Lyme disease
Lyme disease is an infection caused by bacteria of the Borrelia group and carried by ticks of the Ixodes group. It does not pass from person to person.
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Medicines commonly prescribed for Lyme disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 1000 mgActive substance: amoxicillinManufacturer: Laboratorio Reig Jofre, S.A.Prescription requiredDosage form: TABLET, 750 mgActive substance: amoxicillinManufacturer: Teva Pharma S.L.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 60 mlActive substance: doxycyclineManufacturer: Hospira Invicta S.A.Prescription required
Lyme disease is an infection caused by bacteria of the Borrelia group and carried by ticks of the Ixodes group. It does not pass from person to person. The most useful thing to know in advance is this: caught early it is cured by a short course of ordinary antibiotics and leaves nothing behind, while caught late it takes far more effort and can leave lasting damage. So the whole practical side comes down to three things — keeping a tick from attaching, removing it as soon as possible, and recognising the first sign of the disease if it appears.
What the first sign looks like
In most people the first and often the only early sign is erythema migrans, a patch around the bite. It usually appears after one or two weeks, sometimes within a few days, and occasionally two or three months later, by which time the connection with the bite is no longer obvious.
The patch is round or oval, widens day by day and reaches five centimetres across or more — that is its main hallmark. The centre often clears so that it looks like a ring, though it can also stay solid. On pale skin it is pink, red or purplish; on brown and black skin it is harder to see and resembles a bruise. As a rule it does not hurt, does not itch and is not hot, which is what tells it apart from a bacterial skin infection, which comes on over hours and is painful and hot to the touch. The patch lasts for weeks and fades on its own even without treatment, but the patch going does not mean the infection has gone.
About a third of people never get the rash or never notice it, because it sits on the back, under the hair or in a fold. Some develop, days or weeks after the bite, something that feels like flu: fever, chills, headache, aching muscles and joints, heavy tiredness, swollen glands. Note a detail that helps: there is almost never a runny nose, sore throat or cough with it. Summer flu without any cold symptoms after a walk in the woods is a good reason to tell your doctor about the bite.
What happens if the infection is missed
An untreated infection does not go away. Weeks and months later it turns up in other organs, and those problems may be the first thing a person notices if the rash went unseen.
- The nervous system. In Europe this is the commonest late presentation. It brings burning, boring pain along the nerve roots that is worse at night and answers poorly to ordinary painkillers; weakness of the facial muscles on one side or on both sides at once; numbness, pins and needles, and a punishing headache when the membranes around the brain become inflamed.
- The heart. Borrelia can interfere with the conduction of the heartbeat. The result is a slow pulse, skipped beats, dizziness, fainting and breathlessness. This is the rarest and at the same time the most dangerous form, and it needs help without delay.
- The joints. Usually one large joint is affected, the knee most often: it swells, fills with fluid and moves badly, while the pain stays moderate. The swelling builds, subsides for a few weeks and comes back.
- The skin years later. A dusky red-blue area appears on the shin or forearm; over time the skin thins, dries out and becomes translucent like cigarette paper. This is a late change typical of the European strains, and for years it is often put down to poor circulation in the veins.
- Borrelial lymphocytoma. A firm bluish lump on the earlobe, nipple or scrotum, seen mostly in children. It looks alarming but resolves with treatment.
Where ticks live and how to keep them off
Ixodes ticks are found across almost all of Europe: in deciduous and mixed woodland, on woodland edges and meadows with long grass, in scrub along paths and quite often in town parks and gardens. They are active from early spring to late autumn, and in a mild winter they wake on any warm day. They neither jump nor fly: they wait on grass and bushes and take hold of whoever brushes past. Then they spend hours looking for thin skin — behind the knee, in the groin, in the armpit, on the neck, behind the ear, and in children most often on the head.
Far from every tick carries Borrelia, and even an infected tick does not pass the infection on straight away: the risk climbs noticeably once it has been attached for more than a day. Hence a simple conclusion — a tick removed promptly is nearly harmless. It is also worth remembering that in central and eastern Europe, in the Baltic countries and in alpine districts ticks also carry the virus of tick-borne encephalitis. Unlike Lyme disease that virus has a vaccine, and if you live in or regularly visit such places it is worth asking your doctor about it.
To stop a tick reaching your skin, wear light-coloured long sleeves in the countryside, tuck trousers into socks and keep to the middle of the path, away from grass and bushes. Put repellent on exposed skin, and clothing can be treated with a permethrin product. When you get back, shower and check yourself carefully, and check children yourself: a young tick is the size of a poppy seed and its bite is not felt. Check pets too, since they bring ticks indoors.
How to remove a tick properly
Remove it as soon as you find it, and do not go hunting for any special preparation first.
- Take fine-tipped tweezers or a purpose-made tick removal tool.
- Grip the tick as close to the skin as you can, by the head and never by the swollen body.
- Pull steadily straight upwards, without jerking or twisting, until it lets go of the skin.
