What is Lyme disease and are you at risk?

·9-min read
Photo credit: Helin Loik-Tomson - Getty Images
Photo credit: Helin Loik-Tomson - Getty Images

Lyme disease is an infection caught from the bite of an infected tick. It's not particularly common – according to Public Health England, there are 3,000 new cases of Lyme disease annually in England and Wales – but for those who contract the condition, the consequences can be potentially serious.

When detected early on, Lyme disease can be treated effectively with antibiotics and typically clears in two to four weeks. But if it's not treated, or treatment is delayed for some reason, there's a risk you could develop long-lasting symptoms such as inflammatory arthritis, nervous system illnesses, and meningitis.

Here, we look at what exactly Lyme disease is, and explain what causes it, how it's diagnosed and treated. Plus, we detail the separate stages of the condition, explain potential complications, and lay out the most effective prevention options.

What is Lyme disease?

Lyme disease is an infection that starts with a tick bite. A tick is a small, brown mite that needs to consume human or animal blood to survive. In the UK, some ticks carry bacterium called Borrelia burgdorferi in their stomach, which they have caught after feeding on infected deer, birds or mice.

When you're bitten by an infected tick – and the tick remains attached to your body for at least 36 hours – the bacterium can cause Lyme disease. Also known as borrelia or borreliosis, the condition is characterised by a variety of symptoms, from joint pain and swelling to sleep disturbances.

Seeing a tick somewhere on your body does not mean that you have contracted Lyme disease. A tick has to be attached to your skin for at least 36 hours to transmit the infection. Unfortunately, not everyone knows when they have been bitten, as the ticks can be tiny.

What causes Lyme disease?

Lyme disease is caused by an infection with a micro-organism called Borrelia burgdorferi. This bacterium is transmitted by a bite from the wood tick (or hard-bodied tick), a tiny blood-sucking parasite which normally lives on deer, mice and other mammals, as well as birds such as pheasants and blackbirds.

The wood tick is found in many countryside areas, particularly in forests where deer are common, and in heathland. As a person walks through the countryside and brushes against the plants or grass, a tick may attach to them and settle anywhere on the body, but prefers warm, moist and dark places like the crotch or armpits.

Lyme disease transmission

When the tick has found a suitable place on the body, it sticks a probe through the skin to draw up blood, exposing the host to the risk of infection. Not all ticks carry the bacteria but if they do, the bacteria may be injected into the human during the blood-sucking process.

Oftentimes, people with Lyme disease are bitten by tiny, immature ticks called nymphs, which feed during the spring and summer. They can be incredibly difficult to spot. Adult ticks are easier to see and can usually be removed before transmitting the bacterium.

Symptoms of Lyme disease

People experience different symptoms with Lyme disease that vary in severity. The condition is commonly divided into three distinct stages: early, mid-stage and late-stage. However, symptoms can overlap, and often people will experience perhaps one or two of the stages, rather than all three.

The most common – and earliest – symptom of Lyme disease is a distinctive circular rash at the site of the tick bite. This can present anywhere from one to four weeks after being bitten, and is described as looking like a bull's-eye on a dart board. Around one in every three people with Lyme disease do not report seeing a rash.

Other symptoms of Lyme disease include:

  • Fatigue

  • Muscle aches

  • Fever and other flu-like symptoms

  • Joint pain and swelling

  • Nerve pains

  • Swollen lymph nodes

  • Headache

  • Paralysis of the facial muscles

  • Sleep disturbances

  • Difficulty concentrating

Generally, children tend to experience the same Lyme disease symptoms as adults. Lyme disease is always best treated in the early stages.

Lyme disease stages

The Lyme disease symptoms you're likely to experience depends on which stage the disease has reached. Here, we take a closer look at the three stages of Lyme disease.

✅ Stage one: early localised Lyme disease

The very first symptoms of Lyme disease usually start around one week after the tick bite. It often begins with a red spot around the location of the tick's bite, which can appear up to four weeks later. The spot, called erythema migrans, will gradually grow bigger, usually with a pale area in the middle. It's not painful or itchy, but may expand to 30cm.

At this stage of Lyme disease, some people feel like they have caught the flu, with symptoms such as:

  • Fatigue or drowsiness

  • Headaches

  • Mild fever and chills

  • Sore throat

  • Vision changes

  • Joint and muscle pains

  • Swollen lymph glands

✅ Stage two: early disseminated Lyme disease

The next stage of Lyme disease may develop several weeks or even months after the tick bite. At this point, the condition has spread throughout the body, including to other organs – known as systemic infection. Common symptoms can include:

  • Erythema multiforme (EM) lesions

  • Heart rhythm disturbances

  • Numbness in limbs

  • Facial muscle paralysis

  • Meningitis

  • A rash in areas other than the tick bite

You may also experience symptoms from stage one – the two stages often overlap.

