Lyme Disease

• Lyme disease is an infection caused by a bacteria (germ) called Borrelia burgdorferi. The germ is commonly found in mice, squirrels, shrews, and deer. Ixodes ticks (bugs), called black-legged or deer ticks, often feed on the blood from an infected animal. When this occurs, the tick then becomes a carrier of the germ that causes Lyme disease. The infected tick can then infect you with this germ through your skin. Infected deer ticks are commonly found in the Northeastern and North Central United States. Most people become infected with Lyme during the late spring and summer months.
  
  
• Lyme disease commonly causes a skin rash called erythema migrans. You may have problems with your joints (area where two or more bones meet). Lyme disease may also lead to problems with your heart, brain, and nerves. Treatment for Lyme disease may prevent, or decrease symptoms such as joint pain and swelling. Treatment may also help stop the disease from spreading to your organs.

What causes Lyme disease?

You may get Lyme disease if an infected deer tick bites you. Deer ticks eat by feeding on the blood of animals and humans. When you are bitten by a deer tick, it will also attach itself to your skin. Staying attached allows the tick to get the amount of blood it needs from you. It may take 24 to 48 hours for the bacteria from the tick to reach your blood. The longer the infected tick is attached, the greater your risk is of becoming infected.

What increases my risk of getting Lyme disease?

• Age: Lyme disease more commonly occurs in children ages 5 to 14, and adults ages 55 to 70.
  
  
• Occupation: People who work in wooded areas, or areas with heavy brush, are at an increased risk for Lyme disease.
  
  
• Outdoor activities: Doing activities in areas with many trees, bushes, and animals may increase your risk for Lyme disease. This includes hunting, camping, fishing, and gardening.

What are the signs and symptoms of Lyme disease?

Signs and symptoms of Lyme disease may occur within a few days after being bitten. It may also take up to a month before you have any symptoms. You may have any of the following:

• A red rash that looks like a target or bull's eye on your skin. The rash will appear on your skin where the infected tick bit you. There may be a small bump in the center of the rash where the tick was attached. The rash may be raised or flat, itchy, and normally grows in size. Common tick bite sites are the thigh, groin, buttock, scalp (head), or under your arm. Your groin is the area where your abdomen (stomach) meets your upper legs. You may have smaller target like rashes that appear on your skin around the area you were bitten.
  
  
• Abdominal pain, nausea (upset stomach), and diarrhea (loose-watery stools).
  
  
• Fever (high body temperature) and night sweats.
  
  
• Headache and stiff neck.
  
  
• Joint and muscle aches.
  
  
• Sore throat.
  
  
• Weakness and feeling very tired.

What problems may Lyme disease cause?

The following problems may occur shortly, or many months after being infected. Ask your caregiver for more information about the following:

• Arthritis: You may have joint pain and swelling that is constant, or comes and goes. The pain may be severe (very bad), and excess fluid may collect around your joints. You may have trouble moving your joint areas. The pain and swelling is more common in your knees. You may also have pain and swelling in your hips, ankles, wrists, and other joints.
  
  
• Heart problems: You may have swelling in your heart, and the area around it. You may also be at risk of having a heart block. A heart block is when the upper and lower areas of your heart are not working together as they normally do. You may begin to have abnormal heartbeats. You may feel like your heart is jumping in your chest as it beats, and you may feel dizzy. A heart block caused by Lyme disease normally goes away, but may become permanent.
  
  
• Neurological problems: You may begin to have problems with your nerves and the function of your brain. You may have mood changes and trouble thinking clearly. You may begin to have pain, tingling, or numbness (loss of feeling) in your arms or legs. You may have trouble feeling the difference between hot and cold. You may get a facial palsy and have trouble moving areas of your face. Your face may also droop in the areas that are hard to move.
  
  
• Sleep problems: You may begin to have trouble falling and staying asleep.

How is Lyme disease diagnosed?

