An “UpTick” in Lyme Disease

Whether you’re a hiker, camper, or survivalist, you’ll be spending a lot of time in the Great Outdoors.  During your off-grid adventures, you’ll be exposed to all sorts of critters that want a piece of you (watch an episode of “Naked and Afraid” to see what I mean). One of these is the lowly tick.

Ticks are eight-legged spider-like “arachnids” that exist in various species throughout the United States. They latch onto the skin of a host for a meal of blood and transmit various disease-causing microbes (“pathogens”) to humans and animals through infected saliva.

These diseases include:

• Lyme Disease (also called “Lyme Borreliosis”)
• Babesiosis
• Anaplasmosis
• Tularemia
• Rocky Mountain Spotted Fever
• Ehrlichosis
• Relapsing Fever

In this article, we’ll concentrate on Lyme Disease. Lyme Disease is caused by the corkscrew-shaped bacterium known as Borrelia burgdorferi, commonly transmitted by the tiny blacklegged tick, also known as the deer tick.

Experts are expecting more cases of Lyme Disease due to recent mild winters and bumper acorn crops, which have increased the populations of animals that ticks like to feed upon. These include mice, a favorite of baby ticks, and deer, popular targets for adults. Because of the abundance of host animals, the Centers for Disease Control and Prevention (CDC) are estimating 300,000 cases of Lyme Disease this year, which is three times the number reported 20 years ago.

In case you’re wondering, Lyme disease has nothing to do with limes. It was first diagnosed in the town of Old Lyme, Connecticut in 1975. Since then, Lyme has become the most common tick-borne illness in the Northern Hemisphere.

HOW TICKS SPREAD LYME DISEASE

Ticks have a life cycle that can last two-three years and includes egg, larva, juvenile (also called “nymph”), and adult stages. For a larva to develop into a nymph or for a nymph to develop into an adult, a blood meal in needed. It appears that the nymphs cause the most cases of Lyme. The CDC estimates that about 30% carry the disease in the Northeast and Upper Midwest.

To pass along Borrelia burgdorferi to an animal or human, ticks must first find their hosts. They do this in a number of ways: By detecting smells, sensing body heat, or feeling vibrations with movement. Usually, they hang on grasses and bushes, holding on with their back pairs of legs and latching onto passersby with their front pair(s). When the tick finds a favorable place to feed, its mouth parts pierce the skin and start extracting blood.

A thorough examination of the entire body for ticks is warranted within two hours of returning after a day outdoors. This is most easily accomplished during a shower. Look behind the knees, in armpits, behind the ears, even the belly button.

If the tick is found, it may be possible to just brush it off. If that doesn’t work, a number of commercial products are available to remove it. It is reasonable, however, to simply use fine-tipped tweezers to grasp it as close to the skin’s surface as possible, and pull straight upward in an even manner. Twisting or jerking as you pull may cause the mouth parts to remain in the skin.

Thoroughly clean the wound area with isopropyl (rubbing) alcohol and apply antibiotic ointment. Wash hands afterwards. As an added precaution, launder clothing in hot water and dry in high heat. If all this is done soon after the bite occurs, infection is highly unlikely.

DETECTION OF EARLY LYME DISEASE

Sometimes, however, the bite goes unnoticed. Once bacteria are passed to the host by the tick (a process that often requires 24-48 hours), symptoms can become apparent anywhere from 3 days to a month afterwards. You will usually see the following: :

• Rash
• Fever and chills
• Muscle aches
• Fatigue
• Joint pain

In 70 per cent of patients, the rash occurs before the fever and starts as redness in the area of the bite. It often then develops into a red circular “bull’s-eye” that feels warm to the touch. Usually, very little pain or itching is associated. This pattern, which spreads over time, is called “erythema migrans” and may be enough to confirm the diagnosis. Lyme Disease, however, may be missed or misdiagnosed if symptoms are mild or, especially, if the tick bite was missed by the examiner.

When a bite from a blacklegged tick is newly identified, preventative antibiotics may prevent Lyme Disease. A single dose of two 100 mg. doxycycline (Bird-Biotic) may suffice.

For early infection, as evidenced by the presence of erythema migrans, rapid treatment usually results in a cure. Symptoms, however, may last for a time after treatment.

Doxycycline (veterinary equivalent; Bird-Biotic) 100 mg. twice a day for 14-28 days is indicated, or in children (must be over 8 years old) 4mg/kg twice a day for 14-28 days (max of 100 mg.) Avoid doxycycline in pregnant or breastfeeding women.

Alternatively, Amoxicillin (veterinary equivalent: Fish-Mox) can be used in pregnant or breastfeeding women at dosages of 500 mg 3x/day for 14-28 days. 50 mg/kg is the dose for children younger than eight years of age (maximum 500mg 3x/day). Azithromycin (Bird Zithro) has been mentioned as a second alternative and can be used in those allergic to Penicillin-family drugs.

LATE STAGE OR CHRONIC LYME DISEASE

Late stage infections with Borrelia burgdorferi result in a more diverse set of Lyme symptoms, some quite different from those seen early. These may occur months after the tick bite and include:

• Neck pain and stiffness
• Severe headaches
• Multiple rashes away from the site of the bite
• Joint pain and swelling in knees and other large joints
• Bell’s palsy (nerve damage that causes drooping on one side of the face)
• Heart problems such as irregular heartbeats
• Dizziness
• Shortness of breath
• Inflammation of the spinal cord (called “meningitis”)
• Shooting pains, numbness, or tingling in the hands, feet, or face
• Memory loss

Many of the above symptoms may persist for long periods. As of yet, there is not a proven cure for chronic or late stage Lyme disease, but a vaccine is now in development. We’ll discuss  some strategies are to deal with this debilitating condition in a future article.

PREVENTING LYME DISEASE

An ounce of prevention is, they say, worth a pound of cure, and this old saying is particularly relevant when it comes to infections caused by tick bites. For prevention, consider:

• Long pants and sleeves on the trail
• Thick socks and high-top boots (tuck your pants into them)
• Walking in the center of trails
• Using insect repellants like DEET (20% or greater) on skin (oil of citronella or lemon eucalyptus are natural alternatives)
• Applying Permethrin 0.5% insecticide to clothing, hats, shoes, and camping gear 24-48 hours before using (proper application will even withstand laundering)
• Thorough exams after a day outdoors; pay special attention to children and dogs

Paying close attention to the little things, especially ticks, will make sure that your outdoor activities are healthy and memorable (in a good way).

Joe Alton, MD