Lyme Disease in East Tennessee

Signs, Treatment and Prevention of Lyme Disease

Did you know that Lyme disease was named for a town in Connecticut where the illness was first identified in 1975? This infection is caused by a specific type of bacteria most often acquired through a tick bite.

Ticks are small spider-like creatures that live in grass, bushes, wooded areas, and along seashores. They attach their bodies onto a human or animal host. Ticks prefer hairy areas like the scalp, behind the ear, in the armpit and groin, and between fingers and toes. Tick bites often happen at night and occur more often in spring and summer months.

Lyme disease cases have been reported in nearly all states in the U.S. and in large areas in Europe and Asia. The most common areas are the Northeast, upper Midwest, and northwestern states. In Tennessee, there were 39 cases of Lyme disease in 2023, an increase of 18 percent compared to 32 cases in 2022. According to the Tennessee Department of Health, the expansion of black-legged ticks into the southeast U.S. within the past decade has made Lyme disease a growing concern in the northern and eastern regions of Tennessee.

Which Ticks Carry Lyme Disease?

Not all ticks carry the Lyme disease bacteria. Depending on the location, anywhere from fewer than one in 100 to more than half the ticks are infected with it. Ticks that carry the bacteria are:

• Black-legged deer tick (northeastern, mid-Atlantic, and North Central U.S.)
• Western black-legged tick (Pacific coastal U.S.)

What Other Diseases Are Caused by Ticks?

While most tick bites are harmless, several species can cause life-threatening diseases. Tennessee is home to six species that can cause tick-borne illnesses: include:

• American Dog tick (Wood Tick): possibly transmits tularemia and Rocky Mountain spotted fever
• Asian Longhorned tick: does not transmit diseases that affect humans
• Black-Legged tick (Deer Tick): possibly transmits Lyme disease, anaplasmosis, babesiosis, Powassan encephalitis
• Brown Dog tick and Gulf Coast tick: possibly transmit Rocky Mountain spotted fever
• Lone Star tick: possibly transmits ehrlichiosis, tularemia, heartland virus, STARI, alpha-gal syndrome

When is Tick Season in Tennessee?

Lyme disease is a year-round problem in many parts of the U.S. and elsewhere. But April through October is generally the most active tick season. Generally, nymph ticks are most active April through June, and adult ticks are highly active August through October.  

Alicia Brooks, MD, is a primary care physician in Lenoir City, Tennessee, and medical director of Fort Loudoun Primary Care. Dr. Brooks provides holistic, evidence-based, patient-centered care, and enjoys helping her patients navigate their health and wellness. She says that although ticks are active in Tennessee for several months during the year, “there are very few cases of Lyme disease in Tennessee. It’s very rare, although there have been a couple of documented cases in the entire state. Most of the cases have been in people who have traveled elsewhere and gotten it.”  

Symptoms of Lyme Disease

Many people infected with the Lyme bacteria never have symptoms. Their bodies cure the infection without any treatment. For those who do experience symptoms from a Lyme bacteria infection, these symptoms can vary depending on how long the person has been infected.

Dr. Brooks says, “Symptoms of Lyme disease may include fevers and chills, muscle pain, rash – especially the bullseye rash – confusion, impaired concentration and, in its advanced stages, neurologic changes.”

The most common early symptom is a red rash. The rash may:

• Appear several days after infection, or not at all
• Last up to several weeks
• Be very small or grow very large (up to 12 inches across), and may resemble a “bullseye”
• Mimic skin problems such as hives, eczema, sunburn, poison ivy, and flea bites
• Itch or feel hot, or may not be felt at all
• Disappear and return several weeks later

Several days or weeks after a bite from an infected tick, the rash may appear again. If the rash returns, it often affects many parts of the body. Flu-like symptoms also may occur, such as:

• Headache
• Stiff neck
• Aches and pains in muscles and joints
• Low-grade fever and chills
• Tiredness (fatigue)
• Poor appetite
• Swollen glands

Weeks to months after the bite, symptoms may include:

• Nervous system symptoms, including inflammation (meningitis) and weakness, and paralysis of a facial nerve (Bell’s palsy)
• Heart problems, including inflammation of the heart (myopericarditis) and heart rate problems
• Eye problems, including inflammation such as “red eye”

Months to a few years after a bite, other symptoms may develop:

• Inflammation of the joints (arthritis)
• Nervous system symptoms such as numbness in arms or legs, tingling and pain, and trouble with speech, memory and concentration

According to the Centers for Disease Control, a deer tick must be attached to your body for 36-48 hours (about two days) for it to spread bacteria to your blood. Signs and symptoms of Lyme disease typically begin 3-30 days after being bitten by an infected black-legged (deer) tick.

How Is Lyme Disease Diagnosed?

Diagnosing Lyme disease can be hard because the symptoms may seem like other health problems, or it may not be known if the person was exposed to ticks. Nymphal deer ticks are so small they are almost impossible to see.

Diagnosis is usually based on symptoms, particularly the typical rash of Lyme disease, along with a history of a known or possible tick bite. At the time of the first rash, blood testing is still negative and not conclusive. For later symptoms, blood testing can confirm the diagnosis and rule out other conditions. If you have nervous system symptoms or joint swelling, your healthcare provider may test spinal or joint fluid for Lyme antibodies or bacteria.

