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Lyme disease (technically "borreliosis") is an insect-borne illness transmitted through the bite of an infected blacklegged tick (also called the deer tick). The tick—often no bigger than a poppy or sesame seed—latches onto a person’s body. It typically must remain attached to its host for at least 36 hours in order to transmit the bacteria. The most common cause of Lyme disease in the U.S. is the bacterium Borrelia burgdorferi.
Roughly 30,000 cases of Lyme disease are reported each year. However, the U.S. Centers for Disease Control and Prevention (CDC) believes many cases go unreported, and the actual number of infections could be much higher. The vast majority of cases occur in 14 states, mostly clustered in the Northeast and upper Midwest. Those states include Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.
Lyme disease was first identified in 1981, and gets its name from the town of Lyme, Connecticut. In the mid-1970s, an unusual number of children and adults with arthritis-like symptoms were observed in Lyme. These cases were eventually linked to the bite of the blacklegged tick.
Lyme disease can produce a range of symptoms, including rash, fever, and joint pain. Most people recover fully with early antibiotic treatment. However, treatment becomes more difficult if symptoms are missed or misdiagnosed. Without treatment, people can experience more severe or prolonged symptoms.
Lyme disease can affect the entire body, including the skin, joints, nervous system, and heart. Signs and symptoms of Lyme may differ depending on the type of bacterial infection and stage of the disease.
It takes three to 30 days for early signs of Lyme disease to appear, according to the U.S. Centers for Disease Control and Prevention (CDC). The classic sign of Lyme is a skin rash in a bull’s-eye pattern. But not everyone gets or notices this rash, nor does it always resemble a bull’s-eye (some people develop raised or oblong rashes). Some people may experience fever and other flu-like symptoms, such as chills, headache, and fatigue. Muscle or joint pain can also occur.
Without treatment, new and more severe symptoms may develop days or months later. These include additional rashes on other parts of the body, arthritis with severe joint pain or swelling, and in more severe cases, facial paralysis, heart palpitations, or neurological problems.
Borrelia mayonii, a bacterial species that causes Lyme disease in the upper Midwest, causes similar symptoms in its early stages, including fever, headache, neck pain, and rash, and arthritis pain in the later stages. But unlike B. burgdorferi, which typically causes a bull’s-eye rash, B. mayonii is associated with widespread rashes as well as nausea, vomiting, and a higher level of bacteria in the blood.
Even after being treated for Lyme disease, some patients report lingering fatigue, pain, or joint and muscle aches. In a small percentage of patients, symptoms last more than six months. It’s not clear what causes post-treatment Lyme disease syndrome (PTLDS), which is sometimes called chronic Lyme disease. Studies suggest extended antibiotic treatment does not help people recover, but symptoms do improve with time.
Two types of bacteria—B. burgdorferi and B. mayonii—cause Lyme disease in the United States. (Two other species, Borrelia afzelii and Borrelia garinii, are the primary culprits in Europe and Asia.)
B. burgdorferi was long considered the sole cause in the U.S. However, in 2016 scientists confirmed the existence of a second species, B. mayonii, linked to nausea and vomiting in addition to the other typical symptoms.
Lyme disease is spread through the bite of an infected blacklegged tick (Ixodes scapularis). Also known as the deer tick, it is responsible for spreading B. burgdorferi in the northeastern, north central, and mid-Atlantic regions, and B. mayonii in the upper Midwest.
Another species, the Western blacklegged tick (Ixodes pacificus), spreads B. burgdorferi on the Pacific coast. Ticks often become infected when they feed on small animals, such as mice. Nymphs are often the ones that infect humans, usually in the spring or summer months. (Adult ticks can spread the infection, too, but they’re bigger and therefore easier to detect.) Ticks can latch on to any part of the body but frequently hide in areas like the scalp, armpits, or groin.
Just because you have a tick bite doesn’t mean you will get Lyme disease. It can take 36 to 48 hours for transmission to occur, according to the CDC.
When people think of Lyme disease, they often picture the classic red bull’s-eye rash (image below). Some people with Lyme disease do develop this type of rash (which is also called erythema migrans) at the site of the tick bite. It may take three to 30 days (a week on average) for this Lyme disease rash to appear. It can start out as a small, raised bump and, as the rash grows larger, may resemble a target or bull’s-eye.
