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Lyme disease is a bacterial illness caused by a bacterium called a "spirochete." In the United States, the actual name of the bacterium is Borrelia burgdorferi. In Europe, another bacterium, Borrelia afzelii, also causes Lyme disease. Certain ticks found on deer harbor the bacterium in their stomachs. Lyme disease is spread by these ticks when they bite the skin permitting the bacterium to infect the body. Lyme disease can cause abnormalities in the skin, joints, heart and nervous system.


Lyme disease affects different areas of the body in varying degrees as it progresses. The site where the tick bites the body is where the bacteria enter through the skin.

-> Initially, the disease affects the skin causing an expanding reddish rash often associated with "flu-like" symptoms. Later, it can produce abnormalities in the joints, heart and nervous system.
Lyme disease is medically described in three phases as:

(A): Early localized disease with skin inflammation

(B): Early disseminated disease with heart and nervous system involvement, including palsies and meningitis.

(C): Late disease featuring motor and sensory nerve damage and brain inflammation and arthritis.

-> In the early phase of the illness, within days to weeks of the tick bite, the local skin around the bite develops an expanding ring of unraised redness. There may be an outer ring of brighter redness and a central area of clearing, leading to a "bulls-eye" appearance. This classic initial rash is called "erythema migrans" (formerly called erythema chronicum migrans). Patients often can't recall the tick bite (the ticks can be as small as the periods in this paragraph). Also, they may not have the identifying rash to signal the doctor. More than one in four patients never get a rash. The redness of the skin is often accompanied by generalized fatigue, muscle and joint stiffness, swollen glands and headache resembling symptoms of a virus infection.

-> The redness resolves, without treatment, in about a month. Weeks to months after the initial redness of the skin the bacterium and its effects spread throughout the body. Subsequently, disease in the joints, heart and nervous system can occur.

-> The later phases of Lyme disease can affect the heart, causing inflammation of the heart muscle. This can result in abnormal heart rhythm and heart failure. The nervous system can develop facial muscle paralysis (Bell's palsy ), abnormal sensation due to disease of peripheral nerves (peripheral neuropathy), meningitis and confusion. Arthritis, or inflammation in the joints, begins with swelling, stiffness, and pain. Usually, only one or a few joints become affected, most commonly the knees. The arthritis of Lyme disease can look like many other types of inflammatory arthritis and can become chronic .


In early Lyme disease doctors can sometimes make a diagnosis simply by finding the classic red rash (described above), particularly in persons who have recently been in regions in which Lyme disease is common. The doctor might review the patient's history and examine the patient in order to exclude diseases with similar findings in the joints, heart and nervous system. Blood testing for antibodies to Lyme bacteria is generally not necessary or helpful in early stage disease, but can help in diagnosis in later stages. (Antibodies are produced by the body to attack the bacteria and can be evidence of exposure to the bacteria. This antibodies can be detected using a laboratory method called an Elisa assay.) Antibodies, however, can be false indicators of disease, since they can remain for years after the disease is cured. Moreover, false positive tests in patients with nonspecific findings (those that are not specifically suggestive of Lyme disease) can lead to confusion. Currently, the confirmatory test that is most reliable is the Western Blot assay antibody test. More accurate tests are being developed.
Generally, Lyme blood testing is helpful in a patient with symptoms compatible with Lyme disease who has a history of tick bite at least a month prior or unexplained disorders of the heart, joints, or nervous system that are characteristic of Lyme disease.


Most Lyme disease is curable with antibiotics. This is so true that some authors of Lyme disease research have stated that the most common cause of lack of response of Lyme disease to antibiotics is a lack of Lyme disease to begin with! The type of antibiotic depends on the stage of the disease (early or late) and what areas of the body are affected. Early illness is usually treated with oral medicines, for example, doxycycline (Vibramycin), amoxicillin, or cefuroxime axetil. Therefore, if a person finds a typical "bulls-eye" skin rash (described above) developing in an area of a tick bite, they should seek medical attention as soon as possible. Generally, antibiotic treatment resolves the rash within one or two weeks. Later illness such as nervous system disease might require intravenous drugs, for example, ceftriaxone (Rocephin).
For the relief of symptoms, pain relieving medicines might be added. Swollen joints can be reduced by the doctor removing fluid from them (arthrocentesis). An arthrocentesis is a procedure whereby fluid is removed from a joint using a needle and syringe under sterile conditions. It is usually performed in a doctor's office. Rarely, even with appropriate antibiotics arthritis persists. The doctor also can inject cortisone into swollen joints or use oral medications, such as ibuprofen (Motrin, Nuprin), to reduce inflammation and improve function.


Because Lyme disease is transmitted by ticks attaching to the body, it is important to use tick bite avoidance techniques when visiting known tick areas. Insect repellant spray containing DEET onto exposed skin can help. Wearing long clothing can protect the skin. Clothing, children and pets should be examined for ticks. Ticks can be removed gently with tweezers and saved in a jar for later identification. Bathing the skin and scalp, and washing clothing upon returning home might prevent the bite and transmission of the disease.
Vaccines were on the market, however, as of February 25, 2002 the manufacturer announced that the LYMErix™ Lyme disease vaccine will no longer be commercially available. Further studies of vaccines are needed. For now, ideal prevention focuses on the recommendations of the preceding paragraph.


-> Lyme disease is a bacterial illness that is spread by tick bites.

-> Lyme disease can affect the skin, joints, heart, and the nervous system.

-> Lyme disease occurs in phases, the early phase beginning at the site of the tick bite with an expanding ring of redness.

-> Lyme disease is diagnosed based on the patient's clinical signs of illness and the detection of Lyme antibodies in the blood.

-> Lyme disease is treated with antibiotics.


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