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Important Information on Lyme Disease

Twenty-two different species have been collected in Connecticut. Six of these are known to feed on humans and to be associated with six different diseases. (Lyme disease, Ehlichiosis, Babesiosis, Rocky Mountain Spotted Fever, Powassan encephalitis, Tularemia, and Bartonellosis). The most common of these diseases in Connecticut is Lyme disease and the tick most associated with Lyme disease is the black legged or deer tick (Ixodes scapularis).

What is Lyme Disease?

Lyme disease is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried by deer ticks. An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe.

Lyme disease manifests itself as a multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages. If diagnosed and treated early with antibiotics, Lyme disease is almost always readily cured. Generally. Lyme disease in its later stages can also be treated effectively, but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, Lyme disease causes permanent damage.

Although Lyme disease is now the most common arthropod-borne illness in the U.S. (more than 100,000 cases have been reported to the Centers for Disease Control and Prevention [CDC] since 1982), its diagnosis and treatment can be challenging for clinicians due to its diverse manifestations and the unreliability of currently available serological (blood) tests.

The prevalence of Lyme disease in the northeast is due to the presence of large numbers of the deer tick's preferred hosts - white-footed mice and deer - and their proximity to humans. White-footed mice serve as the principal "reservoirs of infection" on which many nymphal (juvenile) ticks feed and become infected with the Lyme disease spirochete. An infected tick can then transmit its store of spirochetes to its next host (e.g., an unsuspecting human).

Studies have shown that an infected tick normally cannot begin transmitting the spirochete until it has been attached to its host about 36-48 hours; the best line of defense against Lyme disease, therefore, is to examine yourself at least once daily and remove any ticks before they become engorged (swollen) with blood.

Generally, if you discover a deer tick attached to your skin that has not yet become engorged, it has not been there long enough to transmit the Lyme disease spirochete. Nevertheless, it is advisable to be alert in case any symptoms do appear; a red rash (especially surrounding the tick bite), flu-like symptoms, or joint pains in the first month following any deer tick bite could signal the onset of Lyme disease.

Diagnosis

If you think you have Lyme disease symptoms you should see your physician immediately. The expanding rash, which may occur in up to 60% of the reported cases, is a specific feature of Lyme disease, and treatment should begin immediately.

Even in the absence of a rash, diagnosis of early Lyme disease should be made solely on the basis of symptoms and evidence of a tick bite, not blood tests, which can often give false results if performed in the first month after initial infection (later on, the tests are considered more reliable). If you live in an endemic area, have symptoms consistent with early Lyme disease and suspect recent exposure to a tick, present your suspicion to your doctor so that he or she may make a more informed diagnosis.

If early symptoms are undetected or ignored, you may develop more severe symptoms weeks, months or perhaps years after you were infected. In this case, the CDC recommends using the ELISA and Western-blot blood tests to determine whether you are infected. These tests, as noted above, are considered more reliable and accurate when performed at least a month after initial infection, although no test is 100% accurate.

When spending time outdoors, make these easy precautions part of your routine:

• Wear enclosed shoes and light-colored clothing with a tight weave to spot ticks easily
• Scan clothes and any exposed skin frequently for ticks while outdoors
• Stay on cleared, well-traveled trails
• Use insect repellant containing DEET (Diethyl-meta-toluamide) on skin or clothes if you intend to go off-trail or into overgrown areas
• Avoid sitting directly on the ground or on stone walls (havens for ticks and their hosts)
• Keep long hair tied back, especially when gardening
• Do a final, full-body tick-check at the end of the day (also check children and pets)

When taking the above precautions, consider these important facts:

• If you tuck long pants into socks and shirts into pants, be aware that ticks that contact your clothes will climb upward in search of exposed skin. This means they may climb to hidden areas of the head and neck if not intercepted first; spot-check clothes frequently.
• Clothes can be sprayed with either DEET or Permethrin. Only DEET can be used on exposed skin, but never in high concentrations; follow the manufacturer's directions.
• Upon returning home, clothes can be spun in the dryer for 20 minutes to kill any unseen ticks
• A shower and shampoo may help to dislodge crawling ticks, but is only somewhat effective. Inspect yourself and your children carefully after a shower. Keep in mind that nymphal deer ticks are the size of poppy seeds; adult deer ticks are the size of sesame seeds.

Any contact with vegetation, even playing in the yard, can result in exposure to ticks, so careful daily self-inspection is necessary whenever you engage in outdoor activities and the temperature exceeds 40 degrees F (the temperature above which deer ticks are active). Frequent tick checks should be followed by a systematic, whole-body examination each night before going to bed. Performed consistently, this ritual is perhaps the single most effective current method for prevention of Lyme disease.

If you DO find a tick attached to your skin, there is no need to panic. Not all ticks are infected, and studies of infected deer ticks have shown that they begin transmitting Lyme disease an average of 36 to 48 hours after attachment. Therefore, your chances of contracting Lyme disease are greatly reduced if you remove a tick within the first 24 hours. Remember, too, that the majority of early Lyme disease cases are easily treated and cured.

To remove a tick, follow these steps:

1. Using a pair of pointed precision tweezers*, grasp the tick by the head or mouthparts right where they enter the skin. DO NOT grasp the tick by the body.
2. Without jerking, pull firmly and steadily directly outward. DO NOT twist the tick out or apply petroleum jelly, a hot match, alcohol or any other irritant to the tick in an attempt to get it to back out. These methods can backfire and even increase the chances of the tick transmitting the disease.
3. Clean the bite wound with disinfectant.
4. Bring the tick to the Health Department on the 8th floor of the Stamford Government Center if you wish to have it tested.

The receptionist at the front desk of the Health Department will provide you with a packet containing information about Lyme Disease and a form to complete so that the results of the analysis can be mailed to the proper address.

Then, monitor the site of the bite for the appearance of a rash beginning 3 to 30 days after the bite. At the same time, learn about the other early symptoms of Lyme disease and watch to see if they appear in about the same timeframe. If a rash or other early symptoms develop, see a physician immediately.