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Lyme Disease: Not Everyone Gets the Bulls-Eye Rash

Even if they never spotted the tick that bit them, most people know that a rash resembling a bulls-eye means there’s a good chance they have Lyme disease, and it’s important to see their health care provider right away. Lyme disease is the most common tick-borne illness in North America. In the U.S. alone, it’s estimated that more than 300,000 new cases of Lyme disease occur every year. Construction sites and other outdoor work areas are prime locations for workers to be exposed to infected ticks.

Depending on where the bulls-eye rash is located, this telltale sign of Lyme disease can be missed, as it’s usually not itchy or painful. It also doesn’t always appear. According to the Centers for Disease Control and Prevention (CDC), about 20-30 percent of infected people never develop a bulls-eye rash. This can lead to delays in getting the right treatment. Lyme disease is a bacterial infection that is usually confirmed through a blood test and treated with antibiotics. However, early Lyme disease can look like the flu virus, and won’t respond to the standard flu treatment of bed rest, fluids and antiviral medication. Without appropriate treatment, Lyme disease can worsen and be misdiagnosed as a number of chronic conditions that include arthritis, fibromyalgia, lupus and multiple sclerosis.

To help ensure they receive timely and appropriate treatment for Lyme disease, all workers who spend time outdoors should be familiar with its symptoms and stages. When Lyme disease is caught early and treated with appropriate antibiotics, people usually make a complete recovery. Lyme disease that goes untreated or is diagnosed late can be debilitating and make it difficult for people to continue to work.

Symptoms and Stages

There are three stages of Lyme disease, and each brings a different set of symptoms:

Stage 1 (early localized Lyme disease): Bacteria have not yet spread throughout the body. Symptoms usually begin several days or weeks after an infected tick bite. Early symptoms include:

  • Bulls-eye rash
  • Fever and chills
  • Headache
  • Neck stiffness
  • Joint and muscle pain

Stage 2 (early disseminated Lyme disease): Bacteria have begun to spread throughout the body. Symptoms may occur weeks to months after an infected tick bite and include:

  • Numbness or pain in the nerve area
  • Paralysis or weakness in the muscles of the face
  • Heart problems, such as skipped heartbeats (palpitations), chest pain or shortness of breath

Stage 3 (late disseminated Lyme disease): Bacteria have spread throughout the body. Symptoms can occur months or years after the tick bite and include:

  • Nerve damage
  • Joint inflammation
  • Heart rhythm problems
  • Thinking and memory problems
  • Speech problems
  • Vision problems
  • Sleep disorders

Watch out for Ticks

Ticks are particularly active during the spring and summer months, so it shouldn’t come as a surprise that people get more tick-borne diseases between May and July than any other time of year. However, construction workers can reduce their risk for Lyme disease and other tick-borne illnesses by wearing appropriate clothing, using tick repellent and performing a tick check immediately after being outdoors. You can read more about how to prevent tick-borne illnesses in our June 2017 article, “Lyme Disease Could Be Lurking in Your Lawn.”

The LHSFNA’s Lyme Disease Health Alert also provides information that Laborers can use to help protect against all tick-borne illnesses. To order this and other Fund publications, go to and click on Publications. The CDC also offers a manual with more information on all of the tick-borne diseases in North America.

[Janet Lubman Rathner]

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