If you spend time outside in the mountains of North Carolina, it’s important to be aware of a new risk: Lyme disease.
Historically, this disease hasn’t been a threat for North Carolinians the way other tickborne diseases like Rocky Mountain spotted fever or ehrlichiosis have been, but over the past decade that has changed. It’s important to know about Lyme disease, so you can tell your provider if you don’t feel well after outdoor recreation in western North Carolina.
Lyme disease in the United States is caused by the bacteria Borrelia burgdorferi and transmitted by blacklegged ticks, also known as deer ticks. While we have always had blacklegged ticks in North Carolina, largely in the eastern part of the state, we haven’t always had related cases of Lyme. Historically, Lyme disease has mostly occurred in the Northeast, upper Midwest and mid-Atlantic regions of the United States, but in recent years, ticks carrying the bacteria have migrated south along the Blue Ridge Mountains.
“There’s been a rapid change, in a five- to 10-year period, so that some parts of western North Carolina look similar in Lyme incidence to states in the Northeast,” says UNC Health infectious diseases physician Ross Boyce, MD. “It’s important for people and their doctors to know this is happening in the western part of the state.”
Dr. Boyce explains symptoms to watch for and precautions to take.
Symptoms of Lyme Disease
The first symptoms of Lyme disease typically develop three to 14 days after a tick bite and include fever, fatigue, headache and body aches. There may be a characteristic bull’s-eye rash, a flat pink rash with a circle surrounding the bite, but Dr. Boyce says that not everyone develops one.
“No one should ever say it’s not Lyme just because the rash doesn’t look like a bull’s-eye,” he says. “The rash can be solid, or there could be multiple circles. There might not even be a rash.”
Because the other symptoms could be attributed to many things, the possibility of Lyme might not be your or your doctor’s first guess, especially in the absence of a rash or if you never found a tick.
“About half of people don’t find the tick that bit them, because a lot of ticks are early in their life cycle when they bite,” Dr. Boyce says. “They may only be the size of a sesame seed. Ticks have also learned how to move to areas where they’re less likely to be found—behind your knee or in your armpit crease.”
For some people, the disease won’t progress any further, and symptoms will go away, though Dr. Boyce says it’s hard to know how common this is as these people likely don’t seek care. For others, the symptoms will progress if the disease goes untreated.
“The most common complication is Lyme-related arthritis, because the bacteria spreads to specific areas in the body,” Dr. Boyce says. “It tends to be seen in one knee. The knee will ache and swell to the size of a baseball.”
Other symptoms can include Bell’s palsy, or weakness or paralysis on one side of the face; pain in other joints or muscles; and a heart rate that slows or becomes irregular to the point of causing dizziness or fainting. These symptoms may start between two weeks and two months after infection.
It is possible for the disease to eventually cause brain damage so that a person seems confused or altered, but Dr. Boyce says this usually takes years and is uncommon.
Diagnosing and Treating Lyme Disease
Lyme disease is treated with a two-week course of the oral antibiotic doxycycline; some people may need a longer course of treatment if the disease progressed. If you’re allergic to doxycycline, amoxicillin can be used.
When treated early, people usually recover completely, but treatment can be delayed if you or your provider don’t consider the possibility of Lyme. That’s why knowing if Lyme is present in an area you’ve traveled to recently can be helpful in considering symptoms.
Dr. Boyce says the nature of the test for Lyme disease can also cause delays.
“It’s an antibody-based test, which means it doesn’t detect the bacteria that causes Lyme, but rather, our body’s response to the infection,” he says. “Right after the bite, your body hasn’t produced antibodies in response to the bacteria. A test could be negative because you don’t have the disease, or because you haven’t developed the antibodies yet.”
If you know you were bit by a tick in an area where Lyme disease is common and have the symptoms of Lyme disease, your doctor shouldn’t wait for the test result to begin treatment with antibiotics. On the other hand, if you’ve had symptoms lasting more than a couple weeks, the test should be accurate. If you aren’t sure whether a tick bit you, but you recently traveled to an area where Lyme is common, consider asking about a test if you develop symptoms that you can’t attribute to anything else.
Preventing Lyme Disease
Ticks don’t fly around looking for a feast or jump down from trees onto humans; rather, they live in grasses, bushes and branches, and they hop on when we brush against them. Being mindful about staying on a trail and avoiding tall grasses and overgrown brushes can help prevent ticks from finding you. Wearing pants, long-sleeved shirts, hats and tall socks is also helpful.
Permethrin, an insecticide that can be applied to clothing and camping gear, but not skin, is effective at repelling ticks. Permethrin can be sprayed onto fabric; some companies sell clothing and accessories with permethrin embedded.
“Ticks smell with their feet, so if they land on something with permethrin, they’ll hop off,” Dr. Boyce says.
For your skin, use an EPA-approved insect repellent with a label that specifies protection against ticks, such as DEET.
After you spend time outside, check your body and clothing for ticks, paying special attention to folds of skin and your scalp. Do the same for your kids and pets.
“We think a tick has to be attached for 24 to 36 hours before it transmits the bacteria that causes Lyme, so if the tick is removed in a few hours, the risk of transmission is low,” Dr. Boyce says.
If you find a tick, remove it with fine-tipped tweezers and then clean the bite area with soap and water or rubbing alcohol. Take a picture of the tick or put it in a sealed plastic bag, so that it can be identified if you develop symptoms.
Typically, finding a tick doesn’t necessitate immediate treatment; most times, the recommendation is to wait to see if symptoms develop. However, in areas with very high Lyme transmission, Dr. Boyce says it can be appropriate to take a single dose of doxycycline as a preventive measure before symptoms begin. While the state of North Carolina does not, as a whole, meet the threshold for that preventive treatment, certain counties in the northwest part of the state may, so reach out to your healthcare provider if you found a tick to discuss your options.
If you live in other parts of the state, it’s still important to be aware of the threat of ticks when you’re outside. Dr. Boyce says it is possible that these ticks will continue to travel.
“There have been sporadic cases throughout the rest of the state, but nothing like the western part,” Dr. Boyce says. “I can’t think why it wouldn’t continue to spread over time. That’s why surveillance and keeping an eye out is important.”
Concerned about an insect bite? Talk to your doctor. If you need a doctor, find one near you.