But not everyone with Lyme disease develops a bull’s-eye rash—or any rash at all. People infected with the B. mayonii strain of the disease often have diffuse rashes on their bodies that do not resemble the bull’s-eye pattern.
Without treatment, joint pain, redness, and swelling can occur.
Two related types of ticks are responsible for spreading Lyme in the U.S. The blacklegged tick (Ixodes scapularis) is a hard-bodied tick found on the East coast and upper Midwest. During its two-year life cycle, the tick transforms from egg to six-legged larva to eight-legged nymph to adult. The Western blacklegged tick goes through the same transformation. It is found mostly on the Pacific coast, particularly northern California.
The blacklegged tick (also known as a deer tick) has four stages of development. It begins life as an egg before hatching into a six-legged larva. Larvae molt into eight-legged nymphs, during which time they are no bigger than a poppy seed. Nymphs become adult ticks, which are about as big as sesame seeds. This type of tick is the primary carrier of Lyme disease.
The Western blacklegged tick looks much like its relative, the blacklegged tick, and goes through the same life cycle. However, it is much less common, found in just six states on the West coast.
Blacklegged ticks don’t fly, but they can crawl. They are usually found in grassy and wooded areas, usually in low-lying vegetation, such as shrubs or grass. When people or animals brush up against vegetation where ticks reside, these speck-sized critters hitch a ride.
A tick punctures the skin, inserts its feeding tube, and slowly sucks blood over the course of several days. If the tick is infected with Lyme disease and remains in place for at least 24 hours, it can transmit that infection.
A target or bull’s-eye pattern is the hallmark of Lyme disease. As many as 70% to 80% of Lyme disease patients develop this type of rash, according to the CDC.
Doctors usually diagnose Lyme disease based on symptoms and a patient’s possible exposure to the blacklegged tick. Often (but not always) people with Lyme disease develop a distinctive, bulls-eye rash. However, many symptoms (including fever, headache, and fatigue) are less specific, making it difficult to pinpoint the cause.
Your doctor may ask whether you’ve spent time outdoors in certain parts of the country, particularly during the summer months. Most cases of Lyme disease in the U.S. are acquired in the Northeast and mid-Atlantic, the West coast, and the upper Midwest. People are exposed to these ticks mainly in grassy or wooded areas.
If you don’t know whether or not a tick has bitten you, your doctor may look for evidence of antibodies against the bacteria that cause Lyme disease. Note: It can take several weeks to develop these antibodies. That’s why doctors use physical findings and patient history to diagnose the condition. Lab tests are performed to confirm the hunch.
There’s no quick-and-easy Lyme disease test. The CDC recommends a two-step blood test. An enzyme immunoassay (such as an ELISA test, short for enzyme-linked immunosorbent assay) or an immunofluorescence assay is the first step. Even if someone is infected, initial testing may not provide a positive reading. If the test is negative but other signs of Lyme disease are present, the doctor may decide to start you on antibiotic treatment. If the test is positive, a second antibody test, called a Western blot test, can confirm that it is Lyme disease and not another medical condition.
According to the CDC, the illness is curable with early diagnosis and prompt treatment. Many people respond well to treatment even when there’s a lag in diagnosing the condition.
However, some Lyme sufferers experience severe symptoms that persist even after treatment.
Antibiotics are the only proven treatment for people who have early signs of Lyme disease. First-line treatment usually consists of a two- to three-week course of an oral antibiotic, such as amoxicillin, doxycycline, or cefuroxime axetil.
Lyme disease patients with heart or nervous system problems may be given a two- to four-week course of IV antibiotics, such as ceftriaxone or penicillin.
People who fail to receive prompt treatment are more likely to have lingering symptoms of fatigue, muscle or joint pain, or memory problems—a condition known as post-treatment Lyme disease syndrome post-treatment Lyme disease syndrome or chronic Lyme disease.
Patients may take Advil or Motrin (ibuprofen) to ease inflammation, reduce fever, and alleviate pain.
See a doctor right away if you think a tick has bitten you. The sooner you start a course of antibiotics, the greater success you may have in curing the illness.
