Lyme Disease

British Columbia Specific Information

Ticks are tiny bugs which feed on blood. For information on ticks, removing ticks, and how to avoid being bitten, see HealthLinkBC File #01 Tick Bites and Disease. You may also be interested in the HealthLinkBC File #96 Insect Repellent and DEET.

While most tick bites do not result in diseases, some can. Some of the diseases passed on by ticks include relapsing fever, tularemia, Rocky Mountain Spotted Fever (RMSF), Q Fever and anaplasmosis. The most well-known is Lyme disease. For more information on Lyme Disease, visit BC Centre for Disease Control - Lyme Disease (Borrelia burgdorferi infection).

Topic Overview

What is Lyme disease?

Lyme disease is an infection that is spread by ticks. You can get Lyme disease if you are bitten by an infected tick. But most people who have had a tick bite don't get Lyme disease. It's still important to see your doctor if you have a tick attached to you that you can't remove.

Lyme disease is found in Canada. It is also found in the United States, Europe, and Asia.

What causes Lyme disease?

Lyme disease is caused by bacteria. Infected ticks spread the bacteria by biting people or animals.

Two types of ticks carry the Lyme disease bacteria in Canada. They are:

Deer ticks. They spread the disease in the eastern and south-central areas of Canada.
Western black-legged ticks. They spread the disease along the Pacific coast, mostly in southern British Columbia.

Remove ticks as soon as you notice them. Infected ticks usually don't spread Lyme disease until they have been attached for at least 36 hours.

What are the symptoms?

One sign of Lyme disease is a round, red rash that spreads at the site of a tick bite. This rash can get very large.

Flu-like symptoms are also common. People in the early stages of Lyme disease may feel very tired and have headaches, sore muscles and joints, and a fever.

These symptoms can start at any time, from 3 days to up to a month after you have been bitten. Some people don't have any symptoms when they are in the early stages of Lyme disease. And they may not even remember getting a tick bite.

If Lyme disease goes untreated, you can have more serious symptoms over time. These include:

Swelling and joint pain (like arthritis).
Tingling and numbness in your hands, feet, and back.
A lack of energy that does not get better.
Trouble focusing your thoughts.
Poor memory.
Weakness or paralysis in your face muscles.

How is Lyme disease diagnosed?

Your doctor will ask you questions about your symptoms. Your doctor will also ask about your activities to try to find out if you have been around infected ticks. You may have a blood test to see if you have certain antibodies in your blood that could mean you have the disease.

How is it treated?

The main treatment for Lyme disease is antibiotics. These medicines usually cure Lyme disease within 3 weeks of starting treatment.

It's important to get treatment for Lyme disease as soon as you can. If it goes untreated, Lyme disease can lead to problems with your skin, joints, nervous system, and heart. These can occur weeks, months, or even years after your tick bite. The problems often get better with antibiotics, but in rare cases they can last the rest of your life.

Can you prevent Lyme disease?

The best way to prevent Lyme disease is to protect yourself from ticks. Cover up as much skin as you can when you're going to be in wooded or grassy areas. Wear a hat, a long-sleeved shirt, and long pants with the legs tucked into your socks. And keep in mind that it's easier to see ticks on light-coloured clothes.

Use a bug repellent that has the chemical DEET to keep away ticks. Use products that contain 0.5% permethrin on your clothing and outdoor gear, such as your tent. You can also buy clothing already treated with permethrin. Permethrin is not available as an insect repellent in Canada, but travel health clinics may be able to advise you on how to buy permethrin or permethrin-treated gear.

Check your pets for ticks after they've been outside. You can't get Lyme disease from your pet. But your pet can bring infected ticks inside. These ticks can fall off your pet and attach to you. Check your clothing and outdoor gear after you have been outside. Remove any ticks you find. Then put your clothing in a clothes dryer on high heat for 1 hour to kill any ticks that might remain.

Cause

Lyme disease is caused by Borrelia burgdorferi bacteria. Infected ticks spread the bacteria by biting people or animals.

