Lyme Disease

Infection with Lyme disease is directly related to exposure to habitats where infected ticks are present. 

In the United States, most infections occur in the following areas:

• Eastern states, primarily New England and the mid-Atlantic
• Northern midwestern states, especially in Wisconsin, Minnesota, and the Great Lakes region
• West Coast, mainly northern California and, less commonly, Oregon and Washington 

Ticks that transmit Lyme disease thrive in wooded and grassy areas, as well as in shrubs and leaf litter. They are often found in places where humans come into contact with their habitats, such as forests, parks, gardens, and even suburban areas with grassy lawns. Ticks can attach themselves to humans and animals when they brush against vegetation or walk through tick-infested areas.

It's worth noting that not all ticks carry the Lyme disease bacterium, and the risk of contracting the disease may vary depending on the location and the prevalence of infected ticks in a particular area. However, it is still important to be cautious and take preventive measures when spending time in tick-prone regions.

Although Lyme disease is not as common in Georgia, local cases are reported yearly.

Lyme disease is primarily spread through the bite of infected ticks. The ticks responsible for transmitting Lyme disease are typically black-legged ticks, also known as deer ticks, in North America. These ticks become infected with the bacterium Borrelia burgdorferi when they feed on infected animals, such as mice, birds, or deer.

When an infected tick bites a human, it transfers the bacteria into the bloodstream. It's important to note that not all tick bites result in Lyme disease. In fact, transmission of the bacterium typically requires the tick to be attached and feeding for at least 24 to 48 hours.

It's worth noting that Lyme disease is not directly spread from person to person. It requires the bite of an infected tick to transmit the bacterium. Therefore, you cannot contract Lyme disease from touching or being in close proximity to someone who has the disease.

Taking preventive measures to reduce exposure to ticks is crucial in lowering the risk of Lyme disease. This includes wearing protective clothing (long sleeves, long pants, and closed-toe shoes), using insect repellents, avoiding tick-infested areas when possible, and conducting thorough tick checks after spending time outdoors in tick-prone regions.

The symptoms of Lyme disease can vary from person to person and can occur in different stages. The signs and symptoms of Lyme disease are often non-specific and can overlap with other conditions, which can sometimes make diagnosis challenging. Here are the typical symptoms associated with Lyme disease:

1. Early Localized Stage:
   • Erythema migrans: This is the most common early symptom and occurs in about 70-80% of cases. It is a characteristic rash that often appears as a red bull's-eye or target-shaped rash at the site of the tick bite. The rash expands over time and is usually not itchy or painful.
2. Early Disseminated Stage:
   • Flu-like symptoms: Fever, chills, fatigue, headache, muscle aches, and swollen lymph nodes.
   • Multiple erythema migrans rashes: Instead of just one rash, multiple rashes can appear on different areas of the body.
   • Neurological symptoms: Some individuals may experience neurological issues such as facial paralysis (Bell's palsy), meningitis (headache, neck stiffness, sensitivity to light), or radiculopathy (pain, numbness, or weakness in the limbs).
   • Heart problems: Rarely, Lyme disease can cause heart palpitations, irregular heartbeat, or inflammation of the heart muscle.
3. Late Persistent Stage:
   • Joint pain and swelling: The most common symptom in this stage is intermittent or chronic joint pain, particularly in the larger joints such as the knees.
   • Neurological symptoms: Some individuals may develop memory problems, cognitive difficulties, tingling or numbness in the hands or feet, and sleep disturbances.
   • Fatigue: Profound fatigue and general malaise can persist.

It's important to note that not all individuals will experience every symptom, and the severity of symptoms can vary. If you suspect you may have Lyme disease or have been bitten by a tick and are experiencing symptoms, it is important to seek medical attention for proper diagnosis and treatment. Early detection and treatment can help prevent the disease from progressing to more severe stages.

Lyme disease is diagnosed based on a combination of clinical symptoms, medical history, and laboratory tests. The diagnostic process for Lyme disease typically involves the following steps:

1. Evaluation of Symptoms and Medical History: A healthcare provider will review your symptoms and ask about potential exposure to ticks or tick-prone areas. It is essential to provide accurate information about any tick bites, the appearance of a rash, and the onset of symptoms.
2. Physical Examination: The healthcare provider will perform a physical examination to assess your symptoms, including checking for any characteristic rashes or signs of infection.
3. Laboratory Tests:
   • Serologic Testing: The most commonly used laboratory tests for Lyme disease are serologic tests that detect antibodies produced by the immune system in response to the infection. These tests include enzyme immunoassay (EIA) and Western blot tests. However, these tests may not be reliable in the early stages of the disease as it takes time for the body to produce detectable levels of antibodies.
   • Polymerase Chain Reaction (PCR): In some cases, PCR testing may be used to detect the presence of the Lyme disease bacterium in a sample of body fluid, such as blood or cerebrospinal fluid (CSF). This test is most useful in the early stages of the disease when the bacteria may still be present in the bloodstream.
   • Other Tests: In certain cases, additional tests such as joint fluid analysis or imaging studies may be performed to evaluate joint inflammation or complications involving the nervous system or heart.

