Lyme Disease Contributions by FoundHealth

Lyme disease is a bacterial infection resulting from the bite of an infected tick. The most common type of tick that carries the bacteria is the tiny deer tick, or black–legged tick, which is about the size of a poppy seed. Lyme disease can also be spread by the lone star tick.

A tick picks up the Lyme disease bacteria, called Borrelia burgdorferi (B. burgdorferi), when it bites an animal that is infected with it (sometimes, lyme disease is referred to as lyme borreliosis). These bacteria are classified as spirochetes because of their spiral shape. Infectious lyme spirochetes, (not tics), are found in human breast milk, tears, urine and semen and can be found in mosquitos, mites, fleas and biting flies; so though tics may be the most common means of lyme disease transmission, there may be other mechanisms that transport the disease about which we may not yet know much.¹

When an infected tick attaches to you and maintains contact with your blood, the bacteria can travel from the tick’s gut to your bloodstream. Once the bacteria enter the bloodstream, they can move to different parts of the body. Though considered to be a bacterial infection, the borrelia spirochete (and all spirochetes for that matter) are very similar in characteristics to parasites. Common sites of infection include the skin, joints, muscles, nerve tissue, and distant skin sites. Ticks are most likely to transfer the infection to you after being in contact with your blood for two or more days.

Though symptoms originate from a bacterial infection, many people continue to feel the symptoms of lyme disease even after the infection might be gone - this is a bit of a quandary. Antibiotics are the commonly touted treatment for lyme disease, and though a course of this medication can be extremely effective at treating the symptoms for many patients, for many, bacteria continue to live in the host's system despite antibiotic treatment.

According to the US Centers for Disease Control and Prevention (CDC), 23,444 cases of Lyme disease were reported in 2010. However, many people believe there are more people infected than these statistics would indicate.¹ The disease is concentrated in certain parts of the country where both the ticks that carry the Lyme bacteria and the mice, deer, and chipmunks that the ticks live on are common. Although Lyme disease is most frequently associated with the Northeast United States, it has been reported in nearly all states.

What are the risk factors for Lyme disease?

What are the symptoms of Lyme disease?

How is Lyme disease diagnosed?

What are the treatments for Lyme disease?

Are there screening tests for Lyme disease?

How can I reduce my risk of Lyme disease?

What questions should I ask my doctor?

Where can I get more information about Lyme disease?

The symptoms of Lyme disease can be confusing and differ among infected persons both in their nature and in their severity. Some people may not have any symptoms at all, but Lyme disease may still be diagnosed through a blood test. Lyme disease may be misdiagnosed as chronic fatigue syndrome.

Lyme disease progresses through different stages with varying and sometimes overlapping symptoms. Symptoms include the following:

Early Infection

These symptoms typically occur within 3-32 days of a tick bite.

Rash

Some infected people first notice a red rash, known as erythema migrans (EM) The rash starts as a small red spot at the site of the tick bite and expands over a period of days or weeks, forming a circular- or oval-shaped rash. The infectious spirochetes move quickly throughout the body's tissues, which is why this rash continues to expand. The rash often resembles a bull’s eye: a red ring surrounding a clear or bluish area with a red center. The size of the rash can range from dime-sized to the entire width of a person’s back. More than one ring may develop. Typically, the rash goes away within four weeks.

Lyme Disease Rash

Although Lyme disease is often associated with this rash, many people do not have the rash right away or at all. Or they may have a red rash, without the bull's eye pattern. If you have other symptoms that you think might be due to Lyme disease, see your doctor; do not wait for a rash to appear.

Flu-like Symptoms

Muscle and joint aches, headache, fever (100°-103°), stiff neck, swollen glands, and fatigue may occur with or without the rash. These symptoms usually last about 5-21 days.

