A tick must be attached for at least 24 h to transmit the spirochete. Tick engorgement and attachment for 72 h are predictors of subsequent human infection. Ixodes ticks in the northeastern and midwestern United States belong to the Ixodes dammini (scapularis) species, in the western United States to Ixodes pacificus, in Europe to Ixodes ricinus, and in Asia to Ixodes persulcatus. Rodents and small mammals are the natural hosts of the larval and nymphal stages.

The incidence of Lyme disease reflects a changing dynamic between the principal reservoir, the white-footed mouse, its food supply, and the suitability of its local habitat. Deer, horses, dogs, and other larger mammals and birds may be occasional hosts to the adult ticks. Most cases have their onset during summer and occur in association with hiking, camping, and residence in wooded, rural, or coastal areas.

Infection can be treated by taking certain antibiotics. However, no immunity is conferred from infection so a person could get Lymedisease again from another infected tick.

Pets and other animals can contract Lymedisease as well, exhibiting symptoms similar to those in humans. Veterinarians can test for Lyme disease in pets and domestic animals exhibiting suspicious signs of arthritis (in younger animals), heart problems, or neurological signs.

Early Symptomps of Lyme Disease
Early symptoms of Lyme disease appear 3 to 32 days after the bite of an infected tick which was attached for at least 24 hours.

Most people with Lyme disease will get a rash called “erythema migrans” where they were bitten. The rash starts as a small red round area, which usually gets bigger and can reach two or more inches across. The center of the rash may clear giving a “bull’s eye” appearance.

Other symptoms during the early stage of Lyme disease include:

• Chills
• Fever
• Headache
• Tiredness
• Stiff neck
• Joint pain
• Swollen lymph nodes
• Rash that spreads to other parts of the body

Early Lyme disease is usually curable using antibiotics that your health care provider can prescribe. Without treatment, the disease may progress to arthritis, meningitis, facial nerve paralysis, or hearing abnormalities. The later symptoms may occur in people who did not recognize early symptoms. Swelling and joint pain may recur over many years.

If you have had a tick attached for more than 24 hours, any of these symptoms, or think you have Lyme disease, promptly check with your medical care provider.

Lyme Disease Signs and Symptoms
B burgdorferi infection caused lyme disease can involve the skin, musculoskeletal system, CNS, and cardiac tissues .

