Introduction

Lyme disease, caused by bacteria and spread by tick bites is an infection commonly acquired from woodlands, parks or forest exposure. When bitten by an infected tick, the person experiences widespread illness with symptoms ranging from severe headaches and fatigue to severe organ failure.¹ Knowledge of the disorder, prevention strategies and treatments are vital to avoid and manage this treatable disorder.

Awareness can help recognise the initial signs of the disease promptly and reduce the risk of severe complications if left untreated. Creating a prevention strategy when going camping or having a picnic at the park can ensure that you and your family have safe fun in nature.

What is Lyme disease?

Lyme disease is caused by a bacterium called Borrelia burdorferi that is present in deer ticks, and small spider-like insects occurring in certain forests and parks. When the tick bites the human, it transmits the bacteria directly into the skin and the bloodstream, infecting the person bitten. Not all ticks are infectious; therefore not all bites lead to the development of the disease. An initial sign of the disease is a characteristic skin rash at the site of the tick bite which looks like a bulls-eye.^1,2

Symptoms

Early symptoms

The early symptoms of Lyme disease are quite mild and can occur between 3 days or a month from a visit to a natural setting (where you could have got bitten by a tick). You may notice:³

1. A skin rash that looks like a bulls-eye on the dartboard (a small red spot with a ring-like redness surrounding it), occurring at the site of the tick bite
2. Feeling like you have the flu: fever, chills, headache, aches and pains in the joints and sometimes, swollen lymph nodes (small swellings in your neck, beneath your jaw, armpits or the groin)

Late symptoms

Sometimes the early symptoms can be missed and confused for another illness like the flu resulting in the more complicated form of illness to occur. The infection spreads to the rest of the body, causing widespread symptoms.⁴

1. Brain and spinal cord: severe headaches and neck stiffness. Swelling in the brain and spinal cord
2. Additional rashes (the characteristic bulls-eye shape) in the rest of the body
3. Joints and muscles: aches and pains in the joints, particularly the knees
4. Asymmetry of the face: face drooping or paralysis
5. Heart: palpitations and inflammation in the heart
6. Shooting pain or numbness or tingling sensation in the hands and feet
7. Problems with short-term memory and brain fog

Diagnosis

In case you or your family develops the symptoms enumerated above, especially after a visit to the park or a forest it would be wise to see a general physician (GP). Lyme disease is difficult to diagnose and easily confused with other illnesses, especially in the earlier stages. Two tests are used to diagnose the disease:⁵

1. Enzyme-linked immunosorbent assay (ELISA): this test detects the presence of the Bacterium Borrelia burgdorferi
2. Western blot test: if the ELISA test is positive or inconclusive, the western blot test is used to confirm the disease

Both these laboratory tests are not very reliable; there are cases of false results in people with Lyme disease. Additionally, these tests are only reliable after a few weeks after being bitten by the infected tick, causing delays in treatment.

The disease is therefore diagnosed based on a detailed clinical evaluation and your medical history. This includes a physical examination of the skin for tick bites if the area you have visited is a known site of infected ticks, and if your symptoms are consistent with the usual course of the disease.⁶

Treatment

Early diagnosis and treatment of Lyme disease is important to avoid complications and further organ damage. The primary treatment is a longer course of antibiotics and some supportive treatment depending on your symptoms.⁷

Antibiotics for early-stage Lyme disease

The early stages of Lyme disease are treated with oral antibiotics. The duration of the course of treatment depends on the severity of symptoms however; you can expect to take them for up to 28 days. Some antibiotics that could be prescribed include:^7,8

• Doxycycline
• Amoxicillin
• Cefuroxime

Treatment for the later stages

For more severe symptoms and widespread disease that affect multiple organ systems, antibiotics may be given through the vein (intravenous line). The duration may be longer due to the severity of the symptoms.⁸

Persistent symptoms

Some individuals may take longer to recover completely despite treatment with a longer course of antibiotics. This chronic course of the disease can last a few months.⁹

