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Ticks and Lyme Disease

What you need to know

TICKS

Activity:  Ticks are most active from May to September but can be encountered throughout the year.  

Habitat: Ticks live in brushy or wooded areas primarily and are less likely to be found on well groomed or mowed lawns. They can be carried into homes by cats and dogs where they may then fall off and later attach to people in the home. For this reason pets should not be allowed to roam in areas where ticks are common. It is important to check pets after they have spent time outdoors so they don't bring ticks into the home.

Appearance:  The two most common types of ticks in the New York Metropolitan area are the Deer Tick ( ixodes dammini) and the Dog Tick. Deer ticks are the main transmitters of  Lyme disease in the New York area.  Deer ticks feed on small mammals but also on birds, deer, dogs, and humans.

The most notable difference between Deer and Dog ticks is that the Deer tick has black legs. In addition, an adult female Deer tick will usually have an orange "shield" on its back which is easily recognizable.

Lyme Disease

 Lyme disease was first recognized in 1975. Investigators discovered that tiny deer ticks infected with a spiral-shaped bacterium or spirochete (which was later named Borrelia burgdorferi) was the cause of Lyme disease . Their research showed that the bacteria lives in the intestines of the tiny Deer tick. Lyme disease has been reported in nearly all states in this country, although most cases are concentrated in the coastal northeast, mid-Atlantic states, Wisconsin and Minnesota, and northern California. Lyme disease is endemic in large areas of Asia and Europe.

 The bacteria enters the bloodstream of a person or other animal after they have been bitten by a tick.  Lyme disease is more likely to be transmitted if the tick has been attached to the person for at least 36 hours. For this reason it is important to examine all pets and individuals after they come indoors to remove ticks before Lyme disease can be transmitted.

Symptoms:        

ECM Rash (erythema chronica migrans)

Muscle and joint aches

Headache

Fever

Fatigue

The Rash - Erythema Chronica Migrans(ECM). In most people, the first symptom of Lyme disease is a red rash known as erythema migrans . The rash starts as a small red spot at the site of the tick bite. The spot expands over a period of days or weeks, forming a circular or oval shaped rash. Sometimes the rash resembles a bull's eye, appearing as a red ring surrounding a clear area with a red center. The rash, which can range in size from that of a dime to the entire width of a person's back, appears within a few weeks of a tick bite and usually occurs at the site of a bite. As infection spreads, rashes can appear at different sites on the body. Most people who contract Lyme disease never notice the rash or get a nonspecific rash which does not look like the classic rash described above.

Erythema migrans is often accompanied by symptoms such as fever, headache, stiff neck, body aches, and fatigue. Although these flu-like symptoms may resemble those of common viral infections, Lyme disease symptoms tend to persist or may occur intermittently.

Arthritis.  Several months after being infected with Lyme disease approximately 50% of patients will develop arthritis if left untreated. This can last a few days to a few months. The arthritis can shift from joint to joint with the knee being most commonly affected. 

Heart Problems. A small percentage of untreated Lyme disease patients can develop cardiac complications, such as an irregular heartbeat.  This usually lasts few days or week, usually start several weeks after infection.

Neurological Symptoms. Lyme disease can also cause symptoms such as stiff neck and severe headache (meningitis),  numbness, pain or weakness in the limbs, or poor motor coordination. A condition known as Bell's palsy can temporary paralysis of facial muscles. This can sometimes be mistaken for a stroke.  

Nervous system abnormalities usually develop several weeks, months, or even years following an untreated infection. 

Lyme disease can be difficult because many of the symptoms are non-specific and are similar to many other illnesses. Making things even more difficult is the fact that most patients with Lyme disease cannot recall having been bitten recently by a tick and many patients never exhibit the classic bullseye rash. 

