The summer months are a peak period for Lyme disease and other tick-borne infections.
By the time you read this, the blacklegged tick that carries Lyme disease and other infections will already be active in the northeast. The risk of Lyme disease—diagnosed in 240,000 to 440,000 new patients every year—demands attention, especially in the Hudson Valley, the most hard-hit area of the country, and especially now, says Dr. Farah M. Ashraf of Premier’s Rheumatology Division. “Lyme disease is the most common vector-borne disease. It is most prevalent from April/May through November, with peak onset in the spring and summer months,” she says.
Lyme disease is caused by infection with the tick-borne spirochete Borrelia burgdorferi. The same type of tick may also carry spirochetes that cause babesiosis and anaplasmosis, both of which can be life threatening. An infected tick must be embedded in the skin for more than 24 hours for the infectious agents to enter the blood stream and cause disease. Lyme is classically diagnosed by the presence of an erythema chronicum migrans (ECM) lesion, the “bull’s-eye” rash that occurs at the site of the tick bite. “The rash is frequently found behind the knee, in the groin or armpit,” Dr. Ashraf says.
Along with rash, typical symptoms include joint pain, muscle pain, flu-like symptoms and nervous symptoms such as Bell’s palsy, a type of facial paralysis. “Swelling of the knee joint occurs about 80 percent of the time,” says Ashraf. There also may be swelling in the lymph nodes of the neck, heart palpitations or chest pain. Left untreated, the infection can cause long-term concerns such as chronic joint pain, chronic fatigue and neurologic problems involving memory and concentration.
Because the symptoms mimic those of other condition, including autoimmune disorders, Lyme disease and other tick-borne infections are often misdiagnosed. Accurate diagnosis is achieved through testing with a Lyme titer and Western Blot analysis. “If the person lives in an area where ticks are endemic, the likelihood of Lyme is higher than it is for autoimmune disease,” Ashraf says.
Standard treatment calls for a 21-day course of the oral antibiotic doxycycline. IV antibiotics are prescribed for those who are oral resistant. “It sometimes requires two to three months of antibiotic treatment to be successful,” she says.
Prevention is the best medicine, of course. When venturing outdoors, be aware that ticks live in moist, humid environments in or near wooded or grassy areas. It is best to walk on trails to avoid contact with leaves, branches, and grasses that may contain ticks. “Common sense measures include wearing clothing that covers up to the wrists and down to the feet,” Dr. Ashraf says. “Wear light colored clothing so it is easier to detect ticks.” Insect repellants are also helpful. Clothing and camping gear containing permethrin kill ticks. Applied to skin, repellants that contain 20 percent or more DEET offer protection for up to several hours, but must be used cautiously with children.
After returning indoors, conduct a complete tick check. “Check the entire body, but especially moist areas like the groin, armpit and belt line, where ticks like to attach,” she says. Showering within two hours of coming indoors may wash off unattached ticks and has been shown to reduce the risk of getting Lyme disease. Also check clothing and equipment for ticks and dispose of them down a drain.
If you find a tick on your skin, remove it immediately with tweezers, grabbing as close to the skin as possible and pulling straight out. “Keep the tick in a plastic bag and bring it to your physician, who can have it tested for the infection,” Ashraf says. If you notice any signs of illness, such as the ECM rash or flu-like symptoms, in the days and weeks following the bite, see your health care provider.