Risk factors and transmission

Exposure to infected ticks is common in the wooded and grassy areas of North America and Europe. Engaging in outdoor activities such as camping, gardening or hiking can increase your risk of getting bitten. Your pets may also bring in the ticks in your home when they are exploring high-risk zones.¹⁰

Seasonal variation

The risk of getting bitten also depends on the season due to the seasonal nature of their life cycle. In the warmer months of the year, the ticks are smaller in size (the size of a poppy seed), making them difficult to detect. This can lead to a longer bite and increased scope of bacteria transmission through the bite.¹¹

Prevention strategies

Preventative measures are the best way to ensure a reduced risk of getting a tick bite and developing Lyme disease. These measures involve a combination of protective measures as well as environmental management.¹²

• Wearing long-sleeved clothing, long trousers tucked into socks and light-coloured clothing (to detect ticks easily)
• Using insect repellent containing DEET or permethrin on clothing and exposed skin
• Avoid walking through long grass and dense shrubs, stick to the hiking trails
• Checking for ticks on clothes and your body after spending time outdoors
• Remove ticks using fine tweezers, by carefully pulling the tick out as close to the skin as possible
• Check your pets for ticks as well to reduce the risk of getting them inside the house
• If you live in a high-risk zone, maintaining the lawns well, cleaning up the litter regularly and creating a barrier between lawns and wooded areas is beneficial 

Addressing the misconceptions about Lyme disease

Misdiagnosis

Lyme disease presents with a variety of symptoms that overlap with other illnesses, making diagnosis quite tricky. The diagnosis is further complicated due to the issues with the current diagnostic tests for the disease. Moreover, some symptoms of Lyme disease can be mistaken for influenza or chronic fatigue syndrome, particularly in the early stages. The characteristic rash does not appear or is not visible in some cases. This can potentially delay treatment, and cause more severe symptoms.¹³

Misconceptions

• Lyme disease can only be contracted in dense forests: This is not always true. Urban parks can also host infected ticks
• There is always a visible tick bite: This is not always true. Sometimes the tick bite is not very apparent to the naked eye. This can lead to a delay in getting support from your GP, leading to more severe symptoms

Addressing these misconceptions can lead to a better prognosis of treatment and an improved understanding of the management plans. Healthcare providers and people with Lyme need to update their knowledge based on the recent developments in the field of Lyme disease treatment to ensure that the illness is diagnosed and treated promptly. This also reduces the risk of the disease affecting the brain, heart and joints and causing severe chronic symptoms.¹⁴

Impact on public health

Talking about the disease and spreading awareness helps reduce the negative impact it has in our community. While a majority of tick bites will not lead to the development of Lyme disease, it is important to be proactive in seeking medical attention if you have been feeling unwell after visiting a park or grassland.

Awareness about parks and forests that are known to host infected ticks can ensure that preventative measures are taken when you visit them. It can also help your GP determine the likelihood of you having the disease after a tick bite. More research is needed to improve the diagnosis and treatments of the disease, especially when symptoms involve various organ systems and are chronic.¹⁵

Summary

Lyme disease is a bacterial illness transmitted by tick bites, commonly developing after a visit to the grasslands, forests or parks. A small percentage of tick bites lead to the development of disease, however, when infected the person has widespread symptoms. Early symptoms include a classic ‘bulls eye’ rash and flu-like symptoms (weakness, headache, aches and pains).

Late symptoms involve the brain and spinal cord (severe headache, neck stiffness, nerve pain), numbness and tingling in the hands and legs, severe inflammation and pain in the joints, and even the heart (palpitations, inflammation). Treatment involves a long course of antibiotics orally or through an IV line (in case of severe symptoms).

Prevention strategies involve wearing full clothing, applying protective insect repellent, checking for ticks as soon as you get back from a high-risk zone and inspecting for tick bites. If you are feeling unwell after a visit to the park or a forest and can see a skin rash or a tick bite, it is important to schedule a GP visit promptly.