Lymes Disease

Introduction:

Because of the wet spring, this summer is expected to be a bad time for Lymes disease. Lymes is the most common tickborne illness in the United States. The Tick is called Ixodes Scapularis, and it transmits a microorganism called Borrelia burgdorferi, which causes Lyme's disease.

Symptoms:

Symptoms of Lymes usually begin 1 to 2 weeks after the tick bite. It is important to treat this disease in its early stages, because the outcomes, costs and risks of treatment are optimal when the disease is treated as early as possible. The rash of Lymes disease is the most important symptom in its rapid diagnosis. Unfortunately, many people with early Lymes disease do not have a rash, and those who do sometimes miss this rash. Also, the initial symptoms of Lyme's disease are nonspecific and can imitate a "summer cold". The rash from Lymes disease is a uniform red oval or circular rash, with approximately 20% of people developing a "bull's-eye" rash. The rash must be distinguished from other skin infections, hypersensitivity reactions, MRSA, eczema, ring worms, hives, and unusual diseases such as spider bites, Erythma multiforme and Granuloma annulare.

Damage from Lymes:

Lymes can affect many areas of the body. Initially, it can affect your skin and then go into your blood, it is important to detect and treat Lymes at or before this stage. If effective treatment is not provided early on, Lymes can go to joints, especially the knee. The disease can also affect nerves, in this case it can affect nerves in the brain and around the brain causing a disease called encephalopathy or meningitis- or it can damage peripheral nerves which are outside of the brain; the most common of these is the facial nerve. In this case the patient frequently develops a facial droop. Unfortunately, the heart can also be a target for Lyme disease. Lyme can also affect other organ systems such as muscles, tendons and others. Without treatment, overtime, Lymes can become more and more disabling.

Treatment:

At one time there was a vaccine to prevent Lymes, unfortunately this was taken off the market due to its side effects. DEET (diethyltoluamide) is one of the most effective ways to prevent the tick, which causes Lymes from infecting humans. This molecule can be found in Cutters, Off, and other products. Since DEET is a weak neurotoxin, it is important to spray this product on your clothes and not on your skin. Avoiding areas with a high tick burdened such as wooded or grassy areas, wearing light-colored clothing (not colorful), avoiding perfumes, frequent body checks and showering within two or three hours after potential exposure are all advocated strategies in preventing Lyme's disease. Appropriate landscape modifications, such as mowing grass, deer exclusion fencing, removing leaf litter, and woodpiles can also reduce the risk of Lyme disease. There are diagnostic tests to help identify Lymes disease, but these tests cannot yet accurately identify the earliest stage of Lyme. At the localized stage of the disease, the sensitivity is only 17%, specificity is 98%, positive predictive value is 75%, and negative predictive value is only 26% (clinical infectious disease 2008; 45(2):188-195). This means that much of Lymes disease is not picked up accurately by testing, and therefore you must rely heavily on the clinical predictions and understanding of your physician to make the diagnosis of Lyme's disease. It is important not to overdiagnose Lymes disease in order to prevent the side effects and costs of unneeded antibiotics - but it is important not to miss the diagnosis of Lyme's disease as well.

If caught early, for people more than eight years old, one dose of an antibiotic can be curative. If the disease is picked up just a little bit later, treatment can still be quite effective, in this case an oral antibiotic must be provided for for 10 -- 21 days. If the heart is involved, hospitalization may be required, and at later phases intravenous antibiotics must be given frequently and for a prolonged period in order to treat this disease. For some people whose diagnosis and treatment was delayed, it appears as if this problem cannot be cured.

Summary:

Using DEET on cloths whenever going outside can help block initial infection. Early detection of Lyme's disease is essential for effective and efficient treatment and cure of this ailment. A low index of suspicion on your part, prompting an early visit to a knowledgeable physician, is essential in helping to prevent the devastating and long lived consequences of Lymes disease.

Bradley H. Kline, D.O./Brunswick Princeton Family Practice/ South Brunswick New Jersey