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June 26, 2012 at 5:44 PMComments: 1 Faves: 2

Lyme Disease: Is It Still A Problem?

By Jeffrey VanWingen M.D. More Blogs by This Author

When I examine my pediatric patients (particularly boys) during the summer, I can almost gauge how much fun they are having by the bruises, scrapes and insect bites on their legs. To some, insect bites are an expected complication of sharing the world with these tiny predators. To others, having an insect bite brings thoughts of diseases which can reach hysteria. 

The most common insect-borne illness we deal with in the U.S. presently is Lyme disease, but it seams that we are not hearing so much about the illness lately.Has Lyme disease become mainstream or is it trending toward extinction? Do the media just have other, better stories to cover? 

This blog will explore the current prevalence of Lyme disease and provide a refresher on good preventative practice.

Lyme Disease - The Basics

Lyme disease was first seen in Lyme, Connecticut in 1997 (which provided for its name.)  Since then, it has steadily increased in incidence. Most recent national data reports toll nearly 30,000 cases in 2009. 

Lyme disease is caused by bacteria called Borrelia burgdorferi which is transmitted to the human bloodstream via the saliva of tick’s bite. Lyme disease is always associated with a tick bite, specifically a deer (or black legged) tick. 

Lyme Disease Early Symptoms

Symptoms of Lyme disease appear somewhere between a few days to a few weeks following a tick bite from an infected tick. The most common early symptoms are:

  • a rash described as “erythema migrans,” or migrating redness
  • fever
  • fatigue
  • headache 

Lyme Disease Later and Less Common Symptoms

While a “bull’s-eye” pattern to the rash is best known, this characteristic is only seen in 19% of cases. Other, later symptoms include:

  • Joint pain (usually ensues in the days to weeks following.)
  • Nerve palsy or failure of a particular nerve (rare),
  • meningitis (rare)
  • heart complications which arise and become chronic (rare)

Lyme Disease - Diagnosis and Treatment

While rash and/or other symptoms raise suspicion about the diagnosis of Lyme disease, a blood test confirms the presence of the infection. Antibiotics are used to treat, most often doxycycline.  The earlier the treatment, the better the outcome.

Lyme Disease Risk Factors

A couple important factors are important to note. 

Location. Geography is the most important. Most Lyme disease is seen in the mid to northern states of the eastern seaboard and in a couple Midwestern states:

  • Connecticut
  • Maine
  • Delaware
  • New York
  • Massachusetts
  • New Hampshire
  • New Jersey
  • Rhode Island
  • Pennsylvania
  • Wisconsin
  • Minnesota

The borders seem to be holding presently on reported infections. 

History of Tick Bite. Second, you need to have been bitten by a tick to get Lyme disease. I see a lot of people concerned about Lyme disease, but we don't really see it around my neck of the woods in Michigan. Further a history of a tick bite is often absent. In such cases, the aches, pains and fatigue are surely caused by something else.

When to See a Doctor

If you are bitten by a tick in one of the states mentioned above, there is reason for concern.  It is important to note whether the tick is engorged with blood. This fact is important because it usually takes 36-48 hours for the tick to become engorged and also this same time frame for the bacteria to be transmitted to humans.

Prophylactic antibiotics are often used to prevent risk of infection if a tick bite occurs in a high risk area but this is controversial. It does sound like a good idea, however, considering that a recent study showed that 31% of ticks in an area of New Jersey were infected with Lyme disease causing bacteria.

Lyme Disease Prevention

As stated before, no tick bite, no Lyme disease. And as such, it is best to prevent exposure to ticks to present Lyme disease.

  • Avoid Their Homes. Avoid the wooded or grassy areas ticks live in.
  • Dress Appropriately. Wear high socks and long pants to prevent skin exposure or attachment in these areas.
  • Use Repellant. Insect repellant can also deter ticks.
  • Keep to Paths. When hiking, stick to the middle of the trail.
  • Maintain Your Yard. Keep grass mowed in your yard to keep ticks from moving in.
  • Protect Your Pets. As pets are a common way that ticks are brought into the home, use a treatment or a collar on your pets.
  • Keep Deer Away. Deer are the most common animal source, however, and keeping them out of your yard can reduce risk. 
  • Check When You Come Inside. Lastly, if you have been outside, do a quick exam of your skin for ticks.  If one is found, use tweezers to remove it.

In conclusion…

Lyme disease is still out there and infections are increasing within the zones of prevalent infection. If you live or travel in these geographic areas, use caution and be mindful of preventative matters. If not, you may let down your guard a bit (at least for now).

Photo Credit: John Tann

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1 Comment

  • This is a topic that interests me greatly, as does parasitology in general. In my years of reading about Lyme disease, I've come to a personal conclusion that the spread of the disease is a direct indicator of the natural balance an area has.

    Overpopulation of nymph-carrying small mammals (mainly due to reduction of natural predators by hunting/loss of habitat) boosts the Ioxdes reproduction rate. If you ever doubt the damage man can do, take a trip to Hawk Mountain Bird Sanctuary in PA (http://www.hawkmountain.org/). They have a display case of a hunter's daily 'take' of birds of prey (remember, they prey on mice, rabbits, and other tick-bearing animals). You'll know, instantly, what balance is not.

    There is also some evidence that indigenous reptiles may help neutralize the Borrelia infection (http://www.ncbi.nlm.nih.gov/pubmed/17626342 and http://eco.confex.com/eco/2008/techprogram/P12720.HTM). However, reptile populations have suffered because of predation by introduced fire ants and high egg failure rates during DDT use times,

    While it's true that recognizing ticks and preventing their bites is very important in reducing the instance of Lyme disease, it's really just the last step in a holistic approach to fight the problem where it begins, in our management of natural resources.

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