US Pharm. 2012;37(8):17-18.
Infection Transmitted By Ticks
Lyme disease is a bacterial infection first described in 1975 in Old Lyme, Connecticut. It is caused by Borrelia burgdorferi,
which is spread to humans through the bite of an infected blacklegged
or deer tick. The transfer of bacteria occurs when a tick bites an
infected deer or mouse, then attaches to human skin and feeds over a
period of 1 to 3 days.
Lyme disease, if recognized and treated with antibiotics,
is a curable infection. The disease progresses in stages, with stage 1
beginning a few days or weeks after an infected tick bite. Early
symptoms resemble the flu, with muscle aches, headache, and fever. It is
during this early stage that the characteristic “bull’s-eye” rash often
appears as a red rash with a clear ring, with or without itching. If
left untreated, stages 2 and 3 disease can lead to joint, heart, and
nerve problems over a period of weeks, months, and even years.
If a tick is found attached to the skin, it should be
removed by pinching the head with tweezers and pulling straight up. The
area of the tick bite should be watched for several weeks for signs of a
bull’s-eye rash or early symptoms of Lyme disease. If symptoms occur,
treatment includes 2 to 4 weeks of antibiotics as well as nonsteroidal
anti-inflammatory drugs (NSAIDs) for pain and stiffness in the muscles
Lyme disease is preventable by using tick repellant on
skin and clothes when walking in wooded or grassy areas. After exposure
to outdoor areas where ticks may thrive, skin and scalp should be
checked thoroughly for attached ticks.
Curable With Antibiotic Therapy If Diagnosed Properly
Humans are infected with Borrelia burgdorferi
through transmission by an infected tick bite, usually from the
blacklegged or deer tick. Lyme disease is not transmitted by
person-to-person contact or through the bite of any other insect.
Infected ticks are only found in a limited number of places in the
United States, predominantly in the Northeast, although cases have been
reported in all 50 states. Human exposure to ticks primarily occurs in
grassy or wooded areas while hiking, hunting, or working outdoors.
Stages of Lyme Disease
Symptoms of Lyme disease appear over a period of time in three stages. Stage 1, early localized Lyme disease,
usually begins within a few days up to a few weeks after the tick bite.
The symptoms resemble the flu, with fever, chills, headache, and muscle
aches. In about three-fourths of the cases, a “bull’s-eye” rash, known
as erythema migrans, appears as a red circle that spreads up to 12 inches in diameter with a clear circle near the center.
Stage 2, early disseminated Lyme disease, develops
in untreated cases several weeks or even months after an infected tick
bite. The spread of the bacteria throughout the body causes symptoms
such as muscle or joint pain and swelling, weakness in muscles of the
face, and heart problems such as skipped beats.
Stage 3, late disseminated Lyme disease, occurs
months or even years after an infected tick bite causes an infection
that is not treated. In addition to the muscle and joint pain of stage
2, symptoms of stage 3 disease include abnormal muscle movements,
numbness, speech and vision problems, difficulty sleeping, and poor
Diagnosis and Treatment
Lyme disease is diagnosed using the history of tick
exposure, physical examination findings, evaluation of symptoms, and
laboratory testing. Not surprisingly, many people who develop Lyme
disease cannot recall being bitten by a tick. Laboratory testing begins
with a blood test to look for antibodies to B burgdorferi, which
may not appear in the blood until several weeks after the bacterial
infection has occurred. A second blood test (sometimes referred to as a Western Blot test) can be used to confirm results from the initial test if necessary.
A confirmed case of Lyme disease is treated with an oral
antibiotic. The recommended antibiotics include doxycycline,
amoxicillin, or cefuroxime axetil. Doxycycline is not approved for use
in children younger than 8 years and is contraindicated in pregnant or
nursing women. Alternative antibiotics such as azithromycin,
clarithromycin, or erythromycin can be used in patients who cannot take
the recommended agents. The exact antibiotic and duration of treatment
depend on the stage of Lyme disease being treated. Patients with rare
but serious complications such as meningitis or heart inflammation are
treated with IV antibiotics. Nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen help relieve muscle and joint stiffness and
In most cases, Lyme disease symptoms disappear with
antibiotic therapy, although a small percentage of patients will
continue to have symptoms even after treatment, which is known as post-Lyme disease syndrome.
This may be caused by a continued reaction by the immune system for
unknown reasons. Further treatment with antibiotics is not effective in
Lyme disease is completely curable with antibiotic
therapy. However, one episode of Lyme disease does not protect against
future infections with B burgdorferi bacteria. If you have
questions about tick bites, Lyme disease, antibiotics used to treat the
disease, or tick repellants, your pharmacist can help.
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