Signs and Symptoms

Untreated Lyme disease has three stages: early localized stage, early disseminated stage, and late stage.

Stage 1: Early Localized Stage

A red rash appears within a few days or weeks of a tick bite. It starts as a small red spot at the site of the bite. The spot gets bigger over time, making a flat or slightly raised circle or oval that sometimes looks like a bull's eye with the bite make at the center. The rash can range in size from that of a dime to the entire width of a person's back. As the infection spreads, rashes can show up at different places on the body. Flu-like symptoms like headache, fatigue, and fever may also appear.

Stage 2: Early Disseminated Stage

Without treatment, the disease can spread through the blood or lymph to different organs of the body. This stage develops weeks to months after the tick bite. Symptoms includes:

• Rashes in different parts of the body
• Severe fatigue
• Nerve pain or numbness
• If the heart is affected: heart problems, such as palpitations, fainting, chest pain, and shortness of breath.
• Neurological symptoms, such as a stiff neck and severe headache (may indicate meningitis), temporary paralysis of muscles in the face (Bell's palsy), numbness, pain or weakness in the limbs, or poor motor coordination.

Stage 3: Late Stage

If Lyme disease continues to be left untreated, it can become established in various parts of the body over months or years after the initial infection. Symptoms include:

• Joint pain and swelling (Lyme arthritis). Approximately 60% of people not treated with antibiotics will develop recurring attacks of arthritis.
• Nerve damage. This results in numbness in hands or feet, shooting pains, and tingling.
• Neurological problems. These can include confusion, memory loss, sudden loss of hearing, or speech problems.

What Causes It?

Deer ticks carrying the bacterium B. burgdorferi bite people. Not every bite from a deer tick causes the disease. The bacterium gets into the skin, after the infected tick has been in place for 24 to 48 hours.

Who is Most At Risk?

Your risk of Lyme disease may be higher if you:

• Spend time in heavily wooded areas or grassy fields where there are ticks
• Do not follow preventive measures, such as using repellant, doing tick checks, and wearing adequate clothing
• Live in the coastal northeast, as well as in Wisconsin, Minnesota, and California, where the majority of cases show up

Although the risk is highest between May and July (when nymph ticks are active), you can get tick bites throughout the year. Cases were reported in all US states and other regions of the world, including Europe and Asia.

What to Expect at Your Provider's Office

Lyme disease is diagnosed based on the typical rash or other symptoms in people who may have been exposed to ticks. Tell your doctor if you think you may have been bitten by a tick. Your doctor may order these tests:

• ELISA is a blood test, which detects antibodies to the bacteria that causes Lyme disease. This is usually the first test to be done. If positive, it must be confirmed with a western blot test.
• Western blot test also detects antibodies to the bacteria, but is more accurate.
• C6 peptide ELISA is a newer confirmation test that may be used in place of the western blot.
• Polymerase chain reaction (PCR) is rarely used. It detects bacteria in joint or spinal fluid.

Treatment Options

Prevention

The best defense against Lyme disease is to guard against tick bites. Measures include:

• DO NOT go into heavily wooded or grassy areas that may be infested with ticks.
• Wear long-sleeved shirts and long pants.
• Apply insect repellent. Use permethrin for your cloths and apply DEET-containing repellant to the exposed skin.
• Wear light-colored clothing, which makes ticks easier to spot.
• Carefully check for ticks after you have been outdoors.

If you find a tick, remove it with tweezers, making sure to remove the head as well as the body. Do not use hot matches, petroleum jelly, nail polish, or other substances to remove the tick. Seeing your doctor and taking antibiotics within 3 days of a tick bite may prevent Lyme disease.

Drug Therapies

Your health care provider may prescribe the following medications:

• Antibiotics. Usually doxycycline (Vibramycin), amoxicillin, and cefuroxime (Ceftin) are prescribed. Later-stage Lyme disease may require intravenous (IV) antibiotics, either ceftriaxone (Rocephin) or penicillin. Note: pregnant and breastfeeding women, and children under 8 years of age should not take doxycycline.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Such as ibuprofen (Advil, Motrin) or naproxen (Aleve), to relieve pain and inflammation.

