Could Your Symptoms Be Untreated Lyme Disease?

By Jacquie Bokow

We live in an area known for Lyme disease. In 2014, 96 percent of confirmed Lyme disease cases in the U.S. were reported from only 14 states, including Maryland. For the past 11 years, Maryland has been steadily decreasing its number of confirmed cases; in 2014 it was responsible for 16 percent, ranking 13th in the nation (in 2009, the year with the greatest number of cases nationwide, it ranked 7th).

Reported Cases of Lyme Disease in the U.S.A. in 2014. Source: CDC.

According to the Centers for Disease Control and Prevention, untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These are typically fever, headache, fatigue, and a characteristic skin rash called erythema migrans, but can include facial paralysis and arthritis (see full list, below). Seek medical attention if you observe any of these symptoms, whether or not you can confirm you’ve been bitten by a tick.

Reported cases of Lyme disease are most common among boys aged 5–9, second most common among boys aged 10–14.

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks (also called deer ticks, Ixodes scapularis). Because of the large number of deer browsing and bedding down in local gardens, our neighborhood has had numerous people struck by this disease.

Early Symptoms (3–30 Days)

Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes
Erythema migrans (EM) rash:
- 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 a period of 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 Symptoms (Days-Months)

Severe headaches and neck stiffness
Additional EM rashes on other areas of the body
Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
Facial palsy (loss of muscle tone or droop on one or both sides of the face)
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
Problems with short-term memory

Note:

Fever and other general symptoms may occur in the absence of rash.
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.

Treatment and Prevention

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.

Ticks can attach to any part of the human body but are often found in hard-to-see areas such as the groin, armpits, and scalp. In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.

Most humans are infected through the bites of immature ticks called nymphs. Nymphs are tiny (less than 2 mm) and difficult to see; they feed during the spring and summer months. Adult Ixodes ticks are most active during the cooler months of the year.

In general, adult ticks are approximately the size of a sesame seed and nymphal ticks are approximately the size of a poppy seed. Adult ticks can also transmit Lyme disease bacteria, but they are much larger and are more likely to be discovered and removed before they have had time to transmit the bacteria.

Avoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible; do not wait for it to detach.

If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick. Ticks can spread other organisms that may cause a different type of rash; a rash with a very similar appearance to EM occurs with Southern Tick-Associated Rash Illness (STARI), but is not Lyme disease.

Visit the CDC website, cdc.gov, which supplied the data for this article, for more information. ■