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Evaluation of a tick bite for possible Lyme disease

Linden Hu, MD
Section Editor
Allen C Steere, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Lyme disease is the most common tick-borne disease in the United States and Europe. It is a spirochetal infection caused by Borrelia species (Borrelia burgdorferi in the United States, and primarily Borrelia afzelii and Borrelia garinii in Europe and Asia) and is transmitted by the bite of infected Ixodes ricinus complex ticks. Lyme disease can involve the skin, joints, nervous system, and heart. In the United States, Ixodes ticks can also transmit human granulocytic anaplasmosis and babesiosis. In Europe, they can also transmit tick-borne encephalitis virus.

Ticks have three stages in their life cycle: larva, nymph, and adult. Lyme disease is most commonly transmitted by nymphal ticks, which are typically most active during the late spring and early summer in temperate regions. Adult ticks can also transmit Lyme disease, but this occurs less commonly because adult ticks are less likely to bite humans and because they are larger and thus more likely to be detected and removed promptly. Adult ticks are most active on warm days in the fall.

Individuals at highest risk for Lyme disease are those who live in an endemic region and have occupational (eg, forestry and telephone line workers) or recreational (eg, hunting, camping, hiking, gardening, children playing in wooded areas) exposure to ticks (figure 1). However, in highly endemic areas, people may be at risk even in their yards, particularly where grassy areas and woodlands meet.

The factors affecting transmission of Lyme disease, methods for tick removal, and indications for antibiotic prophylaxis following a tick bite are reviewed here. The epidemiology, microbiology, prevention, diagnosis, clinical manifestations, and treatment of Lyme disease are discussed separately. (See "Epidemiology of Lyme disease" and "Microbiology of Lyme disease" and "Prevention of Lyme disease" and "Diagnosis of Lyme disease" and "Clinical manifestations of Lyme disease in adults" and "Treatment of Lyme disease".)


Asking the following questions can aid in the risk assessment for Lyme disease following a tick bite:

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Literature review current through: Nov 2017. | This topic last updated: May 16, 2016.
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