Lyme Disease 101


18-month-old Ryan came to my office in July after a family trip to Maine.  He had developed a round red rash, was diagnosed with Lyme Disease and treated with Amoxicillin.  He completed his treatment, his rash resolved and that was that.

As Lyme Disease has become increasingly common, it has become a cause of confusion and concern.  What is Lyme Disease?


Lyme Disease is named after the town of Lyme, Connecticut, where it was identified in the 1970s.  It is caused by a bacteria, Borrelia Burgdorferi, and is carried by the Ixodes Scapularis, or “deer tick”.

Ticks generally become active in the spring. They live in the leaf litter of forest floors, on grasses and plants seeking warm bodies to feed on.  Once attached, it takes about 36-48 hours for an infected tick to pass the bacteria to its “host”.

Lyme is increasingly common in the Northeastern U.S. Its range has also expanded into Canada as a result of warming temperatures. Young children are particularly vulnerable.  There are three different phases of the illness:

Early Localized Lyme

About 80% of infected people get a bull’s eye rash at the site of the tick bite within one month, sometimes with fever and flu-like symptoms. The rash enlarges over days to a large size.  Early Lyme is treated with oral antibiotics for 10-21 days.

Early Disseminated Lyme

Some people get sick weeks to months after the tick bite.  They can then present with multiple round rashes, headache and stiff neck (meningitis), weakness of facial muscles, or (rarely) slowing of the heart rate.  People with this stage of Lyme need longer courses of oral or intravenous antibiotics.

Late Disseminated Lyme

Some people won’t have symptoms for months to years after a tick bite.  The most common symptom of late disease is pain and swelling in one or a few joints.  Patients with Lyme arthritis need to be treated for one month with oral antibiotics.

Post-Lyme Disease Syndrome

A small number of people can have persistent symptoms such as headache, fatigue and joint pain, which persist within the 6 months after treatment of confirmed Lyme. Others with confirmed Lyme arthritis can have persistent joint pain after completing therapy. It is important to note that persistent symptoms are rare, gradually resolve, and the vast majority of people treated with antibiotics make a full recovery.

Testing for Lyme Disease

Blood testing for Lyme is not helpful for the early stage of Lyme, when diagnosis is made by exam and tests can be falsely negative.  Blood testing of patients with specific late Lyme symptoms is important to confirm or rule out the diagnosis.

What is “Chronic Lyme Disease”?

There is growing conversation regarding “Chronic Lyme”.  This term has come into use by advocacy groups such as the International Lyme and Associated Disease Society. It describes a condition of nonspecific symptoms that are attributed to persistent infection.  “Chronic Lyme”, however, has not been clearly defined and is not recognized by established medical organizations.

Patients falsely diagnosed with this condition may have illness that goes untreated, such as a thyroid abnormality or cancer.  Dangerous therapies may be prescribed by “Lyme literate” doctors who charge large amounts of money for treatments that are not approved or covered by insurance, such as prolonged courses of antibiotics or “malariotherapy” (injecting malaria to “burn off” Lyme bacteria).

Be Cautious, Not Scared

Prevention is the best approach.  Wear long pants, socks and shoes, apply insect repellent and perform thorough tick checks in the evening.  If infection does occur, Lyme disease is generally easily recognized and treated.  Persistent symptoms are rare and resolve over time.  Be cautious, but don’t let Lyme Disease take away your family’s enjoyment of the outdoors!