Lyme Disease

A 15 year old female presented to the office with a month long complaint of fatigue and body aches. Otherwise she felt well. Her medical history was unremarkable. She denied pregnancy. Her exam was unremarkable with no evidence of rash. Laboratory investigation was performed including a blood count, thyroid, glucose, and Lyme antibody. Her Lyme test was positive and then confirmed by a Western Blot test. She was given 21 days of Doxycycline and recovered well.

Lyme disease is the most common tick borne illness in the United States. The disease was first reported in 1975 in Lyme, Connecticut due to a cluster of cases involving arthritis in children. Since then, there have been thousands of cases with an annual incidence of 0.5% in endemic areas. The peak months are from May to August and the high risk states include Connecticut, Delaware, Maryland, Rhode Island, New Jersey, New York, and Pennsylvania.

The causative bacteria is Borrelia burgdorferi (type of spirochete). The organism is carried by the white tail deer and the white footed mouse. The bacteria is transmitted from the animal to human by the deer tick (Ixodes). If the tick is removed within 24 hours, the chance of contracting the disease is virtually zero percent. Also, less than 5% of tick bites result in Lyme Disease.

The signs and symptoms include:
1. "Flu-like" symptoms usually several days to several weeks following the tick bite
2. Erythema Migrans (characteristic rash of Lyme Disease)
3. Joint pain
4. Fever
5. Fatigue
6. Headache
7. Neck pain

Erythema Migrans is defined by the CDC as a skin lesion that typically begins as a red spot and expands over a period of days to weeks to form a large round lesion, at least 5 cm (about 2 inches) across. As it grows, it may look like a bull's eye rash.

The symptoms, if untreated, can progress to severe arthritis, cardiac problems, neurologic complications, ocular problems, gastrointestinal complaints, and hepatitis.

Diagnosis is made by blood work (Lyme titer via ELISA and Western Blot). If there are neurologic symptoms, the CSF needs to be tested for meningitis.

Treatment includes:
1. Tick removal
2. Contact your primary physician
3. Antibiotics (Doxycycline, Amoxicillin, or Cefuroxime) for at least 21 days
4. If the symptoms are severe, IV antibiotics may be necessary

Prevention includes:
1. Wear enclosed shoes and light-colored clothing to spot ticks
2. Check clothes and any exposed skin frequently for ticks while outdoors
3. Stay on cleared, well-traveled trails
4. Use insect repellant containing DEET (Diethyl-meta-toluamide) on skin or clothes
5. Avoid sitting directly on the ground or on stone walls
6. Keep long hair tied back
7. Do a full-body tick-check at the end of the day (also check children and pets)

To remove a tick, follow these steps:
1. Using a pair of pointed tweezers, grasp the tick by the head right where it enters the skin. Do not grasp the tick by the body.
2. Pull firmly and steadily directly outward. Dn not twist the tick out or apply petroleum jelly, a hot match, alcohol or any other irritant to the tick in an attempt to get it to back out.
3. Place the tick in a vial of alcohol to kill it.
4. Clean the bite wound

Contact your primary physician for more information.
Also check the CDC link on Lyme Disease.

Have a safe Thanksgiving Holiday!