Your caregiver will ask you about your signs and symptoms. He will check your skin for any rashes or attached ticks. Tell your caregiver if you removed a tick from your skin recently. Also tell your caregiver if you have been in any areas that ticks may live, such as wooded areas. Your caregiver may diagnose you with Lyme disease if he sees a target rash on your skin. You may need any of the following tests:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Lumbar puncture: This procedure may also be called a spinal tap. During a lumbar puncture, you will need to lie very still. Caregivers may give you medicine to make you lose feeling in a small area of your back. Caregivers will clean this area of your back. A needle will be put in, and fluid will be removed from around your spinal cord. The fluid will be sent to a lab to test for the bacteria that causes Lyme disease.
  
  
• Synovial fluid test: Synovial fluid is the fluid that surrounds your joints. The skin over the joint will be cleaned, and medicine may be used to numb the tissue at the insertion site. A needle will be inserted into the space around the joint, and fluid will be removed. This fluid will be sent to a lab to check for the germ that causes Lyme disease.

How is Lyme disease treated?

Treatment for Lyme disease may include any of the following:

• Medicines:
  
  
  • Antibiotics: Antibiotics are germ-killing medicines. You may be given antibiotics to kill the germ that causes Lyme disease.
    
    
  • Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. NSAIDs may help decrease pain and inflammation (swelling) in your joints. Some NSAIDs may also be used to decrease a fever. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
    
    
  • Steroids: You may be given steroids to reduce pain, redness, and swelling in your joints or brain from Lyme disease. If you have severe joint pain and swelling, the steroids may be given as an injection (shot) into your joint.
  
  
• Temporary pacemaker: A pacemaker is a device that helps your heart beat normally. You may need a temporary (short-term) pacemaker if your Lyme disease has caused you to have a heart block. Ask your caregiver for more information about temporary pacemakers.
  
  
• Surgery: You may need surgery if your joint pain and swelling does not improve. Surgery is done to remove swollen tissue from your joint to help decrease your pain. Ask your caregiver for more information about this surgery.

How can I decrease my chances of getting Lyme disease?

• Avoid areas outdoors where you know there are many ticks. Check your skin and scalp for ticks when you return from areas where ticks live. If you find a tick, remove it carefully from your skin with tweezers, and clean the area. Watch the area where the tick attached itself, over the next month, for any redness or a rash.
  
  
• Remove dead leaves and brush from around your home and yard. If you live in a wooded area, make a border between your grass and the woods near your house. Wood chips and gravel can be used to make the border. Spray the grass and tree areas where you live with repellent to keep ticks away.
  
  
• Spray your clothing and exposed skin with a tick repellent. Your caregiver may suggest a repellent that has low levels of DEET in it. Wear protective clothing while in areas where there may be ticks. Wear long-sleeves and tuck your pants into your socks. Wear light colored clothing so you can see a tick that gets on you.

Where can I find more information about Lyme disease?

Contact the following:

• Centers for Disease Control and Prevention (CDC)
  1600 Clifton Road
  Atlanta , GA 30333
  Phone: 1- 800 - 232-4636
  Web Address: http://www.cdc.gov/
  

When should I call my caregiver?

Call your caregiver if:

• Your red target rash grows or spreads to other areas of your body.
  
  
• You suddenly have trouble falling or staying asleep.
  
  
• You have new or worsening pain and swelling in your joints.
  
  
• You have new or worsening weakness and muscle pain.
  
  
• You have changes in your mood, such as feeling depressed (deep sadness), anxious (worry), or easily angered.
  
  
• You think or know you are pregnant.
  
  
• You get a new tick bite.
  
  
• You have questions or concerns about your disease or treatment.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You suddenly have headaches, or your neck becomes stiff and is painful to move.
  
  
• You have new pain in your chest or trouble breathing.
  
  
• You have new or worsening trouble with your memory, concentration, or thinking clearly.
  
  
• You suddenly cannot talk or see well, or you have trouble moving an area of your body.
  
  
• You have new numbness in your arms or legs, or you have new trouble walking.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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