recover, it is possible to get it again if you get bitten by an infected tick. You will have to see your doctor again to get diagnosed and prescribed appropriate treatment.

Lyme disease cannot be passed on genetically. Lyme disease is not inherited but if more than one member of a family contracts Lyme disease, this may be due to the environment they share.

You may get Lyme disease from a tick on a dog if the dog has picked up a tick that is carrying the Lyme disease bacterium, Borrelia burgdorferi. This carrier tick can get onto your skin and bite and infect you with Lyme disease. Not all ticks carry Lyme disease, however. The Lone star tick, American dog tick, Rocky Mountain wood tick and brown dog tick do not carry Lyme disease bacteria and cannot transmit the disease.

If Lyme disease is not caught in its early stages and treated with antibiotics, it can cause serious complications. If left untreated, the infection can spread to your joints, heart and nervous system. This can cause an array of symptoms such as:

• Headaches
• Neck aches
• Heart palpitations
• Inflammatory arthritis
• Serious joint pain
• Facial palsy
• Neuropathy
• Cognitive defects (impaired memory)

Lyme disease may cause weight gain, weight loss and skin disorders due to a buildup of toxins in the body.

Lyme carditis occurs with untreated Lyme disease or in situations where treatment has been unsuccessful. It is a progressive complication that affects the heart. Symptoms of Lyme carditis include chest pain, heart palpitations and ECG changes. All parts of the heart can be affected by Lyme bacteria.

Amongst other complications people may experience, it is possible that Lyme disease contributes to liver problems as it may cause inflammation of the liver (hepatitis).

Lyme disease may not go away on its own without antibiotic treatment. Initial symptoms of Lyme disease may go away on their own within a few weeks, however, additional symptoms may appear days to months later.

Lyme disease is not fatal and can be treated and cured with a course of antibiotics. However, untreated Lyme disease can lead to serious complications which can affect your brain, heart and joints.

Not all ticks carry Lyme disease. Only some species of ticks can carry the Lyme disease bacteria and pass it on to humans. The ticks that carry Lyme disease are referred to as Ixodes and include:

• Blacklegged tick
• Deer tick
• Pacific tick

It is not possible to get Lyme disease from a dog bite. Lyme disease is only passed on to people through an infected tick bite. A dog may, however, have picked up a carrier tick and this tick could latch onto you.

Lyme disease can be treated and cured with a course of antibiotics within 2 to 4 weeks. However, it is possible for symptoms of Lyme disease to last for months or years after treatment. These symptoms include fatigue, joint or muscle pains, headaches, hearing loss, dizziness, mood changes, paresthesia, difficulty sleeping and difficulty thinking. They can disrupt a person’s normal daily activities, however, not all cases of Lyme disease will result in post-treatment Lyme disease syndrome.

Mosquitoes can carry Lyme disease but there is no evidence that they spread the infection to humans.

If you have been bitten by a tick and it is still attached to the skin, remove it as soon as possible.

Do

• Grasp the tick as close to your skin as possible using fine-toothed tweezers or a tick removal device
• Pull upwards slowly and firmly, away from the skin, without twisting

Do not

• Squeeze, crush or puncture the body of the tick
• Burn the tick off (eg. using a cigarette end or match head)
• Apply petroleum jelly, alcohol, nail varnish remover, or other substances

After removal, clean the skin with soap and water or skin disinfectant and wash your hands.

Seek immediate medical advice if you develop any signs or symptoms of Lyme disease.

Find your nearest doctor clinic today.

Dr Sufian Ali is a Medicspot GP based in the West of Scotland, having attended Aberdeen Medical School and completed his GP training in Glasgow. He has enjoyed working in a number of specialties including paediatrics, psychiatry and emergency medicine; while also working in a variety of settings.

Dr Saira Goheer grew up in Glasgow and attended Hutchesons’ Grammar. She qualified from Aberdeen University Medical School in 2010. She returned to Glasgow for her GP training. Saira is now based in Edinburgh working as a qualified GP. She started working for Medicspot in 2019 and has a real passion for travel and fitness.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.