Medically reviewed on May 16, 2018
Lyme disease is caused by four main species of bacteria: Borrelia burgdorferi, Borrelia mayonii, Borrelia afzelii and Borrelia garinii bacteria. Borrelia burgdorferi and Borrelia mayonii cause Lyme disease in the United States, while Borrelia afzelii and Borrelia garinii are the leading causes of Lyme disease in Europe and Asia. The most common tick-borne illness in these regions, Lyme disease is transmitted by the bite of an infected black-legged tick, commonly known as a deer tick.
You're more likely to get Lyme disease if you live or spend time in grassy and heavily wooded areas where ticks carrying the disease thrive. It's important to take common-sense precautions in areas where ticks are prevalent.
The signs and symptoms of Lyme disease vary and usually appear in stages.
Early signs and symptoms
A small, red bump often appears at the site of a tick bite or tick removal and resolves over a few days. This is normal after a tick bite and does not indicate Lyme disease.
However, these signs and symptoms may occur within a month after you've been infected:
Rash. From 3 to 30 days after an infected tick bite, an expanding red area might appear that sometimes clears in the center, forming a bull'&s-eye pattern. The rash (erythema migrans) expands slowly over days and can spread to 12 inches (30 centimeters) across. It is typically not itchy or painful.
Erythema migrans is one of the hallmarks of Lyme disease. Some people develop this rash at more than one place on their bodies.
- Flu-like symptoms. Fever, chills, fatigue, body aches and a headache may accompany the rash.
Later signs and symptoms
If untreated, new signs and symptoms of Lyme infection might appear in the following weeks to months. These include:
- Erythema migrans appearing in other areas of your body.
- Joint pain. Bouts of severe joint pain and swelling are especially likely to affect your knees, but the pain can shift from one joint to another.
- Neurological problems. Weeks, months or even years after infection, you might develop inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement.
Signs and symptoms caused by the bacterium Borrelia mayonii may also include:
- Nausea and vomiting
- Diffuse rashes (rather than a single bull's-eye rash commonly associated with Lyme disease)
Less common signs and symptoms
Several weeks after infection, some people develop:
- Heart problems, such as an irregular heartbeat. Heart problems rarely last more than a few days or weeks.
- Eye inflammation.
- Liver inflammation (hepatitis).
- Severe fatigue.
When to see a doctor
If you've been bitten by a tick and have symptoms
Only a minority of blacklegged tick bites leads to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease. Lyme infection is unlikely if the tick is attached for less than 36 to 48 hours.
If you think you've been bitten and have signs and symptoms of Lyme disease — particularly if you live in an area where Lyme disease is prevalent — contact your doctor. Treatment for Lyme disease is more effective if begun early.
See your doctor even if symptoms disappear
It's important to consult your doctor even if signs and symptoms disappear — the absence of symptoms doesn't mean the disease is gone. Left untreated, Lyme disease can spread to other parts of your body from several months to years after infection, causing arthritis and nervous system problems. Ticks also can transmit other illnesses, such as babesiosis and Colorado tick fever.
People with Lyme disease may experience a characteristic bull's-eye rash. The rash gradually spreads over a period of days and may eventually reach up to 12 inches (30 centimeters) across.
In the United States, Lyme disease is caused by Borrelia burgdorferi and Borrelia mayonii bacteria, carried primarily by blacklegged or deer ticks. The ticks are brown and, when young, often no bigger than a poppy seed, which can make them nearly impossible to spot.
To contract Lyme disease, an infected deer tick must bite you. The bacteria enter your skin through the bite and eventually make their way into your bloodstream. In most cases, to transmit Lyme disease, a deer tick must be attached for 36 to 48 hours. If you find an attached tick looks swollen, it may have fed long enough to transmit bacteria. Removing the tick as soon as possible may prevent infection.
The deer tick (Ixodes scapularis) goes through three life stages. Shown from left to right is the adult female, adult male, nymph and larva on a centimeter scale.
Where you live or vacation can affect your chances of getting Lyme disease. So can your profession and the outdoor activities you enjoy. The most common risk factors for Lyme disease include:
Spending time in wooded or grassy areas. In the United States, deer ticks are most prevalent in the Northeast and Midwest regions, which have heavily wooded areas where deer ticks thrive. Children who spend a lot of time outdoors in these regions are especially at risk. Adults with outdoor occupations also are at increased risk.
In the first two stages of life, deer ticks in the United States feed on mice and other rodents, which are a prime reservoir for Lyme disease bacteria. Adult deer ticks feed primarily on white-tailed deer.
- Having exposed skin. Ticks attach easily to bare flesh. If you're in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants. Don't allow your pets to wander in tall weeds and grasses.
