Primary Lyme disease, a flu-like illness with fever, chills, and muscle aches, occurs in about 50% of those infected. If untreated, the disease may progress to secondary and tertiary stages.

Risk factors include recent tick bite or recent outdoor activities in endemic (high risk) areas. Approximately 16,000 people are affected annually in the United States. See also Lyme disease.

• a flat or slightly raised red lesion at the site of the tick bite
• expansion of the red lesion (rash) to several inches over several days. The rash usually will clear in the center, creating an annular rash, looking somewhat like a bull's eye.
• fever
• headache
• lethargy
• muscle pains and aches
• joint aches
• swollen glands, either near the rash or all over the body

• ELISA or Western blot may show antibodies to Borrelia burgdorferi. This test is usually not positive in the first few weeks after the tick bite, so it is often not accurate early in the disease.
• A skin biopsy can sometimes show the organism.

The objective of treatment is to eliminate the infection by antibiotic therapy, and prevent secondary or tertiary infection. Medications include: doxycycline, tetracycline, cefuroxime, or amoxicillin in children.

Note: Oral tetracycline is usually not prescribed for children until after all the permanent teeth have erupted. It can permanently discolor teeth that are still forming.

The signs and symptoms usually resolve in 3 to 4 weeks, even without treatment. With treatment, all signs and symptoms should resolve completely. The secondary or tertiary form of the disease may develop if the initial infection is not treated.

Neurological or cardiac symptoms may develop in the second stage of the disease, followed by arthritis and brain or nerve damage in the third stage of the disease.

• secondary Lyme disease
• tertiary Lyme disease
• can have co-infection with ehrlichiosis or babesiosis

Call for an appointment with your health care provider if you exhibit symptoms of Lyme disease, particularly if you could have been exposed to ticks.

Call your health care provider if sensory or muscular weakness, numbness or tingling, or heart irregularities develop.

Ticks will show up on white or light colors better than dark colors, making them easier to remove from clothing. Remove ticks immediately by using a tweezers, pulling carefully and steadily. Insect repellent may be helpful. Check pets for ticks also.