What are the stages of Lyme disease? What are the symptoms of Lyme disease at each stage? What causes Lyme disease?

Stages of Lyme Disease

Lyme disease is divided into three main stages: early localized, early disseminated, and late.

Early Localized Lyme Disease

The early localized stage of Lyme disease is distinguished by the appearance of the characteristic erythema migrans rash at the site of the tick bite. This red, ring-like rash typically appears 1-2 weeks after the initial tick bite. Other symptoms during this stage may include flu-like symptoms, malaise, headache, fever, muscle pain (myalgia), and joint pain (arthralgia). Most patients only experience the symptoms of early, localized Lyme disease.

Early Disseminated Lyme Disease

Approximately 20% of patients develop the early disseminated stage of Lyme disease. The most common symptom during this stage is multiple erythema migrans lesions. Other disseminated symptoms can include flu-like symptoms, lymph node swelling (lymphadenopathy), joint/muscle pain, cranial nerve palsies (especially involving the facial nerve or 7th cranial nerve), vision problems, and lymphocytic meningitis. Cardiac manifestations such as conduction abnormalities, myocarditis, or pericarditis may also occur.

Late Lyme Disease

The most common manifestation of late-stage Lyme disease is arthritis, which is usually pauciarticular (affecting a few large joints) and most often affects the knees.

Causes of Lyme Disease

In the United States, Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi and is transmitted by the bite of an Ixodes genus tick, most commonly Ixodes scapularis. In Eurasia, the predominant causes are B. burgdorferi, Borrelia afzelii, and Borrelia garinii.

B. burgdorferi has a particular affinity for the joints, B. garinii is exclusively found in Europe and has a tendency to cause white matter encephalitis, and B. afzelii has an affinity for the skin at the site of infection.

Epidemiology of Lyme Disease

Lyme disease is most commonly reported in the Northeastern and upper Midwestern United States. The primary states with endemic Lyme disease are Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin. Sporadic cases have been reported in northern California, Oregon, and Washington.

In states where Lyme disease is common, the incidence is about 40 per 100,000 people. The infection occurs during late spring, summer, and early fall.

Lyme disease affects people of all ages but appears to be slightly more common in females. There is no clear explanation for this gender difference.

Pathophysiology of Lyme Disease

The most common and first presenting sign of Lyme disease is the erythema migrans rash, which is found in 70% to 80% of cases. The rash appears at the site of the tick bite as an expanding, erythematous (red) skin lesion, measuring 5 cm in diameter or larger. The lesion may present as a homogeneous erythema or display a targetoid (bullseye) appearance.

If left untreated, the disease can progress to other relatively common findings, including early arthritis in up to 30% of cases, neurologic manifestations in 10% to 15% of cases, or cardiac involvement in 1% to 2% of cases.

Histopathology of Lyme Disease

The histologic findings in erythema migrans are nonspecific, usually showing a perivascular cellular infiltrate consisting of histiocytes, lymphocytes, and plasma cells. Rarely, mast cells and neutrophils may also be identified. A biopsy may show eosinophilic infiltrates, which indicate a local reaction to the tick bite. Spirochetes may be identified using antibody-labeled or silver stains, but there is usually a paucity of spirochetes found in the tissues of those infected with Lyme disease.

In acrodermatitis chronica atrophicans, an early biopsy may show a lymphocytic dermal infiltrate, often perivascular in location.

Differential Diagnosis

The differential diagnosis for Lyme disease includes other tick-borne illnesses, such as ehrlichiosis, anaplasmosis, Rocky Mountain spotted fever, and southern tick-associated rash illness (STARI). It is also important to consider other causes of erythema migrans-like rashes, such as cellulitis, contact dermatitis, ringworm, and erythema migrans-like drug reactions.

Lyme Disease – StatPearls – NCBI Bookshelf

Continuing Education Activity

Lyme disease is an infectious disease caused by Borrelia burgdorferi, which is spread by ticks. Lyme disease is divided into three stages: early localized, early disseminated, and late. This activity illustrates the evaluation and management of Lyme disease and reviews the role of the interprofessional team in caring for patients with this condition.

Objectives:

• Describe the pathophysiology of Lyme disease.

• Explain the appearance of the characteristic erythema migrans rash.

• Outline the treatment options for Lyme disease.

• Summarize a well-coordinated interprofessional team approach to provide effective care to patients affected by Lyme disease.

Earn FREE continuing education credits (CME/CE) on this topic.

Introduction

Lyme disease, or Lyme borreliosis, is the most commonly transmitted tick-borne infection in the United States and among the most frequently diagnosed tick-borne infections worldwide. Lyme disease is divided into three stages: early localized, early disseminated, and late. The early localized disease is distinguished by the red ring-like expanding rash of Erythema migrans at the site of a recent tick bite. Other symptoms experienced at this stage may be flu-like symptoms, malaise, headache, fever, myalgia, and arthralgia. Most patients only experience the symptoms of early, localized disease. About 20% of patients develop the early disseminated disease, with the most common symptoms being multiple erythema migrans lesions. Other symptoms of the disseminated stage are flu-like symptoms, lymphadenopathy, arthralgia, myalgia, palsies of the cranial nerves (especially CN-VII), ophthalmic conditions, and lymphocytic meningitis. Additionally, cardiac manifestations such as conduction abnormalities, myocarditis, or pericarditis may occur. The most common manifestation of the late disease is arthritis which is usually pauciarticular and affects large joints, especially the knees. [1][2]

The diagnosis is not always easy, as many patients are not able to recall a tick bite. However, in endemic areas, patients who have the typical rash can be started on treatment without waiting for serology.