Lyme Arthritis

Though general aches and pains are somewhat common symptoms of a lyme infections (as discussed directly above), when these symptoms worsen and show up months after the bite, they might be part of a condition called lyme arthritis. Joints, tendons and muscles can be affected may swell to as much as four times their normal size, and this process might come-and-go with varying immune competence (the ability of the immune system to respond to an infection or other internal condition).¹

For unknown reasons, lyme arthritis tends to resolve on its own, even if left untreated, though it could take up to four years for this to clear on its own. However, it is usually decently responsive to plant-based therapies like herbal therapies.

Neuroborreliosis

Lyme infection can affect the central nervous system, along with tissues, joint and muscles symptoms discussed above. Usually exhibited within seven days of the initial infections, the central nervous system symptoms (including cognitive disturbances, memory loss, vertigo, vision abnormalities, and inflammatory processes like meningismus in the brain) can lay dormant for months and continue to present for years.

Early Widespread Infection

• Multiple EM lesions—The rash may appear in several places on the body.

• Arthritis — Sometimes joint pain is the first symptom that is noticed. Other joint problems include stiffness and swelling, particularly in the large joints, such as the knee, elbow, and shoulder.

• Nervous system problems—The bacteria can affect the brain, spinal cord, and other nerves of the body. Symptoms of this include:
• Weakness and drooping of the face and eyelid on one side (Bell’s palsy )—It may also occur on both sides of the face.
  • Low back pain
  • Wide-spread numbness, tingling, and burning
  • Impaired motor coordination
  • Persistent headache
  • Stiff neck
  • Mood changes
  • Difficulty concentrating or sleeping
  • Generalized weakness

• Eye problems—such as conjunctivitis (redness and inflammation) and/or pressure in eyes

• Other body systems—Affected areas may include the heart, liver, lymph nodes, testes, and eyes.
• Chest pain, heart palpitation
• Continual low-grade fever
• High fever, chills, or sweating
• Muscle twitching

Note:All symptoms of early manifestation usually occur with the first rash or within about six weeks of it. They may go away on their own within a few weeks or months.

Late Infection

Joint pain—painful inflammation of the joints, as well as intermittent or chronic arthritis

Chronic nervous system problems—These may include:

• Memory problems, including dementia
• Depression or other emotional problems
• Sleep disorder
• Nerve pain or problems

Chronic skin problems - can include thinning, thickening, or discoloration of the skin, usually of the hands and feet

References:

1. Buhner, S.H. Healing Lyme: Natural Healing and Prevention of Lyme /borreliosis and Its Coinfections. Silver City, NM Raven Press. 2005

Lyme disease. Lyme Disease Foundation website. Available at: http://www.lyme.org/otherdis/ld.html . Accessed October 5, 2008.

Reported cases of Lyme disease by year, United States, 1992-2007. US Food and Drug Administration website. Available at: http://www.cdc.gov/ncidod/dvbid/lyme/ld_UpClimbLymeDis.htm . Updated September 2005. Accessed October 7, 2008.

Lyme disease is a bacterial infection resulting from the bite of an infected tick. The most common type of tick that carries the bacteria is the tiny deer tick, or black–legged tick, which is about the size of a poppy seed. Lyme disease can also be spread by the lone star tick.

A tick picks up the Lyme disease bacteria, called Borrelia burgdorferi (B. burgdorferi), when it bites an animal that is infected with it (sometimes, lyme disease is referred to as lyme borreliosis). These bacteria are classified as spirochetes because of their spiral shape. Infectious lyme spirochetes, (not tics), are found in human breast milk, tears, urine and semen and can be found in mosquitos, mites, fleas and biting flies; so though tics may be the most common means of lyme disease transmission, there may be other mechanisms that transport the disease about which we may not yet know much.¹

When an infected tick attaches to you and maintains contact with your blood, the bacteria can travel from the tick’s gut to your bloodstream. Once the bacteria enter the bloodstream, they can move to different parts of the body. Though considered to be a bacterial infection, the borrelia spirochete (and all spirochetes for that matter) are very similar in characteristics to parasites. Common sites of infection include the skin, joints, muscles, nerve tissue, and distant skin sites. Ticks are most likely to transfer the infection to you after being in contact with your blood for two or more days.

