Lyme disease generates many questions from patients and loved ones. We take these questions to heart as we work hard towards finding meaningful solutions to improving the care for Lyme disease patients. Some of the most frequently asked questions are answered here.
However, for patient-specific medical advice we ask that you seek the care of a health practitioner.
How can Lyme disease be prevented?
- Lyme disease risk can be reduced by:
- Wearing permethrin treated clothing, minimizing exposed skin, and using tick repellent when enjoying the outdoors
- Staying on the trail when hiking and avoiding tall grass and leaf litter
- Creating a tick-free zone around your home
- Doing daily tick checks
- Removing ticks with tweezers as soon as possible
- Putting clothes in a high heat dryer for 15 minutes
What are the early signs and symptoms of Lyme disease?
- Early symptoms can mimic summer flu and other bacterial and viral illnesses: fever, achiness, extreme fatigue and malaise, severe headache or neck ache
- A red round expanding skin rash may, or may not, be present
- When present, the expanding skin rash is usually greater than 2 inches in size
- Rash is not usually extremely itchy
- Rash lasts for days to weeks and can be accompanied by flu-like symptoms
Does everyone with Lyme disease get a rash?
- No, not everyone with Lyme disease gets a rash. The rash is not always present or easily recognizable in early Lyme disease.
- The rash can often be missed or mistaken for a spider bite when not a stereotypical bull’s eye appearance
- Some people get multiple rashes from spread of the Lyme disease bacteria through the blood stream
Is the Lyme disease rash always a bulls-eye rash?
- No, the Lyme disease rash is usually not a bulls-eye. However, when it is a bulls-eye rash it is usually a tell-tale sign of Lyme disease.
- The rash is more typically a round expanding red skin lesion usually greater than 2 inches in size
Are there other diseases that present with a bulls-eye rash?
- Other infections do not typically present with a bulls-eye rash
- Some primary skin conditions can have multiple small bulls-eye lesions (such as erythema multiforme)
- When a bulls-eye rash is present it is a tell-tale sign and in the appropriate circumstances is diagnostic for Lyme disease
What are some of the systemic symptoms of Lyme disease?
- Systemic symptoms from disseminated disease can be debilitating and impact multiple body systems such as joints, heart, brain, muscles, and the nervous system.
Systemic symptoms include:
- Severe pain, neurologic symptoms and cognitive impairment
- Cardiac problems, including passing out, slow pulse, and life-threatening inflammation of the heart, called carditis
- Facial palsy, meningitis, and headaches
- Signs of meningitis include severe headache, light sensitivity
- Swollen knees and Lyme Arthritis
Can people get allergies from tick bites?
How may co-infections with other tick-borne pathogens complicate Lyme disease?
- Deer ticks can transmit multiple pathogens in a single bite, including Anaplasma, Babesia, Powassan virus and other species of borrelia such as Borrelia mayonii and Borrelia miyamotoi. Other tick-borne illnesses more commonly transmitted by other tick species include Ehrlichiosis, Rocky Mountain Spotted Fever (and other rickettsias) and Southern Tick-Associated Rash Illness (STARI).
- These tick-borne infections on their own can be quite severe and additionally challenging in combination with Lyme disease.
- Rocky Mountain Spotted Fever, Anaplasmosis, and Powassan virus can be fatal.
- Babesia, a malaria-like protozoan, can be particularly challenging for those with compromised immunity, a prior splenectomy, or those who have been taking Rituxan or other immune suppressing drugs.
What are some of the signs and symptoms of Anaplasma?
- Rapid elevated fever
- Elevated liver function tests
- Low platelet counts
What are some of the signs and symptoms of the malaria-like protozoan, Babesia?
- Signs of hemolysis
- Elevated LDH
Note: Babesia can also be transmitted through blood transfusions
Are co-infections spreading geographically?
Yes, co-infections, and Lyme disease, are spreading geographically
Can the bacteria that causes Lyme disease, Borrelia burgdorferi, evade the host immune system?
- Yes, Borrelia burgdorferi blocks the complement system of immune detection, allowing it to survive longer
- B. burgdorferi can also evade the adaptive immune response where antibodies are produced
- B. burgdorferi decorates its cell surface with one set of proteins and when the immune antibody response gets generated it suddenly changes its surface proteins to go undetected and keep ahead of the immune response
What is the prognosis after treatment of Lyme disease?
- Most people diagnosed and treated early with antibiotics get better
- However, 10% – 20% of early diagnosed/early treated patients develop chronic ongoing symptoms
- The risk of chronic symptoms is higher if the initial disease is more severe or if there are neurologic symptoms
- Early diagnosis and treatment usually improves prognosis
Note: A biomarker is needed but currently not available to measure risk of chronic symptoms and measure treatment success
What are some other potential risk factors for developing chronic symptoms from Lyme disease after antibiotic therapy?
- Genetic predispositions
- Immunologic variables
- Complications from other tick-borne co-infections
Why can my dog get vaccinated but I can’t?
- There was a human Lyme disease vaccine, LYMErix, in the late 1990s which was removed from the market in 2002 due to vaccine side effects concerns.
- The French company, Valneva, is developing an improved Lyme disease vaccine, VLA15, presently in human clinical testing
- Other novel vaccines are in animal testing
- There are also mouse vaccination strategies to address that part of the transmission cycle
If you get Lyme disease can you get it again?
- Yes, you can get it again
- Spirochetes may drive pathways that interfere with immunologic memory
- If you’re reinfected with exactly the same strain you may have some resistance
- However, there is not much data to illuminate how protective immunity to subsequent infections may or may not be being generated