Etiology

In the United States, Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi and is transmitted by the bite of an Ixodes genus tick, mostly commonly Ixodes scapularis. In Eurasia, the predominant causes are B. burgdorferi, Borrelia afzelii, and Borrelia garinii.[3][4]

B. Burgdoferi has a particular affinity for the joint. B.garinii is exclusively found in Europe and has selectivity for causing white matter encephalitis. B. afzelli has an affinity for the skin and is found at the site of the infection.

There are several Ixodes subspecies that transmit Borrelia.

Epidemiology

Lyme disease is most commonly reported in the  Northeastern and upper Midwestern United States. The primary states with endemic Lyme disease are Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin. Sporadic cases have been reported in northern California, Oregon, and Washington.[5][6]

In states where Lyme disease is common, the incidence is about 40 per 100,000 people. The infection occurs during late spring, summer, and early fall.

For some unknown reason, Lyme is commonly reported in Caucasians but can infect all races. Perhaps the skin lesion may not always be obvious in dark-skinned individuals.

Lyme disease affects people of all ages but appears to be slightly more common in females.

Pathophysiology

The most common and first presenting sign of Lyme disease is the erythema migrans rash, which is found in 70% to 80% of cases and appears at the site of the tick bite as an expanding, erythematous skin lesion, measuring 5 cm in diameter or larger. The lesion may present as homogeneous erythema or display a targetoid appearance. The appearance of the rash occurs one to two weeks after the initial tick bite. If untreated, disease progression may lead to other relatively common findings including early arthritis in up to 30% in some series; neurologic manifestations, 10% to 15%; or cardiac involvement, 1% to 2%.[7]

Histopathology

Erythema migrans histologic findings are nonspecific, usually showing a perivascular cellular infiltrate which consists of histiocytes, lymphocytes, and plasma cells. Rarely mast cells and neutrophils are identified. A biopsy may show eosinophilic infiltrates, which consist of a local reaction to the bite. Spirochetes may be identified using antibody-labeled or silver stains. Usually, a paucity of spirochetes is found in the tissues of those infected with Lyme disease.

Acrodermatitis Chronica Atrophicans

In acrodermatitis chronica atrophicans, an early biopsy may show a lymphocytic dermal infiltrate, often perivascular in location, with some vascular lymphedema and telangiectasia. Plasma cells may be seen in the cellular infiltrate. Late lesions may demonstrate epidermal thinning with loss of skin appendages. In the later stages, plasma cells may be the only feature to distinguish morphea from acrodermatitis chronica atrophicans.

Fibrotic nodules may show fibrosis of the deeper dermis and hyalinization of collagen bundles. B. burgdorferi can sometimes be cultivated from the lesions.

Borrelial Lymphocytoma

Histologic examination is performed in patients with suspected borrelial lymphocytoma when the history is not clear enough to support a diagnosis. Borrelial lymphocytoma biopsy shows a dense dermal lymphocytic infiltrate with lymphoid follicles and pseudoterminal centers. Lymphocytes with both B- and T-cell markers, occasional macrophages, plasma cells, and eosinophils are seen.

History and Physical

Localized Lyme disease is characterized by erythema migrans occurring 1 to 2 weeks after tick exposure in an endemic area. The differential diagnosis for early Lyme disease with erythema migrans includes other skin conditions such as tinea and nummular eczema. If not treated in the localized stage, patients may go on to develop early disseminated or late disease manifestations. Early neurologic Lyme disease manifestations include facial nerve (CN-VII) palsy, lymphocytic meningitis, or radiculopathy. Cardiac involvement includes myopericarditis and typically presents with heart block. Lyme arthritis is mono- or pauciarticular, generally involving large joints, most commonly the knee, and occurring months removed from the initial tick bite.

Because the symptoms are not very specific, one should consider other infections transmitted by ticks, like coinfection with Babesia microti and Ehrlichia. Co-infection has been reported in about 10% of patients.

Like syphilis, Lyme is classified into 3 stages: localized, disseminated, and persistent. The first two stages are part of early infection, and the third stage is part of persistent or chronic disease. Stage 3 usually occurs within 12 months of the infection.

Stage 1: Early localized disease that may present with erythema migrans and low-grade fever. This stage usually occurs within 1 to 28 days following the tick bite.

The classic rash is seen in 70% of patients and may develop between 5 to 7 days following the tick bite. The uniform rash usually occurs at the site of the tick bite and may burn, itch, or be asymptomatic. The rash tends to expand for a few days, and concentric rings may be visible. If left untreated, the rash persists for 2 to 3 weeks. About 20% may have recurrent episodes of the rash, and multiple lesions are not uncommon. At the same time, flu-like symptoms may be present. The fever is low-grade and may be associated with myalgia, neck stiffness, and headache. Visual problems include eye redness and tearing. About 30% of patients with the rash will have no further progression of symptoms.

Stage 2: Usually develops 3 to 12 weeks after the initial infection. Features may include general malaise, fever, neurological features (dizziness, headache), muscle pain, and cardiac symptoms (chest pain, palpitations, and dyspnea). Cranial neuropathy may present as diplopia. Eye pain and keratitis have also been reported. The knee, ankle, and wrist joints are often involved. These symptoms may last 12 to 20 weeks, but recurrence is rare. Often when a single joint is involved, it may be mistaken for septic arthritis. About 20% of patients have CNS involvement, including encephalopathy, meningitis, and cranial nerve neuropathy. Bell palsy is seen in about 5% of patients. When meningeal symptoms are present,  lumbar puncture is warranted to rule out other causes. Encephalopathy presents with deficits in concentration, cognition, memory loss, and changes in personality. Extreme irritability and depression are also common.

