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LYME DISEASE: WHAT YOU NEED TO KNOW

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by Fern Perlman, MD

Related: Lyme disease, tick, outdoor, bite, doctor, infection, ,


Lyme disease! That dreaded infection! With the warm weather here, it’s time look to refresh yourselves on the symptoms, warnings and treatments.   

How Do You Get Lyme?
   Deer ticks are tiny (head of a pin) blackish-brown creatures that live in forests, grassy areas, fields, woodlands, marshes, and near rivers, lakes and oceans — which covers a lot of local territory. Many people who have been infected with Lyme disease were bitten by the tick while hiking or camping, or during outdoor activities in their own backyards. Lyme disease occurs in all ages, but is highest in ages 5-9 and 45-54.

   The usual period of infectivity is April through October, but the risk of contracting Lyme disease from an infected tick is low unless the tick is engorged and has been feeding for 48-72 hours. Sometimes an infected tick can carry other diseases, such Babesiosis, and Ehrlichiosis.


Finding a Tick
   After you’ve been outdoors, check yourself and your child, taking special care to look behind the ears and under the hairline. If you find a tick, note whether it is attached, flat, or engorged. Take tweezers and pull straight up to remove the tick. If you find an engorged tick or a rash, don’t panic but do call your doctor. Remember the tick must have been feeding for 48-72 hours to transmit disease, so if the tick is on the clothing or walking around, it’s a good sign.


What Are the Symptoms?
   The first and most obvious symptom of Lyme disease is a rash at the site of the bite that begins as a pink circle several inches in diameter — usually on the head, neck, trunk, armpits, groin, or thighs. Often it has a clear area in the center, which is how it came to be called a bull’s-eye rash. It may appear from three to 30 days after the bite, and may expand over time.

   Other early symptoms — occurring several weeks after the tick bite — can include fever, chills, headache, fatigue, and muscle and joint aches and pains. There can be swollen glands in the neck and groin. Untreated Lyme can result in more serious conditions such as multiple circular rashes, palsy of the cranial nerves resulting in facial or Bell’s palsy, conjunctivitis, meningitis, and rarely, carditis. Late disease most commonly presents as recurrent arthritis of large joints, often in the knees. These conditions are extremely uncommon in children who are treated with antibiotics during the early course of the disease —which is why it’s so important to get diagnosed early.


Diagnosis
   The diagnosis of early Lyme disease is most easily made at the presentation of the rash. Other symptoms, however, resemble flu symptoms and can be misdiagnosed. A blood test can indicate Lyme, but antibodies to the bacteria take a few weeks to develop and may not be present initially, leading to false negative results.
   Diagnosis of early and late disease depends on clinical symptoms as well as a blood test. Once a blood test is positive though, it may remain so for life. Consequently a positive blood test after treatment does not mean the treatment was unsuccessful.

   Blood testing is done in two steps. An enzyme screen (EIA or IFA) is done first, and if it is positive, then a Western Blot is done. A Western Blot that is a true positive is never preceded by a negative screen, and conversely a positive screen does not always signify Lyme disease and must be confirmed with a Western Blot.

   It is important to realize that fatigue, muscle pain, and headache alone — without a rash, arthritis, or Bell’s palsy — seldom indicate Lyme disease in a person not engaged in outdoor activity during tick season. A blood test done in response to these symptoms alone has little predictive value.


Treatment Options
   The preferred treatment for early Lyme disease is a 14- to 21-day course of the antibiotic doxycycline for children over the age of 8, and a similar course of amoxicillin or cephalosporin for children ages 8 and under. If symptoms of early-disseminated disease are present, 28 days of treatment is indicated. Late disease is treated with 14 to 28 days of intravenous therapy.

   Some doctors will prescribe a single dose of doxycycline for children over 12 who have been bitten by an engorged tick. This protocol is not universally followed and may not be effective. Testing of an engorged tick has poor predictive value and is not encouraged.


How to Avoid Lyme in the First Place
   The best way to avoid Lyme disease is to avoid those places that are infested with ticks. But often that’s not possible. If you’re camping or hiking, cover arms and legs, wear a hat, pull back long hair, and wear closed shoes. Tuck pants legs into your boots, and wear light-colored clothes so ticks can be more easily spotted. Have your child stay on cleared paths rather than in deep woods or tall grass.

   At home, safeguard your yard by clearing brush, leaves, and tall grass. Ask a licensed professional pest control expert about further steps you can take.

   The insecticide Deet can be used in concentrations of less than 30 percent, but it must be reapplied frequently and washed off at night. Another insecticide, Permethrin, can be sprayed on clothing and is good for 10 to 15 washings.

   Remember, Lyme disease is a treatable condition if caught early. Be careful, take precautions, and check for ticks when you’ve been in an area where ticks might live, but don’t let the threat of these little creatures undermine your outdoor fun.


Fern Perlman, M.D. has been in practice with Bay Street Pediatrics in Westport for over 30 years. She is a senior attending at Norwalk Hospital and an Associate Clinical Professor of Pediatrics at New York Medical College. She and her husband have lived and raised four children in Westport.





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