Though symptoms originate from a bacterial infection, many people continue to feel the symptoms of lyme disease even after the infection might be gone - this is a bit of a quandary. Antibiotics are the commonly touted treatment for lyme disease, and though a course of this medication can be extremely effective at treating the symptoms for many patients, for many, bacteria continue to live in the host's system despite antibiotic treatment.

According to the US Centers for Disease Control and Prevention (CDC), 23,444 cases of Lyme disease were reported in 2010. However, many people believe there are more people infected than these statistics would indicate.¹ The disease is concentrated in certain parts of the country where both the ticks that carry the Lyme bacteria and the mice, deer, and chipmunks that the ticks live on are common. Although Lyme disease is most frequently associated with the Northeast United States, it has been reported in nearly all states.

What are the risk factors for Lyme disease?

What are the symptoms of Lyme disease?

How is Lyme disease diagnosed?

What are the treatments for Lyme disease?

Are there screening tests for Lyme disease?

How can I reduce my risk of Lyme disease?

What questions should I ask my doctor?

Where can I get more information about Lyme disease?

The symptoms of Lyme disease can be confusing and differ among infected persons both in their nature and in their severity. Some people may not have any symptoms at all, but Lyme disease may still be diagnosed through a blood test. Lyme disease may be misdiagnosed as chronic fatigue syndrome.

Lyme disease progresses through different stages with varying and sometimes overlapping symptoms. Symptoms include the following:

Early Infection

These symptoms typically occur within 3-32 days of a tick bite.

Rash

Some infected people first notice a red rash, known as erythema migrans (EM) The rash starts as a small red spot at the site of the tick bite and expands over a period of days or weeks, forming a circular- or oval-shaped rash. The infectious spirochetes move quickly throughout the body's tissues, which is why this rash continues to expand. The rash often resembles a bull’s eye: a red ring surrounding a clear or bluish area with a red center. The size of the rash can range from dime-sized to the entire width of a person’s back. More than one ring may develop. Typically, the rash goes away within four weeks.

Lyme Disease Rash

Although Lyme disease is often associated with this rash, many people do not have the rash right away or at all. Or they may have a red rash, without the bull's eye pattern. If you have other symptoms that you think might be due to Lyme disease, see your doctor; do not wait for a rash to appear.

Flu-like Symptoms

Muscle and joint aches, headache, fever (100°-103°), stiff neck, swollen glands, and fatigue may occur with or without the rash. These symptoms usually last about 5-21 days.

Lyme Arthritis

Though general aches and pains are somewhat common symptoms of a lyme infections (as discussed directly above), when these symptoms worsen and show up months after the bite, they might be part of a condition called lyme arthritis. Joints, tendons and muscles can be affected may swell to as much as four times their normal size, and this process might come-and-go with varying immune competence (the ability of the immune system to respond to an infection or other internal condition).¹

For unknown reasons, lyme arthritis tends to resolve on its own, even if left untreated, though it could take up to four years for this to clear on its own. However, it is usually decently responsive to plant-based therapies like herbal therapies.

Neuroborreliosis

Lyme infection can affect the central nervous system, along with tissues, joint and muscles symptoms discussed above. Usually exhibited within seven days of the initial infections, the central nervous system symptoms (including cognitive disturbances, memory loss, vertigo, vision abnormalities, and inflammatory processes like meningismus in the brain) can lay dormant for months and continue to present for years.

Early Widespread Infection

• Multiple EM lesions—The rash may appear in several places on the body.

• Arthritis — Sometimes joint pain is the first symptom that is noticed. Other joint problems include stiffness and swelling, particularly in the large joints, such as the knee, elbow, and shoulder.

