Question of the Week

May 19, 2009


As spring eases toward summer, Lyme disease season heads into full swing. While those who live in areas that have higher rates of Lyme disease may be more aware of what to watch for, those planning vacations for the summer should also have knowledge of the disease.

"More than 23,000 cases of Lyme disease were reported in 2005, making it the leading tick-borne (carried by ticks) disease in the United States. Experts think that the number Lyme disease cases may be even higher, though, because sometimes people don't know that they have it. Nearly all cases of Lyme disease (95%) in the United States happen in the Northeast, upper Midwest, and Pacific coastal states. ... Some cases have also been reported in parts of Canada as well as in northern and southern Europe and even in Asia."

For those who contract Lyme disease and don't know to think of it as a possible reason for their symptoms (and even for those who do), there can be often be difficulties when those symptoms go misdiagnosed.

"Sometime in the mid 1990s, my sister contracted Lyme disease, likely through being bitten by a deer tick or black-legged tick. The bacterium that had introduced itself to Sue's bloodstream went undetected, and then was misdiagnosed for the better part of two years. ... She was misdiagnosed twice in the early stages of the disease -- once with Chronic Fatigue Syndrome, the second time with Epstein-Barr virus. She was accused of exaggerating her symptoms to avoid work, or inventing them in order to get pain medication. By the time anyone thought to give her a definitive blood test for Lyme, the disease was on the march. Patients treated in the early stages -- within about two to four weeks after the onset of symptoms -- usually make a complete recovery. Not everyone is so fortunate."

Early detection is key, but it is also difficult.

"'It's hard to put a number on how common misdiagnoses are, but early detection can be difficult,' says [Dr. Paul Auwaerter, clinical director of infectious diseases at John Hopkins University School of Medicine and a leading specialist on Lyme disease]. 'It takes the body some time to generate enough antibodies to show up in testing, and the symptoms are common to many other ailments.'"

The longer the disease stays undiagnosed (and therefore untreated) in a person's system, the more damage it can do.

"If Lyme disease is left untreated, it may progress in stages from mild symptoms to serious, long-term disabilities. There are three stages of Lyme disease: early localized, early disseminated, and late persistent.

  • Stage 1: Early localized infection (1 to 4 weeks): Some people with Lyme disease have a rash (called erythema migrans) at the site of the tick bite. The rash is usually circular and it gets larger over time. ... Some people with Lyme disease will have flu-like symptoms with or without a rash. ... In some cases of Lyme disease, the person does not notice any symptoms during this stage.

  • Stage 2: Early disseminated infection (1 to 4 months): If Lyme disease is not detected and treated while early symptoms are present, or if you do not have early symptoms that trigger the need for treatment, the infection may affect the skin, joints, nervous system, and heart within weeks to months after the initial infection....

  • Stage 3: Late persistent infections: If Lyme disease is not promptly or effectively treated, damage to the joints, nerves, and brain may develop months or years after you become infected (late Lyme disease). ... Heart, nervous system, and joint symptoms may be the first signs of Lyme disease in people who did not have a rash or other symptoms of early infection."

Getting treatment earlier is better than later, but knowing what Lyme disease is, how to avoid it, and what to do if it is suspected are all key factors in obtaining an early diagnosis and reducing the risk for complications.

"Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans by the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful in the later stages of disease. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, landscaping, and integrated pest management. The ticks that transmit Lyme disease can occasionally transmit other tick-borne diseases as well."

Even if Lyme disease is not suspected, but a tick bite has been noted, it is important to make health care providers aware of the potential for a tick-borne ailment. While certain areas of the country have a higher instance of certain tick-borne ailments, anyone who notices a tick on their skin and has traveled to (or lives in) an area with reported cases should talk to a health care professional.

"The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick. Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut, in 1975. Cases have now been reported in most parts of the US. Most occur in the Northeast, upper Midwest, and along the Pacific coast. Lyme disease is usually seen during the late spring, summer, and early fall. ... Risk factors for Lyme disease include walking in high grasses, doing activities that increase tick exposure, and having a pet that may carry ticks home."

For those who engage in activities that increase the likelihood of tick exposure, it is important to check the skin for ticks after spending time outdoors.

"If you find a tick: Call your doctor, who may want you to save the tick after removal so that the tick can later be identified as the type that may carry Lyme disease. You can put the tick in a jar of alcohol to kill it. Use tweezers to grasp the tick firmly at its head or mouth, next to your skin. Pull firmly and steadily on the tick until it lets go of the skin. If part of the tick stays in your skin, don't worry. It will eventually come out — although you should call your doctor if you notice any irritation in the area or symptoms of Lyme disease. Swab the bite site with alcohol. One note of caution: don't use "folk remedies' like petroleum jelly or a lit match to kill a tick. They don't get the tick off your skin quickly enough, and may just cause the insect to burrow deeper into your skin."

Questions of the Week:
What do you need to know about Lyme disease? What risk factors do you have for contracting the disease? What can you do to reduce your risks while still enjoying time outside? What can you do to increase the chances of an early diagnosis if you suspect you might have symptoms related to Lyme disease? What can you do if you suspect that you have been misdiagnosed?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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