• Skin. EM appears at the site of the tick bite 3-30 days after the bite and begins as a red macule or papule with areas of redness that expand with partial central clearing. The lesion often feels warm to hot; it may burn, prickle, or itch, and it is more common in the thigh, groin, and axilla. The lesion usually fades within 3-4 weeks (range, 1 day-14 months). The migratory nature of skin lesions most likely represents spirochetemia with secondary seeding of the skin rather than multiple tick bites. EM may be accompanied by fatigue, fever, chills, achiness, headache, and lymphadenopathy. It can also present with CNS and liver involvement. Multiple annular secondary lesions tend to be smaller and less migratory and to lack indurated centers. Acrodermatitis chronica atrophicans lesions follow years after EM. There is usually bluish-red discoloration, and then the lesion becomes sclerotic or atrophic. This condition has been associated with elevated antibodies to B burgdorferi and usually responds to antibiotic therapy; it is seen primarily in elderly women in Europe.
• Musculoskeletal system. Joint symptoms are the second most common clinical manifestation after EM. These symptoms may begin 5-6 weeks (range, 1 week to 2 years) after the bite, and they include, at one end of the spectrum, subjective joint pain, and at the other, arthritis or chronic erosive synovitis. The arthritis is usually of sudden onset, monoarticular or oligoarticular, and migratory. The knee is the most frequently involved joint, followed by the shoulder, elbow, temporomandibular joint, ankle, wrist, and hip. Initially, recurrent attacks of arthritis are common, but their frequency decreases by 10-20% each year. During recurrences, usually more joints are involved than in the initial episode. These attacks last ~ 1 week, with intervals of 1 week to 2 years between attacks. Joint fluid leukocyte counts range from 500 to 110,000 cells/mm3. Of all patients with Lyme disease, ~ 10% develop a severe chronic erosive arthritis often associated with IgG antibody response to OSPs A and B of the organism and with human leukocyte antigen DR4.
• CNS. Neurologic abnormalities begin within 4 weeks (range, 2-11 weeks) after the tick bite. The most common symptoms are headache, stiff neck, photophobia, facial palsy, and peripheral nerve paresthesias. CSF findings are similar to those seen in viral meningitis with lymphocytic pleocytosis of ~ 100 cells/mm3 and elevated protein levels. Cranial nerve VII is the most frequently involved; unilateral or bilateral facial palsies occur in 11% of patients, and these findings can be seen in 50% of patients with meningitis. Other cranial nerves, particularly III, IV, V, and VIII, are less often involved. Months to years after the initial infection, patients may have chronic encephalopathy (manifested by memory impairment, mood changes, sleep disturbances, and difficulty with concentration), polyneuropathy, or, less commonly, leukoencephalitis. These patients may present with neuropsychiatric symptoms, focal CNS disease, or severe fatigue. However, it is often difficult to establish B burgdorferi as the etiologic agent in patients who present with fatigue or psychiatric manifestations.
• Cardiac tissue. Cardiac involvement begins within 5 weeks (range, 3-21 weeks) after the bite, in ~ 5-10% of patients. Such abnormalities usually consist of atrioventricular block (first degree, Wenckebach, or complete heart block) and can last for 3 days-6 weeks. Some patients can present with myopericarditis, pericardial effusion, and chronic cardiomyopathy.
• Other clinical findings. Other unusual manifestations include ophthalmologic involvement (conjunctivitis, keratitis, uveitis, choroiditis, retinal detachments, and optic neuritis), hepatitis, myositis, dermatomyositis, eosinophilic lymphadenitis, and adult respiratory distress syndrome.
• Congenital infection. Maternal-fetal transmission of B burgdorferi has been reported with adverse fetal and neonatal outcome in a few cases (congenital heart disease, encephalitis, cortical blindness, intrauterine fetal death, and premature birth). Of note, a prospective study found no association between congenital malformation and infection by B burgdorferi. Despite the fact that there is no definitive proof that B burgdorferi causes fetal damage or an adverse outcome in the offspring, prompt diagnosis in the mother and treatment should be emphasized.

Most patients with B burgdorferi are found to have detectable antibodies when tested with enzyme-linked immunosorbent assay (60-70% within 2-4 weeks of infection and 90% by the disseminated and persistent stages). However, serologic tests lack standardization, their accuracy is often unsubstantiated, and false-positive results are common. IgM antibody appears 2-4 weeks after the EM lesion, peaks at 6-8 weeks, and declines after 4-6 months. IgG antibody appears 6-8 weeks after the EM lesion, peaks at 4-6 months, and remains at low levels despite antibiotic therapy. A fourfold rise in antibody titer would be suggestive of recent infection. Western blot analysis is used to confirm results obtained by enzyme-linked immunosorbent assay.

The finding that a patient has significant amounts of anti-B burgdorferi-specific antibodies can be interpreted only in the context of the clinical setting. Demonstrating that a patient has an immune response against this organism does not mean that the patient is actively infected or that any symptoms are necessarily related to B burgdorferi infection. Detection of spirochetal DNA by PCR is useful in synovial fluid (75-85% of sensitivity). However, the sensitivity of PCR in CSF, blood, or urine samples has not been well established.

Who gets Lyme disease ?
Anyone who is bitten by a tick carrying the bacteria can get Lyme disease. Proper removal of a biting tick from the skin within 48 hours of being bitten can reduce the risk of disease transmission.
How is Lyme disease spread ?
The spirochete which causes Lyme disease, Borrelia burgdorferi, is transmitted to humans by the bite of an infected tick, which is a “vector” for the disease. The principal vector of Lyme disease in New Jersey is the deer tick, also called the black-legged tick. Immature ticks become infected by feeding on infected white-footed mice and other small mammals, such as deer and meadow voles. Deer ticks can also transmit the organisms that cause babesiosis and ehrlichiosis. Humans can get infected with more than one tick-borne disease at the same time.

