Insight Into Lyme Disease
Lyme Disease is one of the fastest growing infectious diseases in the United States. This disease affects over 1,000,000 people on every continent, with the exception of Antarctica. Although it is believed that Lyme Disease spread from Europe to the United States in the early 20th century, it wasn’t until 1975, when numerous children in Lyme, CT and surrounding areas were treated for juvenile rheumatoid arthritis, that it was first diagnosed.
Cases of Lyme Disease can be found in most states. The highest risk areas can be found along the East Coast and the northwest. The highest number of reported cases can be found in New York, New Jersey, Connecticut, Pennsylvania, Massachusetts, Rhode Island and Maryland. Lyme Disease is not exclusive to these areas. Cases can also be found in Wisconsin, Minnesota, California, Oregon and even in parts of Canada.
Lyme Disease does not discriminate between young and old. According to the U.S. Center for Disease Control and Prevention, people of all ages can become infected. The highest number of reported cases occurs in children between the age of two and fifteen and adults between 30-55.
What should we know about the ticks that can transmit the bacteria causing Lyme Disease? The most common carrier of Lyme Disease is the deer / black legged tick. The Western black-legged tick is most common along the west coast. The ticks thrive in moist, wooded areas and are frequently carried place to place by migrating birds.
Approximately 50% of adult deer ticks and another 5% of Western black-legged ticks in high risk areas are infected with the bacteria causing Lyme Disease. Although Lyme Disease is common in ticks in some areas, it is practically nonexistent in ticks in other areas.
The ticks can be found in three different stages: larva, nymph or adult. It is usually in the nymph stage that the tick transmits the bacteria. Nymphs are most active during the warmer months of May through July.
A tick attaches itself to an animal such as a rat, deer, bird or rabbit. If the animal is infected with the disease causing bacteria, the tick will become infected. This bacteria is then passed on through the bite of an infected tick.
The bacteria that causes Lyme Disease is called Spirochete. The tick passes bacteria to humans or animals through its bite. The bacteria enter the skin at the site of the bite and eventually penetrates the bloodstream.
Since the tick is usually in the nymph stage during this time, its bite is tiny and painless enough to go undetected. Therefore, early detection is vital. Ticks do not transmit the Spirochete for 36 to 48 hours after the initial bite. If a tick is removed within 24 hours, the chances of getting Lyme Disease are lessened. The longer the tick is attached to the skin, the greater the chances it will transmit the bacteria. However, it is important to remember that a tick lodged in the skin does not mean a person will automatically become infected.
A major step in Lyme Disease prevention is to use precaution while outdoors. Wearing long pants and long sleeve shirts minimizes the skin’s exposure to ticks. An additional precautious step is to tuck pants legs into socks or shoes and shirts into waistbands. Light colored clothing is also recommended. This makes ticks easier to spot.
Even the choice of appropriate footwear is important. Shoes or boots are recommended for outdoor activity. Footwear such as sandals will give ticks an added point of entry to the skin.
Once outdoors, be sure to avoid areas where ticks are most likely to be found. Dense woods, tall grass and brushy areas are the most popular locations for ticks. Walking in the center of trails is a good way to avoid overhanging grass and brush.
If there is a tick-infested area, be sure to check the clothes and skin for ticks. All ticks should be removed immediately. Not only is showering after all outdoor activity a precaution against tick bites but washing clothing is a good way to avoid risk. Children and pets should be check as well.
Do not pull a tick off if it has already lodged itself into the skin. Carefully cover the tick with oil. This will loosen the tick’s grip on the skin. Using tweezers, slowly remove all parts of the tick from the skin. Be sure to wash the area thoroughly. Keep a watchful eye on the area for any signs of infection. If concerned, consult a physician.
Early symptoms of Lyme Disease are mild enough that they are commonly overlooked. Flu-like symptoms, fever or muscular pain are experienced enough in everyday life where they are ignored most of the time. After a tick bite, this could be one of the signs of the onset of Lyme Disease.
Aches, chills, fatigue and headaches are also common symptoms. Many of the earlier symptoms of Lyme Disease resemble a viral infection. Symptoms have been known to clear without treatment or go through a waxing and waning pattern.
The most common sign of Lyme Disease is the expanding rash known as Erythema Migrans or EM. The rash occurs in 80-90% of all cases and is usually centered around the site of the bite. Resembling the shape of a bull’s eye, the skin rash occurs anywhere from three days to one month following a tick bite. Over the course of several days, the rash can expand and range in size from that of a dime to the width of a person’s back.
It is important to remember that EM is not the same as the welt that often occurs directly following a tick bite. As bacteria spreads through the blood, other rashes may appear on different parts of the body. However, the EM rash is the most definite sign of Lyme Disease. Treatment should be sought immediately if it appears. An untreated rash can last for weeks before fading or it may fade and reappear.
As the infection progresses, other symptoms of Lyme Disease may begin to occur. A Lyme Disease sufferer may notice irregular heartbeats signaled by dizziness and shortness of breath.
There are numerous physical symptoms during the later stages of Lyme Disease. Unexplained weight changes or hair loss, increased motion sickness or vertigo, frequent or easy bruising and white spots on the fingernails are just a few signs. Poor motor coordination and a loss of strength in the limbs are also characteristics. The person may suffer from eye inflammation or blurred vision. Hearing may become impaired to the point where a person may experience sound sensitivity, ringing in the ears or actual pain.
A person may also experience poor sleeping habits as well as mood swings. A person may suffer memory loss and may feel disoriented or confused. Concentration may be difficult to maintain.
Internal problems may also point to the onset of Lyme Disease. As the disease progresses, problems with the neurological, digestive, circulatory and reproductive systems may occur. Cardiac problems could include heart blocks or inflammation of the heart muscles. Distinctive arthritic problems along with other muscle and joint conditions are common with the late stages of Lyme Disease.
