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Lyme disease in Vermont.


Lyme disease is an infection caused by spirochetes called Borrelia burgdorferi. The infection is transmitted by the bite of black-legged ticks (Ixodes scapularis), known as deer ticks, and western black-legged ticks (Ixodes pacificus). Lyme disease, which can affect the skin, heart, nerves, or joints, is an infection that can be cured with antibiotic therapy.


There are three stages of Lyme disease: early, early disseminated and late Lyme disease.

Symptoms--First Stage

The first stage of Lyme disease is called early Lyme disease. Early Lyme disease usually causes one or more of the following symptoms that occur days to weeks after infection:

* fatigue,

* chills and fever,

* muscle and joint pain,

* headache,

* swollen lymph nodes,

* Erythema migrans

Erythema migrans is the skin rash associated with Lyme disease. This is an expanding rash which usually appears at or near the site of the tick bite. It may appear anywhere from three days to one month after the infected tick's bite, but it usually appears in about seven to 14 days.

The center of the rash may clear as it grows, giving it the appearance of a bull's-eye. The rash may be warm, but it is usually not painful.

The erythema migrans type of skin rash is different from a rash that appears as an allergic reaction to a tick or insect bite.

Symptoms--Second Stage

The second stage of Lyme disease is known as early disseminated Lyme disease, which means that the infection is beginning to spread and is affecting certain body functions. This stage occurs weeks to months after the bite of an infected tick. Problems can include:

* Numbness and pain in arms or legs

* Paralysis of facial muscles (usually on one side of the face)

* Meningitis--fever, stiff neck, and severe headaches

* Abnormal heart beat (rare)

Symptoms--Third Stage

The third stage of Lyme disease is called late disseminated Lyme disease. This stage can occur weeks, months, or even years after infection in untreated patients. Patients with late Lyme disease may get:

* Chronic Lyme arthritis--brief bouts of pain and swelling usually occurring in one or more of the large joints, especially the knees

* Nervous system problems, including memory loss and difficulty concentrating

* Chronic pain in muscles and/or unrestful sleep


The spirochetes enter the body when an infected tick attaches to the skin to take a blood meal. In order to transmit Lyme disease, the infected tick must be attached for 24 to 72 hours.

Not all types of ticks carry Lyme disease. In the eastern United States, the black-legged tick is mainly responsible for transmitting the disease. However, not all black-legged ticks carry the spirochete that causes Lyme disease. Most cases of Lyme disease occur in a few highly affected areas.

A history of a known tick bite will help the doctor to know if Lyme disease caused the current symptoms. However, most people with Lyme disease do not remember being bitten by a tick.

Black-legged ticks are tiny and often go unnoticed. For example, nymphal black-legged ticks, the most common transmitters of Lyme disease, are often about 2mm (see photo--from left to right: adult female, adult male, nymph, larvae. Not to scale. (scale in cm)).


Black-legged ticks live in wooded, brushy and grassy places, including lawns and gardens. Individuals at greatest risk are those who spend time out-of-doors in areas that are highly affected by Lyme disease. A person is more likely to get the disease during the spring and summer because a lot of time is spent outside, often with large amounts of skin exposed.


Early treatment of Lyme disease involves antibiotics and almost always results in a full cure. However, the chances of a complete cure decrease if treatment is delayed.


While outdoors, a few simple precautions can reduce your chance of being bitten:

* Wear long pants and long-sleeved shirts to minimize skin exposure to ticks.

* Tuck your pants into your socks to form a barrier to tick attachment.

* Wear light-colored clothing to make ticks on your clothing easier to see.

* Check for ticks, looking particularly for what may look like nothing more than a new freckle or speck of dirt.

* Use tick and insect repellents containing DEET or permethrin to help protect against Lyme disease. DEET-containing preparations should be used sparingly, not applied to face or hands, and should not exceed 10% concentrations for children over 3 years of age and 30% for adults. DEET should not be used on infants or children under age 3 without first consulting your health care provider. Follow the label instructions carefully.

For more information about Lyme disease, call the Vermont Department of Health, Epidemiology Field Unit, 800-640-4374 or 863-7240. You may also visit the VT Department of Health's website:

Submitted by The Vermont Department of Health
COPYRIGHT 2007 Vermont State Nurses Association, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

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Publication:Vermont Nurse Connection
Article Type:Disease/Disorder overview
Geographic Code:1U1VT
Date:Aug 1, 2007
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