✅ Stage three: late disseminated Lyme disease

Late disseminated Lyme disease occurs when the infection hasn't been treated in the earlier stages, and may present months or years after the initial tick bite took place. Symptoms include:

  • Pain and swelling in the joints (inflammatory arthritis)

  • Brain disorders, causing memory problems, trouble concentrating and sleep disorders

  • Numbness in the arms, legs, hands, or feet

If you're treated for Lyme disease with antibiotics but continue experiencing symptoms, it's is referred to as post Lyme disease syndrome. Most people recover from the condition, which can affect your mobility and cognitive skills, but it can take months or even years.

Is Lyme disease contagious?

There is no evidence that Lyme disease is contagious. You can't get infected from touching, kissing, or having sex with a person who has Lyme disease, or from receiving a transfusion of their blood. Untreated Lyme disease during pregnancy can lead to infection of the placenta, but new mothers cannot transmit the disease to their baby through breast milk.

Lyme disease complications

In most cases, Lyme disease will respond to antibiotic treatment and will clear up in two to four weeks. However, in more severe cases, complications can arise:

🔹 Inflammation of the joints or Lyme arthritis

This condition may present itself in the weeks or, rarely, years after the bite, but it is rare in the UK (although it is the commonest complication in North America and Northern Europe). The inflammation of the joints causes pain and swelling.

Often, only one joint is inflamed and, rarely, more than three. The most commonly affected joint is the knee followed by the shoulder, elbow, foot, and hip. It has symptoms similar to arthritis. When treated, the swelling will go away in about one to four weeks but it may return in later months or even years.

🔹 Acrodermatitis chronica atrophicans

This is a condition that often develops in older women. Several years may pass from the tick bite until the development of this phenomenon. The symptoms usually involve changes in the skin around the tick bite, such as swelling and bluish or reddish discolouration of the skin.

🔹 Lyme disease heart complications

Lyme disease may cause inflammation of the heart tissues, along with arrhythmia and heart failure may develop in severe cases.

🔹 Neuroborreliosis

This is the most common complication of Lyme disease in the UK. About 15 per cent of people with Lyme disease develop problems with the nervous system, or so-called neuroborreliosis, between one and five weeks after the tick bite.

The central nervous system is affected and the symptoms that result may be very mixed and not specific, but can include:

  • Back pain: Typically between the shoulder blades and neck like a slipped disc. The pain worsens at night.

  • Facial palsy: Weakness of the muscles on one or both sides of the face may develop.

  • Meningitis: Fever, headache and stiffness in the neck.

  • Chronic symptoms: In very rare cases, the disease may become chronic. This can involve slow-developing nervous system issues, numbing, partial hearing impairment, depression and dementia.

Neuroborreliosis can present gradually or with sudden symptoms requiring immediate treatment, often with an admission to hospital.

Lyme disease diagnosis

Lyme disease is more likely to be diagnosed when a patient remembers a tick bite and presents the doctor with the erythema migrans rash. But many people don't notice the tick or the rash, so Lyme disease may not be high on the doctor's list if symptoms are very general.

To make a more concrete diagnosis, the doctor may take a blood sample to determine whether the patient has reacted to the bacteria and developed antibodies in their blood. Antibodies can typically be found between two and four weeks after contracting the disease, but sometimes the antibodies do not appear for up to eight weeks.

A person may have Lyme disease even if antibodies are not present in the early phases, so repeat tests may be necessary. Similarly, a positive antibody test does not necessarily mean that borrelia has recently been contracted. Antibodies may be found in the blood several years after an infection is over. Unfortunately, false-positive test results are common.

If the doctor suspects neuroborreliosis, hospital admission is required. Tests will be undertaken on fluids from the spinal canal, to determine whether Lyme disease has entered the nervous system. In cases of chronic neuroborreliois, diagnosis may include a CT scan of the nervous system.

Lyme disease treatment

In the early stages of Lyme disease, oral antibiotic treatment may be sufficient to treat it. If there are other symptoms, the doctor will arrange hospital admission for further investigation and possible further treatment with antibiotics.

Antibiotics prescribed for Lyme disease include:

No particular choice and method is superior to another – the decision is made by the infectious disease specialist and is dependent on the individual circumstances. After treatment with antibiotics, it may take weeks or months for all the symptoms to disappear.

How to prevent Lyme disease

There is currently no vaccine for Lyme disease, so it's important to take steps to prevent being bitten by ticks, particularly when you're out in the countryside:

✔️ Wear trousers tucked into boots and long sleeve clothing when out walking or hiking.
✔️ Use insect repellents every time, ideally one with 10 per cent DEET.
✔️ Always check for ticks – including children and pets – when you get home.
✔️ Remove ticks very carefully, pulling steadily using tweezers or a cotton thread.

Last updated: 23-06-2021

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