Lyme Disease

Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks.  Laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tick-borne diseases as well.


Reducing exposure to ticks is the best defense against Lyme disease, Rocky Mountain Spotted Fever, and other tick-borne infections.


You and your family can take several steps to prevent and control Lyme disease.

Here are the CDC’s, Center for Disease Control and Prevention recommended steps for helping to prevent Lyme disease:


Avoid Direct Contact with Ticks

Avoid wooded and brushy areas with high grass and leaf litter.

Walk in the center of trails.

Repel Ticks on Skin and Clothing

Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.   Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.

Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.


The Environmental Protection Agency (EPA) has an online tool to help you select the repellent that is best for you and your family.


Find and Remove Ticks from Your Body

Bath or shower as soon as possible after coming indoors (preferably within 2 hours) to wash off and more easily find ticks that are crawling on you.


Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.


Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.

Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.


If the clothes are damp, additional time may be needed.

If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.


Following are the CDC’s, Center for Disease Control and Prevention, recommendations for removing a tick.


Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.


Pull upward with steady, even pressure. 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 are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.


After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.


Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.


If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick.


Avoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–do not wait for it to detach.


Following are commonly asked questions about Lyme Disease and the answers from the CDC that will help you have a better understanding of Lyme Disease.


I have been bitten by a tick, do I have Lyme Disease?

If  you have not done so already, remove the tick with fine-tipped tweezers.


The chances that you might get Lyme disease from a single tick bite depend on the type of tick, where you acquired it, and how long it was attached to you. Many types of ticks bite people in the U.S., but only blacklegged ticks transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in the highly endemic areas of the northeastern and north central U.S. are commonly infected. Finally, blacklegged ticks need to be attached for at least 24 hours before they can transmit Lyme disease. This is why it’s so important to remove them promptly and to check your body daily for ticks if you live in an endemic area.


If you develop illness within a few weeks of a tick bite, see your health care provider right away. Common symptoms of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so it’s important to be alert for any illness that follows a tick bite.


Is it true you can get Lyme Disease anywhere in the United States?

No. Lyme disease is spread through the bite of a blacklegged tick (Ixodes scapularis or Ixodes pacificus) that is infected with Borrelia burgdorferi. In the United States, most infections occur in the following endemic areas:

Northeast and mid-Atlantic, from northeastern Virginia to Maine

North central states, mostly in Wisconsin and Minnesota

West Coast, particularly northern California


Maps showing the distribution of human cases are based on where people live, which because of travel, is not necessarily where they became infected. Cases are sometimes diagnosed and reported from an area where Lyme disease is not expected, but they are almost always travel-related.


I live in the southeastern U.S. and get a lot of lone star tick bites. I’ve heard that I can get “southern Lyme disease.” Is this true?

The lone star tick is primarily found in the southeastern and eastern United States. Lone star ticks do not transmit Lyme disease. However, you are correct to be concerned about this very aggressive species. The lone star tick (Amblyomma americanum) can spread human ehrlichiosistularemia, and Southern Tick-Associated Rash Illness (STARI).


The rash of STARI is a red, expanding “bull’ s eye” lesion that develops around the site of a lone star tick bite. The rash usually appears within seven days of tick bite and expands to a diameter of 8 centimeters (3 inches) or more. The rash should not be confused with much smaller areas of redness and discomfort that can occur commonly at tick bite sites. Unlike Lyme disease, STARI has not been linked to arthritis, neurological problems, or chronic symptoms. Nevertheless, the similarity between the STARI bull’s eye rash and the Lyme disease bull’s eye rash has created much public confusion. The pathogen responsible for STARI has not been identified.


In contrast, Lyme disease in North America is caused by a specific type of bacteria, Borrelia burgdorferi, which is transmitted by two species of blacklegged ticks, Ixodes scapularis and Ixodes pacificus. While blacklegged ticks exist in the southern U.S., their feeding habits in this region make them much less likely to maintain, sustain, and transmit Lyme disease.


I have heard that the diagnostic tests that CDC recommends are not very accurate. Can I be treated based on my symptoms or do I need to use a different test? 

You may have heard that the blood test for Lyme disease is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon the stage of disease. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.


Several weeks after infection, currently available ELISA, EIA and IFA tests and two-tier testing have very good sensitivity.

It is possible for someone who was infected with Lyme disease to test negative because:

Some people who receive antibiotics (e.g., doxycycline) early in disease (within the first few weeks after tick bite) may not develop antibodies or may only develop them at levels too low to be detected by the test.

