Lyme disease and tick-borne illnesses: What to know
By Dr. CHARLES BRANSFORD – Guest Columnist
Lyme disease was first identified in our area from a lymph node biopsy in 1983. The Lyme disease causing Borrelia spirochete was found in the biopsy, and we have been learning more and more about the disease ever since.
Many infections occur before people are really thinking about the condition, since the deer tick can come alive as early as March 1. We live in an area where approximately 50 percent of the deer ticks are infected with the Lyme Borrelia organism. If a deer tick bites you and it stays embedded in your skin for 24 hours, the risk of Lyme disease is approximately 5 percent.
The most sensitive sign of the infection is a rash that develops at the site of the bite. The commonly described bull’s-eye rash typically occurs about three to nine days after the bite, and it can have many variations. Bites often occur at the edge of the scalp along the hairline, or in hidden areas such as the groin, armpit or behind an ear. The rash can be very subtle and hard to see, particularly in dark-skinned individuals.
Often the rash appears without other symptoms and will disappear in the three to nine day period, even without treatment. Only about 25 percent of people ever identify an embedded tick when they contract Lyme disease. Others will experience flu-like symptoms with or without the rash. Several other co-infections have been identified with Lyme disease.
In our area the most important second tick born illness is anaplasmosis, which might occur on its own or with Lyme disease. This disease is important to identify because it requires a specific antibiotic (doxycycline) that might not be used for Lyme disease. People can become quite ill from this organism with high fevers and headaches. Doctors are often confused by the illness because it will not have any associated skin rash.
Because people might not have noted the rash or the tick bite, the first presentation for Lyme disease may be what is called "secondary" Lyme disease. This can occur between six weeks to six months after the bite. It can be quite scary and confusing, as the Lyme-causing spirochete can travel to just about any part of the body.
Diagnosing secondary Lyme disease can be difficult since there can be a variety of symptoms. Some of the more common symptoms include Bell’s palsy (sudden facial droop from paralysis of the seventh cranial nerve); diffuse painful arthritis, or a painful swollen knee; meningitis; heart block; or painful neuropathies of all types. Fortunately, the treatment for secondary Lyme disease is quite good, though it often requires six weeks of IV antibiotics. Recovery is usually complete.
So, what can you do to minimize your chance of contracting Lyme disease? Please don’t stop going outside by yourself or with your children. This would be the worst consequence I can imagine. Rather, plan a regular tick check ritual each day after playing outside.
With children, do a thorough check at bath time, remembering to check all those little places ticks can hide. If you find one, simply remove it with your fingers or a tweezers without squeezing too hard. If the tick hasn’t been embedded for too long, it will come out easily. If it is deeply embedded, or if the head doesn’t come out, consider going to the clinic where a doctor can remove it entirely.
If you find an embedded tick, write down where the bite was and the date. If you are not sure if it is a deer tick, keep it in a plastic bag for later identification. Observe the site for rash. Typically, a dime-size redness may occur as a local reaction to the bite and does not necessarily mean Lyme disease. Larger expanding rashes are a concern and should be observed by a professional.
If flu-like symptoms occur, even without a rash, a doctor visit might be warranted. If you develop a rash and are at a place where you can’t get to a doctor, take a cell phone picture of the rash to show your doctor later. This is important because the most reliable diagnostic tool we have is the rash.
Things to remember: The rash will go away even without treatment, but this does not mean you don’t have Lyme disease. The common second tick-borne infection – anaplasmosis – does not develop a skin rash. Only 25 percent of infected people ever notice an actual tick bite. Blood tests for Lyme are not reliable for the first six weeks after an infection and should not be used as a reason to treat or not to treat. After six weeks, particularly with secondary Lyme disease, the blood tests are very helpful.
Dogs also get Lyme disease and frequently bring ticks into the house. Frontline works well for dogs, and the Lyme vaccine is approved for dogs but not humans (the human vaccine was taken off the market due to too many unpredictable side effects).
Treatments for secondary Lyme disease are quite good. The prognosis depends on how early you diagnose and treat the condition. Doctors will usually ask you to be seen in the clinic, rather than provide antibiotics over the phone, since the initial diagnosis is so important. Many things have been labeled as Lyme disease or not Lyme disease in error.
Finally, if you work outside a lot (such as a DNR or park employee) and you are frequently exposed to ticks, there are some preventive antibiotic programs that can be helpful. Please consult with your physician.
We live in one of the most beautiful environments in the world. Don’t let ticks deter you from the fun that only Mother Nature can provide for you and your family.
Charles Bransford, MD, practices Internal Medicine at Stillwater Medical Group, and serves as Medical Director for Lakeview Health.