• Nervous system problems—The bacteria can affect the brain, spinal cord, and other nerves of the body. Symptoms of this include:
• Weakness and drooping of the face and eyelid on one side (Bell’s palsy )—It may also occur on both sides of the face.
  • Low back pain
  • Wide-spread numbness, tingling, and burning
  • Impaired motor coordination
  • Persistent headache
  • Stiff neck
  • Mood changes
  • Difficulty concentrating or sleeping
  • Generalized weakness

• Eye problems—such as conjunctivitis (redness and inflammation) and/or pressure in eyes

• Other body systems—Affected areas may include the heart, liver, lymph nodes, testes, and eyes.
• Chest pain, heart palpitation
• Continual low-grade fever
• High fever, chills, or sweating
• Muscle twitching

Note:All symptoms of early manifestation usually occur with the first rash or within about six weeks of it. They may go away on their own within a few weeks or months.

Late Infection

Joint pain—painful inflammation of the joints, as well as intermittent or chronic arthritis

Chronic nervous system problems—These may include:

• Memory problems, including dementia
• Depression or other emotional problems
• Sleep disorder
• Nerve pain or problems

Chronic skin problems - can include thinning, thickening, or discoloration of the skin, usually of the hands and feet

References:

American Lyme Disease Foundation website. Available at: http://www.aldf.com/ .

Griffith's 5-Minute Clinical Consult.10th ed. Lippincott Williams & Wilkins; 2001.

Lyme Disease Foundation website. Available at: http://www.lyme.org/ .

National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/ .

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop Lyme disease with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing Lyme disease. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

Anyone who lives in an area where there are ticks has a risk of being bitten by a Lyme disease-infected tick. An increased risk is usually directly related to the amount of time a person spends outdoors in areas where there are a lot of ticks.

Geographic Location

Lyme disease is found most often in three geographic locations in the US. These are:

• The northeastern and mid-Atlantic region: Maine to Maryland
• The upper north-central region: Minnesota and Wisconsin
• The northwest: northwestern California and Oregon

Time of Year

Ticks are most active during the warmer months of the year. Peak at-risk times vary from region to region, based on the temperature.

• Northeast and north-central US — Increased risk is between April and November, with the peak occurring in July.
• Southern US—Ticks are active year-round.
• Other areas can be variable, based on the temperature.

Activities

People who work outdoors in jobs such as surveying, landscaping, forestry, gardening, and utility service have a higher risk of Lyme disease. Participating in outdoor recreational activities such as hiking, camping, hunting, and gardening can also increase your risk. Wear full length clothes and closed shoes for protection.

Landscape

The ticks that carry Lyme disease are more likely to live in wet, green, brushy, or wooded areas. They are less likely to be near pruned, well-cared-for plants, but more likely near unmaintained shrubby or brushy plants. Living near or visiting wooded or brushy areas can increase your risk.

Age

Lyme disease occurs more often in children under age 15, and adults between 25-44 years old. This is most likely due to outdoor activities that expose them to ticks.

References:

1. Buhner, S.H. Healing Lyme: Natural Healing and Prevention of Lyme /borreliosis and Its Coinfections. Silver City, NM Raven Press. 2005

Frequently asked questions. American Lyme Disease Foundation website. Available at: http://www.aldf.com/faq.shtml . Accessed October 5, 2008.

Lyme disease. Lyme Disease Foundation website. Available at: http://www.lyme.org/otherdis/ld.html . Accessed October 5, 2008.

Lyme disease. National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/lymeDisease/ . Accessed October 5, 2008.

pp MTReferences:

1. Buhner, S.H. Healing Lyme: Natural Healing and Prevention of Lyme /borreliosis and Its Coinfections. Silver City, NM Raven Press. 2005 p.46

Frequently asked questions. American Lyme Disease Foundation website. Available at: http://www.aldf.com/faq.shtml . Accessed October 5, 2008.

Lyme disease. Lyme Disease Foundation website. Available at: http://www.lyme.org/otherdis/ld.html . Accessed October 5, 2008.

Lyme disease. National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/lymeDisease/ . Accessed October 5, 2008.

