Sometimes she feels a sensation of lights exploding inside her head. Other times her mouth, arms, and legs go all tingly. Audrey, a florist in Philadelphia, suffers from Lyme disease which she got one fine summer day when a nasty tick smaller than a pencil point bit her.
Borrelia burgdorferi, a corkscrew shaped bacteria known as a spirochete, causes Lyme disease. It got its name from Dr. Willy Burgdorfer, who discovered it in 1982.
Although the symptoms of the disease had been reported by people as early as 1908 in Sweden and 1970 in Wisconsin, it was not then recognized as a specific disease. In 1975, in Old Lyme, Connecticut, 50 people including many children came down with a strange disease that resulted in severe arthritis. Scientists studied these people, and in 1982 discovered the cause of the disease and how it was spread—by ticks. They named it Lyme disease after the town in Connecticut. Of course, the residents of this town are not pleased with the notoriety this name has brought them.
Lyme disease is the most common disease in the United States that can be caught from animals or insects. Deer ticks infected with the Lyme bacteria are the culprits. It is not spread from person to person. If you like the great outdoors, you are a potential victim of this tiny creature.
The deer tick has a complex two-year life cycle: Adult ticks feed and mate on large animals, especially deer, in the fall and early winter. In early spring the female ticks drop off the large animal to lay eggs on the ground. The female then dies. After several weeks eggs hatch into larvae. In the spring and summer, larvae feed on white footed mice. The larvae then hibernate until the next spring when they molt into nymphs (baby ticks). All the next summer these nymphs feed on mice. The nymphs molt into adults in the fall, feed on deer all winter, and the two year cycle goes on.
Because white-tailed deer are large and abundant, they are the most common hosts for adult ticks. Ticks may also feed on foxes, raccoons, cows, horses, dogs, and cats. The adult ticks are found in brushy wooded areas about three feet off the ground. The ticks attach to the animal or human host when it brushes up against them.
Larvae and nymphs who feed on infected mice become infected with Lyme disease bacteria, which multiply in the tissues of the mouse. These ticks have very aggressive feeding behavior and spread the disease when they bite mice, other animals, and humans.
Forty-seven states have reported cases of Lyme disease. Connecticut, the state where it first was identified, had the highest rate of infection in 1992: 54 cases for every 100,000 people. New York state had the highest total number of cases. Other states reporting large numbers of cases are Massachusetts, Rhode Island, Pennsylvania, New Jersey, Delaware, Maryland, Virginia, Georgia, North Carolina, Missouri, Minnesota, Ohio, and California. The Canadian provinces of Quebec, Ontario, Manitoba, and British Columbia have reported several cases, but in Canada the total number of annually reported cases is barely 100. It is also seen in several countries of Northern Europe.
Because the deer population is growing rapidly, so are the number of reported Lyme disease victims. In 1994, Lyme disease struck 8,300 people of all ages. Cases have been reported in people from ages 2 to 88.
How Do You Get It?
You get Lyme disease from being bitten by an infected deer tick. But not everyone who is bitten gets sick. Some studies show that only ten percent of those bitten come down with Lyme disease. This may be because the tick must sink its mouth parts into a person’s body and stay attached, sucking blood, for more than 24 hours to allow enough bacteria to enter the bloodstream and cause infection. So, if you remove the I tick before 24 hours, you won’t be infected.
Humans are usually bitten by the nymphs in June and July, when the nymphs are attaching to the mice and people are outdoors with bare skin. Cases can occur, however, anytime between March and October.
Although the most likely places for catching Lyme disease are wooded areas, nature reserves, and suburban gardens near areas inhabited by large numbers of deer, there are a few reports of Lyme disease in people who have never left the city. In Bah timore, Maryland, in 1989, a 44-year-old man who worked for the Baltimore Zoo I came down with Lyme disease. His case was investigated and the culprits were determined to be infected ticks found on raccoons and mice. Because only two or three deer live in this inner city park, it was concluded that adult ticks could survive the winter by feeding on mammals other than deer, such as those found in zoos. This was an unusual occurrence, and no other zoo workers became sick. Visitors to the zoo were not considered to be at risk. The zoo worker was treated and recovered completely.
