Excerpts from ACSH's Booklet: Lyme Disease

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Lyme Disease is a bacterial infection acquired through tick bites. The disease is commonly acquired during summer months primarily in coastal areas of the United States although cases have been reported in over 40 states. A characteristic skin rash frequently occurs at the site of the bite. Later stages may affect the musculo-skeletal and nervous systems, heart and joints.

Lyme disease, also known as Lyme borreliosis, is caused by a spiral-shaped bacterium (spirochete). This bacterium inhabits mainly the digestive tract of deer ticks (Ixodes species). Deer ticks are tiny, eight-legged creatures that frequent wooded areas and can also be found in lawns, particularly those near wooded areas.

To date, physicians in the U.S. have reported almost 14,000 cases of Lyme disease. Lyme disease is now the most common tick-transmitted disease, both in the United States and Europe. Dogs, cats, cows and horses have also developed Lyme disease though they have not yet been shown to be able to transmit it to humans or to serve as sources for infecting ticks.

More and more cases of Lyme disease are seen each year. The increase is related to the increase of the deer population and development of more housing in rural and suburban areas. A study in Westchester County, New York, showed deer ticks to exist in some suburban lawns, particularly those at the fringe of woodlands.

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Physicians have divided Lyme disease into three clinical stages. Stage 1 consists predominantly of skin rashes and flu-like symptoms. Stage 2, which follows several weeks to months later, consists of neurologic, cardiac and musculoskeletal symptoms. Stage 3, which can occur months to years after the initial bite, encompasses arthritic and other neurologic symptoms. There is considerable variability in the range, severity, order of appearance, and duration of symptoms among patients with Lyme disease. In fact, only 60-80 percent of all Lyme disease patients exhibit the "typical" illness pattern.

Stage 1 -- Within 30 days of infection, a characteristic rash may appear at the site of the tick bite. Known as erythema migrans (EM), it typically consists of a bright red ring encircling the bite and often a clear area at the center in a "bulls-eye" pattern. But it may also appear as a bright red blotch or patch. The rash can expand gradually up to several inches in diameter and is generally not itchy. In about half of patients, a small number of secondary skin lesions (usually no more than five), may occur later at a distance from the original bite. These lesions may result from dissemination of the spirochetes. The rash is commonly seen on the thighs and in the groin and underarm areas. About 60-80 percent of people with the rash also experience flu-like symptoms including fatigue, headache, stiff neck, muscle aches and pains, and general malaise. The rash usually disappears within three weeks even without treatment.

About 20-40 percent of Lyme disease patients never exhibit the typical EM rash making accurate diagnosis more difficult. Some develop other types of rashes while others never develop a rash at all.

Early studies showed that approximately 80 percent of patients who are not treated in Stage 1, as well as a small percentage of those who are treated in Stage 1, progress to later stages of the disease.

Stage 2 -- The early neurologic complications of Lyme disease occur in about 15 percent of untreated patients. They consist of inflammation of the brain and its covering membranes (meningo-encephalitis), inflammation of the nerve roots (radiculitis) and facial paralysis (Bell's palsy). These symptoms may last several months but then completely disappear in most instances if properly, diagnosed and treated. On occasion, they become chronic.

The cardiovascular abnormalities of Lyme disease occur in about eight percent of untreated patients. These abnormalities include dizziness, shortness of breath and irregular heart rhythm which may require a temporary pacemaker. These symptoms generally disappear completely within weeks.

Stage 3 -- Arthritis is a common late complication of Lyme disease and presently affects more than 80 percent of patients with untreated EM rashes as well as some who were treated. Generally, the disease involves the large joints -- the knees, shoulders, elbows, ankles and wrists. The joints become swollen and hot. Any motion creates pain. Initial attacks of Lyme arthritis are often brief, but attacks usually recur. A small number of patients develop chronic arthritis.

In Stage 3, a small number of patients also exhibit neurologic abnormalities such as somnolence, loss of memory, mood swings and inability to concentrate.

