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Lyme Disease

Arthritis isn't supposed to be contagious. So when parents in the small village of Old Lyme, Connecticut, noticed an outbreak of joint pain among children, they had trouble getting doctors and health professionals to take them seriously. The year was 1975, a couple of years before anyone had heard of Lyme disease.

When experts finally did start investigating the outbreak, it took a while to figure out what happened: The children were all suffering from a disease spread by deer ticks, tiny bugs no bigger than a sesame seed. Since then, Lyme disease has appeared many times in places far beyond the village that gave it its name. It's a disease worth knowing about -- especially if you spend time outdoors in places where deer ticks thrive.

What is Lyme disease?

Like mosquitoes and other types of blood-sucking bugs, ticks have a bad habit of spreading germs. One of those germs, the bacterium Borrelia burgdorferi, can be especially destructive if it gets into human blood. The germ, often found in deer ticks, can attack joints and induce long-term illness that's hard to shake. The infection and all of the complications that go along with it are called Lyme disease.

The vast majority of tick bites don't end up causing Lyme disease -- or any other illness. But with so many ticks out there, the danger is significant. According to the Centers for Disease Control and Prevention, there are an estimated 300,000 new cases of Lyme disease in the United States every year.

Where is Lyme disease most common?

The threat of Lyme disease depends entirely on the supply of infected ticks. The Northeast is still a hot spot, especially rural areas with the mix of trees and grasslands that supports large numbers of deer and the ticks that come with them. Deer ticks also thrive in rural areas of the Mid-Atlantic (states such as Virginia and Maryland) and the upper Midwest (states such as Minnesota and Wisconsin). Close relatives of deer ticks have caused scattered outbreaks of the disease in California and the Northwest. The disease is very rare in the Deep South, the Southwest, and the Mountain West.

Even though most ticks don't carry the germ that causes Lyme disease, it's worth noting that ticks can carry other infections. For example, the relatively large Rocky Mountain wood ticks won't spread Lyme disease, but they can carry other illnesses such as Rocky Mountain spotted fever.

What are the symptoms of Lyme disease?

Even for professionals, Lyme disease can be a tricky illness to spot. The symptoms vary widely and show up in different parts of the body. To add to the confusion, Lyme disease can mimic other more common illnesses, including the flu and rheumatoid arthritis.

The tick usually needs to be attached for 12 to 24 hours before the infection begins to spread to a person. Up to 80 percent of people infected with Lyme disease develop a red rash at the site of the tick bite. The rash, which shows up anywhere from three to 30 days after the bite, slowly grows and can reach 12 inches across. Often, but not always, the center will fade, making the rash look a little like a bull's-eye. The rash may be warm but usually doesn't hurt.

Apart from the rash, the early symptoms of Lyme disease can feel a lot like the flu: achy muscles and joints, headaches, tiredness, swollen lymph nodes, fever and chills. These symptoms can linger for weeks, much longer than the typical case of the flu.

Often, the illness stops there. But if the infection continues to spread, the trouble may just be beginning. Within days to weeks, infected people can have a wide range of temporary symptoms, including droopy facial muscles, numbness or weakness in limbs, memory loss, mood changes, loss of sleep, heart palpitations, and dizziness. These symptoms may eventually fade on their own, although they can go away even faster with the right treatment.

Without treatment, more than half of people with Lyme disease start suffering severe joint pain and swelling within several months. The pain comes and goes, and it can move from one joint to another. Large joints such as knees are the most likely to be affected. In some cases, nerve damage can cause long-term problems including severe chronic pain, numbness, or trouble with concentration or memory.

Lyme disease has been referred to as the new "great imitator," and Psychology Today notes that it "can masquerade as a host of psychiatric ills, confounding doctors and driving patients to question their very sanity." When Lyme disease infects the central nervous system and brain, it has been associated with vertigo, confusion, mood swings, and depression, among other things. In some cases, a bout of antibiotics will wipe out such symptoms.