- Not removing ticks promptly or properly. Bacteria from a tick bite can enter your bloodstream if the tick stays attached to your skin for 36 to 48 hours or longer. If you remove a tick within two days, your risk of acquiring Lyme disease is low.
Left untreated, Lyme disease can cause:
- Chronic joint inflammation (Lyme arthritis), particularly of the knee
- Neurological symptoms, such as facial palsy and neuropathy
- Cognitive defects, such as impaired memory
- Heart rhythm irregularities
The best way to prevent Lyme disease is to avoid areas where deer ticks live, especially wooded, bushy areas with long grass. You can decrease your risk of getting Lyme disease with some simple precautions:
- Cover up. When in wooded or grassy areas, wear shoes, long pants tucked into your socks, a long-sleeved shirt, a hat and gloves. Try to stick to trails and avoid walking through low bushes and long grass. Keep your dog on a leash.
- Use insect repellents. Apply insect repellent with a 20 percent or higher concentration of DEET to your skin. Parents should apply repellant to their children, avoiding their hands, eyes and mouth. Keep in mind that chemical repellents can be toxic, so follow directions carefully. Apply products with permethrin to clothing or buy pretreated clothing.
- Do your best to tick-proof your yard. Clear brush and leaves where ticks live. Keep woodpiles in sunny areas.
Check yourself, your children and your pets for ticks. Be especially vigilant after spending time in wooded or grassy areas. Deer ticks are often no bigger than the head of a pin, so you may not discover them unless you search carefully.
It's helpful to shower as soon as you come indoors. Ticks often remain on your skin for hours before attaching themselves. Showering and using a washcloth might remove unattached ticks.
- Don't assume you're immune. You can get Lyme disease more than once.
- Remove a tick as soon as possible with tweezers. Gently grasp the tick near its head or mouth. Don't squeeze or crush the tick, but pull carefully and steadily. Once you've removed the entire tick, dispose of it and apply antiseptic to the bite area.
The variable signs and symptoms of Lyme disease are nonspecific and often are found in other conditions, so diagnosis can be difficult. What's more, the ticks that transmit Lyme disease also can spread other diseases at the same time.
If you don't have the characteristic Lyme disease rash, your doctor might ask about your medical history, including whether you've been outdoors in the summer where Lyme disease is common, and do a physical exam.
Lab tests to identify antibodies to the bacteria can help confirm the diagnosis. These tests are most reliable a few weeks after an infection, after your body has had time to develop antibodies. They include:
- Enzyme-linked immunosorbent assay (ELISA) test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis. This test might not be positive during the early stage of Lyme disease, but the rash is distinctive enough to make the diagnosis without further testing in people who live in areas infested with ticks that transmit Lyme disease.
- Western blot test. If the ELISA test is positive, this test is usually done to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.
Antibiotics are used to treat Lyme disease. In general, recovery will be quicker and more complete the sooner treatment begins.
- Oral antibiotics. These are the standard treatment for early-stage Lyme disease. These usually include doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women. A 14- to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective.
- Intravenous antibiotics. If the disease involves the central nervous system, your doctor might recommend treatment with an intravenous antibiotic for 14 to 28 days. This is effective in eliminating infection, although it may take you some time to recover from your symptoms. Intravenous antibiotics can cause various side effects, including a lower white blood cell count, mild to severe diarrhea, or colonization or infection with other antibiotic-resistant organisms unrelated to Lyme.
After treatment, a small number of people still have some symptoms, such as muscle aches and fatigue. The cause of these continuing symptoms, known as post-treatment Lyme disease syndrome, is unknown, and treating with more antibiotics doesn't help. Some experts believe that certain people who get Lyme disease are predisposed to develop an autoimmune response that contributes to their symptoms. More research is needed.
The Food and Drug Administration warns against the use of bismacine, an injectable compound prescribed by some alternative medicine practitioners to treat Lyme disease. Bismacine, also known as chromacine, contains high levels of the metal bismuth. Although bismuth is safely used in some oral medications for stomach ulcers, it's not approved for use in injectable form or as a treatment for Lyme disease. Bismacine can cause bismuth poisoning, which may lead to heart and kidney failure.
Preparing for an appointment
You're likely to start by seeing your family doctor or a general practitioner who might refer you to a rheumatologist, infectious disease specialist or other specialist.
Here's some information to help you prepare for you appointment.
What you can do
- Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including major stresses or recent life changes.
- Create a list of medications, vitamins and supplements you take.
- Take a family member or friend along, if possible. Someone who accompanies you might remember something that you missed or forgot.
- Write down a list of questions to ask your doctor.
For Lyme disease, some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- Other than the most likely cause, what are other possible causes for my symptoms?
- What tests do I need?
- What is the best course of action?
- What alternatives are there to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can take? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Questions your doctor is likely to ask include:
- When did your symptoms start?
- Did a tick bite you?
- Have you been in wooded areas? If so, where?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?