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How is Lyme Disease Diagnosed?

Medically reviewed on July 13, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Maybe it’s the flu. Maybe you’re had an exhausting week. However, if you’ve been hiking or camping recently, there’s a chance the symptoms you feel might point to a different diagnosis—Lyme disease, a tick-borne illness.

From fatigue to chills, Lyme disease can manifest a little differently in each person. Luckily, medical professionals have created protocols to detect and treat this tickborne disease.

If you suspect you “caught the bug”, keep reading to learn how is Lyme disease diagnosed and how a Lyme disease blood test can help.

What is Lyme Disease?

Passed from tick to human, Lyme disease is a bacterial infection. In 2019, the CDC reported 34,945 cases of Lyme disease—more than two-thirds of total tick-borne illness cases. [2]

The Lyme disease bacterium is Borrelia burgdorferi [5]. Once passed to a human, this bacteria will often create symptoms like rashes, headaches, and fevers. If unchecked, the infection can even spread to the heart, nervous system, and muscular system, potentially creating chronic Lyme disease issues. The sooner the infectious disease is treated, the better.

How do you get Lyme disease?

No matter your symptoms, all cases of Lyme disease begin with a tick bite—no exceptions.

Since the first known case in 1975, researchers have concluded that Lyme disease passes from parasitic ticks to humans. [7] There is no evidence that Lyme disease is transferable via air, water, or even other insects. [3] If you spend a lot of time outdoors in tick-infested areas, it’s important to know the origins and risks of catching Lyme disease.

Tick bite transmission

Tiny and sneaky parasites, ticks can easily transfer bacteria to humans. In the case of Lyme disease, it only takes one strong bite to transfer the Borrelia bacterium.

Almost all cases of Lyme disease are caused by two types of ticks—the infected blacklegged tick (or deer tick) or the western blacklegged tick. These ticks like to latch onto soft, out-of-reach, or high blood flow body parts, like the:

  • Scalp and neck
  • Groin
  • Calves
  • Belly button
  • Ears
  • Armpits
  • Waistline

Typically, humans are infected via the bites of tiny immature ticks called nymphs. At less than 2 mm (about the size of a poppy seed), nymphs easily go undetected on the skin. This gives time for Borrelia bacterium to spread, usually needing at least 36 hours to fully transfer. [3] If you catch a tick bite early, you can possibly avoid any bacterial transfer.

At-Risk Areas

If suspecting Lyme disease, healthcare providers will likely ask you one question—have you been spending time outdoors?

Across the US, ticks are usually found in wooded and grassy environments. Tick populations often rise during the warmer months, making these regions more risky for spreading Lyme disease:

  • Northeast
  • Mid-Atlantic
  • Upper Midwest
  • Pacific coast, especially northern California

If you live in these regions and love to hike, camp, or explore the outdoors, it’s important to keep your body covered and protected. Otherwise, you might be putting yourself at risk.

Lyme disease signs and symptoms

Lyme disease is not exactly one size fits all. While certain symptoms are common, some patients might suffer for months while others have minimal side effects—it all depends on the severity of the infection.

Early Lyme disease symptoms start anywhere from 3 to 30 days after an infected tick bite. If left untreated, symptoms can worsen overtime as the infection spreads across your body. Let’s explore a timeline of typical Lyme disease symptoms and physical signs.

0 to 30 days after infection

Over the first month, Lyme disease symptoms range from mild to moderate. You might feel like you have the flu, but a few telltale signs differentiate this infection—in particular, a rash.

Erythema migrans, or EM, is the red rash that often accompanies an infected tick bite. About 70-80% of Lyme disease patients get this rash, which grows with time. [6] EM looks like a red solid or bulls-eye rash around a bite mark, usually warm to the touch but not itchy.

Besides an EM rash, Lyme disease patients can also expect these common symptoms during the first untreated month:

  • Fever
  • Chills
  • Headache
  • Neck stiffness
  • Fatigue
  • Muscle and joint aches
  • Swollen lymph nodes

30 days and longer after infection

If untreated, Borrelia burgdorferi can start to infect your entire body, from the nervous system to your heart. This can create some serious symptoms—or even chronic Lyme disease.

On top of earlier symptoms, long-term Lyme disease patients might notice these physical signs emerge overtime:

  • Severe headaches
  • Multiple EM rashes across the body
  • Facial palsy (weakness of facial muscles)
  • Arthritis or severe joint pain and swelling
  • Heart palpitations, which are feelings that your heart is skipping a beat, fluttering, pounding, or beating too hard or too fast
  • Irregular heart beat (Lyme carditis)
  • Dizziness
  • Inflammation of the brain and spinal cord
  • Nerve pain (shooting pains, numbness, or tingling)

How is Lyme Disease detected?

