Lyme Disease: What You Should Know

Smiling hikers in forest

It’s not yet summer but already I have started to see and remove ticks from patients. According to the CDC, tick-borne diseases have been on the rise this past decade with Lyme disease topping the list, now about 35,000 cases a year. However some of this rise is probably attributable to better diagnosis and awareness.

According to the American Lyme Disease Foundation the most prevalent areas in the US affected by this disease are the upper east coast, as well as in the upper Midwest. These ticks live in tall grasses and on shrubs in wooded areas. They attach and feed on the blood of animals or people as they walk past and brush up against the vegetation in these areas.

What are the symptoms?
Lyme disease is transmitted by the bite of a deer tick called Ixodes scapularis, but field mice can carry these ticks too. The disease is actually caused by bacteria called Borrelia burgdorferi that lives in the tick and is then transmitted during its bite and attachment. However the fact that these ticks are very tiny – an immature tick is the size of a poppy seed while an adult tick is still only the size of sesame seed makes it difficult to spot one on your body. Symptoms can start days or weeks after being bitten. A characteristic circular bull’s eye rash develops around the tick bite. This rash has a reddish outer circle surrounding a central clear normal skin-colored zone. But one of the challenging difficulties in the detection of Lyme disease is that not everyone has the typical rash. There are other symptoms such as fevers, malaise, body aches and pains but these nonspecific flu-like symptoms can also make the diagnosis tricky. These are the early stages of the disease, which if left untreated can progress to complications, and late stage disease that can affect your joints, your heart and even your brain and central nervous system.

What if a deer tick bites you?
Finding the tick bite can be crucial. We know that it takes about 36 hours to develop the disease even after a tick attaches. Therefore prompt removal is key and makes transmission of the bacteria very unlikely. If you find an attached tick on your body, use a fine tweezers and grasp the tick as close as you can to your skin where it’s attached. Firmly with steady pressure pull on the tick backwards until it releases its grip. After removal wash the area of the tick bite and your hands with soap and water or rubbing alcohol. If some mouthparts of the tick remain in your skin don’t worry, they will work their way out on their own. Avoid trying to dig them out as this can only damage your skin and cause an infection. Often this is enough to prevent transmission of the disease. But check with your doctor. According to the Infectious Disease Society of America (IDSA) you may be eligible for a one time single prophylactic dose of an antibiotic called Doxycycline. But the criteria dictates that the tick was definitely a deer tick; that is was attached for at least 36 hours and you must been seen within 72 hours of removal. However, only people over 8 years old can take Doxycycline and the IDSA does not recommend any other prophylactic treatment for younger kids. In those cases they recommend monitoring them with blood tests and starting the full course of antibiotics if a rash or symptoms develop.

What is the treatment for Lyme disease once you develop it?
Because it is a bacterial infection it can be treated with antibiotics.  Commonly used antibiotics are Doxycycline, Amoxicillin or Cefuroxime. The recommended type of antibiotic and length of treatment depends on the age of the patient, the stage of the disease and which body system is affected.

Prevention is the best medicine
The CDC recommends wearing long sleeves and long pants as well as tucking pant legs into socks when walking through wooded areas. However this may be unrealistic, especially during the hot summer months. Therefore one of the most important preventative measure you can do is to shower or bathe immediately after outdoor exposure and do a careful tick inspection of your body, since ticks do not attach right away. Before attachment ticks can be easily brushed or washed off. Also inspect all your clothing for ticks after you come in from the outdoors and undress. Consider using tick repellents or tick pesticides on clothing when you are outside. Common repellents are DEET, Picaridin and a common pesticides used is Permethrin. Make sure you read the instructions and labels on each product very carefully before using.

You can protect your house and backyard from ticks by using tall fences to keep deer out. Clear out your forest borders of excess brush where field mice can live. Treating your property with tick pesticides as well as treating your pets with veterinary products that kill fleas and ticks can prevent your exposure from pets that may bring these ticks into your home.

Remember be vigilant in your tick checks after you have been outdoors because early detection, diagnosis and treatment can prevent any long-term complications from Lyme disease. The famous country singer songwriter Brad Paisley offers some wise advice in his song titled “Ticks” when he states, after kissing in the sticks “I’d like to check you for ticks!”