Summer is here. The time has come to step outside and enjoy the beautiful Northeastern Pennsylvania weather. Biking, running, hiking and camping are just a few of the activities that so many of us partake in this time of year. However, living in Pennsylvania puts us at an increased risk for Lyme disease. First discovered in Lyme, Connecticut in 1976, Lyme disease is transmitted by the deer tick. It is the most common insect-borne infection in the United States. Greater than 90 percent of cases occur in our backyard, the Northeast, during the fall and summer months, with people living in wooded areas being most at risk.
Lyme disease is caused by a bacteria, Borrelia burgdorferi. This bacteria is transmitted from the deer tick (also called the Ixodes tick) after it feeds on infected mice, most commonly the white-footed mouse. The infection is spread after an infected tick bites a person and remains attached for greater than 36 hours. After being bitten, the bacteria multiply at the site of the bite and then migrate after a few days, resulting in the characteristic bullseye rash (also called erythema migrans). If untreated the bacteria can then spread throughout the body through the bloodstream.
Signs and Symptoms
Lyme disease consists of three distinct stages: early localized, early disseminated and late stage.
Early localized stage
Characterized by the appearance of the bullseye rash (erythema migrans), a large, raised rash at the site of the bite with several surrounding concentric rings. The rash is not painful or itchy, although may be warm. The rash usually resolves in 3-4 weeks. Roughly about a quarter of people affected do not develop or even notice the rash.
Early disseminated stage
Symptoms can be present for a few weeks to a few months, can be intermittent and can resemble other illnesses such as the flu or other viral infections:
• Fever, chills
• Muscle aches
• Painful, swollen joints
• New rashes
• Nausea, vomiting, sore throat and enlarged lymph nodes can develop, although these symptoms are less common
• Neurological symptoms: Bell’s palsy, meningitis
• Cardiac symptoms: arrhythmias, myocarditis, pericarditis and chest pain
Symptoms develop months to years after initial infection if untreated:
• Arthritis, painful swelling in large joints especially the knees
• Neuropathy, numbness and shooting pain present in the back, arms and legs
• Difficulty with speaking, mood, memory and sleep
Lyme disease is diagnosed with the presence of symptoms, history of exposure or potential exposure and certain tests. Blood can be tested for antibodies, although this test may be negative in early infection or if a patient has already received antibiotics. However, once antibodies are present, they remain positive even after the infection has resolved.
Patients need to be diagnosed and treated early in order to prevent complications found in later stages. Infections are treated with a course of antibiotics (doxycycline, amoxicillin or cefuroxime) for 2-3 weeks. Azithromycin is an alternative if patients cannot take other antibiotics. Treatment with doxycycline is avoided in pregnant women and children under age eight.
Arthritis can also be treated with antibiotics orally with amoxicillin, doxycycline or ceftriaxone or penicillin IV. Patients may also need symptomatic treatment of pain and inflammation with NSAIDs (such as ibuprofen and naproxen) and/or joint aspirations.
Neurological symptoms and arrhythmia are also treated with antibiotics ceftriaxone, doxycycline or penicillin for 2-4 weeks.
• Avoid wooded, brushy areas with high grass and weeds
• Wear light-colored, long-sleeved shirts with long pants tucked into boots or socks
• Use bug spray/repellent containing 20 percent or more of DEET
• Carefully inspect whole body (specifically under arms, around ears, belly button, behind knees, between legs, around waist and in hair) after being in a wooded area
• Take a shower or bath after returning indoors to identify and wash off ticks
• Inspect pets, clothing and equipment for ticks
If A Tick is Detected
• Immediately remove any ticks. Pull the tick straight off by gripping the head or mouth with tweezers
• Avoid squeezing the body of the tick
• Avoid using petroleum jelly, alcohol or matches to remove the tick
• Seek medical attention
We are fortunate enough to live in Northeastern Pennsylvania and to be able to enjoy all that it has to offer. With a few common sense precautions, we can continue to take part in the many outdoor activities we love and, at the same time, reduce the risk of developing Lyme disease.