How Do You Know If You Have It?
It may be hard to tell if you have Lyme disease because it mimics other illnesses, and in the early stages, there is no accurate test to detect it. But if you are alert and familiar with the symptoms, you should be able to recognize it. Lyme disease occurs in stages. The time interval between stages varies widely. Several weeks to several months can elapse between stages. Symptoms come and go, but if new symptoms appear, it usually signals the beginning of the next stage.
First Stage Symptoms. The first, most significant symptom, which occurs in 70 to 80 percent of Lyme disease victims, is a red rash called erythema chronicum migrans that develops at the site of the tick bite 3 to 32 days after the bite. This rash resembles a red circular patch, which expands over a few weeks to as large as 18 inches (46 cm) in diameter in varying shapes. After the first rash appears, a similar rash may develop in other places such as the thigh, groin, trunk, armpits, or face. Usually the center of the patch clears as it expands, causing a ringlike appearance that some people call a “bull’s eye” rash. Patches may feel warm but are not painful. Any rash that is at least 2 inches (5 cm) in diameter should be considered evidence of Lyme disease.
Flu-like symptoms may develop within a few days to a month after the tick bite, including headaches, chills and fever, aching muscles, stiff neck, joint pains, tiredness, and swollen glands. These symptoms usually come and go. Diagnosis of Lyme disease in the first stage is based on these flu-like symptoms, the presence of the rash, and history of exposure to ticks. People who are unaware of their exposure to ticks or to what Lyme disease is are often diagnosed and treated for a “virus” at this stage.
Second Stage Symptoms. Weeks or months later, untreated Lyme disease will reach its second stage. Symptoms may include migraine-like headaches and arthritis with pain and swelling in hips, knees, shoulders, and other joints. A small percentage (15 to 20 percent) of Lyme disease victims will suffer from nervous system involvement. Such problems as numbness, pain and weakness in arms and legs, muscle weakness of the face (Bell’s palsy), stiff neck, meningitis, memory loss, impaired vision and hearing, or severe fatigue can occur. Only about one in ten untreated victims have problems affecting their heart in the second stage. Their symptoms include dizziness, weakness, and an irregular heartbeat.
Late Stage Symptoms. If untreated, Lyme disease can progress to the late stage, which may start months or even years after the initial infection from the tick bite, but averages six months. Severe arthritis may occur, causing swelling and pain in large joints, especially knees, shoulders, or elbows, but usually not the same joint on both sides of the body at once. Heart and nervous system problems can also occur in late stage Lyme disease.
Tests
Blood tests to diagnose Lyme disease are helpful, but not always accurate. Better tests will soon be available. The best test now in use is called the ELISA test, which is preferred over the fluorescent antibody test (IFA). These tests look for antibodies to the bacteria in your blood. In the first two weeks the test is able to find antibodies in only half the people who have Lyme disease. These results are called false negatives because the test is negative even though Lyme disease is actually present. The test may also be positive in people who do not have Lyme disease. This is called a false positive.
In the later stages of the disease, when there are more antibodies, the tests are more accurate but still not perfect. The test can be useful in the later stages because the rash will be gone and you probably won’t be able to remember an exposure to ticks that happened many months ago.
Even though treatment may not be as successful in the later stages, you need to be tested. If you know what disease you are suffering from, you won’t receive the wrong treatment.
How Sick Will You Be?
Severity of symptoms in Lyme disease varies widely from person to person and from week to week.
Most adults and children experience fever, tiredness, headache, and joint paints intermittently. If untreated, the symptoms change over a period of several weeks. First stage symptoms are usually mild. Later stages can be severe and persistent. Audrey, the florist in Philadelphia, gets tingling in her mouth, arms, and legs and sometimes feels a sensation of lights exploding inside her head.
Some people have loss of memory and can’t concentrate. Patients have told me about migraine headaches, dizziness, fatigue, weakness, and irregular heartbeat. Lyme disease affects different people differently.
If you don’t realize that you have Lyme disease and are not treated, the rash and other symptoms will slowly go away. Some people (the percentage is unknown) who go untreated do not progress to the second stage. But for others, the disease will not go away.
