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Lyme Disease
Lyme disease is a disease named for the Connecticut town where it was first identified. Lyme disease was first recognized in the mid 1970s. It has been widely publicized by the lay press and medical community. The disease is most prevalent in the northeastern area of USA, Great Lakes area and the far western areas of USA. The Ixodes tick, commonly called the deer tick, is the vector that spreads the disease to humans. In some areas at certain times of the year the tick density becomes very high. During these times the Ixodes ticks can be found in well maintained lawns as well as the brushy wooded areas outside of the cities. It has been estimated that in some areas of North Carolina may harbor more than 600 ticks per acre of forest land. Ticks do not fly or hop onto people or animals. They wait on vegetation and are brushed or fall on to their future host when they come into contact with the vegetation. Once a tick grabs onto a host it clings to hair or clothing and waits for the host to rest. It may wait for several hours or days before moving. Eventually it moves to an exposed isolated area of skin, such as belt line or sock line, and attaches itself. It attaches itself unnoticed by the host due to an anesthetic agent in the tick’s saliva. Ticks feed on the host for anywhere from 2 hours to 7 days before detaching themselves.
Lyme disease has three stages. The first stage is manifested by a rash, headache and joint pains. Sometimes muscle aches and joint pains are reported during this stage. Many people think they have flu like syndrome at this time. One problem at this stage with the vague symptoms is incorrect diagnosis. The condition is often confused with many of the common viral infections. However, anytime these symptoms are seen in the summer or late fall the diagnosis should be considered since this is the peak time for Lyme disease to occur. The rash is an annular lesion clear in the center at the site of the tick bite. The area around the clear center is red and somewhat warm but is usually not tender. The reddish color is often intensified by heat such as a warm bath. The red area may be somewhat raised but is rarely swollen.
In stage two the bacteria are spreading from the site of the tick bite. Thus symptoms become more diverse and more systems are affected. In this stage the rash changes to either multiple annular areas on the body or a bluish / purplish area on the nipple or earlobe. In this stage neurologic symptoms may develop. This may present as a weakness or paralysis of one side of the facial muscles. Headache is a common complaint in this stage of the disease. Also, this stage may bring two common joint problems. These problems manifest as muscle and joint pains that migrate from one area to another.
In stage three the joint problems worsen and look like rheumatoid arthritis. The joints become tender and swollen. The knee is the most commonly affected joint. However, the shoulder, ankle and hip are commonly affected. The TMJ (jaw joint) is affected in about 40 % of individuals. The skin changes in stage three demonstrate bluish-red doughy swollen areas on the elbows, feet, heels and the back of the hands. The neurologic manifestations of stage three may present as meningitis like picture with headache and stiff neck. Some people in this stage develop diffuse neurologic like double vision, areas of numbness of focal weakness.
The blood test for Lyme disease is only somewhat useful in making the diagnosis. The reason for this is the length of time that it often takes to develop a positive antibody to the bacteria. In some cases it has taken up to 2 months to develop antibodies to the bacteria. Sometime people with Lyme disease will develop positive antibodies to other tests which makes it even harder to diagnosis the disease. They may even develop a positive test to syphilis. The diagnosis of Lyme disease is still primarily a clinical diagnosis with confirmation from the blood tests.
The treatment of Lyme disease in stage one is usually a 14 – 30 day course of doxycycline or suprax. In stage two and three requires treatment with IV antibiotics if there are any neurologic conditions associated with these stages. Thus, early diagnosis of the disease is important to prevent any long term problems and simplify the treatment regimen.
Mark Smith,MD January 2009
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