Lyme Disease
Lyme disease is caused by bacteria transmitted by the bite of a deer tick. Deer ticks can be smaller than a pinhead and difficult to see. If not disturbed, a tick will remain attached to a person´s skin and feed there for 3 to 6 days. The longer a tick is attached, the greater the chance of being infected by the tick. For Lyme disease to be transmitted, the tick needs to be attached for at least 24 – 36 hours. About one third of deer ticks in Hunterdon County carry the Lyme bacteria. Your chance of getting Lyme disease from a tick bite in Hunterdon County is about 1%; that is one tick bite out of 100 results in Lyme disease.
Lyme disease has been divided into three stages. If treated with antibiotics, it does not progress from one stage to the next.
Stage I occurs as soon as 2 days after the tick bite. A unique rash develops in 90% of children. The rash (called "erythema chronicum migrans") looks like a red ring or bull´s-eye that starts where the person was bitten and expands in size. Rarely, a patient may have multiple bull´s-eye spots. The rash is usually not painful or itchy and lasts 2 weeks to 2 months. A flu-like illness including fever, chills, muscle aches, and headache may also develop.
Stage II occurs 2 to 12 weeks after the tick bite. It develops in only 15% of the people who have not gotten treatment for the disease. The main symptoms are related to the nervous system, for example, stiff neck or weak facial muscles. Very rarely children develop some abnormalities of heart rhythm.
Stage III occurs 6 weeks to 2 years after the tick bite. It develops in about 50% of the people who have not gotten treatment for the disease. Often these people have had no Stage II symptoms. The main symptom of this stage is recurrent attacks of painful, swollen joints (arthritis). It usually affects the knees.
Prevention of Lyme disease is accomplished by avoiding tick bites. Remember that the deer tick must be attached for 24 – 48 hours to transmit the infection, so carefully inspecting your child (and yourself) for ticks every day from head to toe is critical. If a tick is discovered, grasp it with tweezers as close to the skin as possible and apply gentle sustained traction until the tick "lets go." Try to avoid crushing the tick. Once removed, cleanse the areas with soap and water. If the head of the tick is left in the skin, remove it as you would remove a splinter. If you cannot remove the last bits of the tick, simply cleanse the area and observe – the body´s natural defenses will take care of the debris. A small red area often develops around the bite – usually less than the size of a quarter and resembling the redness seen after any insect bite. This usually fades in a day or so, does not enlarge to become a "bull’s eye," and is no cause for concern.
Incorrect tick removal methods include using nail polish, a burning match, petroleum jelly, etc. The only correct way to remove a tick is by gently pulling it off. Dispose of the tick once removed. While laboratories are capable of testing live ticks for the presence of Lyme bacteria, we do not recommend this for two reasons. First, the laboratory warns that a negative test does not assure the tick did not have Lyme bacteria, and second, a positive test does not mean the bacteria was transmitted. Remember, one in three ticks in our area have the bacteria but – only one in a hundred bites result in Lyme disease! If you are not sure if the tick is a deer tick, you may save it for identification.
Many expert resources recommend wearing long-sleeved shirts, pants tucked into socks, and avoiding woody or grassy areas. Insect repellents such as DEET are effective but when used in large amounts or over long periods of time can be toxic to the nervous system. Use them sparingly and in low concentrations (maximum at 10%). Similarly, using insecticides on your lawn carries potential risk. Pets should also be inspected for ticks.
At least two studies have shown that antibiotics given immediately after a tick bite (before symptoms develop) do NOT prevent Lyme disease and expose patients to unnecessary risk. We do not recommend preventive (also called prophylactic) antibiotics for tick bites. Lyme vaccines are available for persons over 15 years of age and are being studied for use in younger children.
Lyme disease is diagnosed by symptoms, particularly in the early stages. Laboratory testing confirms certain cases but is not always necessary. The blood test for Lyme disease measures the body’s immune response to the bacteria instead of looking for the bacteria itself and will therefore be negative early on during the infection. Effective treatment may or may not interfere with future test results so follow-up testing is not recommended. We confirm positive Lyme results with a special highly accurate test called a Western Blot because there is a high false positive rate for the basic test, the titer. Lyme testing is NOT a screening test and should NOT be used in patients without symptoms. The urine test has such a high false positive rate that it is not approved by the FDA or CDC and should never be used.
Treatment for Lyme disease is with antibiotics. Most cases are cured with 3 – 4 weeks of oral medication. Advanced cases may need antibiotics through an intravenous route.
If the symptoms don´t respond to the simple treatment, the diagnosis was probably wrong. Sometimes the minimal symptoms, such as joint aches, may last longer than the course of the antibiotic; additional antibiotics are not needed in this case because the symptoms are a result of the body´s reaction to the dead bacteria.
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