Antibodies against Lyme disease bacteria usually take a few weeks to develop, so tests performed before this time may be negative even if the person is infected. In this case, if the person is retested a few weeks later, they should have a positive test if they have Lyme disease. It is not until 4 to 6 weeks have passed that the test is likely to be positive. This does not mean that the test is bad, only that it needs to be used correctly.


I am pregnant and just found out I have Lyme disease. What should I do? 

If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately. Untreated Lyme disease during pregnancy may lead to infection of the placenta and possible stillbirth.


Thankfully, no serious effects on the fetus have been found in cases where the mother receives appropriate antibiotic treatment for her Lyme disease. In general, treatment for pregnant women with Lyme disease is similar to that of non-pregnant adults, although certain antibiotics, such as doxycycline, are not used because they can affect fetal development.


Additionally, there are no reports of Lyme disease transmission from breast milk.


If I have been diagnosed with Lyme disease, do I need to get tested for other tick-borne diseases (co-infections)?

Maybe. The blacklegged ticks that transmit Lyme disease can sometimes also transmit babesiosis and anaplasmosis. Fortunately, Lyme disease and anaplasmosis are treated with the same antibiotics, so if you are receiving treatment for Lyme disease, anaplasmosis will be treated at the same time (Wormser et al. 2006). Babesiosis is a parasitic disease that is treated with different medications. If your Lyme disease symptoms do not seem to be going away after taking antibiotics, see your health care provider.


There is, however, a great deal of misinformation regarding tick-borne coinfections on the internet. The possibility of having three or more tick-borne infections or having pathogens such Bartonella or Mycoplasma (which have not been shown to be tick-borne), is extremely unlikely.


The chance of having multiple tick-borne infections depends on your location. Several studies have looked at the prevalence of these different organisms in ticks, though methods and locations are very different. Studies have shown that the rate of co-infection in blacklegged ticks varies by region from 1 to 28%. The most common co-infection in ticks is Borrelia burgdorferi (Lyme disease) and Anaplasma phagocytophilum (anaplasmosis). The frequency of tick-borne co-infections in Lyme disease patients from endemic areas ranges from 4 to 45% (Swanson et al. 2006). From 2 to 12% of patients with early Lyme disease may also have anaplasma infection, and 2 to 40% of patients with early Lyme disease may also have babesia infection, depending on the region (Wormser, 2006).


Where can I get a test to make sure that I am cured? 

As with many infectious diseases, there is no test that can “prove” cure. Tests for Lyme disease detect antibodies produced by the human immune system to fight off the bacteria (Borrelia burgdorferi) that cause Lyme disease. These antibodies can persist long after the infection is gone. This means that if your blood tests positive, then it will likely continue to test positive for months or even years even though the bacteria are no longer present.


A research tool called PCR can detect bacterial DNA in some patients. Unfortunately, this is also not helpful as a test of whether the antibiotics have killed all the bacteria. Studies have shown that DNA fragments from dead bacteria can be detected for many months after treatment. Studies have also shown that the remaining DNA fragments are not infectious. Positive PCR test results are analogous to a crime scene – – just because a robbery occurred and the robber left his DNA, it doesn’t’ t mean that the robber is still in the house. Similarly, just because DNA fragments from an infection remain, it doesn’t  mean the bacteria are alive or viable.


I heard that if I get Lyme disease I will always have it. Is that true? 

No. Patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely. Most patients who are treated in later stages of the disease also respond well to antibiotics, although some may have suffered long-term damage to the nervous system or joints. It is not uncommon for patients treated for Lyme disease with a recommended 2 to 4 week course of antibiotics to have lingering symptoms of fatigue, pain, or joint and muscle aches at the time they finish treatment. In a small percentage of cases, these symptoms can last for more than 6 months. These symptoms cannot be cured by longer courses of antibiotics, but they generally improve on their own, over time.


What is “chronic Lyme disease?” 

Lyme disease is an infection caused by the bacterium Borrelia burgdorferi. In the majority of cases, it is successfully treated with oral antibiotics. Physicians sometimes describe patients who have non-specific symptoms (like fatigue, pain, and joint and muscle aches) after the treatment of Lyme disease as having post-treatment Lyme disease syndrome (PTLDS) or post Lyme disease syndrome (PLDS).