- Wash the bite with soap and water or an antiseptic, and wash your hands.
- Write down the date and place of the bite and watch that patch of skin for the next six weeks.
What not to do: smear the tick with oil, cream, nail varnish or spirit, burn it, or twist it off with your fingers. An irritated or crushed tick empties its gut contents into the wound, and the gut is exactly where the bacteria live — so these methods raise the very risk you were trying to avoid. If part of the mouthparts stays in the skin there is nothing to fear: either lift it out carefully like a splinter or leave it, and it will work its way out. Sending the tick for testing is usually unnecessary: the result does not change what is done next, and waiting for it wastes time. In some situations after a bite in a high-risk area a doctor will offer a single preventive dose of antibiotic — that decision is made with the doctor, not on your own.
How the diagnosis is confirmed
If there is a typical erythema migrans, the diagnosis is made from the rash alone and treatment starts at once. Tests here are unnecessary and only delay things: at this stage antibodies have usually not had time to appear, and a negative result would mislead.
In every other situation a blood test for antibodies is used, carried out in two steps: a screening test first and, if it is positive or borderline, a confirmatory one. This method has two properties worth knowing. Antibodies only appear some weeks after infection, so an early negative does not rule the disease out and the test is repeated. Conversely, antibodies persist for years after successful treatment, so they cannot show whether a person has been cured, and repeating the test to check is pointless. If the nervous system is suspected of being involved, the spinal fluid is examined.
The commercial tests advertised online as diagnosis of chronic Lyme deserve a separate warning. Their reliability has not been established, they often come back positive in healthy people, and they lead to antibiotic courses lasting months that do more harm than good. Before paying for such a test, show the request to a doctor.
What the treatment involves
Lyme disease is treated with antibiotics, and in the early stage that is enough: the overwhelming majority of people recover completely. Doxycycline is the usual choice, with amoxicillin or cefuroxime used in pregnancy, while breastfeeding and in young children. The course runs from ten days to three weeks depending on what has developed. When the nervous system or the heart is involved, the antibiotic is given into a vein and treatment takes place in hospital.
Finish the course even if the patch has faded by the third day: a half-treated infection returns later wearing a different face. During the first day of treatment you may briefly feel worse, with a rise in temperature and more aching and redness. That is an expected reaction to bacteria dying off; it passes by itself and does not mean the drug is wrong. Doxycycline makes the skin more sensitive to sunlight, so protection from ultraviolet is needed while you take it, and it is swallowed sitting upright with a full glass of water. Joint and nerve problems settle more slowly than skin ones — recovery can take months — and that is not a reason to extend the antibiotic: repeated and prolonged courses bring no benefit and do bring complications.
When urgent help is needed
Call an ambulance (in European countries, on the single number 112) if, after a tick bite or during Lyme disease, there is:
- fainting or a feeling of about to faint, a slow or irregular pulse, chest pain or sudden breathlessness — this is how heart involvement shows itself, and it can develop within hours;
- a severe headache with vomiting, dislike of light, high temperature and inability to bring the chin to the chest;
- confusion, a seizure, or unusual drowsiness from which the person is hard to rouse.
See a doctor the same day, without putting it off, if the face droops or an eyelid will not close fully; if there is sudden weakness, numbness or severe burning pain in an arm or a leg; if a hot, painful redness is spreading fast around the bite along with a temperature, because that is no longer the rash but a bacterial skin infection; and likewise for any widening patch after a bite, even if you feel perfectly well.
If symptoms remain after treatment
Some people are left, for months after finishing the course, with tiredness, aching muscles and joints, headaches and trouble concentrating and sleeping. Why this happens to some and not to others is still unknown. Something else, though, is known: investigation finds no living bacteria left in the body, and repeat antibiotic courses do not help these people — large trials tested that specifically. What such courses do produce is side effects, up to severe bowel inflammation and complications of long-term intravenous lines.
What is worth doing is checking that there is no other cause for the same complaints: anaemia, low vitamin D, thyroid problems, sleep apnoea, depression. Beyond that, what helps is a gradual return to activity rather than a leap, a settled sleep pattern, treatment of pain and support when mood dips. In most people the picture slowly improves over the course of a year.
Online consultation
A remote consultation is especially useful right after a bite, when a decision has to be made quickly. The doctor looks at a photograph of the bite and says whether the patch resembles erythema migrans, whether to wait or start treatment today, whether a preventive dose of antibiotic is warranted and how exactly to watch the skin over the coming weeks. If treatment is already under way, it is convenient to go through tolerance of the drug online, the dip in the first days and when improvement can be expected. The doctor will also explain why repeating the antibody test after recovery shows nothing useful, help make sense of results from doubtful commercial tests, and advise on tiredness that lingers. And separately, will name the signs that mean calling an ambulance rather than writing in.
This material is for information only and does not replace medical advice.
Consult with a doctor about Lyme disease
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Lyme disease
Discuss your symptoms and possible next steps for Lyme disease with a doctor online.
