Is it Lyme Disease?
One in five people don’t get the classic “bull’s-eye” rash. Get the facts about how Lyme is diagnosed
You have strange joint aches. You’re exhausted. Maybe you feel a little flu-ish. If you live where ticks live, could it be Lyme disease?
Early treatment with antibiotics almost always knocks out B. burgdorferi, the bacterium that cause Lyme, before serious complications can develop. But early treatment requires an early diagnosis. And too often, spotting this tick-borne illness is tricky.
Related: 6 Ways to Prevent Lyme Disease
Among the problems: Blood tests that look for an immune response to the bacterium, which are the most accurate way to confirm Lyme disease according to the Center for Disease Control and Prevention (CDC), are correct just 65 percent of the time. Also, the tests aren’t reliable until four to six weeks after an infection begins, when the body has mounted a strong enough defense to be detectable.
Your doctor can make a diagnosis based on telltale symptoms. But just 70 to 80 percent of people with Lyme get the most classic symptom: a splotchy red “bull’s eye” rash at the bite site. And often, the rash goes unnoticed. And just 30 percent of people with Lyme notice the tick bite that led to their infection.
These steps can help you and your doctor spot and treat a potential Lyme disease infection quickly and accurately.
1. If you find an attached tick, remove it carefully with pointy-tipped tweezers and keep it. Always check for ticks after you’ve been outdoors. If you find one that’s attached to your skin, grab pointy-tipped tweezers and grasp the tick close to the skin's surface. Pull upward with steady pressure.
Deer ticks transmit Lyme bacteria only after they’ve been attached for at least 24 hours. But it’s hard to know what kind of tick is on you or how long a tick’s been there, so save it to show your doctor. Tape it firmly to an index card with transparent tape or seal it tightly inside a zipper-lock plastic bag, recommends the University of Connecticut’s Tick Encounter Resource Center.
If you live in a tick-infested area and find an attached tick, your doctor may put you on preventive antibiotics without testing for Lyme or waiting for symptoms. The Infectious Diseases Society of America (IDSA) recommends preventive treatment for people who meet all of these conditions:
- An attached tick identified as an adult or nymphal I. scapulars tick
- The tick is estimated to have been attached for 36 hours or more (based upon how engorged the tick appears or the amount of time since outdoor exposure)
- The antibiotic can be given within 72 hours of tick removal
- At least 20 percent of the ticks where you live carry the B. burgdorferi bacterium. This is the case for parts of New England, the Mid-Atlantic States, Minnesota and Wisconsin.
- You can take the antibiotic. (It is not recommended for pregnant or breastfeeding women or for children younger than eight.)
2. Watch for symptoms. Some 70 percent of people who develop Lyme disease never see the tick that bit them. So you and your doctor may have to rely on symptoms to start your diagnosis. Within three to 30 days, you may develop fatigue, chills and fever, muscle and joint aches, headaches, swollen lymph glands and a red rash. The rash usually appears at the bite site and expands, with an outer ring of red skin and an inner ring of “clear” skin surrounding the reddish bite spot. Look carefully; the rash may look like a red splotch or may hide in a hard-to-see place.
If you think you have Lyme symptoms, your doctor may prescribe a 10- to 21-day course of antibiotics (usually doxycycline, amoxicillin, or cefuroxime) if you have the telltale rash, with or without other symptoms.
Related: 5 Common Antibiotic Mistakes
Untreated Lyme may lead to advanced symptoms including noticeable joint swelling (especially of the knee), shooting pain, tingling in the hands or feet, memory problems and drooping of one or both sides of the face (Bell’s palsy).
3. Get tested if necessary. If your symptoms aren’t a slam-dunk for Lyme disease, your doctor may order an EIA (enzyme immunoassay) lab test, such as the ELISA (enzyme-linked immunosorbent assay) test. These tests look for signs of an immune response to the Lyme bacteria.
If the results are either positive or inconclusive, the CDC recommends getting an immunoblot test, also called a Western Blot test, to confirm that you have Lyme disease. The results show up as a series of lines. They look a little bit like a bar code, according to the CDC. Each line represents antibodies to a different component of the bacteria. The combination of multiple, specific lines means it’s Lyme disease.
If you’ve had Lyme symptoms for less than 30 days, your doctor may recommend Western Blot tests for IgM antibodies that show up soon after an infection, plus IgG antibodies that show up four to six weeks after an infection. If you’ve had symptoms longer than 30 days, your doctor will likely order just the IgG test.
If the results are positive, your doctor will likely prescribe antibiotics for 10 to 21 days.
If you’ve been diagnosed with Lyme disease and prescribed an antibiotic, don’t stop the medication if you start to feel worse. Within a day of starting antibiotics, up to one in seven people find that their symptoms worsen as the dying bacteria release substances that trigger aches and fatigue. It’s no fun, but it usually clears up after a day or two.