Lyme disease is a bacterial infection passed along when certain ticks bite infected animals then transmit the infection to humans and even pets. Michael Jurgens, MD, in the Department of Family Medicine at University of Iowa Hospitals and Clinics, talks about Lyme disease:
Typically, when and where are ticks that transmit Lyme disease found?
The tick is the Ixodes tick or the deer tick. It's found mainly on white-tailed deer. We don't see a lot here in Iowa, it's mostly in Wisconsin, Minnesota, Missouri, Kansas, and out in New England—it's pretty heavily infested out there—and California. Those are the main areas and of course you pick up the ticks in wooded areas, that sort of thing.
Is there a way to prevent a tick bite? How?
Yes there is. Stay out of wooded areas, that's the most important thing. Of course that's obviously not feasible all of the time. The other thing you can do is of course use insect repellents containing deet, like Off® and Cutter® and things like that. They do work. I have people tell me that they didn't think it worked because they found a tick after applying the stuff. The ticks will still get on you but they won't stick around long—certainly not long enough to feed.
Is there a safe and effective way to remove a tick from the skin?
Grab it with a tweezers or needle-nosed pliers and pull slowly perpendicular to the skin. Slow is important. Ticks cement their mouth in deer skin so they're not going to let go immediately, it takes a little time. When you pull it out, see if something is still in your skin, that's actually the mouth, it's not the head. So you don't need to worry about that. Don't do any of those things like painting them with fingernail polish or burning them, or that sort of thing. That's dangerous and you can actually injure the person who you're trying to remove the tick from.
Should everyone document tick bites, or even send the tick to be tested?
No, certainly not here in Iowa. There's really no point to that. The ticks here and the deer don't carry the disease. If you're down near the Missouri border, or up near Minnesota/Wisconsin border—maybe then—but it's really not worthwhile. It's important to remember that most people who get Lyme disease do not remember a tick bite, only about 30 percent.
What are the general symptoms of Lyme disease?
Lyme disease is a three-phased disease. The early localized reaction is the erythema chronicum migrans—that's a rash that looks like a bull's eye and you have like a flu-like illness with fevers and chills and headache and muscle aches and that sort of thing. The second phase is an early systemic-type phase where you can have:
Cardiac or heart problems—pericarditis, heart block
Neurologic manifestations like meningitis, an inflammation around the brain and facial palsy—Bell's palsy—paralysis of the facial muscles
Arthritis possibly one joint but tends to move around from joint to joint, or migratory arthritis.
In the third phase, you can have some neuro-cognitive disfunction, clouded thinking, problems with memory, and that sort of thing. There is another type of arthritis that often affects the knees.
Those are the three phases and you can actually have all three phases at the same time.They often overlap.
How is Lyme disease diagnosed?
If it's early and you've got the rash, that's about all you need. If the rash is there often the antibody test will still be negative. If you present later, which is what most people do, you can draw blood for antibodies. The tests are good but they're not perfect and there is a fairly high false-positive rate with a lot of those tests.
If left untreated or misdiagnosed, what effect can Lyme disease have on the brain, heart, lungs, eyes, joints, and liver?
When you get to the third phase, it can last a while, often months, maybe even years. But generally, I wouldn't say it's self-limited, but if it's left untreated, it will take longer to resolve.
What is the treatment for Lyme disease?
Treatment of Lyme disease is antibiotics. You can use doxycycline, penicillin, Rocephin, Ceftin, those types of antibiotics, Zithromax, I think everybody's familiar with those. They're all relatively cheap and effective. Sometimes it depends on the phase of the illness that you're presenting with, you may use different antibiotics, but I think most will agree that doxycycline is cheap and effective.
When Lyme disease is treated, do all the symptoms go away?
Generally, the symptoms will go away. Some people will have some persistent arthritis which may require a little bit more aggressive therapy but not with antibiotics. Usually then you're using drugs similar to what you'd use for rheumatoid arthritis and that sort of thing. The neurocognitive disfunction can take some time to resolve, again some months, but it does resolve so all the symptoms will generally go away.
What's your best advice with regard to Lyme disease prevention?
Best prevention is stay in doors. In lieu of that, if you're outdoors, wear a deet-containing insect repellant. Citronella and things like that do not work, and they have not really been adequately studied. So Off® or Cutter® or one of those types of things is your best defense. And stay out of states or areas where the disease is most prevalent.
|
