What are the symptoms of Lyme disease, how is it diagnosed and how can I prevent it?
Lyme disease is a common tick-borne infection that occurs due to the bacteria Borrelia burgdorferi, which is carried in the saliva of the black headed tick, Ixodes. Ticks feed on deer, mice, birds and other animals which are infected with Borrelia bacteria, and these infected ticks bite humans and spread the bacteria. People who have been bitten by an infected tick can become unwell and sometimes present with a rash at the site of the tick bite. Lyme disease is known as the 'great imitator', because people’s symptoms are often mistaken for other illnesses.
In this post we’re going to discuss how Lyme disease can be identified and diagnosed, what symptoms to look out for, and what we can do to help minimise the risk of a tick-borne infection.
What are the symptoms of Lyme disease?
The symptoms of Lyme disease can vary, but classically the development of Lyme disease is divided into three stages, the symptoms of which may overlap. These stages include: early localised Lyme disease, the early disseminated stage and the late disseminated stage. Some patients may develop the symptoms of the late disseminated stage without having had any of the symptoms related to the earlier stages.
Some of the more common symptoms include:
- Circular flat skin rash that looks like a bullseye or a red oval
- Extreme fatigue
- Pain and swelling in the joints
- Muscle aches
- Swelling of the lymph nodes
- Difficulties in concentrating
- Sleep disturbances
Skin rashes are a sign of Lyme disease in children, and may occur shortly after being exposed to the bacteria, or even several months or years later.  However, the classic ‘bullseye’ rash may or may not be found, with studies showing it only presents in 30% to 70% of cases. In addition, the rash is easily mistaken for skin infections, cellulitis or ringworm. Therefore, it is important to seek the advice from a doctor with experience in diagnosing Lyme disease.
How is Lyme disease diagnosed?
If you experience multi-organ symptoms, you should undergo tests recommended for the diagnosis of Lyme disease. A classic Lyme rash does not require further assessment; you should start antibiotic treatment immediately.
Diagnosis of Lyme disease begins with a review of your health and travel history. Your likelihood of exposure to tick bites will be assessed, based on whether you’ve lived in or travelled to an area where ticks are endemic. Many patients do not recall a tick bite, and are not aware that they have travelled to a tick infested area. You’ll have a physical examination to check for signs of Lyme disease including the characteristic skin rash. A Lyme disease rash is not always the classic ‘bullseye’. It can be big, small, elliptical, blistering or bruising.
Diagnostic tests are not usually recommended during the early localised stage of the infection, where the rash is present. It can take four to eight weeks for the body to generate an antibody response. Treatment with antibiotics may eliminate the antibody response. Some patients have not developed an antibody response to Lyme until six months or more after a tick bite.
The following tests can be performed for the diagnosis of Lyme disease:
- Enzyme-linked immunosorbent assay (ELISA). This test helps to detect specific antibodies against B. burgdorferi.
- Western blot. This is a blood test which can be performed to confirm the diagnosis when the ELISA test is positive. It evaluates the presence of antibodies to certain B. burgdorferi proteins.
- Polymerase chain reaction (PCR). This test is recommended for the evaluation of patients with persistent Lyme arthritis and nervous system symptoms.  Unfortunately it is not routinely available in public hospitals worldwide, and many private laboratories who perform this test are not recognised as being accredited, even though they are. This presents a further challenge for patients in getting a diagnosis.
How can I prevent Lyme disease?
- Wear long-sleeved shirts and long trousers when outdoors
- Remove wooded areas in your garden
- Put wood piles in your garden at places where they are exposed to the sun
- Use insect repellent
- Be vigilant and check yourself, your children and your pets regularly for ticks
- When you return home from an outdoor area, put your clothes in a warm tumble dryer to destroy any hidden ticks.
- Remove ticks using tweezers. You can apply the tweezers near the mouth or the head of the tick and pull gently. Check again to make sure all parts of the tick have been removed.  
It is possible to prevent tick-borne infections like Lyme disease by taking precautions to protect yourself against ticks. It is also important to seek early medical intervention by identifying the symptoms of Lyme disease. Being aware of the symptoms will help you to get an early diagnosis and prompt treatment. It is important to find a doctor experienced in the diagnosis and treatment of Lyme disease. Finally, ticks carry other infections besides Borrelia, (the Lyme bacteria), and there are also diseases caused by these infections, but this is the topic for another blog.
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