Lyme Disease

By Dr. Cristina Mitchell
Hillside Family and Community Medicine

With summer upon us, we are at risk for tick-borne illnesses, including Lyme disease. Rhode Island, Connecticut, and Massachusetts all are considered high-risk areas for Lyme. In fact, Rhode Island has the second highest rate of Lyme transmission in the United States (another dubious claim to fame for Little Rhody). Here are answers to several common questions about Lyme disease, including information about ticks and tips for avoiding them.

What is Lyme disease?
Lyme disease is a systemic illness that is transmitted by the deer tick. Symptoms usually appear 7 to 10 days after being bitten by an infected tick, but they can begin between 3 and 30 days following a tick bite. The resulting infection can affect different organ systems, and if left untreated can lead to chronic health problems.

What are the symptoms of Lyme?
The most common symptom of Lyme disease is a rash called erythema migrans. The rash is usually large–more than three inches in diameter–and looks like a round red patch that expands outward. Most often it clears in the middle, and this is why it is sometimes called a bull’s eye rash. Sometimes, however, it is just a big red circular patch without central clearing, especially in geographic areas carrying a great risk of Lyme.

Other clinical features of Lyme include flu-like symptoms (malaise, fatigue), muscle aches, arthritis (pain in one or more joints), and facial nerve palsy. Less common problems include Lyme meningitis and carditis (inflammation of the heart). Other problems can accompany chronic Lyme disease like recurrent arthritis, nervous system symptoms, and heart conduction defects.

Who should be tested for Lyme disease?
Testing for Lyme disease is a little complicated. The body’s response to Lyme infection is slow, so early in the illness, tests can be falsely negative. Usually, antibodies appear after about 2 to 4 weeks. The rash is usually the best early indicator. There is no reason to be screened or have your children screened for Lyme just because you live in an area with a high rate of the disease. Testing should only be done when there are clinical signs and symptoms to suggest Lyme. For example, a child with a bull’s eye rash should have a Lyme test done, and treatment may be started by the doctor before the results are available. Sometimes, if the symptoms do not clearly indicate Lyme disease, a two-step test may be ordered to confirm the diagnosis.

How is Lyme disease treated?
Once a diagnosis is made, either based on clinical findings or test results, antibiotics are used to treat the infection, usually for 2 to 3 weeks. Common antibiotics including amoxicillin can be used to treat Lyme.

What about ticks?
If you get bitten by a tick, it’s important to correctly identify which type of tick it is. The deer tick (Ixodes scapularis) that carries Lyme is very tiny, about 1 millimeter or the size of a fleck of black pepper. It can be quite difficult to see, though it does get bigger when engorged. The common dog tick, which does not carry Lyme, ranges in size but is quite easy to see. Dog ticks become large when engorged, up to 8 millimeters in diameter.

How do I avoid getting bitten?
Preventing tick bites requires multiple strategies. An extreme strategy would be to avoid all grassy areas and shrubs from May to September. A less extreme approach would be to wear light-colored clothing so you can see ticks more easily. Tucking pants into socks can help too. Check yourself and your kids when you come in from playing in high-risk areas. Bug-repellent containing DEET will repel ticks, and in concentrations of less than 15 percent, it can be used on children, but it’s very important to follow directions on the product label.

What should I do if I do find a tick?
It’s important to remove the tick carefully. The best way to remove a tick is to use tweezers and grasp the tick very close to the skin and pull gently. Try not to squeeze the body of the tick. Then clean the bite area with disinfectant and wash your hands (and the tweezers). Using Vaseline or kerosene or holding a lit match to the tick are not recommended.

If a tick has been attached to you for less than 24 hours and is not engorged, chances are that you won’t develop Lyme disease. Your doctor can treat deer tick bites with one dose of antibiotics to further reduce the risk of contracting the disease. Unfortunately, this treatment is for adults only and an equivalent has not been studied in children. Some doctors may prescribe a short course of amoxicillin if the risk of Lyme is especially high.

What about the Lyme vaccine?
There is a Lyme vaccine called Lymerix; however, its effectiveness is questionable and the CDC has yet to recommend that it be used.

Where can I learn more?
– Familydoctor.org
– Centers for Disease Control and Prevention (CDC)
– RI Department of Health

Disclaimer: the information presented here is for general educational purposes only and is should not replace consultation with a medical professional.

Dr. Cristina Mitchell is a family doctor at Hillside Family and Community Medicine and contributor writer for Kidoinfo. She shares her knowledge and expertise related to health issues for kids.

Credit: Image from the CDC website.