Lyme Disease can cause a wide array of symptoms: low grade headaches, muscles aches, sore throats, and abdominal pain. It can easily be mistaken for a summer flu. It is thought that many people have been exposed to Lyme disease over the years but their immune systems have cleared the illness and prevented them from developing symptoms or becoming sick.
In fact, the disease was first identified in Old Lyme, Connecticut in the l980s when some local pediatricians noticed an increased incidence of juvenile arthritis in the community. This was brought to the attention of researchers at Yale, who identified the cause as the spirochete, Borrelia burgdorferi which is transmitted by tick bites. In fact, there used to be a syndrome called “Montauk knee'” that was well known in Eastern Long Island in which a person would have a swollen ‘arthritic’ knee that would last for a couple of years and then resolve.
The disease is caused by a type of germ called a spirochete, that lives in the stomach of a tick. When a person is bitten by a tick that is infected with Lyme, the infectious spirochete can pass from the tick’s intestinal track to the person’s blood stream towards the end of the feeding process when the tick regurgitates. In order for the illness to be transmitted from the tick to the person, the tick has to be attached for at least 36-48 hours.
Lyme disease is classified as either early or late, and localized or disseminated. In early localized disease, a reddish rash appears within a few days or month after a tick bite. The rash can slowly expand, and clear in the central area, giving a target like pattern. This rash is called Erythema Migrans. It usually occurs on the site where the tick has fed. In early disseminated disease, the infection has spread through the bloodstream. There can be multiple circular ‘target’ rashes.
In many cases of early Lyme, the rash will appear before there are measurable antibody titers against the spirochete. Skin biopsies can show DNA traces of the illness in the advancing rash, but this is not routinely done. Starting antibiotics early stops the spirochete in its track.
Because of this lag in antibody response, and the good response to early treatment, most doctors will begin antibiotics is there is a strong suspicion that a rash is due to Lyme. Even if the antibody titers are negative, they will continue antibiotics for a full course (usually 21 days). . Often there is a transient worsening of the rash and a flu like symptoms during the first two days of therapy. This is due to the release of immune substances (cytokines) as the spirochete is killed.
During the early phase of illness, the person can experience headaches, muscles aches and fatigue. Some people can have a sore throat or abdominal pain. In a few instances, the illness can cause a temporary paralysis of the facial nerve (Bell’s Palsy), making it difficult to smile or blink). Many people will go to their doctors at this point, and if there is a suspicious of possible Lyme Disease, get tested and treated with a course of antibiotics. In a small number of people, the illness can attack other areas of the body. Lyme can cause meningitis (inflammation of the spinal fluid), and carditis (inflammation of the heart muscles). In such situations, the person is given a prolonged course of intravenous antibiotics, and is followed by a team of specialists
It is thought that many people exposed to Lyme but never diagnosed, have been able to clear the infection spontaneously. When Lyme disease was first being studied, many people on the east end of Long Island were found to have antibodies to Lyme disease without a recollection of having been sick with it. As with any illness, many people will encounter a pathogen, and be able to defeat it without classic clinical symptoms.
In some people, the illness will progress to what is considered “late” Lymes, and induce arthritis. The hallmark symptom of Lyme arthritis is a swollen joint appearing months after initial exposure. One or more joints can swell and the arthritis can wax and wane for years. In the years before Lyme disease was identified, the arthritis symptoms would resolve in many people after about seven years.
It is thought that people who are genetically more prone to auto-immunity, are among the group of people who have more persistent symptoms of arthritis after completing a course of antibiotics. The germ has been killed off, but the germ had been able to provide ‘auto-immunity’. The person’s immune system, which had been activated against the germ, is now directing itself towards the joints – giving lingering arthritis, with associated symptoms of fatigue.
Children usually make a complete recovery and have an excellent prognosis. It is thought that many children who are exposed to borrelia bergdorferi experience mild flu like symptoms and clear the illness completely. However, it is important to consider the possibility of Lyme in people who visit relatives and vacation in Lyme endemic areas. Doctors in other parts of the country might not think of Lyme when a person develops symptoms after returning home from vacation.
Avoiding Lyme Disease
- Do a tick check every evening, or after a walk in the woods.
- Keep hand mirrors in the bathroom so family members and house guests can inspect the groin and buttock areas, and behind the ears.
- Wear tick protective clothing: long pants gathered at the ankle with a ribbon tucked into socks.
- Use a low concentration DEET spray on clothes and accessories (for example, put some insecticide on a baseball hat, or a hair band. Put some DEET on a ribbon and tie them around the bottom of pants.
- The laundry softener, Bounce, is thought to contain a fragrance that acts as a tick deterrent.
- Be vigilant about ticks in the spring time and Indian summer when the newly awakened baby ticks (nymphs) are most likely to spread the disease as they home in on an unsuspecting warm blood mammal prancing through the woods.
- Take a shower or bath in the evening – this can help tick detection and might possibly wash away a non-attached tick.
- Remind house guests to doing a daily tick check, and mention their travel history to a physician if there were to develop any flu like symptoms after vacationing in a Lyme endemic area.
What to do if you discover an embedded tick?
- Keep a good set of tweezers and a magnifying glass on hand. If you see an embedded tick, try to remove it right away. Look at the tick, aim at the head, apply the tweezers and lift the tick vertically from the surface. It’s important to remove the mouth and gut. If there is a little black spot remaining, look at it with the magnifying glass. One of the pincers might be remaining. Put some antibiotic cream on top of the area rather than traumatizing the area trying to remove a small speck of pincer.
- Check the site where the tick had been for the next month for any sign of a pink circular rash. If one appears, bring the child to the doctor.
- If you discover a tick that has been embedded for more than 36-48 hours, and the tick was from an endemic area, the tick can be sent for PCR analysis for the presence of the spirochete. Insurance carriers typically do not cover this lab test.
- Many doctors will give a few prophylactic doses of doxycycline or in children less than 8 years old, amoxicillin when a tick that has been embedded for a long time is discovered. However, if this is done, should any symptoms of Lyme or a rash appear in the following month, serological tests should be done.
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