Lyme disease is spread by the bite of ticks that are infected with Borreli burgdorferi. On the Pacific Coast, the bacteria are transmitted to humans by the western black-legged tick. For Lyme disease to exist in an area, at least three closely interrelated elements must be present in nature: the Lyme disease bacteria, ticks that can transmit them, and mammals (such as mice and deer) to provide food for the ticks in their various life stages.
April through October is usually considered to be the prime tick season, though Lyme disease can be transmitted by a tick at any time of the year.
Knowing the complex life cycle of the ticks that transmit Lyme disease is important in understanding the risk of acquiring the disease and in finding ways to prevent it. The life cycle of these ticks requires 2 years to complete. Adult ticks feed and mate on large animals, especially deer, in the fall and early spring. Female ticks then drop off these animals to lay eggs on the ground.
By summer, eggs hatch into larvae. Larvae feed on mice and other small mammals and birds in the summer and early fall and then are inactive until the next spring when they molt in nymphs. Nymphs feed on small rodents and other small mammals and birds in the late spring and summer and molt into adults in the fall, completing the 2-year cycle.
Larvae and nymphs typically become infected with Lyme disease bacteria when they feed on infected small animals, particularly the white-footed mouse. Research has indicated that ticks transmit Lyme disease to humans during the nymph stage, Adult ticks can carry and transmit the disease, because they are larger, they are more likely to be noticed and removed from a person's body within a few hours.
Also, adult ticks are most active during the cooler months of the year, when outdoor activity is limited. Nymphs are rarely noticed (They are less than 2mm.) and have ample time to feed and transmit the infection. Ticks are most likely to transmit infection after approximately 2 or more days of feeding.
Lyme disease, the “Great Imitator”, can mimic many other diseases, and is very difficult to diagnose because there is no specific laboratory test that can confirm or rule out the presence of Lyme disease at anything even approaching 100% accuracy.
There is a rash, often shaped like a bullseye, that can appear several days after the victim is infected. However, there are many cases of Lyme disease where the patient never had a rash of any kind before other symptoms began to appear. This rash can last a few hours or several days. In addition to the trademark bullseye rash, which is a ring around a clear centre, the rash can take on the appearance of hives, eczema, sun burn, or poison ivy. It may itch, feel hot, or not be felt at all. The rash may come and go over the course of several weeks.
And this confusion is only the beginning…
Several days or weeks after being bitten by an infected tick, the patient often has the same symptoms as someone with a flu-like illness. Symptoms may include such things as aches and pains in muscles and joints, low grade fever, and/or fatigue.
This often goes on to other, often more severe symptoms. No part of the body is spared by B. burgdoferi. Lyme disease affects each of its victims in a very unique and personal way. Symptoms can include one or more of the following, in no particular predictable combination:
- Jaw — pain, difficulty chewing
- Bladder — frequent or painful urination, repeated symptoms of “urinary tract infection”
- Lung — respiratory infection, with cough, asthma-like wheezing, pneumonia
- Ears and hearing — pain, hearing loss, tinnitus (ringing in the ears), sensitivity to noise
- Eyes and vision — pain, inflammation, photophobia (extreme light sensitivity), scleritis, conjunctivitis, blurred vision, decreased visual acuity, “drooping” of eyelids, and (occasionally) blindness
- Throat — sore throat, cough, hoarseness, difficulty swallowing, swollen glands
- Neurological symptoms — severe headache that is not resolved by usual medications, paralysis of facial muscles, seizures, meningitis, stiff neck, burning sensation, tingling, prickling sensation, poor reflexes or loss of reflexes, loss of co-ordination, and a syndrome that closely mimics multiple sclerosis
- Neuropsychiatric symptoms — mood swings, irritability, poor concentration, cognitive loss (thinking process impairment), memory loss, depression, disorientation, sleep disturbances, overall deterioration of mental status
- Gastrointestinal system — abdominal pain, diarrhea, nausea, vomiting, abdominal cramping, anorexia (loss of appetite)
- Cardiovascular (heart and blood vessels) — dizziness, fainting, weakness, irregular heartbeat, myocarditis (inflammation of the heart muscle), pericarditis (inflammation of the tissue that covers the heart), heart block (blockages in the heart's electrical distribution system), cardiomegaly (enlarged heart), shortness of breath, chest pain
- Muscles — inflammation and pain
- Joints — joint pain, arthritis
- Skin — single or multiple rash, hives
- Other organs — hepatitis (liver infection), elevated liver enzymes, enlarged spleen, swollen testicles, irregular menstrual cycles, sometimes complete cessation of menstruation
- Pregnancy — miscarriage, premature births, birth defects, stillborn babies
All of these, coupled with the possibility that laboratory results are often not definitive for Lyme disease, make it evident that we are up against a really difficult disease to deal with. Fortunately, it can be treated — and it is far better to treat it earlier than later.