Borrelia lymphocytoma is a rare presentation of early Lyme disease that has been reported in Europe. It presents as a nodular red-bluish swelling that usually occurs on the ear lobe or areola of the nipple. The lesions can be painful to touch.

Stage 3: Late Lyme disease may occur many months or years after the initial infection. The typical features include neurological and rheumatological involvement. Many patients may not have a history of erythema migrans. However, these individuals may present with aseptic meningitis, Bell palsy, arthritis, or dysesthesias. Cognitive deficits are common. The key feature of late-stage Lyme is arthritis which tends to affect the knee. the neurological and psychiatric symptoms mimic fibromyalgia. Radicular pain is common. Borrelia encephalomyelitis is rare and can present with ataxia, seizures, hemiparesis, autonomic dysfunction, and hearing loss. Acrodermatitis chronica atrophicans is typically seen in older women and tends to occur on the dorsum of the hands and feet.

Cardiac involvement may present with arrhythmias or transient heart block. Conduction abnormalities are not uncommon, but most cases are isolated and rarely last more than a few days. Rarely does a patient require permanent pacing

Evaluation

In endemic areas with features of the classic rash and recent tick exposure, treatment can be started without waiting for blood work. However, in the vast majority of patients, the symptoms are vague, and testing is needed. Others may not recall a tick bite or develop the rash.

Serologic testing is insensitive during the first few weeks of infection, and patients presenting with erythema migrans rash and a history of residing in or traveling to an endemic region may be treated based on clinical findings. In later stages of the disease, a 2-step approach is recommended for the serologic diagnosis of Lyme disease. The first step is to perform a quantitative screening test for serum antibodies to B. burgdorferi using a sensitive enzyme immunoassay (EIA) or immunofluorescent antibody assay (IFA). A Western blot should follow specimens with positive or equivocal results. Serologic diagnosis is sensitive (greater than 80%) for patients presenting with neurologic or cardiac manifestations.[8][9][10]

Sequential use of serological testing is not recommended in the acute state because antibody titers often remain elevated for a long time. Testing the tick is not recommended either. And biopsy of the skin is rarely done.

Other blood work may reveal elevated ESR, leukopenia, and thrombocytopenia. Joint aspiration is only recommended if one suspects septic arthritis.

In children, Lyme meningitis is rare if:

• the headache is less than 7 days

• CSF has less than 70% mononuclear cells

• Absence of 7th or other cranial nerve palsy

The ECG may reveal an AV block. Brain imaging may show abnormality in 20% of patients with CNS symptoms. Most common are punctate lesions of the periventricular white matter.

Borrelia species are had to culture and not routinely done.

Treatment / Management

Specific treatment is dependent upon the age of the patient and stage of the disease. For patients older than 8 years of age with early, localized disease, doxycycline is recommended for 10 days. Patients under the age of 8 should receive amoxicillin or cefuroxime for 14 days to avoid the potential for tooth staining caused by tetracycline use in young children. Longer courses and parenteral antibiotics may be required for more severe manifestations such as arthritis, atrioventricular heart block, carditis, meningitis, or encephalitis, although European data and newer studies demonstrate that oral treatment regimens or transitioning to oral therapy at hospital discharge may be appropriate for some patients.[11][12][13]

Doxycycline is used in most patients except in children and pregnant women. In children, amoxicillin remains the drug of choice. Pregnant women show a good response to ceftriaxone.

Patients with Lyme carditis should be admitted and monitored until the ECG features of a block subside. Lyme arthritis usually resolves in 6-8 weeks. CNS Lyme disease responds well to antibiotics, most commonly with ceftriaxone. Clinicians should monitor patients for the Jarisch-Herxheimer reaction when starting therapy.

The ocular feature of Lyme disease does respond to topical steroids and IV ceftriaxone or penicillin.

Some patients may experience post-treatment Lyme disease syndrome with nonspecific symptoms. These symptoms do not respond to antibiotics.

The Jarisch-Herxheimer reaction is a cytokine-mediated reaction to the antibiotic-mediated destruction of spirochetes. With Lyme disease, the reaction is seen in 5% to 15% of patients and usually resolves within 1 day.

Differential Diagnosis

In patients with erythema migrans, a careful history and physical examination are all that is required to establish the diagnosis of Lyme disease. However, many patients with Lyme disease present with erythema migrans or extracutaneous symptoms where diagnosis becomes a challenge. In those cases, erythema migrans may never have occurred, may not have been recognized, or may not have been correctly diagnosed by the clinician.

Other problems include the following:

• Acute memory disorders

• Ankylosing spondylitis and rheumatoid arthritis

• Atrioventricular nodal block

• Cellulitis

• Contact dermatitis

• Gout and pseudogout

• Granuloma annulare

• Prion-related diseases

Staging

Stages of Lyme disease

1. Stage 1: Localized disease associated with erythema migrans and flu-like symptoms; duration 1 to 30 days

2. Stage 2: Early disseminated disease with malaise, pain, and flu-like symptoms; may affect the neurological, ocular, and musculoskeletal organs; duration 3 to 10 weeks

3. Stage 3: Late or chronic disease chiefly affects the joints, muscles, and nerves and may last months or years. Lyme arthritis is a hallmark of this stage.

4. The occurrence of post-treatment Lyme syndrome is debatable.

Prognosis

For early cases, treatment is usually curative. However, treatment may be complicated due to late diagnosis, antibiotic treatment failure, and concomitant infection with other tick-borne diseases such as ehrlichiosis, babesiosis, and immune suppression.

