Lyme Disease – How can I protect myself?

Lyme disease is endemic to the seacoast. As the peak incidence of the disease occurs in July, lets look at what generally can be done to lower your risk of the disease.

Lyme disease is a bacterial infection spread to humans by the bite of a particular tick, commonly known as the Deer Tick (Ixodes scapularis in this part of the country). The tick lives primarily on deer and the white-footed mouse, humans, as incidental hosts, are susceptible to the disease. Those at greatest risk live in areas where deer abound. Other than in winter months, the disease can be contracted throughout the year. The majority of infections (80%) occur from April through August reflecting the higher risk of infection from the younger (nymph) tick bites.

It’s important to remember that the vast majority of tick bites do not result in infection. Ticks must go undetected and remain attached for long periods (generally at least 36 hours) before infection can occur. The bacteria that causes the disease (Borrelia burgdorferi) is very susceptible to commonly used antibiotics (penicillin and tetracycline) so the disease remains not only readily treatable but also preventable with small prophylactic doses of antibiotics (see below).

Prevention strategies focus on lowering exposure risk, detecting and removing ticks, possible use of prophylactics, antibiotics, and early recognition of signs and symptoms of the disease.

Minimize exposure: Obviously areas of deer habitation pose the greatest risk. But with increasing population of both humans and deer in the seacoast most rural areas remain at risk. When wearing long pants remember to tuck pant legs into socks and the use of repellants has also been shown to work. Some people advocate, in areas of high deer/tick population, the use of chemical agents ( known as acaricides) over the entire yard. Application is recommended in May and has been shown to markedly reduce tick populations. Applications need to be repeated and should be done by professionals. Simple measures like a border of wood-chips where the lawn abuts the woods also, for some reason, reduces the number of ticks that inhabit the lawn. Some communities are experiencing with treating the mouse host e.g. with bait boxes chemically treated with a substance to kill the ticks.

Detecting and removing ticks: This is extremely important. Careful evaluation of yourself and your children should become routine. The ticks are very small, only 3-4mm in size, and the younger (nymph) ticks is even smaller. All however, enlarge markedly when engorged with blood and become much more detectable. Removal is by gently traction (in order not to dislodge the head): The use of petroleum jelly or a hot match is not recommended. And remember, the tick must remain attached for many hours in order to transmit infection: you don’t need to check for ticks several times a day, just on a regular, daily basis.

Prophylactic antibiotics: There are uncertain situations where the use of a single, preventative dose of antibiotic (usually 200mg of doxycycline , a tetracycline) has been shown to work. These are used if the tick has been attached for over 36 hours, or when an engorged tick is discovered. If you remove the tick yourself, save it to show your treating physician (primary care, pediatrician ,ER physician )and seek treatment within 72 hours.

Early recognition of signs and symptoms: Only about 30% of people diagnosed with Lyme disease recall a bite, so you need to be aware of the primary disease manifestations. These fall into four main areas: dermatological (skin)(seen in the early phase), neurologic, cardiac and joint related (seen in later phases of the infection).

Dermatological signs are the most common with a rash seen in 60-80% of infections. The rash is an expanding red rash whose central area can initially be bright red, blister-like or firm, but later develops a characteristic “central clearing” (i.e. The central area appear normal.) Other insects/spider bites, fungal infections or plant allergies can mimic the rash. Have the rash examined by a qualified provider. The rash is sometimes associated with other symptoms of acute infection such as low-grade fever, swollen lymph glands, neck stiffness malaise/fatigue or joint pain.

Neurologic symptoms may develop in patients who do not recognize and treat early disease. This is often first seen as Bells Palsy (acute facial paralysis). Meningitis may also develop. This presents usually as a persistent headache associated with other symptoms such as memory loss, poor concentrations, sleep disturbance, confusion irritability and/or behavioral/mood disturbances. The other neurologic symptom that is seen is what is called radiculoneuritis – the development of a painful limb, typically a stabbing or burning pains.

Cardiac symptoms are less common and are usually seen as the development of heart block – a profound slowing of the heart rhythm. It is not commonly seen ( in perhaps 5-10% of late disease) but should be evaluated immediately.

Finally joint symptoms are seen. These again develop after the initial infection and while they may develop within a month, they are known to occur many months or even 1-2 years after initial disease. Like many forms of arthritis, this is seen as a painful, swollen, joint.

In summary, the disease is not very common and is very treatable with rare long term or permanent effects. Try to focus on prevention, in particular looking for and removing ticks, and on early recognition, especially the rash. Seek prompt medical attention for any suggestive signs or symptoms.

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