Treatment consists of a course of antibiotics, that should last from four to six weeks. Symptoms usually decrease and then disappear far before the medicine is gone, but not continuing the treatment for the full course often results in Lyme disease recurring – after the spirochete causing the grief has had a chance to become resistant to the medication that was used on the first try.
If the correct diagnosis is not made early in the course of the illness, treatment become more intense once the Lyme disease is finally recognized for what it is. This can mean several weeks where the patient has to remain in hospital, receiving intravenous antibiotics until he or she is well enough to be discharged on oral medications.
In addition to all of this, many patients need additional treatment in the form of physical therapy and nutritional supplements of one sort or another. Since some cases require very strong antibiotics that also kill all the bacteria in the intestines, there are many physicians who also prescribe live bacteria yogurts to help prevent diarrhea.
On occasion, there is an added risk with some antibiotics of intestinal yeast infections that manufacture alcohol as a by-product. This can cause elevated blood alcohol levels for a few hours after meals.
Laboratory testing for the presence or absence of Lyme disease is not overly precise, with a good chance for both false negative and false positive results. This is one of the reasons why it is so very important to remove and keep the ticks that are feeding on you, so that they can be analyzed for the presence or absence of disease-causing organisms.
So, the best course of action when considering whether or not to be treated for Lyme disease includes treatment being given if you are:
- bitten by a tick that tests positive for B. burgdoferi
- bitten by a tick and then develop symptoms
- bitten by a tick and you are pregnant
- bitten by a tick in an area where many of the ticks are infected with B. burgdoferi
Your best protection from Lyme disease includes:
- checking for ticks on your body twice a day
- showering after outdoor activities are finished for the day
- removing and preserving any ticks for laboratory testing
- using insect repellents that include DEET (not 100% effective, though)
- using an insecticide containing Permethrin (somewhat dangerous to people, cannot be used on skin, has to be sprayed on outside of clothing and allowed to dry before putting the clothes on)
- tossing your clothes in a dryer (if one is available) after wearing them outside – ticks don't tolerate high heat well, and this will be enough to kill any that are on your clothing
How common is Lyme disease? We really don't know. It mimics so many other diseases and medical conditions that there is no great confidence that reporting to national infectious disease institutions includes anything approaching 100% of the cases that occur.
However, we can tell you for certain that there were over 300 children treated in hospital for neurologic problems secondary to active Lyme disease in one area of New Jersey in a nine year period, and that a pediatrician with a large practice in that area report seeing at least three well-defined bullseye rashes a day during the tick season. Several of the surrounding communities report that upwards of 60% of the deer ticks are carrying B. burgdoferi.
Some of the cases seen have gone undiagnosed for as much as four years, since the children exhibited symptoms that were so similar to Attention Deficit Disorder, with few other symptoms. As a result of such long periods of undiagnosed Lyme disease, some children have required what the medical community refers to as “aggressive” intravenous antibiotic treatment. Not only is this something that is not easy for the patient, but it is also very expensive.
The risk of exposure to ticks is greatest in the woods and garden fringe areas of properties, but ticks may also be carried by animals into lawns and gardens. Ticks search for host animals from the tips of grasses and shrubs (not from trees) and transfer to animals or persons that brush against vegetation. Ticks cannot crawl; they do not fly or jump.
By now you understand just how important it is to do everything we can to prevent this tick-borne illness, or at least to identify its presence or absence in the ticks that feed on us and the young people we work with. Now that you have the tools (knowledge), you can help us fight this illness.
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