UNIVERSAL HEALTH: Lyme Disease Stages of Development

Lyme Disease is a disease that is caused by the transmission of a microorganism from an infected host to an individual.  Lyme Disease is carried by ticks and has increased 25 fold since the 1980s, when it was made a reportable disease.  This disease was named in 1977 when arthritis was observed in a group of children who were in and around lyme in Connecticut.  This disease generally occurs in the northwestern states, northeastern states, mid-Atlantic, and the upper northcentral region. 

Lyme Disease is linked to a bacterium called Borellia Burgdorferi. The tick that carries it is black-legged, and is known as the Deer Tick. Immature ticks become infected by feeding on small rodents that are infected with the bacterium. Lyme disease is not transmitted person-to-person.

A bite by an infected tick does not automatically result in Lyme disease. The longer the tick is attached, though, the risk of infection occurs. If the tick is attached less than 24 hours, Lyme Disease transmission is unlikely, it usually needs to be attached at least 36-48 hours. Tick attachment for more than 72 hours constitutes a high probability of infection.

Peak season is May-September for tick bites.

The bacteria lives in the gut of the tick or nymph (adolescent ticks) and is transmitted during feeding. The nymph is the highest risk to a human for passing along the bacteria, and are active in late spring and early summer which is when Lyme disease risk the greatest. Adolescent ticks are also a small size which makes them easy to be overlooked, so they stay attached long enough to infect the host. Adult ticks can still transmit Lyme disease in the fall, but they are less likely to attach to humans, and if they do, they are larger and easier to see and remove.

Initial symptoms include flu like symptoms, muscle and joint pain, headache, fatigue, and fever. “Bulls-eye” rash shows up in three to 32 days after being infected with B. burgdorferi. Rash looks flat or raised red area at the site of the tick bite with a clear center with reddened or purple-blue edges. Can be round or triangular in shape and can grow up to 20 inches over time.

People may develop persistent fatigue, fever, chills, muscle and joint pain, and anorexia within 6-9 months if no medical treatment or assessment is sought. Those folks who have Lyme Disease and who are not treated during the early stages of the infection may develop recurrent erythema migrans. Treatment becomes longer at this stage but can still be effective at preventing chronic disease. More than half of untreated people will develop arthritis. Initial swelling is minimal but may later become massive. A low percentage of patients who are infected with untreated Lyme disease actually progresses to a neurological infection.

Central nervous system invasion can occur rapidly, within 2-8 weeks of the bite with complaints of fever, severe headache, concentration decicits, fatigue and or photophobia are common. Meningitis may occur, as well as neuropathy or facial palsy.

Weeks to months after the tick/nymph bite, a small percentage of victims will carditis as a result of a direct invasion of B. burgdorferi into the heart tissue. Victims might complain about light-headedness, syncope, palpitations, chest discomfort, and dyspnea. Symptoms may be severe and lifethreatening, but, with treatment, should resolve within three days to six weeks.

Weeks, months, or possibly years after a tick bite, Lyme Disease may present itself with symptoms found early in the disease. This stage most likely leads to chronic Lyme Disease.

During this stage, symptoms such as musculoskeletal, neurological and cardiovascular problems, have now become chronic and many times irreversible. Arthritis caused by Lyme disease progresses during this stage. Symptoms include severe fatigue, swelling, stiffness, and pain in affected joints. Although the severity of symptoms may decrease months or years later, the arthritis often becomes chronic. Late neurological manifestations of Lyme disease may include persistent headaches, mood changes, sleep disorders, and dementia.

Diagnosis of Lyme disease is based mainly on the history and presenting signs and symptoms of the patient. If the characteristic rash, EM, is not present, the diagnosis is difficult. Additionally, if the rash occurs on the scalp, it may not be noticed under the hair. Diagnosis of Lyme disease is especially challenging when the patient is not aware of having been bitten by a nymph or tick. Initial symptoms of Lyme disease are vague, so infected people may attribute them to the flu.

The goal of treatment of Lyme disease is to minimize symptoms and halt the progression to an additional stage. Treatment may be initiated immediately for individuals who have been bitten by a nymph or tick and live in a high-risk geographical area. Antibiotic treatment is generally effective in the early stage of the disease. A 14 –21 day course of oral antibiotics often clears the infection and prevents complications. If Lyme disease has progressed, an intravenous antibiotic for 14 to 28 days is recommended. This is generally effective in eliminating infection, although it may take some time for the symptoms to remove themselves.

The best prevention against Lyme disease is to limit activities in woody, brushy or grassy areas, especially in high-risk states. Use bug repellent, wear long sleeves, long pants tucked into the socks. A “tick check” should be done daily, with emphasis on the scalp area. Immediate removal of any tick found is essential.

• Using tweezers, grasp the tick as close to the skin as possible and pull straight out.
• Do not try to irritate the tick with heat or chemicals or squeeze the tick's body, as this may cause the tick to inject more germs into the skin.
• Wash the bite area with soap and warm water after removal.