What is Lyme disease?
Lyme disease is a disease that is caused by a bacterium (Borrelia burgdorferi). It is commonly found in North America and Europe. It is spread by deer ticks. Deer ticks bite and feed on the blood of animals and on humans. When they bite an animal that is infected with the bacteria and then bite a human, the bacteria can be transferred to the human through the blood.
You’re more likely to get Lyme disease if you live or spend time areas where deer ticks live, such as heavily wooded areas.
Lyme disease can be prevented and treated
The skin and joint problems are early warning signs for Lyme disease. The skin rash usually appears in 3-14 days after a tick bite. A small red bump will enlarge and have a red ring with a clear area in the center. It looks like a bull’s-eye and is called a “target” lesion.
The medical term for this rash is erythema migrans and is a classic finding in Lyme disease. There may be a single target lesion or multiple lesions.
The joint problems usually appear 2-4 weeks after the infection. This involves joint swelling and pain, especially in the knees. Other early warning signs may include flu-like symptoms and severe fatigue.
For you to get Lyme disease, an infected deer tick must bite you and deposit the bacteria into your blood. The bacteria enter your skin through the bite and eventually make their way into your bloodstream. In order to do this, often an infected tick must be attached for 36 to 48 hours. If you find a tick on you, remove it at once and ask your doctor what to do next.
Why should I care about Lyme disease?
Lyme disease is very common in Minnesota and Wisconsin, where deer ticks are plentiful. Left untreated, Lyme disease can cause:
Chronic joint pain, swelling and inflammation, especially of the knees
Nerve involvement causing facial drooping, severe headaches, and general nerve pain
Muscle weakness
Impaired memory and ability to think appropriately
Heart problems that can be very serious including irregular heartbeats
Eye irritation and inflammation
Liver inflammation (hepatitis)
Chronic severe fatigue
How is Lyme disease diagnosed?
Lyme disease can be diagnosed by a patient’s history of exposure to a biting tick or by a list of symptoms and being in an environment with a large deer tick population. There are several tests your doctor can run to determine if you have Lyme disease, including an ELISA test, Western blot test and PCR test. Your doctor will recommend the best test for your situation.
How can Lyme disease be prevented?
The best way to prevent Lyme disease is to avoid areas where deer ticks live, such as heavily wooded areas or areas with lots of tall grass. If you find yourself in such areas, you can greatly reduce your risk of getting Lyme disease with these simple recommendations:
Wear protective clothing that covers your skin.
Use insect/tick repellents that contain DEET.
Check yourself, your family, your friends and your pets for ticks after spending time in wooded areas or areas with tall grass.
Remove any tick as soon as possible with tweezers.
How is Lyme disease treated?
Oral (and sometimes IV) antibiotics are the treatment of choice for Lyme disease. Your physician will recommend the best course of treatment for you if you have the disease. Early treatment is the most effective.
Remember, if you find a tick on you or play in areas where deer ticks are common and you feel fatigued, develop flu-like symptoms, or have joint pain, call your doctor for additional evaluation. Only a small percent of people who get bitten by a tick get Lyme disease, but it is important to play it safe.
It’s important to check with your physician even if the symptoms disappear, because the disease can still develop. Lyme disease is easily treated, but left untreated it can be devastating and have problems that occur or last for years down the road.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.
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Dr. Crutchfield – the biggest obstacle to Lymes is inaccurate test results (the US test can have up to an 80% error, vs the European test) and reluctance of physicians to treat ongoing Lymes or reinfection. How do you respond to this? What sort of testing do you use, and if a patient has had Lymes for several years without a proper diagnosis, what do you suggest? I appreciate your response.
yes, i agree with Cat, am looking forward to a response.
Hey Cat,
Dr. Crutchfield will be responding to your question soon – it might even be featured in one of his future columns.
Thanks for inquiring!
Response from Dr. Crutchfield:
After consulting an infectious disease expert and colleague, this is what I have learned:
There is an entire industry built around the idea that “the tests regular doctors do for lyme disease are not correct”. It advises that people need to send their blood to unaccredited labs to do non-verified tests. It also advises that you need to see “special providers” because “most doctors don’t know.” There are even some who think “doctors” or “the government” or others are “covering things up.” This industry typically is preying upon people who are tired, aching, depressed, have non-concerning “rashes” (skin findings within the normal range). They talk about the terrible long-term sequella of “missed” Lyme disease. Often the associated providers will prescribe months of IV antibiotics and put in central lines. This type of behavior and misinformation is horrible.
There are 2 ways to diagnosis Lyme Disease
1) When a patient presents with the typical errythema migrans rash that expands over days or weeks to > 5 cm in diameter, this is a clinical diagnosis. If they know there has been a tick bite in the center, you could make the diagnosis before the 5 cm mark. In addition, if they see a tic bite, they can watch the site, and if no lesion develops, they know they did not get Lyme infection from that bite. Of course, they could have gotten bitten by a tic in a different site that they didn’t notice and watch, and get Lyme infection that way. “where there’s one tic, there’s likely more!” Often errythema migrans early Lyme infection rash is accompanied by fever, malaise, headache, mild neck stiffness (not true meningismus), myalgia and/or arthralgia (not arthritis).
At this stage of early Lyme infection, the Lyme antibody tests may not yet be positive, so testing is not necessary, and could give a “false negative” result. During the first 4 weeks after infection (tick bite) it is recommended to make the diagnosis based upon the typical rash +/- associated findings.
Diagnosis of Lyme infection with early disseminated disease (Mulitple erythema migrans, usually many smaller lesions at once) is also a clinical diagnosis.
Patients treated at these early stages may never develop detectable Lyme antibody. That is okay, they are cured and not at risk for late disease.
On the other hand, most patients with early disseminated EM, and all patients with late disease (arthritis, meningitis, carditis) do develop antibodies.
Positive antibodies can disappear over time, or persist for many years. The antibody persistence has nothing to do with whether the infection is cured or not.
2. Appropriate tests for Lyme infection include a 2-step approach:
* First the quantitative antibody test using EIA or IFA
* Then if the screening test is positive or equivocal, the Western Blot for both IgG and IgM antibodies needs to be done. The immunoblot test should not be done before or instead of the screening test because the specificity decreases when done on patients without positive screening results. There are rules for interpretation of the western blot results depending upon the clinical findings and timing stage of disease.
This is the method of testing done in all routine, certified testing labs including Mayo, ARUP, University of MN, etc.
False positive tests on the screening antibody test are relatively common, so treatment is based upon the western blot results in these situations.
Antibody testing is also used for testing for CNS Lyme infection. Lyme PCR testing is just for evaluation of arthritis (joint fluid).
For additional legitimate information please see the website of the Infectious Disease Society of America (http://www.idsociety.org/Index.aspx)
Charles E. Crutchfield III, MD
Clinical Professor of Dermatology
University of Minnesota Medical School
and
Medical Director
CrutchfieldDermatology.com