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What is Lyme Disease?

Jul 11, 2014
By Malcolm Thaler

In the 1970s, there was an epidemic of arthritis, often preceded by a strange, expanding red rash, occurring primarily in children in and around Lyme, CT. The cause of this “Lyme arthritis” was a mystery until investigators discovered that these children had been infected with Borrelia burgdorferi, a spiral-shaped bacteria (spirochete) that had been transmitted to them via a tick bite. They also found that the disease caused more than just joint aches and a rash—it could affect many other organ systems including the heart and nervous system.

From an odd, local curiosity, Lyme disease has spread to become a worldwide scourge. In the US alone—especially in New England, the Mid-Atlantic states, Wisconsin, and Minnesota—approximately 30,000 cases are reported every year, although the actual incidence may be 10 times greater.

In “I’ve Been Bitten by a Tick! What Do I Do?” we talked about how to avoid tick bites and what to do if you’re bitten. Here, we take a deeper dive into the clinical manifestations of Lyme disease and its diagnosis and treatment.

What are the first stages of Lyme disease?

With rare exceptions, a tick has to be attached to your body for at least 48 hours to infect you. Anywhere from three days to one month after the bite of an infected tick, a red rash will appear at the site. Often, it has a central clearing (so it resembles a bull’s-eye) and progressively enlarges, appearing to migrate across the skin. It’s usually painless and sometimes itchy.

The rash is usually accompanied by flu-like symptoms—fever, muscle and joint aches, headache, and fatigue. This is usually when Lyme disease is diagnosed and treatment begins. With or without treatment, the rash—called erythema migrans—will persist for several weeks and then disappear.

What happens when it progresses?

Without treatment, a few weeks after the bite, it’ll reach the second stage—disseminated Lyme disease. The infection spreads and many smaller erythema migrans rashes can appear anywhere on the body. The spirochete can also start causing other problems. Neurologic issues (most commonly Bell’s palsy, a partial paralysis of the face) and heart issues (typically heart block, a disruption in the heart’s electrical system that regulates heartbeat) are most common. Several weeks to months after the tick bite, patients may also develop frank arthritis, usually in one or both knees.

How do you diagnose and treat Lyme disease?

In the early stages your blood won’t yet test positive for Lyme antibodies, but your provider can usually make a clinical diagnosis. Several weeks after its onset, blood tests can help make the diagnosis. Antibiotics are highly effective in all its stages, but more advanced patients may require intravenous antibiotics and, especially in patients with neurologic involvement or arthritis, longer courses of therapy.

What if I don’t feel better?

There’s no evidence—and investigators have looked—that patients who are treated, but continue to complain of symptoms such as fatigue and muscle aches, have ongoing, inadequately treated Lyme disease. Many of these patients have a second infection with the Lyme spirochete, while others may have contracted a second tick-borne illness such as babesiosis or anaplasmosis. No benefit has been associated with continuing to treat these patients with oral or intravenous antibiotics (antibiotics themselves can have significant and sometimes serious side effects). Fortunately, most patients without an established cause for their ongoing symptoms simply get better over time.

So, what should I look out for?

The bottom line: Early treatment can prevent dissemination and more serious consequences. Know the signs and symptoms of the disease as outlined above, and see your healthcare provider if you think you may have Lyme disease.

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Malcolm Thaler

Malcolm enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources, and has extensive expertise in managing a wide range of issues including the prevention and treatment of cardiovascular disease, diabetes, and sports injuries. Malcolm graduated magna cum laude from Amherst College, received his MD from Duke University, and completed his residency in Internal Medicine at Harvard's New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning Internal Medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified through the American Board of Internal Medicine. Malcolm is a One Medical Group provider and sees patients in our New York offices.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

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