How is Lyme disease diagnosed?

If you believe you have Lyme disease but don't have a bull's-eye rash, your doctor should run some blood tests before making a diagnosis. The most common screening, called an ELISA test, checks the blood for antibodies to the germ that causes Lyme disease. If it comes back positive, the doctor will run another test, called a Western blot, just to double-check. It's very important to get the ELISA test first, however. Running a Western blot test first increases the chances of getting a false positive.

How is Lyme disease treated?

When caught in time, Lyme disease is usually easy to treat. Two or three weeks' worth of oral antibiotics (such as doxycycline or amoxicillin) should clear up the infection and prevent any complications. In more advanced cases, it might be necessary to receive regular doses of antibiotics through an IV for two to four weeks. Often your doctor will start treatment before the lab tests are all back, if the symptoms are classic.

What can be done to prevent Lyme disease?

If you spend time outdoors in places where ticks thrive, you'll want to take steps to keep the bugs off of your skin. Even if you don't live in an area where Lyme disease is a problem, ticks are worth avoiding. You should be especially diligent about ticks in the late spring and summer, when most Lyme disease infections occur.

For starters, avoid tall grass and shrubby areas where ticks live, and keep grass around your house mowed. If you do have to go through grass, wear long-sleeved shirts and pants when walking through grasslands or forested areas. Because ticks often live low to the ground, you should pay extra attention to your feet. Wear closed-toe shoes, and consider tucking your pant legs into your socks. Before you head back inside, check your clothes -- especially your socks and pants -- for ticks. Unwanted passengers will be especially easy to spot if you're wearing light clothing. You should also check your skin and your scalp, and give your kids a thorough going-over, too.

Bug repellents can give you an extra dose of protection. Repellents containing 20 percent to 30 percent DEET work well on the skin, and products containing permethrin can keep bugs off of clothes. However, the American Academy of Family Physicians recommends that you don't use products containing DEET on babies younger than 2 months, and don't apply the product to the faces and hands of children in general. Make sure you wash the insect repellent off with soap and water once the kids come home. DEET isn't meant for long-term use because it can cause agitation, seizures, and even coma in high enough exposures. When using repellents, always read the directions carefully, and don't go overboard.

If a tick does latch onto your skin, pull it out with tweezers as soon as possible. If it is on your skin for less than 12 hours, it has almost no chance of giving you Lyme disease. Grab its head with the tweezers and pull out slowly. Don't use rubbing alcohol, nail polish, hot matches, gasoline, petroleum jelly, or other folk remedies for removing ticks. If the bug gets too distressed, it will throw up its stomach contents into your blood. Once the tick is removed, wipe the spot with an antiseptic.

Is there a vaccine for Lyme disease?

There used to be a vaccine against Lyme disease, but it is no longer available. The company that developed the vaccine took it off the market in 2002, partly because not enough people were rolling up their sleeves. The vaccine wears off in a few years, so people who got the shot should assume that they're no longer protected.

References

Centers for Disease Control and Prevention. Lyme Disease Diagnosis. 2017.

Mayo Clinic. Lyme Disease.

American Academy of Family Physicians. Lyme Disease.

Centers for Disease Control and Prevention news release. CDC provides estimate of Americans diagnosed with Lyme disease each year. https://www.cdc.gov/media/releases/2013/p0819-lyme-disease.html

American Society for Microbiology. Lyme disease: The public dimension. Microbe Magazine.

Smith-Fiola, Deborah. Prevent Tick Bites: Prevent Lyme Disease. Rutgers Cooperative Extension. J Agricultural Experiment Station.

Weintraub, P. Lyme Disease: The Great Imitator. Psychology Today.

Centers for Disease Control and Prevention. Lyme Disease Transmission.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Lyme Disease: The Facts, The Challenge.

Savely, G. Update on Lyme Disease, Clinician Reviews.

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