Lyme Disease – Know the Facts
By Christopher L. Montes, M.A., F.D.C. N.C.P., B.C.C.P. | New Britain Youth & Family Services at May 20, 2024 | 7:10 am | Print
May is Lyme Disease Awareness Month. While ticks can be active in nearly every month of the year, the month of May seems to be the time when they are the most prevalent in the Northeast. In Connecticut, the epicenter of what is now called a pandemic, Lyme disease is the most common tick-borne illness.
What we now know as Lyme disease was first reported in 1977 as Lyme arthritis by Dr. Allen Steere in Lyme, Connecticut, as it was first thought to be a type of Juvenile Rheumatoid Arthritis. However, historically it was documented as early as 1883 by Dr. Alfred Buchwald who named the associated rash acrodermatitis chronica atorphicans. It wasn’t until 1982 that Dr. Willy Burgdorfer discovered that the disease was caused by a microscopic spirochetal, corkscrew-shaped, bacterium that is appropriately named Borrelia burgdorferi.
In this region of the United States, Lyme disease is transmitted by the deer tick, or Ixodes scapularis, Female deer ticks (those usually spreading the disease because of their feeding habits), also called blacklegged ticks, have a rusty colored back, black head and black legs. In their nymph stage, deer ticks can be as small as the period at the end of this sentence. Adult deer ticks are about the size of a sesame seed; both transmit the disease. Lyme disease is not known to be transmitted by wood ticks or dog ticks, as some call them. These are all brown and larger than deer ticks.
In order to transmit Lyme disease, deer ticks must usually be attached to their hosts for at least 24 hours. However transmission has been reported after only a few hours of attachment if the tick is improperly removed, causing the tick to disgorge its gut contents beneath the skin of its host. If an attached tick is found, it should be removed by grasping the tick with fine point tweezers as close to the skin as possible and pulling straight out. Washing the area with soap and water and applying an antibiotic ointment such as Bacitracin is medically recommended. Careful observation of the area for up to 4 weeks is wise, keeping an eye out for any expanding redness, although many patients never experience a “telltale” rash, and unknowingly become infected with the disease. The tick itself can be taken to the New Britain Health Department on the third floor of City Hall, where it can be sent to the Connecticut Agricultural Testing Station for confirmation of disease. Although this does not necessarily mean that if a tick tests positive for Lyme disease the person was indeed infected.
Diagnosis of the disease should be made by a physician who is familiar with its symptoms. The United States Centers for Disease Control state that Lyme disease is to be diagnosed clinically, that is by its symptoms, careful observation, and after direct questioning to the patient. Standard laboratory tests are unfortunately unreliable because they only measure antibody response, and do not seek out the disease itself. Antibody response can be quite different amongst patients for several reasons, including early exposure to antibiotics, steroids such as prednisone, the actual strain of the Borrelia burgdorferi infecting the patient (there are over 200), laboratory specificity when measuring antibodies, and prior immunization with the Lymerix vaccine in the 1990’s. Also, these tests do not measure the possibility of co-infections caused by ticks such as Babesiosis, Ehrlichiosis, Tularemia, Rocky Mountain Spotted Fever, and Bartonella. Testing for these diseases must be ordered separately by the physician.
Since the discovery that the disease was caused by bacteria, the only FDA approved treatment has been antibiotic therapy. Several studies have taken place using alternative methods of treatment, but none have been fully accepted by the medical community as a whole. There are two schools of thought regarding the treatment of Lyme disease. The Infectious Disease Society of America tends to treat the disease very conservatively, and does not believe that there is a possibility of long term, or chronic, Lyme disease infection after treatment. Conversely, the International Lyme and Associated Disease Society physicians and scientists believe in more aggressive treatment, in terms of strength and duration of antibiotic therapy. Finding a physician who can not only properly diagnose Lyme disease but also effectively treat it may be difficult.
Symptoms of Lyme disease can be very much like those of other diseases and illnesses. In the early stages of the disease, a flu-like illness ensues. Fever, lethargy, stiff neck, muscle aches, nausea, and headache are quite common. In later stages, some patients have arthritic manifestations, while others have neurological symptoms. Lyme disease is also known to cause cardiac problems, visual and auditory disturbance, intestinal and bladder difficulties, sleep disturbance and even psychiatric illness such as panic disorder and depression. Amy Tan, the award winning author of The Joy Luck Club and other publications described her experience with Lyme disease as having hallucinations and other neuro-psychiatric manifestations prior to diagnosis and proper treatment. Many patients describe a “Lyme fog,” or fuzziness of the brain caused by the disease. Still, others may have Multiple Sclerosis-like symptoms, Lupus-like symptoms, Parkinson’s disease-like symptoms, and Alzheimer’s disease-like symptoms. This is why Lyme disease has been called “The Great Imitator”. The levels of disability from Lyme disease vary from minor to completely disabled In fact, the Social Security Administration now recognizes Lyme disease disability as qualifying for income if the applicant can demonstrate an inability to work, and has a clear diagnosis from the treating physician.
The best prevention against Lyme disease is tucking pant legs into boots, topical application of permethrin products on clothing (not skin) and insect repellants containing DEET on the skin immediately prior to exposure to a tick habitat such as long grass, wooded areas, and yard perimeters where there are bushes, stone walls, and any possibility of field mice or deer being present. These animals most often carry the disease from place to place via tick hitchhikers. Careful inspection of clothing and skin after possible tick exposure is also warranted. If non imbedded ticks are found, destroy them as soon as possible.
The fear of contracting Lyme disease is no reason to totally avoid the outdoors. However, awareness of the disease, its prevention, diagnosis and treatment for anyone living in Connecticut or any other endemic area should be at the forefront our minds.
