Lyme Disease (cont.)

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What are risk factors for developing Lyme disease?

Lyme disease occurs most frequently in children 5-14 years of age and adults 40-50 years of age. The most substantial risk factor for Lyme disease is exposure to the ticks located in the high-risk areas of the country listed above, particularly in the New England states as well as Minnesota and Wisconsin. Additional risk factors include recreational and occupational exposure to ticks and outdoor activities, including gardening, in woods and fields in the high-risk areas. No transplacental transmission (congenital infection) of Lyme disease from the mother to the unborn child has ever been described. Again, Lyme disease is not contagious from one person to another.

What are symptoms and signs of Lyme disease?

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. Days to weeks later, as the bacteria spread in the skin away from the initial tick bite, the infection causes an expanding reddish rash that is 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: (1) early localized disease with skin inflammation; (2) early disseminated disease with heart and nervous system involvement, including palsies and meningitis; and (3) late disease featuring motor and sensory nerve damage and brain inflammation as well as arthritis.

In the early phase of the illness, within days to weeks of the tick bite, the skin around the bite develops an expanding ring of unraised redness. There may be an outer ring of brighter redness with or without a central area of clearing, leading to a "bull's-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. The rash may or may not itch. More than one in four patients never even develop a rash. The redness of the skin is often accompanied by generalized fatigue, muscle and joint stiffness and pain, swollen lymph nodes ("swollen glands"), headache, and less often fever, 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 bacteria and their 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 rhythms and heart failure. The nervous system signs can include 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.

Researchers have also found that anxiety and depression occur with an increased rate in people with Lyme disease. This is another important aspect of the evaluation and management of this condition.

Medically Reviewed by a Doctor on 5/15/2014

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