Lyme disease is the most common vector-borne disease in the United States. Lyme disease is caused by the bacterium Borrelia burgdorferi and rarely, Borrelia mayonii. It 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 tickborne diseases as well.
Early Signs and Symptoms:
- Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash.
- Erythema migrans (EM) rash (see photos):
- Occurs in approximately 70 to 80 percent of infected persons.
- Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days).
- Expands gradually over several days reaching up to 12 inches or more (30 cm) across.
- May feel warm to the touch but is rarely itchy or painful.
- Sometimes clears as it enlarges, resulting in a target or “bull’s-eye” appearance.
- May appear on any area of the body.
Later Signs and Symptoms:
- Severe headaches and neck stiffness.
- Additional EM rashes on other areas of the body.
- Facial palsy (loss of muscle tone or droop on one or both sides of the face).
- Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
- Intermittent pain in tendons, muscles, joints, and bones.
- Heart palpitations or an irregular heart beat (Lyme carditis).
- Episodes of dizziness or shortness of breath.
- Inflammation of the brain and spinal cord.
- Nerve pain.
- Shooting pains, numbness, or tingling in the hands or feet.
More about rashes:
- A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite, is common. This irritation generally goes away in 1-2 days and is not a sign of Lyme disease.
- A rash with a very similar appearance to EM occurs with Southern Tick-associated Rash Illness (STARI), but is not Lyme disease
- Ticks can spread other organisms that may cause a different type of rash.
Journal of Infectious Diseases and Diagnosis
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