Lyme: Beware the tiny tick

Between three days to several weeks after being bitten by a Lyme-carrying tick, 70 to 90 percent will develop circular or oval shaped rash resembling a bull's eye.

By Gary E. Barr
Special to the Rappahannock News
Mysterious, confusing, and diverse, it is a sickness that can cause several serious medical conditions. As Virginia residents hike and work outside during summer, Lyme Disease can be a serious consequence.

“I didn’t have any of the normal symptoms,” said Susan Morgan of Wytheville. “Rob [her husband] thought it was a spider bite. It was in a place on my back that would have been covered and we never saw the tick.”

Within a few days the small red spot grew to a circular target shape eight inches in diameter. Morgan had to take antibiotics for almost a month, but her Lyme Disease eventually cleared up.

Lyme Disease first appeared 100 years ago in Europe. Deer ticks (black-legged ticks) began causing the disease in Lyme, Connecticut in 1975. Since then it has spread and the number of Lyme Disease cases is increasing in Northern Virginia.

Dr. Lawrence R. Whitehurst, a physician at Culpeper Medical Associates, explained:

“In our practice we have had one case of serious Stage III Lyme Disease involving the central nervous system of a patient and one case of Lyme Cardiomyopathy or Lyme-induced heart disease. We have had many cases of Primary localized (Stage I) or Disseminated (Stage II) Lyme and a few cases of Lyme Arthritis.”

Whitehurst has been practicing medicine for 36 years, is Board Certified in Family Medicine, and is an Assistant Visiting Professor of Family Medicine at the University of Virginia.

“There has been a general increase in reported cases of Lyme Disease throughout Northern Virginia and the Tidewater area over the past 5 years,” said Whitehurst. This is directly related to the increase in white tail deer which are the natural host [of] the deer tick.”

In Virginia one of the biggest jumps in cases of Lyme Disease occurred between 2006 and 2007. Statewide there were 357 cases of Lyme Disease in 2006, 1,000 cases in 2007. Since then the Virginia rate has somewhat stabilized at approximately 1,000 cases per year.

Whitehurst pointed out that Lyme Disease is currently the most prevalent vector-borne disease in North America with foci of infection in a corridor running from Maine through Virginia, and in regions of Wisconsin, Michigan, Minnesota, and Northern California. Highly populated cities such as Boston, New York, Philadelphia, Washington, D.C., and the whole Tidewater metropolitan area of Virginia have seen marked increases in the disease.

“One reason for the dramatic rise in Lyme,” Whitehurst said, “is loss of the normal habitat for the deer along with elimination of the natural predator of the deer, the timber wolf. This has caused the deer to move from the mountain areas into farms and fields frequented by humans.”

“Another vector in the chain is the white-footed mouse and this rodent tends to be prevalent in areas of overcrowding [that have] slum conditions with poor sanitation. The tick itself can be found in high grass, weeds, shrubs and other forms of vegetation and it is attracted to warm-blooded mammals as it needs a ‘blood meal’ in each of its stages of life.”

If untreated, Lyme Disease can cause serious problems with joints, the heart, and the body’s nervous system. Facial palsy, partial paralysis of facial nerves, can result along with types of meningitis, nerve inflammations in the body’s limbs, encephalitis (brain swelling), and carditis (heart inflammation).

Whitehurst described why deer tick bites often go undetected.

“The nymph stage tick looks like the adult but it is smaller and only has six legs rather than the eight found in the adult tick. Over a third of active cases cannot remember the original tick bite, and it frequently goes unnoticed since it is usually painless. The nymph stage tick is most active in the late spring and early summer; the adult tick is most active in the summer and fall.”

“Exposure to the deer tick should be reported as soon as suspected. Before any rash has occurred, a single dose of an antibiotic, usually Doxycycline can prevent the illness. Once a spreading red lesion has appeared around a tick bite or multiple red spots resembling bulls-eyes have appeared, 14 to 21 days of an antibiotic are usually adequate to kill the infection.

