LYME DISEASE

The symptoms of Lyme disease depend on the stage of the disease. You may first notice symptoms weeks to months after the tick bite. If the disease isn’t treated, it may progress from mild symptoms to serious, long-term disabilities.

• In the first stage, you may have a rash (erythema migrans that looks like a bull’s eye) at the site of the tick bite. You may also have a lack of energy or a headache and stiff neck. Sometimes people have no symptoms at this stage.
• In the second stage, symptoms may include memory problems and pain and weakness in the arms and legs.
• In the third stage, symptoms may include swelling and pain (like arthritis) in the joints, not being able to control facial muscles, and numbness and tingling in the hands, feet, or back.

If you don’t have symptoms during stage 1, your first symptoms may be those found in stage 2 or 3.

DIAGNOSIS

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.

RECOMMENDED MEDICATIONS

Antibiotics are the main treatment for Lyme disease. The first course of antibiotics almost always cures the infection. But if symptoms continue, more evaluation may be needed.

The type of antibiotic prescribed, the amount, and whether the medicine is taken orally, as an injection, or through a vein (intravenous, or IV) depends on how bad your symptoms are and how long you’ve had Lyme disease.

• Oral antibiotics are prescribed for early Lyme disease. They are also usually prescribed first for chronic Lyme arthritis. 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 (IV) antibiotics are used if:
  • Your nervous system is affected by late Lyme disease and you have bad headaches, neck pain, weakness or numbness in the arms or legs, or problems with thinking or memory.
  • Lyme disease bacteria or antibodies against the bacteria have been found in your spinal fluid.
• Either oral or intravenous antibiotics may be used to treat late Lyme disease symptoms.