Signs and Symptoms

Lyme disease has three stages.

Localized Early Stage

A red rash appears within a few weeks of a tick bite, starting as a small red spot at the site of the bite. The spot gets bigger over time, making a circle or oval and sometimes looking like a bull's eye. The rash can range in size from that of a dime to the entire width of a person's back. As the infection spreads, rashes can show up at different places on the body. You may also have flu-like symptoms.

Early Disseminated Stage

The early disseminated stage includes:

• Pain and swelling in the large joints, such as the knees
• Heart problems, such as palpitations, lightheadedness, fainting, chest pain, and shortness of breath, which may develop in fewer than 10% of people with Lyme disease. Symptoms may show up several weeks after infection and last a few days or weeks.
• Neurological symptoms, such as a stiff neck and severe headache (may indicate meningitis), temporary paralysis of muscles in the face (Bell's palsy), numbness, pain or weakness in the limbs, or poor motor coordination.

Late Stage

The late stage includes:

• Arthritis, 60% of people not treated with antibiotics develop recurring attacks of arthritis, most often in the knees, that last a few days to a few months. About 10 to 20% people who are not treated will develop chronic arthritis.
• Neurological problems, up to 5% of people who do not get treatment develop long-lasting problems, including numbness in hands or feet, shooting pains, and short-term memory problems.
• Sudden loss of hearing, which may occur among a subset of people with Lyme disease.

What Causes It?

Deer ticks carrying the bacterium B. burgdorferi bite people. The bacteria get into the skin, after the infected tick has been in place for 36 to 48 hours.

Who is Most At Risk?

Your risk of Lyme disease may be higher if you:

• Spend time in heavily wooded areas where there are ticks
• Spend time outdoors in summer and fall
• Are young, children and young adults are more likely to get Lyme disease.
• Live in the coastal northeast, as well as in Wisconsin, Minnesota, California, and Oregon, where the majority of cases show up

What to Expect at Your Provider's Office

Lyme disease can be hard to diagnose because many of its symptoms look like those of other illnesses, and there is no definitive lab test for Lyme disease. About 20% of people with Lyme disease do not get a rash. Tell your doctor if you think you may have been bitten by a tick. Your doctor may order these tests:

• ELISA test, which detects antibodies to the bacteria that causes Lyme disease. This test may result in false positives.
• Western blot test, which detects antibodies to proteins of the bacteria
• Polymerase chain reaction (PCR), which detects bacteria in joint fluid and is used for people who may have Lyme arthritis.

Treatment Options

Prevention

The best defense against Lyme disease is to guard against tick bites, such as:

• DO NOT go into heavily wooded areas
• Wear long-sleeved shirts and long pants
• Apply tick repellent

Use an insect repellent with DEET. Wear light-colored clothing, which makes ticks easier to see, and inspect your body carefully after you have been outdoors. If you find a tick, remove it with tweezers, making sure to remove the head as well as the body. Seeing your doctor and taking antibiotics within 3 days of a tick bite may prevent Lyme disease.

Drug Therapies

Your health care provider may prescribe the following medications:

• Antibiotics: usually doxycycline (Vibramycin), amoxicillin, and cefuroxime (Ceftin) are prescribed. Later-stage Lyme disease may require intravenous (IV) antibiotics, either ceftriaxone (Rocephin) or penicillin. Note: pregnant and breastfeeding women, and children under 8 years of age should not take doxycycline.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): such as ibuprofen (Advil, Motrin) or naproxen (Aleve), to relieve pain and inflammation.

Complementary and Alternative Therapies

You should never treat Lyme disease with complementary therapies alone. Anyone who has Lyme disease needs to take antibiotics to cure the disease and avoid complications. Lyme disease does affect many parts of your body, so including complementary therapies along with standard treatment may help.

Some people believe they have long-lasting complications from Lyme disease. Using CAM therapies to treat these long-lasting complications is controversial. Conventional doctors believing that CAM practitioners may be attributing too many random symptoms to Lyme disease. Make sure you see reputable doctors, whether conventional or CAM practitioners, and educate yourself so that you can be your own advocate.

Always tell all of your doctors about the herbs and supplements you are using or considering using.

