Interestingly, the disease only became apparent in 1975 when two mothers noted that a group of children who lived near each other in Lyme, Connecticut, made researchers at Yale University aware that their children had all been diagnosed with joint pain and swelling from juvenile rheumatoid arthritis. This unusual grouping of illnesses was first called Lyme arthritis. In 1982 researchers identified the bacteria that causes this condition and it was renamed Lyme disease, as it was clear that arthritis was only one of its many symptoms. The primary vectors for Lyme disease in the U.S. are the black-legged tick, or deer tick, known as Ixodes scapularis or Ixodes pacificus on the west coast. These ticks are carriers of the Lyme disease spirochete in their stomachs; Ixodes ticks may also transmit, Babesiosis, Anaplasmosis, Powassan virus, and Borrelia miyamotoi among others. The number of cases of tick-borne illness in an area depends on the number of ticks present and how often the ticks are infected with the bacteria. In certain areas of New York, where Lyme disease is common, over half of the ticks are infected. Lyme disease has been reported in all 50 states, as well as China, Europe, Japan, Australia, and parts of the former Soviet Union. In the United States, it is primarily contracted in the Northeast and Mid-Atlantic, from Maine to Maryland, in the Midwest in Minnesota and Wisconsin, and in the West in Oregon and Northern California.

Lyme disease bacteria is only carried by certain ticks, (with multiple names - the Lyme tick, the deer tick, the blacklegged tick, (Ixodes scapularis in the northeastern, mid-Atlantic, and north-central US & ixodes pacificus on the west coast). Not all deer ticks are infected with the Lyme disease bacteria; about 40% of deer ticks in Connecticut carry the Lyme bacteria and many other states have a lower rate of infection. The deer tick may not only carry Lyme disease but may carry other disease including anaplasmosis, babesiosis, Powassan virus, Borrelia miyamotoi and Borrelia mayonii infection.

Dog ticks/wood ticks do not carry the Lyme disease germ, but they can carry the bacteria that causes Rocky Mountain Spotted Fever.

The lone star tick may carry and transmit ehrlichiosis.

• Lyme disease occurs in all age groups, most frequently in children 5-14 years of age and adults 40-50 years of age.

• The most substantial risk factor for Lyme disease is exposure to the ticks located in the high-risk areas of the country, particularly in the New England area, the upper East coast states, as well as Minnesota, Wisconsin, and California.

• Additional risk factors include recreational and occupational exposure to ticks and outdoor activities, including gardening, in woods, and fields in the high-risk areas.

• Duration of tick attachment is very important; if the tick is attached for less than 36 hours the risk of Lyme disease is extremely low.

• Proper tick identification is critical; if it’s not a Lyme tick, it does not carry Lyme disease! https://web.uri.edu/tickencounter/fieldguide/id-guide/

• The season of the year is also important – most Lyme disease cases occur in the spring, summer, and fall; in areas with cold winters, Lyme ticks are usually inactive when temperatures are below 40 degrees F.

• The use of skin protection is also an important factor – DEET containing repellants in the concentration of 20-30% are very effective but should not be used on the skin of infants and small children. Do not use products that are > 30% DEET. Repellants containing permethrin are extremely effective but SHOULD ONLY BE USED ON CLOTHING and not on skin.

• Tick checks after outdoor activity are very important, since early (<36 hours) removal of ticks prevents almost all Lyme disease.

Lyme disease affects different areas of the body in varying degrees as it progresses. The site where the tick attaches to the skin is where the bacteria enter the body. Days to weeks later, as the bacteria spread in the skin, from the site of the bite, the tick-borne infection causes an expanding reddish rash that is often associated with "flu-like" symptoms. If not properly treated early on, it can progress and cause infection primarily in the joints, heart, and nervous system but also in other organs.

Lyme disease is medically described in three stages:

• Early localized Lyme disease - an erythema migrans rash in 80% of people, usually occurring in the first 4 weeks after a tick bite.

• Early disseminated Lyme disease with multiple Lyme rashes, heart, or nervous system involvement, including facial palsies and meningitis, usually occurring in the 4-8 weeks after a tick bite.

• Late Lyme disease, usually occurs 2-12 months after the initial infection. Areas most commonly involved include single large joint arthritis (knee most frequent); Central nervous system or peripheral nerve involvement; less common symptoms may also occur – including eye or other organ involvement.

Doctors involved in the treatment of Lyme disease include primary care physicians (including pediatricians, family medicine doctors, and internists), as well as specialists in infectious disease, cardiology, rheumatology, and neurology.

In early Lyme disease, if a patient has the erythema migrans rash (Lyme rash) with no other symptoms, no blood tests need to be done, especially in regions in which Lyme disease is common. In fact, more than 50% of patients with Lyme disease rash will have negative blood test results in the first two weeks.

When Lyme disease is suspected, Lyme blood testing is helpful in patients who have symptoms compatible with Lyme disease, who had a history of a tick bite at least 3-4 weeks prior, or who have unexplained disorders of the heart, joints, or nervous system that are characteristic of Lyme disease.

It is critical for patients and providers to understand that most “Lyme disease blood tests” do not test for Lyme disease, they test for antibodies. Some are more helpful in early Lyme disease, others in late Lyme disease.

These tests include:

• Lyme disease antibody screen

• Lyme disease IgM and IgG antibodies

• Lyme disease western blots

• Joint fluid PCR tests

• Spinal fluid tests

• Brain MRI scans

• Neuropsychologic testing

On occasion, additional testing for co-infections is performed.