Lyme disease is a serious health threat.

While Lyme disease is not the most severe of tick-borne diseases, it is by far the most prevalent (in the U.S.). If not treated promptly, it can become extremely debilitating and, in rare cases, deadly.

If caught early, Lyme disease responds to a variety of antibiotics. It is not uncommon, however, for the disease to reemerge. Some controversy may exist regarding treatment. As this is not a medical website and does not purport to offer medical advice, it is not the proper venue to fully discuss the myriad issues surrounding the diagnosis and treatment of Lyme disease. But, if you have Lyme disease, or suspect you have it, educating yourself may be a wise step to take.

Lyme disease is an increasing concern.

As the accompanying chart indicates, the incidence of Lyme disease has been growing. The sheer volume of cases is troubling, especially when many believe the disease may be under diagnosed.

State health departments reported 28,921 confirmed cases and 6,277 probable cases of Lyme disease to CDC in 2008. This represents a 5% increase in confirmed cases compared to 2007. The definition and reporting of probable cases was initiated in 2008 based on revisions to the national surveillance case definition.

Lyme disease is prevalent across the U.S.

Lyme disease is distributed across the U.S. Every state except Hawaii has had at least one case in recent years.

Quick Lyme disease background.

• Lyme disease is transmitted in the U.S. by a variety of ticks of the genus Ixodes: the deer tick (Northeast and North-Central), the Western black-legged tick (Pacific Coast), and the black-legged tick (Southeast).
• Lyme disease was first discovered in Lyme, CT, in 1975.
• A corkscrew-schaped bacteria, Borrelia burgdorferi, of the spirochetes family, is the pathogen behind the disease.
• The disease can afflict other animals (dogs, for instance, which develop arthritic symptoms).

Lyme disease symptoms

Lyme disease can infect varying body parts, exhibiting different symptoms at different times. Patients will not necessarily display all symptoms. A key symptom, a circular rash called erythema migrans, is often the first sign of infection, appearing in 70%-80% of cases. The rash initiates at the site of the tick bite approximately 3-30 days after the bite. The rash will gradually expand over several days to as large as 12 inches across. The center may clear as the rash develops, producing a "bull’s eye" effect. Some patients develop additional erythema migrans in other areas after several days. The rash can be warm, but typically isn’t painful.

Other early symptoms include:

• Fatigue
• Chills
• Fever
• Headache
• Muscle and joint aches
• Swollen lymph nodes

Untreated, the infection may spread after a few days or weeks, producing additional symptoms:

• Bell’s palsy, a loss of muscle tone on one or both sides of the face
• Severe headaches and neck stiffness due to meningitis
• Shooting pains
• Heart palpitations
• Dizziness
• Pain moving from joint to joint

After several months, symptoms may include:

• Intermittent bouts of arthritis, with severe joint pain and swelling, particularly in the knees and large joints.
• Numbness or tingling in the hands or feet
• Problems concentrating
• Short-term memory loss

Diagnosis of Lyme disease.

Lyme disease is not easily diagnosed, especially in the absence of a rash, since many of the symptoms are typical of other conditions. Blood tests can be done but are not necessarily conclusive and can show a false negative in the early stages of the disease.

Because Lyme disease is difficult to diagnose and is specific to tick bites, it is important that you tell your physician if you have been bitten by a tick or have been in woodlands or other tick habitat. Also be sure to mention if you have had a rash.

A few states or local health departments may have services available to help identify or test ticks that have been removed from human hosts.

Treatment of Lyme disease.

According to the CDC, patients in the early stages of Lyme disease usually recover rapidly after a few weeks’ treatment with oral antibiotics such as doxycycline, amoxicillin or cefuroxime axetil. Patients with neurological or cardiac infections may require intravenous treatment with ceftriaxone or penicillin. Pregnant patients must avoid some of these antibiotics, as they may affect the fetus.

Patients in later stages of the disease may have persistent, recurring symptoms and may benefit from a second 4-week course of therapy. Some patients continue to have symptoms months and years after the infection. One theory is that these patients have a continued autoimmune response and that longer courses of antibiotics are not beneficial, but rather can cause serious complications.

Additional details on chronic Lyme disease can be found at the NIH Lyme disease web site. Treatment guidelines developed by the Infectious Disease Society of America, can be found at IDSA Guidelines for Treatment of Lyme Disease.

Prevention of Lyme disease.

Due to the serious nature and widespread risk of this disease, prevention should be an uppermost concern of today’s families. The U.S. CDC recommends taking preventive measures against tick bites. Important preventive measures are detailed on our page about ticks