Summer’s here, and thanks to a particularly mild winter in Virginia, the deer ticks are loving it, and their feeding season is in full swing. I’ve plucked three off myself already, and I spend most of my time indoors, so I can only imagine what the woods are like right now.
I work in a walk-in clinic, and at least once per day, someone comes into the office with a bloated, blood-sucking tick attached somewhere. Invariably, the question of Lyme disease comes up, and I find myself giving what I lovingly call “The Tick Talk” several times per day. In fact, I gave it today to my best friend Melissa, after her doctor plucked one of these nasty parasites off of her sweet son’s back. Yuck.
Here’s a rundown on Lyme disease.
- Lyme disease gets its name from the two towns where it was first identified: Lyme and Old Lyme, Connecticut. Not sure I’d feel comfortable living there. I’m sure it’s lovely.
- It is the most common tick-borne disease in the Northern Hemisphere.
- It was first identified in 1975, but remained poorly understood until the bacteria that causes it, B. burgdorferi, was identified in 1982.
- Ticks from the species Ixodes (meaning “hard tick”) transmit the disease to humans through their saliva.
- Bacteria belonging to genus Borrelia cause the illness we call Lyme disease.
- The first picture is of an unengorged tick (hasn’t had it’s meal yet), whereas the picture at right shows an engorged deer tick after a good meal. In my experience, they can get much larger. (Shiver.)
LYME DISEASE: BASICS
- The peak season for Lyme disease is typically May to September.
- In most cases, the tick must be attached to its host for at least 36 hours before the bacteria that causes Lyme disease can be transmitted. So if you pick a tick off within 36 hours, you most likely will not get Lyme disease.
- Lyme disease is not contagious and cannot be transmitted from person to person through any type of contact.
LYME DISEASE: SYMPTOMS
- Symptoms of Lyme disease usually occur within 1-2 weeks, but can present in as short a time as three days. Symptoms can be delayed several years, as well.
- Symptoms typically include a flu-like illness (fever, body aches, headache).
- In early infection, where it is localized or limited to the site of the tick bite, a skin lesion called erythema migrans develops, usually within 1-2 weeks. It resembles a bullseye.
- When the infection has become systemic (throughout the body), it is called disseminated disease. In early disseminated disease, the bullseye lesions can develop anywhere on the body. Other symptoms include Bell’s Palsy, severe headache, and joint pain. These usually develop in the weeks to months after the tick bite, and they usually resolve on their own with treatment.
- Late disseminated disease can occur years after untreated infection and can include arthritic pain, joint swelling, pain syndromes, and neurologic symptoms.
HOW DO I FIND OUT IF I HAVE IT?
- Diagnosis is usually based on history and clinical presentation: Have you been bitten by a tick? Was it a deer tick? Was it attached for at least 36 hours? Are you having symptoms? Does the tick bite have a bullseye lesion?
- Blood tests, usually performed 2-4 weeks after the tick bite, can establish the diagnosis; however, they are not accurate in the immediate post-tick period because it takes several weeks for a detectable volume of antibodies to form in the blood stream.
HOW TO HELP YOUR HEALTHCARE PROVIDER
- If you pull off a tick, try to save it in a plastic baggie and take it with you if you see your healthcare provider. It sounds kind of gross, but it is very helpful.
- There isn’t much utility in seeing your doctor immediately after the tick is removed. Without definite symptoms, the bullseye lesion, and blood tests, there just isn’t much to do. If you think some of the tick may still be embedded, then by all means, come on in. Otherwise, wait a week or two. If you see the bullseye lesion or develop a summer flu-like illness, come in for that, too.
- Remember that blood tests are not useful until about two weeks post-tick bite. And they typically are not terribly accurate anyway and are pretty pricey.
- Remember that lyme disease is not transmittable from person to person. Little Susie should not need a school note to go back if she’s been bitten by a tick. (This week, I’ve had three parents sent to the clinic by the school to get a note saying their child was no longer contagious. Just to let you know, they never were.)
- There is not a test to check for “cured” Lyme disease. Symptoms resolve = you’re good to go.
- Most people who are treated early in the disease (this means soon after symptoms have developed or soon after a positive blood test, not immediately after a tick bite) recover completely. Lyme disease responds very well to common antibiotics, usually doxycycline, amoxicillin, or cefuroxime axetil.
- As with any infection treatable with antibiotics, take the medicine exactly as prescribed and for the full duration of therapy. Often, a Lyme disease antibiotic course will last 21-28 days.
Since we have to share the glorious days of summer with these nasty little suckers, make sure you’re armed with accurate information to keep you and your family safe. Seriously!
- Lyme Disease Myths: 9 Things You Should Know About The Tick-Borne Disease (huffingtonpost.com)
- Information on Lyme disease (globalhealthblogs.wordpress.com)
If you have any questions about Tick Talk, or if you have any suggestions for a future Health Notes feature, please leave a comment, and I’ll get right to it. Thanks!