Introduction

Brief overview of Lyme disease

Lyme disease is a disease that is caused by a bacteria called Borrelia burgdorferi. It is known to be transmitted by a tick, specifically an infected deer tick, also known as the black-legged tick. It is commonly found in temperate countries and environments, especially in the United States, but it is spreading to other countries and continents, because of the increase in reforestation, tourism, travel and intrusion in the natural habitat.¹

Importance of early detection and treatment

Due to the consequences of the latent disease, it is important for early detection and appropriate treatment. ¹

Early signs of Lyme disease^1,2

Signs and symptoms of an early-stage Lyme disease include:

• Erythema migrans (EM) rash (bull's-eye pattern) - this is a red-coloured rash or skin lesions and usually starts as a red spot, where the tick bites for around 1 to 4 weeks. This spot then increases in size, creating a circular, triangular or oval-shaped rash. It is also called the bull’s-eye rash, because of it appears as a red ring that surrounds a clear centre. The size of the rash does change and as it spreads more of the rash can be seen around the body
• Fever
• Chills
• Fatigue
• Headache
• Muscle and joint aches
• Swollen lymph nodes

Progression of Lyme disease^1,2,3,4

In the early stage of Lyme disease, the bite of the tick may resemble a rash in a bulls-eye form.

The signs and symptoms of the second stage of the disease, also known as the early disseminated stage, include:

• Rash spreading in multiple areas of the body
• Bell’s palsy - causes paralysis of the muscles in the face
• Heart block
• Numbness
• Meningitis symptoms - severe headaches, stiff neck, pain, weakness in the limbs
• Lyme carditis - causing heart palpitation, dizziness, shortness of breath

The symptoms of untreated Lyme disease, include:

• Lyme arthritis - swollen joints, pain in joints
• Brain fog - difficulty in concentrating
• Damage to nerves in the body
• Post-treatment Lyme disease syndrome
• Fatigue

Diagnosis and testing^4,5

Clinical diagnosis

When you go to your appointment, your doctor will first ask you about your medical history, especially if you have been exposed to any tick bites or been to woodland areas. Your doctor will also look at the rash and ask you about any other symptoms that you may be experiencing. 

Laboratory testing

To help diagnose Lyme disease, a blood test will be done, in other cases, the healthcare also uses a two-step procedure for ordering antibody tests. The first one being an enzyme-linked immunosorbent assay (ELISA), which is a sensitive screening test and if this tests positive then to confirm the results, a Western blot test is done because is more specific than the ELISA test. In more severe cases a polymerase chain reaction (PCR) is done to detect bacteria in the DNA. 

Treatment^1,5,6

Antibiotic therapy

Depending on at what stage the disease is, the treatment may differ. For early stages of Lyme disease doxycycline, an antibiotic is recommended to those above the age of 8 and for those under the age of 8 amoxicillin is given. The course of the antibiotics also depends on how severe the symptoms are. If you are experiencing arthritis, encephalitis and meningitis, you may need to continue taking antibiotics for a longer period of time. 

How do I manage if I get bitten?

If a tick bites, then the best way to remove it is by going to your local pharmacy or your local GP. But if you do not have any professional help around, then the following steps might be helpful:

• With the help of sterile tweezers, tug gently the head of the tick at the level of the skin until it releases the skin
• Do not crush the body of the tick and avoid using your hands, as you can still be exposed to the bacteria
• Wash the bite area with water and soap
• As soon as you can please seek medical help!

Prevention¹

There are several steps you can take to help avoid bites from ticks, including:

• Spray insect repellents
• Minimising skin exposure by wearing long trousers and long sleeves which fit tightly in your arms and ankles
• Wearing light-coloured clothing to help recognise ticks
• Wearing a hat and tucking your trousers into socks
• Wearing shoes which do not have open toes 
• Walking in open centre trails 
• To be sure, always do a tick check and then take a shower

Summary

Lyme disease is a common disease that comes from a tick bite and it can be treated successfully when acted fast. Be sure to take appropriate preventive measures if you spend time in woodland areas or areas that may have ticks, by wearing long-sleeved clothing and tight clothing, because it is harder for ticks to bite. If you feel any of the symptoms and you were bitten by a tick, be sure to make an appointment with your doctor for further assessment.