I’m pretty sure you’ve heard about Lyme disease, especially if you live in the New England area. When the weather gets warmer and you start working in the yard, playing outdoors or hiking, you might be at risk of being bitten by a tick. In this article, you’ll read about Lyme disease symptoms, test and treatments.
A deer tick is usually the carrier of the bacterial infection (Borrelia burgdorferi) that causes Lyme disease. Lyme disease is the most common tick-borne disease in the United States and Europe.
Interestingly, only a few people diagnosed with Lyme disease actually recall a tick bite. Therefore, remembering a tick bite is helpful in deciding about early treatment. However, it doesn’t rule out an infection with this bacteria.
The tick can hide itself in strange places on your body. Therefore, it’s very important to search your entire skin for possible ticks, every time you get home. You can use a mirror or ask your partner to help you with the search process, especially when you explore your back.
Lyme disease symptoms
The typical Lyme disease rash erythema migrans (literally redness that migrates). It could be an early manifestation of this condition.
Many patients suffering from Lyme disease present with late manifestations of this condition, such as fatigue, joint pain, muscle pain, Bell’s palsy (weakness of the facial muscles), red eyes, weight loss and headaches.
Heart problems related to Lyme disease
In rare cases, Lyme disease can cause problems with heart function. For instance, inflammation of the heart muscles could result in diminished pump function and heart failure. This infection can also cause a blockage of the electrical wiring of the heart.
Lyme disease rash
The most notable symptom of Lyme disease is the so-called bull’s-eye rash. This rash appears 7-14 days after the bite. It typically expands over many days and weeks. It’s hot to touch and usually non-tender.
The rash might occasionally itch or burn.
The first step to diagnose Lyme disease is a detailed history and physical examination. It’s important to know about the activity and travel history and whether the patient was in a forested and bushy area.
The diagnosis of Lyme disease is sometimes straightforward, especially in cases where the tick is available for further examination and the history is clear and reliable.
I’ve had many patients who arrived in the practice with a tick still living in a plastic bag. They could tell me exactly when they noticed the tick, how they removed it and how long the tick was attached to their body. Understandably, similar visits are fewer than we would like to see.
If the history of the patient and the physical examination suggest possible Lyme disease, then blood work might be helpful. It’s understandable that a patient who presents with a bull’s-eye rash and a history that is suggestive of Lyme disease doesn’t require a blood work.
The blood test to confirm Lyme disease is two-tiered. If the first blood work returns positive, a second and more specific blood test to confirm the first result will be ordered.
That is why getting the final blood work result to check for this condition might take several days.
Penicillin, doxycycline and cefuroxime can be used to treat Lyme disease. Doxycycline isn’t recommended for use in children. How long a patient with this condition should be treated with antibiotics, is a matter of discussion. However, most physicians usually treat their patients with two to four weeks of antibiotics.
Treatment of Lyme disease in pregnant woman
The treatment of Lyme disease in pregnant woman is the same as the general population, except doxycycline should be avoided.
Chronic Lyme disease
The discussion of chronic Lyme disease is full of controversy and lively conversations. The number of physicians who believe in diagnosing and treating chronic Lyme disease, is much lower than experts who see this approach as unproven and not evidence-based.
Proponents of a chronic Lyme disease diagnosis suggest that an infection with the Burgdorferi bacteria can happen, even in the absence of antibodies against these bacteria in the blood. Most experts see this suggestion as improbable and speculative.
The practitioners who diagnose chronic Lyme disease often rely on inaccurate and unstandardized blood tests, which are controversial.
When a patient is diagnosed with chronic Lyme disease by a practitioner, the patients end up taking antibiotics for months and years using oral and IV antibiotics.
Several high-quality studies have shown that these patients treated with long term antibiotics, face a higher risk of adverse effects with no clear benefits.
There is no evidence supporting long-term antibiotic therapy in this population. Therefore, most experts do not recommend to treat so-called chronic Lyme disease.
I understand that discussing this approach with patients who are suffering from lasting symptoms caused by Lyme disease is difficult. However, it’s important to remember that often taking unnecessary medications can harm you, more than provide you with any tangible benefits. Too many needless medications are prescribed and consumed in this country and around the world. We should avoid taking medications when there is no evidence supporting it.
How to prevent Lyme disease
Since usual disease prevention should be your main goal, here are a few suggestions for helping to prevent Lyme disease.
- Make sure that you examine your body after any outdoor activities
- Cover your body with protective clothing
- Use a tick repellent containing DEET several times a day when you are outdoor
- Bathe within two hours of returning home
- Place your clothing in a dryer using high heat for about four to five minutes
Patient questions on Lyme Disease
I’ll discuss a few questions that patients have asked me. You can also send me your questions. I’ll try to include them in my upcoming articles and videos. If you would like to ask a question, please go to our Contact page and send me yours.
Julia M. from Boston, MA
In July 2017, Julia presented with a rash on her right upper leg, that expanded within a few days. She removed a deer tick from the center of the rash. She was diagnosed with Lyme disease and treated with antibiotics. The rash improved after few days of antibiotics. A few weeks later, Julia developed another rash on her belly, similar to the first one. The rash expanded again.
The second time I saw her, she asked me whether she is having a relapse.
This is a rare presentation. However, patients could have a reinfection with the same bacteria a few weeks later, even after successful treatment with antibiotics. That is why it’s important that if you notice a new bull’s eye rash, to seek help and see your doctor.
Mary P. from Brookline, MA
Mary is a 25-year old nursing mother diagnosed with Lyme disease in 2016. Then, she asked me whether she could continue nursing, despite being diagnosed with Lyme disease.
There is limited evidence that Lyme disease can be transmitted through breastfeeding. It appears that it’s safe to continue nursing, despite a positive Lyme disease diagnosis.
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