Incubation Period
The incubation period is from 3 to 32 days.
Infectiousness
You can’t catch Lyme disease from another person, only from an infected tick.
Immunity
You can get it more than once. People who work outdoors in areas such as nature reserves or gardens have been infected, successfully treated, and reinfected.
Complications
If it’s not diagnosed and treated early, Lyme disease can lead to serious arthritis or heart or nervous system problems. In a few cases permanent damage to the joints results from untreated late stage disease. In some people the arthritis becomes chronic—it comes and goes but is never cured.
PREGNANCY Most babies born to women who were infected during pregnancy are normal. However, the spirochete can cross the placenta and cause damage to the fetus. Early studies show that women infected with Lyme disease during pregnancy have a slightly higher risk of miscarriage, stillbirth, or having babies born with heart problems or other disabilities. The risk appears to be small, but how small is not yet known.
How Do You Cure It?
Lyme disease is cured with antibiotics. If Lyme disease is diagnosed in its early stage when the rash is present, treatment is successful and recovery is rapid. It’s harder to treat the disease at the second and late stages. In the first stage the usual treatment for children older than nine and adults is tetracycline four times a day or doxycycline twice a day by mouth for 10 to 14 days. Children younger than nine years and pregnant women take either penicillin or amoxicillin three times a day by mouth.
If symptoms persist after 10 to 14 days of treatment, the antibiotics are continued until all the symptoms are gone. It is very rare that treatment will take longer than 30 days.
For most people in whom Lyme disease is not detected until the second stage, the same antibiotics by mouth will be tried for 10 to 14 days. This should do the trick. Sometimes, however, antibiotics don’t work as well at this stage because the bacteria may already have infected joint, heart, and nerve tissue. For these few who have no improvement in symptoms, or even get worse, intravenous therapy will be the next step. Normally this requires hospitalization for the first few days to make sure there is no reaction to the antibiotics. Before discharge, the nurses will teach you how to give IV medication at home. You will also be given help from a home health registered nurse.
Ceftriaxone (Rocephin) is the recommended antibiotic for IV use. It’s given for 14 days initially and another two weeks if symptoms persist. This therapy may have to be repeated every time there is a serious recurrence. But recurrences are uncommon; most people recover when first treated with antibiotics.
Nursing Care
You can give acetaminophen (Tylenol) or aspirin for adults every four hours or as needed for headaches and fever, as well as joint pains. Use warm water packs to help ease joint pains. Give backrubs and light massages to soothe aching muscles. Give plenty of rest, provide nutritious appealing meals, and give lots of support and attention. Become well informed on your patient’s prescribed treatments, and be sure she takes the prescribed medication correctly. If the antibiotics cause reactions or stomach upsets, call the doctor, who can try a different one. Don’t just stop giving them.
Don’t make your patient feel guilty for not taking proper precautions. It’s too late now, and people who get sick feel bad enough without family or friends making it worse. Anyone with a disease needs and deserves compassion. Emotional support and comfort are very important because they can help the body’s immune system fight infection.
If you are caring for someone suffering from the later stages of Lyme disease, try to be sensitive to the on-again, off-again nature of the disease. Some days your patient will feel wonderful and convinced he’s cured. The next day he may suffer a relapse and feel awful. This can be very discouraging, especially if the family doesn’t understand or sympathize with the good and bad days. Remember that this is par for the course with Lyme disease. Try to keep his spirits up. If he is receiving antibiotics, remind him that he can soon expect to feel much better.
How Do You Prevent It?
Education is the best prevention because there is no vaccine available yet and no effective way to eliminate ticks. A vaccine against Lyme disease is currently being tested in humans with promising results. It may be available in 1996. One study published in August 1992 found that people who live in areas with a high number of infected ticks can prevent infection by taking antibiotics right after a tick bite.
The surest prevention—avoiding fields, woods, and gardens where deer ticks are found—is not practical or desirable for most of us and especially not for our children. Some people advocate getting rid of deer to eliminate Lyme disease, as was done on Great Island off Cape Cod, where they eliminated the entire deer herd. No cases of Lyme disease occurred after the deer were gone. But besides not being practical, this approach may not work in the long run because, as was shown at the Baltimore Zoo, the ticks can live on large mammals other than deer if they have to.
