Lyme Disease: what you don’t know can cripple or kill you

Lyme disease is the most common vector-borne (animal carried) disease in the US. A new report from the CDC documents the continuing expansion of geographic scope of the disease. For humans who enjoy the outdoors and for parents, it’s a big deal. (The disease also exists in Europe.)

Lyme disease is named for Lyme, Connecticut, where it was first identified. The disease is an infection by the spirochete Borrelia burgdorferi, usually transferred to humans though the bite of “deer tick.”

The “deer tick” name is misleading. It’s a tiny, black legged tick sometimes described as a “freckle that moves.”  The picture below shows the tick  before and after feeding on a human arm. The tick is carried most commonly by field mice, but can ride on other animals as well.

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The reference to Lyme is misleading, as the tick and disease has now been reported in 35 states.See map.

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There were 275,589 cases reported to the CDC between 2008 and 2015, and that number is increasing.

The number of cases is probably understated. The distinctive bull’s-eye rash that definitively diagnoses the disease occurs in only about 40% cases (see picture below), if that. Without it, symptoms can be confused with other diseases, especially if the doctor is not expecting to see lyme disease. A specific blood test can confirm lyme, but if the doctor isn’t expecting it, he/she may not call for that test.

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Lyme affects all ages. The tick can be found in the grass of a manicured lawn as well as woods. All you need to do is step outdoors.

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Lyme can be treated with antibiotics in the first two weeks after infection. If it’s not, the disease can cross into the brain, where it is out of reach of antibiotics. It can them hibernate and reemerge at times of stress later in life. It can also do progressive damage. That’s why prompt diagnosis is essential. Unfortunately, fewer than 70% of victims recall the tic byte.

My daughter was lucky. As a toddler, she bent down to pet a mouse she found in our yard and was bitten by a tick carried by the mouse. She got the bull’s eye rash and prompt antibiotics. Her grandmother had just read about lyme, and her mother aggressively pushed the doctor, who had not heard of it at that time. Many still haven’t.

The symptoms of the disease vary by stage.Early stage symptoms involve headache, fever and fatigue which are easy to mistake for a number of other diseases. Later stages can involve the heart, joints and nervous system, and can, like shingles, recur at random intervals throughout the remainder of a person’s life.

In the early stages, they include:

 

  • Erythema migrans – rash
  • Fever
  • Myalgias (muscle pain)
  • Malaise
  • Arthralgia (joint pain)
  • Headache
  • Tender local adenopathy (local, not diffuse) (enlarged or swollen lymph nodes)

More advanced disease includes:

 

  • Erythema migrans (single or multiple lesions)
  • Headache
  • Fever
  • Tender adenopathy (regional or generalized)
  • Conjunctivitis (uncommon, never prominent)
  • Carditis (usually manifests as heart block)
  • Meningismus as a sign of aseptic meningitis
  • Cranioneuropathy, especially cranial nerve VII and Bell palsy (peripheral seventh nerve palsy with decreased unilateral function, including the forehead)

 

 

Advanced disease can include severe arthritis.

On the positive side, the tick apparently needs to be in place for 24 hours before infection occurs.

If you are outdoor — whether camping or mowing the law — you need to be vigilant for lyme. Tick repellent with DEET is essential when outdoors. Frequent and thorough checking for ticks is not optional.

While there has been some concerns with DEET use on skin in the past, it’s considered to be safe. Regardless, the effects of lyme are far worse.

 


Sources:

  1. Amy M. Schwartz, MPH; Alison F. Hinckley, PhD; Paul S. Mead, MD; Sarah A. Hook, MA; Kiersten J. Kugeler, PhD, Centers for Disease Control “Surveillance for Lyme Disease — United States, 2008–2015”. Surveillance Summaries / November 10, 2017 / 66(22);1–12.  https://www.cdc.gov/mmwr/volumes/66/ss/ss6622a1.htm?s_cid=ss6622a1_e
  2. John O Meyerhoff, MD, Russell W Steele, MD, Medscape “Lyme Disease,” 29 June 2017. https://emedicine.medscape.com/article/330178-overview

 

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