Marques AR, Martin DS, Philipp MT. Evaluation of the C6 peptide enzyme-linked immunosorbent assay for individuals vaccinated with the recombinant OspA vaccine. J Clin Microbiol.2003;40:2591.

Philipp MT, Marques AR, Fawcett PT, et al. C6 test as an indicator of therapy outcome for patients with localized or disseminated lyme borreliosis. J Clin Microbiol.2003;41:4955.

References:

Frequently asked questions. American Lyme Disease Foundation website. Available at: http://www.aldf.com/faq.shtml . Accessed October 5, 2008.

Frequently asked questions about lyme disease. Infectious Diseases Society of America website. Available at: http://www.idsociety.org/lymediseasefacts.htm . Accessed October 5, 2008.

Lyme disease. Lyme Disease Foundation website. Available at: http://www.lyme.org/otherdis/ld.html . Accessed October 5, 2008.

Lyme disease. National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/lymeDisease/ . Accessed October 5, 2008.

5/28/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Warshafsky S, Lee DH, Francois LK, Nowakowski J, Nadelman RB, Wormser GP. Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis. J Antimicrob Chemother.2010;65(6):1137-1144.

References:

Lyme disease. Lyme Disease Foundation website. Available at: http://www.lyme.org/otherdis/ld.html . Accessed October 5, 2008.

We want you to know about Lyme disease: it's difficult to diagnose. US Food and Drug Administration website. Available at: http://www.fda.gov/cdrh/consumer/lymedisease.html . Updated July 1999. Accessed October 5, 2008.

The diagnosis of Lyme disease is usually based on the presence of symptoms and signs of the disease. If you have removed an attached tick from your body, tell your doctor. For 30 days after being bitten, you should watch closely for the characteristic “bulls-eye” rash at the site of the bite, or a fever. If you think you develop these or any other symptoms, see your doctor immediately. You are much less likely to develop Lyme disease if the tick had been attached to you for less than 24 hours. Treatment with appropriate antibiotics after a tick bite, while not endorsed by all experts, may also reduce your risk.

Presently, there are no tests that are completely accurate in diagnosing Lyme disease; many tests result in false positives or false negatives. However, your doctor may order one or more of the following tests to support the diagnosis of Lyme disease:

Antibody Tests

Antibodies are the body’s defense against an infection. If you have been infected with the Lyme disease bacteria, your body will release specific antibodies to fight it. It takes about four weeks or more for these antibodies to become detectable. Examples include:

• Antibody titer (ELISA or IFA)—This test measures the level of Lyme disease antibodies in the blood. If this test is equivocal or positive, you will need to have a Western Blot to confirm the results
• Western blot — This test detects the presence of the antibody to specific Lyme disease proteins in the blood.

Both of these tests can have false negative results (the test is negative even though you are infected) or false positive results (the test is positive even though you are not infected).

Some reasons why false negatives may occur include:

• The test is performed too soon after infection.
• Too few antibodies are made.
• The test is performed incorrectly.

Some reasons why false positives may occur include:

• The test is performed incorrectly.
• Your immune system produces unrelated antibodies that appear in the test as if they were produced in response to Lyme disease.

Direct Detection Tests

These tests look directly for the bacteria, or pieces of it, in the blood and other fluids of the body, such as urine and spinal fluid. Two main types are:

1. Antigen detection tests—These look for a unique protein from the Lyme disease bacteria that may be in body fluids. This test is useful for detecting Lyme disease in certain situations, such as:

• If you are taking antibiotics
• During a later flare-up of symptoms

2. Polymerase chain reaction (PCR)—This test identifies specific DNA from the Lyme bacteria and is able to detect very small amounts of bacterial DNA

Culture

This test is done by actually growing the Lyme bacteria from fluid taken from an open sore or other source of body fluids. If the bacteria grow, the test is considered positive. Cultures often take many weeks to grow the bacteria and are rarely used today.

Analysis of Spinal Fluid

This test is done when your symptoms indicate that Lyme disease is affecting the nervous system. Spinal fluid is tested for bacteria using one of the tests listed above. The spinal fluid is removed by spinal tap (inserting a needle into the spinal column).