According to Peter Warren, an Extension Agent in Albemarle County, less than half of deer ticks carry the disease and it’s even a smaller percentage of such ticks that can actually transmit the Lyme Disease to humans. As a result, getting bit by a deer tick doesn’t mean you get the disease.

However, Whitehurst warned:

“Once arthritis or inflammation of the heart has occurred, a 30-day course of antibiotics is usually necessary. In severe cases, two to four weeks of intravenous antibiotics may be necessary.”

“It is essential to identify and treat Lyme Disease in its early stages which are in the first six weeks after exposure, the sooner the better. After this time the organism may enter a latent phase which may last for weeks, months or years and then reappear suddenly as full blown Stage 3 disseminated Lyme Disease affecting multiple organ systems, the heart and the central nervous system. I have seen a case like this and it is difficult to treat at best and at worst may leave the patient with a post-Lyme syndrome that resembles Fibromyalgia or Chronic Fatigue Syndrome that lasts for years and is very resistant to treatment,” said Whitehurst.

No one seems quite sure of the many variables related to Lyme Disease and attempts to produce an effective vaccine for humans have been unsuccessful.

“This is a very important and emerging infection in Virginia,” said Dr. Keri Hall, Director of Epidemiology at the Virginia Department of Health. Hall added it’s likely that many cases of Lyme Disease still go undetected.

Can the disease spread from human to human? Whitehurst explains, “Lyme is not communicable between humans; it can only be caught from the deer tick, usually in the nymph stage.”
Why have experts been unable to develop a vaccine for Lyme Disease?

“The CDC [Center for Disease Control] is still actively pursuing a vaccine, but vaccine development is difficult because the infecting organism has very few proteins on its surface that can be used to synthesize an effective vaccine.”

Until then, Whitehurst and groups such as the American Red Cross advise: to wear a good insect repellent and to do a self-examination following any treks in areas with tall grasses and wooded areas. If people do this, the number of Lyme Disease victims will decrease.

Black-legged, or deer ticks, can transmit Lyme Disease to humans.

Looking at Lyme Disease

What is Lyme disease?
Lyme disease is a tick-borne illness caused by infection with the bacteria Borrelia burgdorferi.

Who can get Lyme disease?
People of any age can get Lyme disease, particularly those who spend a significant amount of time in outdoor activities. It occurs most commonly during the late spring and early summer months, but can occur during the fall and winter. Dogs, cats and horses also can get Lyme disease.

How is Lyme disease spread?
The bacteria that cause Lyme disease are transmitted through the bites of infected ticks. In the Eastern U.S., the only tick known to spread Lyme disease is the black-legged tick (formerly called the “deer tick”). Spread of the Lyme disease bacteria from an infected tick to a person is not likely to occur unless the tick has been attached to the person’s body for at least 36 hours. Lyme disease is not known to be spread to humans from other insects or animals, or from one person to another.

What are the symptoms of Lyme disease?
Within days to weeks following an infectious tick bite, most patients (about 80 percenttt) develop a red rash called an erythema migrans (a.k.a., “EM” or “bull’s-eye” rash) around the bite site. This rash slowly expands (up to 12 inches in diameter and clears around the center, but does not itch. It is usually accompanied by general tiredness, fever, headache, stiff neck, muscle aches, and joint pains. If untreated or not properly treated, some patients may develop arthritis, neurological problems, and/or heart problems weeks to months later.

How soon after exposure do symptoms appear?
The EM rash may appear within 3-32 days (usually 1-2 weeks) after exposure. Some patients never have early symptoms of Lyme disease, but become sick with more severe symptoms from weeks to months after tick exposure.

How is Lyme disease diagnosed and treated?
The diagnosis of Lyme disease is based primarily on signs and symptoms of illness. Laboratory tests for Lyme disease may be done on a patient’s blood to help confirm the diagnosis. When Lyme disease is detected early, it is treated with oral antibiotics such as doxycycline or amoxicillin and treatment usually lasts for 10-21 days. In the later stages of Lyme disease, antibiotic treatment lasts longer, is more complicated, and patient response to treatment is slower.

Is there a vaccine for Lyme disease?
There is currently no vaccine for Lyme disease.

