Lyme Disease

What's the Problem?

Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, Connecticut. Investigation revealed that Lyme disease is caused by a bacterium called Borrelia burgdorferi. Lyme disease bacteria are maintained in white-footed mice and other small mammals and are transmitted to humans by the bite of infected deer ticks. There are more than 16,000 infections reported in the United States each year, making it the most common vector-borne disease in the country. The initial infection may cause a large, red, expanding rash, accompanied by general tiredness, fever, headache, stiff neck, muscle aches, and joint pain. If not treated or treated inadequately, some people may develop more serious disease that may include arthritis, neurological abnormalities, inflammation of the brain, and, rarely, cardiac problems.

Who's at Risk?

Lyme disease affects people of all ages. Higher risk areas for Lyme disease are in the northeastern and upper midwestern states, and along the northern Pacific coast of California. Persons in areas where the disease is common and who frequent sites where infected ticks are common – such as grassy or wooded areas – have the highest risk for coming in contact with the bacteria that causes Lyme disease. Many people are likely infected on their own property, and people participating in recreation activities or working outdoors can also be at risk. If detected early, antibiotics can easily treat Lyme disease. If not treated in early stages, more severe manifestations can occur. In later disease, treatment failures may occur and re-treatment may be necessary.

Can It Be Prevented?

Lyme disease is a preventable disease! Avoid areas where ticks are found, such as moist, shady environments with low-lying vegetation, overgrown grass or leaf litter. People can protect themselves from being bitten by ticks by wearing light colored clothing to let them see ticks before they reach the skin, wearing long sleeves, tucking pants into socks or boots, and using insect repellant containing DEET or a permethrin compound. It is important to perform a "tick check" after being outdoors. Removing ticks that have been attached for less than 36 hours greatly decreases the chance of bacteria transmission. A health care provider can help decide if preventive antibiotics are advisable after a tick bite, depending on the risk in a given area.

The building of homes in forested areas has meant that people may encounter infective tick bites in the vicinity of their homes. This makes it challenging for people to avoid and protect against tick bites. There are strategies to reduce the tick population on one's property, such as removing leaf litter, cutting brush, and using methods to reduce the number of ticks on deer and mice.

Though the majority of people experience a large and expanding rash that is usually easy to distinguish from other rashes, infection with the Lyme bacteria is not always noticed or treated in the early stages, risking the complications of disease in the later stages – which are more difficult to treat. If someone suspects Lyme disease, they should see their health care provider promptly and be treated early, before complications arise.

The Bottom Line

Lyme disease is a bacterial disease that can affect large numbers of people in endemic areas. Prevention measures are fairly straightforward, but challenging to employ consistently. Early treatment is effective but requires knowledge and action on the parts of both consumers and health care providers to identify and diagnose.

Case Example

An east coast family has moved out of the city and they are enjoying their new home in the suburbs, complete with woods for hiking and deer in the surrounding area. The kids love to play outdoors. One day, Joey, the family's 10-year old son, notices a red, bull's eye shaped rash on his arm. He feels tired, has a headache and achy muscles. His mother isn't sure if this could just be summer flu, but she's alarmed enough to take Joey to the doctor's office–over his objections. In the waiting room, she notices a brochure about Lyme disease, and realizes that Joey has a classic infection. The doctor is able to treat this early infection with a course of antibiotics, and Joey recovers completely. His mother is relieved that this disease did not go untreated and become more serious. She institutes the brochure's prevention tips by removing brush from around the yard, performing nightly tick checks on her family, and encourages the use of repellent and protective clothing while outdoors.