Maine has more cases of Lyme disease per capita than any other state, but it doesn’t need to hamper our enjoyment of the outdoors. As a doctor with 30 years of experience in emergency rooms, I’m here to share common questions and answers about Lyme disease so fellow Harpswellians can continue their favorite activities without undue fear.
What causes Lyme disease?
A bacterium called Borrelia burgdorferi causes Lyme disease. It is transmitted in the saliva of the deer tick, also known as the black-legged tick, when the tick feeds on its varied hosts, such as humans, the white-footed mouse, or deer.
Although about 50% of deer ticks carry the germ in Maine, any one deer tick bite has about a 1% to 3% chance of infecting a person. The longer the tick is firmly attached, the higher the risk of getting Lyme disease.
The nymph stage of deer tick also carries Lyme disease and feeds on humans. They are tiny and are easily missed on a person’s skin.
Is Lyme disease treatable?
Yes. The early stage of Lyme disease is treated with oral antibiotics with a very high cure rate.
Later stages of Lyme disease may require longer courses of oral, or sometimes intravenous, antibiotics for treatment.
What are the symptoms of Lyme disease?
A diagnostic rash and/or a fever are symptoms of early-stage Lyme disease. The rash and/or fever can occur up to a month after the infecting bite.
Later stages of Lyme disease occur after months if the early stage is not treated. These later stages may cause heart, neurologic or joint problems.
What does the rash look like?
The internet has many photos of the characteristic bull’s-eye rash, but the rash may also be more uniform in color. The rash often occurs at the site of the bite, but can also appear away from the site. There may be only one rash, or there may be multiple rashes at the same time.
Nevertheless, in almost all cases, the rash is typically flat, without swelling. It is not particularly itchy or painful. It is round or oval with a distinct border. The rash grows significantly in size each day. This dramatic change in size is easily tracked by marking the outline of the original rash. As the rash grows in size, the redness gets lighter, becoming very faint when the edge of the rash is very large.
Can I miss the rash?
Yes, if the rash is on an area of the body that you can’t easily see. That is why it is important for another family member to check those places. The rash persists for days and does not disappear in a day or two, so if you are careful to check regularly, you will not miss the rash.
Can I get Lyme disease if I don’t think I’ve had a tick bite?
Yes, because the tick may have bitten you and fallen off without your knowledge. This is particularly true of bites from the tiny nymph-stage ticks.
What are the symptoms of Lyme disease fever?
The fever is often in the range of 102-105 degrees Fahrenheit. It waxes and wanes and is associated with major chills that usually signify a rising temperature. The fever is accompanied by headache, neck and back aches, and diffuse muscle aches. It is not usually associated with respiratory symptoms such as cough, congestion, sore throat or runny nose. It is not usually associated with gastrointestinal symptoms such as vomiting, diarrhea or nausea.
The fever may persist for days and does not resolve in a day or two, as is often the case with a viral illness. Anybody with a fever during tick season that persists longer than 36-48 hours, in conjunction with body aches, should see a physician.
Are Lyme disease blood tests helpful?
In the first few weeks of Lyme disease, the current tests are not helpful and are often misleading. The tests measure the body’s immune response to the germ. That response may take several weeks to become detectable. Therefore, the tests are almost always negative early in the onset of Lyme disease and cannot be used to rule out Lyme disease.
Characteristic symptoms of rash and/or fever are more diagnostic of Lyme disease than blood tests in the early weeks. These symptoms are what most medical professionals use to diagnose early-stage Lyme disease.
In the later stages of Lyme disease, blood tests may be helpful.
Should I start preventive antibiotics when I have removed an attached tick?
If you are knowledgeable about the symptoms of early Lyme disease, it is better to await the presence of those symptoms before starting antibiotics, particularly since the chance of getting Lyme disease from any one tick bite is about 1% to 3%.
Can I get Lyme disease again if I have had it in the past?
Yes.
Is there a vaccine for Lyme disease?
Not yet, but that is an area of active investigation and early human trials.
How can I prevent tick bites and Lyme disease?
Personal protective measures are the best course of action. These are discussed in excellent columns by Ed Robinson, available in past editions of this paper and online at harpswellanchor.org.
It is also important to check pets for any ticks that may be hitching a ride into your house.
Does having my yard sprayed for ticks help prevent Lyme disease?
Ticks are mobile. Any spraying will need to be done several times to decrease the tick population. Spraying with approved pesticides will kill all insects, including pollinators and other beneficial insects. The approved sprays are also toxic to fish and invertebrates, and may cause dogs and cats to become ill.
Personally, we do not spray and have never had Lyme disease, despite living in Lyme-endemic rural areas for decades and having had many deer tick bites. The University of Maine’s Cooperative Extension has more information about how to control tick populations, which you can find at tinyurl.com/tickcontrols.
