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August 20, 2008 Comments (0) News

Lyme Disease: Don’t be that person…

As a medical professional and an avid outdoorsman, I tend to look at our environment in a different manner than most.  There is a reason we have all the latest and greatest tools, shelters, and accessories when we venture from our comfortable homes into the wilderness.  The reason is that there are plenty of things out there that can kill, maim, make us sick, or a combination of all of the above. 

Interestingly enough, most of these things are not what are written about in the average outdoor publication because they don’t have what I call the “cool factor” or “style points”.  For example, if you are attacked by a black bear and live to tell about it, you will always have the scars and an exciting tail to tell around the campfire.  Your buddies will listen intently due to the obvious “cool factor” and you would earn significant “style points” depending on the location of the scars.  On the other hand, telling your buddies about your year long battle with a bacterial infection you acquired form a little tick that bit you on the butt and left you with a nasty rash, partially paralyzed, and depressed just doesn’t have the same effect at the campfire.

In this article, I hope to save you from this unnecessary embarrassment by equipping you with a rudimentary knowledge of Lyme Disease to include the following topics:

1.    What is Lyme Disease?
2.    How is it transmitted
3.    How is it diagnosed
4.    How is it treated
5.    How is it prevented

DISCLAIMER:  This article is for informational purposes only and should not be used in place of the professional opinion of a licensed physician, physician assistant, or nurse practitioner.  All technical information contained in this article has been gathered from medical texts and cited accordingly.  All photographs, graphs, and charts have been used with prior approval of the original source.

A very brief history:

Lyme Disease was described by physicians in Europe as early as 1883 and was considered a skin disease until an outbreak was tracked in 1975 in the towns of Lyme and Old Lyme, CT… hence the name.  It was clear at the time ticks were transmitting the disease but the actual causative agent was not isolated until 1982 by Willy Burgdorfer, PhD. (1)

What is Lyme Disease?

Every year, 20-23,000 people in the US are diagnosed with Lyme Disease.  In humans, it causes a wide range of disorders that can be mild to severe.  The disease is staged 1-3 based on the progression of symptoms.  This will be discussed later in the article. 

The incidence of the disease has been tracked by the Centre for Disease Control since 1992 with interesting results.  Lyme Disease is found in two distinct areas of the US.  The North Eastern sea board has the highest incidents ranging from the Eastern Shore of VA to coast of Maine.  There is also a significant reporting in Wisconsin and Minnesota. Figure 1 (2).

While researching information from the CDC, I found an interesting statistic that showed the disease has a peak incidence in boys from age 5-14.  It starts to pick up again in men at age 30 and gradually peaks from age 65-69 (2).  I can only assume that we (boys and men) have found other interests and are too busy doing other things than playing in the woods from age 15-30.

How is it transmitted?

Lyme Disease caused by the bacteria Borelia burgdorferi that live in the gut of a tick. The bacteria are transmitted to humans when an infected tick bites and latches onto the skin.  As the tick gorges itself on the blood and bodily fluid, the bacteria migrate from the stomach of the tick into skin of the unsuspecting human.  The bacteria have found a new home and start to reproduce causing a series of reactions by the immune system.

The tick that has been identified as the carrier in North America is the “black legged tick” or the “deer tick” (Ixodes scapularis in the Eastern US and Ixodes pacificus in the Western US).

How is it diagnosed?

Although there are several laboratory studies that will aide physicians in making the diagnosis, the FDA has not given the official stamp of approval for a “Lyme Disease Test”.  It is diagnosed primarily on physical signs and symptoms and the disease is staged accordingly:

Stage 1: Early Localized Infection
Target or Bulls Eye shaped rash at the site of the tick bite appears 3-32 days after being bitten (3).  The person may also experience vague flu-like symptoms such as fever and fatigue (4).

Stage2:  Early Disseminated infection
Within days to weeks of the initial rash, others will appear across the body along with purple lumps around the ears, nipples, and groin(5)(6).  Other symptoms include migrating pain in the muscles and joints and occasionally partial facial paralysis such as Bell’s Palsy.  Meningitis and encephalitis have also been reported and causes sever headaches, back aches(6).

Stage 3:  Late Persistent Infection
If left untreated, after several months the disease can lead to chronic conditions of the brain, nervous system, heart, muscles and joints.  People who experience this usually are left with chronic pain, significant paralysis and in rare cases psychosis(7).

How is it treated?

Treatment depends on the stage of the disease process but will likely involve a course of antibiotics and treatment of the other related symptoms.   Early identification and treatment have given the best results with rapid recovery.  If left untreated, patients may be hospitalized to treat neurologic and cardiac complications.