Two types of ticks carry the Lyme disease bacteria in Canada. They are:

Deer ticks. They spread the disease in the eastern and south-central areas of Canada.
Western black-legged ticks. They spread the disease along the Pacific coast, mostly in southern British Columbia.

Dogs, cats, and horses can become infected with Lyme disease bacteria, but they can't pass the illness to humans. But infected ticks may fall off the animals and then bite and infect humans.

Symptoms

The symptoms of Lyme disease depend on the stage of the disease. You may first notice symptoms weeks to months after the tick bite. If the disease isn't treated, it may progress from mild symptoms to serious, long-term disabilities.

In the first stage, you may have a rash (erythema migrans) at the site of the tick bite. You may also have a lack of energy or a headache and stiff neck. Sometimes people have no symptoms at this stage.
In the second stage, symptoms may include memory problems and pain and weakness in the arms and legs.
In the third stage, symptoms may include swelling and pain (like arthritis) in the joints, not being able to control facial muscles, and numbness and tingling in the hands, feet, or back.

If you don't have symptoms during stage 1, your first symptoms may be those found in stage 2 or 3.

What Happens

Lyme disease is caused by a bite from a tick that is infected with bacteria. When an infected tick bites you, bacteria travel to the tick's salivary glands and then into your body through your skin. It takes about 24 hours for a tick to attach itself to the skin and begin to feed. The tick generally must be attached to you for about 36 hours in order for it to transmit the Lyme disease bacteria.

There are three stages of Lyme disease. If the disease isn't treated, it may progress in stages from mild symptoms to serious, long-term disabilities.

What Increases Your Risk

The main risk factor for Lyme disease is exposure to ticks that are infected with Lyme disease bacteria. In areas where Lyme disease is widespread, such as the eastern and south-central areas of Canada, southern British Columbia, and northeastern United States, several factors may increase your risk, including:

Spending time outdoors during the warm months of the year when ticks are most active. This is usually between May and November, with peak activity in June and July.
Having indoor/outdoor pets. They can bring infected ticks into the house. Although dogs and cats can become infected with the Lyme disease bacteria, they cannot pass the illness to humans. But the infected ticks can drop off the animal and then bite and infect a person.
Having a stone fence or a bird feeder near your house. Stone fences often become homes for mice, and mice may feed on spilled seed from a bird feeder. Where there are mice, there are ticks.

Remove ticks right away, as soon as you notice them. Your risk for getting Lyme disease increases the longer a tick is attached to your body. Ticks generally cannot transmit Lyme disease until they are attached for at least 36 hours.

When should you call your doctor?

Call your doctor if:

A tick is attached to your body and you are unable to remove the entire tick.
You have a circular red rash that expands over the course of several days, especially if you know you were recently exposed to ticks. You may also have flu-like symptoms, such as fatigue, headache, stiff neck, fever, chills, or body aches.
You feel very tired or have joint pain (especially with redness and swelling), irregular heartbeats, severe headache, or neck pain.
You are pregnant or nursing and you think you may have been exposed to ticks.

Who to see

The following health professionals can diagnose and prescribe treatment for Lyme disease or complications of Lyme disease:

Examinations and Tests

Lyme disease is often hard to diagnose. Your doctor will take a careful medical history and do a physical examination to help diagnose early Lyme disease. You may be asked if you have recently visited an area where you may have been exposed to ticks. The doctor will ask about your symptoms and look for physical signs of Lyme disease. The clearest physical sign is an expanding, circular red rash (called erythema migrans).

Lyme disease tests are blood tests that help confirm a diagnosis of Lyme disease. These tests can detect antibodies to the bacteria that cause Lyme disease, but they may not be needed. The decision about when to use blood tests for Lyme disease depends on whether your doctor strongly thinks you have Lyme disease and whether the test results will change the course of your treatment.

Other tests, such as a skin biopsy, may be done to confirm a diagnosis.

If possible, put the tick that was attached to you in a dry jar or a ziplock bag and take it to the doctor with you. Sometimes tests can be done on the tick to see if it is a carrier of Lyme disease.

