The Lyme Tick
Lyme disease on the East coast of the United States occurs after humans are bitten by a deer tick. Deer ticks are also called Ixodes ticks or "blacked legged" ticks (because they have black legs).
Most people never see the tick that gave them Lyme disease because the nymph stage of the deer tick is about the size of a poppy seed. This is the stage of the tick that most frequently bites humans.
The tick also has a substance in its saliva that numbs the victim's skin, so that you cannot feel the tick when it is attached. This is quite helpful for the tick. If the patient could feel the tick they could remove it before it was attached long enough to drink the meal of blood it needed.
This numbing effect is very important as deer ticks are hard ticks, which need to be attached for 24-48 hours before they can change their outer "hard" shell enough to fill with blood.
The tick passes to you the Lyme disease bacteria which is a spirochete (spiral shaped) bacteria when it attaches to drink blood.
The Lyme bacteria is called Borrelia Burgdorferi. It is named after the researcher who discovered it, Dr. Willy Burgdorfer.
Most people never see the tick that gave them Lyme disease because the nymph stage of the deer tick is about the size of a poppy seed. This is the stage of the tick that most frequently bites humans.
The tick also has a substance in its saliva that numbs the victim's skin, so that you cannot feel the tick when it is attached. This is quite helpful for the tick. If the patient could feel the tick they could remove it before it was attached long enough to drink the meal of blood it needed.
This numbing effect is very important as deer ticks are hard ticks, which need to be attached for 24-48 hours before they can change their outer "hard" shell enough to fill with blood.
The tick passes to you the Lyme disease bacteria which is a spirochete (spiral shaped) bacteria when it attaches to drink blood.
The Lyme bacteria is called Borrelia Burgdorferi. It is named after the researcher who discovered it, Dr. Willy Burgdorfer.
Acute Lyme Disease
Classic acute Lyme disease usually develops 2-3 weeks after the tick bite (although it can occur sooner or later than this). The most common symptom is a rash which appears around the site of the bite. The skin rash is named erythema chronicum migrans because of the way it looks, how long it lasts and the way it spreads. "Erythema" means redness because the rash is usually red. "Chronicum" means it stays around for some time or is chronic as it usually lasts at least a week although the time can be shorter (only 1-3 days) or last longer (even 6-8 weeks). "Migrans" means the area of redness tends to grow or get larger over the time it is present.
The classic rash resembles a "bull's eye" as it has a central area of redness of the skin, with a second, larger ring of redness around that.
Unfortunately the rash only has this appearance about 25% of the time. More often it is just a large circular or oval spreading area of redness, which can be quite large, sometimes covering the entire chest, upper back or abdomen. The rash can be in any area of skin. If the tick bites the ear, for example, the entire ear can become swollen and red and it can be difficult to recognize it as Lyme disease. Sometimes the rash can have blisters in the center or a black, bluish or even purple color. When the rash has one of these atypical appearances it can easily be missed, or the doctor may think it's a spider bite or other insect bite.
The rash is often, but not always, accompanied by fever, joint pain and body aches.
The classic rash resembles a "bull's eye" as it has a central area of redness of the skin, with a second, larger ring of redness around that.
Unfortunately the rash only has this appearance about 25% of the time. More often it is just a large circular or oval spreading area of redness, which can be quite large, sometimes covering the entire chest, upper back or abdomen. The rash can be in any area of skin. If the tick bites the ear, for example, the entire ear can become swollen and red and it can be difficult to recognize it as Lyme disease. Sometimes the rash can have blisters in the center or a black, bluish or even purple color. When the rash has one of these atypical appearances it can easily be missed, or the doctor may think it's a spider bite or other insect bite.
The rash is often, but not always, accompanied by fever, joint pain and body aches.
Lyme Meningitis and Disseminated Lyme Disease
Some people can have a more severe illness with meningitis-like symptoms such as high fever, headache, neck pain and nausea. Sometimes in these cases the rash may not be visible until 10 days to 2 weeks into the illness. When these more severe physical symptoms are present the patient is more likely to develop multiple Lyme disease rashes. This is called disseminated Lyme disease as there can be circular or oval areas of redness all over the body. A person can also start with one area of Lyme rash, then develop many more areas of Lyme rashes after a few days to weeks.
Bell's Palsy, Peripheral Neuropathy and Radiculopathy
Bell's Palsy is a common neurologic problem that can frequently happen with acute Lyme disease. This is weakness of one side of the face (it can rarely happen in both sides of the face at the same time). This happens when the Lyme disease bacteria infects the motor nerve that supplies the face. Antibiotics help this, but it is important to treat with higher doses of antibiotic and to try different antibiotics. Intravenous antibiotics may be required if the facial weakness does not improve to prevent permanent facial weakness. Other nervous system problems that happen with Lyme disease are peripheral neuropathy (numbness of hands and/or feet, sometimes a burning sensation) and radiculopathy (shooting, painful, burning nerve pain).
Lyme Arthritis
If the rash is missed, ignored, or does not occur the patient will not receive treatment and the Lyme can spread to the joints causing Lyme arthritis. This usually happens 3-6 months after the rash or acute Lyme infection. It begins with sudden swelling in a large joint, with no remembered injury to the joint. This is most frequently one knee, but it can occasionally be both knees, or in other large joints such as the ankle, hip, shoulder or elbow. This should be treated with antibiotics as well, and often requires longer treatment. Even the infectious disease doctors recommend a second month of treatment if the swelling in the joint is not gone after the first month.
Lyme Carditis
Another more serious problem that occurs with Lyme disease is Lyme carditis. This normally happens in 1-4% of patients with acute Lyme disease and is potentially very serious or even fatal. It normally can happen after 1-2 months if the rash or initial illness with fever is not recognized as Lyme disease and thus goes untreated. It can cause chest pain, palpitations and even syncope (fainting) and sudden death due to heart block. Heart block is when the electrical conduction system in the heart is effected. In the most serious kind of heart block, complete heart block, the small chambers of the heart are unable to communicate electrically with the large chambers and the heart rate can become dangerously slow. It is important not to put in a permanent pacemaker too early as this heart block can go away with antibiotic treatment. Sometimes only a temporary pacemaker is needed which can be removed after the Lyme carditis resolves. Of course, a pacemaker can save your life and the decision to place a permanent versus a temporary pacemaker is a decision to be made by you and your cardiologist.