Lyme Disease

Overview

As spring unfolds, people across the country emerge from their wintertime captivity to enjoy the great outdoors. Unfortunately, another creature makes an entrance in the spring, too--the deer tick, best known as the carrier of Lyme disease. Lyme disease is a serious bacterial infection that can affect your joints, nervous system and heart. The key to preventing the disease is avoiding tick bites. Stay bite-free and keep your children and pets bite-free too, and ask your veterinarian about vaccinating your pets.

Lyme disease was first described in the United States in the town of Old Lyme, Connecticut, in 1977, but has now been reported in most parts of the United States. Most cases occur in the Northeast, upper Midwest and along the Pacific Coast and are usually contracted in the spring and summer. Mice and deer are the most commonly infected animals that serve as hosts to the tick. The bacteria that causes this disease, Borrelia burgdorferi, is a spirochete. Lyme disease is not contagious from one person to another, although the spirochete has been shown to cross the placenta, so if you are pregnant and think you have Lyme disease, consult with your health care provider.

Symptoms

The disease is difficult to diagnose because the symptoms mimic other diseases. A characteristic red rash usually occurs at the site of the bite, but the bite often goes unnoticed. A few months after the bite, muscle paralysis, joint inflammation, neurological symptoms and sometimes heart symptoms may occur. The initial infection is called primary Lyme disease; secondary Lyme disease and tertiary Lyme disease may develop.

Ticks carry the bacteria Borrelia burgdorferi, so it's not really the tick at all but the bacteria that it carries. Not all ticks carry the bacteria--the large ones you might find on your dog usually do not.

Early symptoms (7 to 10 days):

An illness with flu-like symptoms during spring and summer
A skin rash that varies in size, shape and color, but often looks like a "bull's eye"
Joint or muscle pain
A flat or slightly raised red lesion (erythema migrans) at the site of the tick bite that is larger than 3 to 5 cm in diameter, often with a clear area in the center (children often get the rash, but many adults do not)
Expansion of the red lesion to several inches over several days (the resulting rash will usually clear in the center, creating an annular rash)
Fever
Headache
Fatigue
Muscle pains
Stiff neck
Joint inflammation in the knees and other large joints
Headache at the base of the neck
Strange, unusual or hostile behavior (not so common, but can occur later in the disease)

Later symptoms (months to years):

Arthritis, especially in knees and hips
Problems with the nervous system
Heart problems

Treatment

Antibiotics are prescribed based on disease stages and manifestations. Doxycycline, cefuroxime, ceftriaxone and penicillin are some common prescriptions. Doxycycline is usually not prescribed for children until after all the permanent teeth have erupted; it can permanently discolor teeth that are still forming. Anti-inflammatory medications are prescribed to relieve joint stiffness.

If diagnosed in the early stages, the disease can be cured with antibiotics. If left untreated, complications involving joints, the heart and the nervous system can occur.

Call your health care provider if symptoms of Lyme disease develop.

Prevention

If you reside, work or play in areas where you are frequently exposed to ticks, you may want to consider being immunized with the LYMErix vaccine to prevent Lyme disease. Contact your health care provider if you live in a high-risk area.

When walking in or near wooded areas use insect repellent with deet.

When walking or hiking in tick-infested areas, tuck long pants into socks to protect the legs, and wear full shoes and long-sleeved shirts. Ticks will show up on white or light colors better than dark colors, making them easier to remove from your clothing. Check yourself and your pets frequently. If you find ticks, remove them immediately by using tweezers and pulling carefully and steadily.

Reduce the tick population around the home by:

Keeping lawns mowed and edges trimmed
Clearing brush, leaf litter and tall grass around houses and at the edges of gardens and open stone walls
Stacking woodpiles neatly in a dry location, off of the ground.
Keeping the ground under bird feeders clean so as not to attract small mammals, or avoid bird feeders all together (even squirrels carry the deer ticks now in many Mid-Atlantic States)
Having a licensed professional spray the residential environment (only the areas frequented by humans) with an insecticide in late May (to control nymphs) and optionally in September (to control adults). This application is not considered healthy for the water supply in many areas, so if you have a well, address these concerns before having a treatment.

To Remove a Tick

Using a pair of fine-tipped tweezers, grasp the tick as close to the skin as possible and pull it straight out until it releases its hold on the skin. To reduce the chance of contact with the bacterium, try not to crush the tick's body. After removing the tick, wash the bite area with soap and water.

Do not use mineral oil, petroleum jelly or a hot match to remove a tick. These methods do not make the tick "back out" as urban legend claims and it may actually cause the tick to inject bacteria into the skin. Remember that if you remove a tick before it is attached for more than 48 hours, you can greatly reduce the chance of contracting Lyme disease.

Watch the site of the bite for the appearance of a rash beginning 3 to 30 days after the bite. At the same time, learn about the other early symptoms of Lyme disease and watch to see if they appear in about the same time frame. If a rash or other early symptoms develop, call your health care provider.