Lyme 101: An Introduction

• Grasp the tick’s mouthparts against the skin, using pointed tweezers.
• Be patient; the long mouthpart is covered with barbs, so removing it can be difficult and time consuming.
• Pull steadily until you can ease the tick out of the skin.
• DO NOT pull back sharply; this may tear the mouthparts from the body of the tick and leave them embedded in the skin.
• If this happens, don’t panic! Embedded mouthparts do not transmit Lyme disease.
• DO NOT squeeze or crush the body of the tick; this may force infected body fluids from the tick into the skin.
• DO NOT apply substances such as petroleum jelly, nail polish, or a lighted match to the tick while it is attached; they may agitate the tick and force more infected fluid into the skin.
• Once you have removed the tick, wash the wound site and your hands with soap and water.
• Observe the bite site over the next two weeks for any signs of an expanding red rash.
• Testing ticks for infection is possible.  Click here if you have a tick you would like to get tested.

Recognizing the Rash
If you are bitten by a tick, a small red bump may appear in a few days to a week, usually at the site of the bite — often in the groin, belt area or behind the knee. This bump may feel warm and tender when touched. If this tick bite has transmitted Lyme disease the redness may expand over the next weeks and form a round or oval red rash, usually bigger than 5 centimeters in size. It may resemble the classic bull’s eye, with a red ring surrounding a clear area and a red center. More often the rash lesion is uniformly red or reddish-blue, is minimally tender and minimally itchy (much less itchy than poison ivy). This rash, called erythema migrans, is a hallmark of Lyme disease and appears in many, but not all infected people.

• If the rash is Lyme disease, it will continue to grow over days or weeks and will not fade in a few days.
• The Lyme rash is often confused with a spider bite.
• Incubation period from tick bite to rash is 3-30 days (usually 3-10 days).
• Lyme disease rash is: (click here for a visual guide)
  – Round or oval, enlarges in size over days/weeks
  – Red, sometimes warm.
  – Usually greater than 2” inches in diameter, often 6-8”
  – Rarely bull’s eye, usually uniformly red
  – Often confused with spider bites

Requesting and Receiving Care

• Diagnosing Lyme Disease
  – Lyme disease is a clinical diagnosis made by a doctor or nurse by examining the patient
  – Acute Lyme disease is not a laboratory diagnosis; a negative Lyme blood test does not exclude Lyme disease.
  – Some people have a flu-like illness and NO rash.
  – Fever, aches, and abrupt severe fatigue can be the main symptoms of acute Lyme.
  – Lyme disease is different from respiratory “cold”.
  – A runny nose and prominent cough are NOT symptoms of acute Lyme disease.

• Fever, chills, fatigue, body aches, swollen glands, and a headache may accompany the rash.
• In some cases, these may be the only symptoms of infection and there is no rash.

Neurological problems

• In some cases, inflammation of the membranes surrounding the brain (meningitis), temporary paralysis of one side of the face (“Bell’s palsy), numbness or weakness in limbs, and impaired muscle movement may occur weeks or months, after an untreated Lyme disease infection.
• Other problems can occur months to years later and include difficulty with short-term memory, migraines, dizziness, ‘brain fog’, poor sleep, lack of verbal fluency, confusion or disorientation, and decreased ability to concentrate.
• Lyme has also been found to mimic several psychiatric disorders.

Joint pain

• Untreated, the infection may cause severe joint pain and swelling from several weeks to months after infection.
• Knees are often affected, but the pain can shift from one joint to another.

Other Symptoms

• Some people experience irregular heartbeat several weeks after infection.
• Eye inflammation, hepatitis, shooting pains, and severe fatigue are also possible.

The earliest stage of Lyme disease occurs at the site of the tick bite. If you do get a Lyme rash, it will get bigger over days or weeks and will not fade over the next few days.  The incubation period from a tick bite to the development of a rash is 3-30 days (usually 3-10 days).

The Lyme rash is red and round or oval and is called erythema migrans. It may have the distinctive bull’s-eye appearance. Often, the rash is uniformly red and usually more than 2” across – often as large as 6-8”. It is sometimes confused with a spider bite.

• The risk of Lyme disease is year round.
• Highest risk late spring to early summer.
• Learn to enjoy the outdoors SAFELY.

Reduce risk

• Stay on marked trails.
• Stay out of tall grass & un-cleared areas of the forest floor.
• Don’t crawl or roll in leaves.
• Low-risk areas are athletic fields or cut lawns.

Inspect for ticks

• Parents should inspect the entire body daily for ticks.
• Shower daily.
• Common sites of attachment: underarm, navel, groin, buttocks.

Repellants, Insecticides, & Protective Clothing

• Use insect repellent such as DEET on the body or Permethrin on clothes.
• Review safety information; assess the risks/benefits of these products.
• Many doctors consider them unsafe for use on children. Do not use on children under 3.
• Use discretion and consult your doctor before using.
• Follow all directions carefully.
• Permethrin is for use on clothing only.
• Wear protective Clothing.
  •  Long sleeves, long pants tucked into socks, & shoes.
  •  Avoid going barefoot or wearing open-toe sandals/shoes.

Choosing an Insect Repellent

To make the most informed risk reduction and health protection decision, look for EPA-registered products that give protection-time information on the label. Make sure the product label tells you:

• Insects it protects against
• Length of time it provides protection
• Names and percentages of active ingredients in the product

The best decisions are made after considering all of this information. It will allow you to make a more informed decision. Protection times on product labels are based upon information submitted to EPA by manufacturers using approved testing methodology. Look for an EPA registration # on the insect label. The Centers for Disease Control and Prevention (CDC) recommend the use of products registered by EPA. This number means the company provided EPA with technical information on the effectiveness of the product against mosquitoes and/or ticks.

For protection over an extended period, use a product with a protection time that fits your level and duration of activity. The length of time you are protected can vary depending on:

• Physical activity/perspiration
• Water exposure
• Air temperature
• Application according to label directions

Re-apply repellent according to label instructions

The label is your guide to using these products safely and effectively.

You may also want to consider non-chemical ways to deter biting insects: window screens or netting, long-sleeve shirts, long pants, and socks.