Treatment Overview

Lyme disease is treated with antibiotics.

The type of antibiotic your doctor gives you and the number of days you take it will depend on your symptoms and the stage of the disease. Talk to your doctor if you have any questions about your antibiotic treatment.

Early treatment

Antibiotic treatment for early Lyme disease is effective, and symptoms usually go away within 3 weeks of treatment.

The earlier antibiotic treatment is started after infection, the faster and more completely you will recover.

If Lyme disease isn't diagnosed and treated until later problems arise, it may take you a long time to get better. Or you may need more treatment.

Later treatment

If the disease gets worse, treatment options include:

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. These are usually helpful for symptoms of arthritis that can occur with late Lyme disease.
Oral antibiotics. These may be used for achy joints caused by chronic Lyme arthritis. But joints that have been badly damaged by Lyme arthritis may take a long time to get better, or antibiotics may not improve symptoms.
Intravenous (IV) antibiotics. These are commonly used to treat nervous system problems such as tingling and numbness or conditions such as meningitis.
Antibiotics plus other treatments. These are used to help people who develop serious heart problems, such as severe irregular heartbeat or pericarditis, from Lyme disease. But these problems are extremely rare. Heart problems may start getting better on their own, even before antibiotics or other treatment has started.

People with partial facial paralysis as a result of Lyme disease may improve on their own without more treatment.

Even after successful treatment for Lyme disease, you can get it again. So it is important to continue to protect yourself against tick bites.

Prevention

Lyme disease can be prevented by avoiding and removing ticks. You can also get the disease again after successful treatment, so it is important to continue to protect yourself against tick bites.

Lyme disease isn't contagious and cannot be spread from person to person. But there are certain precautions you can take to prevent the spread of the illness.

If you have active Lyme disease, don't donate blood. The bacteria that cause the illness can be transmitted this way. If you have been treated for Lyme disease, you may be able to donate blood, but check with the blood bank first.

A pregnant woman may be able to pass Lyme disease to her unborn child, but proven cases are rare. Lyme disease hasn't been shown to cause birth defects or fetal death.

Medications

Antibiotics are the main treatment for Lyme disease. The first course of antibiotics almost always cures the infection. But if symptoms continue, more evaluation may be needed.

The type of antibiotic prescribed, the amount, and whether the medicine is taken orally, as an injection, or through a vein (intravenous, or IV) depends on how bad your symptoms are and how long you've had Lyme disease.

Oral antibiotics are prescribed for early Lyme disease. They are also usually prescribed first for chronic Lyme arthritis.
Intravenous (IV) antibiotics are used if:
- Your nervous system is affected by late Lyme disease and you have bad headaches, neck pain, weakness or numbness in the arms or legs, or problems with thinking or memory.
- Lyme disease bacteria or antibodies against the bacteria have been found in your spinal fluid.
Either oral or intravenous antibiotics may be used to treat late Lyme disease symptoms.

Should you use antibiotics?

Different antibiotics may be used to treat children and adults. The decision to take medicines for Lyme disease may be based on one or more of these factors:

You have symptoms of Lyme disease, especially the red, circular rash, and a history of exposure to ticks in geographic regions where Lyme disease is known to occur.
Blood tests show that you have antibodies to the Lyme disease bacteria in your blood, spinal fluid, or joint fluid.
You are pregnant or breastfeeding and are bitten by a tick.

References

Other Works Consulted

Halperin JJ, et al. (2007). Practice parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 69(1): 91–102.

Tompkins DC, Luft BJ (2009). Lyme disease and other spirochetal zoonoses. In DC Dale et al., eds., ACP Medicine, section 7, chap. 7. Hamilton, ON: BC Decker.

Wormser GP, et al. (2006). The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 43(9): 1089–1134. [Erratum in Clinical Infectious Diseases, 45(7): 941.]

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Brian D. O'Brien MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
W. David Colby IV MSc, MD, FRCPC - Infectious Disease