Fatalities due to Lyme disease are rare. When they do occur, they usually result from cardiac complications.

The diagnosis of Lyme Disease is usually based on history and physical examination. The presence of the characteristic rash and the history of a tick bite in a patient who has been in an endemic area for Lyme disease lead to a straightforward diagnosis. The diagnosis becomes more difficult if one of the classic components is missing. For example, many patients do not recall a tick bite or rash.

Antibiotics are currently the front-line treatment for Lyme disease and its complications. Antibiotics are generally taken orally during Stage 1 and intravenously during later stages.

Early treatment shortens the course of Lyme disease and significantly reduces the frequency of late complications such as arthritis. It is most important, therefore, to diagnose Lyme disease and begin therapy as early as possible. The success of treatment begun during the third disease stage is not so predictable.

The following is a list of precautions which can help reduce the risk of acquiring Lyme disease. Many of these are time-consuming and impractical. It is therefore advisable for people who live in, or visit tick-infested areas to pay particular attention to these precautions during the peak season of May-August and when walking in grass or low brush or wooded areas. Remember:

- None of these precautions will ensure against contracting Lyme disease.

- In endemic areas, it is possible to be bitten by an infected tick even on a suburban lawn.

Avoid endemic areas. The surest way to prevent Lyme disease is to avoid Lyme disease endemic areas. You can get current information on Lyme disease endemic areas by contacting local or state health officials. However, this solution is not always practical or feasible.

AVOID TICK BITES

- Learn about Lyme disease and recommended precautions.

- If possible, walk on paved surfaces and avoid coming into contact with shrubs. When in the woods, walk in the center of paths and trails.

- Clothing -- Wear long-sleeved shirts and long pants, tuck shirt into pants, pants legs into socks or boots and secure sleeves at the wrist. Wearing light-colored clothing will make it easier to detect ticks. Don't wear sandals or open footwear.

- Inspect Clothes -- Brush off any dark spots on clothing. After returning indoors, remove all clothing. Running clothing through a dryer for a half hour will kill remaining ticks.

- Repellents -- Apply insect repellent containing DEET (Diethyltoluamide, found in Deep Woods Off, Cutter and Muskol) to skin and to the outside of clothing, particularly to pants legs, socks and boots. Don't use commercial products with greater than 50 percent DEET concentration on children's skin. You can also apply the tick insecticide product called Permanone, which contains the active ingredient permethrin, to clothing. Since Permanone is not available in all states, check its accessibility with the local health department. Do not apply Permanone directly to the skin.

- Pets -- Walk pets on paved surfaces. Comb them with a fine-tooth comb or with a lint removal roller (made of masking tape) to prevent them from carrying ticks into the house. Use flea and tick collars. Ask your veterinarian about anti-tick sprays and powders.

Immediately remove ticks from your body. Once on a human, ticks may require up to a day to attach and begin feeding. Therefore:

- Inspect your body carefully and frequently for ticks. Look carefully in body areas where ticks are most likely to bite such as lower legs, backs of knees, groin, armpits, neck and back.

- Remove ticks promptly. Brush off those not yet attached, and use tweezers to remove those already affixed. It is best to grasp and remove the tick by its mouth parts because they otherwise break off easily and cause secondary infections. The mouth, (which is easier to distinguish on adult ticks), usually lies closest to the skin. Removing a tick requires patience because ticks hold onto skin very tightly with their sharp barbs. Gently tug outward until the tick lets go. If the skin tears, immediately wash the area with soap and water or alcohol. Save the tick in a plastic bag or a jar of alcohol or tape it to an index card and note the date of the bite. Physicians can have the tick examined by public health entomologists to help make a correct diagnosis.

- DO NOT use flame, vaseline or nail polish remover to try to kill the tick before removing it. These methods will either make it more difficult to remove the tick or cause unnecessary delays in removal.

American Council on Science and Health, Inc.

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