Lyme disease symptoms may look like other health problems and other problems can be mistakenly diagnosed as Lyme disease. If you are unsure about the cause of any symptoms, “seeing your primary care physician or advanced practice provider is the best way to stay updated on your healthcare and catch things early,” Dr. Brooks says. “Having a primary care provider allows you to establish a long-term relationship that helps them know when changes in your health have occurred, even when you can’t always recognize it yourself.” Always talk with your healthcare provider for a correct diagnosis.

Is Lyme Disease Contagious?

Lyme disease is an infection caused by bacteria and is not contagious among humans.

Treatments for Lyme Disease

“Lyme disease is very treatable with an antibiotic, which most people tolerate well,” Dr. Brooks says. “It’s better to treat early than to wait on test results if you have had a tick on you for long enough, or if you have the characteristic bullseye rash.”

If it is within 72 hours (about three days) of a tick being found on your body, your healthcare provider may give you a preventive antibiotic. Lyme disease in the earliest stage is treated with antibiotics for two to three weeks. Later stages may need up to four to eight weeks of antibiotics. Doxycycline is the most common antibiotic used. In some cases, amoxicillin, cefuroxime, or ceftriaxone are used.

Additional treatment will depend on whether the infection is active. If it’s active, treatment depends on what stage and how severe it is, along with these and other factors:

• If you are bitten by a tick and have any Lyme disease symptoms
• If you are bitten by a tick and are pregnant
• If you are bitten by a tick and live in a high-risk area
• What type of tick bites you
• If the tick has taken a blood meal (engorged)
• How long the tick has likely been on your body

Lyme Disease Prevention

Preventing tick bites is key to avoiding Lyme disease. No vaccine prevents the disease in humans, and you can’t become immune to Lyme disease. If you’ve had it once, you can get it again. To avoid tick bites and prevent Lyme disease, follow these guidelines:

Dress to prevent and identify tick bites by wearing:

• Light-colored clothing
• Long-sleeved shirts
• Socks and closed-toe shoes
• Long pants with legs tucked into socks

Check for ticks often on:

• All joints: behind the knees, between fingers and toes, and on underarms
• Other areas where ticks are commonly found, including belly button, neck, hairline, top of the head, and in/behind the ears
• Areas of pressure points, including anywhere that clothing presses tightly on skin

Insect repellents can help.

• Remember to use all repellents safely.
• Use a product with DEET, Picardin or other products approved to repel ticks.
• Products that have permethrin can be sprayed only on clothing, not on your skin.

Other ways to help prevent tick bites:

• Shower after all outdoor activities are over for the day to wash away ticks before they become fully attached to your skin. A tick that is crawling on you but not attached is not a risk.
• Check children and pets for ticks.
• Avoid wooded or high-grass areas.

How to Remove a Tick Attached to Your Skin

• Grasp the tick close to its head or mouth with tweezers. DO NOT use your bare fingers. If needed, use a tissue or paper towel.
• Pull it straight out with a slow and steady motion. Avoid squeezing or crushing the tick. If parts of the body remain in your skin do not try to fish them out – they will not transmit Lyme and you can cause a skin infection. Don’t use petroleum jelly, solvents, knives or a lit match to kill the tick.
• Clean the area thoroughly with soap and water and put an antiseptic lotion or cream on the site. Wash your hands thoroughly.
• Save the tick. Place it in a plastic container or bag so it can be identified if needed.
• Call your healthcare provider to find out about follow-up care. If the tick is found within the first 72 hours after the tick bite, a single dose of doxycycline may be prescribed to help prevent Lyme disease.

No matter how careful you are about animals in your home, or how much care you take when your child plays outdoors, insect bites are sometimes unavoidable. By staying calm and knowing some basic first aid, you can help your loved ones overcome the fear and stress of insect bites.

How to Treat Tick Bites

Dr. Brooks advises adults to treat tick bites by first cleaning the area with soap and water. “If the site is bleeding, cover it with gauze and apply pressure until the bleeding has stopped. Monitor for signs of infection including swelling, redness, increasing pain, a white discharge of pus, or redness spreading around the wound.”

Dr. Brooks says the biggest risk after a tick bite is getting a local infection from bacteria on the skin. “If you see signs of infection or if you have a red circle like a bullseye around the tick bite, see a doctor.”

She adds, “Prevention is key, so wear protective clothing and use insect repellent when you’re in areas where ticks may be. Check your clothing and body for ticks after you finish your outdoor activities. If you get a tick bite, see your healthcare provider if you aren’t sure how long it has been there.”

If you need assistance finding a primary care provider, go to Covenant Health’s Find a Doctor page, or call 865-541-4500.

For more information about insect bites, visit these pages:

Bee Stings

Fleas, Mites and Chiggers

Spider Bites

About the Author

Covenant Health

Headquartered in Knoxville, Tennessee, Covenant Health is a community-owned, healthcare enterprise committed to providing the right care at the right time and place. Covenant Health is the area’s largest employer and has more than 11,000 compassionate caregivers, expert clinicians, and dedicated employees and volunteers.