Approximately 5% of patients will have lingering symptoms of fatigue, pain, or joint and muscle aches after treatment. These symptoms can last for 6 or more months. This is called post-treatment Lyme disease syndrome. Chronic Lyme disease is generally managed similarly to fibromyalgia or chronic fatigue syndrome. Whether chronic disorder exists remains debatable. The reason is that there are many non-validated testing systems on the market that are often falsely positive. In addition, there has been a public hysteria about chronic Lyme disease, with patients demanding treatment. In most cases of so-called chronic Lyme disease, the workup is usually negative. Further, there is no evidence that long-term antibiotic therapy helps. Most patients eventually recover without any residual sequelae.

Complications

• Arthritis

• Carditis

• Neurological deficits

• Ocular manifestations

• Acrodermatitis chronica atrophicans

Consultations

Pearls and Other Issues

Based on the geographic distribution of the shared vector Ixodes scapularis, coinfections with Lyme disease and human granulocytic anaplasmosis and/or babesiosis can occur. Co-infected patients may be more severely ill at presentation, have a persistent fever longer than 48 hours after initiating antibiotic therapy for Lyme disease, or present with anemia, leukopenia, and/or thrombocytopenia. When co-infection is suspected or confirmed, treatment with an appropriate antimicrobial regimen for each infection is necessary for the resolution of the illness.

Enhancing Healthcare Team Outcomes

The key to Lyme disease is prevention, and this requires an interprofessional team approach. All healthcare workers, including the nurse practitioner, pharmacist, and primary care provider, should provide patient education on measures to prevent tick bites while hiking or working outdoors. In areas where ticks are common, cleaning up of the environment by removing the underbrush and spraying an insecticide may reduce the tick burden in the area. The outdoors person should be told to wear appropriate garments and be familiar with the skin features of the tick bite. The nurse should educate the patient on how to remove the tick from the skin and when to seek medical assistance. The pharmacist should educate the patient on medication compliance for those who have been confirmed to have acquired Lyme disease. 

Nurses should educate parents on how to inspect their children for ticks at the end of an outdoor event in an endemic area. While there are many repellants on the market, it is best to avoid them as the risk of harm is greater than any benefit. If one is going to use a repellant, DEET is the one product that is safe; however, it is not 100% effective. finally, the pharmacist should educate the patient about the harms of taking prophylactic doxycycline; a better strategy is to remove the tick as soon as it is visualized.

Finally, pets can also develop Lyme disease and carry the tick. Hence, pet owners should examine their pets on a regular basis and remove the tick. There is no risk of acquiring Lyme disease by removing the tick.

Patients need to be told that there are many unvalidated tests for Lyme disease which offer false-positive results. Even though there is a Lyme vaccine, the public should be educated that the effects of the vaccine are not consistent or long-lasting; hence one should not rely on the vaccine to prevent Lyme disease.[14][15] (Level V)

Outcomes

The prognosis for patients who are treated for Lyme disease is excellent, with no residual deficits. However, a few individuals may develop a recurrent infection if an infected tick bites them. Individuals who receive late treatment may develop neurological and musculoskeletal symptoms. Lyme arthritis is not uncommon. Some patients may develop Lyme carditis which results in a heart block and requires temporary pacing of the heart. Despite the large number of people affected, Lyme disease is not fatal. There continues to be a debate about the existence of post-treatment Lyme disease, but so far, this diagnosis has been promoted by the lay public and media, as there is no good evidence that such a condition exists.[16][17] [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

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Figure

Lyme disease “bulls eye” rash. Contributed by James Gathany, Center for Disease Control and Prevention (CDC PHIL)

References

1.

Cervantes J. [Lyme disease in Perú. A clinical and epidemiological review]. Rev Peru Med Exp Salud Publica. 2018 Apr-Jun;35(2):292-296. [PubMed: 30183906]

2.

Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice. Healthcare (Basel). 2018 Aug 25;6(3) [PMC free article: PMC6165408] [PubMed: 30149626]

3.

Bernard Q, Thakur M, Smith AA, Kitsou C, Yang X, Pal U. Borrelia burgdorferi protein interactions critical for microbial persistence in mammals. Cell Microbiol. 2019 Feb;21(2):e12885. [PMC free article: PMC10082445] [PubMed: 29934966]

4.

Muhammad S, Simonelli RJ. Lyme Carditis: A Case Report and Review of Management. Hosp Pharm. 2018 Jul;53(4):263-265. [PMC free article: PMC6050884] [PubMed: 30038446]

5.

Berry K, Bayham J, Meyer SR, Fenichel EP. The allocation of time and risk of Lyme: A case of ecosystem service income and substitution effects. Environ Resour Econ (Dordr). 2018 Jul;70(3):631-650. [PMC free article: PMC6110530] [PubMed: 30166775]

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Shapiro ED, Wormser GP. Lyme Disease in 2018: What Is New (and What Is Not). JAMA. 2018 Aug 21;320(7):635-636. [PubMed: 30073279]

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Norris SJ. Catching up with Lyme Disease Antigenic Variation Computationally. Trends Microbiol. 2018 Aug;26(8):644-645. [PubMed: 29903419]

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Yeung C, Baranchuk A. Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block. Healthcare (Basel). 2018 Sep 22;6(4) [PMC free article: PMC6315930] [PubMed: 30248981]

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Paparone P, Paparone PW. Variable clinical presentations of babesiosis. Nurse Pract. 2018 Oct;43(10):48-54. [PubMed: 30234826]

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Trayes KP, Savage K, Studdiford JS. Annular Lesions: Diagnosis and Treatment. Am Fam Physician. 2018 Sep 01;98(5):283-291. [PubMed: 30216021]

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Antony S. Mosquito and Tick-borne Illnesses in the United States. Guidelines for the Recognition and Empiric Treatment of Zoonotic Diseases in the Wilderness. Infect Disord Drug Targets. 2019;19(3):238-257. [PubMed: 29943705]

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Centre for Food-borne, Environmental and Zoonotic Infectious Diseases. Synopsis: Lyme Disease in Canada – A Federal Framework. Can Commun Dis Rep. 2017 Oct 05;43(10):212-214. [PMC free article: PMC5764730] [PubMed: 29770048]

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Patton SK, Phillips B. CE: Lyme Disease: Diagnosis, Treatment, and Prevention. Am J Nurs. 2018 Apr;118(4):38-45. [PubMed: 29543607]

14.