How is it prevented?

After an extensive review of literature and web sites on Lyme Disease, I have found no definitive ways to prevent ticks from latching on short of wearing a Haz-Mat suit that is sealed and has its own air supply.  The recommendations range from tucking your pants into your sock and sealing them off with duck tape, spraying yourself with “anti-tick” spray, and my personal favourite… eating the heads of matches.  Ingesting something toxic can be fun and interesting for those who have to figure out what you’ve eaten and save your life.  Over the years I having tried many of these and other methods, I feel I can authoritatively say these are pretty much useless and should be considered hog wash. 

The most obvious means of prevention is stay away from tick infested areas especially when they are most active in the spring and summer.  With that said, the most realistic method of prevention is early detection and timely removal of ticks.  Therefore, it is imperative to conduct a thorough inspection of your body every day you are in the woods.  You can do this yourself or have a friend help with those hard to see areas such as the back, legs, and skin folds of the groin, buttocks and arm pits.  Of course, there is a litany of methods for tick removal, but the only proven method of removal uses the following steps:

  1. Using a pair of fine tweezers (I like the ones on my Swiss Army Knife) gently grasp the mouth parts of the tick.  NOT the body.
  2. Avoid crushing the body of the tick as the bacteria is in the gut.
  3. Firmly but gently pull the tick from the skin.
  4. Immediately cleans the area with soap and water or a sanitizer such as rubbing alcohol or even hand sanitizer.
  5. DON”T use a hot match, petroleum jelly, or nail polish to remove the tick.  This will likely kill the tick but can also cause the tick to expel its stomach contents including bacteria that live there.

It is helpful to have a magnifying glass to aide in the process.  Some para-professionals recommend extracting the tick along with a small chunk of flesh it is attached too.  I have not found this to be supported by current medical texts.  

The essential goal of removal is to remove the tick alive without agitating it.

Deer Tick management:

As the name implies, Deer Ticks use deer and other small mammals such as dogs and cats as a host for nourishment and reproduction (8).  A study conducted in Mumford Cove, CT from 1995 to 2004 investigated the relationship between the total deer population and the tick population.  During the study the deer population was reduced from 77 deer per square mile to 10 deer per square mile.  The results conclusively proved the direct relationship between the deer and ticks as the tick populations decreased by 92%(9).

This study has significant implications proving the risk and incidence of Lyme Disease can be significantly reduced through deer population management.  This of course has political and social implications that cannot be avoided.  The findings should not be surprising as this is a common theme for small mammals such as vermin, deer, dogs and cats to be the intermediate host of disease carrying fleas and ticks.  Such was the case of the plagues that wiped out nearly 60% of the population of Europe in the 1300’s.

Conclusion:

Lyme Disease is only one of several disease spread by ticks.  Ticks are nasty disease laden arthropods that are a nuisance to those of us who like to visit the wilds.  It is important to remember how dangerous they can be and take precautions.  By being proactive and following the steps outlined in this article you can avoid being that guy at the campfire who is tells his story of doing battle with a tick.

References:

  1. Burgdorfer, W. Arthropod-Borne Spirochetoses. A Historical Perspective, Editorial, Eur. J. Clin. Microbiol. Infect. Dis. 201: 1-5, 2001.
  2. CDC. Lyme Disease — United States, 2003-2005. MMWR 2007; 56(23): 573-6.
  3. Fauci, Anthony S. (2008). Harrison’s Principles of Internal Medicine: Editors, Anthony S. Fauci … [Et Al.]. McGraw-Hill Medical Publishing, Chapter 166.
  4. Auwaerter PG, Aucott J, Dumler JS (January 2004). "Lyme borreliosis (Lyme disease): molecular and cellular pathobiology and prospects for prevention, diagnosis and treatment".
  5. Dandache P, Nadelman RB (June 2008). "Erythema migrans". Infect. Dis. Clin. North Am. 22 (2): 235–60, vi.
  6. Stanek G, Strle F (June 2008). "Lyme disease: European perspective". Infect. Dis. Clin. North Am. 22 (2): 327–39, vii.
  7. Fallon BA, Nields JA (1994). "Lyme disease: a neuropsychiatric illness". The American journal of psychiatry 151 (11): 1571–1583.
  8. Stafford K.C. 2004. Tick management handbook: an integrated guide for homeowners, pest control operators, and public health officials for the prevention of tick-associated disease. The Connecticut Agricultural Experiment Station, New Haven, Connecticut, USA
  9. DEP Wildlife Division: Managing Urban Deer in Connecticut 2nd edition June 2007
     

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