The major problem with Lyme Disease is that it mimics many other diseases. This makes it difficult for physicians to correctly diagnose and treat the condition. Inadequacies of lab tests and the elusive nature of the bacteria also hinder diagnosis.
Although a person may be in the very early stages of Lyme Disease, a patient’s immune system has not produced enough antibodies for it to be detected by testing. This makes an antibody test unreliable within the first few weeks of infection. The lack of reliability and quality control of the antibody tests contribute to the inaccuracy of the test results. If the patient is taking antibiotics during this time, antibodies may be prevented from reaching detectable levels.
Antibody tests that have been used to some degree of accuracy have been the Enzyme Linked Immunosorbent Assay (ELISA) and PreVue B. ELISA, the most common antibody test, must be performed while in a lab. The PreVue B test is often used as the first step in testing Lyme Disease. The test searches for the antigen that causes infections. PreVue B is used more often because it can be performed at a physician’s office. Results can be received within an hour.
Doctors will rely on a number of factors to accurately diagnose a patient with Lyme Disease. The history of the tick will be one of the most important factors that a physician will take into consideration. Physical examinations and lab tests will be taken into account.
A physician will consider the patient’s symptoms, the time frame of their initial appearance and rule out any other diseases that may cause these symptoms. A patient’s outdoor exposure and symptoms within other family members can also play a role in the physician’s final diagnosis.
Although the diagnosis of Lyme Disease is difficult, the misdiagnosis of the disease is common and causes great concern. False positive or negative test results frequently happen. Although the condition is later found to be Lyme Disease, some patients have been misdiagnosed as having Multiple Sclerosis, Chronic Fatigue Syndrome, Alzheimers or even Lupus. By the time treatment is received, irreversible damage may have occurred.
Lyme Disease can be detected and treated successfully if caught at an early stage. It is important that a patient continuously follow-up on all tests until a firm diagnosis has been made.
Effective and quick treatment of Lyme Disease is almost as important as an accurate diagnosis. If appropriate treatment is received in the early stages of Lyme Disease, a patient can expect a rapid and complete recovery. Late stages of Lyme Disease can be treated although, in some cases, the chances of complete recovery may have diminished.
If detected early, most Lyme Disease cases can be successfully treated with a three week regimen of antibiotics. A wide variety of antibiotics can be used to combat the disease. For example, amoxicillin or doxycycline are oral antibiotics that can be used to speed the healing of the EM rash and prevent subsequent symptoms such as arthritis and neurological problems from occurring.
The one problem with doxycycline is the drug can permanently stain teeth that are developing in younger children. In this case, amoxicillin and penicillin can be prescribed. These two oral antibiotics can be used in patients under the age of nine, pregnant women or for those who are allergic to erythromycin.
Ceftiaxone can be used once a day for a month in order to relieve neurological symptoms in patients suffering from Lyme Disease. Along with penicillin, this drug can also be taken intravenously for two weeks for heart or cardiac symptoms. Severe symptoms can be treated with Certicosteroids or a temporary pacemaker. Following treatment, a patient may experience fatigue or achiness. Usually, no further medications are necessary. There is rarely long-term damage to the heart.
Other oral antibiotics can be used to combat symptoms of arthritis. If severe, the antibiotics will have to be administered intravenously. Anti-inflammatory drugs can be used for affected joints. Fluid can also be drawn from the joints or the inflamed lining can be surgically removed in an effort to relieve pain or discomfort. The symptoms of arthritis usually subside within a few weeks or months following an appropriate regimen of antibiotics. If left untreated, irreversible damage can occur to the structure of the joints.
Individuals at risk should consider receiving vaccinations against Lyme Disease. This should be discussed in-depth with a physician. Vaccines are safe and can be administered at a doctor’s office or clinic. The vaccines are for preventative measures only and cannot be used to treat symptoms of Lyme Disease. It also does not protect against any other tick borne diseases.
Vaccinations are usually given in a series of three injections over a period of 12 months and are approximately 80% effective. After the initial injection, the second is administered one month later. The third injection is given 12 months after the first. Administration of the vaccine should be timed so the second and third vaccinations are given before the beginning of the transmission season.
The two most common vaccinations are ImuLyme and Lymerix. The ImuLyme vaccine kills the disease causing spirochete within the tick before it can enter the human bloodstream. Lymerix, by SmithKline Beecham, was approved by the FDA in December 1998 and can only be administered to those between the ages of 15 and 70. The vaccine stimulates the immune system to produce antibodies against the bacteria that causes Lyme Disease. Studies suggest that when a tick bites a vaccinated person, the antibodies enter and kill the bacteria in the tick.
Although studies have shown that the vaccine is 80% effective, it is not known how long the vaccine offers protection. It is expected that boosters will be needed in upcoming years.
It is important to realize that vaccinations cannot be administered to everyone. It is not recommended that women who are pregnant, children under the age of 15 and those who suffer from chronic arthritis be vaccinated.
Even though a person is vaccinated, there is no guarantee that the illness will be prevented in the future. The disease can also strike more than once in an individual. Bacteria can remain in the body and cause a patient to relapse in the future.
The research on Lyme Disease is ongoing. There has been much focus on discovering how Lyme Disease behaves in the human body, how they cause symptoms and how they evade the immune system. The National Institute of Allergy and Infectious Diseases is currently funding studies on the effects of Ceftriaxone and Doxycycline on chronic Lyme Disease sufferers. .
Although there is no cure for chronic Lyme Disease, continuing research and studies could provide a vaccine within the next few years. It is important to take preventative measures and to be aware of the early symptoms of Lyme Disease. Early detection and treatment could eliminate the effects of Lyme Disease in the future.