Jacquet C, Goehringer F, Baux E, Conrad JA, Ganne Devonec MO, Schmutz JL, Mathey G, Tronel H, Moulinet T, Chary-Valckenaere I, May T, Rabaud C. Multidisciplinary management of patients presenting with Lyme disease suspicion. Med Mal Infect. 2019 Mar;49(2):112-120. [PubMed: 30190164]

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Benelli G, Duggan MF. Management of arthropod vector data – Social and ecological dynamics facing the One Health perspective. Acta Trop. 2018 Jun;182:80-91. [PubMed: 29454734]

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Goodlet KJ, Fairman KA. Adverse Events Associated With Antibiotics and Intravenous Therapies for Post-Lyme Disease Syndrome in a Commercially Insured Sample. Clin Infect Dis. 2018 Oct 30;67(10):1568-1574. [PubMed: 29672671]

17.

van den Wijngaard CC, Hofhuis A, Wong A, Harms MG, de Wit GA, Lugnér AK, Suijkerbuijk AWM, Mangen MJ, van Pelt W. The cost of Lyme borreliosis. Eur J Public Health. 2017 Jun 01;27(3):538-547. [PubMed: 28444236]

Disclosure: Gwenn Skar declares no relevant financial relationships with ineligible companies.

Disclosure: Kari Simonsen declares no relevant financial relationships with ineligible companies.

Tick bites: Symptoms and treatment

Just thinking about ticks can make your skin crawl. But if you enjoy hiking, hunting, time at the cabin or other shady, damp environments, encounters with ticks can be part of the package.

We’d all prefer to avoid tick bites, but if you find yourself dealing with one, there’s no need to worry – they’re often harmless. We’ll explain how to identify tick bite symptoms, how to remove a tick at home and when you should see a doctor for treatment.

What is a tick exactly?

Ticks are tiny bugs that have eight legs and are related to spiders and mites. They feed off human and animal blood to survive. Ticks are often found in damp, cool, wooded areas during the spring through mid-summer, then again in the fall. But in some areas, they can be active during other seasons as well.

Types of ticks in Minnesota and the Upper Midwest

In Minnesota and the Upper Midwest, there are about a dozen different types of ticks. The three types of ticks that people come across most often are the blacklegged tick (deer tick), the American dog tick (wood tick), and the lone star tick.

What does a tick look like?

Ticks can vary in appearance depending on the type of tick, its life stage and sex. Ticks can be grayish-white, brown, black, reddish-brown or yellowish in color. They can be as small as a grain of sand in the larvae stage to the size of a pencil eraser when fully grown.

When is tick season in Minnesota?

In Minnesota, ticks usually start to emerge after the snow melts, reaching peak activity during the month of May. They’re typically active throughout June.

As temperatures climb, tick activity declines until the fall, usually around the end of September through October. Tick season ends when temperatures drop below freezing or snow covers the ground.

Tick bite symptoms

Many people won’t experience any symptoms from a tick bite, but tick bites can cause:

• Small hard bumps or sores, redness or swelling
• Allergic reactions that can range from mild (local swelling and inflammation at the site of the bite) to severe (anaphylaxis)
• Flu-like symptoms, joint pain or a rash, which can also be symptoms of a tick-borne illness

What does a tick bite feel like?

Most likely, you won’t feel a tick bite because they don’t usually hurt. Ticks are often very small, so you might not see it until it’s been on you a few days and has grown larger. That’s why it’s important to check yourself when you’ve been in places where ticks live.

What does a tick bite look like?

A small bump may appear at the site of the tick bite. But if it develops into a rash, that may indicate illness. A rash usually appears 3-14 days after the tick bite but it can look different depending on the type of tick. Watch for small reddish or purplish spots, or expanded rashes that look like a bullseye.

Where to look for tick bites

If you or your children have been hiking, making mud pies or doing other activities in areas where ticks are common, it’s important to do a quick body check and run your fingers gently over your skin and hair. Ticks are often found behind the knees, between fingers and toes, and on underarms. It’s a good idea to check your belly button, neck, hairline, top of your head, and in and behind your ears, too.

Symptoms of tick-borne diseases

If you’re having symptoms after a tick bite, it could be an indication that something more is going on. After you remove a tick, watch for symptoms of tick-borne illnesses which usually begin 3-30 days after the tick bite. They include:

• A red, expanding rash at the site of the tick bite or on other parts of the body.
• Flu-like symptoms, including fever, fatigue, headache, muscle and joint aches.

It’s important to see your doctor if you develop these symptoms. Even if you’ve had Lyme disease in the past, you can still contract the infection again and may need treatment for a second infection.