Nutrition and Supplements

• Probiotic supplement (containing Lactobacillus acidophilus ): 5 to 10 billion CFUs (colony forming units) a day. Probiotics, or "friendly" bacteria, help maintain intestinal health. If you take antibiotics to treat Lyme disease, the antibiotics will kill the "good" bacteria along with the bad. That can cause diarrhea or yeast infections. Taking probiotics may reduce these side effects. People with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking probiotics.
• Beta-glucan: which is a kind of fiber, is sometimes used to help fight Lyme disease, although there are not any studies to say whether it works or not. Beta-glucan is thought to stimulate the immune system, so people with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking it.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. Some helpful herbs include:

• Garlic ( Allium sativum ): which has antibacterial effects, and one study suggested it may help prevent tick bites. In that study, people who took garlic reported fewer bites than those who took a placebo. More study is needed to tell whether garlic can help repel ticks. Garlic may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Garlic can potentially interfere with several medications, including drugs used to treat HIV/AIDS, and even some birth control medications. Speak to your doctor.
• Essaic: burdock root ( Arctium lappa ), sheep sorrel ( Rumex acetosella ), slippery elm ( Ulmus fulva ), rhubarb ( Rheum palmatum ); Some herbal practitioners may prescribe Essaic to help treat Lyme disease, although there are not any studies to say whether it works. Essaic is a formula that contains several different herbs, and may interact with many medications and potentially cause some dangerous side effects. DO NOT take Essaic on your own. Make sure you have the supervision of an experienced herbal practitioner, and let your doctor know what you are taking.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for Lyme disease based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, including your physical, emotional, and intellectual makeup.

In some cases, such as Lyme disease, a professional homeopath may prescribe specific remedies without considering the individual's constitutional state. Such remedies for Lyme disease include:

• Arsenicum album
• Borrelia burgdorferi nosode
• Carcinosin
• Lac canimum
• Ledum
• Mercurius
• Syphilinum
• Thuja

Prognosis and Possible Complications

Most people who are treated with antibiotics make a full recovery. Getting early treatment can help avoid complications.

Following Up

If you have a severe and advanced case of Lyme disease with varied symptoms, your health care provider may want to see you regularly.

Supporting Research

Ahlemeyer B, Krieglstein J. Neuroprotective effects of Ginkgo biloba extract. Cell Mol Life Sci . 2003;60(9):1779-92.

Alao O, Decker C. Lyme Disease. Disease-a-Month . 2012; 58(6).

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1478-1481.

Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol . 2006;100(4):1164-70.

Bope & Kellerman: Conn's Current Therapy 2014, 1st ed . Philadelphia, PA: Elsevier Saunders. 2013.

Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease. Mayo Clin Proc . 2008 May;83(5):566-71.

Burrascano JJ Jr. Advanced Topics in Lyme Disease: Diagnostic Hints and Treatment Guidelines for Tick Borne Illnesses. 13th ed. Accessed August 8, 2000.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr . 2006;25(2):79-99.

Garcia Melendez ME, Skinner Taylor C, Salas Alanis JC, Ocampo Candiani J. Lyme disease: an update. Gac Med Mex. 2014; 150(1):84-95.

Halperin JJ. Nervous system Lyme disease. Handb Clin Neurol. 2014; 121:1473-83

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med . 2002;8(3):333-40.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry . 2005;66(1):5-29.

Katz TM, Miller JH, Hebert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol. 2008 May;58(5):865-71.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH: LexiComp; 2000: 452-454.

Overstreet ML. Tick bites and Lyme disease: the need for timely treatment. Crit Care Nurs Clin North Am. 2013; 25(2):165-72.

Peeters N, van der Kolk BY, Thijsen SF, Colnot DR. Lyme disease associated with sudden sensorineural hearing loss: case report and literature review. Otol Neurotol . 2013; 34(5):832-7.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47.

Seltzer EG, et al. Long-term outcomes of persons with Lyme disease. JAMA . 2000;283:609-616.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Stjernberg L, Berglund J. Garlic as an insect repellent. JAMA. 2000 Aug 16;284(7):831.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs . 2000;9(9):2103-19.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J . 2005;46(5):585-96.