How can Lyme disease be prevented?
Avoid tick infested areas, such as tall grass and dense vegetation in forests and along forest margins. When in potential tick habitats, tick-specific repellants may be used according to manufacturer’s instructions, such as those containing DEET (up to 50 percent DEET for adults, and less than 30 percent DEET for children) and/or permethrin (apply permethrin to shoes and clothing only, not skin). Be sure to follow the label’s instructions when using any repellent. Wear light colored clothing so that ticks are easier to see and remove. Tuck pant legs into socks to prevent ticks from crawling up under the pants. Wear long-sleeved shirts buttoned at the wrists. Conduct tick checks on yourself, your children, and pets within a few hours of exposure to a tick infested area. Remove any attached ticks promptly by gripping the tick with tweezers as close to the skin as possible and using a gentle steady pulling action. Protect hands with gloves, cloth or tissue when removing ticks from people or animals.

Where can I get more information about Lyme disease?
More information about Lyme disease is available on the Virginia Department of Health website at www.vdh.virginia.gov or through the Centers for Disease Control and Prevention website at www.cdc.gov.

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6 Comments

  1. Calling continuing symptoms after Lyme disease “post-Lyme syndrome” makes it sound like the Lyme is gone and now the patient is left with permanent damage. That’s misleading.

    There is no test that can prove Lyme is gone. In fact multiple studies have demonstrated that Lyme spirochetes persist and multiply despite weeks and months of treatment, including IV. The common practice of treating for an arbitrary 2 – 4 week period is not enough for many who were not diagnosed early in the illness.

    “Post-Lyme syndrome” may well be undertreated, continuing infection. Many people improve if they are treated again with antibiotics. Doctors worry about the risks of long-term antibiotics but studies show that they are not that risky – at least compared with the alternative: a lifetime of misery. Certainly doctors should offer patients the choice.

    Cancer patients are allowed to choose radiation and chemotherapy. Lyme patients should have the same right to choose antibiotics until a better cure is discovered.

  2. Lyme Literate: Beware the Tiny Tic…Beware the Doctor!

    Thank you for your article on Lymes Disease; awareness of this insidious disease is crucial. However, some information in the article was misleading. Less then 20 percent of ALL Lymes patients present the classic bull’s eye and in some studies less then 15 percent of patients recall a tick bite. 70 to 90 percent, as stated in the article, is incorrect. Atypical forms of this rash are far more common and are pathognomonic of Lymes Disease and require no further verification prior to starting 6 weeks antibiotic therapy. Lymes is and should be a clinical diagnosis. Shorter treatment, as stated in the article, has resulted in an upwards of a 40 percent relapse rate. There has never in the history of the illness been one study that proves even in the simplest way that 30 days of antibiotic treatment cures Lymes Disease. However, there is a plethora of documentation in the US and European medical literature demonstrating histologically that short courses of antibiotic treatment fail to eradicate the Lyme spirochete. An uncomplicated case of chronic Lymes requires an average of 6 to 12 months of high dose antibiotic therapy. Many patients with Lymes disease require treatment 1 to 4 years, or until the patient is symptom free. Relapse occur and maintenance antibiotics may be required. There are NO tests available to assure us whether the organism is eradicated or the patient is cured.

    Lymes Disease is the number one tick-borne illness in the United States. There are over 25 different symptoms of Lymes Disease and the disease has been called “the latest great imitator” and is now found in every state in the US. It can attack virtually any system in the body. Estimates state that only one out of every ten cases of Lymes is reported and many people are misdiagnosed. The inadequacies of the current diagnostic tests are outdated and many physicians’ lack of experience with the disease and interpreting results often prevent an incorrect Lyme-Disease diagnosis. These are “Lyme Illiterate” doctors.

