David White, MD
Ticked Off!
We did it! We are number one! Pennsylvania tops the list! Blacklegged ticks have determined that Pennsylvania is our nation’s most livable state. A recent study revealed that blacklegged ticks, or “deer ticks,” have been found in all of Pennsylvania’s 67 counties. But cancel the balloons and parade, these meddlesome neighbors often play host to a bacteria called Borrelia burgdorferi. Infection with Borrelia burgdorferi causes Lyme disease which is an inflammatory condition marked by fever, headache, body aches and often a rash. If left undiagnosed, it can lead to arthritis and neurologic or cardiac disorders.
The bad news is that because of our black-legged neighbors, PA currently leads the country in new, confirmed cases of Lyme disease. Yikes! The good news is that Lyme is preventable and treatable. Though Lyme disease is admittedly complicated and in many ways poorly understood, here are the absolute essentials of what you need to know to protect yourself:
- Inspect Regularly – Inspect daily for ticks, especially in those ‘hard to reach spots’— back, arm pits, behind the knees (popular spot) and within other creases— if you know what I mean.
- Remove Promptly – If a tick is found attached, carefully remove with tweezers immediately. For practical purposes, unless you are an entomologist (if you don’t know what that is, you aren’t one) you can assume it is a blacklegged tick. All current evidence supports that it takes greater than 24 hours of attachment for the bacteria causing Lyme disease to transmit to you.
- Seek Medical Attention – If uncertain as to timing, see a medical provider to consider if it is appropriate to initiate Lyme prophylaxis. A one-time 200mg dose of Doxycycline, if given within 72 hours of tick removal, has been shown to be very effective in preventing infection. No other antibiotics regimens have been deemed appropriate for prevention. Doxycycline has historically only been indicated for patients over 8 years of age due to the known complication of teeth staining in this class of drugs (tetracyclines). More recent studies suggest that short courses of Doxycycline can be taken without staining but this has still not been widely accepted. So if allergic to Doxycycline or if no prophylaxis is offered due to age, you should just observe closely for any signs of infection.
- Watch for Symptoms – Because many of the patients who develop Lyme disease were unaware of ever having been host to a tick, it is essential that you see a medical provider immediately if you develop symptoms suggestive of Lyme. This includes any unusual rash, whether it has the typical “bull’s eye” appearance or not. The Lyme rash can take many forms and even involve multiple locations simultaneously. As the rash is estimated to be present in less than 70% of cases, any isolated or combination of symptoms including fever, headache, body aches, joint pain or swelling that are otherwise without clear explanation should prompt evaluation with a medical provider.
- Get Tested – Short of developing obvious signs and symptoms, the diagnosis of Lyme disease can be elusive. This is in part related to the fact that it can take 4-6 weeks after infection for your body to make a detectable number of antibodies to the Borrelia Burgdorferi. Initial testing involves looking for these antibodies and can therefore be negative in early infection. Thus, treatment should always be initiated if infection is suspected.
- Follow Proper Treatment – Again, Lyme disease is an inflammatory condition caused by a bacterial infection. And like other bacterial infections, Lyme is treatable and curable with antibiotics. Yes, it is true that the longer the delay in diagnosis of an infection, the increased likelihood of complications related to the associated inflammation. Treatment typically involves the oral antibiotics Doxycycline, Amoxicillin or Cefuroxime taken over 21 days. IV antibiotics are appropriate if there is oral treatment failure or in the case of neurologic or cardiac disease.
Bottom line: If in doubt, check it out!