Tick diseases

While most ticks don’t carry disease, it’s important to be aware of common tick illnesses, including:

• Lyme disease is the most common tick illness in the United States. Typical symptoms include fever, headache, fatigue and a skin rash that resembles a bullseye.
• Rocky Mountain spotted fever is often transmitted by dog or wood ticks. Symptoms include fever, headache and a rash. If not treated early with the right antibiotic, this tick disease can be deadly.
• Tularemia is a tick disease that can infect humans and animals. Symptoms can vary depending on how someone becomes infected. This illness can be life threatening if not treated early with antibiotics.
• Ehrlichiosis is spread by lone star ticks. Symptoms include fever, chills, headache, muscle aches and possibly an upset stomach.
• Babesiosis is caused by microscopic parasites that infect red blood cells and are spread by certain ticks. Many people who are infected don’t experience symptoms, but there are effective treatment options for those who do.
• Alpha-gal syndrome, a condition often caused by a lone star tick bite, is a type of food allergy to red meat and other products made from mammals.

How to remove a tick

The longer a tick is on your skin, the more likely you are to experience symptoms or contract a tick illness. If you find a tick embedded on yourself or a family member, remove it as soon as possible following these steps:

• Do not paint the tick with nail polish or other substances before trying to remove it.
• Use tweezers to grasp the tick against the skin surface.
• Pull with a constant steady pressure until the tick is removed.
• Clean the skin with alcohol or soap and water after the tick is removed.
• Call your doctor or clinician after you remove the tick if you think it was embedded for more than 24 hours. They may want to prescribe a single dose of an antibiotic to help prevent infection.
• Keep the tick in a small plastic bag in case you need to show it to your doctor.

Tick bite treatment

Most tick bites don’t require a doctor’s visit. In fact, you can treat a lot of tick bites right at home. To relieve itching, redness, swelling and pain you can:

• Take an oatmeal bath
• Put ice or a cold pack on the bite for 15-20 minutes once an hour until the swelling and pain subside
• Try over-the-counter medicines

When to worry about a tick bite

Generally, tick bites are not a cause for concern, but you should reach out to a doctor if:

• You are unable to remove the tick completely
• A rash develops or you think the bite site is infected
• You develop flu-like symptoms, including fever, chills, fatigue, muscle and joint pain, or a headache

There are several options if you need care for a tick bite:

Call one of our care lines for advice

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Tick bite. Tick-borne encephalitis and borreliosis. Symptoms, prevention and treatment

A carefree holiday in nature can be overshadowed by a tick bite.

In the hot weather of the spring-summer season, ticks wait for their prey, sitting in the grass or bushes. When a person appears, insects move from foliage to clothes, move along it in search of an open area of ​​\u200b\u200bthe body to which they can attach. To bite, ticks choose warm, moist areas of the skin where the blood vessels are not deep (neck, head, armpits, buttocks, the area between the shoulder blades, earlobes, calf muscles).

When bitten, ticks inject an anesthetic into the skin of the victim, so this goes unnoticed.

After saturation, the males quickly fall off the person, and the females can stay on their prey for several more days, having managed to lay up to 2 thousand eggs and increase to 10 mm in diameter.

Attention! Very often, ticks are carriers of such dangerous diseases as systemic borreliosis and tick-borne viral encephalitis!

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90 032 Symptoms of encephalitis

Tick-borne encephalitis is a seasonal viral disease. Encephalitis enters the human body after the bite of an infected tick or when drinking milk from infected cows or goats.

On average, clinical signs of the disease appear one month after the encephalitic tick bite.

Depending on the manifestation of symptoms, tick-borne encephalitis develops in 3 forms:

• focal form – observed in 20% of patients;
• febrile form – occurs in 50% of patients;
• meningeal form – in 30%.

With focal form of tick-borne encephalitis (the most severe form of the disease), the infection penetrates into the substance of the spinal cord and brain. The following signs of a tick bite are observed: chills, convulsions, a strong increase in temperature (above 40 degrees), the appearance of lethargy and drowsiness.

Depending on which part of the brain or spinal cord is affected, symptoms such as delusions, hallucinations, cardiac and respiratory disorders, paralysis and paresis of the muscles of the shoulder and neck, impaired voluntary movements, etc. may be present.

Febrile encephalitis lasts up to 10 days. The disease is undulating in nature, then subsiding, then reappearing in the form of a fever. But weakness, palpitations and sweating persist for a long time.

Menigeal shape . With this form of the disease, inflammation of the membranes of the spinal cord and brain occurs. Within 2 weeks, the patient has a severe headache (in which pills do not help), neck muscle tension, vomiting, fever, fever.

Systemic tick-borne borreliosis (or Lyme disease)

Lyme disease was first identified in the US city of Lyme in 1975.

Borreliosis agent – the bacterium Borrelia burgdorferi, which belongs to the spirochetes. The causative agent of the disease enters the cells of the body and remains dormant for 10 years. This explains the chronic nature of the disease. A patient with borreliosis is not contagious for others, since the infection is transmitted to a person only through a tick bite.

Symptoms of borreliosis

The disease begins 1-2 weeks after infection. In its development, the disease goes through 3 stages. Moreover, stages 1-2 are considered early, and stage 3 is chronic.

Stage 1 borreliosis lasts about a month. Signs of a tick bite resemble acute respiratory infections. A person has a fever, general malaise, body aches, muscle pain and weakness appear.

The main symptom of stage 1 is the appearance near the bite of a round red spot (erythema) with a diameter of 15-20 cm. Over time, the spot may increase in size.

Stage 2 disease lasts for 6 months. Skin lesions in the form of ring-shaped elements, urticaria are characteristic.

Infection spreads throughout the body through the blood and lymph circulation, resulting in damage to the nervous system, joints or heart.

With inflammation of the cardiovascular system, severe arrhythmias, pericarditis and myocarditis (dizziness, palpitations, chest pain and shortness of breath) are observed. There may also be a decrease in sensitivity.