An infectious disease specialist can evaluate your condition and recommend treatment. In Lyme-affected areas of the country, many internists, family medicine physicians, general practitioners, and pediatricians are well versed in diagnosing and treating Lyme disease.
Women who are pregnant and suspect Lyme disease should see a doctor immediately. Appropriate antibiotic treatment can avoid any ill effects to the fetus and ward off complications of the disease that could affect the mother.
If you’ve been treated for Lyme disease but still have pain, fatigue, or problems with concentration or memory, consult your doctor about ways to manage your symptoms. Studies show prolonged antibiotic won’t help. Additional research is needed on safe and effective treatments.
Lyme disease is considered curable when people receive prompt antibiotic treatment for their symptoms. The sooner treatment begins, the speedier and fuller their recovery. Even people whose illness has progressed beyond the early Lyme disease stages often respond well to treatment.
The CDC endorses treatment guidelines developed by the Infectious Diseases Society of America, which represents nearly 10,000 physicians and scientists specializing in infectious disease. However, not all clinicians agree on the best way to diagnose and treat Lyme disease.
Unfortunately, there’s no blood test to confirm whether someone has fully recovered from Lyme disease. The antibodies that people produce to fight off the infection can remain in their blood for months or years after treatment, even though the bacteria that caused Lyme disease are long gone. And some patients report symptoms that linger after treatment, fueling controversy about the best approach to treating patients.
Patients with persistent symptoms may want to get tested for other tick-borne illnesses, such as anaplasmosis or babesiosis. The rate of such “co-infections” with Lyme disease varies by region.
Children are just as prone to getting Lyme disease as anyone else. Depending on where they live and play and how much time they spend outdoors, kids may be at greater risk than many adults.
How do you know if your child has Lyme disease? Parents may suspect Lyme if the family lives in or visits an area where the disease is commonly found. Knowing or suspecting that your son or daughter has been exposed to ticks is another indicator. Contact your health provider if your child is experiencing symptoms, such as rash, fever, chills, fatigue, muscle or joint pain, or facial paralysis.
Children diagnosed with Lyme disease typically receive two to four weeks of antibiotics. Doxycycline or amoxicillin are usually the treatments of choice, unless children are under age eight or are allergic.
If a Lyme diagnosis is inconclusive, the doctor may order a blood test for antibodies to the bacteria that cause Lyme disease. (However, it can take two to three weeks after an infection for antibodies to appear, and if the first test is negative, a second blood test may be ordered later on.)
People can’t catch Lyme disease from other people. There’s no evidence that kissing, touching, or having sex with someone who has Lyme disease puts you at risk of acquiring the illness, and there are no reports of transmission through breast milk or donated blood. However, the bacteria that cause Lyme disease can live in blood, so people currently being treated for the disease should not donate blood.
People cannot acquire Lyme disease from their dogs, either, although cuddling with your furry friend could expose you to ticks that landed on your pet.
Lyme disease is carried by infected ticks, specifically two species of blacklegged ticks. If you live in or visit an area of the country where these infected ticks are prevalent, it’s important to take measures to reduce your risk of getting bitten, especially in the spring and summer months.
Scientists know of just one way that people can acquire Lyme disease, and that’s by getting bit by an infected blacklegged tick or Western blacklegged tick.
Not all tick bites are infectious. Only ticks of the blacklegged variety who inhabit parts of the country where Lyme disease is highly prevalent are commonly infected with Borrelia burgdorferi or Borrelia mayonii, the two species of bacteria that cause Lyme disease in the United States.
It can take 36 to 48 hours for transmission of the disease-causing bacteria to occur, so if a tick is removed in the first 24 hours, chances of infection are lower.
You cannot acquire Lyme disease through close contact with someone who is already infected. It is not transmitted through kissing or sexual intercourse, and there are no reports of transmission through breast milk or donated blood, it says. However, the bacteria that cause Lyme disease can live in blood, so people currently being treated for the disease should not donate blood.
Dogs and cats can get Lyme disease, but they cannot transmit it to humans. However, you pet may carry ticks into your home.
To prevent tick bites, take the proper precautions to avoid these tiny arachnids. Be aware that the Northeast (from Maine to Virginia), upper Midwest (especially Minnesota and Wisconsin), and the Pacific coast (particularly northern California) are hot spots for Lyme disease. May, June, July, and August are peak months for its transmission.