It's important to note that laboratory testing is used to support clinical diagnosis and is not always definitive. Interpretation of test results can be challenging, and false-negative or false-positive results can occur. A healthcare provider with experience in diagnosing and treating Lyme disease is best equipped to evaluate the clinical picture and test results to make an accurate diagnosis.

If you suspect you may have Lyme disease, it is important to consult with a healthcare professional who can assess your symptoms, consider your medical history, and order appropriate laboratory tests if necessary. Early diagnosis and treatment are crucial in managing Lyme disease effectively.

Lyme disease is typically treated with antibiotics. The specific antibiotic prescribed, as well as the duration of treatment, will depend on the stage of the disease and individual factors. The goals of treatment are to eliminate the infection, relieve symptoms, and prevent complications. People treated with antibiotics during early Lyme disease stages usually recover rapidly and completely. The antibiotics most commonly used to treat Lyme disease include doxycycline, amoxicillin, or cefuroxime axetil. Some patients may have persistent or recurrent symptoms and may require another course of antibiotics.

It's important to complete the full course of antibiotics as prescribed, even if symptoms improve before the treatment is finished. This ensures that the infection is fully eradicated and reduces the risk of recurrent or persistent symptoms.

Recent studies have examined the value of giving antibiotics to prevent Lyme disease after a known tick bite. While giving antibiotics for all tick bites is not always advised, it may be beneficial in some cases. Ask your healthcare provider if antibiotics after a tick bite are appropriate for you.

It's essential to consult with a healthcare professional for proper diagnosis and treatment of Lyme disease. Early detection and treatment are important in preventing the disease from progressing to more severe stages and minimizing potential complications.

Post-treatment Lyme disease syndrome (PTLDS), also known as chronic Lyme disease, refers to a condition where individuals continue to experience symptoms after completing the recommended treatment for Lyme disease. PTLDS is characterized by a range of persistent symptoms that can last for months to years, even after the infection has been treated.

The exact cause of PTLDS and patients' susceptibility is not fully understood. It is believed to result from a combination of factors, including residual damage from the initial infection, an ongoing immune response, and possible factors related to the individual's overall health and immune system.

Unfortunately, there is no proven treatment for PTLDS and long-term antibiotic treatments are documented to have caused serious (and sometimes deadly) complications. Management of PTLDS focuses on reducing symptoms and improving quality of life. Patients with PTLDS usually get better over time, but it can take many months to feel completely well.

If you have been treated for Lyme disease and still feel unwell, see your healthcare provider to discuss additional options for managing your symptoms.

Limiting exposure to ticks is the best way to prevent tick‐borne disease. When spending time outdoors in places where contact with ticks may occur, take the following precautions:

• Wear light‐colored clothing so that crawling ticks can be easily seen. 
• Wear pants and long sleeves to reduce skin exposure to ticks.
• Tuck pants into socks and shirts into pants to prevent ticks from crawling up pants legs.
• Apply insect repellent containing DEET to exposed skin and permethrin to clothing.
• After spending time outdoors, thoroughly inspect your body for crawling or attached ticks. Pay particular attention to the head and scalp, as ticks may be hidden in the hair. 
• Populations of ticks may be effectively controlled with pesticides along trails and by keeping the grass mowed.

The Georgia Department of Public Health tracks and monitors cases of tickborne diseases, including Lyme disease, through passive surveillance systems, which rely on healthcare providers to submit laboratory results and medical records for review. 

Georgia Data

From 2019 to 2023, 136 cases of Lyme disease were reported in Georgia residents. However, some of these cases may have been acquired out of state. In 2021, Georgia's incidence was calculated as 0.33 cases per 100,000 population, making it a low-incidence jurisdiction for Lyme disease.

Case Surveillance

What is Case Surveillance? (CSTE) [external link]

NOTE: Disease surveillance systems primarily count cases based on the patient's residential location rather than the specific exposure location.

Answer adapted from https://www.cdc.gov/lyme/stats/humancases.html 

There is no way of knowing exactly how many people get Lyme disease.

Approximately 35,000 Lyme disease cases are reported to the CDC annually. This number is based on the passive reporting system in which state and local health departments report cases of Lyme disease. One criticism of this reporting system is that it relies on busy healthcare providers to submit records (including laboratory results), so many cases are not reported. Therefore, this number is considered an underestimate of Lyme disease cases.

Alternatively, one study based on insurance records showed that approximately 476,000 Americans are diagnosed and treated for Lyme disease each year. This number may be inflated because patients are sometimes treated presumptively (i.e., before or without a positive laboratory result) in medical practice.

Both of these estimates indicate a large burden on the healthcare system and the need for more effective prevention measures.

If you believe you have Lyme disease, please consult your physician to screen for risk factors and begin treatment, if appropriate. Additional information for healthcare providers can be found on the CDC’s Lyme Disease website (https://www.cdc.gov/lyme/healthcare/index.html). For information on local surveillance, please visit https://dph.georgia.gov/epidemiology/zvbd/tick-borne-diseases or contact the Georgia Department of Public Health, Epidemiology Section at 404-657-2588 and ask to speak to the Vectorborne Disease Team.