Stage 3 borreliosis . The disease becomes chronic. The consequences of borreliosis are heart disease, severe inflammation of the joints, combined with extensive damage to the nervous system.

If a disease such as borreliosis is left untreated, it can lead to disability and even death.

With the correct diagnosis of borreliosis and adequate antibiotic therapy, there is a chance for recovery.

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First Aid in case of a tick bite

Immediately after a tick bite, try to go to the nearest emergency room. A qualified doctor will quickly and skillfully save you from an insect.

In specialized hospitals, if necessary, according to indications, emergency prevention of tick-borne encephalitis is carried out by administering immunoglobulin or another antiviral drug in the first three days after a tick bite. In order to prevent tick-borne borreliosis, a course of antibiotic treatment is carried out.

If the visit to the doctor is delayed for any reason, you can try to remove it yourself. However, it often happens that during self-extraction, the insect breaks in half, and the head remains in the wound.

It is necessary, by making counterclockwise movements, to “twist” the insect out of the skin. Keep the tick as close to the skin as possible to prevent tearing of the abdomen. In this case, the fingers must be wrapped with a bandage or gauze.

You can try to remove the tick with a thread: wrap the proboscis of the tick as close to the skin as possible and, performing swinging movements, slowly pull the insect out.

After the manipulations, the bite site must be treated with a solution of iodine or alcohol. The tick must be closed in a vessel with a tightly screwed lid and brought to the laboratory for examination for the presence of the borreliosis virus and tick-borne encephalitis.

What you need to know about a tick bite?

Even if you manage to get rid of a tick, pay attention to changes in your health. If you have a fever, a change in blood pressure or severe headaches, you must urgently make an appointment with an infectious disease specialist, take a blood test for tick-borne borreliosis and encephalitis.

In some cases, you may need to consult a cardiologist, neurologist, general practitioner, rheumatologist, infectious disease specialist.

The material was prepared with the participation of a specialist:

• Kirichenko Alexey Viktorovich

  Traumatologist, orthopedist

  Second qualification category

Tick bite: what to do? (Sergiev Posad)

What should I do if bitten by a tick?

ATTENTION: Online consultations of doctors are available (more than 18 specialties).

A tick bite is an unpleasant situation that can lead to significant health consequences in the form of deadly complications.

The activity of parasites in nature increases in the warm season, and they can imperceptibly harm a person. Arthropods live mainly on trees, but they can also be found on bushes and in the grass – they are able to adapt to different conditions.

Between the bite and the first symptoms of a lesion, a sufficiently long period of time usually passes, and the pathogens of neuroinfections have time to penetrate into the bloodstream, causing a number of irreversible changes.

The likelihood of interaction with these blood-sucking parasites makes people panic, but you should not worry without a reason – a tick bite does not mean an obligatory infection. It is important to know the precautions, as well as the diagnostic algorithm for recognizing a bite, and the immediate procedure for detecting a parasite. Early detection of the tick and timely initiation of treatment determine the success of therapeutic measures, while diagnosis in the later stages leads to difficulty in choosing a treatment, irreversible dysfunction of the central nervous system, or transition to a chronic form. It is also necessary to evaluate the benefits of vaccination and determine the feasibility of its implementation.

Why are ticks dangerous?

Tick-borne encephalitis and borreliosis (Lyme disease) are the main diseases that ticks can carry. This list also includes a number of other infections of the peripheral nervous system and brain. Tick-borne encephalitis is a serious disease with damage to various parts of the nervous structures, which can lead to irreversible changes in the form of paralysis or even death. Borreliosis is also characterized by a complex disorder of the nervous, cardiovascular, and musculoskeletal systems. Parasites can become carriers of pathogens of hemorrhagic vasculitis – an acute viral disease in which the circulatory system is affected, causing serious complications in the form of internal bleeding.

Signs of pathology after a bite

Careful examination reveals a suspicious area of ​​redness on the skin of exposed parts of the body – the arthropod is not able to get through clothes. Initially, you may not notice the parasite, especially if it is in the hair. Local immunity initiates the appearance of hyperreactivity – a rounded spot up to 10-20 cm in diameter, which can increase. Also, a characteristic sign of infection with borreliosis is the formation of a clearly defined contour of red color, which may eventually acquire a blue-white tint. A few weeks later, a crust with cicatricial changes forms at the site where the tick has bitten.

Immediately after the discovery of an arthropod on the skin, it is necessary to establish the stage of its development – the adult form is distinguished by the presence of four pairs of legs, and the nymph larva has only three pairs. It has been studied that the female needs more time to saturate with blood, and an adult can feed for several days.

Timely detection of the parasite at the stage of suction avoids a bite, however, in case of biting through the skin, it is necessary to definitely consult a doctor for observation during the incubation period of possible diseases. This period can take up to two months – the characteristics of the human blood-brain barrier determine the rate of spread of pathogenic viruses or bacteria and the appearance of characteristic symptoms.

The consequences of a tick bite and signs of infection vary depending on the form of the disease and the reaction of the body, but most often appear:

• characteristic swelling and bright redness at the site of contact with the tick;
• fever;
• chills;
• general deterioration of health;
• lethargy, drowsiness;
• fatigue;
• attacks of nausea;
• photophobia – an unpleasant reaction to bright daylight or artificial light;
• various rashes in the form of spots, nodules, pustules;
• shortness of breath – shortness of breath with mild exertion;
• feeling of difficulty in moving and aching in the joints;
• mood changes, emotional instability;
• increased anxiety;
• possible changes in the perception of reality in the form of hallucinations.

Initially, the symptoms of a tick bite may be mild, the skin may look without visual changes, and the signs increase later. A vivid clinical picture is typical for children, elderly patients, as well as people with chronic diseases that adversely affect immune function.

