Every summer, there are more than 30,000 new cases of Lyme disease in the US, with 93% occurring in 10 states—Connecticut (where the disease was originally identified, in the towns of Lyme, Old Lyme and East Haddam), Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin. The Pacific deer tick—a close relative of the species found east of the Rockies—causes Lyme disease in California.
Most recent development: University researchers, in cooperation with the federal Centers for Disease Control and Prevention, conducted the largest-ever field study of Lyme disease, publishing their results in the February 2012 issue of The American Journal of Tropical Medicine. They found Lyme-infected ticks in the 10 states listed above—and also in northern Virginia…along the Illinois/Indiana border…along the New York/Vermont border…in southwestern Michigan…and in east North Dakota.
That’s a fact. But a lot of frightening misinformation has shadowed scientific findings about Lyme disease. What you need to know now…
Lyme disease is an infection by the bacteria Borrelia burgdorferi, caused by a bite from an infected deer tick. The tick regurgitates the bacteria while sucking a “blood meal” from its host. Most humans are infected through the bites of immature ticks called nymphs, which are the size of a poppy seed. Adult deer ticks also can transmit Lyme disease, but because they are so much larger—the size of an apple seed—they are more likely to be discovered before having time to transmit the disease.
From the first, inaccurate stories have emerged about Lyme disease.
Example: In 1977, the tabloid headline “Mystery Disease in Connecticut Cripples Children” introduced Lyme disease to the public. Yes, Lyme arthritis—inflammation and swelling of the joints, particularly the knee joint—is a possible symptom of Lyme disease when it’s not treated with antibiotics in its earliest stage. But of the thousands of children who have developed Lyme arthritis, not a single child, to my knowledge, has ever been crippled.
My perspective: I have been diagnosing and treating Lyme disease since it was first identified in the 1970s, and I have helped conduct more than a dozen scientific studies on the condition—including an investigation of information about Lyme disease on the Internet.
I found that of the eight Web sites with the word “Lyme” in their domain name, seven gave inaccurate information. (The accurate Web site is www.aldf.com, maintained by the American Lyme Disease Foundation.) An accurate Web site without Lyme in its domain name is www.cdc.gov.
If you remove a deer tick within 24 to 48 hours after it has taken up residence on your body, the tick is unlikely to have infected you with Lyme disease. And chances are, even if you don’t remove it and you are bitten, you won’t get Lyme anyway. Of all people bitten by an infected tick, only about one in 20 develops Lyme disease. Also, not every deer tick is infected with Borrelia burgdorferi—in some areas, the rate is as high as one in five ticks…in other areas, the rate is less than one in 100.
If you have been bitten by a tick, the guidelines of the Infectious Diseases Society of America (IDSA) do not routinely recommend that you receive antibiotics unless you develop the obvious rash of Lyme disease—a red, circular “bull’s-eye” (targetlike) rash. Lyme disease’s nonrash symptoms don’t warrant immediate treatment with antibiotics because they’re shared by many conditions and because antibiotics have their own health risks. However, if you are very nervous about developing Lyme disease after a tick bite, talk to your doctor about taking a single, 200-milligram (mg) dose of doxycycline.
The bull’s-eye rash begins three to 30 days after the bite, starting out the size of a quarter and widening to the size of a football as bacteria spread out.
Treatment for “early Lyme disease” (the first month or so after a tick bite with an identifiable rash) is one of the following—doxycycline (100 mg twice a day for 10 to 21 days)…amoxicillin (500 mg three times a day for 14 to 21 days)…or cefuroxime axetil (500 mg twice a day for 14 to 21 days). It typically is not necessary to treat Lyme disease for more than four weeks, and intravenous therapy rarely is needed except for those patients hospitalized with Lyme meningitis (inflammation of the membranes surrounding the brain and spinal cord).
If the disease isn’t treated with antibiotics, at least one out of 10 people will develop Lyme arthritis, which requires a specific antibiotic regimen.
Infection with Lyme disease can be diagnosed with antibody-detecting blood tests (ELISA and immunoblots), but the tests are inaccurate in the first two weeks after infection—clinical signs are the best way to diagnose early Lyme. The two tests are helpful in confirming Lyme arthritis or other rarer manifestations of Lyme disease, such as meningitis, Bell’s (facial) palsy (if bacteria affect nerves in the face) or Lyme carditis (if bacteria infect the heart).
About 10% to 20% of people with Lyme disease develop what infectious disease specialists call post-Lyme disease—they continue to feel bad for months afterward, with symptoms such as joint pain and fatigue, even though blood tests show no active infection. This is a poorly understood phenomenon, but it is not due to persistent infection.
Several double-blind, randomized, placebo-controlled trials show that long-term antibiotic treatment for the symptoms of post-Lyme disease offers little or no benefits, and it frequently is dangerous and occasionally deadly. I recommend emotional support and medical management of the pain, fatigue and other symptoms.
If you live in an area where there are Lyme-infected ticks, it is sensible to take the following precautions when ticks are feeding, usually from early April through September…
Spray exposed skin with the insect repellent DEET before going outdoors into a grassy or wooded area. Research shows that DEET effectively repels deer ticks and that a product with 30% DEET lasts all day.
Check your clothes and body for ticks after coming indoors from a grassy or wooded area. Then take a shower. Washing ticks off your body is a good way to prevent bites.
If you find a feeding tick, remove it—and don’t worry about your technique. Grab the tick with a tissue or handkerchief, and pull it out slowly. You don’t need to twist the tick clockwise or counterclockwise or remove it in any other “special” way.
And it is not a problem if the tick’s feeding mechanism breaks off and remains in the skin. Treat it like a splinter, removing it with a needle, or let it work its way out on its own.
