The woods you hike in this summer may be lovely, dark and remote, but one of the most fearsome creatures you’ll encounter, depending on where you walk, is a very small creature, a blacklegged tick.
These ticks pick up bacteria known as Borrelia burgdorferi when they bite deer or mice that are infected with Lyme disease. By clinging to your body or clothing as you walk past, they can then pass the bacterial infection to you.
Black legged ticks are so tiny that you might need a magnifying glass to see them. And you’re unlikely to feel their bites since they secrete a substance that keeps you from feeling any itch or pain.
Not every black legged tick has Lyme disease and not every bite even by an infected tick will transmit Lyme disease to you. In most cases, the tick must remain on your body for 24 to 36 hours before the disease is transmitted.
The early signs and symptoms of Lyme disease are likely to start showing up several days or even weeks after you were bitten. The most well known sign is a red, circular rash–known as erythema migrans–that forms around the area of the bite. This is sometimes referred to as a “bull’s eye rash” because a gradually enlarging clear area appears around the red, raised point in the center that is the site of the tick bite.
The rash is usually warm but not particularly painful or itchy. Like the bite itself, it may go unnoticed. Common sites are the thighs, groin, trunk and armpits.
Not Always a Rash
Don’t just look for bull’s eye rash, though. From 20 to 30 percent of patients never get a rash but develop other flu-like symptoms such as chills, fever, headache, muscle pain, stiff neck, lightheadedness and generalized itching.
Left untreated, the infection can spread to the brain, heart and joints, causing a number of more serious symptoms that are likely to come and go. These include:
• areas of erythema migrans elsewhere on the body;
• Bell’s palsy (loss of control over muscles on one or both sides of the face);
• severe headaches and stiff neck due to inflammation of the spinal cord;
• pain and swelling in the knees or other large joints;
• shooting pains;
• heart palpitations and rhythm abnormalities.
Even without treatment, most of these symptoms may eventually resolve on their own, but they also may lead to lingering complications such as Bell’s palsy, arthritis or nerve abnormalities.
Most of the symptoms of Lyme disease occur with other diseases as well. To establish a diagnosis, a doctor relies not only on symptoms but a history of possible exposure and blood tests to determine if the patient has antibodies to Borrelia burgdorferi.
Only black legged ticks transmit the bacteria that cause Lyme disease, and these ticks are prevalent mainly in three areas of the United States:
• the northeastern mid-Atlantic from Virginia to Maine;
• north central United States, primarily Wisconsin, Minnesota, a few northern counties of Illinois and some western counties of Michigan; and
• the Pacific coast, mainly northern California. This is a different type of black legged tick, but it can cause Lyme disease..
Although reports of Lyme disease are made from all parts of the country, confirmed cases nearly always can be traced back to travel in one of these three areas. Transmission is most likely during the months of May, June and July.
If you’re a hiker, gardener or have an outdoor job in an area where black legged ticks are prevalent, you should try to protect yourself by walking near the center of trails and avoiding overgrown grass, brush and dead leaves.
Keep your legs and arms covered, with your trousers tucked into the top of your boots or socks. And use 20 percent concentration DEET insect repellant on your clothes and any areas of exposed skin. Permethrin, which kills ticks on contact, can also be applied to clothes, tents and camping gear.
Probably your most important preventive measures are 1) to bathe or shower soon after coming inside and 2) to check your body carefully every time you come in, even from your own yard. Ticks found and removed from your body within the first 24 hours will most likely not transmit the disease to you.
Ticks are tiny. If you find one, forget about all of the folk remedies you’ve heard or read; simply remove the tick with tweezers. Grasp it firmly as close to the skin as possible and pull the tick’s body straight back with a steady motion. Any twisting motion creates a chance that the tick’s head will remain under your skin.
If this happens, try to remove the head with the tweezers, but if this proves impossible, simply cleanse the area with antiseptic.
Having a tick bite is not necessarily an indication that any treatment is needed, but the person should be watched closely for 30 days. Once a diagnosis is confirmed, early treatment is beneficial to head off serious long-term complications.
Treatment involves a two- to three-week course of antibiotics, and it can be curative. About 30 percent of patients, however, continue to have symptoms such as fatigue, joint pain and memory and concentration problems–sometimes severe.
Some advocacy groups (such as the International Lyme and Associated Diseases Society) and doctors have labeled these symptoms chronic lyme disease–a controversial diagnosis.
There is no disagreement about the symptoms nor their severity–only what causes them and whether long-term antibiotics are called for. In some cases, the symptoms may be lingering effects of Lyme disease complications. In other cases, doctors say, they may represent another illness such as osteoarthritis, rheumatoid arthritis, fibromyalgia or chronic fatigue syndrome. Because the exact cause of these symptoms has not been found, according to the Centers for Disease Control, “this condition is properly known as ‘post-treatment Lyme disease syndrome’.”
Studies have found that the severity of these long-term symptoms is more closely associated with the initial severity of Lyme disease symptoms than with the duration of antibiotic treatment. There is little evidence that these symptoms can be relieved through long-term antibiotic treatment. And there is substantial evidence of potential adverse effects from such treatment.
REFERENCES:
Centers for Disease Control, “Lyme disease: a public information guide,”
Centers for Disease Control, “Lyme disease,” page last updated April 6, 2012.
Centers for Disease Control, “Lyme disease transmission,” last updated November 15, 2011.
Centers for Disease Control, “Signs and symptoms of Lyme disease,” last updated November 15, 2011.
Centers for Disease Control, “Lyme disease frequently asked questions (FAQ),” last updated November 15, 2011.
Centers for Disease Control, “Post-treatment Lyme disease syndrome,” last updated March 5, 2012.
Paul M. Lantos, “Chronic Lyme disease: the controversies and the science,” Expert Reviews in Antibiotics and Infectious Therapy, 2011;9(7):787-797.
“Lyme disease,” PubMed Health, reviewed August 26, 2011.
Nancy A. Melville, “‘Rule of 7's’ shows accuracy in Lyme meningitis prediction,” Medscape Medical News, December 19, 2011 (Pediatrics, published online December `19, 2011).
Laura Newman, M.A., “Lyme disease ticks endemic in northeast, northern midwest,” Medscape Medical News, February 2, 2012 (American Journal of Tropical Medicine and Hygiene, 2012;86:320-327.
Raphael B. Stricker and Lorraine Johnson, “Chronic Lyme disease and the ‘Axis of Evil,’” Future Microbiology, 2008;3(6):621-624.
05/28/2012
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