Ordinary people may not feel the signs of a tick bite at first – neuroinfections that are carried by ticks develop rather slowly. Often the progression of the disease is accompanied by fever, increased heart rate, inflammation of the lymph nodes, skin rash, itching in the place where the tick bit.

Also, often an arthropod bite causes a relatively harmless allergic reaction that has nothing to do with a serious endemic disease. It is important to consult a doctor for differential diagnosis of conditions. An allergy to a tick bite is accompanied by a bright local reaction on the skin, nasal congestion, tearing, and redness of the eyes.

Tick-borne encephalitis has a number of characteristic symptoms that are dangerous to health and even life. The onset of the disease may resemble the flu – fever, chills, aching joints and muscles appear. Deterioration of the cardiovascular system leads to interruptions in the work of the heart, arrhythmia, shortness of breath. Often patients complain of changes in the functioning of the gastrointestinal tract – nausea and vomiting, lack of appetite, loosening of the stool.

Neurological complaints may begin – episodes of changes in consciousness up to epileptic seizures. Despite the fact that different microorganisms become the causative agents of diseases, the alarming symptoms in pathologies are similar.

Consequences of non-intervention

The lack of a timely response to a tick bite can lead to the progression of the disease – a neuroinfection develops, which often leads to paralysis, meningitis, deadly complications and disabling consequences. It is important to know how dangerous a tick bite is for a person in order to respond to the problem in time.

Do-it-yourself tick removal

It is necessary to follow all the principles of the removal technique – it is necessary to remove the arthropod completely in a living state in order to maintain the possibility of diagnosing for the presence of the virus.

The classic version involves the use of tweezers as the main tool for extracting the arthropod parasite. A full-fledged reliable girth of the body prevents the main complication of manipulation – the preservation of the head of the tick in the thickness of the human skin. You should rotate his body clockwise around the axis – this avoids sudden movements in order to safely remove the whole tick. There is also a method using sewing thread – the knot is attached to the tick, and twisting is done by rotating the thread.

Contrary to popular belief, the use of oily solutions only complicates the procedure, while making it impossible to analyze the parasite for pathogenic viruses or bacteria.

If, after an attempted removal, a trace remains on the skin in the form of a dark dot, this may indicate that the arthropod’s head was not removed. You should wipe the bite site with alcohol, and then remove the remnants of the parasite.

You can also use iodine or another effective antiseptic to treat the skin. After completing the manipulations, the removed tick must be stored in a glass container with a cotton pad moistened with water. The preservation of the parasite will determine the danger of ticks to humans in the area.

However, it is better to entrust this task to specialists – experienced medical workers know how to quickly and correctly get rid of a tick, then they immediately deliver the material for research to the laboratory.

Non-specific prevention of tick bites

Preventive measures must be taken when traveling to endemic zones and disadvantaged forest-steppe regions with a high risk of infection from the parasite.

The main points to reduce the likelihood of tick bites:

• vaccination before traveling to forest-steppe zones;
• maximum coverage of all parts of the body with clothing, hats, closed shoes;
• avoiding passing under trees and thick bushes;
• thorough examination of all family members for bites, including the scalp;
• treatment with special external agents that repel insects.

Vaccination against tick-borne encephalitis in the Paracelsus clinic

Doctors of the Paracelsus multidisciplinary medical clinic recommend that all people at risk be vaccinated against tick-borne encephalitis – people who live in endemic areas or are going to come to such areas are vaccinated. The Ministry of Health of Russia has determined the list of vaccines that are allowed for vaccination, some of them are produced by domestic companies, and several items are supplied from other countries.

The scheme of application of the vaccine:

• consultation with a general practitioner and determination of the safety of vaccination;
• the first stage of the introduction of the vaccine on a certain day;
• revaccination – after 1-2 months according to the scheme;
• the third vaccination – 12 months after the second stage of the drug administration.

Vaccination can provide a reliable protective effect to prevent infection of the nervous system and the development of complications, so this method of prevention is necessary for everyone who is more susceptible to infection by ticks.

Paracelsus offers vaccination with the domestic vaccine EnceVir, which is effective against common strains of the virus that ticks carry. The Paracelsus team cares about the health of its clients, therefore, before the vaccination, everyone needs to undergo an examination by a therapist and some additional diagnostic methods to assess their general health, possible contraindications and the risk of developing complications of the vaccination.

Treatment at the Paracelsus Center

Timely access to a doctor is the key to preventing severe damage to the nervous system and internal organs, preventing serious complications and minimizing the risk of death.

Only in the conditions of a medical institution can all conditions be provided for the rapid and safe extraction of parasites with subsequent analysis of the tick, as well as a comprehensive diagnosis of the victim for the transmission of infections.

Paracelsus Medical Center is a complex clinic, which is attended by specialists from various fields of medicine. Infectionists and parasitologists of our institution know how to properly remove a tick, as well as treat the bite site. The study of a tick in order to determine the carriage of pathogens of neuroinfections is necessary to understand the further tactics of managing a victim of a bite, since changes that are noticeable during diagnosis may not yet develop in his body.

Further penetration of microorganisms into the human bloodstream causes the formation of specific antibodies that can be detected by laboratory blood tests.

Even if a long period has passed after the moment of the bite, and complaints have appeared recently, it is better to consult a doctor to exclude dangerous diagnoses and take the appropriate tests.

Also, a tick bite can cause allergic reactions, become inflamed and complicated by local infectious processes. In all such cases, a doctor’s examination is necessary with the further appointment of appropriate treatment. The use of antihistamines and local ointments quickly returns the quality of life.