Doctor's Call: Looking out For Lyme
Identifying and taking appropriate steps to avoid Lyme disease infection
As the temperature climbs this July, so does the incidence of Lyme disease. Lyme disease is a bacterial infection that is transmitted to humans via the bite of an infected tick.
It is one of the fastest-growing infectious diseases in the United States, with the number of cases increasing since the mid-1990’s, according to the CDC.
In 2009, 95 percent of all Lyme disease cases were reported from 12 states, with New Jersey having one of the highest rates in the US. Now is the time to be aware of this disease, since July is the month in which most new cases are reported.
Lyme disease is caused by the bacteria Borrelia burgdorferi. The blacklegged, or deer, tick picks up the bacteria when they bite infected mice or deer. This disease is then transmitted to humans when they are bitten by an infected tick. The tick that carries the Lyme-causing bacteria is very small, and often goes unnoticed, even when it is attached. The risk of infection increases with the amount of time the tick is attached, and if it’s attached for more than 24 hours, infection is unlikely. It is believed that only about 1 percent of recognized tick bites result in Lyme disease; this may be because an infected tick must be attached for at least a day for transmission to occur. The first step in treating Lyme disease is removing the tick. Although many old wives’ tales exist about tick removal, the best method is to use a sterilized tweezers to pull upward with steady, even pressure. After removing the tick, it is important to clean the bite area and your hands thoroughly.
Everyone who has been bitten by a tick should be watched closely for at least 30 days, although most people who are bitten by a tick do not get Lyme disease. Medical attention should be sought if you have been bitten by a tick and have either of the following symptoms of early Lyme disease:
- Red, expanding bullseye rash called erythema migrans. This rash can start off small, and can expand to up to 12 inches. This rash is seen in approximately 75 percent of those who end up with Lyme disease and can be seen anywhere from 3 to 30 days after the tick bite.
- Fatigue, chills, fever, headache, muscle and joint aches.
The blacklegged tick is quite small (1-2mm) and difficult to find. Some people find this out the hard way and don't ever see the tick but realize something is wrong when they see the bullseye rash.
A single dose of antibiotics may be offered to someone soon after being bitten by a tick, especially if the time between the tick bite and seeing a doctor is less than 72 hours, if the tick has been identified as the type that carries Lyme, if the tick has been attached for longer than 36 hours, or if the person is over 8 years of age.
A full course of antibiotics is used to treat people who are proven to have Lyme disease. A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. If diagnosed in the early stages, as was the case with the Burns family, Lyme disease can be cured with antibiotics.
In untreated individuals, the bacteria spread through the bloodstream to joints, heart, nervous system, and distant skin sites in the days and weeks following the tick bite, where they can cause a variety of symptoms. Without treatment, complications involving the joints, heart, and nervous system can occur.
Advanced stages of Lyme disease can cause long-term joint inflammation (Lyme arthritis), heart rhythm problems and neurological problems, including decreased concentration and memory and an inflammation of the brain called encephalitis.
Approximately 20 percent of patients treated with antibiotics for Lyme disease will have lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than six months. Although often called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme disease Syndrome” (PTLDS). Fortunately, most cases of PTLDS resolve over time.
The best way to avoid any of the symptoms of Lyme disease is to avoid getting bitten by a tick. Increased risk is seen among those who do activities that increase tick exposure (gardening, hunting, or hiking) and those who have a pet that may carry ticks home. When walking in wooded or grassy areas:
- Spray exposed skin and clothing with insect repellant
- Wear light-colored clothing to make it easier to spot ticks
- Wear long-sleeved shirts and long pants with the cuffs tucked into shoes or socks
- Check yourself and your pets frequently during and after your walk or hike. After returning home, thoroughly inspect yourself and children for ticks, including your scalp.