The blacklegged tick and its relative, the Western blacklegged tick, thrive in humid, wooded habitats, particularly in low-lying grass and brush. When walking or hiking, wear light-colored clothes (so you can spot ticks that may land on you) with long pants tucked into socks or boots and long sleeves. Use insect repellant containing 20% or more DEET. Spray your clothing, too, or wear clothing treated with the insecticide permethrin. Stay on the center of trails or paths; avoid the tick-infested vegetation on the margins. To keep ticks at bay at home, trim brush, mow grass, and rake leaves on your property.
Do a full-body check for ticks (and check your kids, too) after coming indoors. Pay particular attention to the hair, armpits, groin, and knees. The latest research recommends that you toss clothing in the dryer and spin on high heat for at least six minutes to kill any ticks that may have stowed away on your clothing. It’s also a good idea to hit the shower after coming in from the outdoors.
If you or a family member is bitten by a tick, remove it promptly to prevent possible infection. It typically takes at least 36 hours for infected ticks to transmit the bacterium that causes Lyme disease. Pregnant women with Lyme disease should receive antibiotic treatment immediately to stop the infection and prevent it from harming her fetus.
If you find a tick on your body (or on your child’s body), don’t panic. You need to remove it quickly but carefully, because crushing the tick may cause transmission of bacteria that causes Lyme disease. Here’s what the CDC recommends: Using a pair of fine-pointed tweezers, grasp the tick at the point of its attachment, as close to the skin’s surface as possible, and pull upward. Twisting or jerking it could leave parts of the tick behind. Wash your hands and clean the affected area with alcohol or soap and water. Dispose of the live tick by placing it in alcohol, sealing it in a plastic bag or container, wrapping it in tape, or flushing it down the toilet.
Chances of infection are low if you remove the tick within 24 hours. See your doctor if you develop a fever or rash within weeks of a tick bite.
There are lots of folk remedies for tick removal: burning it with the end of a hot match or cigarette; smothering it with nail polish, alcohol, or petroleum jelly; or freezing it with ice, for example. The CDC does not recommend any of these methods. Instead of causing the tick to retreat, it may burrow more deeply, boosting the risk that the tick will transmit disease-causing bacteria.
Anyone can get Lyme disease, even the rich and famous
Appearing on Good Morning America in 2015, pop singer Avril Lavigne described her nightmare-of-a-struggle. “I literally became bedridden last October,” Lavigne said. She recalled waking up with night sweats and flu-like symptoms that came and went for a month.
While doctors suggested she might have chronic fatigue or depression, Lavigne eventually suspected Lyme disease and sought out a specialist. With antibiotics and plenty of rest, her condition improved. “There is hope. Lyme disease does exist, and you can get better,” she said.
Former The Real Housewives of Beverly Hills star Yolanda Hadid has been struggling with chronic Lyme disease for years. Hadid, who is the mother of supermodels Gigi and Bella, battled flu-like symptoms and brain fog for at least a year before her 2012 diagnosis.
“It feels like someone came in and confiscated my brain and tied my hands behind my back to just watch and see life go by without me participating in it," she wrote in a 2015 blog post on bravotv.com.
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How do you know if your pooch has Lyme disease? The illness is different in pets than in people. The American Veterinary Medical Foundation says symptoms of the tick-borne illness may not appear in your pet until two to five months after the infection has occurred.
Common symptoms of Lyme disease in dogs include fever, loss of appetite, joint swelling, and decreased activity. Dogs do not develop a bull’s-eye rash in response to Lyme disease like many people do.
Treatment may include a few weeks of antibiotic treatment.
Lyme disease can’t be spread from one pet to another, or from dog to human. However, if your pet picked up ticks outside, they could end up on your body, too. If your dog has Lyme disease, talk to your vet about whether other household pets or family members should be evaluated for the illness.
You can help protect your dog by taking preventive measures. Inspect your dog daily for ticks, use flea and tick prevention products, and keep your yard landscaped to reduce tick exposure. Have your veterinarian do a tick check at every visit. If you find a tick on your dog, use tweezers to carefully remove it.