What You Need to Know About Lyme Disease and Ticks

With the approach of spring, concern over the tick-borne Lyme disease is again at the forefront of everyone's mind. In New England, the risk is real and the Northeastern states are considered endemic (high risk) areas for contracting the
disease.

Lyme disease is caused by the bacterium "Borrela Burgdorferi" and is transmitted by black legged ticks. Typical symptoms of the infection are fever, headache, fatigue and a characteristic "bulls eye" rash. Untreated, Lyme disease can spread to the joints, the heart and the nervous system.
If caught early, Lyme disease can be successfully treated with antibiotics. If not, the effects can be more severe and can last a significant length of time.

There are blood tests to determine if Lyme disease is present. Dr. Kristin Lee, an infectious disease specialist for Core Physicians in Exeter, said care must be taken not to do the test too early, to avoid a false positive.
"Lyme disease is a controversial issue that has generated a lot of heated exchanges," Lee said. "Many question chronic Lyme and question the neurologic aspects."
Dr. Joseph Gross of River Valley Infectious Disease Specialists in Newburyport, Mass. said there are two very different schools of thought on Lyme disease, with two very different approaches to treatment. What both sides do agree on is that the illness is contracted after a bite from a deer tick.

Lyme disease is carried by more than half of the ticks present in Rockingham County, Lee said.
"One problem is that the ticks are so tiny, we often do not even identify them," Lee said. "They fall off before we even know they were there."
Because of the impacts of Lyme disease, Lee advises that people contact their doctor if they even suspect a tick bite. She said do not even wait to see the classic bull's eye rash because that doesn't always appear.
"Some people get a red, round area of rash without the visual bull's eye," Lee said. "Everyone who is outside, and that includes pets, should be carefully checked for the presence of ticks during the spring and summer months."
Early detection is the key. Lee said a course of antibiotics, for 10 days to four weeks depending on the case, will cure Lyme if it is caught in time.

Gross said if caught right away, before the tick has time to become engorged, a single round of antibiotics may be enough to protect a person. He said they will still have the patient watch themselves for the rash, or for flu-like symptoms for several weeks following the treatment.
"If undiagnosed, a person can run into more chronic problems," Lee said. "Lyme can lead to chronic arthritis, carditis (heart problems) and there can be neurological manifestations. There are reports of subtle cognitive disturbances although there is no real data to support that yet. I tell my patients here's what I do know and believe. I validate what they are feeling because maybe we are missing something. I know that 10 to 20 percent of Lyme sufferers report they continue to feel poorly long after the initial diagnosis."
Dr. Elizabeth Melendy of Core Pediatrics in Plaistow said that cognitive impairments can manifest with Lyme disease.
"There certainly can be neurologic symptoms of Lyme disease but it often happens later into the disease process," Melendy said. "There really are three categories of Lyme disease: early localized, early disseminated and late disease."
Melendy said the early localized disease symptoms occur within the first 30 days after the tick bite and some associated symptoms are the rash, fever fatigue, headache, neck pain, joint aches, or muscle aches.
"Early disseminated disease show symptoms usually within three months of the tick bite and include the rash, carditis, facial nerve palsy (like bell's palsy) or meningitis," Melendy said. "Late disease is weeks to several months after the tick bite and includes arthritis. The neurologic manifestations including facial nerve palsy and meningitis are still very treatable, however, it often requires more invasive testing (like lumbar puncture, also known as spinal tap) and intravenous antibiotics."

Melendy said the facial nerve palsy or meningitis are not subtle or vague symptoms.

"The facial nerve palsy is a partial or full paralysis of the facial nerve causing a droop in the face," Melendy said.

She said meningitis is equally striking with headaches so severe you often can't talk or walk), vision changes or papilledema, which can be noted with ophthalmologic exam, increased intracranial pressure, which can be evaluated with spinal tap.

"Fortunately since these symptoms are not subtle and can be tested for they are usually caught and treated with specific antibiotics," Melendy said.
Of course, the best course of action is to avoid being bitten, Gross said. He advises the use of insecticides with DEET and careful inspection after being outdoors.

"Usually the tick that is missed is attached in a place you might not notice," Gross said. "That allows them to gorge themselves. Twenty-four to 36 hours is the amount of time needed to transmit the disease. Most ticks that remain that long are located in places like the base of the neck, the back of the armpit, lower back, behind the knee or in the groin area."