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Lyme disease is a tick-borne disease that affects several thousand people every year. Lyme disease commonly advances in three stages, with ultimate symptoms causing brain damage. The disease can be prevented and treated, with extremely high degrees of success.
Lyme disease is passed on to people by the Ixodes tick, which can be identified by its signature black legs and is found primarily in a handful of states in the U.S., including Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin. Cases of Lyme disease have been reported in all 50 US states, in Canada, and in Europe and Asia. The ticks pass on Lyme disease, which is caused by a bacterium that dwells within the ticks and “jumps ship” during the tick bite. The bacterium travels into the bloodstream of the person bitten by the tick. The initial result is a rash, and the disease proceeds from there.
The first stage is called the localized stage and involves symptoms that go no further than the area immediately surrounding the initial bite point. A red-ringed rash appears at the bite point. This rash can last up to five weeks. Other symptoms of this stage of Lyme disease include fatigue, headaches and general achiness, joint pain, and swelling of lymph glands near the bite point.
The second stage, or early disseminated stage, of Lyme disease begins anywhere from two weeks to three months after the initial bite. Symptoms of this stage of Lyme disease include rash areas, severe fatigue and headaches, irregular heart rhythm, fever, sensitivity to light, and sometimes even facial paralysis.
The last stage of Lyme disease is called the late stage. The appearance of the symptoms in this stage can range from a few weeks to a few years after the initial bite. Arthritis, especially in the knees, is a common side effect of a bite that has reached the late stage. An extreme complication resulting from the late stage of Lyme disease is a decrease in cognitive function.
The signs and symptoms of Lyme disease are variable, usually involving more than one system. The skin, joints and nervous system are affected most often. In general, Lyme disease can cause:
Rash. A few days to a month before you have other symptoms, a small, red bump may appear at the site of the tick bite. Over the next few days, the redness expands, forming a rash in a bull's-eye pattern, with a red outer ring surrounding a clear area. The rash, called erythema migrans, is one of the hallmarks of Lyme disease. Some people develop several of these rashes, an indication of bacteria multiplying in the blood stream.
Flu-like symptoms. Fever, chills, fatigue, body aches and a headache may accompany the rash.
Migratory joint pain. If the infection is not treated, you may develop bouts of severe joint pain and swelling several weeks to months after you're infected. Your knees are especially likely to be affected, but the pain can shift from one joint to another.
Neurological problems. In some cases, inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement may occur weeks, months or even years after an untreated infection.
Less common signs and symptoms. Some people may experience heart problems — such as an irregular heartbeat — several weeks after infection, but this rarely lasts more than a few days or weeks. Eye inflammation, hepatitis and severe fatigue are possible as well.
If you know you've been bitten and experience signs and symptoms of Lyme disease — particularly if you live in an area where Lyme disease is prevalent — contact your doctor immediately. Treatment for Lyme disease is most effective if begun early. Only a minority of deer tick bites leads to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease.
Antibiotics are the drugs used for treating all phases of Lyme disease. In nearly all cases they can cure Lyme, even in later stages.
According to guidelines from the Infectious Diseases Society of America (IDSA), people bitten by deer ticks should not routinely receive antibiotics to prevent the disease.
A single dose of the antibiotic doxycycline may be given in situations that meet all of the following conditions:
The tick is still attached to the patient and is positively identified as an adult or nymphal I. scapularis (the tick that carries the Lyme disease B. burgdorferi spirochete).
Doxycycline treatment can be started within 72 hours of the tick bite.
There is proof that at least 20% of ticks in that geographic area are infected with B. burgdorferi.
It is safe for the patient to receive doxycycline (this drug must not be given to pregnant women or children younger than 8 years of age).
In general, the risk of developing Lyme disease after being bitten by a tick is only 1 - 3%. However, patients who have removed attached ticks from themselves should inform their doctors. Patients who have been bitten by a tick should be monitored for up to 30 days to make sure they do not develop symptoms of Lyme disease, especially the tell-tale bull’s-eye rash. If you do develop a skin lesion or flu-like illness during this time, be sure to tell your doctor.