Complementary and Alternative Therapies

You should never treat Lyme disease with complementary therapies alone. Only proper antibiotic treatment can cure the disease and avoid complications.

Newsletters and Internet sites have cropped up in recent years advertising untested treatments to people with symptoms of post-Lyme disease syndrome or so-called "chronic Lyme disease" who are frustrated with standard medical treatment. Some remedies may be dangerous and ineffective. Always tell all of your doctors about the herbs and supplements you are using or considering using.

• Probiotic supplement (containing Lactobacillus acidophilus). Probiotics, or "friendly" bacteria, help maintain intestinal health. If you take antibiotics to treat Lyme disease, the antibiotics will kill the "good" bacteria along with the bad. That can cause diarrhea or yeast infections. Taking probiotics may reduce these side effects. People with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking probiotics.
• Bismacine. The FDA has warned people not to use an alternative medicine product called bismacine (also known as chromacine). This injectable product contains high amounts of bismuth, a heavy metal that can be poisonous. People who have taken bismacine have experienced heart and kidney failure, and at least one death has been reported. Although some people claim that bismacine can help treat Lyme disease, it is not approved or recommended for the treatment of any illness or condition.

Herbs cannot cure Lyme disease or its complications. Some herbs may help with certain symptoms, but should never be used instead of conventional antibiotic therapy. Herbs can have side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a provider. Some herbs used by people with Lyme disease include:

• Cat's claw (Uncaria tomentosa). It has antioxidant and anti-inflammatory properties. There are no studies on cat's claw use for Lyme. Cat's claw may interfere with numerous drugs. You should talk to your provider before taking it.
• Garlic (Allium sativum). It has some antibacterial effects and may improve the immune system. Garlic may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Garlic can potentially interfere with several medications, including drugs used to treat HIV/AIDS, and even some birth control medications. Speak to your doctor.
• Essaic. It is a mixture of burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm (Ulmus fulva), rhubarb (Rheum palmatum), and other plants, which may have antioxidant and immune modulatory effects. Although, some people with Lyme disease use Essiac tea, there are no studies to say whether it works. Essaic may interact with many medications and potentially cause some dangerous side effects, including toxic effects on the liver. Consult with your provider before taking Essiac.

Other common herbal therapies with antimicrobial activity include:

• Sweet wormwood (Artemisia annua)
• Olive leaf
• Goldenseal (Hydrastis Canadensis)
• Grapefruit seed extract

All herbs should be taken under the guidance of a qualified prescriber and you should inform all of your providers about all of the conventional and CAM therapies you are considering.

Homeopathy does not cure Lyme disease or its complications. No studies have examined the effectiveness of specific homeopathic remedies for improving Lyme symptoms. Some people use the following homeopathic remedies:

• Arsenicum album
• Borrelia burgdorferi nosode
• Carcinosin
• Lac canimum
• Ledum
• Mercurius
• Syphilinum
• Thuja

Prognosis and Possible Complications

Most people who are treated with antibiotics make a full recovery. Getting early treatment can help avoid complications. Complications include arthritis, heart disease, and neurologic complications.

Following Up

If you have a serious and advanced case of Lyme disease with various symptoms, your doctor may want to see you regularly.

Supporting Research

Ali A. Lyme disease. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 23.

Bockenstedt LK, Lyme disease. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 110.

Fort GG. Lyme disease. In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019:835-836.e1.

Habibi Z, Ghanian S, Ghasemi S, Yousefi M. Chemical composition and antibacterial activity of the volatile oil from seeds of Artemisia annua L. from Iran. Nat Prod Res. 2013;27(2):198-200. PMID: 22348222 www.ncbi.nlm.nih.gov/pubmed/22348222.

Murray MT. Allium sativum (garlic). In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 63.

Murray MT. Hydrastis canadensis (Goldenseal) and other berberine-containing botanicals. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 97.

Steere A. Lyme disease (Lyme borreliosis) due to Borrelia burgdorferi. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 243.

Wei J, Wang S, Pei D, et al. Antibacterial activity of hydroxytyrosol acetate from olive leaves (Olea Europaea L.). Nat Prod Res. 2017:1-4. PMID: 28768425 www.ncbi.nlm.nih.gov/pubmed/28768425.

Wormser GP, Lyme disease,. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 321.