Health Matters- Lyme disease: prevention and treatment

By David Ziegleman, M.D. | Contributor

Tick diagramMay through July is the peak time of year to contract Lyme disease. So, you look in the mirror, and to your surprise you find a tick buried in your left armpit. What do you do?

First, some background information

Lyme disease, which was first described in Lyme, Connecticut, in 1975, is the most common tick-borne disease in the US. It’s caused by a spirochete (corkscrew- shaped) bacterium called Borrelia burgdorfuri and can involve the skin, joints, heart and nervous system. Humans get Lyme disease after being bitten by the black-legged deer tick.

The most common areas in the U.S. to get the infection are the Northeast and the upper Midwest. Vermont was strangely unaffected until 2005 when cases began to increase dramatically. Now the disease is just as prevalent in Vermont as in other New England states at 100-plus reported cases per 100,000 population—or 500 to 900 cases per year. The most common season is May through July and then later in the fall. But people can get Lyme in midsummer and even in the winter if temperatures are above 40 degrees. Ticks are found in highest numbers in grassy, brushy areas at the edges of meadows or lawns. They are designed to latch onto animals, bite gently, then hang on and suck blood for three to five days.

Ticks have three stages of development. The first stage is the larva, which is the size of the period at the end of this sentence. Larvae are not born infected with the Lyme bacteria. They wait in the detritus leaves of the woods or on grass and then latch onto small mammals such as mice. If the mouse has the B. burgdorfuri bacteria in its system, the tick becomes a carrier.

The tick then becomes a nymph, which is the size of a poppy seed. After a second blood meal, the nymph molts and becomes an adult. The nymph and adult ticks have no eyes or ears but can sense a mammal is nearby by vibration and the carbon dioxide it produces. Nymphs and adults can feed on small mammals, as well as larger mammals like deer—or people.

The most important thing to know: PREVENTION

Any time you are in the garden, woods or grass, wear long sleeves and pants. Later that day do a full body check, particularly of your chest, abdomen, armpits, groin, thigh and legs.  A shower shortly after a hike also reduces the chance of getting Lyme by washing off a tick before it is fully latched on. You can wear DEET to repel ticks (and mosquitos).

Tick rash

erythema migrans rash

The three stages of Lyme disease

1. Early localized disease occurs three to 30 days after a tick bite. Symptoms include fever, fatigue and body aches (but no cough or sinus symptoms and no GI symptoms such as diarrhea), as well as an Erythema migrans (migrating redness), a gradually spreading, flat red patch, usually with the tick bite at the center.  The rash can get large (15 cm or more), sometimes with central clearing with a target appearance.

Early localized Lyme disease is treated with two to three weeks of doxycycline or amoxicillin.

2. Early disseminated disease can come on from weeks to months after the tick bite. Symptoms include facial nerve palsy (one or both sides of face are weak, with inability to close the eyelids); headache, neck stiffness, meningitis, painful nerve pain down an arm or leg; and carditis—shortness of breath, palpitations, lightheadedness. At this stage the disease is treated with intravenous and oral antibiotics.

3. Late Lyme: six-month-long episodes of painful, swollen joints; difficulty  concentrating and memory issues. Late Lyme is a challenge to diagnose and, when found, is treated with prolonged antibiotics.

Now back to our question: You see a tick in your armpit, what do you do?

Use a tweezers to grasp the tick close to the skin, pull firmly, straight out.

If you see a black center to the bite area, don’t worry, mouth parts are almost never left behind. Do not use other removal means, like matches or nail polish.

If the tick is in for less than 36 hours, remove the tick. No further treatment is needed. To be careful, however, watch for an EM rash or a feverish, viral type illness. If this occurs, see your doctor.

If the tick has been in for more than 36 hours or for an unknown duration, contact your healthcare provider. You should be treated with one dose of 200 mg doxycycline.

Save the tick if you can and bring it in with you to help with identification. In its nymph stage it may be the size of a poppy seed. If it’s been on your body long enough it will be engorged and fat with blood.

Don’t forget the most important tip: Check yourself and kids for ticks after every trip to the garden and woods. Otherwise, enjoy the outdoors!

David Ziegleman is an assistant professor at the University of Vermont Medical School and an internist practicing at Adult Primary Care in South Burlington. He lives in Charlotte.

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