Lyme Disease—Are You at Risk?

WHILE AIDS is grabbing headlines, Lyme disease is barely making footnotes. Yet, Lyme disease is spreading rapidly. In fact, a few years ago, The New York Times Magazine called it “the fastest-growing infectious disease in the [United States] after AIDS.” Reports from other lands show that the disease is spreading in Asia, Europe, and South America as well.

What is Lyme disease? How is it spreading? Are you at risk?

Ticks, Deer, and You

Some 20 years ago, a mysterious increase in arthritis cases occurred in and around the town of Lyme, Connecticut, which is located in the northeastern part of the United States. The victims were mostly children. Their arthritis began with rashes, headaches, and pains in their joints. One resident noted that soon her “husband and two of the children were on crutches.” Before long, over 50 people in that area were affected, and within years, thousands were suffering the same painful symptoms.

Researchers, realizing that this illness was different from other diseases, named it Lyme disease. Its cause? Borrelia burgdorferi—a corkscrew-shaped bacterium living in ticks. How is it spread? Strolling through the woods, a person may pick up an infected tick. The tick pierces the person’s skin and injects the disease-causing bacterium into the hapless stroller. Since these infected ticks often hitchhike, feed, and mate on deer and since more people are settling in rural areas where deer are thriving, it is no wonder that the incidence of Lyme disease has been rising.

Symptoms and Problems

The first symptom of Lyme disease is generally a skin rash (known as erythema migrans, or EM) that starts as a small red spot. Over a period of days or weeks, the telltale spot expands into a circular, triangular, or oval-shaped rash that may be the size of a dime or may spread over the entire width of one’s back. Fever, headache, stiff neck, body aches, and fatigue often accompany the rash. If not treated in time, more than half the victims suffer attacks of painful and swollen joints, which may last for months. Up to 20 percent of untreated patients end up with chronic arthritis. Though less common, the disease may also affect the nervous system and cause heart problems.—See the accompanying box.

Many experts consider Lyme disease difficult to diagnose because its initial, flulike symptoms are similar to those of other infections. In addition, 1 out of every 4 infected persons does not develop a rash—the only hallmark unique to Lyme disease—and many patients cannot recall if they were bitten by a tick because its bite is usually painless.

The diagnosis of the disease is further hampered because currently available antibody blood tests are unreliable. Antibodies in the patient’s blood tell that the body’s immune system has detected invaders, but some tests cannot tell if those invaders are Lyme disease bacteria. So a patient may test positive for Lyme disease while, in reality, his symptoms stem from other bacterial infections. The National Institutes of Health in the United States (NIH) therefore advises physicians to base their diagnosis on the history of a tick bite, the patient’s symptoms, and a thorough ruling out of other diseases that may have triggered those symptoms.

Treatment and Prevention

If diagnosed in time, most patients can be treated successfully with antibiotics. The sooner the treatment begins, the quicker and fuller will be the recovery. For several months after the treatment, fatigue and achiness may persist, but these symptoms will decrease without the need of more antibiotic therapy. However, warns NIH, “a bout with Lyme disease is no guarantee that the illness will be prevented in the future.”

Will that disquieting prospect ever change? A news release from Yale University School of Medicine in the United States announced that researchers have developed an experimental vaccine that may prevent Lyme disease. This “dual-action” vaccine stimulates the human immune system to produce antibodies that attack and kill invading Lyme bacteria. At the same time, it also destroys the bacteria living in the ticks that bite a vaccinated victim.

“Testing this vaccine,” says Dr. Stephen E. Malawista, one of the researchers who discovered Lyme disease in 1975, “is a major development in our efforts to protect people from the potentially serious consequences of Lyme disease.” Scientists hope, notes The New York Times, that in areas where fear of the disease has kept people indoors, “this vaccine will help reclaim the wilderness for human use.”

Meanwhile, though, you can take some preventive measures of your own. NIH recommends: If walking through areas teeming with ticks, stay in the center of trails. Wear long pants, a long-sleeved shirt, and a hat. Tuck pant legs into socks, and wear shoes that leave no part of the feet exposed. Wearing light-colored clothing makes it easier to detect ticks. Insect repellents applied to clothing and skin are effective, but they can cause serious side effects particularly to children. “Pregnant women should be especially careful to avoid ticks in Lyme disease areas,” cautions NIH, “because the infection can be transferred to the unborn child” and may increase the likelihood of a miscarriage or a stillborn baby.

Once indoors, check yourself and your children for ticks, especially in the hairy regions of the body. Do this carefully because immature ticks are about as tiny as the period that ends this sentence and you can easily mistake them for a speck of dirt. If you have pets, check them before they enter the house—they too can catch Lyme disease.

How do you remove a tick? Not with your bare fingers but with blunt tweezers. Tug gently but firmly near the head of the tick until it releases its hold on the skin, but do not squeeze its body. Then swab the bite area thoroughly with an antiseptic. Removing the tick within 24 hours, says Dr. Gary Wormser, an American specialist in infectious diseases, may save you from Lyme disease infection.

Granted, even in heavily infested areas, the chance of getting crippling Lyme disease is small. Yet, taking those simple precautions will make that small chance even smaller. Are these safeguards worth the trouble? Ask any sufferer of Lyme disease.

[Box on page 14]

Signs of Lyme Disease

Early Infection:

○ Rash

○ Muscle and joint aches

○ Headache

○ Stiff neck

○ Significant fatigue

○ Fever

○ Facial paralysis

○ Meningitis

○ Brief episodes of joint pain and swelling

Less common:

○ Eye inflammation

○ Dizziness

○ Shortness of breath

Late Infection:

○ Arthritis, intermittent or chronic

Less common:

○ Memory loss

○ Difficulty with concentration

○ Change in mood or sleeping habits

One or more of these symptoms may be present at different times during the infection.—Lyme Disease—The Facts, the Challenge, published by the National Institutes of Health.

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A stroll in the woods can put you at risk

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A tick (greatly magnified)

[Credit Line]

Yale School of Medicine

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Tick (actual size)