Single Photon Emission Computed Tomography (SPECT)

This test is rarely used, but may be done in certain cases with symptoms that involve the nervous system. It is a kind of brain scan that looks for brain wave patterns that may indicate Lyme disease infection.

Lyme Disease and Alzheimer's Disease

There seems to exist a correlation between Lyme disease and Alzheimer's disease, possibly suggesting that the infectious agent responsible for an initial Lyme disease infection could later be implicated as a cause of Alzheimer's disease. (This is speculated after autopsy of some Alzheimer's patients showed a presence of Lyme spirochetes in the brain.)¹

The keys to reducing the risk of Lyme disease are to:

• Avoid ticks in the areas where you live and work
• Protect yourself from getting a tick on your body

Reduce or Avoid Tick Habitats

Reducing or avoiding tick habitats can reduce your chances of being bitten. To do this:

• Avoid moist, shaded, wooded, or brushy areas.
• When walking in the outdoors, stay on cleared, well-traveled paths, and walk in the center of trails to avoid overgrown grass and brush.
• Avoid sitting on the ground or on stonewalls.
• Remove leaf litter, brush, and woodpiles from around your home and the edges of your yard.
• Mow the grass often.
• Discourage animals that carry ticks from coming onto your property.

Wear Proper Clothing

Proper clothing can help protect you from tick bites. When spending time outdoors in areas where there may be ticks, you should:

• Wear light-colored long pants and a long-sleeved shirt. This makes it easier for you to see any ticks that may get on you.
• Tuck shirt into pants and pants into socks. Wear a hat and enclosed shoes. This makes it more difficult for ticks to get onto your skin.
• Put your clothes in the dryer for about 20 minutes after spending time outdoors. This will kill any unseen ticks.

Use Insect Repellent

Apply insect repellent containing DEET to clothes and exposed skin. Carefully follow directions for use. Insect repellents containing permethrin can be applied to pants, socks, and shoes. When you return inside, wash repellents off your skin.

Check for and Remove Ticks

The tick usually must be attached to your skin for at least 24-48 hours for the bacteria to get into your bloodstream. To ensure quick removal of any attached ticks you should:

• Do frequent tick checks, including a naked, full body exam when returning from the outdoors.
• If you find any ticks, do the following:

• With fine-point tweezers, grab the tick at the place where it is attached, next to the skin.
• Gently pull the tick straight out.
• Save the tick in a small vial and mark the date.
• Wash your hands and clean the tweezers with alcohol.
• Report the bite to your doctor.
• Watch carefully for any signs of Lyme disease, especially a rash at the site of the bite and/or fever; symptoms usually appear within 30 days of the bite.

Preventive Antibiotics

Doctors vary in their recommendations concerning taking preventive antibiotics following a tick bite. Antibiotic treatment given within 72 hours of a tick bite has been shown to significantly reduce the likelihood of developing Lyme disease. If bitten by a tick, you should check with your doctor to see if taking one or more doses of antibiotic is appropriate for you.

American Lyme Disease Foundation

Address:

American Lyme Disease Foundation, Inc.
PO Box 466
Lyme, CT 06371

E-mail Address:

inquire@aldf.com

Internet address:

http://www.aldf.com/

Description of Services Provided:

This site provides a thorough review of Lyme disease, including symptoms, treatment, and vaccines. Some of their information is available in Spanish.

The Centers for Disease Control and Prevention

Address:

Centers for Disease Control and Prevention
1600 Clifton Rd.
Atlanta, GA 30333,

Phone:

(404) 639-3311
(404) 639-3534
(800) 311-3435

Internet address:

http://www.cdc.gov/

Description of Services Provided:

Among their "Health Topics A to Z," the CDC offers reliable information on Lyme disease. Included are photos of actual ticks and a map of the US showing where the disease is most prevalent.

