Doctor's Blog

Lyme Disease
July, 2009

Lyme disease is a tick-born illness caused by a spirochete Borrelia burgdorferi. There were 248,074 cases reported from 1992 to 2006 in the United States. Of those 93% where from the following ten states: Maryland, Connecticut, Delaware, Minnesota, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin.

The disease can progress in 3 stages. Early localized disease can occur after a few days to one month after the tick bite. Localized disease presents with a rash 80% of the time and nonspecific symptoms of a viral illness. The rash looks like a target or bull’s eye.

Symptoms can develop weeks to months after the tick bite and can involve multiple organ systems including the nervous system, heart and eyes. Twenty five (25) percent of people never remember seeing a tick bite, thus making the diagnosis very difficult. Chronic lyme disease can occur months to years after the initial tick bite. Sixty (60) percent of people develop intermittent joint pain.

It may take 1-2 weeks for the blood test to indicate disease. Treatment with antibiotics can prevent the blood test from ever becoming positive. On the other spectrum, blood tests can remain positive despite successful treatment with antibiotic and complete resolution of symptoms. Therefore, follow up testing is not recommended.

Depending on the symptoms, lyme disease can be treated with doxycycline 100mg twice daily or amoxicillin twice daily for 2-3 weeks. For asymptomatic patients who have a tick bite that was attached for >36 hours, prophylactic treatment with doxycycline 200mg for one dose is recommended. The prophylactic treatment should be given within 72 hours of tick removal.

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