Lyme Disease -- An Overview
Lyme disease (LD) is an infection caused by the spirochete Borrelia burgdorferi, named after its discoverer, Willy Burgdorfer, PhD. A spirochete is a spiral shaped bacterium. Other diseases caused by spirochetes include relapsing fever and syphilis.
LD is most commonly transmitted by a tick bite (usually painless). The tick vectors include Ixodes scapularis (Deer Tick), Ixodes dammini (Deer tick), Amblyomme americanum (Lone Star Tick) and Ixodes pacificus. Ixodes dammini was thought to be the only species responsible for transmission until it was shown to be the same as Ixodes scapularis in 1993. The Deer and Lone Star ticks can be found in New Jersey. The ticks prefer to live in wooded areas, low growing grassland, seashores and yards. Depending on the location, anywhere from less than 1% to more than 90% of the ticks are infected with spirochetes.
The Deer tick has a 2 year life cycle and must feed 3 times. In the larvae stage, it is tan, the size of a pin head and feeds on small animals like the mouse where it can pick up the spirochete. During the nymph stage the tick is the size of a poppy seed, beige or partially transparent and feeds on larger animals such as cats, dogs and humans. The adult ticks are black and/or reddish and feed on cattle, deer, dogs and humans. The Lone Star tick is grey with a white dot.
April through October is considered the "tick season" even though Lyme disease is a year round problem. Ticks are very active in the spring and early summer.
Cases of Lyme disease have been reported in virtually every state, although the Northeastern, Great Lakes, and Pacific Northwest areas are particularly endemic.
Lyme disease is called the "Great Imitator" because it can mimic many other diseases, which makes diagnosis difficult. A rash can appear several days after infection, or not at all. It can last a few hours or up to several weeks. The rash can be very small or very large (up to twelve inches across). A "bullseye" rash is the hallmark of LD. It is a round ring with central clearing. Unfortunately, this is not the only rash associated with Lyme. Various other rashes associated with LD have been reported. One bite can cause multiple rashes. The rash can mimic such skin problems as hives, eczema, sunburn, poison ivy, flea bites, etc. The rash can itch or feel hot or may not be felt at all. The rash can disappear and return several weeks later. For those with dark skin the rash will look like a bruise. If you notice a rash, take a picture of it. Some physicians require evidence of a rash before prescribing treatment.
Early Symptoms: Several days or weeks after a bite from an infected tick, a patient usually experiences "flu-like" symptoms such as aches and pains in their muscles and joints, low grade fever, and/or fatigue.
Other Possible Symptoms -- No organ is spared:
The above is a list of possible symptoms. They can occur in any combination. You may have one or several symptoms but not everyone will experience every symptom. Lyme affects each host in a different way. Having one or many of these symptoms does not indicate that you have Lyme disease. Diagnosis for Lyme is a clinical one and must be made by a physician experienced in recognizing LD. Serological testing is not reliable (See section on Testing).
Lyme Disease is treatable. Antibiotics are recommended for a minimum of four to six weeks. More chronic cases may require a longer treatment. Some physicians are combining more than one drug for more difficult cases.
There is a vaccine available for dogs. There is no vaccine available for people yet. Humans do not develop an immunity to Lyme Disease. Reinfection is possible.
Treatment should be given:
Treatment is either oral or intravenous. Those diagnosed later may require I.V. treatment.
Testing is generally done through a blood test. The tests are not accurate at present. Urine tests and tests of spinal fluid are not reliable either. False positives and false negatives do occur. Medication taken for other ailments and pre-existing conditions can interfere with the tests.
LYME DISEASE PREVENTION
I. The best way to prevent Lyme Disease is to check frequently for ticks.
A. Check all body parts that bend including:
B. Check other areas where ticks are commonly found including:
C. Check pressure points including:
D. Go back and visually check all other areas
E. Run fingers gently over skin. If there is a tick and it is attached, it will feel like the last piece of scab left before a cut completely heals.
II. Shower after all outdoor activities are over for the day. If the tick is still wandering it may wash off.
III. If a tick is found, remove it carefully with fine tweezers. Grab as closely to the skin as possible. Do not squeeze the body, apply Vaseline, use a burnt match, or clean with alcohol while the tick is attached. Any of these actions could cause transmission of the bacteria.
IV. Ticks can be tested. Place tick in a glass or plastic vial with a moistened cotton swab. A clean pill vile is good. If none is available, use a ziploc storage bag as a temporary container.
V. Many Lyme Disease organizations now recommend prophylactic treatment when a person is bitten by a Deer tick in a known endemic area. Since there isn't enough evidence on either side to prove or disprove this theory, the final decision is up to the individual and the treating physician. The recommended treatment is 4-6 weeks of an oral antibiotic. Anyone needing information supporting treatment for a tick bite can obtain it by contacting the Lyme Disease Network.
VI. The use of sprays is a personal decision so you must know the facts. Products that contain DEET are tick repellents. They do not kill the tick and are not 100% effective in discouraging a tick from feeding on you. Products like Permanone contain premethrin and are known to kill ticks. However, they are not to be sprayed on the skin. Permanone can be sprayed on clothing. Once it is dry it is assumed to be safe. Ticks are anti-gravitational. They are generally seeking the highest point. If they get on your body below the clothes line, one hopes they will travel up and die once they come in contact with treated clothing. Note: If the tick meets resistance on its journey to the top of your head it will stop and feed at that point. If you are wearing shorts and the tick gets stuck in the bend behind your knee the Permanone will not be helpful.
VII. Lyme Disease is a 12 month problem. The best defense against
LD is education. Know your facts. For more information contact
the Lyme Disease Network.
courtesy of Frank Demarest.
Pictures of ticks (Ixodes scapularis) are available at Iowa State University's site.
Last update April 30, 1999
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