With its delayed symptoms and tiny carriers, Lyme disease can be hard to detect. So, how do medical professionals diagnose this condition?

Most health care providers take a “collective” approach to diagnosing Lyme disease. Since symptoms can appear differently across patients, they will often give multiple tests to determine a Lyme disease infection. When consulting a healthcare provider, you might be questioned on or tested for:

  • Your recent history and outdoors activities
  • Your symptom timeline
  • Antibodies for Borrelia burgdorferi in the blood
  • Other lab tests
  • Potential illnesses or tickborne diseases with similar symptoms (Tularemia,
  • Powassan Virus disease, Babesiosis, etc.)

Antibodies test

Since Lyme disease is a bacterial infection, most healthcare provider require a positive antibodies test to give an official diagnosis. Otherwise, the diagnosis can be inconclusive or even false.

The CDC recommends healthcare providers follow a two-step approach for Lyme disease testing: if the first test (an antibody screen) is positive, then another type of test (immunoblot assay) is performed for confirmation of results. The two test types in this process will often be: [7]

  • Enzyme-linked immunosorbent assay (ELISA) test – The most common Lyme disease test, ELISA is usually the first step to identify antibodies. However, this test can give a false-positive result if the patient has a different tick borne disease, viral infection, or bacterial infection.
  • Western blot test – After a positive ELISA test, the Western blot test can confirm a Lyme disease diagnosis. This test detects antibodies to certain proteins in Borrelia burgdorferi bacteria.

Lyme disease treatment

There’s one golden rule with Lyme disease treatment—the earlier, the better.

Like many bacterial infections, Lyme disease can spread fast. That’s why early diagnosis is critical. Without intervention, you might be left treating damaging or chronic symptoms down the line. Depending on your infection severity, healthcare providers will prescribe a range of Lyme disease treatments.

Antibiotic treatment

The faster you can block the spread of Borrelia burgdorferi in your system, the more likely you’ll recover fully. To kill off the bacteria, healthcare providers will usually prescribe antibiotics to treat Lyme disease, including: [7]

  • Oral antibiotics – There are many stages of Lyme disease. As an early-stage treatment, healthcare providers will prescribe oral antibiotics to Lyme disease patients. Adults and children over 8-years-old will take doxycycline, amoxicillin, or cefuroxime for two to three weeks.
  • Intravenous antibiotics – If the bacteria has spread to the nervous system, healthcare providers will take a more extreme approach to antibiotic treatment. Intravenous antibiotics can halt a severe Lyme disease infection, protecting the brain and nervous system. However, this intense treatment can leave side effects like diarrhea, a low white blood cell count, and antibiotic resistance from other bacteria variants.

Chronic symptoms treatment

If not caught soon enough, Lyme disease can potentially damage the body—even developing into a chronic condition.

In the medical community, “chronic Lyme disease” or post-treatment Lyme disease carries some speculation. Certain patients have adopted the term to describe long-term effects Lyme disease, despite zero diagnoses or real evidence of Lyme disease. However, the damage from a severe and untreated infection can definitely create chronic health issues like: [4]

  • Lyme carditis (irregular heartbeat or “heart block”)
  • Lyme arthritis (severe joint pain and swelling)
  • Constant fatigue
  • Foggy brain or forgetfulness
  • Eyesight issues
  • Neurological problems (meningitis, Bell’s palsy, impaired movement, etc.)

If your persistent symptoms for 6 months after treatment, consult your healthcare providers. It’s possible that you might have damage from your first infection or a separate illness. While a medical professional can soothe your symptoms, there is no “cure” for chronic health issues from Lyme disease.

Learn about Lyme with Everlywell

If you suspect Lyme disease symptoms but can’t find a rash, our at-home Lyme Disease Test can give some direction.

The Everlywell Lyme Disease Test checks for three different Borellia antibodies—Borrelia burgdorferi, Borrelia garinii, or Borrelia afzeli. This follows the CDC’s two-step approach, giving you a full answer in one test. Order your test today, so you can take a more informed step to getting the medical treatment you deserve.

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  1. Signs & Symptoms. CDC. URL. Accessed July 13, 2022.
  2. Tickborne Disease Surveillance Data Summary. CDC. URL. Accessed July 13, 2022.
  3. Transmission. CDC. URL. Accessed July 13, 2022.
  4. Lyme Disease. Mayo Clinic. URL. Accessed July 13, 2022.
  5. Lyme Disease. Medline Plus. URL. Accessed July 13, 2022.
  6. Chronic Lyme Disease. NIH. URL. Accessed July 13, 2022.
  7. Discovery of the disease agent causing Lyme disease. NIH. URL. Accessed July 13, 2022.
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