The early stages of Lyme disease usually involve classic bull’s-eye rash (erythema migrans) and flu-like symptoms of chills and fever, fatigue, muscle pain, and headache. In rare cases, patients develop an abnormal heartbeat (Lyme carditis).
All of these conditions are treated with 10 - 28 days of antibiotics. The exact number of days depends on the drug used, and the patient’s response to it. Antibiotics for treating Lyme disease generally include:
Doxycycline. This antibiotic is effective against both Lyme disease and human granulocytic anaplasmosis (HGA) and so is the standard antibiotic for any patient over 8 years old (except pregnant women). Doxycycline cannot be used routinely in children under 8 years old. It is a form of tetracycline and as such discolors teeth and inhibits bone growth. It can also cause birth defects, so it must not be used during pregnancy.
Either amoxicillin (one of the penicillins) or cefuroxime -- a drug known as a cephalosporin -- are the alternative treatments for young children and some adults. Amoxicillin is the first choice and also probably the best antibiotic for pregnant women (for pregnant women, always consult your doctor before use). Unfortunately, many people are allergic to penicillin. In addition, strains of bacteria are emerging that are resistant to penicillins.
Intravenous ceftriaxone -- another cephalosporin -- may be warranted if there are signs of infection in the central nervous system (the brain or spinal region) or heart.
Other types of antibiotics, such as macrolides, are not recommended for first-line therapy.
Most cases of Lyme disease involve a rash and flu-like symptoms that resolve within 1 month of antibiotic treatment. However, some patients go on to develop late-stage Lyme disease, which includes Lyme arthritis and neurologic Lyme disease.
Slightly more than half of patients infected with B. burgdorferi develop Lyme arthritis. About 10 - 20% of patients develop neurologic Lyme disease. A very small percentage of patients may develop acrodermatitis chronica atrophicans, a serious type of skin inflammation. These conditions are treated for up to 28 days with antibiotic therapy. If arthritis symptoms persist for several months, a second 2 - 4 week course of antibiotics may be recommended. Oral antibiotics (doxycycline, amoxicillin, or cefuroxime) are used for Lyme arthritis and acrodermatitis chronica atrophicans. (In rare cases, patients with arthritis may need intravenous antibiotics.)
A 2 - 4 week course of intravenous ceftriaxone is used for treating severe cases of neurological Lyme disease. For milder cases, 2 - 4 weeks of oral doxycycline is an effective option.
In about 5% of cases, symptoms persist after treatment, a condition referred to as post-Lyme disease syndrome. The treatment of post-Lyme disease syndrome is a controversial issue. Most doctors do not recommend continuing antibiotic therapy beyond 30 days. Scientific studies do not show any evidence that the benefits of long-term antibiotic treatment outweigh its risks.
Long-term antibiotic treatment can lead to a serious and difficult-to-treat infection called Clostridium difficile, and can also cause the patient to become allergic to the antibiotic. In addition, long-term antibiotic treatment carries its own serious risks, such as the development of antibiotic-resistant superbugs.
Experimental and alternative remedies are also not recommended. However, some patients may benefit from learning pain control and cognitive behavioral techniques to help them cope with and manage their symptoms.
Some people use vitamin B complex, omega-3 and omega-6 fatty acids (found in primrose oil and fish oils), and magnesium supplements (magnesium L-lactate dihydrate) to help relieve symptoms. No evidence suggests that they are beneficial. Any such therapies should be discussed with a doctor. Newsletters and Internet sites have cropped up in recent years advertising untested treatments to patients with symptoms of Lyme disease who are frustrated with standard medical treatment. Some remedies are dangerous, and most are ineffective.
The Food and Drug Administration (FDA) has warned people not to use an alternative medicine product called bismacine (also known as chromacine). This injectable product contains high amounts of bismuth, a heavy metal that can be poisonous. People who have taken bismacine have experienced heart and kidney failure, and one death has been reported. Although some people claim that bismacine can help treat Lyme disease, it is not approved for the treatment of any illness or condition.