    I am a Lymes patient suffering chronic Lymes and am infused daily with strong antibiotics thru my intravenous PICC-LINE with a weekly visit from the home health care nurse. After IV treatment, I will be on a “cocktail” of antibiotics for minimum six months. I have two girls who were treated in 2008 with IV antibiotics as well and missed months of school. They still suffer bouts of Lymes arthritis and fatigue. I am an avid runner and cyclist and because of the disease, have trouble walking up my stairs. I am suffering not only from the arthritis associated with Lymes but my heart has been affected as well. I suffer severe ocular pain and migraine headaches and overwhelming fatigue on a daily basis as well as other Lyme related symptoms. I may never fully recover; therefore, finding a “Lyme Literate” doctor is crucial, a doctor who is willing to think “out of the box!” A Lymes patient MUST be treated clinically then followed with blood tests, which play a supportive role. If gone undiagnosed by a doctor, Lymes can cause neurological problems, heart problems and problems with vision and hearing. Symptoms can come and go and be replaced by new symptoms which may be subtle or pronounced. Lab tests may not indicate an infection; the first few weeks following infection, antibody tests are not reliable because a patient’s immune system has not produced enough antibodies to be detected. Therefore, a wrong diagnosis can be made and many people go undiagnosed and suffer. If left untreated, Lymes can be fatal! My friend lost her husband from Lymes complications and “Lyme Illiterate” doctors! By the time he was properly diagnosed, it was too late.

    It is very important to be your own advocate in the diagnosis of Lymes as well as finding the right doctor; a “Lyme Literate” doctor. It is an insidious and debilitating disease and is slowly becoming an epidemic. Please, be aware of any symptoms you may have and remember less then 15 percent of patients ever see the tick or the bull’s eye, as in my case and one of my daughter’s. Even with the bull’s eye, one can still be misdiagnosed. Lymes is prevalent in our area year round and can be found in every state in the US!

    The ILADS is a wealth of current and up-to-date information and offers a link to “Lyme Literate” doctors in our area. There is also a documentary on Lymes, “Under our Skin,” which hopefully will help bring awareness to this crippling disease!

  3. Researchers Need Help from Lyme Disease diagnosed people! There are a number of research organizations attempting to better understand Lyme disease as well as to develop better diagnostic test kits. On the diagnostics side, biotechnology companies like SeraCare Life Sciences and BioSpecialties Corporation run a number of diagnostics research studies for people diagnosed with Lyme Disease, paying participants $400+ to donate blood samples which are used to develop Lyme Disease diagnostics test kits (see: http://www.idonateplasma.com.) On the research side, Columbia University, and the Lyme Disease Research Foundation of Maryland are researching the proteomics, diagnostics, and epidemiology of Lyme Disease. On the clinical trial side, the National Institute of Health’ sponsor a number of clinical trials.

    There are many programs out there where you can GET PAID to help Lyme Research, the most active of which are below:
    http://www.idonateplasma.com

    https://twitter.com/IDonatePlasma

    http://www.myspace.com/seracare

    http://www.linkedin.com/pub/i-donate-plasma-for-research/21/b09/726

    http://www.facebook.com/pages/PAID-Plasma-Donations-for-Research/101071083280661?ref=ts

    For daily up-to-date information of Lyme Disease research, check out this Twitter List: https://twitter.com/IDonatePlasma/biotechnology-insights

  4. This article has it NOT quite half right…check out (www) canlyme (dot com), ILADS (dot org), California lyme disease association, and google – under our skin, and lyme literate medical doctor to get the truth…
    Lyme disease is under reported, under diagnosed and misdiagnosed. If you have MS, ALS, Fibromyalgia, RA, or any other autoimmune disease or disease without a known cause, you need to rule in or out Lyme disease as the underlying cause. Lyme disease is more prevalent than HIV/AIDS, west Nile and Swine flu combined….With knowledge and the right treatment, Lyme victims can get better…without it they face total debility and early death.

  5. Please note that the rash does not occur as frequently (70-90%) as you state, but more like 45-50%. It can go undetected. A tick only has to be attached for 12 hours to infect you. Regardless of test results, if you know you have been bitten, try to capture the tick after safely removing it and keep it for testing. Then get 4 weeks of doxycycline so you don’t get sick. If you start to feel achy or flu-like, get the antibiotic. DO NOT wait for test results as they are unreliable (<30% accurate) and slow. More information on natcaplyme.org, ILADS.org,, LDA.org and many others.

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