Doctors’ Notes

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Lyme Disease

This note is a follow-up to Dr. Godinez’s Doctor’s Note on Ticks…

(Please see my Doctor’s Note on Ticks for learning about protection against ticks, revised June 2025)

Tick-borne infections are a risk from tick bites.  Lyme Disease is the biggest risk of tick-borne infections in Pennsylvania and PA is number one in the United States for Lyme Disease.  Western Pennsylvania has become the epicenter for Lyme Disease incidence and risk in the last three years.  In 2015, PA ranked 3rd nationally in Lyme Disease incidence (57.4 cases/100,000 persons).  In 2023, the incidence increased to 128.6 cases/100,000 persons. The incidence is expected to be even higher for 2025.

Lyme disease is a tick-borne disease caused by bacterium Borrelia burgdorferi. Its vector is Ixodes scapularis, or what is commonly called the deer tick (black-legged tick).   The deer tick is infected while feeding on white mice. The peak time of the year for ticks to be active is April thru September (or when temperature > 50 degrees F).

  • The risk for Lyme Disease transfer from ticks to humans depends on the life stage of a tick and the area of location where tick populations could be high. The Nymph stage of tick (size of a poppy seed) highest activity from April through July.  The Adult stage of tick (size of a sesame seed) highest activity early spring through fall seasons.
  • As of May 2024, there are no reports of Lyme Disease being spread to infants through breast milk
  • Untreated Lyme Disease during pregnancy can cause infection of placenta
  • Dogs/cats/outdoor pets can carry infected ticks into the home/yard
  • It is recommended to avoid testing deer ticks that are removed from hosts as it is probable these ticks have Lyme Disease in PA.

Lyme disease is diagnosed by clinical history and physical examination.  Laboratory blood testing may also be done but not always.  It manifests in two stages — early and late.

  • The Early stage is localized and develops 7-14 days after the tick bite. The bite site becomes red and bumpy and progresses to a bull’s eye mark.  The rash can be itchy or mildly tender. Other symptoms include malaise, headache, joint aches, fever, and muscle aches. Most symptoms resolve within 2-4 weeks after treatment is started.
  • The Late stage consists of spread to other body systems (joints, heart, nervous) For joints: localized arthritis (usually the knee). For the heart: carditis (inflammation of heart).  For the nervous system: meningitis (inflammation of brain and spine), Bell’s palsy (facial droop with asymmetric smile). The Late stage can take up 3 months or greater to resolve.

Treatment involves oral antibiotics for 10-28 days depending on the Early or Late stages.  Lyme disease is curable and has a good prognosis.  In addition, there is a one-time dose of doxycycline antibiotic to be used if a tick bite attachment > 24 hrs AND asymptomatic.   Contacting the Kids Plus office will help guide you on what to do.

What to do if a tick is discovered on a person?  Scan this QR code to connect to Tick Bite bot (guide from CDC to help assess (attached or not, how to remove tick, and including when to call the doctor for help based on time of attachment).

The best defense is to prevent tick bites!  Please see my Doctor’s Note on Ticks to learn about ticks and techniques to reduce exposure to ticks and lower the risk of transmission of a tickborne infection.

 

Dr. Lucas Godinez

Lead Clinician – Kids Plus Pediatrics