Pregnant women living in an area with a very high rate of Lyme disease should consider staying out of the woods and camping areas completely during the summer months. If you do notice a tick bite, or have any Lyme disease symptoms, be sure to contact your doctor immediately.
Preventive Measures
Do not let the fear of Lyme disease keep you from enjoying outdoor activities. Be careful, use common sense, and you can still enjoy a lovely walk in the woods while protecting yourself and your family from Lyme disease.
1. Wear protective clothing. Wear long-sleeve shirts and long pants tucked into socks, and a hat. Wear light-colored clothing so you can see the ticks on your clothes.
2. Use a repellent containing DEET. Spraying an insect repellent containing 20 to 30 percent DEET on your clothes or skin will prevent tick attachment about 90 percent of the time. Be cautious when spraying DEET on children. There are a few reports of seizures in children after they were sprayed with DEET.
Follow these rules when applying DEET:
■ Do not use concentrations greater than 35 percent for children, and apply sparingly. One application lasts four to eight hours, and some newer products may last longer.
■ Do not inhale or get DEET into your eyes.
■ Never spray DEET on a child’s hands because this can spread DEET to your child’s eyes or mouth.
■ Never spray DEET on wounds or broken or irritated skin.
■ Wash repellent-sprayed skin as soon as you come indoors.
■ If you suspect a reaction to insect repellent, wash the sprayed area with soap and water, and call your doctor or emergency room. Save the repellent can and take it with you. A repellent containing permethrin can also be sprayed on your clothing to prevent tick attachment. It is not safe to use on exposed skin or children’s clothes, but adult outdoor workers may find it useful.
3. Inspect for tick bites. If you are out all day, check for tick bites every three to four hours. As soon as you come in from outdoors remove, wash and dry your clothing at a high temperature. Shower and inspect everybody for ticks, including your dogs and cats.
4. Remove ticks. This is important. If you remove the tick before 24 hours have elapsed, you should be okay. Remember, the tick needs to take a 24-hour blood meal for enough bacteria to get into your bloodstream to cause Lyme disease infection. Learn to recognize what a deer tick looks like. It is very small—much smaller than a dog tick. The nymph, which usually bites humans, is about the size of a pencil point. Remove the tick by placing small tweezers or forceps close to the head of the tick and pulling straight back with a steady force. Be careful. Make sure the whole tick is removed. Wash and apply antiseptic (alcohol, hydrogen peroxide, or iodine) to the bite area after the tick is removed. Don’t squeeze or crush the tick to kill it, even if your kids really want to do this. If it is infected, squeezing will release bacteria onto your hands. Put the tick in a jar filled with alcohol, then cover and save it. If you develop symptoms later on, this insect specimen will be helpful in diagnosing Lyme disease.
5. Keep pets free of ticks. Your dog or cat can get Lyme disease and will have the same symptoms as humans, except fot the rash. Your children cannot catch it from their pets, but they can catch it from the infected ticks living on the dogs. To prevent this, put tick repellent collars on all pets, and inspect them daily for tick bites and remove ticks if possible. It can be close to impossible to find tiny ticks on a furry dog. Dogs who are outside all day in areas with large numbers of ticks may come home with more than 50 tick bites. Don’t try to remove all these. It’s too risky to you. Have your veterinarian remove the ticks.
6. Treat the environment. Scientists are now focusing on treating the environment to get rid of the ticks. Three pesticides that are approved by the Environmental Protection Agency effectively reduced the tick population and the risk of Lyme disease by 95 percent in several studies: carbaryl (Sevin), chlor-pyrifos (Dursban), and cyflutherin (Tempo). You can apply one of these to your yard at the start of Lyme season.
7. Wear gloves when hunting or handling animals. Hunters and animal handlers who have open cuts or wounds on their hands should wear gloves when handling a bleeding animal that may be infected because it is possible for Lyme disease to spread from an infected animal’s blood to the open cut. There have been no reports of this actually having happened, however.
