Lyme Disease

Seek immediate medical attention if you live in or have visited an area where Lyme disease is common and you experience a flulike illness or develop a red or target-like rash anytime from late spring to early fall. Prompt treatment at this stage reduces the risk of further symptoms of Lyme disease.

• Remove any attached ticks by pulling them off you. Removing them promptly is more important than how you remove them. If you cannot remove an attached tick, see your doctor, who will remove it.
• Following removal of a tick, you should see a doctor if any flulike symptoms or rash develop within the next three weeks. If a rash develops, draw a line around it with ink which does not wash off (Magic Marker or Sharpie) each day to see if it is growing.
• Young children with fever and severe headache should see a doctor immediately, because these may be their only symptoms.
• Outdoor workers and anyone whose hobbies or recreational activities place them in wooded or brush areas should be particularly aware of these symptoms because their environmental exposure increases contact with the deer tick.

Lyme disease should be treated promptly; if you cannot see your doctor quickly, go to a hospital's emergency department immediately.

• When the initial disease is not treated, your symptoms may go away, but additional symptoms of Lyme disease can occur months later.
• When this happens, Lyme disease can affect your heart, your muscles and joints, or your nervous system. Since these symptoms can occur with other diseases, be sure to tell your doctor about travel to areas with a high tick population or if you have any possible exposures to ticks (from pets, gardening, walking, or camping in wooded areas, etc.).

Self-Care at Home

Health departments in areas with high rates of infection have undertaken campaigns to raise public awareness of Lyme disease.

• It is known that certain outdoor areas are highly infested with deer ticks and should be avoided if possible -- these include woods and brush areas.
• Generally, the tick counts on suburban lawns are much lower.

Follow-up

Follow-up with continued care is important for people who have early Lyme disease but who fail to improve rapidly and completely.

• Doctors must consider other treatment options and rule out other illnesses that may be mistaken for Lyme disease.
• People with later-stage disease who require IV antibiotics or hospitalization must be monitored in the weeks following their treatment.
• Improvement in the symptoms of Lyme disease, particularly in the heart and nervous system, may occur gradually over a period of months. Lack of immediate improvement in all your symptoms is not a sign of unsuccessful treatment.

Prevention

There are three approaches to preventing Lyme disease.

Avoidance

• Try to stay out of woodlands and brush areas where the tick thrives, especially during the peak season of summer and early fall.
• Wear garments that will create barriers to the tick attaching to the skin and biting.
• Tuck your pant legs into your socks so ticks cannot easily crawl the short distance from the ground to just above the sock line, and wear light-colored clothing to better identify ticks.
• The application of the insecticide DEET (low-concentration preparations are recommended) to clothing and skin (This should be limited in children to prevent absorption of too much DEET) has been found to decrease tick bites and the chance for Lyme infections.

Removal

Deer ticks need to remain attached to your skin for about 24-48 hours to transmit the Borrelia to your skin. Therefore, you should inspect all areas of your body after outdoor activity.

If you notice a bite, it is very important to watch for symptoms, which usually show up in about three weeks.

Ticks attach to areas that are warm and moist.

• the groin
• the armpits
• the underside of a woman's breasts
• the neck and hairline

If you see a tick, promptly remove it. This greatly reduces the likelihood of an infection.

If you have tweezers, grasp the tick as close to your skin as possible and gently lift it away, pulling gradually but firmly. If you don't have tweezers, pull the tick off by its body. Removal is more important than how you remove it.

Often, the complete mouth parts do not come out with the rest of the tick. Leaving these in will not increase the risk of disease transmission but may have implications in terms of local infection or foreign body reaction.

Disinfect the bite site thoroughly with alcohol or other skin antiseptic solution.

Use of gasoline, petroleum, and other organic solvents to suffocate ticks, as well as burning the tick with a match, should be avoided.

If the tick does not come off easily, twist the tweezers like a corkscrew while holding the tick and lift upward.

Antibiotic treatment

Treatment of tick bites within 72 hours of a bite with a single dose of doxycycline has been reported to prevent Lyme disease. This may be appropriate if you live in an endemic area and have removed an engorged tick or multiple ticks. You should discuss this with your doctor.

Outlook

When treated early, most people with Lyme disease experience rapid improvement and minimal complications from the disease. Later stages of illness are avoided by effective treatment of early Lyme disease.

People with later stages of the disease may also do well when they are diagnosed soon after their later-stage symptoms first occur.

A small percentage of people with Lyme disease do not fully recover or recover very slowly. There may be residual facial palsy or residual knee pain. Other people develop chronic muscle and joint pains, fatigue, and concentration difficulties that seem to have arisen from the time of the original Lyme infection. While these chronic and recurring symptoms have been called chronic Lyme disease, recent studies have not shown any evidence of Borrelial infection in the blood or spinal fluid, and further antibiotic therapy does not appear to have a durable effect in relieving the condition. For the present, patients with this problem are being treated with supportive measures.