What are the symptoms of Lyme disease ?
Within days to weeks following a tick bite, 60-80% of persons becoming infected will have a red, slowly expanding “bulls-eye” rash (called erythema migrans), accompanied by general tiredness, fever, headache, stiff neck, muscle aches, and joint pain. If untreated, weeks to months later some people may develop arthritis, including intermittent episodes of swelling and pain in the large joints; neurologic abnormalities, such as aseptic meningitis, facial palsy, motor and sensory nerve inflammation (radiculoneuritis) and inflammation of the brain (encephalitis); and, rarely, cardiac problems, such as atrioventricular block, acute inflammation of the tissues surrounding the heart (myopericarditis) or enlarged heart (cardiomegaly).

How soon do symptoms occur ?
The red “bull’s-eye” rash (erythema migrans) usually appears 7 to 14 days following the tick bite. Some patients present with later manifestations without having had early signs of disease.

How is Lyme disease diagnosed ?
A two-step process is the recommended method for making a diagnosis of Lyme disease. A Lyme disease diagnosis should be based on clinical findings, supported by a series of laboratory tests. An enzyme-linked immunosorbent assay (ELISA), or an indirect fluorescent antibody (IFA), test is usually performed first. If the result of this test is equivocal (uncertain) or positive, a more specific Western immunoblot (WB) test should be performed to confirm the results obtained with the first test. B. burgdoferi can also be grown in culture from clinical specimens; however, this test is often difficult to perform. Polymerase chain reaction (PCR) tests have been used to amplify the DNA of B. burgdoferi in skin, blood, and cerebrospinal and synovial fluids, but this type of testing has not been standardized for the routine diagnosis of Lyme disease.

What is the treatment for Lyme disease ?
Antibiotic therapy for 3-4 weeks is generally effective in early Lyme disease. Later disease manifestations may require intravenous antibiotic therapy for 4 or more weeks. Amoxicillin and doxycycline are two common antibiotics recommended for treatment.

How long is an infected person infectious to others ?
Lyme disease is spread only by the bite of an infected tick. Infected individuals cannot spread the disease to other people.

How can Lyme disease be prevented ?
You can reduce your risk by taking these precautions to avoid tick bites, or to safely remove a tick if you are bitten:
Avoid wooded areas with dense shrubs and leaf litter, where ticks like to hide.
Make your yard less attractive to ticks: mow lawns and prune trees.
Wear solid, light colored clothing with pants tucked into socks. This will help prevent a tick from attaching to your skin and will also make sighting a tick on clothing easier.
Use insect repellents on yourself and your pets. Two types of repellents that are effective for ticks are those containing DEET for use on clothes and exposed skin, and permethrin for use on clothes only. Read label directions carefully.
Examine yourself frequently for ticks while in tick-infested areas.
Perform a full-body exam on yourself, children, and pets after leaving tick habitat.
Remove attached ticks promptly.
Use fine-pointed tweezers:
Grasp the tick’s mouth parts close to the skin.
Apply steady outward pressure.
Do not use petroleum jelly, noxious chemicals, or hot objects to remove ticks. Improper removal can increase the chances of infection.

It is important to note that a different, but similar disease occurs in Florida and this disease is often confused with Lyme disease. Southern Tick-associated Rash Illness is caused by Borrelia lonestari and vectored by the lone star tick, Amblyomma americanum. This disease was first reported in 2001 and occurs wherever lone star ticks are found. Similar to Lyme disease, a red, expanding rash with a central clear area at the site of the tick bite has been reported.

In severe cases of chronic Lyme arthritis, removal of the lining of the affected joints (synovectomy) may be needed if the arthritis has not responded to antibiotics.