The term “chronic Lyme disease” (CLD) has been used to describe people with different illnesses. While the term is sometimes used to describe illness in patients with Lyme disease, in many occasions it has been used to describe symptoms in people who have no evidence of a current or past infection with B. burgdorferi (Marques, 2008). Because of the confusion in how the term CLD is employed, experts in this field do not support its use (Feder et al., 2007).


How many people get Lyme disease? 

Each year, approximately 30,000 cases of Lyme disease are reported to CDC by state health departments and the District of Columbia. However, this number does not reflect every case of Lyme disease that is diagnosed in the United States every year.


Surveillance systems provide vital information but they do not capture every illness. Because only a fraction of illnesses are reported, researchers need to estimate the total burden of illness to set public health goals, allocate resources, and measure the economic impact of disease. CDC uses the best data available and makes reasonable adjustments—based on related data, previous study results, and common assumptions—to account for missing pieces of information.


To improve public health, CDC wants to know how many people are actually diagnosed with Lyme disease each year and for this reason has conducted two studies:

Project 1 (Lyme Disease Testing by Large Commercial Laboratories in the United States) estimated the number of people who tested positive for Lyme disease based on data obtained from a survey of clinical laboratories. Researchers estimated that 288,000 (range 240,000–444,000) infections occur among patients for whom a laboratory specimen was submitted in 2008.

Project 2 (Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005–2010) estimated the number of people diagnosed with Lyme disease based on medical claims information from a large insurance database. In this study, researchers estimated that 329,000 (range 296,000–376,000) cases of Lyme disease occur annually in the United States.


Results of these studies suggest that the number of people diagnosed with Lyme disease each year in the United States is around 300,000. Notably, these estimates do not affect our understanding of the geographic distribution of Lyme disease. Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC. The results obtained using the new estimation methods mirror the geographic distribution of cases that is shown by national surveillance.


Are more recent numbers available? 

Cases of Lyme disease and other reportable conditions are published each week in the MMWR. However, these weekly numbers are provisional and often change when all the data become available after the end of the year. CDC publishes finalized data only after all states and territories have certified their reports. Finalized data for a given year are generally not available until the fall of the following year.


Prompt diagnosis and proper treatment are critical to preventing medical complications of Lyme disease. CDC is committed to providing patients and health care providers with accurate, evidence-based information on the diagnosis and treatment of this condition.

What do the Infectious Diseases Society of America (IDSA) recommendations cover?

The Infectious Diseases Society of America develops clinical practice guidelines on various topics. IDSA guidelines encompass the full scope of Lyme disease clinical care and management, providing not only descriptions of treatment, but also essential information about the diagnosis and prevention of Lyme disease as well as anaplasmosis and babesiosis (other tick-borne diseases). The authors are internationally recognized experts associated with some of the Nation’s leading medical institutions. IDSA guidelines address the full spectrum of disease manifestations including:

Early Lyme disease in the absence of erythema migrans (early skin manifestations)

Lyme arthritis

Early neurologic Lyme disease

Late neurologic Lyme disease

Lyme carditis

Borrelial lymphocytosis (a bluish-red skin condition)

Acrodermatitis chronica atrophicans (a skin condition indicative of late Lyme disease)

Post-treatment Lyme disease syndrome (PTLDS)


Are the IDSA guidelines up to date?

Published in 2006, the IDSA guidelines were reevaluated and upheld by an independent scientific Review Panel whose members were certified to be free from any conflicts of interest by an independent ombudsman. In addition, CDC doctors monitor and evaluate the medical literature, including treatment guidelines, regularly. If new scientific information emerges that conflicts with treatment or management recommendations of the guidelines, CDC will act accordingly to make sure that patients and health care providers are aware.  CDC believes that the current IDSA Lyme disease guidelines, “The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America,” continue to provide comprehensive, accurate information that patients can use in their health care decisions.


What is CDC doing about Lyme disease? 

CDC has a program of service, research, and education focusing on the prevention and control of Lyme disease. Activities of this program include:

Maintaining and analyzing national surveillance data for Lyme disease

Conducting epidemiologic investigations

Offering diagnostic and reference laboratory services

Developing and testing strategies for the control and prevention of this disease in humans

Supporting education of the public and health care providers


In addition, the TickNET program supports research that contributes to the understanding of tick-borne diseases.


US Centers for Disease Control—Lyme Disease


Please note.  This information is provided for your information and comes from the US CDC.  Should you have any concerns or symptoms about any insect bite please contact your doctor as soon as possible.