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Lyme Disease

It’s not the bite that hurts; it’s the bull’s eye that flowers, the disease that ensues, the weakness that results. A reservoir, ticks can transmit a bacterium, Borrelia burgdorferi, thereby inflicting disease upon the host from which this insect feeds.

Named after the city in which it was first recognized, Lyme disease can be a trying experience for the patient concerned. One of the most common symptoms of Lyme disease is the development of a reddish region on the skin shaped like a bull’s eye.

Presentation may include development of flu-like symptoms. Unfortunately, if help is not sought, the disease can disseminate and spread systemically. More “bull’s eyes” can develop. Meningitis, cranial neuropathy, and other nervous system involvement may present. The heart, brain, and joints are all susceptible, vulnerable targets of this bacterium.

Lyme disease, if treated early, can be easily alleviated. If untreated, it worsens to the above mentioned conditions. However, with Lyme disease, prevention is easier, cheaper, and safer than treatment.

Before indulging in prevention, an understanding of the transmission of B. burgdoferi from tick to human warrants discussion. The life cycle of a tick consists of three stages: a larval stage, a nymphal stage, and an adult stage. Transmission of B. burgdoferi is greatest in the nymphal stage.

Ticks enter the nymphal stage during the spring and summer months; hence, the incidence of Lyme disease peaks during this time period. It’s important to recognize that ticks do not fly or jump. In order for them to attach to a person there must be close contact between the tick and the human such as brushing up against shrubbery or the like. After the tick comes into contact with the skin, it takes several hours just for the teeth to fully implant in order for feeding to begin.

The bacterium of concern, B. burgdorferi, is housed deep within the middle of the tick’s stomach. In order to become infected with Lyme disease, the bacteria must travel from the stomach to the salivary glands and, from there, to the host. It takes 36-48 hours for this migration to occur. How do you know this migration happened?

The longer the tick is on the skin, the more it feeds, the greater it grows. A tick must feed and become engorged, much enlarged, to actually transmit disease. If a tick is found attached to the skin but is small and clearly not engorged, transmission of Lyme disease would be highly unlikely.

When one does actually find a tick on the skin, care must be taken to remove it: we don’t want to crush it. This is achieved by use of fine tweezers. Bring the tweezers toward the tick and grab it close to the skin. Remove the tick by pulling it, gently, up and away from the skin. This should be done slowly and with application of gentle, steady force. Do not crush the tick. Remember, the belly houses B. burgdoferi and we are not interested in its disturbance.

Ensure the tick is dead and dispose of it in household trash, or, even better, flush it down the toilet. If the tick is accidentally crushed during the removal process, then the area of skin upon which the tick was crushed should be flushed with warm water and soap or swabbed with alcohol.

Preventative measures can help reduce exposure to ticks: keep the lawn mowed and short, inspect house pets, wear long sleeved clothing and pants, dress in light colored clothing in order to better see the tick, and apply tick repellant.

DEET is a repellant that can be applied to the skin or clothing. Periodic reapplication is a must for proper protection. Permethrin is another repellant that should be applied to clothing, tents, and the like, but should NOT be applied to skin. If applying permethrin to clothing, ensure it dries (about 2 hours) before dressing. Permethrin should be applied no more than biweekly.

As there is no longer a vaccine available for Lyme disease, preventative measures are key to good health. Should infection occur, most patients, unless they have a contradiction (such as pregnant/breastfeeding patients or children) are treated with doxycycline, an antibiotic, for 2-3 weeks.

Finally, Lyme disease is easily preventable and, if disease ensues, usually easily treated. Moreover, unless a person lives in an endemic area, such as the mid-Atlantic region, tick bites will not likely result in disease. If suspicious of infection, seek medical attention, and watch for the bull’s eye but keep in mind that this notable symptom is not always present.