Infectious Diseases Society of America (IDSA)

Address:

1300 Wilson Boulevard, Suite 300
Arlington, VA 22209

Phone:

(703) 299-0200

Internet address:

http://www.idsociety.org/default.aspx/

Description of Services Provided:

The IDSA is an organization for doctors, scientists, and other healthcare professionals who specialize in infectious diseases. The public can access fact sheets and press releases on Lyme disease.

Spiro Chicks

Internet address

http://www.spirochicks.com/

Description of Services Provided:

Patient community of shared experiences and guidance.

References:

Frequently asked questions. American Lyme Disease Foundation website. Available at: http://www.aldf.com/faq.shtml . Accessed October 5, 2008.

Lyme disease. Lyme Disease Foundation website. Available at: http://www.lyme.org/otherdis/ld.html . Accessed October 5, 2008.

Lyme disease. National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/lymeDisease/ . Accessed October 5, 2008.

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

General Screening Guidelines

At this time, routine screening for Lyme disease is not recommended if you have no symptoms.

The following diagnostic tests may be used in certain situations, such as when a person has no symptoms, but has had an attached tick for some length of time (48 hours or more).

Diagnostic Tests

Antibody Tests

Antibodies are the body’s defense against an infection. If you have been infected with the Lyme disease bacteria, your body will make specific antibodies to fight it. It takes about four weeks or more for these antibodies to become detectable. Examples include:

• Antibody titer (ELISA or IFA)—This test measures the level of Lyme disease antibodies in the blood.
• Western blot —This test detects the presence of specific antibodies to Lyme disease in the blood and supports the ELISA test results

Both of these tests can have false negative results (the test is negative even though you are infected) or false positive results (the test is positive even though you are not infected).

Some reasons why false negatives may occur include:

• The test is performed too soon after infection.
• Too few or no antibodies are made.
• The test is performed incorrectly.

Some reasons why false positives may occur include:

• The test is performed incorrectly.
• Your immune system produces unrelated antibodies, which appear to the test as if they were produced in response to Lyme disease.

Direct Detection Tests

These tests look directly for the bacteria, or pieces of it, in the blood and other fluids of the body, such as urine and spinal fluid. Two main types are:

• Antigen detection tests—These look for a unique protein from the Lyme disease bacteria that may be in body fluids. This test is useful for detecting Lyme disease in certain situations, such as:

• If you are taking antibiotics
• During a later flare-up of symptoms
• Polymerase Chain Reaction (PCR)—This test can multiply the number of pieces of the bacteria in the test fluid, making it easier to detect.

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with Lyme disease. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

• Bring someone else with you. It helps to have another person hear what is said and ask questions that you have not thought to ask.
• Write out your questions ahead of time, so you don't forget them.
• Write down the answers you get. Ask for clarification, if necessary.
• Don't be afraid to ask questions or to learn where you can find more information about your condition. You have a right to know.

Specific Questions to Ask Your Doctor

About Lyme disease

• What is Lyme disease?

• How do you get Lyme disease?

• What does a tick that carries Lyme disease look like?

• What should I do if I get a tick on me?

• How do I safely remove a tick if I find one?

• Can you test the tick to see if it carries Lyme disease?

About Your Risk for Developing Lyme Disease

• Based on my medical history and lifestyle, am I at risk for Lyme disease?

• How do I best prevent Lyme disease?

• How do I know if I might have Lyme disease?

• Is there a test for Lyme disease?

About Treatment Options

• How do I best treat Lyme disease?

• What medications are available to help me?

• What are the benefits/side effects of these medications?

• Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements that I am already taking for other conditions?

• Will the medications cure me of the disease?

• Are there any alternative or complementary therapies that will help me?

About Lifestyle Changes

• Can I continue my regular activities?

• What can I do to prevent being bitten by a tick?

About Outlook

• How do I know that my prevention or treatment program is effective?

• Once I am treated, can Lyme disease come back?

• Is Lyme disease contagious?

• Can I get it again if another tick bites me?