Ticks and Lyme Disease – What You Need to Know

A tick on a blade of grass

Tick bites are common and with the increasing prevalence of Lyme disease in our area, tick bites cause a lot of worry for parents and children. If you or your child gets a tick bite don’t panic, it is important to make note of the size, color, and shape of the tick and to remove the tick promptly.

Our patients and their parents have been asking a lot of excellent questions about tick bites and Lyme disease. Please find the answers to these frequently asked questions below and call us with any questions or concerns.

What types of ticks transmit Lyme disease?

In the northeast, Mid-Atlantic and north-central states, deer ticks (Ixodes scapularis) or black-legged ticks are the only ticks known to transmit Lyme disease. On the Pacific coast, the ticks that transmit Lyme disease are the western black-legged tick (Ixodes pacificus). Dog ticks and other kinds of ticks are not known to cause Lyme disease.

The most visible sign of Lyme disease is the characteristic rash called erythema migrans (EM) or 'bull's eye.' This rash usually develops within one month of the tick bite. It typically occurs at the site of the bite, starting as a red area and then expanding in size over days and weeks.

How long does a tick need to be attached to transmit Lyme disease?

Even if the tick is infected with Borrelia burgdorferi (the organism that causes Lyme disease) the risk of developing Lyme disease is low. The tick has to have taken a "blood meal" from the human host before it can pass along an infection. This means the tick has to be attached and feeding for more than 36 hours before it can transmit Lyme. A tick that has not yet attached to the skin is easy to remove or is not engorged (i.e. is still flat) when removed, could not have transmitted Lyme disease or any other infection. That’s why it is important to do regular "tick checks" on yourselves and your children so that ticks can be identified and removed quickly.

What is the best way to remove a tick?

The best way to remove a tick is with fine tweezers. Grasp the tick as close to the skin as possible and pull with firm, gentle pressure – do not jerk or twist. It is important to avoid crushing or squeezing the tick while you are removing it. Do NOT use a match, nail polish, Vaseline, or kerosene to try and smother the tick – these methods may cause the tick to actually inject its body fluids into the skin raising the possibility of disease transmission. After tick removal wash your hands and the area of the bite with soap and water.

What if mouthparts of the tick remain in the skin?

Do not attempt to remove the mouthparts if they are left in the skin after tick removal. As long as the body of the tick has been removed it can no longer transmit infection. The mouthparts will come out over time naturally. Trying to remove these mouthparts can cause more trauma and may cause a local skin infection.

Where do ticks typically live?

Ticks are typically found on the underside of low lying shrubs and brush, in areas between forests and open grass and especially in areas where there are deer. They tend to also be in higher numbers in old stone walls where mice nest. Ticks in their immature or nymphal form are carried by mice, and by deer as adults. When a human or animal goes past them, ticks latch on to the passerby and search for an area to attach and start feeding.

Is there a time of the year when Lyme disease is most likely?

Lyme is most common during late spring and summer when the nymphal ticks are more predominant, these ticks are so tiny (about the size of a poppy seed) that they are easier to miss than the adult-sized ticks (about the size of a sesame seed). Adult ticks can still transmit Lyme disease but they are easier to spot so they are usually noticed and removed more quickly. It is adult ticks that are responsible for the occurrence of Lyme disease during the fall and early winter.

How can I prevent getting a tick bite?

Good ways to prevent tick bites are to wear shoes, long-sleeved shirts, and long pants when outside, especially in brushy areas and areas that border forests. Tucking your pants into your socks and wearing high boots can also help. It is easier to see ticks on light-colored clothing, so that is another useful approach. Applying bug spray to your clothing can repel ticks. After being outdoors it is important to do a thorough tick check of yourself and your children. Ticks tend to like dark, moist areas on the body so pay particular attention to the armpits, groin, hairline, scalp, backs of the knees, and waistline. If you have pets, using a topical product to prevent ticks on your dogs and cats will also help to ensure that your animals are not bringing ticks into your home.

If I find an engorged tick on my body should I get a blood test for Lyme disease?

No. The blood test for Lyme is not useful until two to six weeks after infection develops. It is best to remove the tick and monitor for symptoms. If signs or symptoms of Lyme disease develop see your health care provider to decide whether treatment is necessary. However, the blood tests for Lyme disease are useful and reliable in situations where the symptoms have been present for more than 30 days or it has been over 30 days since the known tick bite.

What are some symptoms of Lyme disease?

The most visible sign of Lyme disease is the characteristic rash called erythema migrans (EM) or "bull's eye."

This rash:

  • Usually develops within one month of the tick bite
  • Typically occurs at the site of the bite, starting as a red area and then expanding in size over days and weeks
  • Can become as large as 8 inches in diameter and typically develops around an area of clear skin giving it a "bull's eye" appearance.

Only about 30% of people who develop this rash actually recall having a tick bite.

It is important to know that it is very common to have a small area of redness (dime size or smaller) at the site of a tick bite immediately after the bite due to irritation from the tick’s saliva. This is a different rash and does not indicate Lyme disease.

This type of rash will go away after 24-48 hours and does not expand over time. If you are not sure which type of rash is present, it is important to see your health care provider.

Other early signs and symptoms of Lyme disease include:

  • Aching joints and muscles
  • Fatigue
  • Fever
  • Headaches
  • Loss of energy
  • Swollen lymph nodes (i.e. "flu-like" symptoms)

If not treated, Lyme can affect the heart, joints, and nervous system.

Is Lyme disease treatable?

Yes. Lyme disease responds well to antibiotics and is curable.

Most symptoms resolve quickly after the start of antibiotics, however, it can occasionally take weeks or months for all symptoms to completely subside.

The number of days of antibiotics required depends on the symptoms present at the time of diagnosis-a typical course of antibiotics is 2-4 weeks.

My friend had a tick bite and her doctor prescribed a dose of antibiotics to prevent Lyme disease; when are prophylactic antibiotics recommended?

Limited data is available on the benefit of using prophylactic antibiotics in children following a tick bite. The only antibiotic used for this prophylaxis is doxycycline.

Its use is only recommended if the following five criteria are met:

  1. The tick is identified as a black-legged (deer) tick.
  2. The tick is thought to have been attached for over 36 hours.
  3. Antibiotics can be started within 72 hours of tick removal.
  4. There is a high (more than 20 percent) incidence of ticks infected with Borrelia burgdorferi (the organism that causes Lyme) in the geographic region where the tick bite occurred.
  5. There are no contraindications to doxycycline use (i.e. the patient is not pregnant, the patient is at least 8 years old, and the patient is not allergic to doxycycline).

Ask your provider for more information if you think you or your child may need a prophylactic dose of doxycycline following a tick bite.

It is important to get outside and play, hike, and explore. The possibility of tick bites should not prevent you and your children from enjoying the outdoors. Being diligent about tick prevention and tick checks will go a long way in avoiding tick-borne illnesses.

Remember that even if a tick bite occurs, the risk of Lyme disease remains low. Please do not hesitate to call Mt. Ascutney Hospital and Health Center at (802) 674-7337 or the Ottauquechee Health Center at (802) 457-3030 if you have any questions or concerns. We are here to help.