Lyme/Lyme-like Disease

Lyme disease is a potentially serious disease caused by the bacteria Borrelia burgdorferi.  These disease-causing bacteria are transmitted to humans and other animals by the bite of an infected tick, called the deer tick or “blacklegged tick”.  There is no evidence to suggest Lyme disease is spread from person-to-person or from an infected pet.  In the United States, the majority of Lyme disease cases occur primarily in three distinct areas: Northeast from Massachuttes to Maryland, in the Midwest in Wisconsin and Minnesota, and in the West in northern California. 

Lyme disease is relatively rare in many other states, including Missouri.  There have been patients in Missouri with symptoms of Lyme disease (including EM rashes) similar from those in other areas of the United States, but B. burgdorferi has not yet been isolated from any patients in Missouri.  Lyme disease is nationally notifiable and is therefore notifiable in Missouri.  Missouri patients who fulfill the strict CDC case definition for Lyme disease are reported as such.  Even though the Missouri EM rashes are similar to those in other parts of the country, the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC, refers them to as EM-like.  The clinical syndrome associated with the EM-like rash appears similar to Lyme disease and is called Lyme-like disease.  (See the Missouri Department of Health and Senior Services’ position paper on Lyme disease).

Lyme disease bacteria can infect several parts of the body, producing different conditions and symptoms at different times.  The first symptom of Lyme disease is typically a small red area or bump at the site of the tick bite.  Unlike most tick bites, the red area continues to expand into a circular or “bull’s-eye” rash called an erythema migrans (EM) rash.  The EM rash develops in approximately 80% of persons with Lyme disease and appears within 3-32 days (usually 7-10 days) following the bite of an infected tick.  Multiple EM rashes may appear and can be as large as 12 inches across. 

The initial signs and symptoms of Lyme disease may include:

• erythema migrans “bull’s-eye” rash
• fatigue
• fever
• chills
• headache
• muscle and joint aches
• swollen lymph nodes

Persons treated with an appropriate antibiotic early in the course of illness usually recover rapidly and completely.  If left untreated, the infection can spread to joints, the heart, and the nervous sytem resulting in a variety conditions, which can be severe.  These conditions can occur weeks, months, and even years after the initial infection.  Diagnosis of Lyme disease is typically based on the clinical findings and supported by a two-staged blood test.  Contact your health care provider if you suspect you have Lyme disease.        

The DHSS Bureau of Communicable Disease Control and Prevention records the number of Lyme disease cases in Missouri every year in an Annual Report of the Bureau’s surveillance, investigation, and prevention activities.  The best way to prevent getting Lyme disease is to avoid getting bitten by ticks.  Therefore, prevention measures should emphasize personal protection when exposed to areas where ticks are present:

• Wear light-colored clothing to make ticks easier to see.  Wear long pants and tuck the pants legs into your socks so that ticks cannot crawl up the inside of your pants legs.
• For adults, use insect repellents containing 20-50% DEET on your skin.  The American Academy of Pediatrics has recommended that repellents containing up to 30% DEET can be used on children over 2 months of age.
• For clothing, permetherin or DEET may be used.
• Be sure to follow the directions on the permetherin or DEET containers and wash off repellents when going indoors.  Carefully read the manufacturer’s label on repellents before using, especially on children.
• Conduct body checks regularly and upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body.
• Parents should check their children for ticks, especially in the hair, when returning from potentially tick-infested areas. Ticks may also be carried into the household on clothing and pets and only attached later so both should be examined carefully to exclude the ticks.

If a tick is attached, it is important the tick be removed promptly.  Immediate removal of ticks using methods listed below may also reduce your risk of developing Lyme disease and other tick-borne illnesses.

• Use fine-tipped tweezers and protect your fingers with a tissue, paper towel, or latex gloves. Avoid removing ticks with your bare hands.
• Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin. If this happens, remove mouthparts with tweezers. Consult your health care provider if illness occurs.
• DO NOT squeeze, crush, or puncture the body of the tick at any time while it is attached.  This could force the disease causing bacteria from the tick into the bite wound.
• DO NOT squeeze the body of the tick to kill it after it has been removed.  This could result in the disease causing bacteria to get onto/into your skin.
• After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.
• DO NOT use matches, gasoline, nail polish remover, or other ointments to remove the tick.  This could cause the tick to release additional saliva containing the disease causing bacteria into the bite wound.
• Inspect your body for additional ticks – don’t forget the hard to see areas including the scalp.
• Note the date of the tick bite and consult your health care provider if you develop any symptoms consistent with Lyme disease.

Please contact your doctor, local health department or the Department of Health and Senior Services (866-628-9891) if you have other questions about Lyme disease.