Blood Tests. Unfortunately, the Lyme disease bacteria itself is difficult to isolate from body. The current Lyme disease test looks for antibodies against B. burgdorferi in the blood. Antibodies are molecules made by the immune system to destroy specific bacteria or viruses. It usually takes several weeks after an infection has occurred for these antibodies to reach levels that are detectable by current methods. Once these antibodies are created the body will continue making them for many years after the infection is gone. For this reason, the presence of antibodies does not ensure that the bacteria is present. In addition, antibodies from old infections with similar organisms ( i.e. syphilis) can also result in false positive results

Because of the faults inherent in these tests, it is often difficult to know for sure if a patient truly has Lyme disease. Since there is no blood test that is completely reliable, the diagnosis is often made on the basis of a careful history, and physical exam together with appropriate supporting blood tests.

Nearly all Lyme disease patients can be effectively treated with an appropriate course of antibiotic therapy. In general, the sooner such therapy is begun following infection, the quicker and more complete the recovery.

• Avoid tick-infested areas, especially in May, June, and July.
• Wear light-colored clothing so that ticks can be easily spotted.
• Wear long-sleeved shirts and closed shoes and socks.
• Tuck pant legs into socks or boots and tuck shirt into pants.
• Apply insect repellent containing permethrin to pants, socks, and shoes, and compounds containing DEET on exposed skin. Do not overuse these products.
• Walk in the center of trails to avoid overgrown grass and brush.
• Inspect the body thoroughly and remove carefully any attached ticks.
• Check pets for ticks.

While these suggestions are sensible and probably effective, they are not always practical. I have spent most of my life living in tick infested areas of Long Island where Lyme disease is endemic. I spend a lot of time outdoors and have been bitten by ticks at least a half dozen times. I can tell you that I rarely follow all of these suggestions. Wearing long sleeve shirts and long pants which are then tucked into boots may reduce your risk of a tick bite, but it also reduces your chance of enjoying your day in the great outdoors; especially on a hot summer day. In addition, avoiding tick infested areas from May through July restricts one from enjoying the outdoors during some of the best times of the year.

Given these short comings in the above recommendations I usually recommend that my patients concentrate on the last four suggestions.

• Apply insect repellent containing permethrin to pants, socks, and shoes, and compounds containing DEET on exposed skin. Do not overuse these products.
• Walk in the center of trails when possible to avoid overgrown grass and brush.
• Inspect the body thoroughly and remove carefully any attached ticks. Since a tick must remain attached to your body for 48-72 hrs to transmit lyme disease, there is plenty of time to get the tick of before it does any damage. I have found through experience that the best way to detect a tick is with your sense of touch. While visual inspection is also important, dear ticks can very small and easily missed. Ticks also like to hide in places that are not easily seen well, making visual detection more difficult. Wet soapy hands are far more sensitive at detecting these small insects. My usual procedure is to shower at the end of the day if I've been in a tick prone area. Start at the top of the head and run your hands slowly over every inch of your body until you get to your toes. What you are feeling for is a small "bump" which can be as small as a poppy seed or as big as a watermelon seed. It will usually flop back and forth as you run your fingers over it. Anything you find should then be visually inspected. If need be use a magnifying glass. If you find a tick, follow the directions below for removal.                                                                                                                       
• Check pets for ticks. Pets frequently bring ticks in the house where they can drop off and attach to people. Since animals have thick fur, visual inspection is not easy and manual inspection is again the best way to find any ticks. You can examine your pet at the end of the day when you are petting him/her the same way that you would examine yourself ( soap and water are not necessary :-) )

The take home message here is "enjoy yourself". Don't let a fear of ticks stop you from having fun ouside. They are easy to remove and if done so in a reasonable amount of time you will minimize any risk of getting Lyme disease.

 

1. Tug gently but firmly with blunt tweezers near the "head" of the tick while gentle rocking it back and forth until it releases its hold on the skin.
2. To lessen the chance of contact with the bacterium, try not to crush the tick's body or handle the tick with bare fingers.
3. Swab the bite area thoroughly with an antiseptic to prevent bacterial infection.
4. If possible, place the tick in a small sealed container and bring it to your physician.

DO NOT!!!!

• Pour flammable liquids on the tick
• Use a flame to remove the tick
• Put Peanut Butter, Vaseline or other substances on the tick to try and "smother" the tick. This will not work and will only leave the tick in the body longer, giving the bacteria more time to be transmitted

 

Be sure to consult your physician after any tick bite for further advice and treatment.