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Lyme Disease – What, How, When and Prevention


Lyme disease is an illness from a tick bite that has 3 stages.

Lyme disease treatment in Andover, MAEarly localized disease: 3-30 days after a tick bite

  • Large red ring (larger than 2inches across) or bull’s eye (called erythema migrans) that starts at the site of the tick bite and can last 2 weeks to 2 months. It is not itchy or painful and is seen in 80% of infected people.
  • A flu like illness with fever, headache, chills, fatigue, joint and muscle pain lasting a few days.
  • Vomiting, diarrhea, abdominal pain and cold symptoms or cough are not typically seen with lyme disease.

Early disseminated disease: 2-12 weeks after the tick bite

20% of people who did not receive treatment will develop these problems:

  • More diffuse rash, similar but smaller than the primary rash of erythema migrans with a flu-like illness of fever, fatigue, headache, muscle and joint pain.
  • Eye problems, meningitis, and palsies of the facial nerves can be seen with or without a flu-like illness.
  • Carditis (heart problems) such as heart block can be seen.

Late disease: 6 weeks to 2 yr after the tick bite

  • Arthritis, most commonly the knee but can be other large joints.
  • Rarely neurological problems (weakness, numbing/tingling, memory issues)


Lyme disease is often diagnoses based on history and exam as lab testing is not helpful in the first 4 weeks of infection and can be difficult to interpret. It is treated with a 2-4 week course of antibiotics. If you have been treated appropriately in the early stage of Lyme disease you almost never develop the later stages.


Lyme disease is caused by a bacteria which is transmitted by the blacklegged tick (in New England, the deer tick). These ticks are very tiny—often the size of a pinhead and do not fly or jump. Tick bites do not hurt or itch. A tick bite can only lead to Lyme disease if the tick is infected with the bacteria and if the tick has been attached longer than 48hr.


Lyme disease is more common April through October with more than 50% cases occurring during June and July.


  • Use repellent
    • products that contain permethrin or picaridin (Duranon, Congo Tick Spray, Permanone) on clothing and shoes, but not on skin.
      • DEET containing products (20-30%) for children 2mo and older applied on skin (except face and hands) and clothing
  • Tick checks
    • remove all clothing and, if possible shower/bath within 2 hr coming in from area where tick exposure is a concern
      • do tick checks especially checking scalp, neck, armpits, and groin
      • remove any tick (using tweezers grasp as close to skin as possible and pull gently and steadily straight upwards avoiding twisting and jerking)
  • check pets and any outdoor gear
  • place clothes in a dryer on high heat for 1 hr to kill any ticks


As spring approaches and we think about enjoying the beautiful outdoors just keep in mind a few ways to keep you and your family safe from ticks and possible tick borne illnesses, such as Lyme disease. A great website with more information is Also check with your child’s doctor’s office as they may have more information and handouts.


Written by Dr Brenda Foley- Pediatrician in Andover, MA