Welcome to tick season.  Here in the Northeast, this actually started weeks ago.  So, we are late. Sorry. It was first described in 1977 in Connecticut as "Lyme arthritis".   Lyme disease is caused by a spirochetal infection by B. Burgdorferi, which is carried by the deer tick.  Although Lyme disease has high concentrations in the North East of the united states, it is also found throughout Europe and parts of Asia. The ticks are typically carried by deer and mice.  Lyme disease is actually the most common disease transmitted by ticks. The ticks are found in wooded areas, on shrubs, tall grass and animals.  The tick usually needs to be attached for at least a day to cause an infection.   If you don't realize that the tick has attached, it can take days to weeks to develop symptoms.

The initial symptoms can include a rash that looks like a "bull's eye".  This is known as erythema migrans.   It is red but the center can be normal skin color, appearing like a ring.  It usually occurs within 1-2 weeks of the tick bite.  About 80% of patients will develop this rash. You may also have lack of appetite, headache, fever or myalgia at this time. You may also have no symptoms at all. The rash below is courtesy of the CDC.

Early disseminated disease is the second stage of Lyme infection which is characterized by multiple rash lesions (that typically occur days to weeks after infection) and/or neurologic and/or cardiac findings (that typically occur weeks to months after infection).  Some of these patients have no history of initial infection with Lyme disease.


The late stage of Lyme infection includes arthritis of one or multiple large joints (think knee or hip).  This can also have neurological symptoms and problems with memory. This typically develops a few months to a year after initial infection. At this stage problems with memory and chronic skin changes can happen (although this is typical of infections in Europe and not in the US). Another picture below courtesy of the CDC below that nicely summarizes the symptoms in picture form.


We test for Lyme disease using a blood test, but it takes about a week to get the test results back. If your medical history and physical exam is consistent with a diagnosis of Lyme disease we will often start treatment before the blood test is back.  It is also possible that some of the blood tests will be negative even though you have clear evidence of Lyme disease (IE the rash described above). 

What should you do if you find a tick or have been bitten?  That often changes depending on a few things.  First if you find a tick on yourself or child, use tweezers to get it off. Pull it off slowly and then wash the area with soap and water.  Some people will keep the tick to show their healthcare provider.  This is not necessary.  If you really want, take a picture with your smart phone.  We would like to know the size, color and if it was attached to your skin.  If the tick was attached less than 72 hours we will typically treat you with one dose of antibiotics if you come to the emergency department.  If it was attached longer then you will likely have a longer course of antibiotics while we await the results of blood tests.  If you find a tick that is just walking on you, you likely do not require any treatment at all.  We are only concerned if the tick was attached, not if it was just walking on you.  If you develop any symptoms or signs of Lyme disease that are listed above, you should see your doctor.  

Some of the things that you can do to prevent getting a tick bite include wearing light colored clothing, long sleeve shirts and pants.  Tuck your pants into your socks (although not fashionable, can save you a tick bite if you're out in the woods).  Showering within a few hours of being outdoors and checking the head, groin, back and armpits are all important.  Make sure to check your children as well.  You can also use bug spray in addition to having your property sprayed if you live in a high tick area.

With many dreams of creepy, crawling bugs in your future…I bid you goodday!


Dr. Paul