May is Lyme Disease Awareness Month and in the spring and summer we all need to be vigilant about preventing tick bites. According to the Centers for Disease Control (CDC) more than 300,000 Americans contract Lyme disease each year.
Lyme disease is on the rise in Vermont. According to the Vermont Department of Health, before 2005 there were very few cases of Lyme disease per year in Vermont. Since then, however, there has been a significant increase (Figure 1).
What is Lyme Disease?
Lyme disease is a bacterial infection that can be transmitted to people through the bite of a blacklegged tick (a.k.a. deer tick) that is infected with the bacteria Borrelia burgdorferi. If the tick is attached to the person for at least 24 hours then the bacteria can be transferred to the person and they can become infected.
There are three stages of Lyme disease. Most people are diagnosed and treated during early infection; however, if left untreated the infection can progress and cause additional manifestations.
1) Early Stage: 7-14 days after tick bite
Erythema migrans rash (see Figure 2) at the site of the tick bite. Frequently the rash has a classic bull’s-eye appearance, but it can also appear homogenous. Flu-like symptoms may also develop including headache, fever, and muscle pain.
2) Intermediate Stage: Days-Weeks after tick bite
Multiple erythema migrans rashes, facial palsy (paralysis or weakness of the muscles in the face), meningitis (inflammation of the membranes surrounding the brain and spinal cord), heart block due to carditis (inflammation of the heart and its surroundings).
3) Late Stage: Months-Years
Intermittent bouts of arthritis with joint swelling, shooting pain, numbness, tingling in hands and feet.
If you have been bitten by a tick and are experiencing these symptoms, it is important to contact your doctor who can provide the proper evaluation and treatment.
How to Prevent Tick Bites:
There are some easy steps we can all take to protect ourselves from being bitten by ticks and still enjoy time outdoors:
1) Avoid Ticks
When outdoors, walk in the center of trails and avoid wooded areas
2) Repel Ticks
Use 20-30 percent DEET on skin/clothing
Treat clothing/gear with permethrin
3) Remove Ticks
Bathe or shower within 2 hours after spending time outside in tick prone areas
Conduct a full body tick check using a mirror
Inspect pets and gear for ticks
Running your clothing in the dryer for 5-10 minutes on high heat after coming indoors should kill any ticks that have attached to your clothing.
Get the Facts:
There is a lot of misinformation regarding Lyme disease. Here we address some of the most frequently asked questions.
Can I contract Lyme disease anywhere in the United States?
- Generally speaking, infected ticks are limited to the Northeast, Northern Midwest, and a few specific locations in Northern California, Oregon, and Washington.
- People often misinterpret CDC surveillance maps of Lyme disease (Figure 3). The reporting system is set up so that cases are reported based on county of residence, not the location of where the infection was acquired. This means that if someone from Texas travels on vacation to Vermont and contracts Lyme disease here, it would still be reported to the local health department in Texas.
Can Lyme disease become a chronic infection?
- With the proper identification and treatment prognosis is generally excellent
- However, some people may develop nonspecific symptoms such as fatigue that can linger after treatment. This is called Post-treatment Lyme disease syndrome.
- Persistent symptoms after proper treatment may be the result of residual tissue damage and/or an autoimmune response
- Studies have not supported that Lyme disease can be a persistent infection after proper treatment.
Are long-term IV antibiotics indicated for Lyme disease?
- The recommended treatment duration for Lyme disease is 2-4 weeks, depending on the manifestation.
- Post-treatment Lyme disease syndrome occurs when patients have persistent symptoms after receiving proper treatment.
- 4 randomized, placebo-controlled studies of long-term IV antibiotics for treatment do not show a benefit
- Antibiotics can have anti-inflammatory effects and therefore may make people feel better even if they do not have an active infection
For more information on Lyme disease, please visit the following websites:
Information in this article was taken from the following sources:
- Hu LT. In the clinic. Lyme disease (review).Ann Intern Med. 2012 Aug 7;157(3):ITC2-2 – ITC2-16.
- Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134.
Molly Markowitz, first year medical student of the Larner College of Medicine at UVM, is a member of Lyme Corps, a CDC-sponsored program which conducts Lyme disease education.